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de Liyis BG, Ardhaputra GYB, Liyis S, Wihandani DM, Siahaan YMT, Pinatih KJP. High C-Reactive Protein/ Albumin Ratio Predicts Mortality and Hemorrhage in Stroke Patients Undergoing Mechanical Thrombectomy: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 188:211-219.e1. [PMID: 38810878 DOI: 10.1016/j.wneu.2024.05.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Stroke outcomes are multifactorial, and the C-Reactive Protein to Albumin Ratio (CAR) has emerged as a potential prognostic marker. This study aims to evaluate CAR prognostic significance in stroke. METHODS Systematic searches across ScienceDirect, Medline, and Cochrane databases identified longitudinal studies. Unfavorable outcomes, including poor prognosis (modified rankin scale> 2), mortality, and severe complications like hemorrhage or restenosis, were considered. Analyses for unfavorable outcomes were conducted based on prior intervention, stroke type, and outcome type. RESULTS The meta-analysis included 12 cohort studies comprising 5042 participants. Elevated CAR (OR: 1.72; 95% confidence interval [CI]: 1.17-2.52; P = 0.01) and CRP (OR: 1.91; 95% CI: 1.31-2.77; P < 0.001) levels on admission were associated with unfavorable outcomes; no such association was observed for albumin (OR: 0.66; 95%CI: 0.24-1.80; P = 0.42). Elevated CAR levels were associated with unfavorable outcomes in patients undergoing mechanical thrombectomy (odds ratio [OR]: 2.70; 95% CI: 1.14-6.38; P < 0.02) and those with ischemic stroke (OR: 1.99; 95% CI: 1.24-3.18; P < 0.001), but no significant association was found in patients with hemorrhagic stroke. Furthermore, concerning specific outcomes, high CAR levels were associated with mortality (OR: 1.71; 95% CI: 1.00-2.95; P = 0.05) and hemorrhage (OR: 6.02; 95% CI: 1.61-23.87; P = 0.05). The area under the curve for CAR was 0.72 (0.68-0.76), with a sensitivity of 0.61 (0.49-0.71) and specificity of 0.73 (0.64-0.81). CONCLUSIONS Elevated CAR emerges as an effective marker in assessing unfavorable outcomes in stroke patients with moderately high sensitivity and specificity. High CAR levels exhibited statistically significant mortality and hemorrhage in stroke patients undergoing mechanical thrombectomy.
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Affiliation(s)
| | | | | | - Desak Made Wihandani
- Department of Biochemistry, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Yusak Mangara Tua Siahaan
- Department of Neurology, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Indonesia
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Quintana-Castanedo L, Sánchez-Ramón S, Maseda R, Illera N, Pérez-Conde I, Molero-Luis M, Butta N, Arias-Salgado EG, Monzón-Manzano E, Zuluaga P, Martínez-Santamaría L, Fernández-Arquero M, Llames SG, Meana Á, de Lucas R, Del Río M, Vicente Á, Escámez MJ, Sacedón R. Unveiling the value of C-reactive protein as a severity biomarker and the IL4/IL13 pathway as a therapeutic target in recessive dystrophic epidermolysis bullosa: A multiparametric cross-sectional study. Exp Dermatol 2024; 33:e15146. [PMID: 39075828 DOI: 10.1111/exd.15146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/24/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024]
Abstract
Patients with recessive dystrophic epidermolysis bullosa (RDEB) experience numerous complications, which are exacerbated by inflammatory dysregulation and infection. Understanding the immunological mechanisms is crucial for selecting medications that balance inflammation control and immunocompetence. In this cross-sectional study, aiming to identify potential immunotherapeutic targets and inflammatory biomarkers, we delved into the interrelationship between clinical severity and systemic inflammatory parameters in a representative RDEB cohort. Encompassing 84 patients aged 1-67 and spanning all three Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) severity categories, we analysed the interrelationship of infection history, standard inflammatory markers, systemic cytokines and Ig levels to elucidate their roles in RDEB pathophysiology. Our findings identify C-reactive protein as an excellent biomarker for disease severity in RDEB. A type 2 inflammatory profile prevails among moderate and severe RDEB patients, correlating with dysregulated circulating IgA and IgG. These results underscore the IL4/IL13 pathways as potential evidence-based therapeutic targets. Moreover, the complete inflammatory scenario aligns with Staphylococcus aureus virulence mechanisms. Concurrently, abnormalities in IgG, IgE and IgM levels suggest an immunodeficiency state in a substantial number of the cohort's patients. Our results provide new insights into the interplay of infection and immunological factors in the pathogenesis of RDEB.
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Affiliation(s)
- Lucía Quintana-Castanedo
- Department of Dermatology, IdiPAZ Health Research Institute, Hospital La Paz, Madrid, Spain
- Department of Dermatology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Silvia Sánchez-Ramón
- Department of Immunology, IML and IdISSC Health Research Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Rocío Maseda
- Department of Dermatology, IdiPAZ Health Research Institute, Hospital La Paz, Madrid, Spain
| | - Nuria Illera
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Madrid, Spain
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)-ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
| | - Isabel Pérez-Conde
- Department of Dermatology, IdiPAZ Health Research Institute, Hospital La Paz, Madrid, Spain
| | | | - Nora Butta
- Department of Hematology and Hemotherapy, IdiPAZ Health Research Institute, Hospital La Paz, Madrid, Spain
| | - Elena G Arias-Salgado
- Department of Hematology and Hemotherapy, IdiPAZ Health Research Institute, Hospital La Paz, Madrid, Spain
| | - Elena Monzón-Manzano
- Department of Hematology and Hemotherapy, IdiPAZ Health Research Institute, Hospital La Paz, Madrid, Spain
| | - Pilar Zuluaga
- Department of Statistics and Operations Research, Faculty of Medicine, Madrid, Spain
| | - Lucía Martínez-Santamaría
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Madrid, Spain
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)-ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
| | - Miguel Fernández-Arquero
- Department of Immunology, IML and IdISSC Health Research Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Sara G Llames
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)-ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
- Unidad de Ingeniería Tisular, Centro Comunitario Sangre y Tejidos de Asturias (CCST), Oviedo, Spain
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica (FIO), Oviedo, Spain
| | - Álvaro Meana
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)-ISCIII, Madrid, Spain
- Unidad de Ingeniería Tisular, Centro Comunitario Sangre y Tejidos de Asturias (CCST), Oviedo, Spain
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica (FIO), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Raúl de Lucas
- Department of Dermatology, IdiPAZ Health Research Institute, Hospital La Paz, Madrid, Spain
| | - Marcela Del Río
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Madrid, Spain
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)-ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
| | - Ángeles Vicente
- Department of Cell Biology, Faculty of Medicine, UCM, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María José Escámez
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Madrid, Spain
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)-ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
| | - Rosa Sacedón
- Department of Cell Biology, Faculty of Medicine, UCM, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Gao H, Cheng X, Zuo X, Huang Z. Exploring the Impact of Adequate Energy Supply on Nutrition, Immunity, and Inflammation in Elderly Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:1391-1402. [PMID: 38915774 PMCID: PMC11194172 DOI: 10.2147/copd.s450209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/08/2024] [Indexed: 06/26/2024] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) progression in the elderly is notably influenced by nutritional, immune, and inflammatory status. This study aimed to investigate the impact of adequate energy supply on these indicators in COPD patients. Methods COPD patients meeting specific criteria were recruited and categorized into energy-adequate and energy-deficient groups based on their energy supply. Comparable demographic factors such as age, gender, smoking and drinking history, COPD duration, inhaled drug classification, and home oxygen therapy application were observed. Notable differences were found in BMI and inhaled drug use between the two groups. Results The energy-adequate group exhibited significant improvements in various health indicators, including lymphocyte count, hemoglobin, CRP, total cholesterol, prealbumin, albumin, PNI, SII, SIRI, CAR, and CONUT scores in the secondary auxiliary examination. These positive changes suggest a notable enhancement in nutritional, immune, and inflammatory status. Conclusion This research highlights the substantial benefits of adequate energy supply in elderly COPD patients. The observed improvements in nutritional, immune, and inflammatory markers underscore the importance of addressing energy needs to positively influence disease-related outcomes in this population. These findings have implications for developing targeted interventions to optimize the well-being of elderly individuals with COPD.
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Affiliation(s)
- Hui Gao
- Department of General Practice, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei Province430000, People’s Republic of China
| | - Xi Cheng
- Department of General Practice, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei Province430000, People’s Republic of China
| | - Xu Zuo
- Department of Respiratory and Digestive, Geriatric Hospital Affiliated with Wuhan University of Science and Technology, Wuhan, Hubei Province, 430000, People’s Republic of China
| | - Zhaolan Huang
- Department of Respiratory and Digestive, Geriatric Hospital Affiliated with Wuhan University of Science and Technology, Wuhan, Hubei Province, 430000, People’s Republic of China
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Zhou HH, Tang YL, Xu TH, Cheng B. C-reactive protein: structure, function, regulation, and role in clinical diseases. Front Immunol 2024; 15:1425168. [PMID: 38947332 PMCID: PMC11211361 DOI: 10.3389/fimmu.2024.1425168] [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: 04/29/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024] Open
Abstract
C-reactive protein (CRP) is a plasma protein that is evolutionarily conserved, found in both vertebrates and many invertebrates. It is a member of the pentraxin superfamily, characterized by its pentameric structure and calcium-dependent binding to ligands like phosphocholine (PC). In humans and various other species, the plasma concentration of this protein is markedly elevated during inflammatory conditions, establishing it as a prototypical acute phase protein that plays a role in innate immune responses. This feature can also be used clinically to evaluate the severity of inflammation in the organism. Human CRP (huCRP) can exhibit contrasting biological functions due to conformational transitions, while CRP in various species retains conserved protective functions in vivo. The focus of this review will be on the structural traits of CRP, the regulation of its expression, activate complement, and its function in related diseases in vivo.
