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Özsoy M, Yalçin S, Varlibaş A, Çifci A, Cesur S, Aksoy A, Berkem R. Determination of SARS-CoV-2 IgG antibody levels in hematology-oncology patients after COVID-19 vaccination. Eur Rev Med Pharmacol Sci 2024; 28:1624-1631. [PMID: 38436195 DOI: 10.26355/eurrev_202402_35492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Cancer patients are among the high-risk groups where COVID-19 infection tends to be severe and can lead to increased mortality. Therefore, they are included in the priority groups for COVID-19 vaccination. This study aimed to compare the levels of SARS-CoV-2 immunoglobulin G (IgG) antibodies following two different COVID-19 vaccinations between hematology-oncology patients and healthcare personnel and to identify factors associated with these antibody levels. PATIENTS AND METHODS A prospective study was conducted with 91 hematology-oncology patients (cancer group) and 75 healthcare personnel (control group) from January 2020 to June 2023. The cancer and control groups comprised adults who had received a booster dose, with either a single dose of BNT162b2 or two doses of CoronaVac™ spaced one month apart, following their primary vaccination with two doses of either CoronaVac™ or BNT162b2. Four weeks after the administration of the booster dose, levels of SARS-CoV-2 IgG antibodies were assessed using an ELISA kit. Antibody levels above 50 AU/mL were accepted as signifying seropositivity. RESULTS The median SARS-CoV-2 IgG antibody level was lower in the cancer group compared to the control group (4,509 vs. 7,268, p = 0.004), while the rate of seroconversion was similar between the groups (97.8% vs. 100%, p = 0.564). In the cancer group, no association was found between SARS-CoV-2 IgG antibody levels and age, sex, comorbidity, type of malignancy, stage and duration, or type of vaccine. CONCLUSIONS In cancer patients, the seroconversion positivity rate was about 98%. However, antibody responses were still lower compared to the control group. No difference was detected in antibody levels among cancer patients based on the type of vaccine.
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Affiliation(s)
- M Özsoy
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Ankara Training and Research Hospital, Ankara, Turkey.
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Sudo M, Shamekhi J, Aksoy A, Al-Kassou B, Tanaka T, Silaschi M, Weber M, Nickenig G, Zimmer S. A simply calculated nutritional index provides clinical implications in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2024; 113:58-67. [PMID: 37178161 PMCID: PMC10808226 DOI: 10.1007/s00392-023-02220-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Malnutrition is associated with adverse outcomes in patients with aortic stenosis. The Triglycerides × Total Cholesterol × Body Weight Index (TCBI) is a simple scoring model to evaluate the status of nutrition. However, the prognostic relevance of this index in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. This study aimed to evaluate the association of the TCBI with clinical outcomes in patients undergoing TAVR. METHODS A total of 1377 patients undergoing TAVR were evaluated in this study. The TCBI was calculated by the formula; triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg)/1000. The primary outcome was all-cause mortality within 3 years. RESULTS Patients with a low TCBI, based on a cut-off value of 985.3, were more likely to have elevated right atrial pressure (p = 0.04), elevated right ventricular pressure (p < 0.01), right ventricular systolic dysfunction (p < 0.01), tricuspid regurgitation ≥ moderate (p < 0.01). Patients with a low TCBI had a higher cumulative 3-year all-cause (42.3% vs. 31.6%, p < 0.01; adjusted HR 1.36, 95% CI 1.05-1.77, p = 0.02) and non-cardiovascular mortality (15.5% vs. 9.1%, p < 0.01; adjusted HR 1.95, 95% CI 1.22-3.13, p < 0.01) compared to those with a high TCBI. Adding a low TCBI to EuroSCORE II improved the predictive value for 3-year all-cause mortality (net reclassification improvement, 0.179, p < 0.01; integrated discrimination improvement, 0.005, p = 0.01). CONCLUSION Patients with a low TCBI were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality. The TCBI may provide additional information for risk stratification in patients undergoing TAVR.
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Affiliation(s)
- Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Jasmin Shamekhi
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Adem Aksoy
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Salam B, Al Zaidi M, Sprinkart AM, Nowak S, Theis M, Kuetting D, Aksoy A, Nickenig G, Attenberger U, Zimmer S, Luetkens JA. Opportunistic CT-derived analysis of fat and muscle tissue composition predicts mortality in patients with cardiogenic shock. Sci Rep 2023; 13:22293. [PMID: 38102168 PMCID: PMC10724270 DOI: 10.1038/s41598-023-49454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
Prognosis estimation in patients with cardiogenic shock (CS) is important to guide clinical decision making. Aim of this study was to investigate the predictive value of opportunistic CT-derived body composition analysis in CS patients. Amount and density of fat and muscle tissue of 152 CS patients were quantified from single-slice CT images at the level of the intervertebral disc space L3/L4. Multivariable Cox regression and Kaplan-Meier survival analyses were performed to evaluate the predictive value of opportunistically CT-derived body composition parameters on the primary endpoint of 30-day mortality. Within the 30-day follow-up, 90/152 (59.2%) patients died. On multivariable analyses, lactate (Hazard Ratio 1.10 [95% Confidence Interval 1.04-1.17]; p = 0.002) and patient age (HR 1.04 [95% CI 1.01-1.07], p = 0.017) as clinical prognosticators, as well as visceral adipose tissue (VAT) area (HR 1.004 [95% CI 1.002-1.007]; p = 0.001) and skeletal muscle (SM) area (HR 0.987 [95% CI 0.975-0.999]; p = 0.043) as imaging biomarkers remained as independent predictors of 30-day mortality. Kaplan-Meier survival analyses showed significantly increased 30-day mortality in patients with higher VAT area (p = 0.015) and lower SM area (p = 0.035). CT-derived VAT and SM area are independent predictors of dismal outcomes in CS patients and have the potential to emerge as new imaging biomarkers available from routine diagnostic CT.
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Affiliation(s)
- Babak Salam
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Muntadher Al Zaidi
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Sebastian Nowak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Maike Theis
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Adem Aksoy
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.
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Blachutzik F, Meier S, Weissner M, Schlattner S, Gori T, Ullrich H, Gaede L, Achenbach S, Möllmann H, Chitic B, Aksoy A, Nickenig G, Weferling M, Pons-Kühnemann J, Dörr O, Boeder N, Bayer M, Elsässer A, Hamm CW, Nef H. Coronary intravascular lithotripsy and rotational atherectomy for severely calcified stenosis: Results from the ROTA.shock trial. Catheter Cardiovasc Interv 2023; 102:823-833. [PMID: 37668088 DOI: 10.1002/ccd.30815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/07/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Severely calcified coronary lesions present a particular challenge for percutaneous coronary intervention. AIMS The aim of this randomized study was to determine whether coronary intravascular lithotripsy (IVL) is non-inferior to rotational atherectomy (RA) regarding minimal stent area (MSA). METHODS The randomized, prospective non-inferiority ROTA.shock trial enrolled 70 patients between July 2019 and November 2021. Patients were randomly (1:1) assigned to undergo either IVL or RA before percutaneous coronary intervention of severely calcified coronary lesions. Optical coherence tomography was performed at the end of the procedure for primary endpoint analysis. RESULTS The primary endpoint MSA was lower but non-inferior after IVL (mean: 6.10 mm2 , 95% confidence interval [95% CI]: 5.32-6.87 mm2 ) versus RA (6.60 mm2 , 95% CI: 5.66-7.54 mm2 ; difference in MSA: -0.50 mm2 , 95% CI: -1.52-0.52 mm2 ; non-inferiority margin: -1.60 mm2 ). Stent expansion was similar (RA: 0.83 ± 0.10 vs. IVL: 0.82 ± 0.11; p = 0.79). There were no significant differences regarding contrast media consumption (RA: 183.1 ± 68.8 vs. IVL: 163.3 ± 55.0 mL; p = 0.47), radiation dose (RA: 7269 ± 11288 vs. IVL: 5010 ± 4140 cGy cm2 ; p = 0.68), and procedure time (RA: 79.5 ± 34.5 vs. IVL: 66.0 ± 19.4 min; p = 0.18). CONCLUSION IVL is non-inferior regarding MSA and results in a similar stent expansion in a random comparison with RA. Procedure time, contrast volume, and dose-area product do not differ significantly.
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Affiliation(s)
- F Blachutzik
- Medizinische Klinik 1, Justus Liebig Universität Giessen, Giessen, Germany
| | - S Meier
- Medizinische Klinik 1, Justus Liebig Universität Giessen, Giessen, Germany
| | - M Weissner
- Kerckhoff-Klinik, Kardiologie, Bad Nauheim, Germany
| | - S Schlattner
- Medizinische Klinik 1, Justus Liebig Universität Giessen, Giessen, Germany
| | - T Gori
- Kardiologie 1, Universitätsmedizin Mainz, Mainz, Germany
| | - H Ullrich
- Kardiologie 1, Universitätsmedizin Mainz, Mainz, Germany
| | - L Gaede
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Möllmann
- St. Johannes-Hospital, Innere Medizin 1, Dortmund, Germany
| | - B Chitic
- St. Johannes-Hospital, Innere Medizin 1, Dortmund, Germany
| | - A Aksoy
- Medizinische Klinik 2, Universitätsklinikum Bonn, Bonn, Germany
| | - G Nickenig
- Medizinische Klinik 2, Universitätsklinikum Bonn, Bonn, Germany
| | - M Weferling
- Kerckhoff-Klinik, Kardiologie, Bad Nauheim, Germany
| | - J Pons-Kühnemann
- Institute for Medical Informatics, Justus Liebig University Giessen, Giessen, Germany
| | - O Dörr
- Medizinische Klinik 1, Justus Liebig Universität Giessen, Giessen, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Germany
| | - N Boeder
- Medizinische Klinik 1, Justus Liebig Universität Giessen, Giessen, Germany
| | - M Bayer
- Medizinische Klinik 1, Justus Liebig Universität Giessen, Giessen, Germany
| | - A Elsässer
- Klinik für Innere Medizin - Kardiologie, Universitätsklinikum Oldenburg, Oldenburg, Germany
| | - C W Hamm
- Medizinische Klinik 1, Justus Liebig Universität Giessen, Giessen, Germany
- Kerckhoff-Klinik, Kardiologie, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Germany
| | - H Nef
- Medizinische Klinik 1, Justus Liebig Universität Giessen, Giessen, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Germany
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Al-Kassou B, Al-Shaikh H, Aksoy A, Shamekhi J, Zietzer A, Sugiura A, Veulemans V, Adam M, Grube E, Bakhtiary F, Zimmer S, Kelm M, Baldus S, Nickenig G, Sedaghat A. Impact of transradial versus transfemoral access for preprocedural coronary angiography on TAVR-associated complications. Int J Cardiol Heart Vasc 2023; 46:101205. [PMID: 37122629 PMCID: PMC10130599 DOI: 10.1016/j.ijcha.2023.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
Background Vascular injury and bleeding complications remain frequent after transcatheter aortic valve replacement (TAVR). Whether the access-site of preprocedural coronary angiography (CAG) affects TAVR-related complications is not known. The aim of this study was to evaluate the impact of transradial (TRA) versus transfemoral access (TFA) for preprocedural CAG on outcomes in patients undergoing subsequent TAVR. Methods The study cohort included 1002 patients undergoing transfemoral TAVR, of whom 39.4% (395/1002) had undergone radial and 60.6% (607/1002) femoral access for pre-TAVR CAG. The primary endpoint was a composite of 30-day mortality and major vascular complications after TAVR. Key secondary endpoints included VARC-3-defined complications. Results The primary endpoint occurred less frequently in patients with prior TRA (3.3%) as compared to patients with prior TFA (6.3%, p = 0.04), which was mainly driven by significantly lower rates of major vascular complications (0.8% vs 2.5%, p = 0.05). Moreover, incidences of periprocedural access-related vascular injury and unplanned endovascular interventions were lower in TRA patients (13.2% vs 18.0%, p = 0.05). The rate of major bleeding tended to be lower in the TRA (1.5%) as compared to the TFA group (3.5%) but was not significantly different (p = 0.07). Moreover, the rate of life-threatening bleeding was comparable between both groups (0.5% vs 0.8%, p = 0.71). Conclusion Transradial access for preprocedural CAG was associated with significantly lower rates of vascular complications following subsequent TAVR as compared to transfemoral access. However, despite the tendency to lower major bleedings with transradial access, no significant association was detectable between the access-site of coronary angiography and TAVR-related bleeding complications.
