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Bhatla A, Kim CH, Nimbalkar M, Ng‐Thow‐Hing AS, Isakadze N, Spaulding E, Zaleski A, Craig KJ, Verbrugge DJ, Dunn P, Nag D, Bankar D, Martin SS, Marvel FA. Cardiac Rehabilitation Enabled With Health Technology: Innovative Models of Care Delivery and Policy to Enhance Health Equity. J Am Heart Assoc 2024; 13:e031621. [PMID: 38226509 PMCID: PMC10926793 DOI: 10.1161/jaha.123.031621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/11/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Anjali Bhatla
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Chang H. Kim
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Mansi Nimbalkar
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Anthony Sky Ng‐Thow‐Hing
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Nino Isakadze
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Erin Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
- School of NursingJohns Hopkins UniversityBaltimoreMD
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | | | | | | | | | | | - Seth S. Martin
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Francoise A. Marvel
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
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Zaleski A, Thomas Craig KJ, Caddigan E, Yang H, Cheng Z, McNutt SL, Baquet-Simpson A. Leveraging Clinical Informatics to Address the Quintuple Aim for End-of-Life Care. AMIA Annu Symp Proc 2024; 2023:784-793. [PMID: 38222390 PMCID: PMC10785881] [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: 01/16/2024]
Abstract
As the population of older adults grows at an unprecedented rate, there is a large gap to provide culturally tailored end-of-life care. This study describes a payor-led, informatics-based approach to identify Medicare members who may benefit from a Compassionate CareSM Program (CCP), which was designed to provide specialized care management services and support to members who have end-stage and/or life-limiting illnesses by addressing the quintuple aim. Potential participants are identified through machine learning models whereby nurse care managers then provide tailored outreach via telephone. A retrospective, observational cohort analysis of propensity-weighted Medicare members was performed to compare decedents who did or did not participate in the CCP. This program enhanced the end-of-life care experience while providing equitable outcomes regardless of age, gender, and geography and decreased inpatient (-37%) admissions with concomitant reduced (-59%) medical spend when compared to decedents that did not utilize the end-of-life care management program.
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Affiliation(s)
- Amanda Zaleski
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health, Wellesley, MA, US
| | - Kelly J Thomas Craig
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health, Wellesley, MA, US
| | - Eamon Caddigan
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, US
| | - Hannah Yang
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, US
| | - Zenon Cheng
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, US
| | | | - Alena Baquet-Simpson
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health, Wellesley, MA, US
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Craig KJ, Ji YJ, Zhang YC, Berk A, Zaleski A, Abdelsamad O, Coetzer H, Verbrugge DJ, Hua G. Real-world Application of Racial and Ethnic Imputation and Cohort Balancing Techniques to Deliver Equitable Clinical Trial Recruitment. AMIA Annu Symp Proc 2024; 2023:319-328. [PMID: 38222354 PMCID: PMC10785904] [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: 01/16/2024]
Abstract
Enhancing diversity and inclusion in clinical trial recruitment, especially for historically marginalized populations including Black, Indigenous, and People of Color individuals, is essential. This practice ensures that generalizable trial results are achieved to deliver safe, effective, and equitable health and healthcare. However, recruitment is limited by two inextricably linked barriers - the inability to recruit and retain enough trial participants, and the lack of diversity amongst trial populations whereby racial and ethnic groups are underrepresented when compared to national composition. To overcome these barriers, this study describes and evaluates a framework that combines 1) probabilistic and machine learning models to accurately impute missing race and ethnicity fields in real-world data including medical and pharmacy claims for the identification of eligible trial participants, 2) randomized controlled trial experimentation to deliver an optimal patient outreach strategy, and 3) stratified sampling techniques to effectively balance cohorts to continuously improve engagement and recruitment metrics.
