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Mueller-Graf F, Frenkel P, Merz J, Reuter S, Vollmar B, Tusman G, Pulletz S, Böhm SH, Zitzmann A, Reuter DA, Adler A. Respiratory gating improves correlation between pulse wave transit time and pulmonary artery pressure in experimental pulmonary hypertension. Physiol Meas 2024; 45:03NT02. [PMID: 38422512 DOI: 10.1088/1361-6579/ad2eb5] [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: 07/17/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
Objective. Since pulse wave transit time (PWTT) shortens as pulmonary artery pressure (PAP) increases it was suggested as a potential non-invasive surrogate for PAP. The state of tidal lung filling is also known to affect PWTT independently of PAP. The aim of this retrospective analysis was to test whether respiratory gating improved the correlation coefficient between PWTT and PAP.Approach. In each one of five anesthetized and mechanically ventilated pigs two high-fidelity pressure catheters were placed, one directly behind the pulmonary valve, and the second one in a distal branch of the pulmonary artery. PAP was raised using the thromboxane A2 analogue U46619 and animals were ventilated in a pressure controlled mode (I:E ratio 1:2, respiratory rate 12/min, tidal volume of 6 ml kg-1). All signals were recorded using the multi-channel platform PowerLab®. The arrival of the pulse wave at each catheter tip was determined using a MATLAB-based modified hyperbolic tangent algorithm and PWTT calculated as the time interval between these arrivals.Main results. Correlation coefficient for PWTT and mean PAP wasr= 0.932 for thromboxane. This correlation coefficient increased considerably when heart beats either at end-inspiration (r= 0.978) or at end-expiration (r= 0.985) were selected (=respiratory gating).Significance. The estimation of mean PAP from PWTT improved significantly when taking the respiratory cycle into account. Respiratory gating is suggested to improve for the estimation of PAP by PWTT.
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Affiliation(s)
- Fabian Mueller-Graf
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, D-18057 Rostock, Germany
- Rudolf-Zenker-Institute for Experimental Surgery, University Medical Center Rostock, D-18057 Rostock, Germany
| | - Paul Frenkel
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, D-18057 Rostock, Germany
| | - Jonas Merz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, D-18057 Rostock, Germany
| | - Susanne Reuter
- Rudolf-Zenker-Institute for Experimental Surgery, University Medical Center Rostock, D-18057 Rostock, Germany
| | - Brigitte Vollmar
- Rudolf-Zenker-Institute for Experimental Surgery, University Medical Center Rostock, D-18057 Rostock, Germany
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires, Argentina
| | - Sven Pulletz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, D-18057 Rostock, Germany
| | - Stephan H Böhm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, D-18057 Rostock, Germany
| | - Amelie Zitzmann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, D-18057 Rostock, Germany
| | - Daniel A Reuter
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, D-18057 Rostock, Germany
| | - Andy Adler
- Systems and Computer Engineering, Carleton University, Ottawa, Canada
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Mukherjee D, Konduri GG. Pediatric Pulmonary Hypertension: Definitions, Mechanisms, Diagnosis, and Treatment. Compr Physiol 2021; 11:2135-2190. [PMID: 34190343 DOI: 10.1002/cphy.c200023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pediatric pulmonary hypertension (PPH) is a multifactorial disease with diverse etiologies and presenting features. Pulmonary hypertension (PH), defined as elevated pulmonary artery pressure, is the presenting feature for several pulmonary vascular diseases. It is often a hidden component of other lung diseases, such as cystic fibrosis and bronchopulmonary dysplasia. Alterations in lung development and genetic conditions are an important contributor to pediatric pulmonary hypertensive disease, which is a distinct entity from adult PH. Many of the causes of pediatric PH have prenatal onset with altered lung development due to maternal and fetal conditions. Since lung growth is altered in several conditions that lead to PPH, therapy for PPH includes both pulmonary vasodilators and strategies to restore lung growth. These strategies include optimal alveolar recruitment, maintaining physiologic blood gas tension, nutritional support, and addressing contributing factors, such as airway disease and gastroesophageal reflux. The outcome for infants and children with PH is highly variable and largely dependent on the underlying cause. The best outcomes are for neonates with persistent pulmonary hypertension (PPHN) and reversible lung diseases, while some genetic conditions such as alveolar capillary dysplasia are lethal. © 2021 American Physiological Society. Compr Physiol 11:2135-2190, 2021.