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Affiliation(s)
- Baravan Al-Kassou
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Hasanin Al-Shaikh
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Adem Aksoy
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Andreas Zietzer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Division of Cardiology, University Hospital of Duesseldorf, Germany
- CARID, Cardiovascular Research Institute Duesseldorf, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Farhad Bakhtiary
- Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- CARID, Cardiovascular Research Institute Duesseldorf, Germany
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
- RheinAhrCardio, Praxis für Kardiologie, Bad Neuenahr-Ahrweiler, Germany
- Corresponding author.
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Keskin C, Aksoy A, Kalyoncuoğlu E, Keleş A, İlik AA, Kömeç O, Yüzgüleç E, Akgün H, Alak SG, Tokur O. Effect of intracanal cryotherapy on the inflammatory cytokine, proteolytic enzyme levels and postoperative pain in teeth with asymptomatic apical periodontitis: A randomised clinical trial. Int Endod J 2023. [PMID: 37222468 DOI: 10.1111/iej.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/20/2023] [Accepted: 05/21/2023] [Indexed: 05/25/2023]
Abstract
AIM to investigate the changes in the biomarker levels related to inflammation and tissue destruction in the periapical exudate of mandibular premolar teeth with asymptomatic apical periodontitis after receiving intracanal cryotherapy, to compare cryotherapy and control groups in terms of analgesic intake, interappointment, and postoperative pain, and evaluate the correlation between biomarker levels and interappointment pain. METHODOLOGY Mandibular premolar teeth of 44 patients aged 18-35 years, diagnosed with asymptomatic apical periodontitis, were root canal treated in two visits (registered as NCT04798144). Baseline periapical exudate samples were obtained, and the patients were assigned to either control or intracanal cryotherapy group according to the final irrigation with distilled water either at room temperature or 2.5°C. The canals were dressed with calcium hydroxide. In the second visit, the calcium hydroxide was removed with passive ultrasonic irrigation, and the periapical exudate was sampled again. IL-1β, IL-2, IL-6, IL-8, TNF-α, PGE2 and MMP-8 levels were determined with ELISA. Postoperative pain levels were recorded for six days following both visits using a visual analogue scale. Data were analysed using t-test, Mann-Whitney U, and correlation tests. RESULTS There was a significant correlation between the pain scores reported after first visit and IL-1β and PGE2 levels (p < .05). IL-1β, IL-2, and IL-6 levels showed no significant difference in the cryotherapy group (p > .05), while they significantly increased in the control group (p < .05). There was a decrease in IL-8, TNF-α, PGE2 , and MMP-8 levels, however, the difference was not significant (p > .05). Pain scores were significantly lower in the cryotherapy group for the first three days (p < .05), except for 24th hours (p > .05). CONCLUSIONS The positive correlation between interappointment pain and IL-1β and PGE2 levels might indicate that these biomarker levels can be used to predict the severity of postoperative pain. Intracanal cryotherapy was effective in reducing postoperative pain in the short term in teeth with asymptomatic apical periodontitis. Cryotherapy prevented an increase in IL-1β, IL-2, and IL-6 levels compared to the control group.
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Affiliation(s)
- C Keskin
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - A Aksoy
- Department of Pharmacology & Toxicology, Ondokuz Mayis University, Faculty of Veterinary, Samsun, Turkey
| | - E Kalyoncuoğlu
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - A Keleş
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - A Arkan İlik
- Department of Endodontics, Faculty of Dentistry, Medipol University, Ankara, Turkey
| | - O Kömeç
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | | | - H Akgün
- Samsun Oral and Dental Health Hospital, Samsun, Turkey
| | - S G Alak
- Private Practice, İstanbul, Turkey
| | - O Tokur
- Department of Pharmacology & Toxicology, Ondokuz Mayis University, Faculty of Veterinary, Samsun, Turkey
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Al Zaidi M, Marggraf V, Repges E, Nickenig G, Skowasch D, Aksoy A, Pizarro C. Relevance of serum levels of the endoplasmic reticulum stress protein GRP78 (glucose-regulated protein 78 kDa) as biomarker in pulmonary diseases. Cell Stress Chaperones 2023; 28:333-341. [PMID: 37020080 PMCID: PMC10167071 DOI: 10.1007/s12192-023-01341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/15/2023] [Accepted: 03/26/2023] [Indexed: 04/07/2023] Open
Abstract
Cellular stress and inflammation contribute to the initiation and progression of a variety of pulmonary diseases. Endoplasmic reticulum (ER) stress and its main regulator GRP78 (glucose-regulated protein 78 kDa) appear to be involved in the pathogenesis of pulmonary diseases, and GRP78 was found to be a biomarker in a wide range of inflammatory diseases. The aim of this study was to investigate the relevance of serum GRP78 in pulmonary disorders.In this prospective cohort study, 78 consecutive patients with chronic obstructive pulmonary disease (COPD, n = 28), asthma (n = 38) or interstitial lung disease (ILD, n = 12) underwent measurement of serum GRP78 levels by ELISA.The mean age of patients was 59.8 ± 12.4 years, 48.7% were female. Patients with elevated GRP78 levels (> median) offered a significantly better oxygenation status (capillary pO2: 75.3 ± 11.7 mmHg vs. 67.8 ± 15.9 mmHg, p = 0.02). Significant correlations were observed between GRP78, on the one hand, and haemoglobin, high-sensitivity C-reactive protein (hs-CRP) and eosinophil counts, on the other hand (haemoglobin: Pearson's r = -0.25, hs-CRP: r = 0.30, eosinophils: r = 0.63).Subsequently, we evaluated GRP78 measurements in function of severity stratifiers of the specific underlying pulmonary disease. ILD patients with a severe diffusion impairment (DLCO< 40% of predicted), exhibited a significant decrease in GRP78 levels (p = 0.01). In COPD and asthma, both characterized by obstructive ventilatory defects, a forced expiratory volume in one second (FEV1) <30% of predicted was accompanied by significantly lower GRP78 (p = 0.0075).In both obstructive and restrictive pulmonary disorders, GRP78 protein concentrations were reduced with increasing disease severity. These data suggest a prevalent role of GRP78 in the presently studied pulmonary disorders.
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Affiliation(s)
- Muntadher Al Zaidi
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Vanessa Marggraf
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Elena Repges
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dirk Skowasch
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Adem Aksoy
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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8
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Blachutzik F, Meier S, Weissner M, Schlattner S, Gori T, Ullrich-Daub H, Gaede L, Achenbach S, Möllmann H, Chitic B, Aksoy A, Nickenig G, Weferling M, Dörr O, Boeder N, Bayer M, Elsässer A, Hamm C, Nef H. Comparison of Coronary Intravascular Lithotripsy and Rotational Atherectomy in the Modification of Severely Calcified Stenoses. Am J Cardiol 2023; 197:93-100. [PMID: 37012181 DOI: 10.1016/j.amjcard.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 04/05/2023]
Abstract
Debulking techniques are often necessary for successful lesion preparation in percutaneous coronary intervention. The aim of this study was to compare plaque modification of severely calcified lesions by coronary intravascular lithotripsy (IVL) with that of rotational atherectomy (RA) using optical coherence tomography (OCT). ROTA.shock was a 1:1 randomized, prospective, double-arm, multicenter noninferiority trial designed to compare final minimal stent area after IVL with RA for lesion preparation in percutaneous coronary interventional treatment of severely calcified lesions. On the basis of OCT acquired before and immediately after IVL or RA in 21 of the 70 patients included, we performed a detailed analysis of the modification of the calcified plaque. After RA and IVL, calcified plaque fractures were present in 14 of the patients (67%), with a significantly greater number of fractures after IVL (3.23 ± 0.49) than after RA (1.67 ± 0.52; p < 0.001). Plaque fractures after IVL were longer than after RA (IVL: 1.67 ± 0.43 mm vs RA: 0.57 ± 0.55 mm; p = 0.01), resulting in a greater total volume of the fractures (IVL: 1.47 ± 0.40 mm3 vs RA: 0.48 ± 0.27 mm3; p = 0.003). Use of RA was associated with a greater acute lumen gain than was use of IVL (RA: 0.46 ± 0.16 mm2 vs IVL: 0.17 ± 0.14 mm2; p = 0.03). In conclusion, we were able to show differences in plaque modification of calcified coronary lesions by OCT: although RA leads to a greater acute lumen gain, IVL induces more and longer fractures of the calcified plaque.
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Affiliation(s)
- Florian Blachutzik
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany.
| | - Sophie Meier
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Melissa Weissner
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Sophia Schlattner
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Tommaso Gori
- University Medical Center Mainz, Cardiology I, Mainz, Germany; German Center for Cardiovascular Research, Rhine-Main Partner Site, Mainz, Germany
| | | | - Luise Gaede
- Department of Cardiology, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Bogdan Chitic
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Adem Aksoy
- Department of Internal Medicine 2, University Hopsital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine 2, University Hopsital Bonn, Bonn, Germany
| | - Maren Weferling
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Oliver Dörr
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany; German Center for Cardiovascular Research, Rhine-Main Partner Site, Mainz, Germany
| | - Niklas Boeder
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Matthias Bayer
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University of Oldenburg, Oldenburg, Germany
| | - Christian Hamm
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany; Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Rhine-Main Partner Site, Mainz, Germany
| | - Holger Nef
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany; German Center for Cardiovascular Research, Rhine-Main Partner Site, Mainz, Germany
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9
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Guler O, Oymak E, Yazici G, Akagunduz OO, Cetinayak O, Erpolat P, Aksoy A, Duzova M, Yildirim BA, Kurt M, Canyılmaz E, Akyurek S, Atalar B, Yavas G, Oksuz D, Saglam E, Celik OK, Cengiz M, Onal C. The Treatment Outcomes of Patients with Cervical Esophageal Carcinoma Undergoing Definitive Chemoradiotherapy: A Multi-Institutional Analysis TROD 01-005. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Al‐Kassou B, Veulemans V, Shamekhi J, Maier O, Piayda K, Zeus T, Aksoy A, Zietzer A, Meertens M, Mauri V, Weber M, Sinning J, Grube E, Adam M, Bakhtiary F, Zimmer S, Baldus S, Kelm M, Nickenig G, Sedaghat A. Optimal protamine-to-heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR-A multicenter experience. Clin Cardiol 2022; 46:67-75. [PMID: 36259730 PMCID: PMC9849438 DOI: 10.1002/clc.23936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite major advances, transcatheter aortic valve replacement (TAVR) is still associated with procedure-specific complications. Although previous studies reported lower bleeding rates in patients receiving protamine for heparin reversal, the optimal protamine-to-heparin dosing ratio is unknown. HYPOTHESIS The aim of this study was a comparison of two different heparin antagonization regimens for the prevention of bleeding complications after TAVR. METHODS The study included 1446 patients undergoing TAVR, of whom 623 received partial and 823 full heparin antagonization. The primary endpoint was a composite of 30-day mortality, life-threatening, and major bleeding. Safety endpoints included stroke and myocardial infarction at 30 days. RESULTS Full antagonization of heparin resulted in lower rates of the primary endpoint as compared to partial heparin reversal (5.6% vs. 10.4%, p < .01), which was mainly driven by lower rates of life-threatening (0.5% vs. 1.6%, p = .05) and major bleeding (3.2% vs. 7.5%, p < .01). Moreover, the incidence of major vascular complications was significantly lower in patients with full heparin reversal (3.5% vs. 7.5%, p < .01). The need for red-blood-cell transfusion was lower in patients receiving full as compared to partial heparin antagonization (10.4% vs. 15.9%, p < .01). No differences were observed in the incidence of stroke and myocardial infarction between patients with full and partial heparin reversal (2.2% vs. 2.6%, p = .73 and 0.2% vs. 0.4%, p = .64, respectively). CONCLUSIONS Full heparin antagonization resulted in significantly lower rates of life-threatening and major bleeding after TAVR as compared to partial heparin reversal. The occurrence of stroke and myocardial infarction was low and comparable between both groups.
