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Santangelo G, Tumminello G, Barbieri L, Mallardi GPF, Faggiano A, Moscardelli S, Rossi A, Cozza F, Carugo S, Faggiano P. Unraveling the Enigma of Moderate Aortic Stenosis: Challenges and Future Prospects. J Clin Med 2024; 13:3478. [PMID: 38930005 PMCID: PMC11204855 DOI: 10.3390/jcm13123478] [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: 04/26/2024] [Revised: 05/26/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
According to current guidelines, only clinical surveillance is recommended for patients with moderate aortic valve stenosis (AS), while aortic valve replacement may be considered in patients undergoing surgery for other indications. Recent studies have shown that moderate AS is associated with a high risk of adverse cardiovascular events, including death, especially in patients with left ventricular dysfunction. In this context, multimodality imaging can help to improve the accuracy of moderate AS diagnosis and to assess left ventricular remodeling response. This review discusses the natural history of this valve disease and the role of multimodality imaging in the diagnostic process, summarizes current evidence on the medical and non-medical management, and highlights ongoing trials on valve replacement.
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Affiliation(s)
- Gloria Santangelo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.); (G.T.); (L.B.); (G.P.F.M.); (A.F.); (S.C.)
| | - Gabriele Tumminello
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.); (G.T.); (L.B.); (G.P.F.M.); (A.F.); (S.C.)
| | - Lucia Barbieri
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.); (G.T.); (L.B.); (G.P.F.M.); (A.F.); (S.C.)
| | - Giulio Pio Federico Mallardi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.); (G.T.); (L.B.); (G.P.F.M.); (A.F.); (S.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.); (G.T.); (L.B.); (G.P.F.M.); (A.F.); (S.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Silvia Moscardelli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy;
| | | | - Fabiana Cozza
- Cardiothoracic Department Unit, Fondazione Poliambulanza, 25124 Brescia, Italy;
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.); (G.T.); (L.B.); (G.P.F.M.); (A.F.); (S.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Pompilio Faggiano
- Cardiothoracic Department Unit, Fondazione Poliambulanza, 25124 Brescia, Italy;
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Zhang T, O’Connor C, Sheridan H, Barlow JW. Vitamin K2 in Health and Disease: A Clinical Perspective. Foods 2024; 13:1646. [PMID: 38890875 PMCID: PMC11172246 DOI: 10.3390/foods13111646] [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: 04/30/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
Vitamins are essential organic compounds that vary widely in chemical structure and are vital in small quantities for numerous biochemical and biological functions. They are critical for metabolism, growth, development and maintaining overall health. Vitamins are categorised into two groups: hydrophilic and lipophilic. Vitamin K (VK), a lipophilic vitamin, occurs naturally in two primary forms: phylloquinone (VK1), found in green leafy vegetables and algae, and Menaquinones (VK2), present in certain fermented and animal foods and widely formulated in VK supplements. This review explores the possible factors contributing to VK deficiency, including dietary influences, and discusses the pharmacological and therapeutic potential of supplementary VK2, examining recent global clinical studies on its role in treating diseases such as osteoporosis, osteoarthritis, rheumatoid arthritis, cardiovascular disease, chronic kidney disease, diabetes, neurodegenerative disorders and cancers. The analysis includes a review of published articles from multiple databases, including Scopus, PubMed, Google Scholar, ISI Web of Science and CNKI, focusing on human studies. The findings indicate that VK2 is a versatile vitamin essential for human health and that a broadly positive correlation exists between VK2 supplementation and improved health outcomes. However, clinical data are somewhat inconsistent, highlighting the need for further detailed research into VK2's metabolic processes, biomarker validation, dose-response relationships, bioavailability and safety. Establishing a Recommended Daily Intake for VK2 could significantly enhance global health.