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Affiliation(s)
- Devashis Mukherjee
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children's Research Institute, Children's Wisconsin, Milwaukee, Wisconsin, 53226, USA
| | - Girija G Konduri
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children's Research Institute, Children's Wisconsin, Milwaukee, Wisconsin, 53226, USA
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3
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Schäfer M, Ivy DD, Nguyen K, Boncella K, Frank BS, Morgan GJ, Miller-Reed K, Truong U, Colvin K, Yeager ME. Metalloproteinases and their inhibitors are associated with pulmonary arterial stiffness and ventricular function in pediatric pulmonary hypertension. Am J Physiol Heart Circ Physiol 2021; 321:H242-H252. [PMID: 34085841 DOI: 10.1152/ajpheart.00750.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Disturbed balance between matrix metalloproteinases (MMPs) and their respective tissue inhibitors (TIMPs) is a well-recognized pathophysiological component of pulmonary arterial hypertension (PAH). Both classes of proteinases have been associated with clinical outcomes as well as with specific pathological features of ventricular dysfunction and pulmonary arterial remodeling. The purpose of this study was to evaluate the circulating levels of MMPs and TIMPs in children with PAH undergoing the same-day cardiac magnetic resonance imaging (MRI) and right heart catheterization. Children with PAH (n = 21) underwent a same-day catheterization, comprehensive cardiac MRI evaluation, and blood sample collection for proteomic analysis. Correlative analysis was performed between protein levels and 1) standard PAH indices from catheterization, 2) cardiac MRI hemodynamics, and 3) pulmonary arterial stiffness. MMP-8 was significantly associated with the right ventricular end-diastolic volume (R = 0.45, P = 0.04). MMP-9 levels were significantly associated with stroke volume (R = -0.49, P = 0.03) and pulmonary vascular resistance (R = 0.49, P = 0.03). MMP-9 was further associated with main pulmonary arterial stiffness evaluated by relative area change (R = -0.79, P < 0.01).TIMP-2 and TIMP-4 levels were further associated with the right pulmonary artery pulse wave velocity (R = 0.51, P = 0.03) and backward compression wave (R = 0.52, P = 0.02), respectively. MMPs and TIMPs warrant further clinically prognostic evaluation in conjunction with the conventional cardiac MRI hemodynamic indices.NEW & NOTEWORTHY Metalloproteinases have been associated with clinical outcomes in pulmonary hypertension and with specific pathological features of ventricular dysfunction and pulmonary arterial remodeling. In this study, we demonstrated that plasma circulating levels of metalloproteinases and their inhibitors are associated with standard cardiac MRI hemodynamic indices and with the markers of proximal pulmonary arterial stiffness. Particularly, MMP-9 and TIMP-2 were associated with several different markers of pulmonary arterial stiffness. These findings suggest the interplay between the extracellular matrix (ECM) remodeling and overall hemodynamic status in children with PAH might be assessed using the peripheral circulating MMP and TIMP levels.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - D Dunbar Ivy
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Kathleen Nguyen
- Linda Crnic Institute for Down Syndrome, University of Colorado Denver, Aurora, Colorado.,Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Katie Boncella
- Linda Crnic Institute for Down Syndrome, University of Colorado Denver, Aurora, Colorado.,Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Benjamin S Frank
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Gareth J Morgan
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Kathleen Miller-Reed
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Uyen Truong
- Heart Center, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
| | - Kelley Colvin
- Linda Crnic Institute for Down Syndrome, University of Colorado Denver, Aurora, Colorado.,Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Michael E Yeager
- Linda Crnic Institute for Down Syndrome, University of Colorado Denver, Aurora, Colorado.,Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
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4
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Ollivier C, Sun H, Amchin W, Beghetti M, Berger RMF, Breitenstein S, Garnett C, Gullberg N, Hassel P, Ivy D, Kawut SM, Klein A, Lesage C, Migdal M, Nije B, Odermarsky M, Strait J, de Graeff PA, Stockbridge N. New Strategies for the Conduct of Clinical Trials in Pediatric Pulmonary Arterial Hypertension: Outcome of a Multistakeholder Meeting With Patients, Academia, Industry, and Regulators, Held at the European Medicines Agency on Monday, June 12, 2017. J Am Heart Assoc 2020; 8:e011306. [PMID: 31088189 PMCID: PMC6585335 DOI: 10.1161/jaha.118.011306] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Haihao Sun
- 2 Food and Drug Administration Silver Spring MD
| | | | - Maurice Beghetti
- 3 Pediatric Cardiology Unit Centre Universitaire de Cardiologie et Chirurgie Cardiaque Pédiatrique University Hospitals of Geneva City of Geneva Switzerland
| | - Rolf M F Berger
- 4 Center for Congenital Heart Diseases Department of Pediatric Cardiology Beatrix Children's Hospital University Medical Center Groningen University of Groningen the Netherlands
| | | | | | | | | | - Dunbar Ivy
- 7 Heart Institute Children's Hospital Colorado University of Colorado School of Medicine Aurora CO
| | - Steven M Kawut
- 8 Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | | | | | - Marek Migdal
- 11 Childrens Memorial Health Institute Warsaw Poland
| | | | - Michal Odermarsky
- 12 Department of Paediatric Cardiology Paediatric Heart Center Lund University and Skåne University Hospital Lund Sweden
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5
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Piskin S, Patnaik SS, Han D, Bordones AD, Murali S, Finol EA. A canonical correlation analysis of the relationship between clinical attributes and patient-specific hemodynamic indices in adult pulmonary hypertension. Med Eng Phys 2020; 77:1-9. [PMID: 32007361 DOI: 10.1016/j.medengphy.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/19/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease affecting approximately 10-52 cases per million, with a higher incidence in women, and with a high mortality associated with right ventricle (RV) failure. In this work, we explore the relationship between hemodynamic indices, calculated from in silico models of the pulmonary circulation, and clinical attributes of RV workload and pathological traits. Thirty-four patient-specific pulmonary arterial tree geometries were reconstructed from computed tomography angiography images and used for volume meshing for subsequent computational fluid dynamics (CFD) simulations. Data obtained from the CFD simulations were post-processed resulting in hemodynamic indices representative of the blood flow dynamics. A retrospective review of medical records was performed to collect the clinical variables measured or calculated from standard hospital examinations. Statistical analyses and canonical correlation analysis (CCA) were performed for the clinical variables and hemodynamic indices. Systolic pulmonary artery pressure (sPAP), diastolic pulmonary artery pressure (dPAP), cardiac output (CO), and stroke volume (SV) were moderately correlated with spatially averaged wall shear stress (0.60 ≤ R2 ≤ 0.66; p < 0.05). Similarly, the CCA revealed a linear and strong relationship (ρ = 0.87; p << 0.001) between 5 clinical variables and 2 hemodynamic indices. To this end, in silico models of PH blood flow dynamics have a high potential for predicting the relevant clinical attributes of PH if analyzed in a group-wise manner using CCA.