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Affiliation(s)
- Baravan Al‐Kassou
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Verena Veulemans
- Division of CardiologyUniversity Hospital of DuesseldorfDuesseldorfGermany,Division of CardiologyCardiovascular Research Institute DuesseldorfDüsseldorfGermany
| | - Jasmin Shamekhi
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Oliver Maier
- Division of CardiologyUniversity Hospital of DuesseldorfDuesseldorfGermany
| | - Kerstin Piayda
- Division of CardiologyUniversity Hospital of DuesseldorfDuesseldorfGermany
| | - Tobias Zeus
- Division of CardiologyUniversity Hospital of DuesseldorfDuesseldorfGermany
| | - Adem Aksoy
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Andreas Zietzer
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Max Meertens
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Victor Mauri
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Marcel Weber
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Jan‐Malte Sinning
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Eberhard Grube
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Matti Adam
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Farhad Bakhtiary
- Department of Cardiac SurgeryHeart Center, University Hospital BonnBonnGermany
| | - Sebastian Zimmer
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Stephan Baldus
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Malte Kelm
- Division of CardiologyUniversity Hospital of DuesseldorfDuesseldorfGermany,Division of CardiologyCardiovascular Research Institute DuesseldorfDüsseldorfGermany
| | - Georg Nickenig
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
| | - Alexander Sedaghat
- Department of Medicine IIHeart Center, University Hospital BonnBonnGermany
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11
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Al Zaidi M, Repges E, Jansen F, Tiyerili V, Zimmer S, Nickenig G, Aksoy A. Characterization of the mitochondrial unfolded protein response in human coronary artery endothelial cells. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The unfolded protein response of the endoplasmic reticulum (UPRER) is highly activated in cardiovascular diseases and aims to restore homeostasis by improving protein folding. An analogue cytoprotective mitochondrial unfolded protein response (UPRMito) regulated by an orthologue of the activating transcription factor 5 (ATF5) was described in model organism c. elegans. However, in humans it is not clear if there is a distinct UPRMito, and if there is an activation of an UPRMito during stress induced by cardiovascular diseases. The endothelium is subjected to high levels of mitochondrial stress, e.g. in atherosclerosis.
Purpose
To provide a systematic characterization of the UPRMito in human coronary artery endothelial cells (HCAEC).
Methods and results
HCAEC were treated with Nicotinamide Riboside (NR), a NAD+ precursor that activates UPRMito without inducing cellular stress. NR treatment did not induce toxicity and improved cell viability at a concentration of 100μM NR. Quantitative PCR confirmed a dose-dependent upregulation of UPRMito markers. Additionally, we measured expression of ATF4, which is discussed to regulate an integrated stress response in mammals by activating both the UPRMito and UPRER. ATF4 upregulation upon NR treatment was more pronounced than ATF5 upregulation. Analysis of GTEX-Data showed that ATF5 is almost exclusively expressed in liver tissue, while ATF4 shows ubiquitous expression. Among 54 tissues, aortic tissue and coronary arterial tissue are among the five tissues with the highest ATF4 expression.
Analysis of RNA-seq-data of human carotid atherosclerosis revealed that the two transcription factors are differentially regulated. ATF4 is downregulated in unstable plaque, while ATF5 is upregulated. Moreover, ATF4 is in both conditions highly more abundant than ATF5. Accordingly, endothelial cells incubated under atherosclerotic conditions (oxLDL + high glucose) exhibited a ATF4 down- and ATF5 upregulation. Genes previously described to be involved in the UPRMito exhibited a similar expression pattern as ATF4.
To further elucidate these findings, we will perform transcriptomic analyses of HCAEC treated with atherosclerotic stimuli (IL-1β, oxLDL), UPRER inductors (Thapsigargin, Tunicamycin) and stressors of mitochondrial proteostasis (Oligomycin, MitoBloCK-6), to analyze, if ATF5- or ATF4-related pathways are dysregulated. Specific inhibitors and UPRMito activators will be used to investigate the significance of ATF4 and ATF5 on endothelial cell function (proliferation, migration, apoptosis, monocyte adhesion).
Conclusion
The UPRMito is dysregulated during the pathogenesis of atherosclerosis in HCAEC. Further findings are required to elucidate, if the UPRMito is activated separately and specifically by ATF5 or as part of an integrated cellular stress response by ATF4. A deeper understanding of these stress responses is crucial for the identification of novel therapeutic targets in atherosclerosis.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University hospital Bonn
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Affiliation(s)
- M Al Zaidi
- University hospital Bonn , Bonn , Germany
| | - E Repges
- University hospital Bonn , Bonn , Germany
| | - F Jansen
- University hospital Bonn , Bonn , Germany
| | - V Tiyerili
- University hospital Bonn , Bonn , Germany
| | - S Zimmer
- University hospital Bonn , Bonn , Germany
| | - G Nickenig
- University hospital Bonn , Bonn , Germany
| | - A Aksoy
- University hospital Bonn , Bonn , Germany
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12
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Al Zaidi M, Repges E, Sommer-Weisel S, Jansen F, Zimmer S, Tiyerili V, Nickenig G, Aksoy A. Serum levels of the endoplasmic-reticulum-stress chaperone GRP78 identify patients with coronary artery disease and predict mortality. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Endoplasmic-reticulum-stress (ER Stress) and associated chaperones like the main ER-Stress moderator GRP78 (glucose-regulated-protein, 78kDa) are involved in the pathogenesis of coronary artery disease (CAD). In addition to their intracellular localization and effects, secretion and extracellular properties of chaperones, including GRP78, were recently described. However, a diagnostic or prognostic relevance of serum ER-chaperones in patients with CAD has not been established yet.
Purpose
To investigate the significance of serum GRP78 in patients undergoing coronary angiography for suspected CAD.
Methods
Serum concentration of GRP78 was measured by ELISA in 789 patients with indication for coronary angiography (both ACS and CCS). CAD was defined as >50% stenosis in any major coronary artery. Clinical endpoint was one-year all-cause mortality.
Results
Mean age was 70.8±11.9 years and 65% of patients were male. 192 (24%) patients presented with acute coronary syndrome (ACS). CAD was found in 72.4% of patients. Mean GRP78 serum concentration was 2492 ng/ml. Increased levels of GRP78 (> median) were associated with diabetes (29.9% vs. 23.1%, p=0.03), a higher BMI (28.9±7.1 kg/m2 vs. 27.0±6.0 kg/m2, p<0.0001) and chronic kidney disease (CKD: 23.3% vs. 17.1%, p=0.03). There was no difference regarding age or sex.
GRP78 levels were increased in patients with CAD when compared to patients without CAD (2640 ng/ml [95% CI: 2415–2864] vs. 2178 ng/ml [95% CI: 1893–2463], p=0.013, Fig A). Interestingly, GRP78 levels were lower in patients with ACS than in patients with CCS (2284 ng/ml [95% CI: 1944–2642] vs. 2822 [95% CI: 2531–3113], p=0.018, Fig B). To further elucidate these findings, we analyzed available proteomics of patients with hypertrophic cardiomyopathy undergoing septal ablation as a model for a planned myocardial infarction (PMI)1. Coronary sinus blood samples drawn 10 and 60 min after PMI showed a downregulation of GRP78 levels compared to baseline.
Finally, we assessed prognostic relevance of GRP78 in patients with CAD. Increased GRP78 levels were associated with lower one-year mortality (5.3% vs. 10.6% vs. p=0.016). Increased GRP78 levels were associated with reduced one-year mortality in both continuous (HR: 0.48 [95% CI: 0.25–0.92]) and categorial analyses stratified by median GRP78. After adjusting for age, sex, BMI, diabetes, CKD and ACS, GRP78 remained an independent predictor of one-year mortality (HR: 0.51 [0.26–0.96], p=0.039).
Conclusion
GRP78 serum levels are generally elevated in patients with CAD but downregulated during ACS. Reduced levels are associated with increased one-year mortality. These results support previous findings that GRP78 secretion is a protective mechanism in cardiovascular diseases. Further mechanistic studies are warranted to foster our understanding of the effects of extracellular GRP78 and to aid in the identification of modifying therapeutic targets.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University hospital Bonn
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Affiliation(s)
- M Al Zaidi
- University hospital Bonn , Bonn , Germany
| | - E Repges
- University hospital Bonn , Bonn , Germany
| | | | - F Jansen
- University hospital Bonn , Bonn , Germany
| | - S Zimmer
- University hospital Bonn , Bonn , Germany
| | - V Tiyerili
- University hospital Bonn , Bonn , Germany
| | - G Nickenig
- University hospital Bonn , Bonn , Germany
| | - A Aksoy
- University hospital Bonn , Bonn , Germany
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13
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Repges E, Al Zaidi M, Jansen F, Zimmer S, Tiyerlili V, Aksoy A. The endoplasmic reticulum (ER) chaperone GRP78 is secreted during ER Stress and alleviates endothelial cell inflammation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Glucose-Regulated Protein 78kD (GRP78) is a chaperone and the main regulator of the ER-stress response. Upon ER Stress, GRP78 activates the unfolded protein response (UPR), which aims to clear unfolded proteins and restore ER homeostasis. A prolonged activation of the UPR triggers inflammation, thus contributing to the progression of cardiovascular diseases. Recently, extracellular secretion of GRP78 was described. However, the pathophysiological relevance of secreted GRP78 in atherosclerosis and endothelial cell inflammation remains to be elucidated.
Aim
Aim of this study is to investigate the role of GRP78 secretion in endothelial cells.
Methods and results
First, we sought to investigate if vascular cells secrete GRP78 during ER Stress. Human coronary artery endothelial cells (HCAEC) were treated with the ER stress inductor tunicamycin for up to 48h. After ER Stress induction, Western Blot and ELISA experiments detected an increased intracellular GRP78 expression. Intriguingly, prolonged ER Stress also promoted extracellular secretion of GRP78. Proteomic analysis confirmed that after ER-Stress induction, GRP78 is one of the most highly upregulated extracellular proteins (2.43-fold). Co-incubation with Brefeldin A, an inhibitor of ER-Golgi protein transport, abolished extracellular secretion (Fig.1). Hence, ER-Stress-induced GRP78 secretion is an actively regulated process.
Next, the effect of GRP78 containing conditioned medium (CM) on HCAEC was analyzed. Treatment with GRP78 containing CM decreased GRP78 mRNA expression in target cells (0.35-fold vs. control [+BFA], p<0.0001). Furthermore, it increased viability (93.0% vs. 79.6%, p=0.017) and decreased formation of reactive oxygen species (0.78-fold). Moreover, expression of markers of vascular inflammation and ER Stress (e.g., NF-κB and CHOP) was decreased when compared to control CM with additional BFA treatment.
However, ER Stress induced by tunicamycin exhibits deleterious effects on donor cells and is therefore not feasible for in vivo usage. Thus, we utilized Bip protein inducer x (Bix), a recently described small-molecule activator of GRP78. Treatment with Bix also promoted expression of GRP78 and general UPR activation (e.g., ATF4, XBP1). Moreover, in contrast to tunicamycin, Bix treatment did not impair viability of HCAEC.