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Affiliation(s)
- Tao Zhang
- School of Food Science & Environmental Health, Technological University Dublin, Grangegorman, 7, D07 ADY7 Dublin, Ireland;
- The Trinity Centre for Natural Products Research (NatPro), School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, 2, D02 PN40 Dublin, Ireland;
| | - Christine O’Connor
- School of Food Science & Environmental Health, Technological University Dublin, Grangegorman, 7, D07 ADY7 Dublin, Ireland;
| | - Helen Sheridan
- The Trinity Centre for Natural Products Research (NatPro), School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, 2, D02 PN40 Dublin, Ireland;
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, 2, D02 PN40 Dublin, Ireland
| | - James W. Barlow
- Department of Chemistry, RCSI University of Medicine and Health Sciences, 2, D02 YN77 Dublin, Ireland
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Hariri E, Kassis N, Kapadia SR. Letter by Hariri et al Regarding Article, "Vitamin K2 and D in Patients With Aortic Valve Calcification: A Randomized Double-Blinded Clinical Trial". Circulation 2023; 148:1267-1268. [PMID: 37844149 DOI: 10.1161/circulationaha.123.064607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Essa Hariri
- Department of Internal Medicine (E.H., N.K.), Cleveland Clinic Foundation, OH
| | - Nicholas Kassis
- Department of Internal Medicine (E.H., N.K.), Cleveland Clinic Foundation, OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (S.R.K.), Cleveland Clinic Foundation, OH
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De Azevedo D, Geers J, Gheysens O, Dweck M, Vancraeynest D. 18F-Sodium Fluoride PET/CT in Assessing Valvular Heart and Atherosclerotic Diseases. Semin Nucl Med 2023; 53:241-257. [PMID: 36116988 DOI: 10.1053/j.semnuclmed.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Aortic valve stenosis is the most common valvular disease in Western countries, while atherosclerotic cardiovascular disease is the foremost cause of death and disability worldwide. Valve degeneration and atherosclerosis are mediated by inflammation and calcification and inevitably progress over time. Computed tomography can visualise the later stages of macroscopic calcification but fails to assess the early stages of microcalcification and cannot differentiate active from burnt out disease states. Molecular imaging has the ability to provide complementary information related to disease activity, which may allow us to detect disease early, to predict disease progression and to monitor preventive or therapeutic strategies for in both aortic stenosis and atherosclerosis. PET/CT is a non-invasive imaging technique that enables visualization of ongoing molecular processes within small structures, such as the coronary arteries or heart valves. 18F-sodium fluoride (18F-NaF) binds hydroxyapatite deposits in the extracellular matrix, with preferential binding to newly developing deposits of microcalcification, which provides an assessment of calcification activity. In recent years, 18F-NaF has attracted the attention of many research groups and has been evaluated in several pathological cardiovascular processes. Histologic validation of the 18F-NaF PET signal in valvular disease and atherosclerosis has been reported in multiple independent studies. The selective high-affinity binding of 18F-NaF to microscopic calcified deposits (beyond the resolution of μCT) has been demonstrated ex vivo, as well as its ability to distinguish between areas of macro- and active microcalcification. In addition, prospective clinical studies have shown that baseline 18F-NaF uptake in patients with aortic stenosis and mitral annular calcification is correlated with subsequent calcium deposition and valvular dysfunction after a follow-up period of 2 years. In patients with surgical bioprosthetic aortic valves but without morphological criteria for prosthetic degeneration, increased 18F-NaF uptake at baseline was associated with subsequent bioprosthetic degeneration over time. Similar data were obtained in a cohort of patients with transcatheter aortic valve implantation. Furthermore, several studies have confirmed the association of coronary 18F-NaF uptake with adverse atherosclerotic plaque features, active disease and future disease progression. 18F-NaF uptake is also associated with future fatal or nonfatal myocardial infarction in patients with established coronary artery disease. The link between 18F-NaF uptake and active atherosclerotic disease has not only been demonstrated in the coronary arteries, but also in peripheral arterial disease, abdominal aortic aneurysms and carotid atherosclerosis. It can be assumed that 18F-NaF PET/CT will strengthen the diagnostic toolbox of practitioners in the coming years. Indeed, there is a strong medical need to diagnose degenerative valvular disease and to detect active atherosclerotic disease states. Finally, the use of 18F-NaF as a biomarker to monitor the efficacy of drug therapies in preventing these pathological processes is attractive. In this review, we consider the role of 18F-NaF PET/CT imaging in cardiac valvular diseases and atherosclerosis.
