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Marsela E, Hirsch E, Slipczuk L, Travin MI, Moadel RM, Jorde UP, Vukelic S. High-Output Heart Failure in Multiple Myeloma: Novel Application of Tc-99m MAA to Identify Intramedullary Shunting. JACC Case Rep 2024; 29:102387. [PMID: 38912004 PMCID: PMC11193010 DOI: 10.1016/j.jaccas.2024.102387] [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: 04/01/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/25/2024]
Abstract
We introduce the innovative use of technetium-99m-labeled macroaggregated albumin to diagnose high-output heart failure in a patient with multiple myeloma with persistent congestion symptoms. Symptom resolution occurred with lenalidomide and steroids. This marks the first clinical use of technetium-99m-labeled macroaggregated albumin for clarifying high-output heart failure etiology.
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Affiliation(s)
- Enklajd Marsela
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eric Hirsch
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Leandro Slipczuk
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mark I. Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Renée M. Moadel
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ulrich P. Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sasa Vukelic
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Ptaszek B, Podsiadło S, Jandziś Z, Teległów A, Piotrowska A, Jurczyszyn A, Czerwińska-Ledwig O. Rheological properties of blood in multiple myeloma patients. Sci Rep 2024; 14:4260. [PMID: 38383860 PMCID: PMC10881564 DOI: 10.1038/s41598-024-54947-4] [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: 09/08/2023] [Accepted: 02/19/2024] [Indexed: 02/23/2024] Open
Abstract
Multiple myeloma (MM) is considered to be one of the hematological malignancies formed by excessive and abnormal proliferation of plasmocytes. Among other parameters, several blood tests are used to diagnose multiple myeloma. The hemorheological profile in multiple myeloma is not widely studied. Hemorheology includes the study of measuring the deformability and aggregation of erythrocytes, blood viscosity, and sedimentation rate. The degree of deformability of blood cells is necessary to maintain proper vital functions. Proper deformability of red blood cells ensures proper blood circulation, tissue oxidation and carbon dioxide uptake. The aim of the study was to compare morphology and blood rheology parameters in patients with MM and healthy individuals. The study included 33 patients with MM, and 33 healthy subjects of the same age. The hematological blood parameters were evaluated using ABX MICROS 60 hematology analyzer. The LORCA Analyzer to study erythrocyte aggregation and deformability. Patients with MM had lower red blood cells count (RBC) (9.11%) (p < 0.001) and half time of total aggregation (T1/2) (94.29%) (p < 0.001) values and higher mean corpuscular volume (MCV) (5.50%) (p < 0.001), aggregation index (AI) (68.60%) (p < 0.001), total extent of aggregation (AMP) (87.92%) (p < 0.001) values than the healthy control group. Aggregation in patients with MM is different compared to healthy individuals. It was observed that the percentage of cell aggregation is almost 50% higher than in the control group. The study of morphology, aggregation and deformability of erythrocytes in patients with suspected MM may be helpful in making clinical decisions.
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Affiliation(s)
- Bartłomiej Ptaszek
- Institute of Applied Sciences, University of Physical Education in Krakow, 31-571, Kraków, Poland.
