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Nazir A. Exercise as a modality to improve heart transplantation-related functional impairments: An article review. World J Transplant 2024; 14:91637. [DOI: 10.5500/wjt.v14.i3.91637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 06/14/2024] [Accepted: 07/02/2024] [Indexed: 07/31/2024] Open
Abstract
Heart transplantation (HT), the treatment choice of advanced heart failure patients, is proven effective in increasing the survival and functional status of the recipients. However, compared to normal controls, functional status is lower in HT recipients. Exercise given in cardiac rehabilitation has been shown to improve exercise capacity as measured with peak oxygen uptake (VO2 peak) and muscle strength after completion of the program and cessation of exercise results in loss of exercise benefits. Several factors related to cardiac denervation and the use of immunosuppressive agents in HT recipients result in functional impairments including cardiovascular, pulmonary, exercise capacity, psychological, and quality of life (QoL) problems. High-intensity interval training (HIIT) is the most common type of exercise used in HT recipients and given as a hospital-based program. Improvement of functional impairments was found to have occurred due to primarily musculoskeletal adaptations through improvement of muscle structure and aerobic capacity and cardiovascular adaptations. In general, exercise given after transplantation improved VO2 peak significantly and improvement was better in the HIIT group compared to moderate intensity continuous training or no-exercise groups. Improvement of QoL was ascribed to improvement of exercise capacity, symptoms, pulmonary function, physical capacity improvement, anxiety, and depression.
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Affiliation(s)
- Arnengsih Nazir
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine Universitas Padjadjaran, Bandung 40161, West Java, Indonesia
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Schmalkuche K, Rother T, Burgmann JM, Voß H, Höffler K, Dogan G, Ruhparwar A, Schmitto JD, Blasczyk R, Figueiredo C. Heart immunoengineering by lentiviral vector-mediated genetic modification during normothermic ex vivo perfusion. Front Immunol 2024; 15:1404668. [PMID: 38903492 PMCID: PMC11188324 DOI: 10.3389/fimmu.2024.1404668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Heart transplantation is associated with major hurdles, including the limited number of available organs for transplantation, the risk of rejection due to genetic discrepancies, and the burden of immunosuppression. In this study, we demonstrated the feasibility of permanent genetic engineering of the heart during ex vivo perfusion. Lentiviral vectors encoding for short hairpin RNAs targeting beta2-microglobulin (shβ2m) and class II transactivator (shCIITA) were delivered to the graft during two hours of normothermic EVHP. Highly efficient genetic engineering was indicated by stable reporter gene expression in endothelial cells and cardiomyocytes. Remarkably, swine leucocyte antigen (SLA) class I and SLA class II expression levels were decreased by 66% and 76%, respectively, in the vascular endothelium. Evaluation of lactate, troponin T, and LDH levels in the perfusate and histological analysis showed no additional cell injury or tissue damage caused by lentiviral vectors. Moreover, cytokine secretion profiles (IL-6, IL-8, and TNF-α) of non-transduced and lentiviral vector-transduced hearts were comparable. This study demonstrated the ex vivo generation of genetically engineered hearts without compromising tissue integrity. Downregulation of SLA expression may contribute to reduce the immunogenicity of the heart and support graft survival after allogeneic or xenogeneic transplantation.
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Affiliation(s)
- Katharina Schmalkuche
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
- Transregional Collaborative Research Centre 127, Hannover Medical School, Hannover, Germany
| | - Tamina Rother
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Jonathan M. Burgmann
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Henrike Voß
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Klaus Höffler
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D. Schmitto
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
- Transregional Collaborative Research Centre 127, Hannover Medical School, Hannover, Germany
| | - Constanca Figueiredo
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
- Transregional Collaborative Research Centre 127, Hannover Medical School, Hannover, Germany
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M M, Attawar S, BN M, Tisekar O, Mohandas A. Ex vivo lung perfusion and the Organ Care System: a review. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:23-36. [PMID: 38725180 PMCID: PMC11075812 DOI: 10.4285/ctr.23.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/29/2024] [Accepted: 03/08/2024] [Indexed: 05/14/2024]
Abstract
With the increasing prevalence of heart failure and end-stage lung disease, there is a sustained interest in expanding the donor pool to alleviate the thoracic organ shortage crisis. Efforts to extend the standard donor criteria and to include donation after circulatory death have been made to increase the availability of suitable organs. Studies have demonstrated that outcomes with extended-criteria donors are comparable to those with standard-criteria donors. Another promising approach to augment the donor pool is the improvement of organ preservation techniques. Both ex vivo lung perfusion (EVLP) for the lungs and the Organ Care System (OCS, TransMedics) for the heart have shown encouraging results in preserving organs and extending ischemia time through the application of normothermic regional perfusion. EVLP has been effective in improving marginal or borderline lungs by preserving and reconditioning them. The use of OCS is associated with excellent short-term outcomes for cardiac allografts and has improved utilization rates of hearts from extended-criteria donors. While both EVLP and OCS have successfully transitioned from research to clinical practice, the costs associated with commercially available systems and consumables must be considered. The ex vivo perfusion platform, which includes both EVLP and OCS, holds the potential for diverse and innovative therapies, thereby transforming the landscape of thoracic organ transplantation.
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Affiliation(s)
- Menander M
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
| | - Sandeep Attawar
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
| | - Mahesh BN
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
| | - Owais Tisekar
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
| | - Anoop Mohandas
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
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Rouhi AD, Choudhury RA, Hoeltzel GD, Ghanem YK, Bababekov YJ, Suarez-Pierre A, Yule A, Vigneshwar NG, Williams NN, Dumon KR, Nydam TL. Ventricular Remodeling Following Metabolic and Bariatric Surgery Decreases Need for Heart Transplantation: A Predictive Model. Obes Surg 2024; 34:15-21. [PMID: 38017330 DOI: 10.1007/s11695-023-06948-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE For patients with obesity and congestive heart failure (CHF) who require heart transplantation (HT), aggressive weight loss has been associated with ventricular remodeling, or subclinical alterations in left and right ventricular structure that affect systolic function. Many have suggested offering metabolic and bariatric surgery (MBS) for these patients. As such, we evaluated the role of MBS in HT for patients with obesity and CHF using predictive modelling techniques. MATERIALS AND METHODS Markov decision analysis was performed to simulate the life expectancy of 30,000 patients with concomitant obesity, CHF, and 30% ejection fraction (EF) who were deemed ineligible to be waitlisted for HT unless they achieved a BMI < 35 kg/m2. Life expectancy following diet and exercise (DE), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) was estimated. Base case patients were defined as having a pre-intervention BMI of 45 kg/m2. Sensitivity analysis of initial BMI was performed. RESULTS RYGB patients had lower rates of HT and received HT quicker when needed. Base case patients who underwent RYGB gained 2.2 additional mean years survival compared with patients who underwent SG and 10.3 additional mean years survival compared with DE. SG patients gained 6.2 mean years of life compared with DE. CONCLUSION In this simulation of 30,000 patients with obesity, CHF, and reduced EF, MBS was associated with improved survival by not only decreasing the need for transplantation due to improvements in EF, but also increasing access to HT when needed due to lower average BMI.
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Affiliation(s)
- Armaun D Rouhi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Rashikh A Choudhury
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Gerard D Hoeltzel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yazid K Ghanem
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Yanik J Bababekov
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Alejandro Suarez-Pierre
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Arthur Yule
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Navin G Vigneshwar
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Trevor L Nydam
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
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Pastena P, Frye JT, Ho C, Goldschmidt ME, Kalogeropoulos AP. Ischemic cardiomyopathy: epidemiology, pathophysiology, outcomes, and therapeutic options. Heart Fail Rev 2024; 29:287-299. [PMID: 38103139 DOI: 10.1007/s10741-023-10377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
Ischemic cardiomyopathy (ICM) is the most prevalent cause of heart failure (HF) in developed countries, with significant morbidity and mortality, despite constant improvements in the management of coronary artery disease. Current literature on this topic remains fragmented. Therefore, this review aimed to summarize the most recent data on ICM, focusing on its definition, epidemiology, outcomes, and therapeutic options. The most widely accepted definition is represented by a left ventricular dysfunction in the presence of significant coronary artery disease. The prevalence of ICM is largely influenced by age and sex, with older individuals and males being more affected. Its pathophysiology is characterized by plaque buildup, thrombus formation, hypoperfusion, ischemic cell death, and left ventricular remodeling. Despite improvements in therapy, ICM still represents a public health burden, with a 1-year mortality rate of 16% and a 5-year mortality rate of approximately 40% in the USA and Europe. Therefore, optimization of cardiovascular function, prevention of progressive remodeling, reduction of HF symptoms, and improved survival are the main goals of treatment. Therapeutic options for ICM include lifestyle changes, optimal medical therapy, revascularization, device therapy, mechanical circulatory support, and cardiac transplantation. Personalized management strategies and tailored patient care are needed to improve the outcomes of patients with ICM.
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Affiliation(s)
- Paola Pastena
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Jesse T Frye
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Carson Ho
- College of Arts and Sciences, Stony Brook University, Stony Brook, NY, USA
| | - Marc E Goldschmidt
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Andreas P Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
- Stony Brook University Medical Center, Health Sciences Center, 101 Nicolls Road, T-16-080, Stony Brook, NY, USA.
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Tiwari A, Mukherjee S. Role of Complement-dependent Cytotoxicity Crossmatch and HLA Typing in Solid Organ Transplant. Rev Recent Clin Trials 2024; 19:34-52. [PMID: 38155466 DOI: 10.2174/0115748871266738231218145616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Solid organ transplantation is a life-saving medical operation that has progressed greatly because of developments in diagnostic tools and histocompatibility tests. Crossmatching for complement-dependent cytotoxicity (CDC) and human leukocyte antigen (HLA) typing are two important methods for checking graft compatibility and reducing the risk of graft rejection. HLA typing and CDC crossmatching are critical in kidney, heart, lung, liver, pancreas, intestine, and multi-organ transplantation. METHODS A systematic literature search was conducted on the internet, using PubMed, Scopus, and Google Scholar databases, to identify peer-reviewed publications about solid organ transplants, HLA typing, and CDC crossmatching. CONCLUSION Recent advances in HLA typing have allowed for high-resolution evaluation, epitope matching, and personalized therapy methods. Genomic profiling, next-generation sequencing, and artificial intelligence have improved HLA typing precision, resulting in better patient outcomes. Artificial intelligence (AI) driven virtual crossmatching and predictive algorithms have eliminated the requirement for physical crossmatching in the context of CDC crossmatching, boosting organ allocation and transplant efficiency. This review elaborates on the importance of HLA typing and CDC crossmatching in solid organ transplantation.
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Affiliation(s)
- Arpit Tiwari
- Amity Institute of Biotechnology, Amity University Uttar Pradesh Lucknow Campus, Lucknow, Uttar Pradesh, India
| | - Sayali Mukherjee
- Amity Institute of Biotechnology, Amity University Uttar Pradesh Lucknow Campus, Lucknow, Uttar Pradesh, India
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Tanveer Y, Arif A, Tsenteradze T, Anika NN, Bakht D, Masood QF, Affaf M, Batool W, Yadav I, Gasim RW, Mohamed Y, Abdelmonim Khogali Mohamed M, Ekhator C, Mohsin SN, Khan R. Revolutionizing Heart Transplantation: A Multidisciplinary Approach to Xenotransplantation, Immunosuppression, Regenerative Medicine, Artificial Intelligence, and Economic Sustainability. Cureus 2023; 15:e46176. [PMID: 37908951 PMCID: PMC10613786 DOI: 10.7759/cureus.46176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Heart transplantation (HTx) stands as a life-saving intervention for patients with end-stage heart disease, but the field is fraught with numerous challenges that span from the scarcity of donor organs to long-term complications arising from immunosuppressive therapies. This comprehensive review article offers an in-depth exploration of the multifaceted aspects of HTx. The review covers groundbreaking advancements in xenotransplantation, enabled by cutting-edge genetic engineering techniques, and the promising role of stem cell therapies, particularly porcine mesenchymal stem cells, in cardiac regeneration. It also delves into the evolution and limitations of immunosuppressive therapies and the revolutionary potential of artificial intelligence (AI) and machine learning (ML) in enhancing donor-recipient matching and predicting patient outcomes. Economic considerations, especially in the context of rising healthcare costs, are examined to assess the sustainability of these advancements. The article further discusses the significant improvements in patient outcomes over the years, while highlighting persisting challenges, such as graft failure, rejection, and infection. It underscores the importance of experience and specialized training, evidenced by the presence of an institutional learning curve. The review concludes by advocating for a multifaceted, collaborative approach involving clinicians, researchers, and policymakers to overcome existing challenges. Through coordinated efforts that consider medical, ethical, and economic factors, the field of HTx is poised for further evolution, offering renewed hope for improved patient care and outcomes.