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Affiliation(s)
- Hai-Hong Zhou
- Centre for Translational Medicine, Gansu Provincial Academic Institute for Medical Research, Lanzhou, China
- Centre for Translational Medicine, Gansu Provincial Cancer Hospital, Lanzhou, China
- Centre for Translational Medicine, Sun Yat-sen University Cancer Center Gansu Hospital, Lanzhou, China
| | - Yu-Long Tang
- Ministry of Education (MOE), Key Laboratory of Cell Activities and Stress Adaptations, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Tian-Hao Xu
- Ministry of Education (MOE), Key Laboratory of Cell Activities and Stress Adaptations, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Bin Cheng
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences, Lanzhou University, Lanzhou, China
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Song L, Lu YM, Zhang JC, Yuan YM, Li GR. The Association Between S100A12 Protein and C-Reactive Protein with Malignant Ventricular Arrhythmias Following Acute Myocardial Infarction in the Elderly. J Inflamm Res 2024; 17:461-468. [PMID: 38288422 PMCID: PMC10822764 DOI: 10.2147/jir.s439198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
Objective To investigate the association of S100A12 protein and C-reactive protein (CRP) with the onset of malignant ventricular arrhythmias (MVA) after acute myocardial infarction (AMI) in the elderly. Methods A total of 159 elderly AMI patients admitted to Chongming Hospital affiliated to Shanghai University of Medicine & Health Sciences from January 2018 to January 2023 were enrolled in the study. CRP levels were determined using an automatic biochemical analyzer, and S100A12 levels were measured using enzyme-linked immunosorbent assay (ELISA). Patients were categorized based on the Lown classification into groups without MVA and with MVA. Univariate analysis was initially performed to identify independent variables, followed by multivariate logistic regression to determine the risk factors for malignant ventricular arrhythmias post-AMI. The predictive value of S100A12 protein and CRP for malignant ventricular arrhythmias after acute myocardial infarction in the elderly was analyzed using the receiver operating characteristic (ROC) curve. Results Among the 159 patients with AMI, 27 (17%) had MVA. Multivariate logistic regression analysis indicated that both S100A12 protein and CRP could be independent risk factors for malignant ventricular arrhythmias following acute myocardial infarction in the elderly (p < 0.05). The area under the ROC curve showed the area under the curve (AUC) for S100A12 protein to be 0.7147, for CRP 0.7356, and for the combined diagnosis 0.8350 (p < 0.05). Conclusion S100A12 protein and CRP are independent risk factors for MVA after MI in the elderly. The combined application of S100A12 protein and CRP has higher diagnostic sensitivity and specificity.
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Affiliation(s)
- Lei Song
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, 202150, People’s Republic of China
| | - Ying-Min Lu
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, 202150, People’s Republic of China
| | - Jin-Chun Zhang
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, 202150, People’s Republic of China
| | - Yu-Min Yuan
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, 202150, People’s Republic of China
| | - Gui-Ru Li
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, 202150, People’s Republic of China
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Mendes-Filho SPDM, de Souza Pinheiro R, Martins FS, Giroldi PJ, e Melo RH, de Oliveira EL, dos Santos AB, Medeiros DCO, Lopes JA, Chaves YO, Zuliani JP, Nogueira PA. Kinetics of IL-6, C-reactive Protein and Fibrinogen Levels in COVID-19 Outpatients Who Evolved to Hypoxemia. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2024; 17:2632010X231222795. [PMID: 38188270 PMCID: PMC10768631 DOI: 10.1177/2632010x231222795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
Introduction Despite the efficacy of the COVID-19, the search for improvements in the management of severe/critical cases continues to be important. The aim is to demonstrate the kinetics of 4 serological markers in patients with COVID-19 who evolved in hypoxemia. Methods From June to December 2020, the Health Secretariat of Rondônia State, Brazil, established a home medical care service team (HMCS) that provided clinical follow-up for health professionals and military personnel with COVID-19. The clinical and laboratory monitoring was individualized at home by a nursing and medical team. In addition to laboratory parameters, C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, and D-dimer levels were periodically taken to monitor the evolution of treatment. Results Of 218 patients telemonitored, 48 patients needed special care by the HMCS team due to shortness of breath. Chest tomography showed multiple ground-glass shadows and lung parenchymal condensations that was compatible with secondary bacterial infection associated with leukocytosis, for which antibiotics were prescribed. The symptoms were accompanied by increases of CRP and IL-6 levels followed by fibrinogen after a few days, for which an anticoagulant therapy was included. Thirty-three patients evolved to improvements in clinical signs and laboratory results. Between the sixth and eighth day of illness, 15 patients presented signs of hypoxemia with low O2 saturation accompanied with an increase in the respiratory rate, with some of them requiring oxygen therapy. As they did not present signs of clinical severity, but their laboratory markers showed an abrupt IL-6 peak that was higher than the increase in CRP and a new alteration in fibrinogen levels, they received a supplemental dose of anticoagulant and a high dose of corticosteroids, which resulted in clinical improvement. Conclusion Our study demonstrates that monitoring of IL-6 and CRP may identify precocious hypoxemia in COVID-19 patients and prevented the progressive deterioration of the lung injury.
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Affiliation(s)
| | - Rebeca de Souza Pinheiro
- Programa de Pós-graduação de Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus/AM, Brazil
| | - Fernanda Simão Martins
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
| | - Paulo Jose Giroldi
- Laboratório Estadual de Patologia e Análises Clínicas (LEPAC), Porto Velho/RO, Brazil
| | - Raul Honorato e Melo
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
- Hospital Cemetron, Porto Velho/RO, Brazil
| | | | - Anibal Borin dos Santos
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
| | | | | | - Yury Oliveira Chaves
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz – Amazonas (FIOCRUZ – AMAZONAS), Manaus/AM, Brazil
| | | | - Paulo Afonso Nogueira
- Programa de Pós-graduação de Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus/AM, Brazil
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz – Amazonas (FIOCRUZ – AMAZONAS), Manaus/AM, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus/AM, Brazil
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Poddar NK, Khan A, Fatima F, Saxena A, Ghaley G, Khan S. Association of mTOR Pathway and Conformational Alterations in C-Reactive Protein in Neurodegenerative Diseases and Infections. Cell Mol Neurobiol 2023; 43:3815-3832. [PMID: 37665407 DOI: 10.1007/s10571-023-01402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
Inflammatory biomarkers have been very useful in detecting and monitoring inflammatory processes along with providing helpful information to select appropriate therapeutic strategies. C-reactive protein (CRP) is a nonspecific, but quite useful medical acute inflammatory biomarker and is associated with persistent chronic inflammatory processes. Several studies suggest that different levels of CRP are correlated with neurological disorders such as Alzheimer's disease (AD). However, dynamics of CRP levels have also been observed in virus/bacterial-related infections leading to inflammatory responses and this triggers mTOR-mediated pathways for neurodegeneration diseases. The biophysical structural transition from CRP to monomeric CRP (mCRP) and the significance of the ratio of CRP levels on the onset of symptoms associated with inflammatory response have been discussed. In addition, mTOR inhibitors act as immunomodulators by downregulating the expression of viral infection and can be explored as a potential therapy for neurological diseases.
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Affiliation(s)
- Nitesh Kumar Poddar
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007.
| | - Arshma Khan
- Department of Biotechnology, Invertis University, Bareilly, Uttar Pradesh, India, 243123
| | - Falak Fatima
- Amity Institute of Biotechnology, Amity University, Uttar Pradesh, Noida, India, 201301
| | - Anshulika Saxena
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007
| | - Garima Ghaley
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007
| | - Shahanavaj Khan
- Department of Medical Lab Technology, Indian Institute of Health and Technology (IIHT), Deoband, Saharanpur, Uttar Pradesh, India, 247554.
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Lv B, Huang S, Huang H, Niu N, Liu J. Endothelial Glycocalyx Injury in SARS-CoV-2 Infection: Molecular Mechanisms and Potential Targeted Therapy. Mediators Inflamm 2023; 2023:6685251. [PMID: 37674786 PMCID: PMC10480029 DOI: 10.1155/2023/6685251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 07/05/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023] Open
Abstract
This review aims at summarizing state-of-the-art knowledge on glycocalyx and SARS-CoV-2. The endothelial glycocalyx is a dynamic grid overlying the surface of the endothelial cell (EC) lumen and consists of membrane-bound proteoglycans and glycoproteins. The role of glycocalyx has been determined in the regulation of EC permeability, adhesion, and coagulation. SARS-CoV-2 is an enveloped, single-stranded RNA virus belonging to β-coronavirus that causes the outbreak and the pandemic of COVID-19. Through the respiratory tract, SARS-CoV-2 enters blood circulation and interacts with ECs possessing angiotensin-converting enzyme 2 (ACE2). Intact glycolyx prevents SARS-CoV-2 invasion of ECs. When the glycocalyx is incomplete, virus spike protein of SARS-CoV-2 binds with ACE2 and enters ECs for replication. In addition, cytokine storm targets glycocalyx, leading to subsequent coagulation disorder. Therefore, it is intriguing to develop a novel treatment for SARS-CoV-2 infection through the maintenance of the integrity of glycocalyx. This review aims to summarize state-of-the-art knowledge of glycocalyx and its potential function in SARS-CoV-2 infection.