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Affiliation(s)
- David De Azevedo
- Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, Belgium.
| | - Jolien Geers
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Midlothian, Edinburgh, UK; Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Marc Dweck
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - David Vancraeynest
- Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, Belgium
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Tzolos E, Kwiecinski J, Berman D, Slomka P, Newby DE, Dweck MR. Latest Advances in Multimodality Imaging of Aortic Stenosis. J Nucl Med 2022; 63:353-358. [PMID: 34887339 PMCID: PMC8978201 DOI: 10.2967/jnumed.121.262304] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Aortic stenosis is a common condition associated with major morbidity, mortality, and health-care costs. Nevertheless, we currently lack any effective medical therapies that can treat or prevent disease development or progression. Modern advances in echocardiography and CT have helped improve the assessment of aortic stenosis severity and monitoring of disease progression, whereas cardiac MRI informs on myocardial health and the development of fibrosis. In a series of recent studies, 18F-NaF PET/CT has been shown to assess valvular disease activity and progression, providing mechanistic insights that can inform potential novel therapeutic approaches. This review will examine the latest advances in the imaging of aortic stenosis and bioprosthetic valve degeneration and explore how these techniques can assist patient management and potentially accelerate novel therapeutic developments.
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Affiliation(s)
- Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland; and
| | - Daniel Berman
- Division of Nuclear Medicine, Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Piotr Slomka
- Division of Nuclear Medicine, Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom;
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Lassen ML, Tzolos E, Massera D, Cadet S, Bing R, Kwiecinski J, Dey D, Berman DS, Dweck MR, Newby DE, Slomka PJ. Aortic valve imaging using 18F-sodium fluoride: impact of triple motion correction. EJNMMI Phys 2022; 9:4. [PMID: 35092520 PMCID: PMC8800969 DOI: 10.1186/s40658-022-00433-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Current 18F-NaF assessments of aortic valve microcalcification using 18F-NaF PET/CT are based on evaluations of end-diastolic or cardiac motion-corrected (ECG-MC) images, which are affected by both patient and respiratory motion. We aimed to test the impact of employing a triple motion correction technique (3 × MC), including cardiorespiratory and gross patient motion, on quantitative and qualitative measurements. MATERIALS AND METHODS Fourteen patients with aortic stenosis underwent two repeat 30-min PET aortic valve scans within (29 ± 24) days. We considered three different image reconstruction protocols; an end-diastolic reconstruction protocol (standard) utilizing 25% of the acquired data, an ECG-gated (four ECG gates) reconstruction (ECG-MC), and a triple motion-corrected (3 × MC) dataset which corrects for both cardiorespiratory and patient motion. All datasets were compared to aortic valve calcification scores (AVCS), using the Agatston method, obtained from CT scans using correlation plots. We report SUVmax values measured in the aortic valve and maximum target-to-background ratios (TBRmax) values after correcting for blood pool activity. RESULTS Compared to standard and ECG-MC reconstructions, increases in both SUVmax and TBRmax were observed following 3 × MC (SUVmax: Standard = 2.8 ± 0.7, ECG-MC = 2.6 ± 0.6, and 3 × MC = 3.3 ± 0.9; TBRmax: Standard = 2.7 ± 0.7, ECG-MC = 2.5 ± 0.6, and 3 × MC = 3.3 ± 1.2, all p values ≤ 0.05). 3 × MC had improved correlations (R2 value) to the AVCS when compared to the standard methods (SUVmax: Standard = 0.10, ECG-MC = 0.10, and 3 × MC = 0.20; TBRmax: Standard = 0.20, ECG-MC = 0.28, and 3 × MC = 0.46). CONCLUSION 3 × MC improves the correlation between the AVCS and SUVmax and TBRmax and should be considered in PET studies of aortic valves using 18F-NaF.
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Affiliation(s)
- Martin Lyngby Lassen
- Department of Medicine (Division of Artificial Intelligence in Medicine), Cedars-Sinai Medical Center, 8700 Beverly Blvd Ste. Metro 203, Los Angeles, CA, 90048, USA
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Evangelos Tzolos
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd Ste. Metro 203, Los Angeles, CA, 90048, USA
- British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, UK
| | - Daniele Massera
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Sebastien Cadet
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, UK
| | - Jacek Kwiecinski
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd Ste. Metro 203, Los Angeles, CA, 90048, USA
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Damini Dey
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, UK
| | - Piotr J Slomka
- Department of Medicine (Division of Artificial Intelligence in Medicine), Cedars-Sinai Medical Center, 8700 Beverly Blvd Ste. Metro 203, Los Angeles, CA, 90048, USA.
