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Griffin MT, Werner TJ, Alavi A, Revheim ME. The value of FDG-PET/CT imaging in the assessment, monitoring, and management of COVID-19. EUROPEAN PHYSICAL JOURNAL PLUS 2023; 138:283. [PMID: 37008755 PMCID: PMC10040919 DOI: 10.1140/epjp/s13360-023-03797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/11/2023] [Indexed: 06/19/2023]
Abstract
The pathogenesis of Coronavirus Disease 2019 (COVID-19) involves cytokine-driven recruitment and accumulation of inflammatory cells at sites of infection. These activated neutrophils, monocytes, and effector T cells are highly glycolytic and thus appear as [18]F-labeled fluorodeoxyglucose (FDG) avid sites on positron emission tomography (PET) imaging. FDG-PET-computed tomography (FDG-PET/CT) is a highly sensitive modality for the detection, monitoring, and assessing response related to COVID-19 disease activity that holds significant clinical relevance. To date, concerns over cost, access, and undue radiation exposure have limited the use of FDG-PET/CT in COVID-19 to a small number of individuals where PET-based interventions were already indicated. In this review, we summarize the existing literature on the use of FDG-PET in the detection and monitoring of COVID-19 with particular focus on several areas of clinical relevance that warrant future research: (1) incidental early detection of subclinical COVID-19 in patients who have undergone FDG-PET for other underlying diseases, (2) standardized quantitative assessment of COVID-19 disease burden at specific points in time, and (3) analysis of FDG-PET/CT data leading to better characterization of COVID-19 pathogenesis. Employing FDG-PET/CT for these purposes may allow for the earliest detection of COVID-19-associated venous thromboembolism (VTE), standardized monitoring of disease progression and response to treatment, and better characterization of the acute and chronic complications of this disease.
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Affiliation(s)
- Matthew T. Griffin
- Drexel University College of Medicine, Philadelphia, PA USA
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | - Thomas J. Werner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Postbox 4950, 0424 Nydalen, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Postbox 1078, 0316 Blindern, Oslo, Norway
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway
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Atzeni F, Maiani S, Corda M, Rodríguez-Carrio J. Diagnosis and management of cardiovascular risk in rheumatoid arthritis: main challenges and research agenda. Expert Rev Clin Immunol 2023; 19:279-292. [PMID: 36651086 DOI: 10.1080/1744666x.2023.2170351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) exhibit a cardiovascular (CV) risk that is 1.5-2.0 times higher compared to the general population. This CV risk excess is likely caused by the involvement of chronic inflammation and immune dysregulation. Therefore, conventional algorithms and imaging techniques fail to fully account for this risk excess and provide a suboptimal risk stratification, hence limiting clinical management in this setting. AREAS COVERED Compelling evidence has suggested a role for adaptations of conventional algorithms (Framingham, SCORE, AHA, etc) or the development of RA-specific algorithms, as well as the use of a number of several, noninvasive imaging techniques to improve CV risk assessment in RA populations. Similarly, in-depth analyses of atherosclerosis pathogenesis in RA patients have shed new light into a plethora of soluble biomarkers (such as inflammatory cytokines, vascular remodeling mediators or autoantibodies) that may provide incremental value for CV risk stratification. EXPERT OPINION Extensive research has demonstrated a lack of performance of chart adaptations in capturing real CV risk in RA population, as well as for RA-specific algorithms. Similarly, limitations have been detected in the use of soluble mediators. The development of a novel, RA-specific algorithm including classical and non-traditional risk factors may be advisable.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Silvia Maiani
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Marco Corda
- S.C. Cardiologia UTIC, ARNAS, G.Brotzu, Cagliari, Italy
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo, Spain.,Area of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Li L, Ge Y, Wan X, Wu K, Liu D. Positron emission tomographic studies of the association between atherogenesis and aortitis among psoriatic patients. Arch Med Sci 2023; 19:16-24. [PMID: 36817680 PMCID: PMC9897097 DOI: 10.5114/aoms.2020.94983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/16/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is increased interest in the use of positron emission tomography (PET) in psoriatic patients. We used PET induced with tracer fluorine-18 (18F) fluorodeoxyglucose (FDG) to study the association between the process of early-atherogenesis (eAg) and aortitis by quantifying enhanced aortic vascular inflammation along with calculation of total coronary plaque load (TCPL) and non-calcified atherosclerotic plaque load (NcAPL). In order to study the utility of aortitis in capturing eAg, we also assessed luminal stenosis atherosclerosis (LSA) and high-risk coronary plaques (HrCP). MATERIAL AND METHODS The study was conducted at our hospital between 1 April 2014 and 31 December 2017, and the analysis was done in July 2018. We recruited 180 consecutive psoriatic patients and subjected them to 18F-FDG PET. However, in order to characterise eAg, 160 out of 180 patients were also subjected to coronary angiographic computed tomographic studies (CACTS). RESULTS Among 180 psoriatic patients (76 women, 42%) (mean [SD] age, 51.1 [13.2] years), greater prevalence values of LSA (odd ratio [OR], 3.71; 95% confidence interval [CI], 1.84-7.89; p = 0.001) and HrCP (OR, 3.11; 95% CI: 1.54-6.51; p = 0.003) along with enhanced TCPL (standardised β = 0.44; p < 0.001) were observed in patients with enhanced aortitis. However, the association between aortitis and HrCP was controlled by low-attenuation plaque (LAP), while the same between aortitis and TCPL was controlled by NcAPL (β = 0.45; p < 0.001). CONCLUSIONS Association between aortitis and broad coronary angiographic indices was achieved and hence predicted the possibility of a surrogate role of aortitis in eAg.
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Affiliation(s)
- Lin Li
- Department of Radiology, Liaocheng People’s Hospital, Liaocheng City, Shandong Province, China
| | - Yinglin Ge
- Department of Radiology, The Second People’s Hospital of Liaocheng, Shandong Province, China
| | - Xianghui Wan
- Department of Radiology, Liaocheng People’s Hospital, Liaocheng City, Shandong Province, China
| | - Kunpeng Wu
- Department of Radiology, Liaocheng People’s Hospital, Liaocheng City, Shandong Province, China
| | - Daliang Liu
- Department of Radiology, Liaocheng People’s Hospital, Liaocheng City, Shandong Province, China
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Krajina I, Stupin A, Šola M, Mihalj M. Oxidative Stress Induced by High Salt Diet—Possible Implications for Development and Clinical Manifestation of Cutaneous Inflammation and Endothelial Dysfunction in Psoriasis vulgaris. Antioxidants (Basel) 2022; 11:antiox11071269. [PMID: 35883760 PMCID: PMC9311978 DOI: 10.3390/antiox11071269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
Although oxidative stress is recognized as an important effector mechanism of the immune system, uncontrolled formation of reactive oxygen and nitrogen species promotes excessive tissue damage and leads to disease development. In view of this, increased dietary salt intake has been found to damage redox systems in the vessel wall, resulting in endothelial dysfunction associated with NO uncoupling, inflammation, vascular wall remodeling and, eventually, atherosclerosis. Several studies have reported increased systemic oxidative stress accompanied by reduced antioxidant capacity following a high salt diet. In addition, vigorous ionic effects on the immune mechanisms, such as (trans)differentiation of T lymphocytes are emerging, which together with the evidence of NaCl accumulation in certain tissues warrants a re-examination of the data derived from in vitro research, in which the ionic influence was excluded. Psoriasis vulgaris (PV), as a primarily Th17-driven inflammatory skin disease with proven inflammation-induced accumulation of sodium chloride in the skin, merits our interest in the role of oxidative stress in the pathogenesis of PV, as well as in the possible beneficial effects that could be achieved through modulation of dietary salt intake and antioxidant supplementation.