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Affiliation(s)
- Bingxuan Lv
- The Second Hospital of Shandong University, Shandong University, 247 Beiyuan Street, Jinan 250033, China
| | - Shengshi Huang
- Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, 16766 Jingshi Road, Jinan 250014, China
| | - Hong Huang
- Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, 16766 Jingshi Road, Jinan 250014, China
| | - Na Niu
- Department of Pediatrics, Shandong Provincial Hospital, Shandong First Medical University, 324 Jingwu Road, Jinan 250021, China
| | - Ju Liu
- Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, 16766 Jingshi Road, Jinan 250014, China
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Sheriff A, Kunze R, Brunner P, Vogt B. Being Eaten Alive: How Energy-Deprived Cells Are Disposed of, Mediated by C-Reactive Protein-Including a Treatment Option. Biomedicines 2023; 11:2279. [PMID: 37626775 PMCID: PMC10452736 DOI: 10.3390/biomedicines11082279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
In medicine, C-reactive protein (CRP) has become established primarily as a biomarker, predicting patient prognosis in many indications. Recently, however, there has been mounting evidence that it causes inflammatory injury. As early as 1999, CRP was shown to induce cell death after acute myocardial infarction (AMI) in rats and this was found to be dependent on complement. The pathological effect of CRP was subsequently confirmed in further animal species such as rabbit, mouse and pig. A conceptual gap was recently closed when it was demonstrated that ischemia in AMI or ischemia/hypoxia in the severe course of COVID-19 causes a drastic lack of energy in involved cells, resulting in an apoptotic presentation because these cells cannot repair/flip-flop altered lipids. The deprivation of energy leads to extensive expression on the cell membranes of the CRP ligand lysophosphatidylcholine. Upon attachment of CRP to this ligand, the classical complement pathway is triggered leading to the swift elimination of viable cells with the appearance of an apoptotic cell by phagocytes. They are being eaten alive. This, consequently, results in substantial fibrotic remodeling within the involved tissue. Inhibiting this pathomechanism via CRP-targeting therapy has been shown to be beneficial in different indications.
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Affiliation(s)
- Ahmed Sheriff
- Department of Gastroenterology, Infectiology, Rheumatology, Charité University Medicine Berlin, 10117 Berlin, Germany
- Pentracor GmbH, 16761 Hennigsdorf, Germany (P.B.); (B.V.)
| | - Rudolf Kunze
- Pentracor GmbH, 16761 Hennigsdorf, Germany (P.B.); (B.V.)
| | | | - Birgit Vogt
- Pentracor GmbH, 16761 Hennigsdorf, Germany (P.B.); (B.V.)
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11
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Virbickiene A, Lapinskas T, Garlichs CD, Mattecka S, Tanacli R, Ries W, Torzewski J, Heigl F, Pfluecke C, Darius H, Ince H, Nordbeck P, Butter C, Schuster A, Mitzner S, Dobiliene O, Sheriff A, Kelle S. Imaging Predictors of Left Ventricular Functional Recovery after Reperfusion Therapy of ST-Elevation Myocardial Infarction Assessed by Cardiac Magnetic Resonance. J Cardiovasc Dev Dis 2023; 10:294. [PMID: 37504550 PMCID: PMC10380630 DOI: 10.3390/jcdd10070294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Left ventricular global longitudinal strain (LV GLS) is a superior predictor of adverse cardiac events in patients with myocardial infarction and heart failure. We investigated the ability of morphological features of infarcted myocardium to detect acute left ventricular (LV) dysfunction and predict LV functional recovery after three months in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS Sixty-six STEMI patients were included in the C-reactive protein (CRP) apheresis in Acute Myocardial Infarction Study (CAMI-1). LV ejection fraction (LVEF), LV GLS, LV global circumferential strain (LV GCS), infarct size (IS), area-at-risk (AAR), and myocardial salvage index (MSI) were assessed by CMR 5 ± 3 days (baseline) and 12 ± 2 weeks after (follow-up) the diagnosis of first acute STEMI. RESULTS Significant changes in myocardial injury parameters were identified after 12 weeks of STEMI diagnosis. IS decreased from 23.59 ± 11.69% at baseline to 18.29 ± 8.32% at follow-up (p < 0.001). AAR and MVO also significantly reduced after 12 weeks. At baseline, there were reasonably moderate correlations between IS and LVEF (r = -0.479, p < 0.001), LV GLS (r = 0.441, p < 0.001) and LV GCS (r = 0.396, p = 0.001) as well as between AAR and LVEF (r = -0.430, p = 0.003), LV GLS (r = 0.501, p < 0.001) and weak with LV GCS (r = 0.342, p = 0.020). At follow-up, only MSI and change in LV GCS over time showed a weak but significant correlation (r = -0.347, p = 0.021). Patients with larger AAR at baseline improved more in LVEF (p = 0.019) and LV GLS (p = 0.020) but not in LV GCS. CONCLUSION The CMR tissue characteristics of myocardial injury correlate with the magnitude of LV dysfunction during the acute stage of STEMI. AAR predicts improvement in LVEF and LV GLS, while MSI is a sensitive marker of LV GCS recovery at three months follow-up after STEMI.
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Affiliation(s)
- Agneta Virbickiene
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | | | | | - Radu Tanacli
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Wolfgang Ries
- Medical Clinic, DIAKO Flensburg, 24939 Flensburg, Germany
| | - Jan Torzewski
- Cardiovascular Center Oberallgäu-Kempten, 87439 Kempten, Germany
| | - Franz Heigl
- Medical Care Center Kempten-Allgäu, 87437 Kempten, Germany
| | - Christian Pfluecke
- Christian Pfluecke, Department of Internal Medicine I, Städtisches Klinikum Görlitz, Girbigsdorfer Straße 1-3, 02828 Görlitz, Germany
| | - Harald Darius
- Clinic for Cardiology, Angiology, Nephrology, Intensive Care Medicine, Vivantes Clinic Neukölln, 12351 Berlin, Germany
| | - Hueseyin Ince
- Divisions of Cardiology and Nephrology, Department of Internal Medicine, University Medicine Rostock, 18057 Rostock, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Christian Butter
- Department of Cardiology, University Hospital Heart Centre Brandenburg in Bernau, Brandenburg Medical School (MHB) Theodor Fontane, 16321 Berlin, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, 10785 Göttingen, Germany
| | - Steffen Mitzner
- Divisions of Cardiology and Nephrology, Department of Internal Medicine, University Medicine Rostock, 18057 Rostock, Germany
| | - Olivija Dobiliene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Ahmed Sheriff
- Pentracor GmbH, 16761 Hennigsdorf, Germany
- Gastroenterology/Infectiology/Rheumatology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
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12
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Zelek WM, Harrison RA. Complement and COVID-19: Three years on, what we know, what we don't know, and what we ought to know. Immunobiology 2023; 228:152393. [PMID: 37187043 PMCID: PMC10174470 DOI: 10.1016/j.imbio.2023.152393] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus was identified in China in 2019 as the causative agent of COVID-19, and quickly spread throughout the world, causing over 7 million deaths, of which 2 million occurred prior to the introduction of the first vaccine. In the following discussion, while recognising that complement is just one of many players in COVID-19, we focus on the relationship between complement and COVID-19 disease, with limited digression into directly-related areas such as the relationship between complement, kinin release, and coagulation. Prior to the 2019 COVID-19 outbreak, an important role for complement in coronavirus diseases had been established. Subsequently, multiple investigations of patients with COVID-19 confirmed that complement dysregulation is likely to be a major driver of disease pathology, in some, if not all, patients. These data fuelled evaluation of many complement-directed therapeutic agents in small patient cohorts, with claims of significant beneficial effect. As yet, these early results have not been reflected in larger clinical trials, posing questions such as who to treat, appropriate time to treat, duration of treatment, and optimal target for treatment. While significant control of the pandemic has been achieved through a global scientific and medical effort to comprehend the etiology of the disease, through extensive SARS-CoV-2 testing and quarantine measures, through vaccine development, and through improved therapy, possibly aided by attenuation of the dominant strains, it is not yet over. In this review, we summarise complement-relevant literature, emphasise its main conclusions, and formulate a hypothesis for complement involvement in COVID-19. Based on this we make suggestions as to how any future outbreak might be better managed in order to minimise impact on patients.
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Affiliation(s)
- Wioleta M Zelek
- Dementia Research Institute and Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
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13
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Madhurantakam S, Lee ZJ, Naqvi A, Karnam JB, Muthukumar S, Prasad S. Multiplex sensing of IL-10 and CRP towards predicting critical illness in COVID-19 infections. BIOSENSORS & BIOELECTRONICS: X 2023; 13:100307. [PMID: 36742375 PMCID: PMC9890195 DOI: 10.1016/j.biosx.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Here we present a sensitive method for the detection and quantification of two (IL -10 and CRP) immuno-responsive biomarkers in various biofluids. The significance of these immune response biomarkers lies in them displaying elevated levels in critically ill COVID -19 patients. The developed electrochemical sensor contains a gold film electrode with ZnO nanoparticles deposited on its surface to increase the surface area of the working electrode while integrating antibody-antigen interactions into the detection system. This multiplex biosensor has a wide linear range from 0.01 μg/mL to 100 μg/mL and 0.1 pg/mL to 1000 pg/mL for CRP and IL10, respectively. The cross-reactivity of this multiplex sensor platform was evaluated between these two proteins and was <20%. Recovery studies were performed by spiking known concentrations in serum and urine samples. The recovery was calculated and ranged from 80% to 100%, confirming clinical applicability. This electrochemical sensing platform can aid in the early screening of COVID -19 patients to monitor for the development of more serious and potentially lethal symptoms.