After treatment with Bix-induced CM, apoptosis (0.77-fold vs. 1.64-fold, p<0.0001) and expression of markers of vascular inflammation (e.g., Il-6) were significantly decreased compared to control CM. Furthermore, presence of GRP78 was able to promote proliferation and viability.
Conclusion
Endothelial ER Stress promotes GRP78 secretion. Presence of GRP78 in conditioned medium ameliorates subsequent ER Stress and endothelial inflammation, which play a critical role in atherogenesis. Modification of GRP78 secretion by Bix might be a feasible and innovative therapeutic option for vascular inflammation and endothelial regeneration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Repges
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - M Al Zaidi
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - F Jansen
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - S Zimmer
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - V Tiyerlili
- St. Johannes Hospital, Klinik für Innere Medizin I , Dortmund , Germany
| | - A Aksoy
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
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14
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Al-Kassou B, Veulemans V, Shamekhi J, Maier O, Aksoy A, Zietzer A, Meertens M, Weber M, Sinning JM, Adam M, Zimmer S, Baldus S, Kelm M, Nickenig G, Sedaghat A. Optimal protamine-to-heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR – a multicentre experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite major advances, transcatheter aortic valve replacement (TAVR) is associated with procedure-related vascular and bleeding complications, that have a significant impact on mortality. A recently published study has shown that heparin antagonization using protamine resulted in significantly lower rates of serious bleeding events in patients undergoing TAVR as compared to those without heparin reversal. However, the optimal protamine-to-heparin dosing ratio to prevent bleeding complications without increasing ischemic complications in patients undergoing TAVR is unknown. Accordingly, daily clinical practice varies between selective to routine administration of protamine in different dosing ratios.
Purpose
The aim of this observational multicentre study was to compare the safety and efficacy of two different protamine-to-heparin dosing ratios for the prevention of bleeding complications after TAVR.
Methods
The study included 1446 patients undergoing TAVR, of whom 623 (43.1%) received partial and 823 (56.9%) full heparin antagonization (0.4–0.6 mg versus 0.9–1.0 mg protamine/100 units of heparin). The indication for partial or full heparin antagonization was left to the discretion of the operator, who made the decision according to the patient's individual thrombotic and bleeding risk. The primary endpoint was a composite of 30-day mortality, life-threatening and major bleeding. Safety endpoints included stroke and myocardial infarction at 30 days.
Results
The overall study population had a mean age of 81.1±6.0 years; 47.9% were of female gender.
The baseline characteristics were well balanced between the two groups. Full antagonization of heparin resulted in significantly lower rates of the primary endpoint as compared to partial heparin reversal (5.6 vs. 10.4%, p<0.01), mainly driven by lower rates of life-threatening (0.5 vs 1.6%, p=0.05) and major bleeding (3.2 vs 7.5%, p<0.01). The incidence of major vascular complications was significantly lower in patients with full heparin reversal (3.5 vs 7.5%, p<0.01), as presented in Figure 1. Accordingly, the post-interventional drop in hemoglobin level and the need for red-blood-cell transfusion was lower in patients receiving full as compared to partial heparin reversal (1.5±1.2 vs 1.7±1.2 g/dl, p<0.01; 10.4 vs 15.9%, p<0.01, respectively). Regarding safety endpoints, no differences were observed in the incidence of stroke and myocardial infarction between the groups (2.2 vs 2.6%, p=0.73 and 0.2 vs 0.4%, p=0.64, respectively). Multivariate regression analyses revealed that full antagonization of heparin (OR: 0.43 [95% CI: 0.24–0.81], p<0.01) was independently associated with the primary end point
Conclusion
Full heparin antagonization resulted in significantly lower rates of life-threatening and major bleeding after TAVR as compared to partial heparin reversal. The occurrence of stroke and myocardial infarction was low and comparable between both groups.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation).
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Affiliation(s)
- B Al-Kassou
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - V Veulemans
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - J Shamekhi
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - O Maier
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - A Aksoy
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - A Zietzer
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - M Meertens
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - M Weber
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - J M Sinning
- St Vinzenz-Hospital, Department of Cardiology , Cologne , Germany
| | - M Adam
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - S Zimmer
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S Baldus
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - M Kelm
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - A Sedaghat
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
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15
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Tovar Forero MN, Sardella G, Salvi N, Cortese B, di Palma G, Werner N, Aksoy A, Escaned J, Salazar CH, Gonzalo N, Ugo F, Cavallino C, Sheth TN, Kardys I, Van Mieghem NM, Daemen J. Coronary lithotripsy for the treatment of underexpanded stents: the international & multicentre CRUNCH registry. EUROINTERVENTION 2022; 18:574-581. [PMID: 35318955 PMCID: PMC10241293 DOI: 10.4244/eij-d-21-00545] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stent underexpansion increases the risk of cardiac adverse events. At present, there are limited options to treat refractory stent underexpansion. In this context, the intravascular lithotripsy (IVL) system might be a safe and effective strategy. AIMS We aimed to evaluate the safety and efficacy of IVL in addressing resistant stent underexpansion due to heavy underlying calcification. METHODS This was an international multicentre registry including patients receiving IVL therapy to treat stent underexpansion from December 2017 to August 2020. Angiographic and intracoronary imaging data were collected. The efficacy endpoint was device success (technical success with a final percentage diameter stenosis <50%). The safety endpoint was in-hospital major adverse cardiac events (MACE). RESULTS Seventy patients were included, the mean age was 73±9.2 years and 76% were male. The median time from stent implantation to IVL therapy was 49 days (0-2,537). Adjuvant treatment with non-compliant balloon dilatations pre- and post-IVL was performed in 72.3% and 76.8% of patients, respectively, and additional stenting was performed in 22.4%. Device success was 92.3%. Minimum lumen diameter increased from 1.49±0.73 mm to 2.41±0.67 mm (p<0.001) and stent expansion increased by 124.93±138.19% (p=0.016). No IVL-related procedural complications or MACE were observed. The use of bailout IVL therapy directly after stenting and the presence of ostial underexpanded lesions negatively predicted lumen diameter gain. CONCLUSIONS Coronary lithotripsy is safe and effective in increasing lumen and stent dimensions in underexpanded stents secondary to heavily calcified lesions.
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Affiliation(s)
| | - Gennaro Sardella
- Policlinico Umberto I' "Sapienza" University of Rome, Rome, Italy
| | - Nicolò Salvi
- Policlinico Umberto I' "Sapienza" University of Rome, Rome, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, Clinica San Carlo, Milano, Italy and Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Gaetano di Palma
- Cardiovascular Research Team, Clinica San Carlo, Milano, Italy and Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Nikos Werner
- Heart Center, Trier, Germany
- Heart Center Bonn, University Hospital, Bonn, Germany
| | - Adem Aksoy
- Heart Center Bonn, University Hospital, Bonn, Germany
| | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Carlos H Salazar
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Tej N Sheth
- McMaster University, Hamilton, Ontario, Canada
| | - Isabella Kardys
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Joost Daemen
- Erasmus University Medical Center, Rotterdam, the Netherlands
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Nef H, Schlattner S, Weissner M, Gori T, Ullrich H, Gaede L, Achenbach S, Möllmann H, Blumenstein J, Aksoy A, Nickenig G, Weferling M, Dörr O, Boeder N, Bayer M, Hamm C, Blachutzik F. TCT-176 Randomized Comparison of Intracoronary Lithotripsy and Rotational Atherectomy for the Treatment of Severely Calcified Vessels—ROTA.shock Trial. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Al Zaidi M, Pizarro C, Bley C, Repges E, Sedaghat A, Zimmer S, Jansen F, Tiyerili V, Nickenig G, Skowasch D, Aksoy A. ER-stress-induced secretion of circulating glucose-regulated protein 78kDa (GRP78) ameliorates pulmonary artery smooth muscle cell remodelling. Cell Stress Chaperones 2022; 27:561-572. [PMID: 36029373 PMCID: PMC9485380 DOI: 10.1007/s12192-022-01292-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is driven by vascular remodelling due to inflammation and cellular stress, including endoplasmic reticulum stress (ER stress). The main ER-stress chaperone, glucose-regulated protein 78 kDa (GRP78), is known to have protective effects in inflammatory diseases through extracellular signalling. The aim of this study is to investigate its significance in PAH. Human pulmonary arterial smooth muscle cells (PASMC) were stimulated with compounds that induce ER stress, after which the secretion of GRP78 into the cell medium was analysed by western blot. We found that when ER stress was induced in PASMC, there was also a time-dependent secretion of GRP78. Next, naïve PASMC were treated with conditioned medium (CM) from the ER-stressed donor PASMC. Incubation with CM from ER-stressed PASMC reduced the viability, oxidative stress, and expression of inflammatory and ER-stress markers in target cells. These effects were abrogated when the donor cells were co-treated with Brefeldin A to inhibit active secretion of GRP78. Direct treatment of PASMC with recombinant GRP78 modulated the expression of key inflammatory markers. Additionally, we measured GRP78 plasma levels in 19 PAH patients (Nice Group I) and correlated the levels to risk stratification according to ESC guidelines. Here, elevated plasma levels of GRP78 were associated with a favourable risk stratification. In conclusion, GRP78 is secreted by PASMC under ER stress and exhibits protective effects from the hallmarks of PAH in vitro. Circulating GRP78 may serve as biomarker for risk adjudication of patients with PAH. Proposed mechanism of ER-stress-induced GRP78 secretion by PASMC. Extracellular GRP78 can be measured as a circulating biomarker and is correlated with favourable clinical characteristics. Conditioned medium from ER-stressed PASMC reduces extensive viability, ROS formation, inflammation, and ER stress in target cells. These effects can be abolished by blocking protein secretion in donor cells by using Brefeldin A.
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Affiliation(s)
- Muntadher Al Zaidi
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carmen Pizarro
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carolin Bley
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Elena Repges
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Felix Jansen
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dirk Skowasch
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Adem Aksoy
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Sudo M, Shamekhi J, Sedaghat A, Aksoy A, Zietzer A, Tanaka T, Wilde N, Weber M, Sinning JM, Grube E, Veulemans V, Adam M, Kelm M, Baldus S, Nickenig G, Zimmer S, Tiyerili V, Al-Kassou B. Predictive value of the Fibrosis-4 index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2022; 111:1367-1376. [DOI: 10.1007/s00392-022-02055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
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Al-Kassou B, Aksoy A, Shamekhi J, Zietzer A, Sinning JM, Grube E, Bakhtiary F, Zimmer S, Nickenig G, Sedaghat A. Impact of Transradial Versus Transfemoral Artery Approach for Pre-Procedural Coronary Angiography on Outcomes in Patients Undergoing Subsequent TAVR. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lüsebrink E, Zimmer S, Schrage B, Dabboura S, Majunke N, Scherer C, Aksoy A, Krogmann A, Hoffmann S, Szczanowicz L, Binzenhöfer L, Peterss S, Kühn C, Hagl C, Massberg S, Schäfer A, Thiele H, Westermann D, Orban M. Intracranial haemorrhage in adult patients on venoarterial extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care 2022; 11:303-311. [PMID: 35213724 DOI: 10.1093/ehjacc/zuac018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/15/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
AIMS Intracranial haemorrhage (ICH) is one of the most serious complications of adult patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and is associated with increased morbidity and mortality. However, the prevalence and risk factors of ICH in this cohort are still insufficiently understood. We hypothesized that a considerable proportion of patients undergoing VA-ECMO support suffer from ICH and that specific risk factors are associated with the occurrence of ICH. Therefore, the purpose of this study was to further investigate the prevalence and associated mortality as well as to identify risk factors for ICH in VA-ECMO patients. METHODS AND RESULTS We conducted a retrospective multicentre study including adult patients (≥18 years) treated with VA-ECMO in cardiac intensive care units (ICUs) at five German clinical sites between January 2016 and March 2020, excluding patients with ICH upon admission. Differences in baseline characteristics and clinical outcome between VA-ECMO patients with and without ICH were analysed and risk factors for ICH were identified. Among the 598 patients included, 70/598 (12%) developed ICH during VA-ECMO treatment. In-hospital mortality in patients with ICH was 57/70 (81%) and 1-month mortality 60/70 (86%), compared to 332/528 (63%) (P = 0.002) and 340/528 (64%) (P < 0.001), respectively, in patients without ICH. Intracranial haemorrhage was positively associated with diabetes mellitus [odds ratio (OR) 2, 95% confidence interval (CI) 1.11-3.56; P = 0.020] and lactate (per mmol/L) (OR 1.06, 95% CI 1.01-1.11; P = 0.020), and negatively associated with platelet count (per 100 G/L) (OR 0.32, 95% CI 0.15-0.59; P = 0.001) and fibrinogen (per 100 mg/dL) (OR 0.64, 95% CI 0.49-0.83; P < 0.001). CONCLUSION Intracranial haemorrhage was associated with a significantly higher mortality rate. Diabetes mellitus and lactate were positively, platelet count, and fibrinogen level negatively associated with the occurrence of ICH. Thus, platelet count and fibrinogen level were revealed as potentially modifiable, independent risk factors for ICH. The findings address an area with limited data, provide information about risk factors and the epidemiology of ICH, and may be a starting point for further investigations to develop effective strategies to prevent and treat ICH.