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Evaluating Medical Therapy for Calcific Aortic Stenosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:2354-2376. [PMID: 34857095 DOI: 10.1016/j.jacc.2021.09.1367] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Despite numerous promising therapeutic targets, there are no proven medical treatments for calcific aortic stenosis (AS). Multiple stakeholders need to come together and several scientific, operational, and trial design challenges must be addressed to capitalize on the recent and emerging mechanistic insights into this prevalent heart valve disease. This review briefly discusses the pathobiology and most promising pharmacologic targets, screening, diagnosis and progression of AS, identification of subgroups that should be targeted in clinical trials, and the need to elicit the patient voice earlier rather than later in clinical trial design and implementation. Potential trial end points and tools for assessment and approaches to implementation and design of clinical trials are reviewed. The efficiencies and advantages offered by a clinical trial network and platform trial approach are highlighted. The objective is to provide practical guidance that will facilitate a series of trials to identify effective medical therapies for AS resulting in expansion of therapeutic options to complement mechanical solutions for late-stage disease.
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Mazur P, Kopytek M, Ząbczyk M, Undas A, Natorska J. Towards Personalized Therapy of Aortic Stenosis. J Pers Med 2021; 11:1292. [PMID: 34945764 PMCID: PMC8708539 DOI: 10.3390/jpm11121292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022] Open
Abstract
Calcific aortic stenosis (CAS) is the most common cause of acquired valvular heart disease in adults with no available pharmacological treatment to inhibit the disease progression to date. This review provides an up-to-date overview of current knowledge of molecular mechanisms underlying CAS pathobiology and the related treatment pathways. Particular attention is paid to current randomized trials investigating medical treatment of CAS, including strategies based on lipid-lowering and antihypertensive therapies, phosphate and calcium metabolism, and novel therapeutic targets such as valvular oxidative stress, coagulation proteins, matrix metalloproteinases, and accumulation of advanced glycation end products.
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Affiliation(s)
- Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55902, USA;
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
| | - Magdalena Kopytek
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
- Center for Research and Medical Technologies, John Paul II Hospital, 31-202 Kraków, Poland
| | - Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
- Center for Research and Medical Technologies, John Paul II Hospital, 31-202 Kraków, Poland
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
- Center for Research and Medical Technologies, John Paul II Hospital, 31-202 Kraków, Poland
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
- Center for Research and Medical Technologies, John Paul II Hospital, 31-202 Kraków, Poland
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9
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Andrews JPM, MacNaught G, Moss AJ, Doris MK, Pawade T, Adamson PD, van Beek EJR, Lucatelli C, Lassen ML, Robson PM, Fayad ZA, Kwiecinski J, Slomka PJ, Berman DS, Newby DE, Dweck MR. Cardiovascular 18F-fluoride positron emission tomography-magnetic resonance imaging: A comparison study. J Nucl Cardiol 2021; 28:1-12. [PMID: 31792913 PMCID: PMC8616877 DOI: 10.1007/s12350-019-01962-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND 18F-Fluoride uptake denotes calcification activity in aortic stenosis and atherosclerosis. While PET/MR has several advantages over PET/CT, attenuation correction of PET/MR data is challenging, limiting cardiovascular application. We compared PET/MR and PET/CT assessments of 18F-fluoride uptake in the aortic valve and coronary arteries. METHODS AND RESULTS 18 patients with aortic stenosis or recent myocardial infarction underwent 18F-fluoride PET/CT followed immediately by PET/MR. Valve and coronary 18F-fluoride uptake were evaluated independently. Both standard (Dixon) and novel radial GRE) MR attenuation correction (AC) maps were validated against PET/CT with results expressed as tissue-to-background ratios (TBRs). Visually, aortic valve 18F-fluoride uptake was similar on PET/CT and PET/MR. TBRMAX values were comparable with radial GRE AC (PET/CT 1.55±0.33 vs. PET/MR 1.58 ± 0.34, P = 0.66; 95% limits of agreement - 27% to + 25%) but performed less well with Dixon AC (1.38 ± 0.44, P = 0.06; bias (-)14%; 95% limits of agreement - 25% to + 53%). In native coronaries, 18F-fluoride uptake was similar on PET/MR to PET/CT regardless of AC approach. PET/MR identified 28/29 plaques identified on PET/CT; however, stents caused artifact on PET/MR making assessment of 18F-fluoride uptake challenging. CONCLUSION Cardiovascular PET/MR demonstrates good visual and quantitative agreement with PET/CT. However, PET/MR is hampered by stent-related artifacts currently limiting clinical application.