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Affiliation(s)
- Senol Piskin
- Department of Mechanical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA; Department of Mechanical Engineering, Istinye University, Zeytinburnu, Istanbul 34010, Turkey
| | - Sourav S Patnaik
- Department of Mechanical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
| | - David Han
- Department of Management Science and Statistics, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
| | - Alifer D Bordones
- Department of Biomedical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
| | - Srinivas Murali
- Department of Radiology and Department of Cardiology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, USA.
| | - Ender A Finol
- Department of Mechanical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
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6
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Alkholy UM, Mohamed SA, Elhady M, Attar SE, Abdalmonem N, Zaki A. Vascular endothelial growth factor and pulmonary hypertension in children with beta thalassemia major. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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7
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Alkholy UM, Mohamed SA, Elhady M, Attar SE, Abdalmonem N, Zaki A. Vascular endothelial growth factor and pulmonary hypertension in children with beta thalassemia major. J Pediatr (Rio J) 2019; 95:593-599. [PMID: 29859904 DOI: 10.1016/j.jped.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to illustrate the association between vascular endothelial growth factor level and pulmonary artery hypertension in children with β-thalassemia major. METHOD This case-control study was conducted on 116 children with β-thalassemia major; 58 of them had pulmonary artery hypertension. They were compared to 58 healthy children who were age and sex-matched (control group). Serum levels of vascular endothelial growth factor and echocardiographic assessment were done for all children. RESULTS Vascular endothelial growth factor serum level was significantly higher in children with β-thalassemia major with pulmonary artery hypertension than in those without pulmonary artery hypertension, as well as in control groups (p<0.001). Vascular endothelial growth factor serum level had a significant positive correlation with pulmonary artery pressure and serum ferritin, as well as a significant negative correlation with the duration of chelation therapy. Logistic regression analysis revealed that elevated vascular endothelial growth factor (Odd Ratio=1.5; 95% Confidence Interval, 1.137-2.065; p=0.005) was an independent risk factor of pulmonary artery hypertension in such children. Vascular endothelial growth factor serum level at a cutoff point of >169pg/mL had 93.1% sensitivity and 93.1% specificity for the presence of pulmonary artery hypertension in children with β-thalassemia major. CONCLUSION Elevated vascular endothelial growth factor serum level is associated with pulmonary artery hypertension in children with β-thalassemia.
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Affiliation(s)
- Usama M Alkholy
- Zagazig University, Faculty of Medicine, Department of Pediatrics, Kassala, Egypt.
| | - Soma Abdalla Mohamed
- Al-Azhar University, Faculty of Medicine, Department of Pediatrics (for girls), Cairo, Egypt
| | - Marwa Elhady
- Al-Azhar University, Faculty of Medicine, Department of Pediatrics (for girls), Cairo, Egypt
| | - Shahinaz El Attar
- Al-Azhar University, Faculty of Medicine, Department of Biochemistry (for girls), Cairo, Egypt
| | - Nermin Abdalmonem
- Zagazig University, Faculty of Medicine, Department of Pediatrics, Kassala, Egypt
| | - Ahmed Zaki
- Mansoura University, Faculty of Medicine, Department of Pediatrics, Mansoura, Egypt
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8
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Exploration of potential biochemical markers for persistence of patent ductus arteriosus in preterm infants at 22-27 weeks' gestation. Pediatr Res 2019; 86:333-338. [PMID: 30287890 DOI: 10.1038/s41390-018-0182-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/03/2018] [Accepted: 07/09/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Early identification of infants at risk for complications from patent ductus arteriosus (PDA) may improve treatment outcomes. The aim of this study was to identify biochemical markers associated with persistence of PDA, and with failure of pharmacological treatment for PDA, in extremely preterm infants. METHODS Infants born at 22-27 weeks' gestation were included in this prospective study. Blood samples were collected on the second day of life. Fourteen biochemical markers associated with factors that may affect PDA closure were analyzed and related to persistent PDA and to the response of pharmacological treatment with ibuprofen. RESULTS High levels of B-type natriuretic peptide, interleukin-6, -8, -10, and -12, growth differentiation factor 15 and monocyte chemotactic protein 1 were associated with persistent PDA, as were low levels of platelet-derived growth factor. High levels of erythropoietin were associated with both persistent PDA and failure to close PDA within 24 h of the last dose of ibuprofen. CONCLUSIONS High levels of inflammatory markers were associated with the persistence of PDA. High levels of erythropoietin were associated with both the persistence of PDA and failure to respond to pharmacological treatment.