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Affiliation(s)
- Ivana Krajina
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Ana Stupin
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia;
- Institute and Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Marija Šola
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Correspondence: (M.Š.); (M.M.); Tel.: +385-31-512-800 (M.M.)
| | - Martina Mihalj
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia;
- Institute and Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Correspondence: (M.Š.); (M.M.); Tel.: +385-31-512-800 (M.M.)
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Parel PM, Berg AR, Hong CG, Florida EM, O'Hagan R, Sorokin AV, Mehta NN. Updates in the Impact of Chronic Systemic Inflammation on Vascular Inflammation by Positron Emission Tomography (PET). Curr Cardiol Rep 2022; 24:317-326. [PMID: 35171444 DOI: 10.1007/s11886-022-01651-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this review, we focus on the clinical and epidemiological studies pertaining to systemic and vascular inflammation by positron emission tomography (PET) in patients with chronic inflammatory conditions such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), human immunodeficiency virus (HIV), and psoriasis to highlight the importance of chronic systemic inflammation on vascular inflammation by PET in these disease states. RECENT FINDINGS Recent clinical and translation advancements have demonstrated the durable relationship between chronic systemic inflammation and cardiovascular disease (CVD). In chronic inflammatory states, this relationship is robustly evident in the form of increased vascular inflammation, yet traditional risk estimates often underestimate the subclinical cardiovascular risk conferred by chronic inflammation. PET has emerged as a novel, non-invasive imaging modality capable of both quantifying the degree of systemic and vascular inflammation and detecting residual inflammation prior to cardiovascular events. We begin by demonstrating the role of inflammation in the pathogenesis of atherosclerosis, discussing how PET has been utilized to measure systemic and vascular inflammation and their effect on subclinical atherosclerosis, and finally reviewing recent applications of PET in constructing improved risk stratification for patients at high risk for stroke and CVD.
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Affiliation(s)
- Philip M Parel
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Alexander R Berg
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Christin G Hong
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Elizabeth M Florida
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Ross O'Hagan
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Alexander V Sorokin
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Nehal N Mehta
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA.
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Kondakov A, Lelyuk V. Clinical Molecular Imaging for Atherosclerotic Plaque. J Imaging 2021; 7:jimaging7100211. [PMID: 34677297 PMCID: PMC8538040 DOI: 10.3390/jimaging7100211] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Atherosclerosis is a well-known disease leading to cardiovascular events, including myocardial infarction and ischemic stroke. These conditions lead to a high mortality rate, which explains the interest in their prevention, early detection, and treatment. Molecular imaging is able to shed light on the basic pathophysiological processes, such as inflammation, that cause the progression and instability of plaque. The most common radiotracers used in clinical practice can detect increased energy metabolism (FDG), macrophage number (somatostatin receptor imaging), the intensity of cell proliferation in the area (labeled choline), and microcalcifications (fluoride imaging). These radiopharmaceuticals, especially FDG and labeled sodium fluoride, can predict cardiovascular events. The limitations of molecular imaging in atherosclerosis include low uptake of highly specific tracers, possible overlap with other diseases of the vessel wall, and specific features of certain tracers’ physiological distribution. A common protocol for patient preparation, data acquisition, and quantification is needed in the area of atherosclerosis imaging research.
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18Fluorodeoxyglucose uptake in relation to fat fraction and R2* in atherosclerotic plaques, using PET/MRI: a pilot study. Sci Rep 2021; 11:14217. [PMID: 34244569 PMCID: PMC8270927 DOI: 10.1038/s41598-021-93605-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/24/2021] [Indexed: 12/20/2022] Open
Abstract
Inflammation inside Atherosclerotic plaques represents a major pathophysiological process driving plaques towards rupture. Pre-clinical studies suggest a relationship between lipid rich necrotic core, intraplaque hemorrhage and inflammation, not previously explored in patients. Therefore, we designed a pilot study to investigate the feasibility of assessing the relationship between these plaque features in a quantitative manner using PET/MRI. In 12 patients with high-grade carotid stenosis the extent of lipid rich necrotic core and intraplaque hemorrhage was quantified from fat and R2* maps acquired with a previously validated 4-point Dixon MRI sequence in a stand-alone MRI. PET/MRI was used to measure 18F-FDG uptake. T1-weighted images from both scanners were used for registration of the quantitative Dixon data with the PET images. The plaques were heterogenous with respect to their volumes and composition. The mean values for the group were as follows: fat fraction (FF) 0.17% (± 0.07), R2* 47.6 s−1 (± 10.9) and target-to-blood pool ratio (TBR) 1.49 (± 0.48). At group level the correlation between TBR and FFmean was − 0.406, p 0.19 and for TBR and R2*mean 0.259, p 0.42. The lack of correlation persisted when analysed on a patient-by-patient basis but the study was not powered to draw definitive conclusions. We show the feasibility of analysing the quantitative relationship between lipid rich necrotic cores, intraplaque haemorrhage and plaque inflammation. The 18F-FDG uptake for most patients was low. This may reflect the biological complexity of the plaques and technical aspects inherent to 18F-FDG measurements. Trial registration: ISRCTN, ISRCTN30673005. Registered 05 January 2021, retrospectively registered.
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Atzeni F, Rodríguez-Carrio J, Popa CD, Nurmohamed MT, Szűcs G, Szekanecz Z. Cardiovascular effects of approved drugs for rheumatoid arthritis. Nat Rev Rheumatol 2021; 17:270-290. [PMID: 33833437 DOI: 10.1038/s41584-021-00593-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
The risk of cardiovascular disease is increased in patients with rheumatoid arthritis compared with the general population owing to the influence of traditional and non-traditional risk factors. Inflammation has a pivotal contribution and can accelerate the atherosclerotic process. Although dampening inflammation with DMARDs should theoretically abrogate this process, evidence suggests that these drugs can also promote atherosclerosis directly and indirectly, hence adding to an increased cardiovascular burden. However, the extent and direction of the effects largely differ across drugs. Understanding how these drugs influence endothelial damage and vascular repair mechanisms is key to understanding these outcomes. NSAIDs and glucocorticoids can increase the cardiovascular risk. Conversely, conventional, biologic and targeted DMARDs control inflammation and reduce this risk, although some of these drugs can also aggravate traditional factors or thrombotic events. Given these data, the fundamental objective for clinicians should be disease control, in an individualized approach that considers the most appropriate drug for each patient, taking into account joint and cardiovascular outcomes. This Review provides a comprehensive analysis of the effects of DMARDs and other approved drugs on cardiovascular involvement in rheumatoid arthritis, from a clinical and mechanistic perspective, with a roadmap to inform the research agenda.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy.