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Affiliation(s)
- Jack P M Andrews
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK.
| | - Gillian MacNaught
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alastair J Moss
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Mhairi K Doris
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Tania Pawade
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Philip D Adamson
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Christophe Lucatelli
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Zahi A Fayad
- Icahn School of Medicine at Mount Sinai, New York, PA, USA
| | - Jacek Kwiecinski
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | | | | | - David E Newby
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Marc R Dweck
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
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Maresz K. Growing Evidence of a Proven Mechanism Shows Vitamin K2 Can Impact Health Conditions Beyond Bone and Cardiovascular. Integr Med (Encinitas) 2021; 20:34-38. [PMID: 34602875 PMCID: PMC8483258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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11
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Donato M, Faggin E, Cinetto F, Felice C, Lupo MG, Ferri N, Rattazzi M. The Emerging Role of Nutraceuticals in Cardiovascular Calcification: Evidence from Preclinical and Clinical Studies. Nutrients 2021; 13:nu13082603. [PMID: 34444763 PMCID: PMC8401694 DOI: 10.3390/nu13082603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023] Open
Abstract
Cardiovascular calcification is the ectopic deposition of calcium-phosphate crystals within the arterial wall and the aortic valve leaflets. This pathological process leads to increased vascular stiffness, reduced arterial elasticity, and aortic valve stenosis, increasing the risk of cardiovascular diseases. Although cardiovascular calcification is an increasing health care burden, to date no medical therapies have been approved for treating or preventing it. Considering the current lack of therapeutic strategies and the increasing prevalence of cardiovascular calcification, the investigation of some nutraceuticals to prevent this pathological condition has become prevalent in recent years. Recent preclinical and clinical studies evaluated the potential anti-calcific role of nutraceuticals (including magnesium, zinc, iron, vitamin K, and phytate) in the progression of vascular calcification, providing evidence for their dietary supplementation, especially in high-risk populations. The present review summarizes the current knowledge and latest advances for nutraceuticals with the most relevant preclinical and clinical data, including magnesium, zinc, iron, vitamin K, and phytate. Their supplementation might be recommended as a cost-effective strategy to avoid nutritional deficiency and to prevent or treat cardiovascular calcification. However, the optimal dose of nutraceuticals has not been identified and large interventional trials are warranted to support their protective effects on cardiovascular disease.
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Affiliation(s)
- Maristella Donato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padua, Italy; (M.D.); (M.G.L.); (N.F.)
| | - Elisabetta Faggin
- Department of Medicine—DIMED, University of Padova, 35122 Padua, Italy; (E.F.); (F.C.); (C.F.)
| | - Francesco Cinetto
- Department of Medicine—DIMED, University of Padova, 35122 Padua, Italy; (E.F.); (F.C.); (C.F.)
- Medicina Generale I^, Ca’ Foncello Hospital, 31100 Treviso, Italy
| | - Carla Felice
- Department of Medicine—DIMED, University of Padova, 35122 Padua, Italy; (E.F.); (F.C.); (C.F.)
- Medicina Generale I^, Ca’ Foncello Hospital, 31100 Treviso, Italy
| | - Maria Giovanna Lupo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padua, Italy; (M.D.); (M.G.L.); (N.F.)
| | - Nicola Ferri
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padua, Italy; (M.D.); (M.G.L.); (N.F.)
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, 35122 Padua, Italy; (E.F.); (F.C.); (C.F.)
- Medicina Generale I^, Ca’ Foncello Hospital, 31100 Treviso, Italy
- Correspondence: ; Tel.: +39-04-9821-1867 or +39-04-2232-2207
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12
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Agstam S, Agarwal T, Gupta A, Bansal S. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in aortic stenosis - Is this the light at the end of the tunnel for patients with aortic stenosis? Indian Heart J 2021; 73:249-252. [PMID: 33865531 PMCID: PMC8065365 DOI: 10.1016/j.ihj.2021.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/01/2021] [Accepted: 01/14/2021] [Indexed: 11/01/2022] Open
Abstract
The exploratory analysis of FOURIER trial has offered a ray of hope for patients with nonrheumatic aortic stenosis (AS). At present, the only definitive treatment of severe AS is aortic valve replacement (AVR). Despite transaortic valvular replacement revolutionizing the treatment of AS, it still remains a progressive condition, with no disease-modifying pharmacotherapy. Angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, eplerenone, nitrates and statins all have been tried previously but failed to slow down the progression of aortic stenosis. Recently, there has been an emerging role of lipoprotein A [Lp(a)] in the pathogenesis of AS. This raises the possibility that long-term therapy with specific emphasis on Lp(a) reduction may reduce or slow the progression of AS.