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Affiliation(s)
- Kelly J Craig
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health, Wellesley, MA, US
| | | | | | | | - Amanda Zaleski
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health, Wellesley, MA, US
| | | | | | - Dorothea J Verbrugge
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health, Wellesley, MA, US
| | - Guangying Hua
- Clinical Trial Services, CVS Health, Woonsocket, RI, US
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Zaleski A, Sigler B, Leggitt A, Choudhary S, Berns R, Rhee K, Schwarzwald H. The Influence of a Wearable-Based Reward Program on Health Care Costs: Retrospective, Propensity Score-Matched Cohort Study. J Med Internet Res 2023; 25:e45064. [PMID: 36917152 PMCID: PMC10131601 DOI: 10.2196/45064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) technology holds great promise as an easily accessible and effective solution to improve population health at scale. Despite the abundance of mHealth offerings, only a minority are grounded in evidence-based practice, whereas even fewer have line of sight into population-level health care spending, limiting the clinical utility of such tools. OBJECTIVE This study aimed to explore the influence of a health plan-sponsored, wearable-based, and reward-driven digital health intervention (DHI) on health care spending over 1 year. The DHI was delivered through a smartphone-based mHealth app available only to members of a large commercial health plan and leveraged a combination of behavioral economics, user-generated sensor data from the connected wearable device, and claims history to create personalized, evidence-based recommendations for each user. METHODS This study deployed a propensity score-matched, 2-group, and pre-post observational design. Adults (≥18 years of age) enrolled in a large, national commercial health plan and self-enlisted in the DHI for ≥7 months were allocated to the intervention group (n=56,816). Members who were eligible for the DHI but did not enlist were propensity score-matched to the comparison group (n=56,816). Average (and relative change from baseline) medical and pharmacy spending per user per month was computed for each member of the intervention and comparison groups during the pre- (ie, 12 months) and postenlistment (ie, 7-12 months) periods using claims data. RESULTS Baseline characteristics and medical spending were similar between groups (P=.89). On average, the total included sample population (N=113,632) consisted of young to middle-age (mean age 38.81 years), mostly White (n=55,562, 48.90%), male (n=46,731, 41.12%) and female (n=66,482, 58.51%) participants. Compared to a propensity score-matched cohort, DHI users demonstrated approximately US $10 per user per month lower average medical spending (P=.02) with a concomitant increase in preventive care activities and decrease in nonemergent emergency department admissions. These savings translated to approximately US $6.8 million in avoidable health care costs over the course of 1 year. CONCLUSIONS This employer-sponsored, digital health engagement program has a high likelihood for return on investment within 1 year owing to clinically meaningful changes in health-seeking behaviors and downstream medical cost savings. Future research should aim to elucidate health behavior-related mechanisms in support of these findings and continue to explore novel strategies to ensure equitable access of DHIs to underserved populations that stand to benefit the most.
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Affiliation(s)
- Amanda Zaleski
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health, Hartford, CT, United States
| | - Brittany Sigler
- Aetna Digital Product Development, CVS Health, Wellesley, MA, United States
| | - Alan Leggitt
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, United States
| | - Shruti Choudhary
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, United States
| | - Ryan Berns
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, United States
| | - Kyu Rhee
- Aetna Medical Affairs, CVS Health, Hartford, CT, United States
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Cilhoroz BT, Zaleski A, Taylor B, Fernandez AB, Santos LP, Vonk T, Thompson PD, Pescatello LS. The Relationship between Postexercise Hypotension and Heart Rate Variability before and after Exercise Training. J Cardiovasc Dev Dis 2023; 10:jcdd10020064. [PMID: 36826560 PMCID: PMC9958830 DOI: 10.3390/jcdd10020064] [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] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023] Open
Abstract
Because data are scarce, we examined the relationship between postexercise hypotension (PEH) and heart rate variability (HRV) before and after aerobic exercise training among adults with hypertension. Participants completed a 12 w aerobic training program. Before and after training, they performed a peak graded exercise stress test (GEST) and nonexercise control (CONTROL) and were left attached to an ambulatory BP monitor. Prior to CONTROL, HRV was measured supine for 5 min using a 12-lead electrocardiogram (ECG). The participants (n = 18) were middle-aged (52.1 ± 11.7 y) and 50% men with hypertension (131.7 ± 9.8/85.9 ± 8.5 mmHg) and obesity (30.0 ± 3.7 kg·m-2). Before training, ambulatory systolic BP (ASBP) and diastolic ABP (ADBP) decreased by 3.2 ± 2.1 mmHg and 2.5 ± 1.5 mmHg, respectively, from baseline after the GEST versus CONTROL (p < 0.05). After training, ASBP tended to decrease by 3.5 ± 2.2 mmHg (p = 0.055) and ADBP decreased by 1.7 ± 2.5 mmHg (p = 0.001) from baseline after the GEST versus CONTROL. Before training, HRV high frequency (HFms2) (β = -0.441), age (β = 0.568), and resting SBP (β = 0.504) accounted for 66.8% of the ASBP response (p = 0.001), whereas the low frequency (LF)/HF ratio (β = 0.516) and resting DBP (β = 0.277) accounted for 35.7% of the ADBP response (p = 0.037). After training, the standard deviation of NN intervals (SDNN) (β = -0.556), age (β = 0.506), and resting SBP (β = 0.259) accounted for 60.7% of the ASBP response (p = 0.004), whereas SDNN (β = -0.236) and resting DBP (β = 0.785) accounted for 58.5% of the ADBP response (p = 0.001). Our preliminary findings show that adults with hypertension and parasympathetic suppression (i.e., lower SDNN and HFms2 and higher LF/HF) may elicit PEH to the greatest degree independent of training status versus adults with parasympathetic predominance, suggesting that resting HRV may be an important determinant of PEH.