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Affiliation(s)
| | - Zachary J Lee
- Department of Bioengineering, The University of Texas at Dallas, 75080, USA
| | - Aliya Naqvi
- Department of Bioengineering, The University of Texas at Dallas, 75080, USA
| | | | | | - Shalini Prasad
- Department of Bioengineering, The University of Texas at Dallas, 75080, USA
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14
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Køstner AH, Fuglestad AJ, Georgsen JB, Nielsen PS, Christensen KB, Zibrandtsen H, Parner ET, Rajab IM, Potempa LA, Steiniche T, Kersten C. Fueling the flames of colon cancer – does CRP play a direct pro-inflammatory role? Front Immunol 2023; 14:1170443. [PMID: 37006231 PMCID: PMC10065292 DOI: 10.3389/fimmu.2023.1170443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundSystemic inflammation, diagnostically ascribed by measuring serum levels of the acute phase reactant C-reactive protein (CRP), has consistently been correlated with poor outcomes across cancer types. CRP exists in two structurally and functionally distinct isoforms, circulating pentameric CRP (pCRP) and the highly pro-inflammatory monomeric isoform (mCRP). The aim of this pilot study was to map the pattern of mCRP distribution in a previously immunologically well-defined colon cancer (CC) cohort and explore possible functional roles of mCRP within the tumor microenvironment (TME).MethodsFormalin-fixed, paraffin-embedded (FFPE) tissue samples from 43 stage II and III CC patients, including 20 patients with serum CRP 0-1 mg/L and 23 patients with serum CRP >30 mg/L were immunohistochemically (IHC) stained with a conformation-specific mCRP antibody and selected immune and stromal markers. A digital analysis algorithm was developed for evaluating mCRP distribution within the primary tumors and adjacent normal colon mucosa.ResultsmCRP was abundantly present within tumors from patients with high serum CRP (>30 mg/L) diagnostically interpreted as being systemically inflamed, whereas patients with CRP 0-1 mg/L exhibited only modest mCRP positivity (median mCRP per area 5.07‰ (95%CI:1.32-6.85) vs. 0.02‰ (95%CI:0.01-0.04), p<0.001). Similarly, tissue-expressed mCRP correlated strongly with circulating pCRP (Spearman correlation 0.81, p<0.001). Importantly, mCRP was detected exclusively within tumors, whereas adjacent normal colon mucosa showed no mCRP expression. Double IHC staining revealed colocalization of mCRP with endothelial cells and neutrophils. Intriguingly, some tumor cells also colocalized with mCRP, suggesting a direct interaction or mCRP expression by the tumor itself.ConclusionOur data show that the pro-inflammatory mCRP isoform is expressed in the TME of CC, primarily in patients with high systemic pCRP values. This strengthens the hypothesis that CRP might not only be an inflammatory marker but also an active mediator within tumors.
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Affiliation(s)
- Anne Helene Køstner
- Center for Cancer Treatment, Sorlandet Hospital, Kristiansand, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- *Correspondence: Anne Helene Køstner,
| | - Anniken Jørlo Fuglestad
- Center for Cancer Treatment, Sorlandet Hospital, Kristiansand, Norway
- Department of Oncology, Akershus University Hospital, Nordbyhagen, Norway
| | | | - Patricia Switten Nielsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ibraheem M. Rajab
- College of Science, Health and Pharmacy, Roosevelt University Schaumburg, Schaumburg, IL, United States
| | - Lawrence A. Potempa
- College of Science, Health and Pharmacy, Roosevelt University Schaumburg, Schaumburg, IL, United States
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Kersten
- Center for Cancer Treatment, Sorlandet Hospital, Kristiansand, Norway
- Department of Oncology, Akershus University Hospital, Nordbyhagen, Norway
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15
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Perin EC, Borow KM, Henry TD, Mendelsohn FO, Miller LW, Swiggum E, Adler ED, Chang DH, Fish RD, Bouchard A, Jenkins M, Yaroshinsky A, Hayes J, Rutman O, James CW, Rose E, Itescu S, Greenberg B. Randomized Trial of Targeted Transendocardial Mesenchymal Precursor Cell Therapy in Patients With Heart Failure. J Am Coll Cardiol 2023; 81:849-863. [PMID: 36858705 DOI: 10.1016/j.jacc.2022.11.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Mesenchymal precursor cells (MPCs) are allogeneic, immunoselected cells with anti-inflammatory properties that could improve outcomes in heart failure with reduced ejection fraction (HFrEF). OBJECTIVES This study assessed the efficacy and safety of MPCs in patients with high-risk HFrEF. METHODS This randomized, double-blind, multicenter study evaluated a single transendocardial administration procedure of MPCs or sham-control in 565 intention-to-treat patients with HFrEF on guideline-directed therapies. The primary endpoint was time-to-recurrent events caused by decompensated HFrEF or successfully resuscitated symptomatic ventricular arrhythmias. Hierarchical secondary endpoints included components of the primary endpoint, time-to-first terminal cardiac events, and all-cause death. Separate and composite major adverse cardiovascular events analyses were performed for myocardial infarction or stroke or cardiovascular death. Baseline and 12-month echocardiography was performed. Baseline plasma high-sensitivity C-reactive protein levels were evaluated for disease severity. RESULTS The primary endpoint was similar between treatment groups (HR: 1.17; 95% CI: 0.81-1.69; P = 0.41) as were terminal cardiac events and secondary endpoints. Compared with control subjects, MPCs increased left ventricular ejection fraction from baseline to 12 months, especially in patients with inflammation. MPCs decreased the risk of myocardial infarction or stroke by 58% (HR: 0.42; 95% CI: 0.23-0.76) and the risk of 3-point major adverse cardiovascular events by 28% (HR: 0.72; 95% CI: 0.51-1.03) in the analysis population (n = 537), and by 75% (HR: 0.25; 95% CI: 0.09-0.66) and 38% (HR: 0.62; 95% CI: 0.39-1.00), respectively, in patients with inflammation (baseline high-sensitivity C-reactive protein ≥2 mg/L). CONCLUSIONS The primary and secondary endpoints of the trial were negative. Positive signals in prespecified, and post hoc exploratory analyses suggest MPCs may improve outcomes, especially in patients with inflammation.
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Affiliation(s)
- Emerson C Perin
- Center for Clinical Research, The Texas Heart Institute, Houston, Texas, USA.
| | | | - Timothy D Henry
- Department of Cardiology, The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Farrell O Mendelsohn
- Princeton Baptist Medical Center, Cardiology PC Research, Birmingham, Alabama, USA
| | - Leslie W Miller
- Department of Cardiology, Morton Plant Hospital, Clearwater, Florida, USA
| | - Elizabeth Swiggum
- Division of Cardiology, Royal Jubilee Hospital and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California-San Diego, La Jolla, California, USA
| | - David H Chang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - R David Fish
- Center for Clinical Research, The Texas Heart Institute, Houston, Texas, USA
| | - Alain Bouchard
- Princeton Baptist Medical Center, Cardiology PC Research, Birmingham, Alabama, USA
| | - Margaret Jenkins
- Global Pharma Consulting Pty, Ltd, Melbourne, Victoria, Australia
| | | | | | | | | | - Eric Rose
- Mesoblast, Ltd, Melbourne, Victoria, Australia
| | | | - Barry Greenberg
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
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16
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Sustainability of C-Reactive Protein Apheresis in Acute Myocardial Infarction-Results from a Supplementary Data Analysis of the Exploratory C-Reactive Protein in Acute Myocardial Infarction-1 Study. J Clin Med 2022; 11:jcm11216446. [PMID: 36362673 PMCID: PMC9655548 DOI: 10.3390/jcm11216446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
In the multicenter, non-randomized, exploratory C-reactive protein (CRP) Apheresis in Myocardial Infarction (CAMI-1) study, CRP apheresis after ST-Elevation Myocardial Infarction (STEMI) significantly decreased blood CRP concentrations in humans. Cardiac damage was assessed by Cardiac Magnetic Resonance (CMR1) 3−9 d after onset of STEMI symptoms and quantified by myocardial infarct size (IS; %), left ventricular ejection fraction (LVEF; %), circumferential strain (CS) and longitudinal strain (LS). Compared with the control group (n = 34), cardiac damage was significantly lower in the apheresis group (n = 32). These findings suggested improved wound healing due to CRP apheresis already within few days after the STEMI event. In the current supplementary data analysis of CAMI-1, we have tested by a follow-up CMR (CMR2) after an average of 88 (65−177) d whether the effect of CRP apheresis is clinically maintained. After this time period, wound healing in STEMI is considered complete. Whereas patients with low CRP production and a CRP gradient cut off of <0.6 mg/L/h in the hours after STEMI (9 of 32 patients in the CRP apheresis group) did not significantly benefit from CRP apheresis in CMR2, patients with high CRP production and a CRP gradient cut off of >0.6 mg/L/h (23 of 32 patients in the CRP apheresis group) showed significant treatment benefit. In the latter patients, CMR2 revealed a lower IS (−5.4%; p = 0.05), a better LVEF (+6.4%; p = 0.03), and an improved CS (−6.1%; p = 0.005). No significant improvement, however, was observed for LS (−2.9%; p = 0.1). These data suggest a sustained positive effect of CRP apheresis on heart physiology in STEMI patients with high CRP production well beyond the period of its application. The data demonstrate the sustainability of the CRP removal from plasma which is associated with less scar tissue.