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13
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Donato M, Ferri N, Lupo MG, Faggin E, Rattazzi M. Current Evidence and Future Perspectives on Pharmacological Treatment of Calcific Aortic Valve Stenosis. Int J Mol Sci 2020; 21:ijms21218263. [PMID: 33158204 PMCID: PMC7663524 DOI: 10.3390/ijms21218263] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Calcific aortic valve stenosis (CAVS), the most common heart valve disease, is characterized by the slow progressive fibro-calcific remodeling of the valve leaflets, leading to progressive obstruction to the blood flow. CAVS is an increasing health care burden and the development of an effective medical treatment is a major medical need. To date, no effective pharmacological therapies have proven to halt or delay its progression to the severe symptomatic stage and aortic valve replacement represents the only available option to improve clinical outcomes and to increase survival. In the present report, the current knowledge and latest advances in the medical management of patients with CAVS are summarized, placing emphasis on lipid-lowering agents, vasoactive drugs, and anti-calcific treatments. In addition, novel potential therapeutic targets recently identified and currently under investigation are reported.
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Affiliation(s)
- Maristella Donato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padova, Italy; (M.D.); (N.F.); (M.G.L.)
| | - Nicola Ferri
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padova, Italy; (M.D.); (N.F.); (M.G.L.)
| | - Maria Giovanna Lupo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padova, Italy; (M.D.); (N.F.); (M.G.L.)
| | - Elisabetta Faggin
- Department of Medicine—DIMED, University of Padova, 35122 Padova, Italy;
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, 35122 Padova, Italy;
- Correspondence: ; Tel.: +39-0498-211-867 or +39-0422-322-207
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14
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Tzolos E, Andrews JPM, Dweck MR. Aortic valve stenosis-multimodality assessment with PET/CT and PET/MRI. Br J Radiol 2020; 93:20190688. [PMID: 31647323 PMCID: PMC7465843 DOI: 10.1259/bjr.20190688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aortic valve disease is the most common form of heart valve disease in developed countries and a growing healthcare burden with an ageing population. Transthoracic and transoesophageal echocardiography remains central to the diagnosis and surveillance of patients with aortic stenosis, providing gold standard assessments of valve haemodynamics and myocardial performance. However, other multimodality imaging techniques are being explored for the assessment of aortic stenosis, including combined PET/CT and PET/MR. Both approaches provide unique information with respect to disease activity in the valve alongside more conventional anatomic assessments of the valve and myocardium in this condition. This review investigates the emerging use of PET/CT and PET/MR to assess patients with aortic stenosis, examining how the complementary data provided by each modality may be used for research applications and potentially in future clinical practice.
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Affiliation(s)
- Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jack PM Andrews
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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15
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Fletcher AJ, Singh T, Syed MBJ, Dweck MR. Imaging aortic valve calcification: significance, approach and implications. Clin Radiol 2020; 76:15-26. [PMID: 32446601 DOI: 10.1016/j.crad.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
Aortic stenosis is the most prevalent valvular heart disease worldwide, and rates are increasing with the growing and more elderly population. Although the precise mechanisms that underpin aortic valve stenosis are incompletely understood, pathological valvular calcification has emerged as a key instigator in mediating the biomechanical stiffening that can lead to symptoms, the need for aortic valve replacement, and death if left untreated. Here, we review the currently understood processes leading to aortic valve calcification, summarise the contemporary imaging assessments of valve calcification, and highlight how these might improve patient care and accelerate our pathological understanding and the development of an effective medical therapy.
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Affiliation(s)
- A J Fletcher
- University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, Royal Infirmary of Edinburgh, UK
| | - T Singh
- University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, Royal Infirmary of Edinburgh, UK
| | - M B J Syed
- University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, Royal Infirmary of Edinburgh, UK
| | - M R Dweck
- University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, Royal Infirmary of Edinburgh, UK.