| | - Szymon Podsiadło
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, 31-571, Kraków, Poland
| | - Zuzanna Jandziś
- Faculty of Motor Rehabilitation, University of Physical Education in Krakow, 31-571, Kraków, Poland
| | - Aneta Teległów
- Institute of Basic Sciences, University of Physical Education in Krakow, 31-571, Kraków, Poland
| | - Anna Piotrowska
- Institute of Basic Sciences, University of Physical Education in Krakow, 31-571, Kraków, Poland
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, 31-501, Kraków, Poland
| | - Olga Czerwińska-Ledwig
- Institute of Basic Sciences, University of Physical Education in Krakow, 31-571, Kraków, Poland
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Ye L, Ding W, Xiao D, Jia Y, Zhao Z, Ao X, Wang J. O-GlcNAcylation: cellular physiology and therapeutic target for human diseases. MedComm (Beijing) 2023; 4:e456. [PMID: 38116061 PMCID: PMC10728774 DOI: 10.1002/mco2.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
O-linked-β-N-acetylglucosamine (O-GlcNAcylation) is a distinctive posttranslational protein modification involving the coordinated action of O-GlcNAc transferase and O-GlcNAcase, primarily targeting serine or threonine residues in various proteins. This modification impacts protein functionality, influencing stability, protein-protein interactions, and localization. Its interaction with other modifications such as phosphorylation and ubiquitination is becoming increasingly evident. Dysregulation of O-GlcNAcylation is associated with numerous human diseases, including diabetes, nervous system degeneration, and cancers. This review extensively explores the regulatory mechanisms of O-GlcNAcylation, its effects on cellular physiology, and its role in the pathogenesis of diseases. It examines the implications of aberrant O-GlcNAcylation in diabetes and tumorigenesis, highlighting novel insights into its potential role in cardiovascular diseases. The review also discusses the interplay of O-GlcNAcylation with other protein modifications and its impact on cell growth and metabolism. By synthesizing current research, this review elucidates the multifaceted roles of O-GlcNAcylation, providing a comprehensive reference for future studies. It underscores the potential of targeting the O-GlcNAcylation cycle in developing novel therapeutic strategies for various pathologies.
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Affiliation(s)
- Lin Ye
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Wei Ding
- The Affiliated Hospital of Qingdao UniversityQingdao Medical CollegeQingdao UniversityQingdaoChina
| | - Dandan Xiao
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Yi Jia
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Zhonghao Zhao
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Xiang Ao
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Jianxun Wang
- School of Basic MedicineQingdao UniversityQingdaoChina
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Alessandrino K, Tjostheim SS, Flynn KM, Cole C, Aschenbroich S. Myocardial plasma cell tumor with intratumoral amyloidosis in a dog. J Vet Cardiol 2023; 50:23-28. [PMID: 37918088 DOI: 10.1016/j.jvc.2023.09.004] [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: 01/14/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023]
Abstract
A 12-year-old mixed breed dog was evaluated for marked hypercalcemia that was identified during assessment for acute polydipsia and polyuria. Physical examination identified a new grade II/VI left apical systolic murmur. A mass involving the left ventricular posterior wall and left atrium was identified by echocardiography, suggesting neoplastic invasion into the myocardium. The patient was euthanized, and post-mortem cardiac evaluation identified an intramyocardial amyloid-producing plasma cell tumor. Multiple myeloma was suspected but could not be confirmed due to the limited post-mortem evaluation. This case is the first report of myocardial amyloidosis in a dog with a myeloma-related disorder (MRD). Dogs with MRD and myocardial involvement may not exhibit clinical signs that localize to the cardiovascular system; therefore, echocardiography should be considered during the staging process.
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Affiliation(s)
- K Alessandrino
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - S S Tjostheim
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA.