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17
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Novel therapeutic strategies to reduce reperfusion injury after acute myocardial infarction. Curr Probl Cardiol 2022; 47:101398. [PMID: 36108813 DOI: 10.1016/j.cpcardiol.2022.101398] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 02/06/2023]
Abstract
For almost 30 years, urgent revascularization termed primary percutaneous coronary intervention (pPCI) has been a cornerstone of modern care for acute myocardial infarction (AMI). It lowers mortality and improved cardiovascular outcome compared to conservative therapy including thrombolysis. Reperfusion injury, which occurs after successful re-opening of the formerly occluded coronary artery, had been exploited as a potential therapeutic target. When revascularisation became faster and pPCI was successfully performed within 60-90 minutes of symptom onset, the interest in a potential additive effect of targeting reperfusion injury vanished. More recently, several meta-analyses indicated that limiting reperfusion injury prevents microvascular obstruction and reduces final infarct size, thereby lowering the probability of heart failure events and improving quality of life in AMI survivors. Here, we describe the current strategies to limit reperfusion injury and to improve post-AMI outcomes such as systemic or intracoronary hypothermia, left-ventricular unloading, intracoronary infusion of super-saturated oxygen, intermittent coronary sinus occlusion, and C-reactive protein apharesis.
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Special Issue “C-Reactive Protein and Cardiovascular Disease: Clinical Aspects”. J Clin Med 2022; 11:jcm11133610. [PMID: 35806892 PMCID: PMC9267697 DOI: 10.3390/jcm11133610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 01/08/2023] Open
Abstract
This Special Issue focuses on the clinical relevance of C-reactive protein [...]
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19
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Komarova N, Panova O, Titov A, Kuznetsov A. Aptamers Targeting Cardiac Biomarkers as an Analytical Tool for the Diagnostics of Cardiovascular Diseases: A Review. Biomedicines 2022; 10:biomedicines10051085. [PMID: 35625822 PMCID: PMC9138532 DOI: 10.3390/biomedicines10051085] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
The detection of cardiac biomarkers is used for diagnostics, prognostics, and the risk assessment of cardiovascular diseases. The analysis of cardiac biomarkers is routinely performed with high-sensitivity immunological assays. Aptamers offer an attractive alternative to antibodies for analytical applications but, to date, are not widely practically implemented in diagnostics and medicinal research. This review summarizes the information on the most common cardiac biomarkers and the current state of aptamer research regarding these biomarkers. Aptamers as an analytical tool are well established for troponin I, troponin T, myoglobin, and C-reactive protein. For the rest of the considered cardiac biomarkers, the isolation of novel aptamers or more detailed characterization of the known aptamers are required. More attention should be addressed to the development of dual-aptamer sandwich detection assays and to the studies of aptamer sensing in alternative biological fluids. The universalization of aptamer-based biomarker detection platforms and the integration of aptamer-based sensing to clinical studies are demanded for the practical implementation of aptamers to routine diagnostics. Nevertheless, the wide usage of aptamers for the diagnostics of cardiovascular diseases is promising for the future, with respect to both point-of-care and laboratory testing.
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20
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Seven COVID-19 Patients Treated with C-Reactive Protein (CRP) Apheresis. J Clin Med 2022; 11:jcm11071956. [PMID: 35407564 PMCID: PMC8999883 DOI: 10.3390/jcm11071956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 01/08/2023] Open
Abstract
Background: The fulminant course of COVID-19, triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents with a high mortality rate and still lacks a causative treatment. C-reactive protein (CRP) has been shown to increase dramatically during the disease progression and correlates with deleterious outcomes. Selective CRP apheresis can reduce circulating CRP levels fast and effective. Methods: Seven hospitalized patients with documented severe COVID-19 progression, elevated CRP plasma levels (>100 mg/L) and signs of respiratory failure were treated with CRP apheresis. Two to twelve CRP apheresis sessions were performed generally in 24 h time intervals and depending on CRP plasma levels. Results: All patients had comorbidities. CRP apheresis reduced CRP plasma levels by up to 84% within a few hours, without exhibiting side effects in any patient. Despite signs of severe lung infiltration in all patients, only one patient died. The other patients showed improvements within the chest X-ray after CRP apheresis and were able to recover regardless of intubation and/or ECMO (4 patients). All remaining six patients were discharged from the hospital in good clinical condition. Conclusions: This case series presents a mortality rate of only 14%, which is dramatically lower than expected from the presented CRP levels as well as comorbidities and ventilation requirements. Our clinical observations regarding the here presented seven patients support the hypothesis that CRP is a candidate to be therapeutically targeted in the early stage of severe COVID-19.
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Torzewski J, Brunner P, Ries W, Garlichs CD, Kayser S, Heigl F, Sheriff A. Targeting C-Reactive Protein by Selective Apheresis in Humans: Pros and Cons. J Clin Med 2022; 11:jcm11071771. [PMID: 35407379 PMCID: PMC8999816 DOI: 10.3390/jcm11071771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 01/08/2023] Open
Abstract
C-reactive protein (CRP), the prototype human acute phase protein, may be causally involved in various human diseases. As CRP has appeared much earlier in evolution than antibodies and nonetheless partly utilizes the same biological structures, it is likely that CRP has been the first antibody-like molecule in the evolution of the immune system. Like antibodies, CRP may cause autoimmune reactions in a variety of human pathologies. Consequently, therapeutic targeting of CRP may be of utmost interest in human medicine. Over the past two decades, however, pharmacological targeting of CRP has turned out to be extremely difficult. Currently, the easiest, most effective and clinically safest method to target CRP in humans may be the specific extracorporeal removal of CRP by selective apheresis. The latter has recently shown promising therapeutic effects, especially in acute myocardial infarction and COVID-19 pneumonia. This review summarizes the pros and cons of applying this novel technology to patients suffering from various diseases, with a focus on its use in cardiovascular medicine.
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Affiliation(s)
- Jan Torzewski
- Cardiovascular Center Oberallgaeu-Kempten, Clinic Association Allgaeu, 87439 Kempten, Germany;
| | | | - Wolfgang Ries
- Medical Clinic, Diakonissenhospital Flensburg, 24939 Flensburg, Germany; (W.R.); (C.D.G.)
| | - Christoph D. Garlichs
- Medical Clinic, Diakonissenhospital Flensburg, 24939 Flensburg, Germany; (W.R.); (C.D.G.)
| | - Stefan Kayser
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (P.B.); (S.K.)
| | - Franz Heigl
- Medical Care Center Kempten-Allgaeu, 87439 Kempten, Germany;
| | - Ahmed Sheriff
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (P.B.); (S.K.)
- Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité University Medicine, 12200 Berlin, Germany
- Correspondence:
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22
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Anwar F, Alhayyani S, Al‐Abbasi FA, Nadeem MS, Kumar V. Pharmacological role of Vitamin C in stress‐induced cardiac dysfunction via alteration in Gut microbiota. J Biochem Mol Toxicol 2022; 36:e22986. [DOI: 10.1002/jbt.22986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/22/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Firoz Anwar
- Department of Biochemistry, Faculty of Sciences King Abdulaziz University Jeddah Kingdom of Saudi Arabia
| | - Sultan Alhayyani
- Department of Chemistry College of Sciences and Arts, King Abdulaziz University Rabigh Saudi Arabia
| | - Fahad A. Al‐Abbasi
- Department of Biochemistry, Faculty of Sciences King Abdulaziz University Jeddah Kingdom of Saudi Arabia
| | - Muhammad Shahid Nadeem
- Department of Biochemistry, Faculty of Sciences King Abdulaziz University Jeddah Kingdom of Saudi Arabia
| | - Vikas Kumar
- Natural Product Discovery Laboratory, Department of Pharmaceutical Sciences Shalom Institute of Health and Allied Sciences, SHUATS Allahabad Uttar Pradesh India
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Paul P, Picard C, Lyonnet L, Resseguier N, Hubert L, Arnaud L, Di Cristofaro J, Laine M, Paganelli F, Dignat-George F, Frère C, Sabatier F, Guieu R, Bonello L. FCGR2A-HH Gene Variants Encoding the Fc Gamma Receptor for the C-Reactive Protein Are Associated with Enhanced Monocyte CD32 Expression and Cardiovascular Events’ Recurrence after Primary Acute Coronary Syndrome. Biomedicines 2022; 10:biomedicines10020495. [PMID: 35203703 PMCID: PMC8962261 DOI: 10.3390/biomedicines10020495] [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: 01/29/2022] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 01/08/2023] Open
Abstract
Fcγ receptors (FcγRs) interact with the C-reactive protein (CRP) and mediate activation of inflammation-related pathogenic mechanisms affecting cardiovascular health. Our study evaluated whether FcγRIIA and FcγRIIIA profiles are associated with the recurrence of adverse cardiovascular events during the first year after a primary acute coronary syndrome (ACS). The primary endpoint was the recurrence of cardiovascular events (RCE), identified as a composite outcome comprising acute heart failure (AHF) and major adverse cardiovascular events (MACE). We obtained blood samples of 145 ACS patients to measure hsCRP circulating levels, to identify FcγRIIA-131RH rs1801274 and FcγRIIIA-158FV rs396991 polymorphisms, to analyze circulating monocytes and NK cell subsets expressing CD16 and CD32, and to detect serum-mediated FCGR2A-HH activation by luciferase reporter assays. The hsCRP, CD32-expression, and Fc-R mediated activation levels were similar in all patients regardless of their MACE risk. In contrast, the hsCRP levels and the proportion of CD14+ circulating monocytes expressing the CD32 receptor for CRP were significantly higher in the patients who developed AHF. The FCGR2A rs1801274 HH genotype was significantly more common in patients who developed RCE and MACE than in RCE-free patients and associated with an enhanced percentage of circulating CD32+CD14+ monocytes. The FCGR2A-HH genotype was identified as an independent predictor of subsequent RCE (OR, 2.7; p = 0.048; CI, 1.01–7.44) by multivariate analysis. These findings bring preliminary evidence that host FCGR2A genetic variants can influence monocyte CD32 receptor expression and may contribute to the fine-tuning of CD32-driven chronic activating signals that affect the risk of developing RCEs following primary ACS events.