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Affiliation(s)
- Burak T. Cilhoroz
- Department of Exercise Science, Falk College of Sports and Human Dynamics, Syracuse University, Syracuse, NY 13244, USA
- Correspondence: ; Tel.: +1-516-725-6889; Fax: +1-315-443-2562
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
- Department of Preventive Cardiology, Hartford Hospital, Hartford, CT 06106, USA
| | - Beth Taylor
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | - Lucas P. Santos
- Exercise Pathophysiology Laboratory, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-003, Brazil
| | - Thijs Vonk
- Department of Physiology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Paul D. Thompson
- Department of Preventive Cardiology, Hartford Hospital, Hartford, CT 06106, USA
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Cilhoroz BT, Zaleski A, Taylor B, Fernandez AB, Santos L, Volk T, Thompson PD, Pescatello L. PARASYMPATHATIC PREDOMINANCE IS ASSOCIATED WITH POSTEXERCISE HYPOTENSION BEFORE AND AFTER TRAINING AMONG ADULTS WITH HYPERTENSION. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000880688.28227.19] [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: 11/21/2022]
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Cilhoroz B, Zaleski A, Taylor B, Fernandez A, Santos L, Leister K, Thompson PD, Pescatello LS. THE RELATIONSHIP BETWEEN POST-EXERCISE HYPOTENSION AND HEART RATE VARIABILITY BEFORE AND AFTER TRAINING. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760124.24363.6a] [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: 11/21/2022]
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Pescatello LS, Wu Y, Panza GA, Zaleski A, Guidry M. Development of a Novel Clinical Decision Support System for Exercise Prescription Among Patients With Multiple Cardiovascular Disease Risk Factors. Mayo Clin Proc Innov Qual Outcomes 2021; 5:193-203. [PMID: 33718793 PMCID: PMC7930885 DOI: 10.1016/j.mayocpiqo.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 01/29/2023] Open
Abstract
Cardiovascular disease (CVD) risk factors cluster in an individual. Exercise is universally recommended to prevent and treat CVD. Yet, clinicians lack guidance on how to design an exercise prescription (ExRx) for patients with multiple CVD risk factors. To address this unmet need, we developed a novel clinical decision support system to prescribe exercise (prioritize personalize prescribe exercise [P3-EX]) for patients with multiple CVD risk factors founded upon the evidenced-based recommendations of the American College of Sports Medicine (ACSM) and American Heart Association. To develop P3-EX, we integrated (1) the ACSM exercise preparticipation health screening recommendations; (2) an adapted American Heart Association Life's Simple 7 cardiovascular health scoring system; (3) adapted ACSM strategies for designing an ExRx for people with multiple CVD risk factors; and (4) the ACSM frequency, intensity, time, and time principle of ExRx. We have tested the clinical utility of P3-EX within a university-based online graduate program in ExRx among students that includes physicians, physical therapists, registered dietitians, exercise physiologists, kinesiologists, fitness industry professionals, and kinesiology educators in higher education. The support system P3-EX has proven to be an easy-to-use, guided, and time-efficient evidence-based approach to ExRx for patients with multiple CVD risk factors that has applicability to other chronic diseases and health conditions. Further evaluation is needed to better establish its feasibility, acceptability, and clinical utility as an ExRx tool.