| | - Javier Rodríguez-Carrio
- Department of Functional Biology, Immunology Area, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Călin D Popa
- Department of Rheumatology, Sint Maartenskliniek Nijmegen, Nijmegen, The Netherlands
| | - Michael T Nurmohamed
- Deptartment of Rheumatology, Amsterdam University Medical Center & Reade, Amsterdam, The Netherlands
| | - Gabriella Szűcs
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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The critical role of FDG-PET/CT imaging in assessing systemic manifestations of COVID-19 infection. Eur J Nucl Med Mol Imaging 2021; 48:956-962. [PMID: 33416953 PMCID: PMC7791152 DOI: 10.1007/s00259-020-05148-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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10
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Gelfand JM, Shin DB, Duffin KC, Armstrong AW, Blauvelt A, Tyring SK, Menter A, Gottlieb S, Lockshin BN, Simpson EL, Kianifard F, Sarkar RP, Muscianisi E, Steadman J, Ahlman MA, Playford MP, Joshi AA, Dey AK, Werner TJ, Alavi A, Mehta NN. A Randomized Placebo-Controlled Trial of Secukinumab on Aortic Vascular Inflammation in Moderate-to-Severe Plaque Psoriasis (VIP-S). J Invest Dermatol 2020; 140:1784-1793.e2. [PMID: 32088207 PMCID: PMC7434644 DOI: 10.1016/j.jid.2020.01.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
Psoriasis, a chronic immune-mediated disease, is associated with an increased risk of cardiovascular events and mortality. Secukinumab selectively neutralizes IL-17A and has reported high efficacy with a favorable safety profile in various psoriatic disease manifestations. Subsequent to the 12-week randomized, placebo-controlled, double-blind treatment period, patients with moderate-to-severe psoriasis received secukinumab for 40 weeks. Vascular inflammation using 18F-2-fluorodeoxyglucose-positron emission tomography/computed tomography imaging and blood-based cardiometabolic was assessed at week 0, 12, and 52. The difference in change in aortic inflammation from baseline to week 12 for secukinumab (n = 46) versus placebo (n = 45) was -0.053 (95% confidence interval = -0.169 to 0.064; P= 0.37). Small increases in total cholesterol, low-density lipoprotein, and low-density lipoprotein particles, but no changes in markers of inflammation, adiposity, insulin resistance, or predictors of diabetes, were observed with secukinumab treatment compared with placebo. At week 52, reductions in TNF-α (P= 0.0063) and ferritin (P= 0.0354), and an increase in fetuin-A (P= 0.0024), were observed with secukinumab treatment compared with baseline. No significant changes in aortic inflammation or markers of advanced lipoprotein characterization, adiposity, or insulin resistance were observed with secukinumab treatment compared with baseline. Secukinumab exhibited a neutral impact on aortic vascular inflammation and biomarkers of cardiometabolic disease after 52 weeks of treatment.
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Affiliation(s)
- Joel M Gelfand
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniel B Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - April W Armstrong
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | | | - Stephen K Tyring
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alan Menter
- Division of Dermatology, Baylor Scott &White, Dallas, Texas, USA
| | - Scott Gottlieb
- Dermatology and Skin Surgery Center, Exton, Pennsylvania, USA
| | | | - Eric L Simpson
- OSHU Dermatology Clinic, South Waterfront, Portland, Oregon, USA
| | - Farid Kianifard
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Elisa Muscianisi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Mark A Ahlman
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas J Werner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abass Alavi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Szentpetery A, Haroon M, FitzGerald O. Cardiovascular Comorbidities in Psoriatic Disease. Rheumatol Ther 2020; 7:5-17. [PMID: 31813119 PMCID: PMC7021890 DOI: 10.1007/s40744-019-00185-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 02/06/2023] Open
Abstract
Psoriatic disease (PsD) is a multisystem inflammatory disorder with a high prevalence of cardiovascular (CV) risk factors contributing to accelerated atherosclerosis and its sequelae. Imaging studies, notably with ultrasound, computed tomography, and positron emission tomography (PET) scanning have confirmed significant atherosclerotic change with plaque formation and vessel stenosis. Atherosclerosis is likely driven by a combination of traditional risk factors which occur more frequently in PsD and by systemic inflammation with associated pro-inflammatory cytokine production. While the mechanisms driving atherosclerosis in PsD are incompletely understood, it is now best practice to try to minimize the impact of CV risk factors by regular assessment, prevention, and treatment and also by ensuring that inflammatory musculoskeletal and cutaneous disease is adequately suppressed. Future studies need to focus on improving our understanding of the mechanisms driving atherosclerosis and, as a consequence, developing more rationale approaches to prevention and treatment.
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Affiliation(s)
- Agnes Szentpetery
- Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden
| | - Muhammad Haroon
- Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland.
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18F-FDG uptake velocity but not uptake level is associated with progression of carotid plaque. Eur Radiol 2020; 30:2403-2411. [PMID: 31900697 DOI: 10.1007/s00330-019-06535-8] [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: 08/06/2019] [Revised: 10/05/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate whether baseline 18F-fluorodeoxyglucose (FDG) uptake is associated with carotid plaque progression. METHODS A total of 156 subjects with carotid plaque were enrolled and underwent carotid magnetic resonance imaging (MRI) (at baseline and the 12-month follow-up) and positron emission tomography-computed tomography (PET-CT) (baseline). Carotid plaque progression was evaluated by two indices (the incidence of plaque progression and percentage of plaque increase) with three-dimensional (3D) imaging, while the 18F-FDG uptake was evaluated by the 18F-FDG uptake levels and 18F-FDG uptake velocity. The association between plaque progression and 18F-FDG uptake was investigated by the trend test and multivariate logistic regression analysis. RESULTS Of the 156 subjects, 80 (51.3%) showed carotid plaque progression during the 12-month follow-up. Firstly, no association was found between 18F-FDG uptake levels and plaque progression. Secondly, significant differences in the incidence of plaque progression were observed among the groups with different uptake velocities, showing a significant decreasing trend ranging from high to intermediate to low (p = 0.002, trend test). After adjusting for covariates, an adequate prediction of the 18F-FDG uptake velocity for the incidence of plaque progression was revealed (OR = 0.682, p < 0.05). In addition, no association was found between the 18F-FDG uptake velocity and the percentage of plaque increase in the subjects with plaque progression (p = 0.757, trend test). CONCLUSIONS Our findings suggest 18F-FDG uptake velocity is independently associated with the incidence of carotid plaque progression. Additionally, the 18F-FDG uptake velocity, as another important parameter of PET-CT, warrants further study in future clinical research. KEY POINTS • The18F-FDG uptake levels were not associated with the carotid plaque progression. • The18F-FDG uptake velocity could predict the incidence of carotid plaque progression. • The18F-FDG uptake velocity with related factors warrants more attention in future clinical research.
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Kubota K, Ogawa M, Ji B, Watabe T, Zhang MR, Suzuki H, Sawada M, Nishi K, Kudo T. Basic Science of PET Imaging for Inflammatory Diseases. PET/CT FOR INFLAMMATORY DISEASES 2020. [PMCID: PMC7418531 DOI: 10.1007/978-981-15-0810-3_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
FDG-PET/CT has recently emerged as a useful tool for the evaluation of inflammatory diseases too, in addition to that of malignant diseases. The imaging is based on active glucose utilization by inflammatory tissue. Autoradiography studies have demonstrated high FDG uptake in macrophages, granulocytes, fibroblasts, and granulation tissue. Especially, activated macrophages are responsible for the elevated FDG uptake in some types of inflammation. According to one study, after activation by lipopolysaccharide of cultured macrophages, the [14C]2DG uptake by the cells doubled, reaching the level seen in glioblastoma cells. In activated macrophages, increase in the expression of total GLUT1 and redistributions from the intracellular compartments toward the cell surface have been reported. In one rheumatoid arthritis model, following stimulation by hypoxia or TNF-α, the highest elevation of the [3H]FDG uptake was observed in the fibroblasts, followed by that in macrophages and neutrophils. As the fundamental mechanism of elevated glucose uptake in both cancer cells and inflammatory cells, activation of glucose metabolism as an adaptive response to a hypoxic environment has been reported, with transcription factor HIF-1α playing a key role. Inflammatory cells and cancer cells seem to share the same molecular mechanism of elevated glucose metabolism, lending support to the notion of usefulness of FDGPET/CT for the evaluation of inflammatory diseases, besides cancer.