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Affiliation(s)
- Pascale Paul
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
- INSERM UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Parc Scientifique de Luminy Case 928, 163 Avenue de Luminy, CEDEX 09, 13288 Marseille, France
- Correspondence:
| | - Christophe Picard
- Biologie des Groupes Sanguins, Établissement Français du Sang, UMR 7268 ADÉS EFS/CNRS, Aix-Marseille Université, 13005 Marseille, France; (C.P.); (L.H.); (J.D.C.)
| | - Luc Lyonnet
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
| | - Noémie Resseguier
- Support Unit for Clinical Research and Economic Evaluation, EA3279, CEReSS-Health Service Research and Quality of Life Center, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France;
| | - Lucas Hubert
- Biologie des Groupes Sanguins, Établissement Français du Sang, UMR 7268 ADÉS EFS/CNRS, Aix-Marseille Université, 13005 Marseille, France; (C.P.); (L.H.); (J.D.C.)
| | - Laurent Arnaud
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
| | - Julie Di Cristofaro
- Biologie des Groupes Sanguins, Établissement Français du Sang, UMR 7268 ADÉS EFS/CNRS, Aix-Marseille Université, 13005 Marseille, France; (C.P.); (L.H.); (J.D.C.)
| | - Marc Laine
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; (M.L.); (F.P.)
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Franck Paganelli
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; (M.L.); (F.P.)
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Françoise Dignat-George
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
| | - Corinne Frère
- Institute of Cardiometabolism and Nutrition, GRC 27 GRECO, Sorbonne University, INSERM UMRS_1166, 75013 Paris, France;
| | - Florence Sabatier
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
| | - Regis Guieu
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Department of Biochemistry, Assistance Publique-Hôpitaux, 13005 Marseille, France
| | - Laurent Bonello
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; (M.L.); (F.P.)
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
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Holzknecht M, Reinstadler SJ. CRP: a potential target in reperfused STEMI? Reply to the letter: "Targeting CRP in microvascular obstruction after PCI". Int J Cardiol 2022; 355:5. [PMID: 35192861 DOI: 10.1016/j.ijcard.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria..
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Wallukat G, Mattecka S, Wenzel K, Schrödl W, Vogt B, Brunner P, Sheriff A, Kunze R. C-Reactive Protein (CRP) Blocks the Desensitization of Agonistic Stimulated G Protein Coupled Receptors (GPCRs) in Neonatal Rat Cardiomyocytes. J Clin Med 2022; 11:jcm11041058. [PMID: 35207331 PMCID: PMC8878432 DOI: 10.3390/jcm11041058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Recently, C-reactive protein (CRP) was shown to affect intracellular calcium signaling and blood pressure in vitro and in vivo, respectively. The aim of the present study was to further investigate if a direct effect on G-protein coupled receptor (GPCR) signaling by CRP can be observed by using CRP in combination with different GPCR agonists on spontaneously beating cultured neonatal rat cardiomyocytes. All used agonists (isoprenaline, clenbuterol, phenylephrine, angiotensin II and endothelin 1) affected the beat rate of cardiomyocytes significantly and after washing them out and re-stimulation the cells developed a pronounced desensitization of the corresponding receptors. CRP did not affect the basal beating-rate nor the initial increase/decrease in beat-rate triggered by different agonists. However, CRP co-incubated cells did not exhibit desensitization of the respective GPCRs after the stimulation with the different agonists. This lack of desensitization was independent of the GPCR type, but it was dependent on the CRP concentration. Therefore, CRP interferes with the desensitization of GPCRs and has to be considered as a novel regulator of adrenergic, angiotensin-1 and endothelin receptors.
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Affiliation(s)
- Gerd Wallukat
- Berlin Cures GmbH, BBB Campus, 13125 Berlin, Germany; (G.W.); (K.W.)
| | - Stephan Mattecka
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (S.M.); (B.V.); (P.B.); (A.S.)
| | - Katrin Wenzel
- Berlin Cures GmbH, BBB Campus, 13125 Berlin, Germany; (G.W.); (K.W.)
| | - Wieland Schrödl
- Institute of Bacteriology and Mycology Faculty of Veterinary Medicine, University of Leipzig, 04103 Leipzig, Germany;
| | - Birgit Vogt
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (S.M.); (B.V.); (P.B.); (A.S.)
| | - Patrizia Brunner
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (S.M.); (B.V.); (P.B.); (A.S.)
| | - Ahmed Sheriff
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (S.M.); (B.V.); (P.B.); (A.S.)
- Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité University Medicine, 12200 Berlin, Germany
| | - Rudolf Kunze
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (S.M.); (B.V.); (P.B.); (A.S.)
- Correspondence:
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26
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Kajikawa T, Mastellos DC, Hasturk H, Kotsakis GA, Yancopoulou D, Lambris JD, Hajishengallis G. C3-targeted host-modulation approaches to oral inflammatory conditions. Semin Immunol 2022; 59:101608. [PMID: 35691883 DOI: 10.1016/j.smim.2022.101608] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Periodontitis is an inflammatory disease caused by biofilm accumulation and dysbiosis in subgingival areas surrounding the teeth. If not properly treated, this oral disease may result in tooth loss and consequently poor esthetics, deteriorated masticatory function and compromised quality of life. Epidemiological and clinical intervention studies indicate that periodontitis can potentially aggravate systemic diseases, such as, cardiovascular disease, type 2 diabetes mellitus, rheumatoid arthritis, and Alzheimer disease. Therefore, improvements in the treatment of periodontal disease may benefit not only oral health but also systemic health. The complement system is an ancient host defense system that plays pivotal roles in immunosurveillance and tissue homeostasis. However, complement has unwanted consequences if not controlled appropriately or excessively activated. Complement overactivation has been observed in patients with periodontitis and in animal models of periodontitis and drives periodontal inflammation and tissue destruction. This review places emphasis on a promising periodontal host-modulation therapy targeting the complement system, namely the complement C3-targeting drug, AMY-101. AMY-101 has shown safety and efficacy in reducing gingival inflammation in a recent Phase 2a clinical study. We also discuss the potential of AMY-101 to treat peri-implant inflammatory conditions, where complement also seems to be involved and there is an urgent unmet need for effective treatment.
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Affiliation(s)
- Tetsuhiro Kajikawa
- University of Pennsylvania, Penn Dental Medicine, Department of Basic and Translational Sciences, Philadelphia, PA, USA; Tohoku University Graduate School of Dentistry, Department of Periodontology and Endodontology, Sendai, Miyagi, Japan
| | - Dimitrios C Mastellos
- National Center for Scientific Research 'Demokritos', Division of Biodiagnostic Sciences and Technologies, INRASTES, Athens, Greece
| | - Hatice Hasturk
- The Forsyth Institute, Center for Clinical and Translational Research, Cambridge, MA, USA
| | - Georgios A Kotsakis
- University of Texas Health Science Center at San Antonio, School of Dentistry, Department of Periodontics, San Antonio, TX, USA
| | | | - John D Lambris
- University of Pennsylvania, Perelman School of Medicine, Department of Pathology and Laboratory Medicine, Philadelphia, PA, USA
| | - George Hajishengallis
- University of Pennsylvania, Penn Dental Medicine, Department of Basic and Translational Sciences, Philadelphia, PA, USA.
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27
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Balietti M, Casoli T, Giacconi R, Giuli C. Platelet total PLA2 activity, serum oxidative level and plasma Cu/Zn ratio: a vicious cycle with a potential role to monitor MCI and Alzheimer's disease progression. Rejuvenation Res 2021; 25:16-24. [PMID: 34913745 DOI: 10.1089/rej.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Alzheimer's disease (AD) has no cure, mainly because of late diagnosis. Early diagnostic biomarkers are crucial. Phospholipases A2 (PLA2) are hydrolases with several functions in the brain, nevertheless their deregulation contributes to neurodegeneration. We evaluated platelet total PLA2 activity (ptotPLA2) in healthy elderly subjects (HE, n = 102), patients suffering from Mild Cognitive Impairment (MCI, n = 90) and AD (n = 91). Platelets are considered "circulating neurons" and ptotPLA2 seems to mirror the cerebral activity. ptotPLA2 of the three cohorts was similar, but in MCI the higher ptotPLA2 the worse the global cognitive status (Mini Mental State Examination score, MMSE) and in AD the lower ptotPLA2 the more severe the pathology stage (Clinical Dementia Rating, CDR). Accordingly, MCI with MMSE ≥ 26 overlapped HE, in MCI with MMSE < 26 and in AD with CDR 1 ptotPLA2 increased, in AD with CDR 2 ptotPLA2 decreased. In MCI ptotPLA2 positively correlated with blood oxidation and inflammation, in AD it was the opposite. Finally, Discrimination Index (DI) - calculated multiplying ptotPLA2, oxidative level and Cu/Zn ratio (an inflammation parameter) - differentiated MCI patients who progressed to dementia in the following 24 months and AD patients with the worse pathology development. Summarizing, ptotPLA2 changes during MCI and AD progression, is linked, in opposite way, to oxidative/inflammatory status in MCI and AD and might help, when included in DI, to identify MCI converters to dementia and AD patients with the more severe prognosis. ptotPLA2 may have a diagnostic/prognostic value and be a potential therapeutic target.