| | - K M Flynn
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - C Cole
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - S Aschenbroich
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
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Javaid S, Frasier K, Chaudhary AJ, Del Castillo O. The Burden of Heart Failure and Its Impact on Mortality and Outcomes in Hospitalized Multiple Myeloma Patients: A Nationwide Study. Cureus 2023; 15:e47570. [PMID: 38022174 PMCID: PMC10666562 DOI: 10.7759/cureus.47570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Multiple myeloma is a hematologic malignancy characterized by its association with a range of cardiovascular comorbidities, most notably heart failure. Our study aims to investigate the impact of heart failure on individuals who are hospitalized for multiple myeloma. Methods In this retrospective cohort study, we assembled a cohort of patients diagnosed with multiple myeloma from the National Inpatient Sample (NIS) data from 2019 to 2020. Within this study population, patients were classified according to the presence or absence of heart failure as a secondary diagnosis, with further stratification into distinct groups such as heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). The primary outcome studied was inpatient mortality. Secondary outcomes were length of stay, total hospitalization charges, acute respiratory failure, acute kidney injury, intensive care unit (ICU) admission, and mechanical ventilation. Confounders were adjusted using multivariate regression analysis. Results Among the 38,735 patients admitted with multiple myeloma, 5.6% (2,195 patients) were diagnosed with HFpEF, while 3% (1,170 patients) had HFrEF. The mortality rate was significantly higher in HFpEF patients compared to HFrEF and non-heart failure individuals (aOR: 1.68, [CI: 1.17-2.43]; P = 0.005). Length of hospital stay did not differ between these two groups; however, total hospitalization charges were more significant in the presence of heart failure versus without heart failure (coefficient: 33597; CI: 1730-65463; P = 0.04; and coefficient: 26107; CI: 5414-46800; P = 0.01 for HFrEF and HFpEF, respectively). Similarly, a significant increase in the odds of acute respiratory failure, care at the ICU, and requirement for mechanical ventilation was observed in patients with both types of heart failure compared to those without heart failure. Conclusion HFpEF was associated with high mortality rates and greater incidence of acute kidney injury in multiple myeloma patients compared to those with HFrEF and non-heart failure counterparts. However, both heart failure subtypes were associated with heightened total hospitalization charges and the increased likelihood of encountering acute respiratory failure, admission to the ICU, and the utilization of mechanical ventilation compared to patients without heart failure.
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Affiliation(s)
- Saad Javaid
- Internal Medicine, Wyckoff Heights Medical Center, New York, USA
| | - Kelly Frasier
- Internal Medicine, Nuvance Health, Poughkeepsie, USA
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Paterek A, Oknińska M, Pilch Z, Sosnowska A, Ramji K, Mackiewicz U, Golab J, Nowis D, Mączewski M. Arginase Inhibition Mitigates Bortezomib-Exacerbated Cardiotoxicity in Multiple Myeloma. Cancers (Basel) 2023; 15:cancers15072191. [PMID: 37046852 PMCID: PMC10093116 DOI: 10.3390/cancers15072191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Multiple myeloma (MM) is associated with increased cardiovascular morbidity and mortality, while MM therapies also result in adverse cardiac effects. Endothelial dysfunction and impaired nitric oxide (NO) pathway is their possible mediator. OBJECTIVE Since MM is associated with increased arginase expression, resulting in the consumption of ʟ-arginine, precursor for NO synthesis, our aim was to test if cardiotoxicity mediated by MM and MM therapeutic, bortezomib (a proteasome inhibitor), can be ameliorated by an arginase inhibitor through improved endothelial function. METHODS We used a mouse Vĸ*MYC model of non-light chain MM. Cardiac function was assessed by echocardiography. RESULTS MM resulted in progressive left ventricular (LV) systolic dysfunction, and bortezomib exacerbated this effect, leading to significant impairment of LV performance. An arginase inhibitor, OAT-1746, protected the heart against bortezomib- or MM-induced toxicity but did not completely prevent the effects of the MM+bortezomib combination. MM was associated with improved endothelial function (assessed as NO production) vs. healthy controls, while bortezomib did not affect it. OAT-1746 improved endothelial function only in healthy mice. NO plasma concentration was increased by OAT-1746 but was not affected by MM or bortezomib. CONCLUSIONS Bortezomib exacerbates MM-mediated LV systolic dysfunction in a mouse model of MM, while an arginase inhibitor partially prevents it. Endothelium does not mediate either these adverse or beneficial effects. This suggests that proteasome inhibitors should be used with caution in patients with advanced myeloma, where the summation of cardiotoxicity could be expected. Therapies aimed at the NO pathway, in particular arginase inhibitors, could offer promise in the prevention/treatment of cardiotoxicity in MM.