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Key Words
- 1-RM, one repetition maximum
- ACSM, American College of Sports Medicine
- AHA, American Heart Association
- AHA7CVH, American Heart Association Life’s Simple 7 cardiovascular health scoring system
- BG, blood glucose
- BMI, body mass index
- BP, blood pressure
- CV, cardiovascular
- CVD, cardiovascular disease
- CVH, cardiovascular health
- DBP, diastolic blood pressure
- Ex Rx, exercise prescription
- FITT, frequency, intensity, time, and type
- HDL-C, high-density lipoprotein cholesterol
- HR, heart rate
- HRR, heart rate reserve
- HTN, hypertension
- LDL-C, low-density lipoprotein cholesterol
- P3-EX, prioritize personalize prescribe exercise clinical decision support system
- PNF, proprioceptive neuromuscular facilitation
- RPE, rating of perceived exertion
- SBP, systolic blood pressure
- SOB, shortness of breath
- T1DM, type 1 diabetes mellitus
- T2DM, type 2 diabetes mellitus
- TC, total cholesterol
- VO2R, oxygen uptake reserve
- WC, waist circumference
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Affiliation(s)
| | - Yin Wu
- Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Gregory A. Panza
- Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, CT
- Department of Preventive Cardiology, Hartford Hospital, Hartford, CT
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Cilhoroz B, Giles D, Zaleski A, Taylor B, Fernhall B, Pescatello L. Validation of the Polar V800 heart rate monitor and comparison of artifact correction methods among adults with hypertension. PLoS One 2020; 15:e0240220. [PMID: 33031480 PMCID: PMC7544136 DOI: 10.1371/journal.pone.0240220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022] Open
Abstract
Heart rate variability (HRV) measurements via ambulatory monitors have become common. We examined the validity of recording R-R intervals using the Polar V800™ compared to 12-lead electrocardiograms (ECG) among middle-aged (44.7±10.1years); overweight to obese (29.8±4.3 kg.m-2) adults (n = 25) with hypertension (132.3±12.2/ 84.3±10.2 mmHg). After resting for 5-min in the supine position, R-R intervals were simultaneously recorded using the Polar V800™ and the 12-lead ECG. Artifacts present in uncorrected (UN) R-R intervals were corrected with the Kubios HRV Premium (ver. 3.2.) automatic (AC) and threshold-based (TBC) correction, and manual correction (MC) methods. Intra-class correlation coefficients (ICC), Bland-Altman limits of agreement (LoA), and effect sizes (ES) were calculated. We detected 71 errors with the Polar V800™ for an error rate of 0.85%. The bias (LoAs), ES, and ICC between UN and ECG R-R intervals were 0.69ms (-215.80 to +214.42ms), 0.004, and 0.79, respectively. Correction of artifacts improved the agreeability between the Polar V800™ and ECG HRV measures. The biases (LoAs) between the AC, TBC, and MC and ECG R-R intervals were 3.79ms (-130.32 to +137.90ms), 1.16ms (-92.67 to +94.98ms), and 0.37ms (-41.20 to +41.94ms), respectively. The ESs of AC, TBC, and MC were 0.024, 0.008, and 0.002, and ICCs were 0.91, 0.95, and 1.00, respectively. R-R intervals measured using the Polar V800™ compared to 12-lead ECG were comparable in adults with hypertension, especially after the artifacts corrected by MC. However, TBC correction also yielded acceptable results.
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Affiliation(s)
- Burak Cilhoroz
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, United States of America
- Department of Exercise Science, Syracuse University, Syracuse, New York, United States of America
- * E-mail:
| | - David Giles
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, United States of America
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut, United States of America
| | - Beth Taylor
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, United States of America
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut, United States of America
| | - Bo Fernhall
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Linda Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, United States of America
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut, United States of America
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Cilhoroz BT, Schifano ED, Panza GA, Ash GI, Corso L, Chen M, Deshpande V, Zaleski A, Farinatti P, Santos LP, Taylor BA, O'Neill RJ, Thompson PD, Pescatello LS. FURIN variant associations with postexercise hypotension are intensity and race dependent. Physiol Rep 2019; 7:e13952. [PMID: 30706700 PMCID: PMC6356167 DOI: 10.14814/phy2.13952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 12/16/2022] Open
Abstract
FURIN is a proprotein convertase subtilisin/kexin enzyme important in pro-renin receptor processing, and FURIN (furin, paired basic amino acid cleaving enzyme) variants are involved in multiple aspects of blood pressure (BP) regulation. Therefore, we examined associations among FURIN variants and the immediate blood pressure (BP) response to bouts of aerobic exercise, termed postexercise hypotension (PEH). Obese (30.9 ± 3.6 kg m-2 ) Black- (n = 14) and White- (n = 9) adults 42.0 ± 9.8 year with hypertension (139.8 ± 10.4/84.6 ± 6.2 mmHg) performed three random experiments: bouts of vigorous (VIGOROUS) and moderate (MODERATE) intensity cycling and control. Subjects were then attached to an ambulatory BP monitor for 19 h. We performed deep-targeted exon sequencing with the Illumina TruSeq Custom Amplicon kit. FURIN genotypes were coded as the number of minor alleles (#MA) and selected for additional statistical analysis based upon Bonferonni or Benjamini-Yekutieli multiple testing corrected P-values under time-adjusted linear models for 19 hourly BP measurements. After VIGOROUS over 19 h, as FURIN #MA increased in rs12917264 (P = 2.4E-04) and rs75493298 (P = 6.4E-04), systolic BP (SBP) decreased 30.4-33.7 mmHg; and in rs12917264 (P = 1.6E-03) and rs75493298 (P = 9.7E-05), diastolic BP (DBP) decreased 17.6-20.3 mmHg among Blacks only. In addition, after MODERATE over 19 h in FURIN rs74037507 (P = 8.0E-04), as #MA increased, SBP increased 20.8 mmHg among Blacks only. Whereas, after MODERATE over the awake hours in FURIN rs1573644 (P = 6.2E-04), as #MA increased, DBP decreased 12.5 mmHg among Whites only. FURIN appears to exhibit intensity and race-dependent associations with PEH that merit further exploration among a larger, ethnically diverse sample of adults with hypertension.