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Affiliation(s)
- Marta Balietti
- INRCA, Neurobiology of Aging, Via Birrelli 8, Ancona, Italy, 60121;
| | | | | | - Cinzia Giuli
- INRCA IRCCS Hospital, Unit of Geriatrics, contrada Mossa 2, Fermo, Italy, 63900;
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28
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Holzknecht M, Tiller C, Reindl M, Lechner I, Fink P, Lunger P, Mayr A, Henninger B, Brenner C, Klug G, Bauer A, Metzler B, Reinstadler SJ. Association of C-Reactive Protein Velocity with Early Left Ventricular Dysfunction in Patients with First ST-Elevation Myocardial Infarction. J Clin Med 2021; 10:5494. [PMID: 34884196 PMCID: PMC8658672 DOI: 10.3390/jcm10235494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
C-reactive protein velocity (CRPv) has been proposed as a very early and sensitive risk predictor in patients with ST-elevation myocardial infarction (STEMI). However, the association of CRPv with early left ventricular (LV) dysfunction after STEMI is unknown. The aim of this study was to investigate the relationship between CRPv and early LV dysfunction, either before or at hospital discharge, in patients with first STEMI. This analysis evaluated 432 STEMI patients that were included in the prospective MARINA-STEMI (Magnetic Resonance Imaging In Acute ST-elevation Myocardial Infarction. ClinicalTrials.gov Identifier: NCT04113356) cohort study. The difference of CRP 24 ± 8 h and CRP at hospital admission divided by the time (in h) that elapsed during the two examinations was defined as CRPv. Cardiac magnetic resonance (CMR) imaging was conducted at a median of 3 (IQR 2-4) days after primary percutaneous coronary intervention (PCI) for the determination of LV function and myocardial infarct characteristics. The association of CRPv with the CMR-derived LV ejection fraction (LVEF) was investigated. The median CRPv was 0.42 (IQR 0.21-0.76) mg/l/h and was correlated with LVEF (rS = -0.397, p < 0.001). In multivariable linear as well as binary logistic regression analysis (adjustment for biomarkers and clinical and angiographical parameters), CRPv was independently associated with LVEF (β: 0.161, p = 0.004) and LVEF ≤ 40% (OR: 1.71, 95% CI: 1.19-2.45; p = 0.004), respectively. The combined predictive value of peak cardiac troponin T (cTnT) and CRPv for LVEF ≤ 40% (AUC: 0.81, 95% CI 0.77-0.85, p < 0.001) was higher than it was for peak cTnT alone (AUC difference: 0.04, p = 0.009). CRPv was independently associated with early LV dysfunction, as measured by the CMR-determined LVEF, revealing an additive predictive value over cTnT after acute STEMI treated with primary PCI.
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Affiliation(s)
- Magdalena Holzknecht
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Christina Tiller
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Martin Reindl
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Ivan Lechner
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Priscilla Fink
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Patrick Lunger
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (A.M.); (B.H.)
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (A.M.); (B.H.)
| | - Christoph Brenner
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Gert Klug
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Axel Bauer
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Bernhard Metzler
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
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Patients with COVID-19: in the dark-NETs of neutrophils. Cell Death Differ 2021; 28:3125-3139. [PMID: 34031543 PMCID: PMC8142290 DOI: 10.1038/s41418-021-00805-z] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 infection poses a major threat to the lungs and multiple other organs, occasionally causing death. Until effective vaccines are developed to curb the pandemic, it is paramount to define the mechanisms and develop protective therapies to prevent organ dysfunction in patients with COVID-19. Individuals that develop severe manifestations have signs of dysregulated innate and adaptive immune responses. Emerging evidence implicates neutrophils and the disbalance between neutrophil extracellular trap (NET) formation and degradation plays a central role in the pathophysiology of inflammation, coagulopathy, organ damage, and immunothrombosis that characterize severe cases of COVID-19. Here, we discuss the evidence supporting a role for NETs in COVID-19 manifestations and present putative mechanisms, by which NETs promote tissue injury and immunothrombosis. We present therapeutic strategies, which have been successful in the treatment of immunο-inflammatory disorders and which target dysregulated NET formation or degradation, as potential approaches that may benefit patients with severe COVID-19.
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Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis. World Neurosurg 2021; 163:e1-e42. [PMID: 34728391 DOI: 10.1016/j.wneu.2021.10.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The goal of this study was to systematically review the utility of serum biomarkers in the setting of ischemic stroke (IS) to predict long-term outcome. METHODS A systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986-2018. All studies assessing long-term functional outcome (defined as 30 days or greater) following IS with respect to serum biomarkers were included. Data were extracted and pooled using a meta-analysis of odds ratios. RESULTS Of the total 2928 articles in the original literature search, 183 studies were ultimately selected. A total of 127 serum biomarkers were included. Biomarkers were grouped into several categories: inflammatory (32), peptide/enzymatic (30), oxidative/metabolic (28), hormone/steroid based (23), and hematologic/vascular (14). The most commonly studied biomarkers in each category were found to be CRP, S100β, albumin, copeptin, and D-dimer. With the exception of S100β, all were found to be statistically associated with >30-day outcome after ischemic stroke. CONCLUSIONS Serum-based biomarkers have the potential to predict functional outcome in IS patients. This meta-analysis has identified CRP, albumin, copeptin, and D-dimer to be significantly associated with long-term outcome after IS. These biomarkers have the potential to serve as a platform for prognosticating stroke outcomes after 30 days. These serum biomarkers, some of which are routinely ordered, can be combined with imaging biomarkers and used in artificial intelligence algorithms to provide refined predictive outcomes after injury. Ultimately these tools will assist physicians in providing guidance to families with regards to long-term independence of patients.
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31
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Reina-Couto M, Pereira-Terra P, Quelhas-Santos J, Silva-Pereira C, Albino-Teixeira A, Sousa T. Inflammation in Human Heart Failure: Major Mediators and Therapeutic Targets. Front Physiol 2021; 12:746494. [PMID: 34707513 PMCID: PMC8543018 DOI: 10.3389/fphys.2021.746494] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/20/2021] [Indexed: 12/28/2022] Open
Abstract
Inflammation has been recognized as a major pathophysiological contributor to the entire spectrum of human heart failure (HF), including HF with reduced ejection fraction, HF with preserved ejection fraction, acute HF and cardiogenic shock. Nevertheless, the results of several trials attempting anti-inflammatory strategies in HF patients have not been consistent or motivating and the clinical implementation of anti-inflammatory treatments for HF still requires larger and longer trials, as well as novel and/or more specific drugs. The present work reviews the different inflammatory mechanisms contributing to each type of HF, the major inflammatory mediators involved, namely tumor necrosis factor alpha, the interleukins 1, 6, 8, 10, 18, and 33, C-reactive protein and the enzymes myeloperoxidase and inducible nitric oxide synthase, and their effects on heart function. Furthermore, several trials targeting these mediators or involving other anti-inflammatory treatments in human HF are also described and analyzed. Future therapeutic advances will likely involve tailored anti-inflammatory treatments according to the patient's inflammatory profile, as well as the development of resolution pharmacology aimed at stimulating resolution of inflammation pathways in HF.
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Affiliation(s)
- Marta Reina-Couto
- Departamento de Biomedicina – Unidade de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto (MedInUP), Porto, Portugal
- Departamento de Medicina Intensiva, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Patrícia Pereira-Terra
- Departamento de Biomedicina – Unidade de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Janete Quelhas-Santos
- Departamento de Biomedicina – Unidade de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Carolina Silva-Pereira
- Departamento de Biomedicina – Unidade de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto (MedInUP), Porto, Portugal
| | - António Albino-Teixeira
- Departamento de Biomedicina – Unidade de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto (MedInUP), Porto, Portugal
| | - Teresa Sousa
- Departamento de Biomedicina – Unidade de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto (MedInUP), Porto, Portugal
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Labarrere CA, Kassab GS. Pattern Recognition Proteins: First Line of Defense Against Coronaviruses. Front Immunol 2021; 12:652252. [PMID: 34630377 PMCID: PMC8494786 DOI: 10.3389/fimmu.2021.652252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023] Open
Abstract
The rapid outbreak of COVID-19 caused by the novel coronavirus SARS-CoV-2 in Wuhan, China, has become a worldwide pandemic affecting almost 204 million people and causing more than 4.3 million deaths as of August 11 2021. This pandemic has placed a substantial burden on the global healthcare system and the global economy. Availability of novel prophylactic and therapeutic approaches are crucially needed to prevent development of severe disease leading to major complications both acutely and chronically. The success in fighting this virus results from three main achievements: (a) Direct killing of the SARS-CoV-2 virus; (b) Development of a specific vaccine, and (c) Enhancement of the host's immune system. A fundamental necessity to win the battle against the virus involves a better understanding of the host's innate and adaptive immune response to the virus. Although the role of the adaptive immune response is directly involved in the generation of a vaccine, the role of innate immunity on RNA viruses in general, and coronaviruses in particular, is mostly unknown. In this review, we will consider the structure of RNA viruses, mainly coronaviruses, and their capacity to affect the lungs and the cardiovascular system. We will also consider the effects of the pattern recognition protein (PRP) trident composed by (a) Surfactant proteins A and D, mannose-binding lectin (MBL) and complement component 1q (C1q), (b) C-reactive protein, and (c) Innate and adaptive IgM antibodies, upon clearance of viral particles and apoptotic cells in lungs and atherosclerotic lesions. We emphasize on the role of pattern recognition protein immune therapies as a combination treatment to prevent development of severe respiratory syndrome and to reduce pulmonary and cardiovascular complications in patients with SARS-CoV-2 and summarize the need of a combined therapeutic approach that takes into account all aspects of immunity against SARS-CoV-2 virus and COVID-19 disease to allow mankind to beat this pandemic killer.