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Affiliation(s)
| | - Aleena Arif
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Tamar Tsenteradze
- General Surgery, Cardiology, and Internal Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Nabila N Anika
- Surgery, Baylor College of Medicine, Houston, USA
- Internal Medicine, Holy Family Red Crescent Medical College and Hospital, Dhaka, BGD
| | - Danyal Bakht
- Medicine and Surgery, Mayo Hospital, Lahore, PAK
| | | | - Maryam Affaf
- Internal Medicine, Women Medical and Dental College, Abbottabad, PAK
| | - Wajiha Batool
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Indresh Yadav
- Internal Medicine, Samar Hospital and Research Center Pvt. Ltd., Janakpur, NPL
- Internal Medicine, Community Based Medical College Bangladesh, Mymensingh, BGD
| | - Rayan W Gasim
- Internal Medicine, University of Khartoum, Khartoum, SDN
| | - Youssef Mohamed
- Intensive Care Unit, Ibrahim Malik Teaching Hospital, Khartoum, SDN
| | | | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, New York, USA
| | - Syed Naveed Mohsin
- Orthopedics, St. James's Hospital, Dublin, IRL
- General Surgery, Cavan General Hospital, Cavan, IRL
| | - Rehman Khan
- Internal Medicine, Mayo Hospital, Lahore, PAK
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Clavellina D, Balkan W, Hare JM. Stem cell therapy for acute myocardial infarction: Mesenchymal Stem Cells and induced Pluripotent Stem Cells. Expert Opin Biol Ther 2023; 23:951-967. [PMID: 37542462 PMCID: PMC10837765 DOI: 10.1080/14712598.2023.2245329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) remains a leading cause of death in the United States. The limited capacity of cardiomyocytes to regenerate and the restricted contractility of scar tissue after AMI are not addressed by current pharmacologic interventions. Mesenchymal stem/stromal cells (MSCs) have emerged as a promising therapeutic approach due to their low antigenicity, ease of harvesting, and efficacy and safety in preclinical and clinical studies, despite their low survival and engraftment rates. Other stem cell types, such as induced pluripotent stem cells (iPSCs) also show promise, and optimizing cardiac repair requires integrating emerging technologies and strategies. AREAS COVERED This review offers insights into advancing cell-based therapies for AMI, emphasizing meticulously planned trials with a standardized definition of AMI, for a bench-to-bedside approach. We critically evaluate fundamental studies and clinical trials to provide a comprehensive overview of the advances, limitations and prospects for cell-based therapy in AMI. EXPERT OPINION MSCs continue to show potential promise for treating AMI and its sequelae, but addressing their low survival and engraftment rates is crucial for clinical success. Integrating emerging technologies such as pluripotent stem cells and conducting well-designed trials will harness the full potential of cell-based therapy in AMI management. Collaborative efforts are vital to developing effective stem cell therapies for AMI patients.
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Affiliation(s)
- Diana Clavellina
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Wayne Balkan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Kohli G, George DD, Grenga A, Santangelo G, Gosev I, Schartz D, Kessler A, Khan I, Barrus B, Gu Y, Bhalla T, Mattingly TK, Bender MT. Mechanical Thrombectomy for Ischemic Stroke Secondary to Large Vessel Occlusions in Patients on Extracorporeal Membrane Oxygenation. Cerebrovasc Dis 2023; 52:532-538. [PMID: 36716722 DOI: 10.1159/000528218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/20/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The use of short-term mechanical circulatory support (MCS) devices and procedures for function- and life-sustaining therapy is becoming a routine practice at many centers. Concomitant with the increasing use of MCS is the increasing recognition of acute brain injuries, including acute ischemic stroke, which may be caused by a myriad of MCS-driven factors. The aim of this case series was to document our experience with mechanical thrombectomy (MT) for ischemic stroke in extracorporeal membrane oxygenation (ECMO) patients. METHODS We retrospectively reviewed a prospectively maintained database of patients undergoing endovascular thrombectomy for large vessel occlusion at our institution. We identified patients that were on ECMO and underwent thrombectomy. Baseline demographics and procedural and functional outcomes were collected. RESULTS Three patients on ECMO were identified to have a large vessel occlusion and underwent thrombectomy. Two patients had an internal carotid artery terminus occlusion and one had a basilar artery occlusion. An mTICI 3 recanalization was achieved in all patients without postoperative hemorrhagic complications. Two patients achieved a 3-month mRS of 1, while one had mRS 4. CONCLUSION Ischemic stroke can be associated with significant morbidity in MCS patients. We demonstrate that MT can be safely performed in this patient population with good outcomes.
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Affiliation(s)
- Gurkirat Kohli
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Derek D George
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Audrey Grenga
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Gabrielle Santangelo
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Igor Gosev
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Derrek Schartz
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Alex Kessler
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Imad Khan
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Bryan Barrus
- Baptist Health Cardiothoracic Surgery Clinic, Little Rock, Arkansas, USA
| | - Yang Gu
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Tarun Bhalla
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas K Mattingly
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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Nasri A, Dupuis J, Carrier M, Racine N, Parent MC, Ducharme A, Fortier A, Hausermann L, White M, Tremblay-Gravel M. Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation. Front Cardiovasc Med 2022; 9:841025. [DOI: 10.3389/fcvm.2022.841025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
AimTo investigate the effect of the new definition of pulmonary hypertension (PH) and new pulmonary vascular resistance (PVR) thresholds on the prevalence, clinical characteristics, and events following cardiac transplantation (CTx) over 30 years.MethodsPatients who underwent CTx between 1983 and 2014 for whom invasive hemodynamic data was available were analyzed (n = 342). Patients transplanted between 1983 and 1998 were classified as early era and those transplanted between 1999 and 2014 were classified as recent era. Group 2 PH was diagnosed in the presence of a mean pulmonary artery pressure (mPAP) > 20 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg. Isolated post capillary PH (Ipc-PH) was defined as PVR ≤ 2 wood units and combined pre and post capillary PH (Cpc-PH) was defined PVR > 2 wood units. Moderate to severe PH was defined as mPAP ≥ 35 mmHg. The primary outcome was 30-day mortality and long-term mortality according to type and severity of PH. Proportions were analyzed using the chi-square test, and survival analyses were performed using Kaplan-Meier curves and compared using the logrank test.ResultsThe prevalence of PH in patients transplanted in the early era was 89.1%, whilst 84.2% of patients transplanted in the recent era had PH (p = 0.3914). There was no difference in the prevalence of a pre-capillary component according to era (p = 0.4001), but severe PH was more common in the early era (51.1% [early] vs 38.0% [recent] p = 0.0151). Thirty-day and long-term mortality were not significantly associated with severity or type of PH. There was a trend toward increased 30-day mortality in mild PH (10.1%), compared to no PH (4.4%) and moderate to severe PH (6.6%; p = 0.0653). Long-term mortality did not differ according to the severity of PH (p = 0.1480). There were no significant differences in 30-day or long-term mortality in IpcPH compared to CpcPH (p = 0.3974 vs p = 0.5767, respectively).ConclusionOver 30 years, PH has remained very prevalent before CTx. The presence, severity, and type (pre- vs post-capillary) of PH is not significantly associated with short- or long-term mortality.
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11
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Sierra-Pagan JE, Garry DJ. The regulatory role of pioneer factors during cardiovascular lineage specification – A mini review. Front Cardiovasc Med 2022; 9:972591. [PMID: 36082116 PMCID: PMC9445115 DOI: 10.3389/fcvm.2022.972591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular disease (CVD) remains the number one cause of death worldwide. Ischemic heart disease contributes to heart failure and has considerable morbidity and mortality. Therefore, alternative therapeutic strategies are urgently needed. One class of epigenetic regulators known as pioneer factors has emerged as an important tool for the development of regenerative therapies for the treatment of CVD. Pioneer factors bind closed chromatin and remodel it to drive lineage specification. Here, we review pioneer factors within the cardiovascular lineage, particularly during development and reprogramming and highlight the implications this field of research has for the future development of cardiac specific regenerative therapies.
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Affiliation(s)
- Javier E. Sierra-Pagan
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Daniel J. Garry
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
- Paul and Sheila Wellstone Muscular Dystrophy Center, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Daniel J. Garry
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Toll-like receptors and damage-associated molecular patterns in the pathogenesis of heart transplant rejection. Mol Cell Biochem 2022; 477:2841-2850. [PMID: 35678986 DOI: 10.1007/s11010-022-04491-4] [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: 02/21/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Significant strides have been made in our understanding of the immune system and its role in cardiac transplant rejection. Despite the growing knowledge of immune responses, the mortality rate following cardiac transplantation remains grim. Related to procedural and pathological complications, toll-like receptor (TLR) and damage-associated molecular pattern (DAMP) signaling is the most direct and earliest interface between tissue integration and the innate immune response. This in turn can activate an adaptive immune response that further damages myocardial tissue. Furthermore, relevant literature on the status of DAMPs in the context of heart-transplantation remains limited, warranting further attention in clinical and translational research. This review aims to critically appraise the perspectives, advances, and challenges on DAMP-mediated innate immune response in the immune-mediated rejection of cardiac transplantation. Detailed analysis of the influence of TLR and DAMP signaling in mounting the immune response against the transplanted heart holds promise for improving outcomes through early detection and prevention of varied forms of organ rejection.
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Poty A, Krim F, Lopes P, Garaud Y, Leprêtre PM. Benefits of a Supervised Ambulatory Outpatient Program in a Cardiovascular Rehabilitation Unit Prior to a Heart Transplant: A Case Study. Front Cardiovasc Med 2022; 9:811458. [PMID: 35665250 PMCID: PMC9160327 DOI: 10.3389/fcvm.2022.811458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Preoperative peak oxygen uptake (V.O2peak) and ventilatory efficiency (V.E/V.CO2slope) are related to the vital prognosis after cardiac transplantation (HTx). The objective of our study was to evaluate the effects of exercise-based cardiac rehabilitation (ECR) program on the preoperative exercise capacity of a HTx candidate. A male patient, aged 50–55 years, with chronic heart failure was placed on the HTx list and performed 12 weeks of intensive ECR (5 sessions-a-week). Our results showed that the cardiac index continuously increased between the onset and the end of ECR (1.40 vs. 2.53 L.min–1.m2). The first 20 sessions of ECR induced a V.O2peak increase (15.0 vs. 19.3 ml.min–1.kg–1, corresponding to 42.0 and 53.0% of its maximal predicted values, respectively). The peak V.O2 plateaued between the 20th and the 40th ECR session (19.3 vs. 19.4 ml.min–1.kg–1) then progressively increased until the 60th ECR session to reach 25.7 ml.min–1.kg–1, i.e., 71.0% of the maximal predicted values. The slope of V.E/V.CO2 showed a biphasic response during the ECR program, with an increase between the onset and the 20th ECR session (58.02 vs. 70.48) and a decrease between the 20th and the 40th ECR session (70.48 vs. 40.94) to reach its minimal value at the 60th ECR session (31.97). After the first 40 sessions of the ECR program, the Seattle Heart Failure Model score predicted median survival time was estimated at 7.2 years. In conclusion, the improvement in exercise capacity and cardiorespiratory function following the ECR helped delay the heart transplant surgery in our patient awaiting heart transplantation.