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Affiliation(s)
| | | | - Gregory A. Panza
- Department of KinesiologyUniversity of ConnecticutStorrsConnecticut
- Department of Preventive CardiologyHartford HospitalHartfordConnecticut
| | | | - Lauren Corso
- Department of KinesiologyUniversity of ConnecticutStorrsConnecticut
| | - Ming‐Hui Chen
- Department of StatisticsUniversity of ConnecticutStorrsConnecticut
| | - Ved Deshpande
- Department of StatisticsUniversity of ConnecticutStorrsConnecticut
| | - Amanda Zaleski
- Department of KinesiologyUniversity of ConnecticutStorrsConnecticut
- Department of Preventive CardiologyHartford HospitalHartfordConnecticut
| | - Paulo Farinatti
- Department of Physical Activity SciencesRio de Janeiro State UniversityRio de JaneiroBrazil
| | - Lucas P. Santos
- Department of Medical SciencesFederal University of Rio Grande do SulPorto AlegreBrazil
| | - Beth A. Taylor
- Department of KinesiologyUniversity of ConnecticutStorrsConnecticut
- Department of Preventive CardiologyHartford HospitalHartfordConnecticut
| | - Rachel J. O'Neill
- Institute for Systems GenomicsUniversity of ConnecticutStorrsConnecticut
- Department of Molecular and Cell BiologyUniversity of ConnecticutStorrsConnecticut
| | - Paul D. Thompson
- Department of Preventive CardiologyHartford HospitalHartfordConnecticut
| | - Linda S. Pescatello
- Department of KinesiologyUniversity of ConnecticutStorrsConnecticut
- Institute for Systems GenomicsUniversity of ConnecticutStorrsConnecticut
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Cilhoroz BT, Panza GA, Schifano ED, Ash GI, Corso LM, Chen MH, Deshpande V, Zaleski A, Farinatti P, Taylor BA, O’Neill RJ, Thompson PD, Pescatello LS. FURIN Variant Associations with Postexercise Hypotension are Ethnicity and Intensity Dependent. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535988.19797.e9] [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: 11/21/2022]
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12
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Pescatello LS, Schifano ED, Ash GI, Panza GA, Corso LML, Chen MH, Deshpande V, Zaleski A, Cilhoroz B, Farinatti P, Taylor BA, O'Neill RJ, Thompson PD. Deep-targeted sequencing of endothelial nitric oxide synthase gene exons uncovers exercise intensity and ethnicity-dependent associations with post-exercise hypotension. Physiol Rep 2017; 5:e13510. [PMID: 29180482 PMCID: PMC5704084 DOI: 10.14814/phy2.13510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/27/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 12/17/2022] Open
Abstract
In previous studies, we found an endothelial nitric oxide synthase gene (NOS3) variant rs2070744 associated with the ambulatory blood pressure (BP) response following bouts of moderate and vigorous intensity acute exercise, termed post-exercise hypotension (PEH). In a validation cohort, we sequenced NOS3 exons for associations with PEH Obese (30.9 ± 3.6 kg.m-2) African American (n = 14) [AF] and Caucasian (n = 9) adults 42.0 ± 9.8 years with hypertension (139.8 ± 10.4/84.6 ± 6.2 mmHg) performed three random experiments: bouts of vigorous and moderate intensity cycling and control. Subjects were attached to an ambulatory BP monitor for 19 h. We performed deep-targeted exon sequencing with the Illumina TruSeq Custom Amplicon kit. Variant genotypes were coded as number of minor alleles (#MA) and selected for additional statistical analysis based upon Bonferonni or Benjamini-Yekutieli multiple testing-corrected P-values under time-adjusted linear models for 19 hourly BP measurements for each subject. After vigorous intensity over 19 h, among NOS3 variants passing multiple testing thresholds, as the #MA increased in rs891512 (P = 6.4E-04), rs867225 (P = 6.5E-04), rs743507 (P = 2.6E-06), and rs41483644 (P = 2.4E-04), systolic (SBP) decreased from 17.5 to 33.7 mmHg; and in rs891512 (P = 9.7E-05), rs867225 (P = 2.6E-05), rs41483644 (P = 1.6E-03), rs3730009 (P = 2.6E-04), and rs77325852 (P = 5.6E-04), diastolic BP decreased from 11.1 mmHg to 20.3 mmHg among AF only. In contrast, after moderate intensity over 19 h in NOS3 rs3918164, as the #MA increased, SBP increased by 16.6 mmHg (P = 2.4E-04) among AF only. NOS3 variants exhibited associations with PEH after vigorous, but not moderate intensity exercise among AF only. NOS3 should be studied further for its effects on PEH in a large, ethnically diverse sample of adults with hypertension to confirm our findings.