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Affiliation(s)
- Enzo Lüsebrink
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
| | - Sebastian Zimmer
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Salim Dabboura
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nicolas Majunke
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | - Clemens Scherer
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
| | - Adem Aksoy
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Alexander Krogmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Sabine Hoffmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians Universität München, Munich, Germany
| | - Lukasz Szczanowicz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | - Leonhard Binzenhöfer
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Christian Kühn
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinischen Hochschule Hannover, Hannover, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
| | - Andreas Schäfer
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Martin Orban
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
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Karagoz ZK, Aydin S, Ugur K, Tigli A, Deniz R, Baykus Y, Sahin I, Yalcin MH, Yavuz A, Aksoy A, Aydin S. Molecular communication between Apelin-13, Apelin-36, Elabela, and nitric oxide in gestational diabetes mellitus. Eur Rev Med Pharmacol Sci 2022; 26:3289-3300. [PMID: 35587081 DOI: 10.26355/eurrev_202205_28748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a type of diabetes that affects from 3.8% to 6.9% of pregnancies worldwide, causing significant mortality and unfavorable obstetric outcomes, such as delivery trauma and macrosomia risk. The fundamental processes of this metabolic disorder that first appeared during pregnancy are still unknown. Tissue hormones, particularly adipokines, have aided in understanding the pathophysiology of numerous disorders in recent years. This study aims to determine if Apelin-13 (APLN-13), Apelin-36 (APLN-36), Elabela (ELA), and nitric oxide (NO) molecules have all a part in the pathophysiology of GDM. PATIENTS AND METHODS The study included 30 pregnant control women and 30 pregnant women who had been diagnosed with GDM in the second trimester and whose body mass index and age were compatible with each other. Blood samples were collected from 60 participants during the second trimester (30 control pregnant women and 30 GDM pregnant women) and postpartum (17 controls vs. 14 GDM). In these blood samples, the amounts of APLN-13, APLN-36, ELA, and NO were studied using the ELISA method. In addition, the participants' glucose, lipid profiles, and other parameters were obtained from the hospital record files. At postpartum, 29 pregnant women (13 control and 16 pregnant women with GDM) dropped out of the study without explanation. RESULTS In the second trimester and postpartum plasma of mothers with GDM, APLN-13, APLN-36, NO, and ELA molecules were found to be significantly higher (< 0.05), compared to those of the control mothers, while APLN-13, APLN-36, NO values were significantly lower (0.05). While APLN-13, APLN-36, NO amounts in mothers with GDM were positively correlated with glucose amounts, they were negatively correlated with ELA amounts. Similarly, the triglyceride amounts in mothers with GDM were positively correlated with APLN-13, APLN-36 and NO, while they were negatively correlated with the ELA amounts. Due to gestational diabetes, APLN-13, APLN-36, NO, glucose, and triglyceride increased, and ELA decreased. CONCLUSIONS It is predicted that the glucose increase in GDM is because Apelins reduce glucose transport to erythrocytes by inhibiting the sodium-dependent glucose transporter (SGLT) and that the increase in triglyceride and NO may be associated with high glucose levels in GDM. As a result, we believe that the above-mentioned chemicals may cause GDM Pathology by triggering one another.
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Affiliation(s)
- Z K Karagoz
- Department of Endocrinology and Metabolic Diseases, Department of Cardiovascular Surgery (Anatomy), Fethi Sekin City Hospital, Elazig, Turkey.
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22
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Karagoz ZK, Aydin S, Aksoy A, Kalayci M, Ugur K, Kuloglu T, Cinar V, Yardim M, Aydin Y, Akbulut T, Yalcin MH, Sahin I, Uslu A, Akkoc RF, Aydin S. Basal blood concentrations of some orexigenic and anorexigenic hormones in obese and nonobese individuals according to blood groups. Eur Rev Med Pharmacol Sci 2022; 26:2818-2831. [PMID: 35503626 DOI: 10.26355/eurrev_202204_28612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Obesity is a serious public health problem associated with excessive food intake. Regulation of food intake in highly organized organisms is under the control of a large number of orexigenic and anorexigenic molecules. Therefore, the main purpose of this study has been to determine the relationship between obesity and some of the circulating orexigenic and anorexigenic peptides that have a role in appetite control and to determine whether the concentrations of these molecules differ according to blood groups. PATIENTS AND METHODS The study included 400 individuals of whom 100 were obese women, 100 obese men, 100 healthy men and 100 healthy women. Obese women and men were divided into 4 groups, according to their blood groups. In the control group, healthy women and healthy men were similarly divided into 4 blood groups. Each blood group within the groups, therefore, had 25 participants. RESULTS When leptin, nesfatin-1, obestatin and neuropeptide-Y, ghrelin and galanin levels of the control group and obese participants were compared, regardless of blood groups, leptin, nesfatin-1, obestatin and neuropeptide-Y were significantly higher, whereas only the ghrelin levels were significantly lower in obese patients. When the amounts of these hormones were measured according to gender, the situation was similar. When leptin, nesfatin-1, obestatin and neuropeptide-Y values of the control and obese participants' blood groups were compared with each other; these hormones were high in all blood groups; however, leptin levels in A blood group, nesfatin-1 levels in AB and O blood group, obestatin levels in AB blood group, neuropeptide-Y levels in A, B, AB blood groups were significantly higher. When the ghrelin levels of the blood groups in the control group and obese participants were compared, it was only significantly lower in the AB blood group. The ghrelin levels in the other blood groups of the obese individuals were again low, but not significantly so. When the distribution of hormones according to gender was evaluated, a situation parallel to the above results was recorded. CONCLUSIONS Leptin, nesfatin-1, obestatin and neuropeptide-Y and galanin levels of obese individuals were significantly higher than the control values, whereas the ghrelin values were significantly lower regardless of blood groups. Also, these hormones in blood partly varied with ABO blood groups. These different concentrations of hormones in ABO blood groups might be related with stimulation or suppression of appetite in human. However, further studies in other ethnic groups are needed to confirm these results.
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Affiliation(s)
- Z K Karagoz
- Department of Endocrinology and Metabolic Diseases, Fethi Sekin City Hospital, Elazig, Turkey.
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Ugur K, Erman F, Turkoglu S, Aydin Y, Aksoy A, Lale A, Karagöz ZK, Ugur I, Akkoc RF, Yalniz M. Asprosin, visfatin and subfatin as new biomarkers of obesity and metabolic syndrome. Eur Rev Med Pharmacol Sci 2022; 26:2124-2133. [PMID: 35363362 DOI: 10.26355/eurrev_202203_28360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Metabolic syndrome (MetS) and obesity are important public health problems associated with adipose tissue mass. Asprosin, visfatin, and subfatin are new members of which fate in MetS and obesity has not been fully revealed yet. Thus, this study was to investigate the association between asprosin, visfatin, subfatin, and biochemical values, demographic data, and body composition measurement values in MetS patients with and without obesity. PATIENTS AND METHODS Blood samples were taken from a total of 90 people, including 31 MetS patients with obesity, 29 MetS patients without obesity, and 30 healthy (control). Asprosin, visfatin, and subfatin were studied by the ELISA method. RESULTS There was a negative correlation between asprosin and Body Mass Index (BMI) in the MetS + Obese group. The correlations between asprosin and urea and fasting insulin (FI) levels in the MetS group were positive and statistically significant (p < 0.05). While there was a statistically significant negative correlation (p < 0.05) between visfatin and BMI in the MetS + Obese group, the correlation with waist circumference in the MetS + Obese and MetS groups was statistically significant and negative (p < 0.05). There was a statistically significant negative relationship (p < 0.05) between aspartate aminotransferase value and visfatin. The results between visfatin values and asprosin and subfatin in all groups were significant (p < 0.05). CONCLUSIONS There is a direct relationship between circulating amounts of asprosin, visfatin, and subfatin hormones and age, weight, height, diastolic blood pressure, high-density lipoprotein-cholesterol, aspartate aminotransferase, alanine transaminase, and creatinine. Therefore, asprosin, visfatin, and subfatin hormones are the new biomarkers of metabolic turbulence.
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Affiliation(s)
- K Ugur
- Department of Internal Medicine (Endocrinology and Metabolism Diseases), Faculty of Medicine, Fırat University, Elazig, Turkey.
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Aksoy A, Varoglu A, Onalan E, Tektemur A, Artas G. Research Article siRNA-mediated mesothelin silencing for treatment of mesothelioma. Genet Mol Res 2022. [DOI: 10.4238/gmr18955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aksoy A, Tiyerili V, Jansen N, Al Zaidi M, Thiessen M, Sedaghat A, Ulrich Becher M, Jansen F, Nickenig G, Zimmer S. Propensity-score-matched comparison of safety, efficacy, and outcome of intravascular lithotripsy versus high-pressure PTCA in coronary calcified lesions. Int J Cardiol Heart Vasc 2021; 37:100900. [PMID: 34950765 PMCID: PMC8671124 DOI: 10.1016/j.ijcha.2021.100900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/03/2022]
Abstract
Calcified coronary lesions are frequently in patients with coronary artery disease. Intravascular lithotripsy was shown to be safe and effective for treating calcified lesions in coronary artery disease. Data of intravascular lithotripsy in comparison to standard techniques are lacking. Intravascular lithotripsy showed higher rate of procedural success without differences in rate of MACE after 12 months in comparison to high- pressure NC-Balloon PTCA.
Background Data regarding safety, efficacy, and outcome of intravascular lithotripsy (IVL) in comparison to standard techniques are lacking. This study sought to compare IVL with non-compliant high-pressure balloon percutaneous coronary angioplasty (PTCA). Methods and results We performed a retrospective propensity-score-matched study to compare procedural success in 57 consecutive patients who received IVL-guided PCI in calcified coronary lesions with 171 matched patients who were treated with high-pressure PTCA with a non-compliant (NC)-balloon. The mean minimal lumen diameter (MLD) for the IVL group was 1.08 ± 0.51 mm, and the median percent diameter stenosis on quantitative angiography was 70.2% (interquartile range, 60.2–78.6%). MLD in the high-pressure dilatation group was 0.97 ± 0.43 mm, and the median percent diameter stenosis was 71.5% (interquartile range, 58.5–77.0%). IVL-guided PCI reduced median stenosis to 17.5% (interquartile range, 9.3–19.8%) with an acute gain of 0.93 ± 0.7 mm. High-pressure dilatation resulted in a final median stenosis of 19.3% (interquartile range, 13.33–28.5%). Procedural success was significantly higher (82.5% vs. 61.4%; p: 0.0035) in the IVL group. MACE through 12 months occurred in 10.5% of cases in the IVL group and in 11.1% of the high-pressure group (p = 0.22). Angiographic complications (coronary dissection, slow or no reflow, new coronary thrombus formation, abrupt vessel closure) were very low (0.2% vs. 0.12%). Conclusion IVL resulted in a significantly higher rate of procedural success compared to high- pressure NC-balloon dilatation in patients with calcified coronary lesions. The rate of MACE through 12 months was similar to the standard therapy.