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Affiliation(s)
- Antoine Poty
- Exercise Physiology and Rehabilitation Laboratory, Picardie Jules Verne University, Amiens, France
- Fundation Léopold Bellan, Chateau d’Ollencourt, Unit of Cardiac Rehabilitation, Tracy-le-Mont, France
| | - Florent Krim
- Service de Réadaptation Cardiovasculaire, Centre Hospitalier de Corbie, Corbie, France
- Association Picardie de Recherche en Réadaptation Cardiaque, Association Picardie de Recherche en Réadaptation Cardiaque, Corbie, France
| | - Philippe Lopes
- Laboratoire de Biologie de l’Exercice Pour la Performance et la Santé, Université d’Évry Val d’Essonne, Évry, France
| | - Yves Garaud
- Fundation Léopold Bellan, Chateau d’Ollencourt, Unit of Cardiac Rehabilitation, Tracy-le-Mont, France
| | - Pierre-Marie Leprêtre
- Exercise Physiology and Rehabilitation Laboratory, Picardie Jules Verne University, Amiens, France
- Service de Réadaptation Cardiovasculaire, Centre Hospitalier de Corbie, Corbie, France
- Association Picardie de Recherche en Réadaptation Cardiaque, Association Picardie de Recherche en Réadaptation Cardiaque, Corbie, France
- *Correspondence: Pierre-Marie Leprêtre,
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14
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Abstract
Cardiac transplantation is considered the gold-standard treatment option for patients suffering from end-stage heart failure refractory to maximum medical therapy. A major determinant of graft function and recipient survival is a comprehensive evaluation of the donor allograft. Challenges arise when designing and implementing an evidence-based donor evaluation protocol due to the number of influential donor-specific characteristics and the complex interactions that occur between them. Here, we present our systematic approach to donor evaluation by examining the impact that relevant donor variables have on graft function and recipient outcomes.
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Affiliation(s)
- Robert Tatum
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107 USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, 20 Hawkins Drive E318, Iowa City, IA 52242 USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107 USA
| | - H. Todd Massey
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107 USA
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15
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Potential Application of Exosomes in Vaccine Development and Delivery. Pharm Res 2022; 39:2635-2671. [PMID: 35028802 PMCID: PMC8757927 DOI: 10.1007/s11095-021-03143-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Exosomes are cell-derived components composed of proteins, lipid, genetic information, cytokines, and growth factors. They play a vital role in immune modulation, cell-cell communication, and response to inflammation. Immune modulation has downstream effects on the regeneration of damaged tissue, promoting survival and repair of damaged resident cells, and promoting the tumor microenvironment via growth factors, antigens, and signaling molecules. On top of carrying biological messengers like mRNAs, miRNAs, fragmented DNA, disease antigens, and proteins, exosomes modulate internal cell environments that promote downstream cell signaling pathways to facilitate different disease progression and induce anti-tumoral effects. In this review, we have summarized how vaccines modulate our immune response in the context of cancer and infectious diseases and the potential of exosomes as vaccine delivery vehicles. Both pre-clinical and clinical studies show that exosomes play a decisive role in processes like angiogenesis, prognosis, tumor growth metastasis, stromal cell activation, intercellular communication, maintaining cellular and systematic homeostasis, and antigen-specific T- and B cell responses. This critical review summarizes the advancement of exosome based vaccine development and delivery, and this comprehensive review can be used as a valuable reference for the broader delivery science community.
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16
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Mexiletine and False Positive Urine Drug Screen for Amphetamine: A Case Review. Case Rep Med 2021; 2021:7134394. [PMID: 34887926 PMCID: PMC8651372 DOI: 10.1155/2021/7134394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Advanced heart failure patients commonly suffer from ventricular arrhythmias which can be managed by antiarrhythmic drugs like mexiletine. These ventricular arrhythmias can be complicated by illicit drug use which alter outcomes and can potentially impact the patient-physician relationship through countertransference. However, mexiletine can lead to false positive urine drug screen testing for amphetamine, and these false-positive urine drug screen test results can affect the decision-making process. Health care providers should be aware of this fact and should either use confirmatory testing or look for confounding compounds in patients who deny using illicit substances and have a positive urine drug screen. Our patient is 64 years old who arrived at the emergency department after experiencing a shock by his intracardiac defibrillator. The patient tested positive for amphetamine on his urine drug screen and was later ruled out by confirmatory quantitative testing.
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17
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Ryan CT, Santiago A, Tariq N, Lamba HK. Effect of Laparoscopic Sleeve Gastrectomy on Heart Transplant Status in 4 Patients with Left Ventricular Assist Devices. Tex Heart Inst J 2021; 47:284-289. [PMID: 33472222 DOI: 10.14503/thij-19-7161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Bariatric surgery helps many morbidly obese patients lose substantial weight. However, few data exist on its long-term safety and effectiveness in patients who also have continuous-flow left ventricular assist devices and in whom heart transplantation is contemplated. We retrospectively identified patients at our institution who had undergone ventricular assist device implantation and subsequent laparoscopic sleeve gastrectomy from June 2015 through September 2017, and we evaluated their baseline demographic data, preoperative characteristics, and postoperative outcomes. Four patients (3 men), ranging in age from 32 to 44 years and in body mass index from 40 to 57, underwent sleeve gastrectomy from 858 to 1,849 days after left ventricular assist device implantation to treat nonischemic cardiomyopathy. All had multiple comorbidities. At a median follow-up duration of 42 months (range, 24-47 mo), median body mass index decreased to 31.9 (range, 28.3-44.3) at maximal weight loss, with a median percentage of excess body mass index lost of 72.5% (range, 38.7%-87.4%). After achieving target weight, one patient was listed for heart transplantation, another awaited listing, one was kept on destination therapy because of positive drug screens, and one regained weight and remained ineligible. On long-term follow-up, laparoscopic sleeve gastrectomy appears to be safe and feasible for morbidly obese patients with ventricular assist devices who must lose weight for transplantation consideration. Additional studies are warranted to evaluate this weight-loss strategy after transplantation and immunosuppression.
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Affiliation(s)
- Christopher T Ryan
- Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030
| | - Adriana Santiago
- Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030
| | - Nabil Tariq
- Bariatric and Metabolic Surgery Center, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030
| | - Harveen K Lamba
- Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030
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18
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Edwards S, Allen S, Sidebotham D. Anaesthesia for heart transplantation. BJA Educ 2021; 21:284-291. [PMID: 34306729 DOI: 10.1016/j.bjae.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- S Edwards
- Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
| | - S Allen
- Auckland City Hospital, Auckland, New Zealand
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19
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Karruli A, de Cristofaro J, Andini R, Iossa D, Bernardo M, Amarelli C, Mattucci I, Zampino R, Zarrilli R, Durante-Mangoni E. Risk Factors and Outcome of Multidrug-Resistant Infections after Heart Transplant: A Contemporary Single Center Experience. Microorganisms 2021; 9:microorganisms9061210. [PMID: 34205082 PMCID: PMC8230299 DOI: 10.3390/microorganisms9061210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022] Open
Abstract
(1) Background: The aim of this study was to assess risk factors for multidrug-resistant/extensively drug-resistant (MDR/XDR) bacterial infections in heart transplant (HT) patients within three months after surgery and its impact on patient outcome. (2) Methods: Retrospective analysis of clinical, hemato-chemical, imaging, treatment and outcome data from 47 heart transplant recipients from January 2016 to December 2018. MDR/XDR infections were compared to non-MDR/XDR and noninfected patients. (3) Results: Most participants were males, median age 51 years: 35 (74.5%) developed an infection after HT; 14 (29.8%) were MDR/XDR infections. Prolonged hospital stay before HT correlated to MDR/XDR infection (p < 0.001). Sequential organ failure assessment (SOFA) score at sampling day was higher in MDR/XDR (p = 0.027). MDR/XDR were mostly blood-stream (BSI) (p = 0.043) and skin-soft tissue (SSTI) (p = 0.047) infections. Gram-negative infections were the most frequent, specifically carbapenem-resistant Klebsiella pneumoniae. Antibiotic therapy duration for MDR/XDR infections was longer (p = 0.057), eradication rate lower (p = 0.083) and hospital stay longer (p = 0.005) but not associated with a worse outcome. (4) Conclusions: MDR/XDR infections affect compromised HT recipients with a history of prolonged hospitalization, causing a lower rate of eradication and increased hospital stay. These frequently present as BSI and SSTI. We emphasize the need to prevent contamination of central venous catheters and the surgical site.
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Affiliation(s)
- Arta Karruli
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.K.); (J.d.C.); (D.I.)
| | - Jacopo de Cristofaro
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.K.); (J.d.C.); (D.I.)
| | - Roberto Andini
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.A.); (R.Z.)
| | - Domenico Iossa
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.K.); (J.d.C.); (D.I.)
| | - Mariano Bernardo
- Unit of Microbiology & Virology, AORN Ospedali dei Colli, 80131 Naples, Italy;
| | - Cristiano Amarelli
- Unit of Cardiac Transplant, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (C.A.); (I.M.)
| | - Irene Mattucci
- Unit of Cardiac Transplant, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (C.A.); (I.M.)
| | - Rosa Zampino
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.A.); (R.Z.)
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy
| | - Raffaele Zarrilli
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy;
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.K.); (J.d.C.); (D.I.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.A.); (R.Z.)
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7702645
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20
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Xiao L, Li C, Sun Y, Chen Y, Wei H, Hu D, Yu T, Li X, Jin L, Shi L, Marian AJ, Wang DW. Clinical Significance of Variants in the TTN Gene in a Large Cohort of Patients With Sporadic Dilated Cardiomyopathy. Front Cardiovasc Med 2021; 8:657689. [PMID: 33996946 PMCID: PMC8120103 DOI: 10.3389/fcvm.2021.657689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/05/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Mutations in the TTN gene are the most common causes of dilated cardiomyopathy (DCM). The clinical significance of TTN gene variants remains inadequately understood. Methods: Whole-exome sequencing and phenotypic characterisation were performed, and patients were followed up for a median of 44 months. Results: We analyzed the association of the TTN variants with the clinical outcomes in a prospective study of 1,041 patients with sporadic DCM. TTN truncating variants (tTTN) were detected in 120 (11.5%) patients as compared with 2.4/10,000 East Asian populations in the Genome Aggregation Database (GnomAD; p < 0.0001). Pathogenic TTN missense variants were also enriched in DCM as compared with the GnomAD populations (27.6 vs. 5.9%, p < 0.0001). DCM patients with tTTN had a lower left ventricular ejection fraction (28.89 ± 8.72 vs. 31.81 ± 9.97, p = 0.002) and a lower frequency of the left bundle branch block (3.3 vs. 11.3%, p = 0.011) than those without or with mutations in other known causal genes (OCG). However, tTTN were not associated with the composite primary endpoint of cardiac death and heart transplantation during the follow-up period [adjusted hazard ratio (HR): 0.912; 95% confidence interval: 0.464–1.793; p = 0.790]. There was also no sex-dependent effect. Concomitant tTTN and pathogenic variants in OCG were present in only eight DCM patients and did not affect the outcome. Conclusion: The phenotype of DCM caused by tTTN, major causes of sporadic DCM, is not distinctly different from those caused by other causal genes for DCM.
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Affiliation(s)
- Lei Xiao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Chenze Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Sun
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Yanghui Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Haoran Wei
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Hu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Yu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Xianqing Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Li Jin
- Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
| | - Leming Shi
- Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
| | - Ali J Marian
- Center for Cardiovascular Genetics, Houston, TX, United States
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China.,Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
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21
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Da Silveira Cavalcante L, Tessier SN. Zebrafish as a New Tool in Heart Preservation Research. J Cardiovasc Dev Dis 2021; 8:39. [PMID: 33917701 PMCID: PMC8068018 DOI: 10.3390/jcdd8040039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022] Open
Abstract
Heart transplantation became a reality at the end of the 1960s as a life-saving option for patients with end-stage heart failure. Static cold storage (SCS) at 4-6 °C has remained the standard for heart preservation for decades. However, SCS only allows for short-term storage that precludes optimal matching programs, requires emergency surgeries, and results in the unnecessary discard of organs. Among the alternatives seeking to extend ex vivo lifespan and mitigate the shortage of organs are sub-zero or machine perfusion modalities. Sub-zero approaches aim to prolong cold ischemia tolerance by deepening metabolic stasis, while machine perfusion aims to support metabolism through the continuous delivery of oxygen and nutrients. Each of these approaches hold promise; however, complex barriers must be overcome before their potential can be fully realized. We suggest that one barrier facing all experimental efforts to extend ex vivo lifespan are limited research tools. Mammalian models are usually the first choice due to translational aspects, yet experimentation can be restricted by expertise, time, and resources. Instead, there are instances when smaller vertebrate models, like the zebrafish, could fill critical experimental gaps in the field. Taken together, this review provides a summary of the current gold standard for heart preservation as well as new technologies in ex vivo lifespan extension. Furthermore, we describe how existing tools in zebrafish research, including isolated organ, cell specific and functional assays, as well as molecular tools, could complement and elevate heart preservation research.