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9
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Rosenzweig EB, Abman SH, Adatia I, Beghetti M, Bonnet D, Haworth S, Ivy DD, Berger RMF. Paediatric pulmonary arterial hypertension: updates on definition, classification, diagnostics and management. Eur Respir J 2019; 53:1801916. [PMID: 30545978 PMCID: PMC6351335 DOI: 10.1183/13993003.01916-2018] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 12/16/2022]
Abstract
Paediatric pulmonary arterial hypertension (PAH) shares common features of adult disease, but is associated with several additional disorders and challenges that require unique approaches. This article discusses recent advances, ongoing challenges and distinct approaches for the care of children with PAH, as presented by the Paediatric Task Force of the 6th World Symposium on Pulmonary Hypertension. We provide updates of the current definition, epidemiology, classification, diagnostics and treatment of paediatric PAH, and identify critical knowledge gaps. Several features of paediatric PAH including the prominence of neonatal PAH, especially in pre-term infants with developmental lung diseases, and novel genetic causes of paediatric PAH are highlighted. The use of cardiac catheterisation as a diagnostic modality and haemodynamic definitions of PAH, including acute vasoreactivity, are addressed. Updates are provided on issues related to utility of the previous classification system to reflect paediatric-specific aetiologies and approaches to medical and interventional management of PAH, including the Potts shunt. Although a lack of clinical trial data for the use of PAH-targeted therapy persists, emerging data are improving the identification of appropriate targets for goal-oriented therapy in children. Such data will likely improve future clinical trial design to enhance outcomes in paediatric PAH.
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Affiliation(s)
- Erika B Rosenzweig
- Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Steven H Abman
- University of Colorado, Children's Hospital Colorado, Denver, CO, USA
| | - Ian Adatia
- Glenwood Children's Heart Clinic, Edmonton, AB, Canada
| | - Maurice Beghetti
- Pediatric Cardiology Unit and Centre Universitaire de Cardiologie et Chirurgie Cardiaque Pédiatrique, University Hospitals of Geneva and Lausanne, Lausanne, Switzerland
| | - Damien Bonnet
- Hôpital Necker Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | | | - D Dunbar Ivy
- University of Colorado, Children's Hospital Colorado, Denver, CO, USA
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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10
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Trittmann JK, Bartenschlag A, Zmuda EJ, Frick J, Stewart WCL, Nelin LD. Using clinical and genetic data to predict pulmonary hypertension in bronchopulmonary dysplasia. Acta Paediatr 2018; 107:2158-2164. [PMID: 30267614 PMCID: PMC6226353 DOI: 10.1111/apa.14600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/28/2018] [Accepted: 09/25/2018] [Indexed: 02/03/2023]
Abstract
AIM Pulmonary hypertension significantly increases morbidity and mortality in infants with bronchopulmonary dysplasia. The frequency of single nucleotide polymorphisms in arginase-1 (ARG1 rs2781666) and dimethylarginine dimethylaminohydrolase-1 (DDAH1 rs480414) genes has been found to differ in a cohort of bronchopulmonary dysplasia patients with pulmonary hypertension (cases) and without pulmonary hypertension (controls). Therefore, we tested the hypothesis that combining these genotypes with phenotypic data would better predict pulmonary hypertension in bronchopulmonary dysplasia patients. METHODS Bronchopulmonary dysplasia patients (n = 79) born at <35 weeks gestation were studied. Pulmonary hypertension was diagnosed by echocardiographic criteria (n = 20). ROC curves to predict pulmonary hypertension in bronchopulmonary dysplasia were generated from genotype and/or clinical data. RESULTS Cases were born at an earlier gestation and weighed less at birth than did controls. ROC curves for rs2781666 had an AUC of 0.61, while rs480414 had an AUC of 0.66. Together, the AUC was 0.70. When clinical data were added to the genetic model, AUC was 0.73. CONCLUSION These findings demonstrate that ROC predictive modelling of pulmonary hypertension in bronchopulmonary dysplasia improves with inclusion of both genotypic and phenotypic data. Further refinement of these types of models could facilitate the implementation of precision medicine approaches to pulmonary hypertension in bronchopulmonary dysplasia.