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Key Words
- AMI, Acute myocardial infarction
- CAD, Coronary artery disease
- Calcification
- DES, Drug eluting stent
- High-pressure PTCA
- IVL, Intravascular lithotripsy
- LAD, Left anterior descending artery
- Lithotripsy
- MACE, Major adverse cardiovascular event
- MLD, Minimal lumen diameter
- NC, non-compliant
- PCI, Percutaneous coronary intervention
- PSM, Propensity-score-matched
- PTCA, Percutaneous transluminal coronary angioplasty
- QCA, Quantitative Coronary Analysis
- RA, Rotational atherectomy (RA)
- RCA, Right coronary artery
- Shockwave
- TIMI, Thrombolysis in myocardial infarction
- atm, Atmosphere
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Affiliation(s)
- Adem Aksoy
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Nora Jansen
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Muntadher Al Zaidi
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Maximillian Thiessen
- Department of Computer Science, University of Bonn, Germany.,Fraunhofer Institute for Intelligent Analysis and Information Systems, Sankt Augustin, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Felix Jansen
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
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Taldybay A, Aidarbayeva D, Aksoy A, Jenis J, Oxikbayev B. Prospects of studying and using Saussurea elegans Ledeb. in the foothills of the Zhetysu Alatau. ijmph 2021. [DOI: 10.26577/ijbch.2021.v14.i2.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aksoy A, Al Zaidi M, Repges E, Becher MU, Müller C, Oldenburg J, Zimmer S, Nickenig G, Tiyerili V. Vitamin K Epoxide Reductase Complex Subunit 1-Like 1 (VKORC1L1) Inhibition Induces a Proliferative and Pro-inflammatory Vascular Smooth Muscle Cell Phenotype. Front Cardiovasc Med 2021; 8:708946. [PMID: 34778390 PMCID: PMC8578699 DOI: 10.3389/fcvm.2021.708946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/05/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Vitamin K antagonists (VKA) are known to promote adverse cardiovascular remodeling. Contrarily, vitamin K supplementation has been discussed to decelerate cardiovascular disease. The recently described VKOR-isoenzyme Vitamin K epoxide reductase complex subunit 1-like 1 (VKORC1L1) is involved in vitamin K maintenance and exerts antioxidant properties. In this study, we sought to investigate the role of VKORC1L1 in neointima formation and on vascular smooth muscle cell (VSMC) function. Methods and Results: Treatment of wild-type mice with Warfarin, a well-known VKA, increased maladaptive neointima formation after carotid artery injury. This was accompanied by reduced vascular mRNA expression of VKORC1L1. In vitro, Warfarin was found to reduce VKORC1L1 mRNA expression in VSMC. VKORC1L1-downregulation by siRNA promoted viability, migration and formation of reactive oxygen species. VKORC1L1 knockdown further increased expression of key markers of vascular inflammation (NFκB, IL-6). Additionally, downregulation of the endoplasmic reticulum (ER) membrane resident VKORC1L1 increased expression of the main ER Stress moderator, glucose-regulated protein 78 kDa (GRP78). Moreover, treatment with the ER Stress inducer tunicamycin promoted VKORC1L1, but not VKORC1 expression. Finally, we sought to investigate, if treatment with vitamin K can exert protective properties on VSMC. Thus, we examined effects of menaquinone-7 (MK7) on VSMC phenotype switch. MK7 treatment dose-dependently alleviated PDGF-induced proliferation and migration. In addition, we detected a reduction in expression of inflammatory and ER Stress markers. Conclusion: VKA treatment promotes neointima formation after carotid wire injury. In addition, VKA treatment reduces aortal VKORC1L1 mRNA expression. VKORC1L1 inhibition contributes to an adverse VSMC phenotype, while MK7 restores VSMC function. Thus, MK7 supplementation might be a feasible therapeutic option to modulate vitamin K- and VKORC1L1-mediated vasculoprotection.
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Affiliation(s)
- Adem Aksoy
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Muntadher Al Zaidi
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Elena Repges
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Cornelius Müller
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
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Al Zaidi M, Aksoy A, Repges E, Becher MU, Mueller C, Oldenburg J, Zimmer S, Nickenig G, Tiyerili V. Vitamin K epoxide reductase complex subunit 1-like 1 (VKORC1L1) inhibition induces a proliferative and pro-inflammatory vascular smooth muscle cell phenotype. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Vitamin K antagonists (VKA) like Warfarin are known to promote adverse cardiovascular remodelling. Contrarily, vitamin K supplementation has been discussed to decelerate cardiovascular disease. The recently described VKOR-isoenzyme Vitamin K epoxide reductase complex subunit 1-like 1 (VKORC1L1) is involved in vitamin K maintenance and exerts antioxidant properties. In this study, we sought to investigate the role of VKORC1L1 in neointima formation and on vascular smooth muscle cell (VSMC) function.
Methods and results
Treatment of wild-type mice with Warfarin increased maladaptive neointima formation after carotid artery injury. This was accompanied by reduced vascular mRNA expression of VKORC1L1.
In vitro, Warfarin was found to reduce VKORC1L1 mRNA expression in VSMC. VKORC1L1 downregulation by siRNA promoted viability, migration and formation of reactive oxygen species. VKORC1L1 knockdown further increased expression of key markers of vascular inflammation (NFκB, IL-6). Additionally, downregulation of the endoplasmic reticulum (ER) membrane resident VKORC1L1 increased expression of the main ER Stress moderator, glucose-regulated protein 78 kDa (GRP78). Moreover, treatment with the ER Stress inducer Tunicamycin promoted VKORC1L1, but not VKORC1 expression.
Finally, we sought to investigate, if treatment with vitamin K can mediate the protective properties of VKORC1L1. Thus, we examined effects of menaquinone-7 (MK7) on VSMC phenotype switch. MK7 treatment dose-dependently alleviated PDGF-induced proliferation and migration. In addition, we detected a reduction in expression of inflammatory and ER Stress markers.
Conclusion
VKA-induced neointima formation is associated with reduced vascular VKORC1L1 expression. VKORC1L1 inhibition contributes to an adverse VSMC phenotype while MK7 restores VSMC function. Thus, MK7 supplementation might be a feasible therapeutic option to modulate vitamin K- and VKORC1L1-mediated vasculoprotection.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Al Zaidi
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - A Aksoy
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - E Repges
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - M U Becher
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - C Mueller
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - J Oldenburg
- University Hospital Bonn, Institute of Experimental Haematology and Transfusion Medicine (IHT), Bonn, Germany
| | - S Zimmer
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - V Tiyerili
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
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Erol C, Basoglu T, Sakin A, Ozden E, Cubuk D, Yumuk P, Dogan M, Oksuzoglu B, Yildirim H, Oner I, Karakurt Eryilmaz M, Dulgar O, Turkmen Bekmez E, Dogan N, Ozen M, Gurler F, Paksoy N, Aksoy A, Hizal M, Sendur M. 1405P Efficacy and safety of perioperative FLOT (5-FU, LV, oxaliplatin, docetaxel) chemotherapy in gastric and gastroesophageal junction adenocarcinoma: Real-life data from Turkish oncology group. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kavsur R, Becher MU, Nassan W, Sedaghat A, Aksoy A, Schrickel JW, Nickenig G, Tiyerili V. CHA 2DS 2-VASC score predicts coronary artery disease progression and mortality after ventricular arrhythmia in patients with implantable cardioverter-defibrillator. Int J Cardiol Heart Vasc 2021; 34:100802. [PMID: 34095451 PMCID: PMC8165543 DOI: 10.1016/j.ijcha.2021.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 11/14/2022]
Abstract
Aim The CHA2DS2-VASC score has expanded its use beyond the initial purpose of predicting the risk of stroke in patients with atrial fibrillation. We aimed to investigate the value of the CHA2DS2-VASC score as a risk assessment tool to predict relevant coronary artery disease (CAD) leading to percutaneous coronary intervention (PCI), and all-cause mortality after detected ventricular arrhythmia (VA) in patients with an Implantable Cardioverter-Defibrillator (ICD). Methods A total of 183 ICD-patients who underwent coronary angiography after VA were included and classified according to their CHA2DS2-VASC score in a low(1-3), intermediate(4-5) and high(6-8) score group. We evaluated the predictive value of CHA2DS2-VASC score for the presence of relevant CAD leading to percutaneous coronary intervention (PCI), as well as late all-cause mortality. Results A total of 60 patients (32.8%) had significant CAD and underwent successful PCI. After adjustment for relevant parameters such as ischemic cardiomyopathy, angina pectoris, left ventricular ejection fraction, CHA2DS2-VASC score remained the only independent predictor of CAD leading to PCI [HR 1.73 (1.07–2.80)]. The Area under curve was 0.64 (0.56–72, p = 0.002). Kaplan-Meier analysis and log-rank showed an increased three-year mortality of ICD-patients with an intermediate or high score after VA (p = 0.003). Multivariate cox-regression analysis revealed that CHA2DS2-VASC score was also independently associated with all-cause mortality following adjustment for clinically relevant variables (HR 2.20, 1.17–4.14). Conclusions CHA2DS2-VASC score can be a predictor of CAD leading to PCI in ICD-patients after VA. ICD-Patients with a high score have an increased risk for reduced three-year all-cause mortality after VA.
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Key Words
- AF, Atrial fibrillation
- CABG, Coronary artery bypass graft
- CAD, Coronary artery disease
- CK-MB, Creatine Kinase MB Isoenzyme
- Coronary angiography
- Coronary artery disease
- ICD, Implantable Cardioverter-Defibrillator
- Implantable Cardioverter Defibrillator
- LDL, Low-Density Lipoprotein
- LVEF, Left Ventricular Ejection Fraction
- PCI, Percutaneous Coronary Intervention
- VA, Ventricular Arrhythmia
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
- Ventricular fibrillation
- Ventricular tachycardia
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Affiliation(s)
- Refik Kavsur
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marc Ulrich Becher
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Welat Nassan
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Sedaghat
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Adem Aksoy
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jan Wilko Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Aldibekova A, Sultanova B, Aksoy A, Kurmanbayeva M. Comparative study of root, stem, and leaf anatomy of young Sogdian ash trees (Fraxinus sogdiana Bunge) growing in river valleys of the Sharyn State National Park. ijbch 2021. [DOI: 10.26577/ijbch.2021.v14.i1.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schrage B, Becher PM, Bernhardt A, Bezerra H, Blankenberg S, Brunner S, Colson P, Cudemus Deseda G, Dabboura S, Eckner D, Eden M, Eitel I, Frank D, Frey N, Funamoto M, Goßling A, Graf T, Hagl C, Kirchhof P, Kupka D, Landmesser U, Lipinski J, Lopes M, Majunke N, Maniuc O, McGrath D, Möbius-Winkler S, Morrow DA, Mourad M, Noel C, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Pazzanese V, Reichenspurner H, Sandri M, Schulze PC, H G Schwinger R, Sinning JM, Aksoy A, Skurk C, Szczanowicz L, Thiele H, Tietz F, Varshney A, Wechsler L, Westermann D. Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study. Circulation 2020; 142:2095-2106. [PMID: 33032450 PMCID: PMC7688081 DOI: 10.1161/circulationaha.120.048792] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. METHODS Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort. RESULTS Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98]; P=0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site-related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%). CONCLUSIONS In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.