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Affiliation(s)
- Luciana Da Silveira Cavalcante
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 2114, USA;
- Shriners Hospitals for Children, Boston, MA 2114, USA
| | - Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 2114, USA;
- Shriners Hospitals for Children, Boston, MA 2114, USA
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22
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Monguió-Tortajada M, Prat-Vidal C, Moron-Font M, Clos-Sansalvador M, Calle A, Gastelurrutia P, Cserkoova A, Morancho A, Ramírez MÁ, Rosell A, Bayes-Genis A, Gálvez-Montón C, Borràs FE, Roura S. Local administration of porcine immunomodulatory, chemotactic and angiogenic extracellular vesicles using engineered cardiac scaffolds for myocardial infarction. Bioact Mater 2021; 6:3314-3327. [PMID: 33778207 PMCID: PMC7973387 DOI: 10.1016/j.bioactmat.2021.02.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
The administration of extracellular vesicles (EV) from mesenchymal stromal cells (MSC) is a promising cell-free nanotherapy for tissue repair after myocardial infarction (MI). However, the optimal EV delivery strategy remains undetermined. Here, we designed a novel MSC-EV delivery, using 3D scaffolds engineered from decellularised cardiac tissue as a cell-free product for cardiac repair. EV from porcine cardiac adipose tissue-derived MSC (cATMSC) were purified by size exclusion chromatography (SEC), functionally analysed and loaded to scaffolds. cATMSC-EV markedly reduced polyclonal proliferation and pro-inflammatory cytokines production (IFNγ, TNFα, IL12p40) of allogeneic PBMC. Moreover, cATMSC-EV recruited outgrowth endothelial cells (OEC) and allogeneic MSC, and promoted angiogenesis. Fluorescently labelled cATMSC-EV were mixed with peptide hydrogel, and were successfully retained in decellularised scaffolds. Then, cATMSC-EV-embedded pericardial scaffolds were administered in vivo over the ischemic myocardium in a pig model of MI. Six days from implantation, the engineered scaffold efficiently integrated into the post-infarcted myocardium. cATMSC-EV were detected within the construct and MI core, and promoted an increase in vascular density and reduction in macrophage and T cell infiltration within the damaged myocardium. The confined administration of multifunctional MSC-EV within an engineered pericardial scaffold ensures local EV dosage and release, and generates a vascularised bioactive niche for cell recruitment, engraftment and modulation of short-term post-ischemic inflammation.
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Affiliation(s)
- Marta Monguió-Tortajada
- ICREC Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,REMAR-IVECAT Group, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Prat-Vidal
- ICREC Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Miriam Moron-Font
- REMAR-IVECAT Group, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain
| | - Marta Clos-Sansalvador
- REMAR-IVECAT Group, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Alexandra Calle
- Departamento de Reproducción Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), Madrid, Spain
| | - Paloma Gastelurrutia
- ICREC Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Adriana Cserkoova
- ICREC Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain
| | - Anna Morancho
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), UAB, Barcelona, Spain
| | - Miguel Ángel Ramírez
- Departamento de Reproducción Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), Madrid, Spain
| | - Anna Rosell
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), UAB, Barcelona, Spain
| | - Antoni Bayes-Genis
- ICREC Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Service, Germans Trias i Pujol University Hospital, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain
| | - Carolina Gálvez-Montón
- ICREC Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc E Borràs
- REMAR-IVECAT Group, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.,Nephrology Service, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Santiago Roura
- ICREC Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, 08500, Spain
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23
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Numan L, Ramjankhan FZ, Oberski DL, Oerlemans MIFJ, Aarts E, Gianoli M, Van Der Heijden JJ, De Jonge N, Van Der Kaaij NP, Meuwese CL, Mokhles MM, Oppelaar AM, De Waal EEC, Asselbergs FW, Van Laake LW. Propensity score-based analysis of long-term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support. ESC Heart Fail 2021; 8:1596-1603. [PMID: 33635573 PMCID: PMC8006731 DOI: 10.1002/ehf2.13267] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 12/31/2022] Open
Abstract
Aims Left ventricular assist device therapy has become the cornerstone in the treatment of end‐stage heart failure and is increasingly used as destination therapy next to bridge to transplant or recovery. HeartMate 3 (HM3) and HeartWare (HVAD) are centrifugal continuous flow devices implanted intrapericardially and most commonly used worldwide. No randomized controlled trials have been performed yet. Analysis based on large registries may be considered as the best alternative but has the disadvantage of different standard of care between centres and missing data. Bias is introduced, because the decision which device to use was not random, even more so because many centres use only one type of left ventricular assist device. Therefore, we performed a propensity score (PS)‐based analysis of long‐term clinical outcome of patients that received HM3 or HVAD in a single centre. Methods and results Between December 2010 and December 2019, 100 patients received HVAD and 81 patients HM3 as primary implantation at the University Medical Centre Utrecht. We performed PS matching with an extensive set of covariates, resulting in 112 matched patients with a median follow‐up of 28 months. After PS matching, survival was not significantly different (P = 0.21) but was better for HM3. The cumulative incidences for haemorrhagic stroke (P = 0.01) and pump thrombosis (P = 0.02) were significantly higher for HVAD patients. The cumulative incidences for major bleeding, ischaemic stroke, right heart failure, and driveline infection were not different between the groups. We found no interaction between the surgeon who performed the implantation and survival (P = 0.59, P = 0.78, and P = 0.89). Sensitivity analysis was performed, by PS matching without patients on preoperative temporary support resulting in 74 matched patients. This also resulted in a non‐significant difference in survival (P = 0.07). The PS‐adjusted Cox regression showed a worse but non‐significant (P = 0.10) survival for HVAD patients with hazard ratio 1.71 (95% confidence interval 0.91–3.24). Conclusions Survival was not significantly different between both groups after PS matching, but was better for HM3, with a significantly lower incidence of haemorrhagic stroke and pump thrombosis for HM3. These results need to be interpreted carefully, because matching may have introduced greater imbalance on unmeasured covariates. A multicentre approach of carefully selected centres is recommended to enlarge the number of matched patients.
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Affiliation(s)
- Lieke Numan
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Faiz Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Daniel L Oberski
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Martinus I F J Oerlemans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Emmeke Aarts
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Monica Gianoli
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joris J Van Der Heijden
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas De Jonge
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Niels P Van Der Kaaij
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christiaan L Meuwese
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne-Marie Oppelaar
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eric E C De Waal
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Linda W Van Laake
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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Auguste G, Rouhi L, Matkovich SJ, Coarfa C, Robertson MJ, Czernuszewicz G, Gurha P, Marian AJ. BET bromodomain inhibition attenuates cardiac phenotype in myocyte-specific lamin A/C-deficient mice. J Clin Invest 2021; 130:4740-4758. [PMID: 32484798 DOI: 10.1172/jci135922] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/27/2020] [Indexed: 01/03/2023] Open
Abstract
Mutation in the LMNA gene, encoding lamin A/C, causes a diverse group of diseases called laminopathies. Cardiac involvement is the major cause of death and manifests as dilated cardiomyopathy, heart failure, arrhythmias, and sudden death. There is no specific therapy for LMNA-associated cardiomyopathy. We report that deletion of Lmna in cardiomyocytes in mice leads to severe cardiac dysfunction, conduction defect, ventricular arrhythmias, fibrosis, apoptosis, and premature death within 4 weeks. The phenotype is similar to LMNA-associated cardiomyopathy in humans. RNA sequencing, performed before the onset of cardiac dysfunction, led to identification of 2338 differentially expressed genes (DEGs) in Lmna-deleted cardiomyocytes. DEGs predicted activation of bromodomain-containing protein 4 (BRD4), a regulator of chromatin-associated proteins and transcription factors, which was confirmed by complementary approaches, including chromatin immunoprecipitation sequencing. Daily injection of JQ1, a specific BET bromodomain inhibitor, partially reversed the DEGs, including those encoding secretome; improved cardiac function; abrogated cardiac arrhythmias, fibrosis, and apoptosis; and prolonged the median survival time 2-fold in the myocyte-specific Lmna-deleted mice. The findings highlight the important role of LMNA in cardiomyocytes and identify BET bromodomain inhibition as a potential therapeutic target in LMNA-associated cardiomyopathy, for which there is no specific effective therapy.
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Affiliation(s)
- Gaelle Auguste
- Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, and Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Leila Rouhi
- Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, and Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Scot J Matkovich
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cristian Coarfa
- Department of Cell Biology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Grazyna Czernuszewicz
- Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, and Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Priyatansh Gurha
- Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, and Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Ali J Marian
- Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, and Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
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Xiao H, Ali S, Zhang Z, Sarfraz MS, Zhang F, Faisal M. Big Data, Extracting Insights, Comprehension, and Analytics in Cardiology: An Overview. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6635463. [PMID: 33604008 PMCID: PMC7868142 DOI: 10.1155/2021/6635463] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/09/2021] [Accepted: 01/20/2021] [Indexed: 11/23/2022]
Abstract
Healthcare system facilitates the treatment of patients with the support of wearable, smart, and handheld devices, as well as many other devices. These devices are producing a huge bulk of data that need to be moulded for extracting meaningful insights from them for the useful use of researchers and practitioners. Various approaches, methods, and tools are in use for doing so and to extract meaningful information in the field of healthcare. This information is being used as evidence to further analyze the data for the early care of patient and to devise treatment. Early care and treatment can facilitate healthcare and the treatment of the patient and can have immense potentiality of dropping the care cost and quality refining of care and can decrease waste and chances of error. To facilitate healthcare in general and cardiology in specific, the proposed study presents an overview of the available literature associated with big data, its insights, and analytics. The presented report will help practitioners and researchers to devise new solutions for early care in healthcare and in cardiology.
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Affiliation(s)
- Hui Xiao
- Zhongnan Hospital of Wuhan University, Information Center, Wuhan 430071, China
| | - Sikandar Ali
- Department of Computer Science and Technology, China University of Petroleum-Beijing, Beijing 102249, China
| | - Zhen Zhang
- Zhongnan Hospital of Wuhan University, Information Center, Wuhan 430071, China
| | - Muhammad Shahzad Sarfraz
- Department of Computer Science, National University of Computer and Emerging Sciences Islamabad, Chiniot-Faisalabad Campus, Chiniot, Pakistan
| | - Fang Zhang
- Zhongnan Hospital of Wuhan University, Information Center, Wuhan 430071, China
| | - Mohammad Faisal
- Department of Computer Science and Information Technology, University of Malakand, Chakdara, Pakistan
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Distinct Myocardial Transcriptomic Profiles of Cardiomyopathies Stratified by the Mutant Genes. Genes (Basel) 2020; 11:genes11121430. [PMID: 33260757 PMCID: PMC7768427 DOI: 10.3390/genes11121430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases are the number one cause of morbidity and mortality worldwide, but the underlying molecular mechanisms remain not well understood. Cardiomyopathies are primary diseases of the heart muscle and contribute to high rates of heart failure and sudden cardiac deaths. Here, we distinguished four different genetic cardiomyopathies based on gene expression signatures. In this study, RNA-Sequencing was used to identify gene expression signatures in myocardial tissue of cardiomyopathy patients in comparison to non-failing human hearts. Therefore, expression differences between patients with specific affected genes, namely LMNA (lamin A/C), RBM20 (RNA binding motif protein 20), TTN (titin) and PKP2 (plakophilin 2) were investigated. We identified genotype-specific differences in regulated pathways, Gene Ontology (GO) terms as well as gene groups like secreted or regulatory proteins and potential candidate drug targets revealing specific molecular pathomechanisms for the four subtypes of genetic cardiomyopathies. Some regulated pathways are common between patients with mutations in RBM20 and TTN as the splice factor RBM20 targets amongst other genes TTN, leading to a similar response on pathway level, even though many differentially expressed genes (DEGs) still differ between both sample types. The myocardium of patients with mutations in LMNA is widely associated with upregulated genes/pathways involved in immune response, whereas mutations in PKP2 lead to a downregulation of genes of the extracellular matrix. Our results contribute to further understanding of the underlying molecular pathomechanisms aiming for novel and better treatment of genetic cardiomyopathies.