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Affiliation(s)
- J K Trittmann
- Pulmonary Hypertension Group, Center for Perinatal Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - A Bartenschlag
- Pulmonary Hypertension Group, Center for Perinatal Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - E J Zmuda
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - J Frick
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - W C L Stewart
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Battelle Center for Mathematical Medicine, Columbus, OH, USA
| | - L D Nelin
- Pulmonary Hypertension Group, Center for Perinatal Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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Sensitive Cardiac Troponins: Could They Be New Biomarkers in Pediatric Pulmonary Hypertension Due to Congenital Heart Disease? Pediatr Cardiol 2018; 39:718-725. [PMID: 29340731 DOI: 10.1007/s00246-018-1811-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/04/2018] [Indexed: 12/24/2022]
Abstract
To analyze the role of sensitive cardiac troponin I (scTnI) and high-sensitive troponin T (hscTnT) in the determination of myocardial injury caused by volume and pressure load due to pulmonary hypertension (PH) and to investigate if these markers may be useful in the management of PH in childhood. Twenty-eight patients with congenital heart disease (CHD) with left to right shunt and PH, 29 patients with CHD with left to right shunt but without PH, and 18 healthy children, in total 75 individuals, were included in the study. All cases were aged between 4 and 36 months. Echocardiographic evaluation was performed in all cases, and invasive hemodynamic investigation was performed in 33 cases. Blood samples were obtained from all cases, for the measurement of brain natriuretic peptide (BNP), pro-brain natriuretic peptide (pro-BNP), sensitive cardiac troponin I (scTnI), and high-sensitive troponin T (hscTnT) levels. The mean BNP, pro-BNP, scTnI, and hsTnT levels were statistically significantly higher in patients with PH than in the patients without PH (p < 0.001). A statistically significant positive correlation was determined between pulmonary artery systolic pressure and scTnI and hscTnT levels (r = 0.34 p = 0.01, r = 0.46 p < 0.001, respectively) levels. Pulmonary hypertension determined in congenital heart diseases triggers myocardial damage independently of increased volume or pressure load and resistance, occurring by disrupting the perfusion via increasing ventricular wall tension and the myocardial oxygen requirement. Serum scTnI and hscTnT levels may be helpful markers to determine the damage associated with PH in childhood.
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12
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Circulating miRNAs in Pediatric Pulmonary Hypertension Show Promise as Biomarkers of Vascular Function. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4957147. [PMID: 28819545 PMCID: PMC5551515 DOI: 10.1155/2017/4957147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/18/2017] [Accepted: 05/04/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to evaluate the utility of circulating miRNAs as biomarkers of vascular function in pediatric pulmonary hypertension. METHOD Fourteen pediatric pulmonary arterial hypertension patients underwent simultaneous right heart catheterization (RHC) and blood biochemical analysis. Univariate and stepwise multivariate linear regression was used to identify and correlate measures of reactive and resistive afterload with circulating miRNA levels. Furthermore, circulating miRNA candidates that classified patients according to a 20% decrease in resistive afterload in response to oxygen (O2) or inhaled nitric oxide (iNO) were identified using receiver-operating curves. RESULTS Thirty-two circulating miRNAs correlated with the pulmonary vascular resistance index (PVRi), pulmonary arterial distensibility, and PVRi decrease in response to O2 and/or iNO. Multivariate models, combining the predictive capability of multiple promising miRNA candidates, revealed a good correlation with resistive (r = 0.97, P2-tailed < 0.0001) and reactive (r = 0.86, P2-tailed < 0.005) afterloads. Bland-Altman plots showed that 95% of the differences between multivariate models and RHC would fall within 0.13 (mmHg-min/L)m2 and 0.0085/mmHg for resistive and reactive afterloads, respectively. Circulating miR-663 proved to be a good classifier for vascular responsiveness to acute O2 and iNO challenges. CONCLUSION This study suggests that circulating miRNAs may be biomarkers to phenotype vascular function in pediatric PAH.
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13
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Idiopathic Pulmonary Arterial Hypertension in Children: A Review. Pulm Ther 2017. [DOI: 10.1007/s41030-017-0035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Goss KN, Everett AD, Mourani PM, Baker CD, Abman SH. Addressing the challenges of phenotyping pediatric pulmonary vascular disease. Pulm Circ 2017; 7:7-19. [PMID: 28680562 PMCID: PMC5448545 DOI: 10.1086/689750] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/14/2016] [Indexed: 12/20/2022] Open
Abstract
Pediatric pulmonary vascular disease (PVD) and pulmonary hypertension (PH) represent phenotypically and pathophysiologically diverse disease categories, contributing substantial morbidity and mortality to a complex array of pediatric conditions. Here, we review the multifactorial nature of pediatric PVD, with an emphasis on improved recognition, phenotyping, and endotyping strategies for pediatric PH. Novel tailored approaches to diagnosis and treatment in pediatric PVD, as well as the implications for long-term outcomes, are highlighted.
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Affiliation(s)
- Kara N Goss
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Allen D Everett
- Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter M Mourani
- Section of Pediatric Critical Care, Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Christopher D Baker
- Pediatric Pulmonary Medicine, Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Steven H Abman
- Pediatric Pulmonary Medicine, Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
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15
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Sun H, Stockbridge N, Ariagno RL, Murphy D, Nelson RM, Rodriguez W. Reliable and developmentally appropriate study end points are needed to achieve drug development for treatment of pediatric pulmonary arterial hypertension. J Perinatol 2016; 36:1029-1033. [PMID: 27416322 PMCID: PMC5585871 DOI: 10.1038/jp.2016.103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/29/2016] [Accepted: 04/11/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify suitable end points and surrogates for pediatric pulmonary arterial hypertension (PAH) as the lack of developmentally appropriate end point and clinical trials contribute to the unmet medical need. STUDY DESIGN Reviewed the efficacy end points and surrogates for all trials (1995 to 2013) that were submitted to the Food and Drug Administration (FDA) to support the approval of PAH therapy and conducted literature search. RESULTS An increase in the 6 min walking distance (6MWD) was used as a primary end point in 8/9 adult PAH trials. This end point is not suitable for infants and young children because of performance limitations and lack of control data. One adult PAH trial used time to the first morbidity or mortality event as a primary end point, which could potentially be used in pediatric PAH trials. In the sildenafil pediatric PAH trial, the change in pulmonary vascular resistance index or mean pulmonary artery pressure was used as a surrogate for the 6MWD to assess exercise capacity. However, two deaths and three severe adverse events during the catheterizations made this an unacceptably high-risk surrogate. The INOmax persistent pulmonary hypertension of the newborn trial used a reduction in initiation of extracorporeal membrane oxygenation treatment as a primary end point, which is not feasible for other pediatric PAH trials. A Literature review revealed none of the existing noninvasive markers are fully validated as surrogates to assess PAH efficacy and long-term safety. CONCLUSIONS For pediatric PAH trials, clinical end points are acceptable, and novel validated surrogates would be helpful. FDA seeks collaboration with academia, industry and parents to develop other suitable and possibly more efficient efficacy end points to facilitate pediatric PAH drug development.