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Affiliation(s)
- Aleksandra Paterek
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, 99/103 Marymoncka Street, 01-813 Warsaw, Poland
| | - Marta Oknińska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, 99/103 Marymoncka Street, 01-813 Warsaw, Poland
| | - Zofia Pilch
- Department of Immunology, Medical University of Warsaw, 5 Nielubowicza Street, 02-097 Warsaw, Poland
| | - Anna Sosnowska
- Department of Immunology, Medical University of Warsaw, 5 Nielubowicza Street, 02-097 Warsaw, Poland
| | - Kavita Ramji
- Department of Immunology, Medical University of Warsaw, 5 Nielubowicza Street, 02-097 Warsaw, Poland
| | - Urszula Mackiewicz
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, 99/103 Marymoncka Street, 01-813 Warsaw, Poland
| | - Jakub Golab
- Department of Immunology, Medical University of Warsaw, 5 Nielubowicza Street, 02-097 Warsaw, Poland
- Centre of Preclinical Research, Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland
| | - Dominika Nowis
- Department of Immunology, Medical University of Warsaw, 5 Nielubowicza Street, 02-097 Warsaw, Poland
- Laboratory of Experimental Medicine, Medical University of Warsaw, 5 Nielubowicza Street, 02-097 Warsaw, Poland
| | - Michał Mączewski
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, 99/103 Marymoncka Street, 01-813 Warsaw, Poland
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Al‐Kuraishy HM, Al‐Gareeb AI, Mohammed AA, Alexiou A, Papadakis M, Batiha GE. The potential link between Covid-19 and multiple myeloma: A new saga. Immun Inflamm Dis 2022; 10:e701. [PMID: 36444620 PMCID: PMC9673426 DOI: 10.1002/iid3.701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Covid-19 is considered a primary respiratory disease-causing viral pneumonia and, in severe cases, leads to acute lung injury and acute respiratory distress syndrome (ARDS). In addition, though, extra-pulmonary manifestations of Covid-19 have been shown. Furthermore, severe acute respiratory distress syndrome coronavirus type 2 (SARS-CoV-2) infection may coexist with several malignancies, including multiple myeloma (MM). METHODS This critical literature review aimed to find the potential association between SARS-CoV-2 infection and MM in Covid-19 patients with underlying MM. Narrative literature and databases search revealed that ARDS is developed in both MM and Covid-19 due to hypercalcemia and proteasome dysfunction. RESULTS Notably, the expression of angiogenic factors and glutamine deficiency could link Covid-19 severity and MM in the pathogenesis of cardiovascular complications. MM and Covid-19 share thrombosis as a typical complication; unlike thrombosis in Covid-19, which reflects disease severity, thrombosis does not reflect disease severity in MM. In both conditions, thromboprophylaxis is essential to prevent pulmonary thrombosis and other thromboembolic disorders. Moreover, Covid-19 may exacerbate the development of acute kidney injury and neurological complications in MM patients. CONCLUSION These findings highlighted that MM patients might be a risk group for Covid-19 severity due to underlying immunosuppression and most of those patients need specific management in the Covid-19 era.
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Affiliation(s)
- Hayder M. Al‐Kuraishy
- Department of Clinical Pharmacology and Medicine, College of MedicineALmustansiriyia UniversityBaghdadIraq
| | - Ali I. Al‐Gareeb
- Department of Clinical Pharmacology and Medicine, College of MedicineALmustansiriyia UniversityBaghdadIraq
| | - Ali A Mohammed
- The Chest Clinic, Barts Health NHS TrustWhipps Cross University HospitalLondonUK
| | - Athanasios Alexiou
- Department of Science and EngineeringNovel Global Community Educational FoundationHebershamAustralia
- AFNP MedWienAustria
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten‐HerdeckeUniversity of Witten‐HerdeckeWuppertalGermany
| | - Gaber El‐Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary MedicineDamanhour UniversityDamanhourEgypt
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