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The Impact of Obesity on Left Ventricular Assist Device Outcomes. ACTA ACUST UNITED AC 2020; 56:medicina56110556. [PMID: 33113962 PMCID: PMC7690722 DOI: 10.3390/medicina56110556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The understanding of high body mass index (BMI) and outcomes after Left Ventricular Assist Device (LVAD) implantation continues to evolve and the relationship has not been established yet. In this study, we investigated the effects of obesity (BMI > 30 kg/m2) on post–LVAD implantation outcomes. HeartWare LVAD and Heart Mate III LVAD were implanted. The primary outcome that was measured was mortality (in-hospital and on follow-up). The secondary outcomes that were measured were major adverse events. Materials and Methods: At our institution, the West German Heart and Vascular Center (Essen, Germany), from August 2010 to January 2020, a total of 210 patients received a long-term LVAD. Patients were stratified according to BMI ≥ 30 kg/m2 representing the obesity threshold. The first group (n = 162) had an average BMI of 24.2 kg/m2 (±2.9), and the second group (n = 48) had an average BMI of 33.9 kg/m2 (±3.2). Baseline demographics were analysed alongside comorbidities per group. Results: Overall mortality was not significantly different between the obese group (51.1% n = 24) and the nonobese group (55.2%, n = 85) (p = 0.619). The difference between the mean duration of survival of patients who expired after hospital discharge was insignificant (2.1 years ± 1.6, group 1; 2.6 years ± 1.5, group 2; p = 0.29). In-hospital mortality was unvaried between the two groups: group 1: n = 34 (44% out of overall group 1 deaths); group 2: n = 11 (45.8% out of overall group 2 deaths) (p > 0.05). Postoperative complications were unvaried between the obese and the non-obese group (all with p > 0.05). However, a significant difference was found with regards to follow-up neurological complications (18.5% vs. 37.8%, p = 0.01) and LVAD thrombosis (14.7% vs. 33.3%, p = 0.01), as both were higher in the obese population. Conclusion: Obesity does not form a barrier for LVAD implantation in terms of mortality (in-hospital and on follow up). However, a significantly higher incidence of follow-up LVAD thrombosis and neurological complications has been found in the obese group of patients.
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Butler MG. Classic Ehlers-Danlos syndrome and cardiac transplantation - Is there a connection? World J Cardiol 2020; 12:368-372. [PMID: 32879701 PMCID: PMC7439450 DOI: 10.4330/wjc.v12.i8.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/02/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Ehlers-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders comprised of several types. Classic EDS is an autosomal dominant disorder with stretchable skin, delayed wound healing with poor scarring, joint hypermobility with subluxations or dislocations, easy bruisability, hernias, aneurysms and cardiac abnormalities. Advances in genomics technology using next-generation sequencing has led to the discovery of causative genes for connective tissue disorders, hereditary cardiomyopathies and cardiovascular diseases including several genes for connective tissue disorders. A 55 year-old male exhibited thin stretchable skin, atrophic scars, easy bruising, joint pain and dislocations requiring multiple knee surgeries and a Beighton hyperflexibility score of 6 out of 7. He was found to have a heterozygous missense COL5A1 gene variant involving exon 3 at nucleotide c:305T>A with an amino acid position change at p.lle102Asn consistent with classic EDS. He had a heart transplant at 43 years of age due to cardiac failure of unknown cause. This patient with classic EDS is brought to medical attention and should be of interest to cardiologists, heart transplant specialists and surgeons, particularly in individuals with unexplained cardiac failure and then diagnosed prior to surgical intervention to avoid poor wound healing, scarring and other tissue involvement (e.g., vascular anomalies, blood pressure instability, aneurysms) as components of EDS.
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Affiliation(s)
- Merlin G Butler
- Departments of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS 66160, United States
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Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome. PLoS One 2020; 15:e0237989. [PMID: 32834010 PMCID: PMC7446916 DOI: 10.1371/journal.pone.0237989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Acute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgical intervention. This retrospective study aimed to clarify the individual characteristics, short-term and mid-term outcomes, and prognostic factors of patients who underwent surgical repair of ATAAD with preoperative cardiopulmonary resuscitation (CPR). METHODS Between January 2007 and January 2020, 656 consecutive patients underwent ATAAD repair at our institution; 22 (3.4%) of these patients underwent CPR prior to surgery. Patients who underwent preoperative CPR were classified as the survivor group (n = 9) and non-survivor group (n = 13), according to whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed and compared. Three-year cumulative survival rates and cerebral performance categories (CPC) scores are presented. RESULTS In patients undergoing CPR prior to ATAAD surgery, the in-hospital mortality rate was 59.1%. A total of 72.7% of patients underwent concomitant surgical resuscitation procedures during CPR such as emergent subxiphoid pericardiotomy and/or emergent cardiopulmonary bypass. The survivor group had a higher rate of return of spontaneous heartbeat (ROSB) compared to the non-survivor group (100% versus 53.8%; P = 0.017). The 3-year cumulative survival rates were 35.1% (95% confidence interval [CI], 27.6%-42.6%) and 85.7% (95% CI, 81.9%-88.8%) for overall patients and for survivors, respectively. As for the neurological outcome, 77.8% (7/9) of patients had full cerebral performance (CPC-1) at the 3-month follow-up examination after discharge. CONCLUSIONS Patients with ATAAD undergoing preoperative CPR, especially those without ROSB after CPR, are at high risk for in-hospital mortality. However, the short-term and mid-term outcomes, including the cerebral performance after discharge and 3-year survival rate, are promising for patients who survived to discharge.
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Szczurek W, Gąsior M, Skrzypek M, Szyguła-Jurkiewicz B. Apelin Improves Prognostic Value of HFSS (Heart Failure Survival Score) and MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) Scales in Ambulatory Patients with End-Stage Heart Failure. J Clin Med 2020; 9:jcm9072300. [PMID: 32698411 PMCID: PMC7408713 DOI: 10.3390/jcm9072300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022] Open
Abstract
This prospective study aimed to determine the effect of adding apelin to the MAGGIC (Meta-Analysis Global Group In Chronic Heart Failure) and HFSS (Heart Failure Survival Score) scales for predicting one-year mortality in 240 ambulatory patients accepted for heart transplantation (HT) between 2015-2017. The study also investigated whether the combination of N-terminal pro-brain natriuretic peptide (NT-proBNP) with MAGGIC or HFSS improves the ability of these scales to effectively separate one-year survivors from non-survivors on the HT waiting list. The median age of the patients was 58.0 (51.50.0-64.0) years and 212 (88.3%) of them were male. Within a one year follow-up, 75 (31.2%) patients died. The area under the curves (AUC) for baseline parameters was as follows-0.7350 for HFSS, 0.7230 for MAGGIC, 0.7992 for apelin and 0.7028 for NT-proBNP. The HFSS-apelin score generated excellent power to predict the one-year survival, with the AUC of 0.8633 and a high sensitivity and specificity (80% and 78%, respectively). The predictive accuracy of MAGGIC-apelin score was also excellent (AUC: 0.8523, sensitivity of 75%, specificity of 79%). The addition of NT-proBNP to the HFSS model slightly improved the predictive power of this scale (AUCHFFSS-NT-proBNP: 0.7665, sensitivity 83%, specificity 60%), while it did not affect the prognostic strength of MAGGIC (AUCMAGGIC-NT-proBNP: 0.738, sensitivity 71%, specificity 69%). In conclusion, the addition of apelin to the HFSS and MAGGIC models significantly improved their ability to predict the one-year survival in patients with advanced HF. The MAGGIC-apelin and HFSS-apelin scores provide simple and powerful methods for risk stratification in end-stage HF patients. NT-proBNP slightly improved the prognostic power of HFSS, while it did not affect the predictive power of MAGGIC.
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Affiliation(s)
- Wioletta Szczurek
- Silesian Center for Heart Diseases in Zabrze,41-800 Zabrze, Poland
- Correspondence: ; Tel.: +48-694-138-970 or +48-323-733-860
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (B.S.-J.)
| | - Michał Skrzypek
- Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Bożena Szyguła-Jurkiewicz
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (B.S.-J.)
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Carvalho TD, Milani M, Ferraz AS, Silveira ADD, Herdy AH, Hossri CAC, Silva CGSE, Araújo CGSD, Rocco EA, Teixeira JAC, Dourado LOC, Matos LDNJD, Emed LGM, Ritt LEF, Silva MGD, Santos MAD, Silva MMFD, Freitas OGAD, Nascimento PMC, Stein R, Meneghelo RS, Serra SM. Brazilian Cardiovascular Rehabilitation Guideline - 2020. Arq Bras Cardiol 2020; 114:943-987. [PMID: 32491079 PMCID: PMC8387006 DOI: 10.36660/abc.20200407] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Universidade do Estado de Santa Catarina (Udesc), Florianópolis , SC - Brasil
| | | | | | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Instituto de Cardiologia de Santa Catarina , Florianópolis , SC - Brasil
- Unisul: Universidade do Sul de Santa Catarina (UNISUL), Florianópolis , SC - Brasil
| | | | | | | | | | | | - Luciana Oliveira Cascaes Dourado
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Rio de Janeiro , RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar , Salvador , BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública , Salvador , BA - Brasil
| | | | - Mauro Augusto Dos Santos
- ACE Cardiologia do Exercício , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | | | | | - Pablo Marino Corrêa Nascimento
- Universidade Federal Fluminense (UFF), Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Romeu Sergio Meneghelo
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro , RJ - Brasil
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Ullah W, Sattar Y, Darmoch F, Al-Khadra Y, Mir T, Ajmal R, Moussa-Pacha H, Glazier J, Asfour A, Gardi D, Alraies MC. The impact of peripheral arterial disease on patients with mechanical circulatory support. IJC HEART & VASCULATURE 2020; 28:100509. [PMID: 32300637 PMCID: PMC7150524 DOI: 10.1016/j.ijcha.2020.100509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 01/05/2023]
Abstract
Patient having LVAD and history of PAD have a higher odd to develop acute myocardial infarction as compared to non-PAD. Major bleeding requiring transfusion, and thromboembolic complications were higher in patients with PAD disease. The LVAD placement in prior PAD can have high odds of surgical wound infections, and implant-related complications as compared to non-PAD. The odds of developing acute renal failure are high in LVAD with PAD as compared to non-PAD group. LVAD placement in history of PAD can have high in-hospital mortality are high as compared to non-PAD group.
Background Left ventricular assist devices (LVAD) are indicated as bridging or destination therapy for patients with advanced (Stage D) heart failure and reduced ejection fraction (HFrEF). Due to the clustering of the mutual risk factors, HFrEF patients have a high prevalence of peripheral arterial disease (PAD). This, along with the fact that continuous flow LVAD influence shear stress on the vasculature, can further deteriorate the PAD. Methods We queried the National Inpatient Sample (NIS) database (2002–2014) to identify the burden of pre-existing PAD cases, its association with LVAD, in-hospital mortality, and other complications of LVAD. The adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using the Cochran–Mantel–Haenszel test. Results A total of 20,817 LVAD patients, comprising of 1,625 (7.8%) PAD and 19,192 (91.2%) non-PAD patients were included in the study. The odds of in-hospital mortality in PAD patients were significantly higher compared to non-PAD group (OR 1.29, CI, 1.07–1.55, P = 0.007). The PAD group had significantly higher adjusted odds as compared to non-PAD group for acute myocardial infarction (aOR 1.29; 95% CI, 1.07–1.55, P = 0.007), major bleeding requiring transfusion (aOR, 1.286; 95% CI, 1.136–1.456, P < 0.001), vascular complications (aOR, 2.360; 95% CI, 1.781–3.126, P < 0.001), surgical wound infections (aOR, 1.50; 95% CI, 1.17–1.94, P = 0.002), thromboembolic complications (aOR, 1.69; 95% CI, 1.36–2.10, P < 0.001), implant-related complications (aOR, 1.47; 95% CI, 1.19–1.80, P < 0.001), and acute renal failure (aOR, 1.26; 95% CI, 1.12–1.43, P < 0.001). Conclusion PAD patients can have high LVAD associated mortality as compared to non-PAD.