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Affiliation(s)
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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Ringel J, Ramlow A, Bock C, Sheriff A. Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase. Front Immunol 2021; 12:708101. [PMID: 34408751 PMCID: PMC8366396 DOI: 10.3389/fimmu.2021.708101] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/20/2021] [Indexed: 02/04/2023] Open
Abstract
Background Plasma levels of C-reactive protein (CRP), induced by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) triggering COVID-19, can rise surprisingly high. The increase of the CRP concentration as well as a certain threshold concentration of CRP are indicative of clinical deterioration to artificial ventilation. In COVID-19, virus-induced lung injury and the subsequent massive onset of inflammation often drives pulmonary fibrosis. Fibrosis of the lung usually proceeds as sequela to a severe course of COVID-19 and its consequences only show months later. CRP-mediated complement- and macrophage activation is suspected to be the main driver of pulmonary fibrosis and subsequent organ failure in COVID-19. Recently, CRP apheresis was introduced to selectively remove CRP from human blood plasma. Case Report A 53-year-old, SARS-CoV-2 positive, male patient with the risk factor diabetes type 2 was referred with dyspnea, fever and fulminant increase of CRP. The patient's lungs already showed a pattern enhancement as an early sign of incipient pneumonia. The oxygen saturation of the blood was ≤ 89%. CRP apheresis using the selective CRP adsorber (PentraSorb® CRP) was started immediately. CRP apheresis was performed via peripheral venous access on 4 successive days. CRP concentrations before CRP apheresis ranged from 47 to 133 mg/l. The removal of CRP was very effective with up to 79% depletion within one apheresis session and 1.2 to 2.14 plasma volumes were processed in each session. No apheresis-associated side effects were observed. It was at no point necessary to transfer the patient to the Intensive Care Unit or to intubate him due to respiratory failure. 10 days after the first positive SARS-CoV-2 test, CRP levels stayed below 20 mg/l and the patient no longer exhibited fever. Fourteen days after the first positive SARS-CoV-2 test, the lungs showed no sign of pneumonia on X-ray. Conclusion This is the first report on CRP apheresis in an early COVID-19 patient with fulminant CRP increase. Despite a poor prognosis due to his diabetes and biomarker profile, the patient was not ventilated, and the onset of pneumonia was reverted.
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Affiliation(s)
| | - Anja Ramlow
- Apheresis Unit, Pentracor GmbH, Hennigsdorf, Germany
| | | | - Ahmed Sheriff
- Apheresis Unit, Pentracor GmbH, Hennigsdorf, Germany
- Gastroenterology/Infectiology/Rheumatology, Charité University Medicine Berlin, Berlin, Germany
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Bargieł W, Cierpiszewska K, Maruszczak K, Pakuła A, Szwankowska D, Wrzesińska A, Gutowski Ł, Formanowicz D. Recognized and Potentially New Biomarkers-Their Role in Diagnosis and Prognosis of Cardiovascular Disease. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57070701. [PMID: 34356982 PMCID: PMC8305174 DOI: 10.3390/medicina57070701] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 01/08/2023]
Abstract
Atherosclerosis and its consequences are the leading cause of mortality in the world. For this reason, we have reviewed atherosclerosis biomarkers and selected the most promising ones for review. We focused mainly on biomarkers related to inflammation and oxidative stress, such as the highly sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), and lipoprotein-associated phospholipase A2 (Lp-PLA2). The microRNA (miRNA) and the usefulness of the bone mineralization, glucose, and lipid metabolism marker osteocalcin (OC) were also reviewed. The last biomarker we considered was angiogenin (ANG). Our review shows that due to the multifactorial nature of atherosclerosis, no single marker is known so far, the determination of which would unambiguously assess the severity of atherosclerosis and help without any doubt in the prognosis of cardiovascular risk.
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Affiliation(s)
- Weronika Bargieł
- Faculty of Medicine, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (W.B.); (K.C.); (K.M.); (A.P.); (D.S.); (A.W.)
| | - Katarzyna Cierpiszewska
- Faculty of Medicine, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (W.B.); (K.C.); (K.M.); (A.P.); (D.S.); (A.W.)
| | - Klara Maruszczak
- Faculty of Medicine, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (W.B.); (K.C.); (K.M.); (A.P.); (D.S.); (A.W.)
| | - Anna Pakuła
- Faculty of Medicine, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (W.B.); (K.C.); (K.M.); (A.P.); (D.S.); (A.W.)
| | - Dominika Szwankowska
- Faculty of Medicine, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (W.B.); (K.C.); (K.M.); (A.P.); (D.S.); (A.W.)
| | - Aleksandra Wrzesińska
- Faculty of Medicine, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (W.B.); (K.C.); (K.M.); (A.P.); (D.S.); (A.W.)
| | - Łukasz Gutowski
- Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806 Poznan, Poland;
| | - Dorota Formanowicz
- Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806 Poznan, Poland;
- Correspondence:
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Ries W, Torzewski J, Heigl F, Pfluecke C, Kelle S, Darius H, Ince H, Mitzner S, Nordbeck P, Butter C, Skarabis H, Sheriff A, Garlichs CD. C-Reactive Protein Apheresis as Anti-inflammatory Therapy in Acute Myocardial Infarction: Results of the CAMI-1 Study. Front Cardiovasc Med 2021; 8:591714. [PMID: 33778017 PMCID: PMC7988098 DOI: 10.3389/fcvm.2021.591714] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/18/2021] [Indexed: 12/26/2022] Open
Abstract
Background: C-reactive protein (CRP) is a well-known marker of inflammation. It is less known that CRP mediates tissue damage in acute myocardial infarction (AMI) thus potentially worsening prognosis. A newly developed specific CRP adsorber allows efficient lowering of CRP levels and may improve survival. Objectives: Aim of this multi-center, controlled, non-randomized first-in-man CRP apheresis in Acute Myocardial Infarction study (CAMI-1) was to investigate the relationship between CRP levels (CRP gradient), myocardial infarct size and function as well as safety and efficacy of CRP apheresis in the setting of acute ST-segment Elevation Myocardial Infarction (STEMI) in humans. Methods: Eighty-three patients (45 apheresis, 38 controls) were recruited. CRP apheresis was performed 24 ± 12, 48 ± 12, and optionally 72 ± 12 h after onset of symptoms. First aphereses were performed at a median CRP concentration of 23.0 mg/L (range 9–279). In each apheresis session, 5,900 ± 400 mL plasma was processed via peripheral venous access. Primary study endpoint was a reduction in myocardial infarct size after STEMI as determined by cardiovascular magnetic resonance (CMR). Results: In controls, the CRP concentration significantly correlated with infarct size (p = 0.002) and decreased myocardial function (p ≤ 0.001). The CRP concentration in apheresis patients did not correlate with infarct size (p = 0.66) or left ventricular (LV) function (p = 0.79) and global strains and therefore significantly differed from controls (p = 0.03 and p = 0.002). Three major adverse cardiac events occurred in the control group after 12 months, none occurred in the apheresis group. Mean CRP depletion achieved over all apheresis procedures was 53.0 ± 15.1%. Apheresis sessions were well-tolerated. Reduced infarct size in the apheresis group compared to the control group (primary endpoint) was not achieved according to the original statistical analysis plan. Taking into account the individual CRP levels, however, revealed significant results. Modifications of the analysis plan were introduced in order to recruit a sufficient number of patients. Conclusions: This pilot study in humans reveals a correlation between CRP concentration and myocardial infarct size. CRP concentrations in STEMI can effectively be reduced by CRP apheresis without relevant side effects. CRP apheresis has the potential to interfere with deleterious aspects of STEMI. By lowering CRP levels, it resulted in the loss of correlation of CRP concentrations with myocardial infarct sizes as well as LV function. These results encourage a larger, randomized clinical trial. Clinical Trial Registration:https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00008988, DRKS00008988.
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Affiliation(s)
- Wolfgang Ries
- Medical Clinic, Diakonissenhospital Flensburg, Flensburg, Germany
| | - Jan Torzewski
- Cardiovascular Center Oberallgäu-Kempten, Kempten, Germany
| | - Franz Heigl
- Medical Care Center Kempten-Allgäu, Kempten, Germany
| | - Christian Pfluecke
- Department for Internal Medicine/Cardiology, Heart Center Dresden, Dresden, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Harald Darius
- Clinic for Cardiology, Angiology, Nephrology, Intensive Care Medicine, Vivantes Clinic Neukölln, Berlin, Germany
| | - Hueseyin Ince
- Divisions of Cardiology and Nephrology, Department of Internal Medicine, University Medicine Rostock, Rostock, Germany
| | - Steffen Mitzner
- Divisions of Cardiology and Nephrology, Department of Internal Medicine, University Medicine Rostock, Rostock, Germany
| | - Peter Nordbeck
- Medical Clinic (Cardiology), University Clinic Würzburg, Würzburg, Germany
| | - Christian Butter
- Immanuel Clinic Bernau, Heart Center Brandenburg, Bernau, Germany
| | | | - Ahmed Sheriff
- Department of Gastroenterology/Infectiology/Rheumatology, Charité University Medicine Berlin, Berlin, Germany
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