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Gelfand JM, Shin DB, Alavi A, Torigian DA, Werner T, Papadopoulos M, Takeshita J, Noe MH, Dey AK, Playford MP, Mehta NN. A Phase IV, Randomized, Double-Blind, Placebo-Controlled Crossover Study of the Effects of Ustekinumab on Vascular Inflammation in Psoriasis (the VIP-U Trial). J Invest Dermatol 2020; 140:85-93.e2. [PMID: 31326395 PMCID: PMC6926160 DOI: 10.1016/j.jid.2019.07.679] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023]
Abstract
Psoriasis is a T helper type 17 autoimmune disease associated with an increased risk cardiovascular events and mortality. Ustekinumab, an antibody to p40, blocks cytokines IL-12 and IL-23, and is a highly effective and safe treatment for psoriasis. We conducted a randomized double-blinded placebo-controlled trial to determine the effect of ustekinumab on aortic vascular inflammation (AVI) measured by imaging, and key biomarkers of inflammation, lipid, and glucose metabolism in the blood of patients with moderate-to-severe psoriasis. A total of 43 patients were randomized, and at week 12, ustekinumab-treated patients had a -18.65% (95% confidence interval = -29.45% to -7.85%) reduction in AVI, a reduction in inflammatory biomarkers, and an increase in apolipoprotein B lipoproteins compared with placebo. At week 12, placebo patients were crossed over such that all patients received ustekinumab for 52 weeks. At the end of 52 weeks of ustekinumab treatment, there was no change in AVI compared with baseline, inflammatory markers were reduced, and there were increases in selected measures of lipids and leptin. These results show that blockade of IL-12 and/or IL-23 may transiently reduce AVI, with more durable reduction in inflammatory cytokines associated with cardiovascular disease.
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Affiliation(s)
- Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abass Alavi
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Drew A Torigian
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tom Werner
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryte Papadopoulos
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Megan H Noe
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
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Choi H, Uceda DE, Dey AK, Mehta NN. Application of Non-invasive Imaging in Inflammatory Disease Conditions to Evaluate Subclinical Coronary Artery Disease. Curr Rheumatol Rep 2019; 22:1. [PMID: 31832865 DOI: 10.1007/s11926-019-0875-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Traditional risk models, such as the Framingham risk score, fail to capture the increased cardiovascular disease risk seen in patients with chronic inflammatory diseases. This review will cover imaging modalities and their emerging applications in assessing subclinical cardiovascular disease for both research and clinical care in patients with chronic inflammatory diseases. RECENT FINDINGS Multiple imaging modalities have been studied to assess for subclinical cardiovascular disease via functional/physiologic, inflammatory, and anatomic assessment in patients with chronic inflammatory diseases. The use of imaging to evaluate subclinical cardiovascular disease in patients with chronic inflammatory diseases has the potential to capture early sub-clinical atherosclerosis, to improve risk stratification of future cardiovascular events, and to guide effective disease management.
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Affiliation(s)
- Harry Choi
- National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Domingo E Uceda
- National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Amit K Dey
- National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Nehal N Mehta
- National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
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16
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Groenendyk JW, Shukla P, Dey AK, Elnabawi YA, Aksentijevich M, Choi H, Genovese LD, Harrington CL, Natarajan B, Goyal A, Reddy AS, Rodante J, Kabbany MT, Sadek A, Al Najafi M, Playford MP, Joshi AA, Ahlman MA, Gelfand JM, Bluemke DA, Mehta NN. Association of aortic vascular uptake of 18FDG by PET/CT and aortic wall thickness by MRI in psoriasis: a prospective observational study. Eur J Nucl Med Mol Imaging 2019; 46:2488-2495. [PMID: 31385013 DOI: 10.1007/s00259-019-04454-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/18/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The contribution of inflammation to the incidence of cardiovascular disease (CVD) has been increasingly recognized in recent years. We investigated the relationship of aortic vascular uptake of 18F-FDG by PET/CT and aortic wall thickness (AWT) by MRI in psoriasis, a chronic inflammatory disease with increased incidence of CVD. One hundred sixty-five patients with plaque psoriasis participated in an ongoing longitudinal cohort study. Subclinical atherosclerosis was assessed as aortic uptake of 18F-FDG by PET/CT reported as target-to-background ratio (TBR) and AWT by MRI reported as maximal thickness. RESULTS Patients with psoriasis were middle aged, predominantly male, and had mild CV risk by traditional risk factors. Psoriasis severity as measured by PASI score was a notable determinant of AWT (ρ = 0.20, p = 0.01). Moreover, aortic vascular uptake of 18F-FDG associated with AWT by MRI at baseline in unadjusted analysis (β = 0.27 p = 0.001) and following adjustment for traditional cardiovascular risk factors, waist-to-hip ratio, and statin use (β = 0.21 p = 0.01). Finally, following 1 year of psoriasis treatment, a decrease in aortic vascular uptake of 18F-FDG was associated with a reduction in AWT in fully adjusted models (β = 0.33, p = 0.02). CONCLUSION In conclusion, we demonstrate that psoriasis severity and aortic vascular uptake of 18F-FDG in the aorta were associated with AWT. Following treatment of psoriasis, a decrease in aortic vascular uptake of 18F-FDG was associated with a reduction in AWT at 1 year. These findings suggest that aortic vascular uptake of 18F-FDG is associated with early evidence of vascular disease assessed by aortic wall thickness. Prospective studies in larger populations including other inflammatory diseases are warranted.
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Affiliation(s)
- Jacob W Groenendyk
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Parag Shukla
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Youssef A Elnabawi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Milena Aksentijevich
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Harry Choi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Leonard D Genovese
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Charlotte L Harrington
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Balaji Natarajan
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Aditya Goyal
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Aarthi S Reddy
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Justin Rodante
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Mohammad Tarek Kabbany
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Ahmed Sadek
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Mina Al Najafi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Aditya A Joshi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Mark A Ahlman
- National Institutes of Health Clinical Center, 10 Center Drive, Clinical Research Center, Bethesda, MD, 20892, USA
| | - Joel M Gelfand
- University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA.
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Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions. Nat Rev Rheumatol 2019; 15:461-474. [PMID: 31292564 DOI: 10.1038/s41584-019-0256-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
Cardiometabolic comorbidities present a considerable burden for patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA). Both RA and PsA are associated with an increased risk of cardiovascular disease (CVD). PsA more often exhibits an increased risk of metabolically linked comorbidities such as obesity, insulin resistance, type 2 diabetes mellitus and non-alcoholic fatty liver disease. Although both RA and PsA are characterized by a state of chronic inflammation, the mechanisms that contribute to CVD risk in these conditions might not be identical. In RA, systemic inflammation is thought to directly contribute to CVD risk, whereas in PsA, adiposity is thought to contribute to a notable metabolic phenotype that, in turn, contributes to CVD risk. Hence, appropriate management strategies that consider the increased risk of cardiometabolic comorbidities in patients with inflammatory arthropathy are important. In RA, such strategies should focus on the prediction of CVD risk and its management through targeting chronic inflammation and traditional CVD risk factors. In PsA, management strategies should additionally focus on targeting metabolic components, including weight management, which might not only help improve disease activity in the joints, entheses and skin, but also reduce the risk of metabolic comorbidities and improve the quality of life of patients.
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Yang EJ, Smith MP, Ly K, Bhutani T. Evaluating guselkumab: an anti-IL-23 antibody for the treatment of plaque psoriasis. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:1993-2000. [PMID: 31354244 PMCID: PMC6587972 DOI: 10.2147/dddt.s137588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The approval of guselkumab marks the entry of the IL-23 inhibitor class into the therapeutic armamentarium for patients with moderate-to-severe plaque psoriasis. This class specifically targets the upstream portion of the type 17 helper T (Th17) axis, which has been implicated as a key driver of the abnormal inflammatory state observed in psoriasis. Guselkumab is highly efficacious, with over 85% of the patients achieving ≥75% reduction in Psoriasis Area and Severity Index from baseline (PASI 75) and over 70% of the patients achieving PASI 90 response in its Phase III clinical trials. Additionally, this medication is well-tolerated, with non-serious infections such as nasopharyngitis and upper respiratory infections (URIs) being the most common adverse events (AEs) reported in its clinical trials. Guselkumab offers yet another effective treatment option in the rapidly growing list of available biological therapies for moderate-to-severe plaque psoriasis.