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Key Words
- BiVAD, biventricular assist device
- CABG, coronary artery bypass surgery
- CAD, coronary artery disease
- CKD, chronic kidney disease
- End-stage heart failure
- LOS, length of stay
- LVAD, left ventricular assist device
- Left ventricular assist device
- MCS, mechanical circulatory support
- NIS, National Inpatient Sample
- OMT, optimal medical therapy
- PAD, peripheral arterial disease
- PCI, percutaneous coronary intervention
- Peripheral arterial disease
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Affiliation(s)
- Waqas Ullah
- Abington Hospital - Jefferson Health, United States
| | - Yasar Sattar
- Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, United States
| | - Fahed Darmoch
- Beth Israel Hospital, Harvard University, United States
| | | | - Tanveer Mir
- Wayne State University, Detroit Medical Center, United States
| | - Rasikh Ajmal
- Wayne State University, Detroit Medical Center, United States
| | - Homam Moussa-Pacha
- University of Texas Health Science Center, McGovern Medical School, Memorial Hermann Heart & Vascular Institute, USA
| | - James Glazier
- Wayne State University, Detroit Medical Center, United States
| | | | - Delair Gardi
- Wayne State University, Detroit Medical Center, United States
| | - M Chadi Alraies
- Wayne State University, Detroit Medical Center, United States
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Gulin D, Planinic Z, Habek JC, Sikic J. Is there a place for angiotensin receptor-neprilysin inhibitors in the treatment of heart failure patients after heart transplantation? Indian J Pharmacol 2020; 51:413-415. [PMID: 32029965 PMCID: PMC6984019 DOI: 10.4103/ijp.ijp_562_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Abstract
We present a case report of a heart failure patient after heart transplantation due to end-stage ischemic cardiomyopathy with significant clinical and echocardiographic improvement 3 months after the introduction of sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor. This new class of drugs is proved to be beneficial in heart failure patients, especially with reduced ejection fraction (HFrEF), but they have not yet been used in heart failure patients after heart transplantation. We believe that the increase of left ventricular systolic function, improvement of global longitudinal strain, and reduction of pulmonary hypertension with consequent clinical recovery in our patient may have been caused by sacubitril/valsartan.
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Affiliation(s)
- Dario Gulin
- Department of Cardiovascular Diseases, University Hospital "Sveti Duh", Zagreb, Croatia.,University of Zagreb School of Medicine, Zagreb, Croatia
| | - Zrinka Planinic
- Department of Cardiovascular Diseases, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Jasna Cerkez Habek
- Department of Cardiovascular Diseases, University Hospital "Sveti Duh", Zagreb, Croatia.,Croatian Catholic University, Zagreb, Croatia
| | - Jozica Sikic
- Department of Cardiovascular Diseases, University Hospital "Sveti Duh", Zagreb, Croatia.,University of Zagreb School of Medicine, Zagreb, Croatia
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Abstract
Background: With an aging population, the prevalence of heart failure continues to rise. The use of guideline-directed medical therapy and mechanical circulatory support devices has helped to improve outcomes, but cardiac transplantation remains the definitive treatment for end-stage heart failure. Methods: We provide an update on cardiac transplantation and review indications, contraindications, and important aspects of perioperative and postoperative management. We also highlight the current challenges faced by the transplant community. Results: Advances in surgical techniques and immunosuppression have increased survival rates posttransplant. However, the risk of rejection and adverse effects from chronic immunosuppression continue to affect long-term outcomes. Conclusion: Despite tremendous progress in the management of cardiac transplant patients, we have much opportunity to further optimize cardiac transplant waitlisting and improve posttransplant outcomes.
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35
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Thongprayoon C, Lertjitbanjong P, Hansrivijit P, Crisafio A, Mao MA, Watthanasuntorn K, Aeddula NR, Bathini T, Kaewput W, Cheungpasitporn W. Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis. MEDICINES (BASEL, SWITZERLAND) 2019; 6:medicines6040108. [PMID: 31683875 PMCID: PMC6963309 DOI: 10.3390/medicines6040108] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/20/2019] [Accepted: 10/29/2019] [Indexed: 05/01/2023]
Abstract
Background: Acute kidney injury (AKI) is a common complication following solid-organ transplantation. However, the epidemiology of AKI and mortality risk of AKI among patients undergoing cardiac transplantation is not uniformly described. We conducted this study to assess the incidence of AKI and mortality risk of AKI in adult patients after cardiac transplantation. Methods: A systematic review of EMBASE, MEDLINE, and Cochrane Databases was performed until June 2019 to identify studies evaluating the incidence of AKI (by standard AKI definitions), AKI requiring renal replacement therapy (RRT), and mortality risk of AKI in patients undergoing cardiac transplantation. Pooled AKI incidence and mortality risk from the included studies were consolidated by random-effects model. The protocol for this study is registered with PROSPERO (no. CRD42019134577). Results: 27 cohort studies with 137,201 patients undergoing cardiac transplantation were identified. Pooled estimated incidence of AKI and AKI requiring RRT was 47.1% (95% CI: 37.6-56.7%) and 11.8% (95% CI: 7.2-18.8%), respectively. The pooled ORs of hospital mortality and/or 90-day mortality among patients undergoing cardiac transplantation with AKI and AKI requiring RRT were 3.46 (95% CI, 2.40-4.97) and 13.05 (95% CI, 6.89-24.70), respectively. The pooled ORs of 1-year mortality among patients with AKI and AKI requiring RRT were 2.26 (95% CI, 1.56-3.26) and 3.89 (95% CI, 2.49-6.08), respectively. Conclusion: Among patients undergoing cardiac transplantation, the incidence of AKI and severe AKI requiring RRT are 47.1% and 11.8%, respectively. AKI post cardiac transplantation is associated with reduced short term and 1-year patient survival.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MM 55905, USA.
| | | | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17105, USA.
| | - Anthony Crisafio
- St George's University, School of Medicine University Centre Grenada, West Indies, St George, Grenada.
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA.
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand.
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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AAV-Mediated Expression of AP-1-Neutralizing RNA Decoy Oligonucleotides Attenuates Transplant Vasculopathy in Mouse Aortic Allografts. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2019; 15:246-256. [PMID: 31720303 PMCID: PMC6838891 DOI: 10.1016/j.omtm.2019.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/24/2019] [Indexed: 11/21/2022]
Abstract
Transplant vasculopathy (TV), characterized by obstructive lesions in affected vessels, represents one of the long-term complications of cardiac transplantation. Activation of the transcription factor activator protein-1 (AP-1) is implicated in smooth muscle cell (SMC) phenotypic switch from contractile to synthetic function, increasing the migration and proliferation rate of these cells. We hypothesize that adeno-associated virus (AAV)-mediated delivery of an RNA hairpin AP-1 decoy oligonucleotide (dON) might effectively ameliorate TV severity in a mouse aortic allograft model. Aortic allografts from DBA/2 mice ex vivo transduced with modified AAV9-SLR carrying a targeting peptide within the capsid surface were transplanted into the infrarenal aorta of C57BL/6 mice. Cyclosporine A (10 mg/kg BW) was administered daily. AP-1 dONs were intracellularly expressed in the graft tissue as small hairpin RNA proved by fluorescent in situ hybridization. Explantation after 30 days and histomorphometric evaluation revealed that AP-1 dON treatment significantly reduced intima-to-media ratio by 41.5% (p < 0.05) in the grafts. In addition, expression of adhesion molecules, cytokines, as well as numbers of proliferative SMCs, matrix metalloproteinase-9-positive cells, and inflammatory cell infiltration were significantly decreased in treated aortic grafts. Our findings demonstrate the feasibility, efficacy, and specificity of the anti-AP-1 RNA dON approach for the treatment of allograft vasculopathy in an animal model. Moreover, the AAV-based approach in general provides the possibility to achieve a prolonged delivery of nucleic-acids-based therapeutics in to the blood vessel wall.
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Alonzo M, AnilKumar S, Roman B, Tasnim N, Joddar B. 3D Bioprinting of cardiac tissue and cardiac stem cell therapy. Transl Res 2019; 211:64-83. [PMID: 31078513 PMCID: PMC6702075 DOI: 10.1016/j.trsl.2019.04.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 12/17/2022]
Abstract
Cardiovascular tissue engineering endeavors to repair or regenerate damaged or ineffective blood vessels, heart valves, and cardiac muscle. Current strategies that aim to accomplish such a feat include the differentiation of multipotent or pluripotent stem cells on appropriately designed biomaterial scaffolds that promote the development of mature and functional cardiac tissue. The advent of additive manufacturing 3D bioprinting technology further advances the field by allowing heterogenous cell types, biomaterials, and signaling factors to be deposited in precisely organized geometries similar to those found in their native counterparts. Bioprinting techniques to fabricate cardiac tissue in vitro include extrusion, inkjet, laser-assisted, and stereolithography with bioinks that are either synthetic or naturally-derived. The article further discusses the current practices for postfabrication conditioning of 3D engineered constructs for effective tissue development and stability, then concludes with prospective points of interest for engineering cardiac tissues in vitro. Cardiovascular three-dimensional bioprinting has the potential to be translated into the clinical setting and can further serve to model and understand biological principles that are at the root of cardiovascular disease in the laboratory.
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Affiliation(s)
- Matthew Alonzo
- Inspired Materials & Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), Department of Metallurgical, Materials and Biomedical Engineering, University of Texas at El Paso, El Paso, Texas
| | - Shweta AnilKumar
- Inspired Materials & Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), Department of Metallurgical, Materials and Biomedical Engineering, University of Texas at El Paso, El Paso, Texas
| | - Brian Roman
- Inspired Materials & Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), Department of Metallurgical, Materials and Biomedical Engineering, University of Texas at El Paso, El Paso, Texas
| | - Nishat Tasnim
- Inspired Materials & Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), Department of Metallurgical, Materials and Biomedical Engineering, University of Texas at El Paso, El Paso, Texas
| | - Binata Joddar
- Inspired Materials & Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), Department of Metallurgical, Materials and Biomedical Engineering, University of Texas at El Paso, El Paso, Texas; Border Biomedical Research Center, University of Texas at El Paso, El Paso, Texas.
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38
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Severin R, Sabbahi A, Ozemek C, Phillips S, Arena R. Approaches to improving exercise capacity in patients with left ventricular assist devices: an area requiring further investigation. Expert Rev Med Devices 2019; 16:787-798. [PMID: 31453716 DOI: 10.1080/17434440.2019.1660643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction: Left ventricular assist device (LVAD) implantation has become a well-established treatment option for patients with end stage heart failure (HF) who are refractory to medical therapy. While LVADs implantation does effectively improve hemodynamic performance many patients still possess peripheral pathological adaptations often present in end-stage HF. Therefore, increased attention has been placed on investigating the effects of exercise training for patients with LVADs to improve clinical outcomes. However, the available evidence on exercise training for patients with LVADs is limited. Areas covered: The purpose of this narrative review is to summarize: 1) The evolution of LVAD technology and usage; 2) The physiological responses to exercise in patients with LVADs; 3) The available evidence regarding exercise training; 4) Potential strategies to implement exercise training programs for this patient population. Expert opinion: The available evidence for exercise training to improve physical function and clinical outcomes for patients with LVADs is promising but limited. Future research is needed to further elucidate the ideal exercise training parameters, method of delivery for exercise training, and unique barriers and facilitators to exercise training for patients receiving LVAD implantation.