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Affiliation(s)
- Benedikt Schrage
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Peter Moritz Becher
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Alexander Bernhardt
- Cardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Hiram Bezerra
- Tampa General Hospital, University of South Florida (H.B.)
| | - Stefan Blankenberg
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Stefan Brunner
- Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.)
| | - Gaston Cudemus Deseda
- Division of Anesthesia, Critical Care and Pain Medicine (G.C.D.), Massachusetts General Hospital, Boston
| | - Salim Dabboura
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.)
| | - Matthias Eden
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany (I.E., T.G.)
| | - Derk Frank
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Norbert Frey
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Masaki Funamoto
- Division of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston
| | - Alina Goßling
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany (I.E., T.G.)
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik (C.H.), LMU Klinikum, Munich, Germany
| | - Paulus Kirchhof
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Institute of Cardiovascular Sciences, University of Birmingham and University Hospitals Birmingham and Sandwell and West Birmingham National Health ServiceTrusts, United Kingdom (P.K.)
| | - Danny Kupka
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).,Franklin/German Centre for Cardiovascular Research (DZHK), partner site Berlin/Institute of Health (BIH), Germany (U.L., C.S.)
| | - Jerry Lipinski
- Department of Internal Medicine, University of California, San Diego (J.L.)
| | - Mathew Lopes
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Octavian Maniuc
- Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.)
| | - Daniel McGrath
- Division of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.)
| | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.)
| | - Curt Noel
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.)
| | | | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.).,Department of Anesthesia and Intensive Care, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) ISMETT (Istituto Mediterraneo trapianti e terapie avanzate), UPMC (University of Pittsburgh Medical Center)Italy, Palermo, Italy (F.P.)
| | - Sandeep M Patel
- Department of Interventional Cardiology, St. Rita's Medical Center, Lima, OH (S.M.P.)
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.)
| | - Vittorio Pazzanese
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.)
| | - Hermann Reichenspurner
- Cardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany
| | - Marcus Sandri
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.)
| | | | - Jan-Malte Sinning
- University Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.)
| | - Adem Aksoy
- University Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.)
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).,Franklin/German Centre for Cardiovascular Research (DZHK), partner site Berlin/Institute of Health (BIH), Germany (U.L., C.S.)
| | - Lukasz Szczanowicz
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Franziska Tietz
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Anubodh Varshney
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Lukas Wechsler
- Medizinische Klinik II, Klinikum Weiden, Germany (R.H.G.S., L.W.)
| | - Dirk Westermann
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
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Öz Tunçer G, Sahin I, Akça Ü, Aksoy A. REGISTRIES, CARE, QUALITY OF LIFE, MANAGEMENT OF NMD. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Salazar CH, Gonzalo N, Aksoy A, Tovar Forero MN, Nef H, Van Mieghem NM, Latib A, Ocaranza Sanchez R, Werner N, Escaned J. Feasibility, Safety, and Efficacy of Intravascular Lithotripsy in Severely Calcified Left Main Coronary Stenosis. JACC Cardiovasc Interv 2020; 13:1727-1729. [PMID: 32703602 DOI: 10.1016/j.jcin.2020.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 10/23/2022]
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Aksoy A, Colak S, Yagiz B, Seniz BN, Omma A, Yildiz Y, Atas N, Ilgin C, Sari A, Erden A, Karadag O, Dalkiliç E, Bolca N, Onur MN, Ergelen R, Direskeneli H, Alibaz-Oner F. THU0289 PREDICTORS AND SEVERITY OF POST-THROMBOTIC SYNDROME IN VASCULAR BEHÇET’S DISEASE: RETROSPECTIVE MULTICENTER STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Postthrombotic syndrome(PTS) defines chronic manifestations of venous insufficiency following deep vein thrombosis(DVT).It is the most frequent and disabling complication of DVT.Objectives:Aim of the study is to describe clinical characteristics and predictors of PTS,severe PTS among Behçet’s disease(BD)patients with known low extremity DVT.Also,to depict venous Doppler ultrasonography(US)findings and its association with the clinical characteristic and treatments.Methods:This retrospective multicenter study included 205(166men,39women;mean age 39±9.5 years)BD patients with DVT history.The Villalta scale was used to assess the presence and severity of PTS.Doppler US of bilateral legs are performed within 1 week of clinical evaluation.Total number of vessels with reflux,thrombi,recanalization and collaterals were calculated and presented as scores.Results:Of 205 BD patients with known DVT history; 127(62%) had PTS and 18% had severe PTS diagnosed by Villalta scale.(Table 1)Table 1.Demographic and Clinical Characteristics of PatientsEntire Study Population (n:205)PTS present (n:127)PTS absent (n:78)P valueSex(male,%)166,81%101,79.5%65,83.3%.584History of smoking,%105,52%64,51.2%41,53.2%.895BMI(n:198)26.2±4.626.7±525.6±3.8.123Disease duration,years9(5-15)10(5-16)8(5-13).205DVT following time years6(3-11)7(3-11.5)5(3-9).179Current age39±9.540.5±9.636.8±8.8.012Number of vascular events1(1-2)1(1-2)1(1-2).723VeinesQoL total82±16.375.8±1492.2±14.6<.001VeinesQoL symptom37.5±934.4±8.342.6±7.7<.001Doppler Findingsİliofemoral thrombi41,26.5%32,35%9,17%.014Bilateral involvement62,43.4%45,49%17,33%.080All median values presented with interquartileranges(IQR)Table 2 summarize multivariate logistic regression analyses for the risk of having PTS-moderate/severePTS.Table 2.Multivariate Regression Analysis of presence of PTSOdds Ratio(with 95%CI)PCurrent age1.05(1.01-1.10).048BSAS1.06(1.04-1.10).000Bilateral Doppler USG involvement2.81(1.18-6.67).019İliofemoral thrombi2.74(1.02-7.38).045Moderate/severe PTSOdds RatiopBody mass index1.09(1.001-1.19).048IS0.10 (0.02-0.05).005Severe PTS patients had increased reflux(p=.027) compared to mild group and decreased recanalization scores(p=.013)compared to moderate group(Figure1)Patients treated with AC+IS had increased recanalization(p:.078),collateral scores compared patients treated with only ISs(p=.004)(Figure2)Conclusion:After an acuteDVT,BD patients faced with high risk of having PTS,severe PTS.ISs decreases the risk of having PTS.Our results also suggest that AC treatment may decrease severity of PTS by increasing recanalization of thrombi.Figure 1.US scores for PTS absent and present group Reflux score(p=.054) and thrombosis scores(p=.02)Figure 2.US scores for treatment groupsReferences:Disclosure of Interests:None declared
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Aksoy A, El Kahlout KEM, Yardimci H. Comparative Evaluation of the Effects of Binzalkonium Chloride, Iodine, Gluteraldehyde and Hydrogen Peroxide Disinfectants against Avian Salmonellae Focusing on Genotypic Resistance Pattern of the Salmonellae Serotypes toward Benzalkonium Chloride. Braz J Poult Sci 2020. [DOI: 10.1590/1806-9061-2019-1055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Aksoy A, Salazar C, Becher MU, Tiyerili V, Weber M, Jansen F, Sedaghat A, Zimmer S, Leick J, Grube E, Gonzalo N, Sinning JM, Escaned J, Nickenig G, Werner N. Intravascular Lithotripsy in Calcified Coronary Lesions. Circ Cardiovasc Interv 2019; 12:e008154. [DOI: 10.1161/circinterventions.119.008154] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background:
Optimal plaque preparation of calcified coronary lesions is key to prevent stent failure. The purpose of this study was to determine the strategy success and safety of intravascular lithotripsy (IVL) in calcified lesions of an all-comers cohort.
Methods:
Patients with calcified coronary lesions were screened in 3 centers. Seventy-one patients were eligible for IVL. Patients were assigned to (group A) primary IVL therapy for patients with calcified de-novo lesions (n=39 lesions), (group B) secondary IVL therapy for patients with calcified lesions in which noncompliant balloon dilatation failed (n=22 lesions), and (group C) tertiary IVL therapy in patients with stent underexpansion after previous stenting (n=17 lesions). Primary end point was strategy success (stent expansion with <20% in-stent residual stenosis) and safety outcomes (procedural complications, in-hospital major adverse cardiovascular event).
Results:
Seventy-eight calcified lesions were treated using the Shockwave C
2
balloon. Mean diameter stenosis of calcified lesions was 71.8±13.1% at baseline, decreased to 45.1±17.4% immediately after IVL, and to 17.5±15.2% after stenting. Mean minimal lumen diameter was 1.01±0.49 mm at baseline and increased to 1.90±0.61 after IVL, and to 2.88±0.56 mm after stenting. The primary end point of strategy success was reached in 84.6% (group A), 77.3% (group B), and 64.7% (group C). Device delivery and IVL treatment were possible in all lesions. Four type b dissections were observed without further sequelae. No patient suffered from in-hospital major adverse cardiovascular event. Seven Shockwave balloons ruptured during treatment without any sequelae.
Conclusions:
IVL provides a valid strategy for lesion preparation in severely calcified coronary lesions with high success rate, low procedural complications, and low major adverse cardiovascular event rates.
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Affiliation(s)
- Adem Aksoy
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Carlos Salazar
- Hospital Clinico San Carlos IdiSSC, Universidad Complutense, Madrid, Spain (C.S., N.G., J.E.)
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Felix Jansen
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Jürgen Leick
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder Trier, Germany (J.L., N.W.)
| | - Eberhard Grube
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Nieves Gonzalo
- Hospital Clinico San Carlos IdiSSC, Universidad Complutense, Madrid, Spain (C.S., N.G., J.E.)
| | - Jan-Malte Sinning
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Javier Escaned
- Hospital Clinico San Carlos IdiSSC, Universidad Complutense, Madrid, Spain (C.S., N.G., J.E.)
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Nikos Werner
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder Trier, Germany (J.L., N.W.)
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Aksoy A, Salazar C, Zimmer S, Escaned J, Nickenig G, Sinning JM, Werner N. TCT-653 Intravascular Lithotripsy for Lesion Preparation in Calcified Coronary Lesions: First Data of Prospective, Observational Multicenter Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Aksoy A, Yayıcı Köken Ö, Çavdarlı B, Talim B, Yüksel D. EP.25A limb girdle muscular dystrophy phenotype with mutations in ISPD and TTN. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Aksoy A, Salazar C, Becher UM, Jansen F, Tiyerili V, Zimmer S, Grube E, Sinning JM, Nickenig G, Gonzalo N, Escaned J, Werner N. P973Intravascular lithotripsy for lesion preparation in calcified coronary lesions: a prospective, observational, two-center registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Intravascular coronary lithotripsy (IVL) is a novel alternative treatment for heavily calcified lesions. This study sought to determine the strategy success and safety of IVL on calcified lesions in an all-comers cohort of patients.
Methods
Patients with moderate and severely calcified coronary lesions were screened in two centers in Spain and Germany starting April 2018. Until February 2019, 61 patients with 67 lesions were eligible for IVL. Patients were assigned to the following groups: A) Primary IVL therapy for patients with circumferential calcified de-novo coronary lesions (n=32), B) Secondary IVL therapy for patients with moderate or severe calcified coronary lesions in which conventional non-compliant balloon dilatation failed (n=18) and C) Tertiary IVL therapy in patients with in-stent stenosis due to stent underexpansion after previous stenting (n=17). Primary endpoint was strategy success and safety outcome. Strategy success was defined as successful stent delivery and expansion with attainment of <20% in-stent residual stenosis of the target lesion. Safety outcome were procedural complication, defined as coronary dissection, slow or no-reflow phenomenon, new coronary thrombus formation during PCI, abrupt vessel closure and device failure (inability to place the balloon, malfunction, or burst) and in hospital MACE.