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Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA; .,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA;
| | - Mary Patricia Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA; .,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA; .,School of Medicine, Wayne State University, Detroit, MI, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA;
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Alavi A, Werner TJ, Høilund-Carlsen PF. What can be and what cannot be accomplished with PET to detect and characterize atherosclerotic plaques. J Nucl Cardiol 2018; 25:2012-2015. [PMID: 28695405 DOI: 10.1007/s12350-017-0977-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Moghbel M, Al-Zaghal A, Werner TJ, Constantinescu CM, Høilund-Carlsen PF, Alavi A. The Role of PET in Evaluating Atherosclerosis: A Critical Review. Semin Nucl Med 2018; 48:488-497. [DOI: 10.1053/j.semnuclmed.2018.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Three days of high-dose glucocorticoid treatment attenuates large-vessel 18F-FDG uptake in large-vessel giant cell arteritis but with a limited impact on diagnostic accuracy. Eur J Nucl Med Mol Imaging 2018; 45:1119-1128. [DOI: 10.1007/s00259-018-4021-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
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22
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Enteropathy in Psoriasis: A Systematic Review of Gastrointestinal Disease Epidemiology and Subclinical Inflammatory and Functional Gut Alterations. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0213-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Teague HL, Ahlman MA, Alavi A, Wagner DD, Lichtman AH, Nahrendorf M, Swirski FK, Nestle F, Gelfand JM, Kaplan MJ, Grinspoon S, Ridker PM, Newby DE, Tawakol A, Fayad ZA, Mehta NN. Unraveling Vascular Inflammation: From Immunology to Imaging. J Am Coll Cardiol 2017; 70:1403-1412. [PMID: 28882238 DOI: 10.1016/j.jacc.2017.07.750] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/17/2022]
Abstract
Inflammation is a critical factor in early atherosclerosis and its progression to myocardial infarction. The search for valid surrogate markers of arterial vascular inflammation led to the increasing use of positron emission tomography/computed tomography. Indeed, vascular inflammation is associated with future risk for myocardial infarction and can be modulated with short-term therapies, such as statins, that mitigate cardiovascular risk. However, to better understand vascular inflammation and its mechanisms, a panel was recently convened of world experts in immunology, human translational research, and positron emission tomographic vascular imaging. This contemporary review first strives to understand the diverse roles of immune cells implicated in atherogenesis. Next, the authors describe human chronic inflammatory disease models that can help elucidate the pathophysiology of vascular inflammation. Finally, the authors review positron emission tomography-based imaging techniques to characterize the vessel wall in vivo.
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Affiliation(s)
- Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark A Ahlman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Abass Alavi
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Andrew H Lichtman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Steven Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul M Ridker
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ahmed Tawakol
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zahi A Fayad
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nehal N Mehta
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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Abstract
PURPOSE OF REVIEW Patients with psoriasis and psoriatic arthritis, collectively termed psoriatic disease (PsD), are at an increased risk of developing cardiovascular diseases (CVD). The purpose if this manuscript is to review recent evidence about the epidemiology and underlying mechanisms of CVD in psoriatic patients and approaches to improve the management of these comorbidities. RECENT FINDINGS Studies have shown that CVD risk is independent of traditional cardiovascular risk factors and is related to the systemic inflammatory nature of PsD. The use of surrogate markers, such as imaging of subclinical atherosclerosis, allows detection of patients at high cardiovascular risk before the occurrence of clinical events. These modalities could be clinically useful as clinical cardiovascular risk algorithms, such as the Framingham Risk Score, and have been shown to underestimate the actual cardiovascular risk in patients with PsD. Additional challenges related to the management of CVD in psoriatic patients include the underdiagnosis and undertreatment of traditional cardiovascular risk factors in rheumatology, dermatology and primary care setting. Effective measures used to control PsD, such as tumour necrosis factor inhibitors and methotrexate, has been associated with reduced cardiovascular risk in psoriatic patients. These findings highlight the importance of controlling disease activity as potential target that could lead to reduced cardiovascular risk. Together this highlights the importance of optimization of cardiovascular risk stratification and management of cardiovascular risk factors in patients with PsD.
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Affiliation(s)
- Curtis Sobchak
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
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25
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Egeberg A, Skov L, Joshi AA, Mallbris L, Gislason GH, Wu JJ, Rodante J, Lerman JB, Ahlman MA, Gelfand JM, Mehta NN. The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events. J Am Acad Dermatol 2017; 77:650-656.e3. [PMID: 28826925 DOI: 10.1016/j.jaad.2017.06.028] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/02/2017] [Accepted: 06/12/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Psoriasis is associated with risk of cardiovascular (CV) disease (CVD) and a major adverse CV event (MACE). Whether psoriasis duration affects risk of vascular inflammation and MACEs has not been well characterized. OBJECTIVES We utilized two resources to understand the effect of psoriasis duration on vascular disease and CV events: (1) a human imaging study and (2) a population-based study of CVD events. METHODS First, patients with psoriasis (N = 190) underwent fludeoxyglucose F 18 positron emission tomography/computed tomography (duration effect reported as a β-coefficient). Second, MACE risk was examined by using nationwide registries (adjusted hazard ratios in patients with psoriasis (n = 87,161) versus the general population (n = 4,234,793). RESULTS In the human imaging study, patients were young, of low CV risk by traditional risk scores, and had a high prevalence of cardiometabolic diseases. Vascular inflammation by fludeoxyglucose F 18 positron emission tomography/computed tomography was significantly associated with disease duration (β = 0.171, P = .002). In the population-based study, psoriasis duration had strong relationship with MACE risk (1.0% per additional year of psoriasis duration [hazard ratio, 1.010; 95% confidence interval, 1.007-1.013]). LIMITATIONS These studies utilized observational data. CONCLUSION We found detrimental effects of psoriasis duration on vascular inflammation and MACE, suggesting that cumulative duration of exposure to low-grade chronic inflammation may accelerate vascular disease development and MACEs. Providers should consider inquiring about duration of disease to counsel for heightened CVD risk in psoriasis.
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Affiliation(s)
- Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Lotus Mallbris
- Unit of Dermatology and Venerology, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Danish Heart Foundation, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jashin J Wu
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Justin Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph B Lerman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark A Ahlman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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26
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Vesey AT, Jenkins WSA, Irkle A, Moss A, Sng G, Forsythe RO, Clark T, Roberts G, Fletcher A, Lucatelli C, Rudd JHF, Davenport AP, Mills NL, Al-Shahi Salman R, Dennis M, Whiteley WN, van Beek EJR, Dweck MR, Newby DE. 18F-Fluoride and 18F-Fluorodeoxyglucose Positron Emission Tomography After Transient Ischemic Attack or Minor Ischemic Stroke: Case-Control Study. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.004976. [PMID: 28292859 PMCID: PMC5367506 DOI: 10.1161/circimaging.116.004976] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 01/12/2017] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background— Combined positron emission tomography (PET) and computed tomography (CT) can assess both anatomy and biology of carotid atherosclerosis. We sought to assess whether 18F-fluoride or 18F-fluorodeoxyglucose can identify culprit and high-risk carotid plaque. Methods and Results— We performed 18F-fluoride and 18F-fluorodeoxyglucose PET/CT in 26 patients after recent transient ischemic attack or minor ischemic stroke: 18 patients with culprit carotid stenosis awaiting carotid endarterectomy and 8 controls without culprit carotid atheroma. We compared standardized uptake values in the clinically adjudicated culprit to the contralateral asymptomatic artery, and assessed the relationship between radiotracer uptake and plaque phenotype or predicted cardiovascular risk (ASSIGN score [Assessing Cardiovascular Risk Using SIGN Guidelines to Assign Preventive Treatment]). We also performed micro PET/CT and histological analysis of excised plaque. On histological and micro PET/CT analysis, 18F-fluoride selectively highlighted microcalcification. Carotid 18F-fluoride uptake was increased in clinically adjudicated culprit plaques compared with asymptomatic contralateral plaques (log10standardized uptake valuemean 0.29±0.10 versus 0.23±0.11, P=0.001) and compared with control patients (log10standardized uptake valuemean 0.29±0.10 versus 0.12±0.11, P=0.001). 18F-Fluoride uptake correlated with high-risk plaque features (remodeling index [r=0.53, P=0.003], plaque burden [r=0.51, P=0.004]), and predicted cardiovascular risk [r=0.65, P=0.002]). Carotid 18F-fluorodeoxyglucose uptake appeared to be increased in 7 of 16 culprit plaques, but no overall differences in uptake were observed in culprit versus contralateral plaques or control patients. However, 18F-fluorodeoxyglucose did correlate with predicted cardiovascular risk (r=0.53, P=0.019), but not with plaque phenotype. Conclusions— 18F-Fluoride PET/CT highlights culprit and phenotypically high-risk carotid plaque. This has the potential to improve risk stratification and selection of patients who may benefit from intervention.