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16
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Zheng KH, Tzolos E, Dweck MR. Pathophysiology of Aortic Stenosis and Future Perspectives for Medical Therapy. Cardiol Clin 2020; 38:1-12. [DOI: 10.1016/j.ccl.2019.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Rogers MA, Aikawa E. Cardiovascular calcification: artificial intelligence and big data accelerate mechanistic discovery. Nat Rev Cardiol 2020; 16:261-274. [PMID: 30531869 DOI: 10.1038/s41569-018-0123-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cardiovascular calcification is a health disorder with increasing prevalence and high morbidity and mortality. The only available therapeutic options for calcific vascular and valvular heart disease are invasive transcatheter procedures or surgeries that do not fully address the wide spectrum of these conditions; therefore, an urgent need exists for medical options. Cardiovascular calcification is an active process, which provides a potential opportunity for effective therapeutic targeting. Numerous biological processes are involved in calcific disease, including matrix remodelling, transcriptional regulation, mitochondrial dysfunction, oxidative stress, calcium and phosphate signalling, endoplasmic reticulum stress, lipid and mineral metabolism, autophagy, inflammation, apoptosis, loss of mineralization inhibition, impaired mineral resorption, cellular senescence and extracellular vesicles that act as precursors of microcalcification. Advances in molecular imaging and big data technology, including in multiomics and network medicine, and the integration of these approaches are helping to provide a more comprehensive map of human disease. In this Review, we discuss ectopic calcification processes in the cardiovascular system, with an emphasis on emerging mechanistic knowledge obtained through patient data and advances in imaging methods, experimental models and multiomics-generated big data. We also highlight the potential and challenges of artificial intelligence, machine learning and deep learning to integrate imaging and mechanistic data for drug discovery.
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Affiliation(s)
- Maximillian A Rogers
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Center for Excellence in Vascular Biology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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18
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Jaminon A, Reesink K, Kroon A, Schurgers L. The Role of Vascular Smooth Muscle Cells in Arterial Remodeling: Focus on Calcification-Related Processes. Int J Mol Sci 2019; 20:E5694. [PMID: 31739395 PMCID: PMC6888164 DOI: 10.3390/ijms20225694] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 12/22/2022] Open
Abstract
Arterial remodeling refers to the structural and functional changes of the vessel wall that occur in response to disease, injury, or aging. Vascular smooth muscle cells (VSMC) play a pivotal role in regulating the remodeling processes of the vessel wall. Phenotypic switching of VSMC involves oxidative stress-induced extracellular vesicle release, driving calcification processes. The VSMC phenotype is relevant to plaque initiation, development and stability, whereas, in the media, the VSMC phenotype is important in maintaining tissue elasticity, wall stress homeostasis and vessel stiffness. Clinically, assessment of arterial remodeling is a challenge; particularly distinguishing intimal and medial involvement, and their contributions to vessel wall remodeling. The limitations pertain to imaging resolution and sensitivity, so methodological development is focused on improving those. Moreover, the integration of data across the microscopic (i.e., cell-tissue) and macroscopic (i.e., vessel-system) scale for correct interpretation is innately challenging, because of the multiple biophysical and biochemical factors involved. In the present review, we describe the arterial remodeling processes that govern arterial stiffening, atherosclerosis and calcification, with a particular focus on VSMC phenotypic switching. Additionally, we review clinically applicable methodologies to assess arterial remodeling and the latest developments in these, seeking to unravel the ubiquitous corroborator of vascular pathology that calcification appears to be.