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Affiliation(s)
- H Sun
- Office of Pediatric Therapeutics/Office of Commissioner, Food and Drug Administration, Silver Spring, Maryland, USA
| | - N Stockbridge
- Division of Cardiovascular and Renal Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - RL Ariagno
- Stanford University, Division of Neonatal & Developmental Medicine, Palo Alto, California, USA,Senior Oak Ridge Institute for Science and Education, Silver Spring, Maryland, USA
| | - D Murphy
- Office of Pediatric Therapeutics/Office of Commissioner, Food and Drug Administration, Silver Spring, Maryland, USA
| | - RM Nelson
- Office of Pediatric Therapeutics/Office of Commissioner, Food and Drug Administration, Silver Spring, Maryland, USA
| | - W Rodriguez
- Office of Pediatric Therapeutics/Office of Commissioner, Food and Drug Administration, Silver Spring, Maryland, USA
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16
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Șuteu CC, Muntean I, Blesneac C, Căpîlna B, Benedek T, Togănel R. A Correlative Study of Spirometric Parameters and Markers of Right Ventricular Dysfunction in Pediatric Patients with Pulmonary Arterial Hypertension. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background: Alteration in lung function is present in children with pulmonary arterial hypertension (PAH). We aimed to study the pulmonary function indices obtained by spirometry in pediatric patients with PAH, and to correlate them with B-type natriuretic peptide (BNP) and echocardiographic parameters.
Methods: Thirty-one children with PAH were enrolled in this study, of those 26 patients (83.87%) associated shunt defect and 5 patients (16.12%) were diagnosed with idiopathic PAH. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), forced expiratory flow at 25–75% of the pulmonary volume (FEF 25–75) were evaluated by spirometry and correlated with BNP and echocardiographic parameters that reflect right ventricle function.
Results: Restrictive pattern of pulmonary function was present in 51.6% (n = 16) of all PAH children. There were significant correlations between BNP with FVC (p = 0.001), FEV1 (p = 0.001), and FEV1/FVC (p = 0.001). Serum BNP level was significantly increased in the group of patients without shunt. Of those echocardiographic parameters that reflect right ventricle function, we found that TAPSE significantly correlated with PEFR (r = −0.47, p <0.01), and with FEF 25–75 (r = −0.39, p <0.01).
Conclusions: Deterioration of the pulmonary function indices are correlated with BNP and echocardiographic parameters, markers of RV dysfunction. Being easy and reliable tests, pulmonary functions can be introduced among the follow-up tools in children with PAH.
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Affiliation(s)
- Carmen Corina Șuteu
- Department M4, III rd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Iolanda Muntean
- Department M4, III rd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Cristina Blesneac
- Department M4, III rd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Brîndușa Căpîlna
- Pediatric Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
| | - Theodora Benedek
- Department M3, Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Rodica Togănel
- Department M4, III rd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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17
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Sun H, Stockbridge N, Ariagno RL, Murphy D. The Role of Biomarkers and Surrogate End Points in Drug Development for Neonatal Pulmonary Arterial Hypertension. Neoreviews 2016; 17:e87-e92. [PMID: 28943808 PMCID: PMC5609821 DOI: 10.1542/neo.17-2-e87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease in newborns, infants, and children. It is associated with significant morbidity and mortality, but has limited treatment options. Except for inhaled nitric oxide, which is approved for persistent pulmonary hypertension of the newborn (PPHN), no drug is approved for the treatment of newborns, infants, and children with PAH. The lack of developmentally appropriate pediatric efficacy end points and pediatric clinical trials contribute to this unmet medical need. The noninvasive biomarkers reported in the literature that can be used as potential surrogate end points to assess disease severity and treatment response in neonates, infants, and children with PAH are reviewed herein. In addition, the role of the US Food and Drug Administration in developing potential biomarkers as surrogate end points to facilitate drug development for the treatment of children with PPHN and PAH in children is reviewed herein.