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Affiliation(s)
- Alex T Vesey
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom.
| | - William S A Jenkins
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Agnese Irkle
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Alastair Moss
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Greg Sng
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Rachael O Forsythe
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Tim Clark
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Gemma Roberts
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Alison Fletcher
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Christophe Lucatelli
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - James H F Rudd
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Anthony P Davenport
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Nicholas L Mills
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Rustam Al-Shahi Salman
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Martin Dennis
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - William N Whiteley
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Edwin J R van Beek
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - Marc R Dweck
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
| | - David E Newby
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom
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Harrington CL, Dey AK, Yunus R, Joshi AA, Mehta NN. Psoriasis as a human model of disease to study inflammatory atherogenesis. Am J Physiol Heart Circ Physiol 2017; 312:H867-H873. [PMID: 28258057 DOI: 10.1152/ajpheart.00774.2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 02/08/2023]
Abstract
Inflammation is known to play a significant role in the process of atherogenesis and cardiovascular disease (CVD). Indeed, patients with chronic inflammatory diseases are at increased risk for cardiovascular events. However, the mechanisms linking chronic inflammation and CVD remain poorly understood. Psoriasis, a chronic inflammatory skin disease associated with a greater risk of early cardiovascular events, provides a suitable human model to study the pathophysiology of inflammatory atherogenesis in humans. Additionally, cytokines such as TNF-α, IL-17A, and other immune pathways are the common links between the pathogenesis of psoriasis and atherosclerosis, and hence the approved treatments for psoriasis, which include selective cytokine inhibition (e.g., anti-TNF, anti-IL-17A, and anti-IL-12/23) and immune modulation (e.g., methotrexate or cyclosporine), provide an opportunity to examine the effect of modulating these pathways on atherogenesis. We have been using this human model in a large, prospective cohort study, and this review summarizes our approach and results of using this human model to study inflammatory atherogenesis. Specifically, we review simultaneous multimodal imaging of several vascular beds using 18fludeoxyglucose positron emission tomography/computed tomography, 18fludeoxyglucose positron emission tomography/MRI, and coronary computed tomography angiography as well as cardiovascular biomarkers to better understand how modulation of inflammation may impact vascular diseases.
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Affiliation(s)
- Charlotte L Harrington
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Amit K Dey
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Raza Yunus
- Department of Medicine, The George Washington University, Washington, District of Columbia
| | - Aditya A Joshi
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; and .,Department of Medicine, The George Washington University, Washington, District of Columbia
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Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees AS, Gelfand JM. Psoriasis and comorbid diseases: Implications for management. J Am Acad Dermatol 2017; 76:393-403. [PMID: 28212760 PMCID: PMC5839668 DOI: 10.1016/j.jaad.2016.07.065] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 12/13/2022]
Abstract
As summarized in the first article in this continuing medical education series, the currently available epidemiologic data suggest that psoriasis may be a risk factor for cardiometabolic disease. Emerging data also suggest associations between psoriasis and other comorbidities beyond psoriatic arthritis, including chronic kidney disease, inflammatory bowel disease, hepatic disease, certain malignancies, infections, and mood disorders. Recognizing the comorbid disease burden of psoriasis is essential for ensuring comprehensive care of patients with psoriasis. The clinical implications of the comorbid diseases that are associated with psoriasis and recommendations for clinical management are reviewed in this article.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Sungat Grewal
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sinéad M Langan
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, United Kingdom
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Alexis Ogdie
- Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Chaturvedi A, Dey AK, Joshi AA, Mehta NN. Vascular Inflammation Imaging in Psoriasis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Poredos P, Spirkoska A, Lezaic L, Mijovski MB, Jezovnik MK. Patients with an Inflamed Atherosclerotic Plaque have Increased Levels of Circulating Inflammatory Markers. J Atheroscler Thromb 2016; 24:39-46. [PMID: 27237221 PMCID: PMC5225131 DOI: 10.5551/jat.34884] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Inflammation is highlighted in the pathogenesis and destabilization of atherosclerotic lesions. Noninvasive identification of inflammation of atherosclerotic lesions has been challenging. 18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is a useful technique for detecting inflamed atherosclerotic plaques in vivo. However, it is time consuming, expensive, and accompanied by radiation. Therefore, we investigated the relationship between levels of circulating inflammatory markers and the degree of inflammation of atherosclerotic plaques shown by 18F-FDG uptake. We aimed to identify high-risk patients with inflamed, unstable atherosclerotic plaques on the basis of the determination of inflammatory markers. Methods: The study included 37 patients, 21 with high-grade stenosis of internal carotid artery (ICA group) and 16 with occlusion of common femoral artery (CFA group), who underwent endarterectomy. Mean age of the study population was 69.43 ± 6.2 years. Eight out of 21 patients with ICA stenosis and all patients with CFA occlusion were symptomatic. In all patients before endarterectomy, 18F-FDG-PET imaging was performed and blood samples were obtained for determination of circulating inflammatory markers: high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor alpha (TNF-α), interleukins, and selectins. Both groups were compared with a sex- and age-matched control group composed of 27 healthy volunteers. Results: 18F-FDG uptake, calculated by target-to-background ratio (TBR) was not significantly different between the groups. Levels of inflammatory markers were elevated, and there were no significant differences between ICA and CFA groups, with an exception of interleukin 6 (IL-6) levels, which was higher in the ICA group (3.2 ± 2.5 ng/L vs. 1.8 ± 1.3 ng/L, p < 0.05). There was a positive interrelationship between 18F-FDG-PET and most of the systemic inflammatory markers: hsCRP (r = 0.417, p = 0.010), IL-6 (r = 0.603, p < 0.001), and TNF-α (r = 0.374, p = 0.023). However, correlation between 18F-FDG-PET and P-selectin, E-selectin, and t-PA was not found. Conclusion: Our study showed that an interrelationship exists between the intensity of inflammatory process of atherosclerotic lesions shown by FDG uptake and circulating inflammatory markers. Therefore, the determination of circulating inflammatory markers can have a potential to identify individuals with unstable, inflamed atherosclerotic plaques.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana
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31
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Goel S, Miller A, Agarwal C, Zakin E, Acholonu M, Gidwani U, Sharma A, Kulbak G, Shani J, Chen O. Imaging Modalities to Identity Inflammation in an Atherosclerotic Plaque. Radiol Res Pract 2015; 2015:410967. [PMID: 26798515 PMCID: PMC4699110 DOI: 10.1155/2015/410967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022] Open
Abstract
Atherosclerosis is a chronic, progressive, multifocal arterial wall disease caused by local and systemic inflammation responsible for major cardiovascular complications such as myocardial infarction and stroke. With the recent understanding that vulnerable plaque erosion and rupture, with subsequent thrombosis, rather than luminal stenosis, is the underlying cause of acute ischemic events, there has been a shift of focus to understand the mechanisms that make an atherosclerotic plaque unstable or vulnerable to rupture. The presence of inflammation in the atherosclerotic plaque has been considered as one of the initial events which convert a stable plaque into an unstable and vulnerable plaque. This paper systemically reviews the noninvasive and invasive imaging modalities that are currently available to detect this inflammatory process, at least in the intermediate stages, and discusses the ongoing studies that will help us to better understand and identify it at the molecular level.