Results
61 patients with 67 calcified lesions were treated with IVL. Mean diameter of calcified stenosis on quantitative coronary angiography was 72.02±13.8% at baseline and decreased to 17.7±15.84% (p-value: <0.01) after IVL with an acute gain of 1.9±0.63 mm. Mean minimal lumen diameter was 1.0±0.5 mm at baseline and increased after IVL to 2.9±0.6 mm. The overall average of applied pulses was 63±22. The primary endpoint of strategy success was reached overall in 85.2% of patients. 4 type b dissections (3 in group A, 1 in group B) were observed without further sequelae. There were no in-hospital MACE. In one patient (1.6%) non-ischemia driven target lesion failure was observed in routine follow up coronary angiography and was in need for revascularization. According to the subgroups, strategy success in primary IVL treatment (group A) and secondary IVL treatment (group B) was reached in 81.3% and 83.3% of cases, respectively. In tertiary IVL therapy (group C), the primary study endpoint was reached in 64.7% of cases. Device delivery and IVL treatment of target lesion could be performed in all lesions without vessel complications. 7 IVL balloons ruptured during treatment without any sequelae. Rupture was observed in most cases after repositioning of the balloon within the calcified lesion.
Conclusions
IVL provides a valid strategy for lesion preparation in severely calcified coronary lesions, with high success rate, and low procedural complication and MACE rates. Longitudinal studies will confirm if these favourable initial results of IVL-supported PCI are followed by good long-term results.
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Affiliation(s)
- A Aksoy
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - C Salazar
- Hospital Clinic San Carlos, Universidad Complutense, Madrid, Spain
| | - U M Becher
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - F Jansen
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - V Tiyerili
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - S Zimmer
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - E Grube
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - J M Sinning
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - N Gonzalo
- Hospital Clinic San Carlos, Universidad Complutense, Madrid, Spain
| | - J Escaned
- Hospital Clinic San Carlos, Universidad Complutense, Madrid, Spain
| | - N Werner
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
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Aydin S, Kuloglu T, Aydin Y, Yalcin MH, Ugur K, Albayrak S, Aksoy A, Sahin I, Dagli AF, Akkoc RF, Aydin S. Effects of iloprost and sildenafil treatment on elabela, apelin-13, nitric oxide, and total antioxidant and total oxidant status in experimental enzyme-positive acute coronary syndrome in rats. Biotech Histochem 2019; 95:145-151. [PMID: 31429306 DOI: 10.1080/10520295.2019.1653497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Despite significant advances in medicine, mortality due to cardiovascular disease is not yet preventable. We investigated the amounts of elabela (ELA) and apelin, synthesized by cardiomyocytes, and changes of these compounds in cardiac tissue and circulation after administration of iloprost (ILO) and sildenafil (SIL) in rats with induced myocardial ischemia (MI). We also investigated a connection with circulating troponin-I, creatine kinase (CK), creatine kinase-myocardial band (CK-MB) and nitric oxide (NO), and total anti-oxidant (TAS)/total oxidant status (TOS). We established eight study groups of five rats each. Group 1, sham, was given only physiologic serum; group 2, ILO; group 3, SIL; group 4, ILO + SIL; group 5, MI; group 6, MI + ILO; group 7, MI + SIL; group 8, MI + ILO + SIL. Troponin-I, CK, CK-MB and TAS-TOS were investigated using an autoanalyzer. NO, ELA and apelin were analyzed by ELISA. Tissue apelin and ELA expressions and localizations were determined by immunohistochemistry. The MI group compared to the control (sham) group showed that ELA, apelin, troponin-I, CK, CK-MB, NO and TOS levels were elevated significantly. Concentrations of these factors increased in MI, but decreased after ILO and SIL administration. The largest decrease of TOS was identified in the ILO + SIL group. ELA and apelin may be novel indicators of MI and administration of ILO and SIL, individually or together, may be useful for treating MI.
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Affiliation(s)
- S Aydin
- Department of Cardiovascular Surgery, Fethi Sekin City Hospital, Elazig, Turkey.,Department of Anatomy, School of Medicine, Firat University, Elazig, Turkey
| | - T Kuloglu
- Department of Histology and Embryology, School of Medicine, Firat University, Elazig, Turkey
| | - Y Aydin
- Department of Internal Medicine, School of Veterinary Medicine, Ankara University, Ankara, Turkey
| | - M H Yalcin
- Department of Histology and Embryology, School of Veterinary Medicine, Firat University, Elazig, Turkey
| | - K Ugur
- Department of Endocrine and Metabolism Diseases, School of Medicine, Firat University, Elazig, Turkey
| | - S Albayrak
- Department of Brain Surgery, Elazig Education and Research Hospital, Health Science University, Elazig, Turkey
| | - A Aksoy
- Department of Nutrition and Dietetics, Bitlis Eren University, Bitlis, Turkey
| | - I Sahin
- Department of Medical Biology, School of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey.,Department of Medical Biochemistry and Clinical Biochemistry, (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
| | - A F Dagli
- Department of Pathology, School of Medicine, Firat University, Elazig, Turkey
| | - R F Akkoc
- Department of Anatomy, School of Medicine, Firat University, Elazig, Turkey
| | - S Aydin
- Department of Medical Biochemistry and Clinical Biochemistry, (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
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Baş B, Aksoy A, Atmaca E, Öz AA, Kaya Ö, Kazan D, Yılmaz E, Kütük N. Effect of occlusal splint on interleukin 6, malondialdehyde and 8-hydroxydeoxyguanosine levels in the synovial fluid of patients with temporomandibular disorders. Int J Oral Maxillofac Surg 2019; 48:1558-1563. [PMID: 31109746 DOI: 10.1016/j.ijom.2019.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/27/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
The actual role of splint therapy in preventing excessive loading of the temporomandibular joint (TMJ) is still debated. Lower intra-articular pressure levels have been measured in patients wearing occlusal splints, which may also reduce oxidative stress in the articular spaces. The aim of this study was to determine whether splint therapy reduces oxidative stress and inflammation in TMJ internal derangement patients by measuring interleukin 6 (IL-6), malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG) levels in the synovial fluid (SF). Twenty-four patients with a temporomandibular disorder (TMD) were included in the study. TMJ SF samples were obtained prior to arthrocentesis. Twelve patients used a 2-mm hard acrylic, maxillary stabilization-type splint for 3 months after arthrocentesis. Twelve patients had no treatment after the SF aspiration. Second SF samples were obtained from all patients at 3 months post arthrocentesis. IL-6, MDA, and 8-OHdG levels in the samples were evaluated. All patients showed a significant symptomatic improvement after treatment (P < 0.005). No statistical correlation was found between the two groups concerning pre-treatment and 3-month SF levels of MDA, 8-OHdG, and IL-6. Although splint therapy was found to be successful in eliminating clinical symptoms of TMD, the results showed no beneficial effect on inflammation and oxidative stress markers in the synovial fluid.
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Affiliation(s)
- B Baş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - A Aksoy
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - E Atmaca
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - A A Öz
- Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Ö Kaya
- Private Dental Clinic, Izmir, Turkey
| | - D Kazan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey.
| | - E Yılmaz
- Private Dental Clinic, Samsun, Turkey
| | - N Kütük
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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Aksoy A, Ertürk YE, Eyduran E, Tariq MM. Utility of MARS Algorithm for Describing Non-Genetic Factors Affecting Pasture Revenue of Morkaraman Breed and Romanov × Morkaraman F1 Crossbred Sheep under Semi Intensive Conditions. PAK J ZOOL 2018. [DOI: 10.17582/journal.pjz/2019.51.1.235.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ozturk A, Celik S, Kodaz H, Yildiz I, Ocak A, Hacibekiroglu I, Bayoglu I, Ercelep O, Ekinci A, Menekse S, Gumusay O, Oven B, Aldemir M, Geredeli C, Baykara M, Uysal M, Sevinc A, Aksoy A, Ulas A, Inanc M, Tanriverdi O, Avci N, Turan N, Gumus M. P3.01-33 EGFR Mutation in Patients with NSCLC and Its Relationship Between Survival and Clinicopathological Features: An Update Analysis. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aksoy A, Ertürk YE, Eyduran E, Tariq MM. Comparing Predictive Performances of MARS and CHAID Algorithms for Defining Factors Affecting Final Fattening Live Weight in Cultural Beef Cattle Enterprises. PAK J ZOOL 2018. [DOI: 10.17582/journal.pjz/2018.50.6.2279.2286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Erturk YE, Aksoy A, Tariq MM. Effect of Selected Variables Identified by Mars on Fattening Final Live Weight of Crossbred Beef Cattle in Eastern Turkey. PAK J ZOOL 2018. [DOI: 10.17582/journal.pjz/2018.50.4.1403.1412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Aksoy A, Ertürk YE, Erdoğan S, Eyduran E, Tariq MM. Estimation of Honey Production in Beekeeping Enterprises from Eastern Part of Turkey through Some Data Mining Algorithms. PAK J ZOOL 2018. [DOI: 10.17582/journal.pjz/2018.50.6.2199.2207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Aksoy A, Köken Ö, Özyürek H, Talim B. A rare form of congenital muscle disorders; megakonial congenital muscular dystrophy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jehle J, Mueller C, Aksoy A, Zimmer S, Nickenig G, Tiyerili V. P5161Deletion of multidrug resistance-associated protein 1 improves endothelial function and attenuates atherosclerosis in MRP1−/− LDL−/− double knockout mice. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jehle J, Müller CFH, Aksoy A, Zimmer S, Nickenig G, Tiyerili V. Genetic disruption of multidrug resistance-associated protein 1 improves endothelial function and attenuates atherosclerosis in MRP1 -/- LDLr -/- double knockout mice. Arch Med Sci 2017; 13:930-936. [PMID: 28721160 PMCID: PMC5510514 DOI: 10.5114/aoms.2017.68239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/08/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Multidrug resistance-associated protein 1 (MRP1) is an anion transporter which is implicated in the efflux of the intracellular antioxidant anion glutathione as well as leukotrienes. Pharmacological inhibition of MRP1 exhibits antioxidative and anti-atherosclerotic effects both in vitro and in vivo. However, pharmacological inhibitors of MRP1 lack selectivity, which prompted us to study the in vivo impact of a genetic disruption of MRP1 on endothelial dysfunction, reactive oxygen species formation and atherogenesis in an atherosclerotic mouse model. MATERIAL AND METHODS MRP1-/- LDLr-/- double knockout mice. were fed a high-fat and cholesterol-rich diet for 7 weeks. Thereafter, endothelial function was assessed in isolated aortic rings. Reactive oxygen species were quantified by L-012 chemiluminescence, and the atherosclerotic plaque burden was measured following oil red O staining. RESULTS Endothelium-dependent vasodilation of MRP1-/- LDLr-/- double knockout mice was significantly improved compared to MRP1-competent LDLr-/- single knockout mice (0.56 ±0.06 vs. 0.78 ±0.08; n = 10; p = 0.048). This improvement was accompanied by a significant reduction in reactive oxygen species formation within the aortic tissue (102 ±27 RLU/s/mg vs. 315 ±78 RLU/s/mg, n = 9-11, p = 0.03). Moreover, the atherosclerotic plaque burden of MRP1-/- LDLr-/- double knockout mice was significantly reduced (0.06 ±0.01 vs. 0.12 ±0.02; n = 6; p = 0.047). Finally, arterial blood pressure was significantly reduced in MRP1-/- LDLr-/- double knockout mice (93 ±5 mm Hg vs. 128 ±4 mm Hg; n = 8-12; p < 0.001). CONCLUSIONS Genetic disruption of MRP1 appears to reduce blood pressure and vascular oxidative stress in vivo, which leads to improved endothelial function and a reduced plaque burden in atherosclerotic mice. Therefore, MRP1 might represent a promising therapeutic target to improve endothelial function in patients suffering from atherosclerosis.
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Affiliation(s)
- Julian Jehle
- Klinik II für Innere Medizin, Universität Bonn, Bonn, Germany
| | | | - Adem Aksoy
- Klinik II für Innere Medizin, Universität Bonn, Bonn, Germany
| | | | - Georg Nickenig
- Klinik II für Innere Medizin, Universität Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Klinik II für Innere Medizin, Universität Bonn, Bonn, Germany
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