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Affiliation(s)
- Haihao Sun
- Office of Pediatric Therapeutics, US Food and Drug Administration, Silver Spring, MD
| | - Norman Stockbridge
- Division of Cardiologic and Renal Product, US Food and Drug Administration, Silver Spring, MD
| | - Ronald L Ariagno
- Office of Pediatric Therapeutics, US Food and Drug Administration, Silver Spring, MD
- Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA
| | - Dianne Murphy
- Office of Pediatric Therapeutics, US Food and Drug Administration, Silver Spring, MD
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18
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Kheyfets VO, Dunning J, Truong U, Ivy DD, Hunter KA, Shandas R. Assessment of N-terminal prohormone B-type natriuretic peptide as a measure of vascular and ventricular function in pediatric pulmonary arterial hypertension. Pulm Circ 2015; 5:658-66. [PMID: 26697173 DOI: 10.1086/683697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease that puts excessive mechanical loads on the ventricle due to a gradual increase in pulmonary vascular impedance. We hypothesize that the increase in right ventricular (RV) afterload is reflected in the concentration of circulating biochemical markers of ventricular strain and stress (B-type natriuretic peptide [BNP] and N-terminal prohormone BNP [NT-proBNP]). We retrospectively analyzed right heart catheterization (RHC) and serum biochemical analysis data ([Formula: see text]) for a pediatric PAH cohort with no sign of left ventricular dysfunction. Using RHC data, we computed an estimate of pulmonary vascular resistance (PVR), compliance, and ventricular-vascular coupling. We also compared how the early onset of interventricular decoupling (characterized as septal flattening) impacts serum NT-proBNP concentrations. Our data revealed correlated NT-proBNP expression with both the resistive and reactive components of RV afterload, an estimate of ventricular-vascular coupling, and a significant increase in biomarker expression in patients with a flattened interventricular septum. Furthermore, the strong correlation between PVR and NT-proBNP appears to break down under flat septum morphology. Over 80% of resistive RV afterload variance is reflected in serum NT-proBNP concentration in pediatric patients with PAH with no sign of left ventricular dysfunction. Reactive afterload appears to contribute to myocardial NT-proBNP release at advanced stages of PAH. Therefore, in mild-to-moderate PAH, resistive afterload is likely the greatest contributor to RV wall stress. These findings could also be used to estimate invasive RHC measurements from serum biochemical analysis, but more work is needed to improve correlations and overcome the issue of interventricular decoupling.
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Affiliation(s)
- Vitaly O Kheyfets
- Department of Bioengineering, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA ; Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jamie Dunning
- Department of Bioengineering, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA ; Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Uyen Truong
- Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - D Dunbar Ivy
- Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kendall A Hunter
- Department of Bioengineering, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA ; Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Robin Shandas
- Department of Bioengineering, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA ; Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
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19
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Colvin KL, Yeager ME. Proteomics of pulmonary hypertension: could personalized profiles lead to personalized medicine? Proteomics Clin Appl 2015; 9:111-20. [PMID: 25408474 DOI: 10.1002/prca.201400157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/13/2014] [Accepted: 11/13/2014] [Indexed: 12/12/2022]
Abstract
Pulmonary hypertension (PH) is a fatal syndrome that arises from a multifactorial and complex background, is characterized by increased pulmonary vascular resistance and right heart afterload, and often leads to cor pulmonale. Over the past decades, remarkable progress has been made in reducing patient symptoms and delaying the progression of the disease. Unfortunately, PH remains a disease with no cure. The substantial heterogeneity of PH continues to be a major limitation to the development of newer and more efficacious therapies. New advances in our understanding of the biological pathways leading to such a complex pathogenesis will require the identification of the important proteins and protein networks that differ between a healthy lung (or right ventricle) and a remodeled lung in an individual with PH. In this article, we present the case for the increased use of proteomics--the study of proteins and protein networks--as a discovery tool for key proteins and protein networks operational in the PH lung. We review recent applications of proteomics in PH, and summarize the biological pathways identified. Finally, we attempt to presage what the future will bring with regard to proteomics in PH and offer our perspectives on the prospects of developing personalized proteomics and custom-tailored therapies.
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Affiliation(s)
- Kelley L Colvin
- Department of Pediatrics-Critical Care, University of Colorado Denver, Aurora, CO, USA; Cardiovascular Pulmonary Research, University of Colorado Denver, Aurora, CO, USA; Department of Bioengineering, University of Colorado Denver, Aurora, CO, USA; Linda Crnic Institute for Down Syndrome, University of Colorado Denver, Aurora, CO, USA
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20
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Lohani O, Colvin KL, Yeager ME. Biomarkers for pediatric pulmonary arterial hypertension: challenges and recommendations. Paediatr Respir Rev 2015; 16:225-31. [PMID: 26036720 DOI: 10.1016/j.prrv.2015.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
Pediatric pulmonary arterial hypertension (PAH) is an uncommon disease that can occur in neonates, infants, and children, and is associated with high morbidity and mortality. Despite advances in treatment strategies over the last two decades, the underlying structural and functional changes to the pulmonary arterial circulation are progressive and lead eventually to right heart failure. The management of PAH in children is complex due not only to the developmental aspects but also because most evidence-based practices derive from adult PAH studies. As such, the pediatric clinician would be greatly aided by specific characteristics (biomarkers) objectively measured in children with PAH to determine appropriate clinical management. This review highlights the current state of biomarkers in pediatric PAH and looks forward to potential biomarkers, and makes several recommendations for their use and interpretation.