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Affiliation(s)
- Richard Severin
- Department of Physical Therapy, University of Illinois , Chicago , IL , USA
| | - Ahmad Sabbahi
- Department of Physical Therapy, University of Illinois , Chicago , IL , USA
| | - Cemal Ozemek
- Department of Physical Therapy, University of Illinois , Chicago , IL , USA
| | - Shane Phillips
- Department of Physical Therapy, University of Illinois , Chicago , IL , USA
| | - Ross Arena
- Department of Physical Therapy, University of Illinois , Chicago , IL , USA
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Nygaard S, Christensen AH, Rolid K, Nytrøen K, Gullestad L, Fiane A, Thaulow E, Døhlen G, Godang K, Saul JP, Wyller VBB. Autonomic cardiovascular control changes in recent heart transplant recipients lead to physiological limitations in response to orthostatic challenge and isometric exercise. Eur J Appl Physiol 2019; 119:2225-2236. [PMID: 31407088 PMCID: PMC6763412 DOI: 10.1007/s00421-019-04207-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Heart transplantation causes denervation of the donor heart, but the consequences for cardiovascular homeostasis remain to be fully understood. The present study investigated cardiovascular autonomic control at supine rest, during orthostatic challenge and during isometric exercise in heart transplant recipients (HTxR). METHODS A total of 50 HTxRs were investigated 7-12 weeks after transplant surgery and compared with 50 healthy control subjects. Continuous, noninvasive recordings of cardiovascular variables were carried out at supine rest, during 15 min of 60° head-up tilt and during 1 min of 30% of maximal voluntary handgrip. Plasma and urine catecholamines were assayed, and symptoms were charted. RESULTS At supine rest, heart rate, blood pressures and total peripheral resistance were higher, and stroke volume and end diastolic volume were lower in the HTxR group. During tilt, heart rate, blood pressures and total peripheral resistance increased less, and stroke volume and end diastolic volume decreased less. During handgrip, heart rate and cardiac output increased less, and stroke volume and end diastolic volume decreased less. Orthostatic symptoms were similar across the groups, but the HTxRs complained more of pale and cold hands. CONCLUSION HTxRs are characterized by elevated blood pressures and total peripheral resistance at supine rest as well as attenuated blood pressures and total peripheral resistance responses during orthostatic challenge, possibly caused by low-pressure cardiopulmonary baroreceptor denervation. In addition, HTxRs show attenuated cardiac output response during isometric exercise due to efferent sympathetic denervation. These physiological limitations might have negative functional consequences.
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Affiliation(s)
- Sissel Nygaard
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anders Haugom Christensen
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Katrine Rolid
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kari Nytrøen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Arnt Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Thaulow
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Gaute Døhlen
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - J Philip Saul
- Department of Pediatrics, West Virginia University, Morgantown, USA
| | - Vegard Bruun Bratholm Wyller
- Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Paediatrics, Akershus University Hospital, 1478, Lørenskog, Norway.
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40
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Pons S, Sonneville R, Bouadma L, Styfalova L, Ruckly S, Neuville M, Radjou A, Lebut J, Dilly MP, Mourvillier B, Dorent R, Nataf P, Wolff M, Timsit JF. Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation. Ann Intensive Care 2019; 9:17. [PMID: 30684052 PMCID: PMC6347647 DOI: 10.1186/s13613-019-0490-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/12/2019] [Indexed: 01/09/2023] Open
Abstract
Background Infectious complications are a major cause of morbidity and mortality after heart transplantation (HT). However, the epidemiology and outcomes of these infections in the recent population of adult heart transplant recipients have not been investigated. Methods We conducted a single-center retrospective study on infectious complications occurring within 180 days following HT on consecutive heart transplant recipients, from January 2011 to June 2015 at Bichat University Hospital in Paris, France. Risk factors for non-viral infections occurring within 8, 30 and 180 days after HT were investigated using competing risk analysis. Results Overall, 113 patients were included. Fifty-eight (51%) HTs were high-priority allocations. Twenty-eight (25%) patients had an extracorporeal membrane oxygenation (ECMO) support at the time of transplantation. Ninety-two (81%) patients developed at least one infection within 180 days after HT. Bacterial and fungal infections (n = 181 episodes) occurred in 80 (71%) patients. The most common bacterial and fungal infections were pneumonia (n = 95/181 episodes, 52%), followed by skin and soft tissue infections (n = 26/181, 14%). Multi-drug-resistant bacteria were responsible for infections in 21 (19%) patients. Viral infections were diagnosed in 44 (34%) patients, mostly Cytomegalovirus infection (n = 39, 34%). In multivariate subdistribution hazard model, prior cardiac surgery (subdistribution hazard ratio sHR = 2.7 [95% CI 1.5–4.6] p < 0.01) and epinephrine or norepinephrine at the time of HT (sHR = 2.3 [95% CI 1.1–5.2] p = 0.04) were significantly associated with non-viral infections within 8 days after HT. Prior cardiac surgery (sHR = 2.5 [95% CI 1.4–4.4] p < 0.01), recipient age over 60 years (sHR = 2.0 [95% CI 1.2–3.3] p < 0.01) and ECMO following HT (sHR = 1.7 [95% CI 1.0–2.8] p = 0.04) were significantly associated with non-viral infection within 30 days after HT, as well as within 180 days after HT. Conclusion This study confirmed the high rate of infections following HT. Recipient age, prior cardiac surgery and ECMO following HT were independent risk factors for early and late bacterial and fungal infections. Electronic supplementary material The online version of this article (10.1186/s13613-019-0490-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stéphanie Pons
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Romain Sonneville
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France. .,UMR 1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France.
| | - Lila Bouadma
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases Prevention, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France
| | | | | | - Mathilde Neuville
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Aguila Radjou
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Jordane Lebut
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Marie-Pierre Dilly
- Department of Anesthesiology, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Bruno Mourvillier
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases Prevention, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France
| | - Richard Dorent
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Patrick Nataf
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Michel Wolff
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Jean-François Timsit
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases Prevention, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France
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41
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Peña B, Laughter M, Jett S, Rowland TJ, Taylor MRG, Mestroni L, Park D. Injectable Hydrogels for Cardiac Tissue Engineering. Macromol Biosci 2018; 18:e1800079. [PMID: 29733514 PMCID: PMC6166441 DOI: 10.1002/mabi.201800079] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/27/2018] [Indexed: 12/21/2022]
Abstract
In light of the limited efficacy of current treatments for cardiac regeneration, tissue engineering approaches have been explored for their potential to provide mechanical support to injured cardiac tissues, deliver cardio-protective molecules, and improve cell-based therapeutic techniques. Injectable hydrogels are a particularly appealing system as they hold promise as a minimally invasive therapeutic approach. Moreover, injectable acellular alginate-based hydrogels have been tested clinically in patients with myocardial infarction (MI) and show preservation of the left ventricular (LV) indices and left ventricular ejection fraction (LVEF). This review provides an overview of recent developments that have occurred in the design and engineering of various injectable hydrogel systems for cardiac tissue engineering efforts, including a comparison of natural versus synthetic systems with emphasis on the ideal characteristics for biomimetic cardiac materials.
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Affiliation(s)
- Brisa Peña
- Cardiovascular Institute, School of Medicine, Division of Cardiology, University of Colorado Denver Anschutz Medical Campus, 12700 E.19th Avenue, Bldg. P15, Aurora, CO, 80045, USA
| | - Melissa Laughter
- Bioengineering Department, University of Colorado Denver Anschutz Medical Campus, Bioscience 2 1270 E. Montview Avenue, Suite 100, Aurora, CO, 80045, USA
| | - Susan Jett
- Cardiovascular Institute, School of Medicine, Division of Cardiology, University of Colorado Denver Anschutz Medical Campus, 12700 E.19th Avenue, Bldg. P15, Aurora, CO, 80045, USA
| | - Teisha J Rowland
- Cardiovascular Institute, School of Medicine, Division of Cardiology, University of Colorado Denver Anschutz Medical Campus, 12700 E.19th Avenue, Bldg. P15, Aurora, CO, 80045, USA
| | - Matthew R G Taylor
- Cardiovascular Institute, School of Medicine, Division of Cardiology, University of Colorado Denver Anschutz Medical Campus, 12700 E.19th Avenue, Bldg. P15, Aurora, CO, 80045, USA
| | - Luisa Mestroni
- Cardiovascular Institute, School of Medicine, Division of Cardiology, University of Colorado Denver Anschutz Medical Campus, 12700 E.19th Avenue, Bldg. P15, Aurora, CO, 80045, USA
| | - Daewon Park
- Bioengineering Department, University of Colorado Denver Anschutz Medical Campus, Bioscience 2 1270 E. Montview Avenue, Suite 100, Aurora, CO, 80045, USA
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Wdowczyk J, Makowiec D, Gruchała M, Wejer D, Struzik ZR. Dynamical Landscape of Heart Rhythm in Long-Term Heart Transplant Recipients: A Way to Discern Erratic Rhythms. Front Physiol 2018; 9:274. [PMID: 29686620 PMCID: PMC5900061 DOI: 10.3389/fphys.2018.00274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/08/2018] [Indexed: 12/26/2022] Open
Abstract
It is commonly believed that higher values of heart rate variability (HRV) indices account for better organization of the network of feedback reflexes driving an organism's response to actual bodily needs. In order to evaluate this organization in heart transplant (HTX) recipients, 58 nocturnal Holter signals of 14 HTX patients were analyzed. Their dynamical properties were evaluated by short-term HRV indices and measures grounded on entropy. Estimates grouped according to the patients' clinical progress: free of complications versus with complications, and arranged in order of the length of time since the HTX, lead us to the conclusion that higher HRV is associated with a worse outcome for HTX patients. Moreover, short-term HRV indices that are constant, rather than increasing over time, serve well in the prognosis of the future state of a HTX patient. These findings suggest that increases observed in HRV indices are related to erratic rhythms resulting from remodeling of the cardiac tissue (including heterogeneous innervation) in long-term HTX patients. Therefore, we hypothesize that dynamical landscape markers (entropy and fragmentation measures together with the short-term HRV indices) can serve as a tool in the exploration of the genesis of (non-respiratory sinus) arrhythmia.
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Affiliation(s)
- Joanna Wdowczyk
- First Cardiology Clinic, Medical University of Gdańsk, Gdańsk, Poland
| | - Danuta Makowiec
- Faculty of Mathematics, Physics and Informatics, Institute of Theoretical Physics and Astrophysics, University of Gdańsk, Gdańsk, Poland
| | - Marcin Gruchała
- First Cardiology Clinic, Medical University of Gdańsk, Gdańsk, Poland
| | - Dorota Wejer
- Faculty of Mathematics, Physics and Informatics, Institute of Experimental Physics, University of Gdańsk, Gdańsk, Poland
| | - Zbigniew R Struzik
- Laboratory for Advanced Brain Signal Processing, RIKEN Brain Science Institute, Wako, Japan.,Graduate School of Education, University of Tokyo, Tokyo, Japan
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43
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Winstead RJ, Pandya K, Flynn J, Davis GA, Sieg A, Guglin M, Schadler A, Evans RA. Factor VIIa administration in orthotopic heart transplant recipients and its impact on thromboembolic events and post-transplant outcomes. J Thromb Thrombolysis 2018; 45:452-456. [PMID: 29508176 DOI: 10.1007/s11239-018-1627-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Recombinant, activated factor VIIa (rFVIIa) is used during cardiac surgeries to mitigate refractory coagulopathic bleeding. The purpose of this study was to examine whether rFVIIa use in orthotopic heart transplant (OHT) recipients was associated with a higher incidence of thromboembolic (TE) events compared to patients who did not. A single-center, retrospective, cohort study was performed on OHT recipients who received rFVIIa for refractory coagulopathic bleeding from January 2013 to December 2015. Patients were evaluated for up to 6 months after transplantation and assessed for TE events, rejection, readmissions, graft survival, and patient survival. Categorical variables were analyzed using the Chi square test while student's t or ANOVA testing was utilized for continuous variables. Of the 62 patients who met inclusion criteria, 27 patients received rFVIIa, and 35 patients were selected for the control group. The overall incidence of TE events was not significantly different between patients who received rFVIIa compared to patients in the control group (14.8% vs 11.4%) (p = 0.69). Within 14 days, 14.81% of rFVIIa patients suffered a TE event compared to 5.7% of the control group (p = 0.23). Rejection, readmissions, graft survival, and patient survival were not significantly different at any time points. Use of rFVIIa in heart transplantation showed no difference in the overall rate of TE events, however, there was a nonsignificant trend toward higher risk of early TE development in the rFVIIa group compared to the control group.