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Affiliation(s)
- Sunny Goel
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Avraham Miller
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Chirag Agarwal
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Elina Zakin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Acholonu
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Umesh Gidwani
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY 11203, USA
| | - Guy Kulbak
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - On Chen
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Naik HB, Natarajan B, Stansky E, Ahlman MA, Teague H, Salahuddin T, Ng Q, Joshi AA, Krishnamoorthy P, Dave J, Rose SM, Doveikis J, Playford MP, Prussick RB, Ehrlich A, Kaplan MJ, Lockshin BN, Gelfand JM, Mehta NN. Severity of Psoriasis Associates With Aortic Vascular Inflammation Detected by FDG PET/CT and Neutrophil Activation in a Prospective Observational Study. Arterioscler Thromb Vasc Biol 2015; 35:2667-76. [PMID: 26449753 DOI: 10.1161/atvbaha.115.306460] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/25/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand whether directly measured psoriasis severity is associated with vascular inflammation assessed by (18)F-fluorodeoxyglucose positron emission tomography computed tomography. APPROACH In-depth cardiovascular and metabolic phenotyping was performed in adult psoriasis patients (n=60) and controls (n=20). Psoriasis severity was measured using psoriasis area severity index. Vascular inflammation was measured using average aortic target-to-background ratio using (18)F-fluorodeoxyglucose positron emission tomography computed tomography. RESULTS Both the psoriasis patients (28 men and 32 women, mean age 47 years) and controls (13 men and 7 women, mean age 41 years) were young with low cardiovascular risk. Psoriasis area severity index scores (median 5.4; interquartile range 2.8-8.3) were consistent with mild-to-moderate skin disease severity. Increasing psoriasis area severity index score was associated with an increase in aortic target-to-background ratio (β=0.41, P=0.001), an association that changed little after adjustment for age, sex, and Framingham risk score. We observed evidence of increased neutrophil frequency (mean psoriasis, 3.7±1.2 versus 2.9±1.2; P=0.02) and activation by lower neutrophil surface CD16 and CD62L in blood. Serum levels of S100A8/A9 (745.1±53.3 versus 195.4±157.8 ng/mL; P<0.01) and neutrophil elastase-1 (43.0±2.4 versus 30.8±6.7 ng/mL; P<0.001) were elevated in psoriasis. Finally, S100A8/A9 protein was related to both psoriasis skin disease severity (β=0.53; P=0.02) and vascular inflammation (β=0.48; P=0.02). CONCLUSIONS Psoriasis severity is associated with vascular inflammation beyond cardiovascular risk factors. Psoriasis increased neutrophil activation and neutrophil markers, and S100A8/A9 was related to both skin disease severity and vascular inflammation.
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Affiliation(s)
- Haley B Naik
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Balaji Natarajan
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Elena Stansky
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Mark A Ahlman
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Heather Teague
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Taufiq Salahuddin
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Qimin Ng
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Aditya A Joshi
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Parasuram Krishnamoorthy
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Jenny Dave
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Shawn M Rose
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Julia Doveikis
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Martin P Playford
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Ronald B Prussick
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Alison Ehrlich
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Mariana J Kaplan
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Benjamin N Lockshin
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Joel M Gelfand
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Nehal N Mehta
- From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
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Gholami S, Salavati A, Houshmand S, Werner TJ, Alavi A. Assessment of atherosclerosis in large vessel walls: A comprehensive review of FDG-PET/CT image acquisition protocols and methods for uptake quantification. J Nucl Cardiol 2015; 22:468-79. [PMID: 25827619 DOI: 10.1007/s12350-015-0069-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/05/2015] [Indexed: 01/02/2023]
Abstract
There is growing evidence showing the importance of fluorodeoxyglucose positron emission tomography (FDG-PET) in the evaluation of vessel wall inflammation and atherosclerosis. Although this imaging modality has been increasingly used, there are various methods for image acquisition and evaluating FDG uptake activity in the vessel walls and atherosclerotic lesions, including qualitative visual scaling, semi-quantitative, and quantitative evaluations. Using each of these image acquisition protocols and measurement methods may result in different findings. In this review, we are going to describe the various image acquisition methods and common measurement strategies reflected in the literature and discuss their advantages and flaws.
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Affiliation(s)
- Saeid Gholami
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA,
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Alie N, Eldib M, Fayad ZA, Mani V. Inflammation, Atherosclerosis, and Coronary Artery Disease: PET/CT for the Evaluation of Atherosclerosis and Inflammation. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:13-21. [PMID: 25674025 PMCID: PMC4294600 DOI: 10.4137/cmc.s17063] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 12/16/2022]
Abstract
Atherosclerosis is a prevalent cardiovascular disease marked by inflammation and the formation of plaque within arterial walls. As the disease progresses, there is an increased risk of major cardiovascular events. Owing to the nature of atherosclerosis, it is imperative to develop methods to further understand the physiological implications and progression of the disease. The combination of positron emission tomography (PET)/computed tomography (CT) has proven to be promising for the evaluation of atherosclerotic plaques and inflammation within the vessel walls. The utilization of the radiopharmaceutical tracer, 18F-fluorodeoxyglucose (18F-FDG), with PET/CT is invaluable in understanding the pathophysiological state involved in atherosclerosis. In this review, we will discuss the use of 18F-FDG-PET/CT imaging for the evaluation of atherosclerosis and inflammation both in preclinical and clinical studies. The potential of more specific novel tracers will be discussed. Finally, we will touch on the potential benefits of using the newly introduced combined PET/magnetic resonance imaging (MRI) for non-invasive imaging of atherosclerosis.
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Affiliation(s)
- Nadia Alie
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mootaz Eldib
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Venkatesh Mani
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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de Barros ALB, Chacko AM, Mikitsh JL, Al Zaki A, Salavati A, Saboury B, Tsourkas A, Alavi A. Assessment of global cardiac uptake of radiolabeled iron oxide nanoparticles in apolipoprotein-E-deficient mice: implications for imaging cardiovascular inflammation. Mol Imaging Biol 2015; 16:330-9. [PMID: 24297372 DOI: 10.1007/s11307-013-0709-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Atherosclerosis is a leading cause of death in industrialized countries and is characterized by the accumulation of lipids and inflammatory cells, including macrophages, in blood vessel walls. Therefore, the ability to image macrophages could help identify plaques that are precursors of acute thrombotic events. Previous research has shown that long-circulating nanoparticles could be used to detect macrophages within atherosclerotic plaques of the aorta. By conducting this study, we investigated whether global cardiac uptake of radiolabeled nanoparticles could allow assessment of total macrophage burden in the coronary arteries. PROCEDURES Dextran-coated iron oxide nanoparticles (IONPs) were labeled with iodine-125 via Bolton-Hunter (sulfosuccinimidyl-3-[4-hydroxyphenyl]propionate) method. IONPs were characterized by means of dynamic light scattering and transmission electronic microscopy. Biodistribution studies were performed in healthy and atherosclerotic mice. Additionally, digital autoradiography of hearts from both healthy and atherosclerotic mice was performed to assess regional and global atherosclerotic burden. RESULTS The [(125)I]IONPs exhibited high radiolabel stability and long blood circulation, which eventually led to high heart uptake in apoE -/- mice when compared with healthy controls. Furthermore, digital autoradiography showed substantially enhanced emission of signals from the hearts of atherosclerotic mice, while no or minimal cardiac signals were detected in healthy mice. CONCLUSIONS This preparation showed adequate physical-chemical properties for in vivo studies, such as small size (∼30 nm), good radiolabel stability, and long circulation time. There was also significant accumulation in the heart of apoE-/- mice compared with that of healthy control animals. These findings suggest that radiolabeled dextran-coated iron oxide nanoparticles may have potential to become a useful tool to detect macrophages in the atherosclerosis plaques of coronary arteries; however, these preliminary findings should be confirmed by further studies in a larger scale in various atherosclerosis models.