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Affiliation(s)
- Ozus Lohani
- Department of Bioengineering, University of Colorado Denver; Department of Pediatrics-Critical Care
| | - Kelley L Colvin
- Department of Bioengineering, University of Colorado Denver; Department of Pediatrics-Critical Care; Cardiovascular Pulmonary Research, University of Colorado Denver; Linda Crnic Institute for Down Syndrome, Denver, Colorado
| | - Michael E Yeager
- Department of Bioengineering, University of Colorado Denver; Department of Pediatrics-Critical Care; Cardiovascular Pulmonary Research, University of Colorado Denver; Linda Crnic Institute for Down Syndrome, Denver, Colorado.
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21
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Nies MK, Ivy DD, Everett AD. The untapped potential of proteomic analysis in pediatric pulmonary hypertension. Proteomics Clin Appl 2015; 8:862-74. [PMID: 25348110 DOI: 10.1002/prca.201400067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/21/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022]
Abstract
Analysis of the human proteome has become increasingly sophisticated, and offers invaluable potential insight into the pathophysiology of human disease. The increasing standardization of methods, speed, and sophistication of mass spectrometric analysis, availability of reliable antibodies, and dissemination of information among the scientific community has allowed for exponential growth of our knowledge base. The continued effort to provide a molecular explanation for future medical applications based on biomarker discovery is epitomized by the outstanding efforts of the human proteome project, whose goal is to generate a map of the human proteome. However, proteomic analysis is underrepresented in pediatric illness; given the unique challenges of research in the pediatric population, proteomic analysis represents enormous untapped potential, especially in the further elucidation of the pathophysiology of rare diseases such as pulmonary hypertension (PH). In this article, we will describe the unique challenge of pediatric research, the importance of alternative avenues such as proteomics for in-depth analysis of pediatric pathobiology at the cellular level, the specific need for proteomic investigation of pediatric PH, the current status of PH proteomics, and future directions.
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Affiliation(s)
- Melanie K Nies
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
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22
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Beghetti M, Berger RMF. The challenges in paediatric pulmonary arterial hypertension. Eur Respir Rev 2015; 23:498-504. [PMID: 25445948 DOI: 10.1183/09059180.00007714] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, progressive disease affecting both adults and children. While overall survival has improved in recent years, the need for improved therapeutic approaches remains. Treatments for paediatric PAH have not yet been sufficiently examined, particularly regarding potential toxicities and optimal dosing, and there is a lack of appropriate clinical trial end-points and validated treatment goals that might enable a goal-oriented therapeutic approach. Adult randomised controlled trials in PAH are demonstrating a shift towards more long-term designs, focusing on mortality and morbidity end-points rather than changes in 6-min walking distance. However, such trial designs may not be feasible within the paediatric setting due to challenges such as sufficient recruitment and retention of paediatric patients. Consideration should, therefore, be given towards identifying optimal end-points for the paediatric population, allowing sufficient duration to evaluate efficacy and safety of potential treatments. Herein we consider some of the complexities involved in the management of paediatric PAH, specifically presenting diagnostic challenges as well as reflecting on the lack of evidence currently available to support various therapeutic approaches within the paediatric population.
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Affiliation(s)
- Maurice Beghetti
- Paediatric Cardiology Unit, Children's University Hospital Geneva, Geneva, Switzerland. Centre for Congenital Heart Diseases, Dept of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rolf M F Berger
- Paediatric Cardiology Unit, Children's University Hospital Geneva, Geneva, Switzerland. Centre for Congenital Heart Diseases, Dept of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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23
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Farrow KN, Steinhorn RH. Pulmonary hypertension in premature infants. Sharpening the tools of detection. Am J Respir Crit Care Med 2015; 191:12-4. [PMID: 25551345 DOI: 10.1164/rccm.201411-2112ed] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kathryn N Farrow
- 1 Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago, Illinois
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24
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Becker MO, Kill A, Kutsche M, Guenther J, Rose A, Tabeling C, Witzenrath M, Kühl AA, Heidecke H, Ghofrani HA, Tiede H, Schermuly RT, Nickel N, Hoeper MM, Lukitsch I, Gollasch M, Kuebler WM, Bock S, Burmester GR, Dragun D, Riemekasten G. Vascular Receptor Autoantibodies in Pulmonary Arterial Hypertension Associated with Systemic Sclerosis. Am J Respir Crit Care Med 2014; 190:808-17. [DOI: 10.1164/rccm.201403-0442oc] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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25
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Nagiub M, Lee S, Guglani L. Echocardiographic Assessment of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia: Systematic Review of Literature and a Proposed Algorithm for Assessment. Echocardiography 2014; 32:819-33. [DOI: 10.1111/echo.12738] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mohamed Nagiub
- Division of Pediatric Cardiology; Department of Pediatrics; Children Hospital of Richmond; Virginia Commonwealth University; Richmond Virginia
| | - Sam Lee
- Division of Pediatric Cardiology; Department of Pediatrics; Children Hospital of Richmond; Virginia Commonwealth University; Richmond Virginia
| | - Lokesh Guglani
- Division of Pediatric Pulmonary Medicine; The Carman and Ann Adams Department of Pediatrics; Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Michigan
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