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Affiliation(s)
- Armand Jaminon
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Koen Reesink
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Abraham Kroon
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands;
| | - Leon Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
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19
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Roumeliotis S, Dounousi E, Eleftheriadis T, Liakopoulos V. Association of the Inactive Circulating Matrix Gla Protein with Vitamin K Intake, Calcification, Mortality, and Cardiovascular Disease: A Review. Int J Mol Sci 2019; 20:E628. [PMID: 30717170 PMCID: PMC6387246 DOI: 10.3390/ijms20030628] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/07/2023] Open
Abstract
Matrix Gla Protein (MGP), a small Gla vitamin K-dependent protein, is the most powerful natural occurring inhibitor of calcification in the human body. To become biologically active, MGP must undergo vitamin K-dependent carboxylation and phosphorylation. Vitamin K deficiency leads to the inactive uncarboxylated, dephosphorylated form of MGP (dpucMGP). We aimed to review the existing data on the association between circulating dpucMGP and vascular calcification, renal function, mortality, and cardiovascular disease in distinct populations. Moreover, the association between vitamin K supplementation and serum levels of dpucMGP was also reviewed.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
| | - Evangelia Dounousi
- Department of Nephrology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
| | - Theodoros Eleftheriadis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
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20
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Doris MK, Everett RJ, Shun-Shin M, Clavel MA, Dweck MR. The Role of Imaging in Measuring Disease Progression and Assessing Novel Therapies in Aortic Stenosis. JACC Cardiovasc Imaging 2019; 12:185-197. [PMID: 30621990 PMCID: PMC6323414 DOI: 10.1016/j.jcmg.2018.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/10/2018] [Accepted: 10/18/2018] [Indexed: 01/20/2023]
Abstract
Aortic stenosis represents a growing health care burden in high-income countries. Currently, the only definitive treatment is surgical or transcatheter valve intervention at the end stages of disease. As the understanding of the underlying pathophysiology evolves, many promising therapies are being investigated. These seek to both slow disease progression in the valve and delay the transition from hypertrophy to heart failure in the myocardium, with the ultimate aim of avoiding the need for valve replacement in the elderly patients afflicted by this condition. Noninvasive imaging has played a pivotal role in enhancing our understanding of the complex pathophysiology underlying aortic stenosis, as well as disease progression in both the valve and myocardium. In this review, the authors discuss the means by which contemporary imaging may be used to assess disease progression and how these approaches may be utilized, both in clinical practice and research trials exploring the clinical efficacy of novel therapies.
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Affiliation(s)
- Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Russell J Everett
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Matthew Shun-Shin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Marie-Annick Clavel
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
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21
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Eersels K, Diliën H, Lowdon JW, Steen Redeker E, Rogosic R, Heidt B, Peeters M, Cornelis P, Lux P, Reutelingsperger CP, Schurgers LJ, Cleij TJ, van Grinsven B. A Novel Biomimetic Tool for Assessing Vitamin K Status Based on Molecularly Imprinted Polymers. Nutrients 2018; 10:E751. [PMID: 29891757 PMCID: PMC6024727 DOI: 10.3390/nu10060751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/24/2018] [Accepted: 06/08/2018] [Indexed: 11/18/2022] Open
Abstract
Vitamin K was originally discovered as a cofactor required to activate clotting factors and has recently been shown to play a key role in the regulation of soft tissue calcification. This property of vitamin K has led to an increased interest in novel methods for accurate vitamin K detection. Molecularly Imprinted Polymers (MIPs) could offer a solution, as they have been used as synthetic receptors in a large variety of biomimetic sensors for the detection of similar molecules over the past few decades, because of their robust nature and remarkable selectivity. In this article, the authors introduce a novel imprinting approach to create a MIP that is able to selectively rebind vitamin K₁. As the native structure of the vitamin does not allow for imprinting, an alternative imprinting strategy was developed, using the synthetic compound menadione (vitamin K₃) as a template. Target rebinding was analyzed by means of UV-visible (UV-VIS) spectroscopy and two custom-made thermal readout techniques. This analysis reveals that the MIP-based sensor reacts to an increasing concentration of both menadione and vitamin K₁. The Limit of Detection (LoD) for both compounds was established at 700 nM for the Heat Transfer Method (HTM), while the optimized readout approach, Thermal Wave Transport Analysis (TWTA), displayed an increased sensitivity with a LoD of 200 nM. The sensor seems to react to a lesser extent to Vitamin E, the analogue under study. To further demonstrate its potential application in biochemical research, the sensor was used to measure the absorption of vitamin K in blood serum after taking vitamin K supplements. By employing a gradual enrichment strategy, the sensor was able to detect the difference between baseline and peak absorption samples and was able to quantify the vitamin K concentration in good agreement with a validation experiment using High-Performance Liquid Chromatography (HPLC). In this way, the authors provide a first proof of principle for a low-cost, straightforward, and label-free vitamin K sensor.
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Affiliation(s)
- Kasper Eersels
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Hanne Diliën
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Joseph W Lowdon
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Erik Steen Redeker
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Renato Rogosic
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Benjamin Heidt
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Marloes Peeters
- Division of Chemistry and Environmental Science, School of Science and the Environment, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK.
| | - Peter Cornelis
- Soft-Matter Physics and Biophysics Section, Department of Physics and Astronomy, KU Leuven, Celestijnenlaan 200 D, B-3001 Leuven, Belgium.
| | - Petra Lux
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands.
| | - Chris P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands.
| | - Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands.
| | - Thomas J Cleij
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Bart van Grinsven
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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