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Affiliation(s)
- André Luís Branco de Barros
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA,
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Rose S, Dave J, Millo C, Naik HB, Siegel EL, Mehta NN. Psoriatic arthritis and sacroiliitis are associated with increased vascular inflammation by 18-fluorodeoxyglucose positron emission tomography computed tomography: baseline report from the Psoriasis Atherosclerosis and Cardiometabolic Disease Initiative. Arthritis Res Ther 2014; 16:R161. [PMID: 25078679 PMCID: PMC4261785 DOI: 10.1186/ar4676] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 07/17/2014] [Indexed: 02/05/2023] Open
Abstract
Introduction Psoriasis and psoriatic arthritis (PsA) increase cardiovascular disease (CVD) risk, but surrogate markers for CVD in these disorders are inadequate. Because the presence of sacroiliitis may portend more severe PsA, we hypothesized that sacroiliitis defined by computed tomography (CT) would be associated with increased vascular inflammation defined by 18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT), which is an established measure of CVD. Methods Participants (n = 65) underwent whole-body FDG-PET/CT. Metabolic activity of the aorta was measured using the maximal standardized uptake value (SUVmax), a measure of atherosclerotic plaque activity. The primary outcome was aortic vascular inflammation. Linear regression (with β-coefficients (β) and P-values reported for PsA and sacroiliitis) was used to adjust for CVD risk factors to determine associations of PsA or sacroiliitis with vascular inflammation. Likelihood ratio testing was performed to evaluate the contribution of sacroiliitis to vascular disease estimation compared to the effects of PsA and traditional CVD risk factors. Results Vascular inflammation (measured as SUVmax) was greater (P < 0.001) in patients with sacroiliitis (mean ± SD = 7.33 ± 2.09) defined by CT compared to those without sacroiliitis (6.39 ± 1.49, P = 0.038). There were associations between PsA and aortic inflammation (β = 0.124, P < 0.001) and between sacroiliitis and aortic inflammation (β = 0.270, P < 0.001) after adjusting for CVD risk factors. Sacroiliitis predicted vascular inflammation beyond PsA and CVD risk factors (χ2 = 124.6, P < 0.001). Conclusions Sacroiliitis is associated with increased vascular inflammation detected by FDG-PET/CT, suggesting that sacroiliac joint disease may identify patients at greater risk for CVD. Large, ongoing prospective studies are required to confirm these findings. Electronic supplementary material The online version of this article (doi:10.1186/ar4676) contains supplementary material, which is available to authorized users.
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Rose S, Sheth NH, Baker JF, Ogdie A, Raper A, Saboury B, Werner TJ, Thomas P, Vanvoorhees A, Alavi A, Torigian DA, Gelfand JM, Mehta NN. A comparison of vascular inflammation in psoriasis, rheumatoid arthritis, and healthy subjects by FDG-PET/CT: a pilot study. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2013; 3:273-278. [PMID: 24224139 PMCID: PMC3819587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Psoriasis (PSO) and rheumatoid arthritis (RA) increase cardiovascular diseases (CVD) beyond traditional risk factors. Vascular inflammation has previously been demonstrated to be present in PSO and RA using [18F]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging. However, vascular inflammation has not been compared in these two disorders relative to a healthy reference population. Thus, vascular inflammation was quantitatively assessed in patients with PSO (n=10), RA (n=5), and healthy subjects (n=10) using FDG-PET/CT. METHODS FDG-PET/CT mean standardized uptake value (SUVmean) was determined slice by slice within the ascending, aortic arch, descending thoracic, suprarenal abdominal, and infrarenal abdominal aorta, and the mean metabolic volumetric product (MVPmean) was then calculated for each aortic subsegment. Plasma lipids and metabolic and inflammatory markers were also assessed. RESULTS CVD risk profiles were largely similar across groups. After adjustment for CV risk factors, regional aortic vascular inflammation based on MVPmean was elevated for both PSO (beta coefficients 0.31-1.47, p<0.001) and RA (beta coefficients 0.15-0.69, p<0.05) compared to healthy subjects. CONCLUSIONS These observations using FDG-PET/CT to estimate vascular inflammation support epidemiological findings of premature atherosclerosis in PSO and RA. The use of FDG-PET/CT to investigate vascular inflammation across systemic inflammatory diseases warrants further examination in larger study populations.
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Affiliation(s)
- Shawn Rose
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of HealthBethesda, MD
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of HealthBethesda, MD
| | - Nikhil H Sheth
- Cardiovascular Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Joshua F Baker
- Department of Medicine, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Alexis Ogdie
- Department of Medicine, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Anna Raper
- Cardiovascular Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Babak Saboury
- Department of Radiology, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Thomas J Werner
- Department of Radiology, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Preethi Thomas
- Department of Medicine, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Abby Vanvoorhees
- Department of Dermatology, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Drew A Torigian
- Department of Radiology, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
- Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of HealthBethesda, MD
- Cardiovascular Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA
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38
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Yu Y, Sheth N, Krishnamoorthy P, Saboury B, Raper A, Baer A, Ochotony R, Doveikis J, Derohannessian S, Voorhees ASV, Torigian DA, Alavi A, Gelfand JM, Mehta NN. Aortic vascular inflammation in psoriasis is associated with HDL particle size and concentration: a pilot study. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2012; 2:285-292. [PMID: 23173102 PMCID: PMC3499940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 09/09/2012] [Indexed: 06/01/2023]
Abstract
Psoriasis is a model Th1-mediated inflammatory disease associated with increased incidence of stroke and cardiovascular disease (CVD). The mechanism behind these associations is unknown, however abnormal HDL particle composition measured by nuclear magnetic resonance (NMR) spectroscopy has been shown to be associated with CVD. Using [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT), a validated surrogate marker of CVD, we assessed whether HDL particle size and concentration were associated with vascular inflammation in patients with psoriasis. Patients with psoriasis were prospectively enrolled (439 aortic samples from 10 patients). Lipoprotein profiles using NMR spectroscopy were obtained and the relationship between vascular inflammation within the thoracic aorta by FDG-PET/CT was analyzed for association with lipoprotein particle characteristics. The plasma total cholesterol (206 mg/dL (IQR 154-229)), LDL (105 (90-161)), and triglyceride levels were within normal range (151 (94-191)) while HDL levels were low (28.9 (27.2-31.3)); however, the NMR profile demonstrated an atherogenic profile with increased small LDL and HDL particles. Total HDL particle concentration (p<0.001) and HDL particle size (p<0.001) were associated with decreased aortic inflammation, while concentration of small HDL particles was associated with increased inflammation (p<0.001). The association of total HDL particle concentration (β -0.0113, p=0.002) and small HDL particle concentration (β 0.026, p<0.001) with aortic inflammation persisted following adjustment for CVD risk factors. Total HDL particle concentration and small HDL particle concentration were associated with vascular inflammation within the thoracic aorta in psoriasis. These findings suggest that HDL particle characteristics may play an important role in psoriatic vascular inflammation and CVD.
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Affiliation(s)
- Yiding Yu
- Cardiovascular Institute, University of Pennsylvania 6 Penn Tower, Philadelphia, Pennsylvania, USA
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