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Affiliation(s)
- Ryan J Winstead
- University of Kentucky Healthcare, 800 Rose St, H110, Lexington, KY, 40536, USA.
| | - Komal Pandya
- University of Kentucky Healthcare, 800 Rose St, H110, Lexington, KY, 40536, USA.,University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Jeremy Flynn
- University of Kentucky Healthcare, 800 Rose St, H110, Lexington, KY, 40536, USA.,University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - George A Davis
- University of Kentucky Healthcare, 800 Rose St, H110, Lexington, KY, 40536, USA.,University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Adam Sieg
- University of Kentucky Healthcare, 800 Rose St, H110, Lexington, KY, 40536, USA.,University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Maya Guglin
- University of Kentucky Healthcare, 800 Rose St, H110, Lexington, KY, 40536, USA
| | - Aric Schadler
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Rickey A Evans
- University of South Carolina College of Pharmacy, Columbia, SC, USA
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Song J, Su W, Chen X, Zhao Q, Zhang N, Li MG, Yang PC, Wang L. Micro RNA-98 suppresses interleukin-10 in peripheral B cells in patient post-cardio transplantation. Oncotarget 2018; 8:28237-28246. [PMID: 28415669 PMCID: PMC5438646 DOI: 10.18632/oncotarget.16000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/28/2017] [Indexed: 12/26/2022] Open
Abstract
The immune tolerance to the transplant heart survival is critical. Regulatory B cells are one of the major immune regulatory cell populations in the immune tolerance. Micro RNAs (miR) can regulate the activities of immune cells, such as the expression of interleukin (IL)-10 by B cells. This study tests a hypothesis that micro RNA (miR)-98 plays a role in the regulation of interleukin (IL)-10 expression in B cells (B10 cell) after heart transplantation. In this study, the peripheral blood samples were collected from patients before and after heart transplantation. The expression of miR-98 and IL-10 in B cells was assessed by real time RT-PCR. An allograft heart transplantation mouse model was developed. We observed that after heart transplantation, the frequency of peripheral B10 cell and the IL-10 mRNA levels in peripheral B cells were significantly decreased, the levels of miR-98 were increased in peripheral B cells and the serum levels of cortisol were increased in the patients. Treating naive B cells with cortisol in the culture suppressed the expression of IL-10 in B cells, which was abolished by knocking down the miR-98 gene. Administration with anti-miR-98, or cortisol inhibitor, or adoptive transfer with B10 cells, significantly enhanced the survival rate and time of mice received allograft heart transplantation. In conclusion, the enhancement of serum cortisol affects the immune tolerant feature of B cells, which can be attenuated by anti-miR-98-carrying liposomes.
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Affiliation(s)
- Jiangping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing, 100037, China
| | - Wenjun Su
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing, 100037, China
| | - Xiao Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing, 100037, China
| | - Qian Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing, 100037, China
| | - Ningning Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing, 100037, China
| | - Mao-Gang Li
- The Research Center of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Ping-Chang Yang
- The Research Center of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Liqing Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing, 100037, China
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45
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Keating BJ, Pereira AC, Snyder M, Piening BD. Applying genomics in heart transplantation. Transpl Int 2018; 31:278-290. [PMID: 29363220 PMCID: PMC5990370 DOI: 10.1111/tri.13119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/18/2017] [Accepted: 01/17/2018] [Indexed: 12/13/2022]
Abstract
While advances in patient care and immunosuppressive pharmacotherapies have increased the lifespan of heart allograft recipients, there are still significant comorbidities post-transplantation and 5-year survival rates are still significant, at approximately 70%. The last decade has seen massive strides in genomics and other omics fields, including transcriptomics, with many of these advances now starting to impact heart transplant clinical care. This review summarizes a number of the key advances in genomics which are relevant for heart transplant outcomes, and we highlight the translational potential that such knowledge may bring to patient care within the next decade.
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Affiliation(s)
- Brendan J. Keating
- Division of Transplantation, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Michael Snyder
- Department of Genetics, Stanford University, Stanford, CA, USA
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46
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Peña B, Bosi S, Aguado BA, Borin D, Farnsworth NL, Dobrinskikh E, Rowland TJ, Martinelli V, Jeong M, Taylor MRG, Long CS, Shandas R, Sbaizero O, Prato M, Anseth KS, Park D, Mestroni L. Injectable Carbon Nanotube-Functionalized Reverse Thermal Gel Promotes Cardiomyocytes Survival and Maturation. ACS APPLIED MATERIALS & INTERFACES 2017; 9:31645-31656. [PMID: 28895403 PMCID: PMC5672802 DOI: 10.1021/acsami.7b11438] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The ability of the adult heart to regenerate cardiomyocytes (CMs) lost after injury is limited, generating interest in developing efficient cell-based transplantation therapies. Rigid carbon nanotubes (CNTs) scaffolds have been used to improve CMs viability, proliferation, and maturation, but they require undesirable invasive surgeries for implantation. To overcome this limitation, we developed an injectable reverse thermal gel (RTG) functionalized with CNTs (RTG-CNT) that transitions from a solution at room temperature to a three-dimensional (3D) gel-based matrix shortly after reaching body temperature. Here we show experimental evidence that this 3D RTG-CNT system supports long-term CMs survival, promotes CMs alignment and proliferation, and improves CMs function when compared with traditional two-dimensional gelatin controls and 3D plain RTG system without CNTs. Therefore, our injectable RTG-CNT system could potentially be used as a minimally invasive tool for cardiac tissue engineering efforts.
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Affiliation(s)
- Brisa Peña
- Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, School of Medicine, Division of Cardiology, 12700 E. 19th Avenue, Bldg. P15, Aurora, Colorado 80045, United States
| | - Susanna Bosi
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Trieste 34127, Italy
| | - Brian A. Aguado
- Department of Chemical and Biological Engineering and Howard Hughes Medical Institute and the BioFrontiers Institute, University of Colorado at Boulder, 3415 Colorado Avenue, Boulder, Colorado 80309, United States
| | - Daniele Borin
- Department of Engineering and Architecture, University of Trieste, Trieste 34127, Italy
| | - Nikki L. Farnsworth
- Bioengineering Department, University of Colorado Denver Anschutz Medical Campus, Bioscience 2 1270 E. Montview Avenue, Suite 100, Aurora, Colorado 80045, United States
| | - Evgenia Dobrinskikh
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, 12700 E. 19th Avenue, Bldg. P15, Aurora, Colorado 80045, United States
| | - Teisha J. Rowland
- Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, School of Medicine, Division of Cardiology, 12700 E. 19th Avenue, Bldg. P15, Aurora, Colorado 80045, United States
| | - Valentina Martinelli
- International Center for Genetic Engineering and Biotechnology, Area Science Park, Padriciano 99, Trieste 34149, Italy
| | - Mark Jeong
- Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, School of Medicine, Division of Cardiology, 12700 E. 19th Avenue, Bldg. P15, Aurora, Colorado 80045, United States
| | - Matthew R. G. Taylor
- Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, School of Medicine, Division of Cardiology, 12700 E. 19th Avenue, Bldg. P15, Aurora, Colorado 80045, United States
| | - Carlin S. Long
- Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, School of Medicine, Division of Cardiology, 12700 E. 19th Avenue, Bldg. P15, Aurora, Colorado 80045, United States
| | - Robin Shandas
- Bioengineering Department, University of Colorado Denver Anschutz Medical Campus, Bioscience 2 1270 E. Montview Avenue, Suite 100, Aurora, Colorado 80045, United States
| | - Orfeo Sbaizero
- Department of Engineering and Architecture, University of Trieste, Trieste 34127, Italy
| | - Maurizio Prato
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Trieste 34127, Italy
- Carbon Nanobiotechnology Laboratory, CIC biomaGUNE, Paseo de Miramón 182 20009, Donostia-San Sebastián 20009, Spain
- Basque Foundation for Science, Ikerbasque, Bilbao 48013, Spain
| | - Kristi S. Anseth
- Department of Chemical and Biological Engineering and Howard Hughes Medical Institute and the BioFrontiers Institute, University of Colorado at Boulder, 3415 Colorado Avenue, Boulder, Colorado 80309, United States
| | - Daewon Park
- Bioengineering Department, University of Colorado Denver Anschutz Medical Campus, Bioscience 2 1270 E. Montview Avenue, Suite 100, Aurora, Colorado 80045, United States
| | - Luisa Mestroni
- Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, School of Medicine, Division of Cardiology, 12700 E. 19th Avenue, Bldg. P15, Aurora, Colorado 80045, United States
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Current status of the implantable LVAD. Gen Thorac Cardiovasc Surg 2016; 64:501-8. [PMID: 27270581 DOI: 10.1007/s11748-016-0671-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
With the ongoing shortage of available organs for heart transplantation, mechanical circulatory support devices have been increasingly utilized for managing acute and chronic heart failure that is refractory to medical therapy. In particular, the introduction of the left ventricular assist devices (LVAD) has revolutionized the field. In this review, we will discuss a brief history of the LVAD, available devices, current indications, patient selection, complications, and outcomes. In addition, we will discuss recent outcomes and advancements in the field of noncardiac surgery in the LVAD patient. Finally, we will discuss several topics for surgical consideration during LVAD implantation.
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Mahmoud AI, Lee RT. Adrenergic function restoration in the transplanted heart: a role for neural crest-derived cells. Cardiovasc Res 2016; 109:348-9. [PMID: 26786156 DOI: 10.1093/cvr/cvw013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ahmed I Mahmoud
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02139, USA Harvard Stem Cell Institute, Cambridge, MA 02138, USA Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Richard T Lee
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02139, USA Harvard Stem Cell Institute, Cambridge, MA 02138, USA Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Donor-derived exosomes induce specific regulatory T cells to suppress immune inflammation in the allograft heart. Sci Rep 2016; 7:20077. [PMID: 26822278 PMCID: PMC4731812 DOI: 10.1038/srep20077] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/09/2015] [Indexed: 02/08/2023] Open
Abstract
To inhibit the immune inflammation in the allografts can be beneficial to organ transplantation. This study aims to induce the donor antigen specific regulatory T cells (Treg cell) inhibit the immune inflammation in the allograft heart. In this study, peripheral exosomes were purified from the mouse serum. A heart transplantation mouse model was developed. The immune inflammation of the allograft heart was assessed by histology and flow cytometry. The results showed that the donor antigen-specific T helper (Th)2 pattern inflammation was observed in the allograft hearts; the inflammation was inhibited by immunizing the recipient mice with the donor-derived exosomes. Purified peripheral exosomes contained integrin MMP1a; the latter induced CD4+ T cells to express Fork head protein-3 and transforming growth factor (TGF)-β via inhibiting the Th2 transcription factor, GATA binding protein 3, in CD4+ T cells. Administration with the donor-derived exosomes significantly prolonged the allograft heart survival. We conclude that the donor-derived peripheral exosomes have the capacity to inhibit the immune inflammation in the allograft heart via inducing specific Treg cells, implicating that administration with the donor-derived exosomes may be beneficial to cardiac transplantation.
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Wang YQ, Yang PT, Yuan H, Cao X, Zhu XL, Xu G, Mo ZH, Chen ZH. Low bone mineral density is associated with increased arterial stiffness in participants of a health records based study. J Thorac Dis 2015; 7:790-8. [PMID: 26101634 DOI: 10.3978/j.issn.2072-1439.2015.04.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/10/2015] [Indexed: 11/14/2022]
Abstract
AIMS Many epidemiological studies have shown that low bone mineral density (BMD) and atherosclerosis appear to be related. However, their precise correlation is not completely understood after full adjustment the shared confounders of atherosclerosis and bone metabolism. The aim of this cross-sectional study was to investigate the relationship between BMD and subclinical atherosclerosis in a healthy Chinese population and the difference in gender. METHODS The study population consisted of 2,487 subjects (1,467 men, 1,020 women) who participated in health check-up programs and were selected to be free of major diseases which might affect atherosclerosis and bone metabolism. Bone status was assessed by BMD in lumbar spine. The brachial-ankle PWV (baPWV) was assessed as a functional marker of atherosclerosis. The ankle-brachial index (ABI), carotid artery intima-media thickness (CIMT), estimated glomerular filtration rate (eGRF) and microalbuminuria were evaluated as indexes of structural markers of atherosclerosis. RESULTS After adjustment for risk factors, significant association was shown between baPWV and BMD in both genders (male: r=-0.084, P=0.035; female: r=-0.088, P=0.014). The correlation was stronger in females than in males, and in females, the correlation was stronger after menopause. Similarly, mean baPWV differed significantly according to the decreased BMD (normal BMD, Osteopenia, Osteoporosis). In contrast, no significant differences were observed for ABI, CIMT, eGFR or microalbuminuria with BMD. CONCLUSIONS Independent of confounding factors, low BMD is associated with the functional marker of subclinical atherosclerosis (increased baPWV), but not with structural markers (ABI, CIMT, eGFR or microalbuminuria) among healthy females and males.
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Affiliation(s)
- Ya-Qin Wang
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ping-Ting Yang
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Hong Yuan
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xia Cao
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xiao-Ling Zhu
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Guo Xu
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Zhao-Hui Mo
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Zhi-Heng Chen
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
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