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Affiliation(s)
- Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut
| | | | - Garrett I Ash
- School of Nursing, Yale University, New Haven, Connecticut
| | - Gregory A Panza
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Lauren M L Corso
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Ved Deshpande
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Burak Cilhoroz
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Paulo Farinatti
- Department of Physical Activity Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Beth A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Rachel J O'Neill
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut
| | - Paul D Thompson
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
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Elsaid O, Taylor B, Zaleski A, Panza G, Thompson PD. Rationale for investigating metformin as a protectant against statin-associated muscle symptoms. J Clin Lipidol 2017; 11:1145-1151. [DOI: 10.1016/j.jacl.2017.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/23/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022]
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Abstract
Hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins are well tolerated, but associated with various statin-associated symptoms (SAS), including statin-associated muscle symptoms (SAMS), diabetes mellitus (DM), and central nervous system complaints. These are "statin-associated symptoms" because they are rare in clinical trials, making their causative relationship to statins unclear. SAS are, nevertheless, important because they prompt dose reduction or discontinuation of these life-saving mediations. SAMS is the most frequent SAS, and mild myalgia may affect 5% to 10% of statin users. Clinically important muscle symptoms, including rhabdomyolysis and statin-induced necrotizing autoimmune myopathy (SINAM), are rare. Antibodies against HMG-CoA reductase apparently provoke SINAM. Good evidence links statins to DM, but evidence linking statins to other SAS is largely anecdotal. Management of SAS requires making the possible diagnosis, altering or discontinuing the statin treatment, and using alternative lipid-lowering therapy.
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Affiliation(s)
- Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.
| | - Gregory Panza
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut; Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Amanda Zaleski
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut; Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Beth Taylor
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut; Department of Kinesiology, University of Connecticut, Storrs, Connecticut
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Pescatello LS, Schifano ED, Ash GI, Panza GA, Lamberti L, Chen MH, Deshpande V, Zaleski A, Farinatti P, Taylor BA, Thompson PD. Deep-targeted exon sequencing reveals renal polymorphisms associate with postexercise hypotension among African Americans. Physiol Rep 2016; 4:e12992. [PMID: 27940662 PMCID: PMC5064144 DOI: 10.14814/phy2.12992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/23/2022] Open
Abstract
We found variants from the Angiotensinogen-Converting Enzyme (ACE), Angiotensin Type 1 Receptor (AGTR1), Aldosterone Synthase (CYP11B2), and Adducin (ADD1) genes exhibited intensity-dependent associations with the ambulatory blood pressure (BP) response following acute exercise, or postexercise hypotension (PEH). In a validation cohort, we sequenced exons from these genes for their associations with PEH Obese (30.9 ± 3.6 kg m-2) adults (n = 23; 61% African Americans [AF], 39% Caucasian) 42.0 ± 9.8 years with hypertension (139.8 ± 10.4/84.6 ± 6.2 mmHg) completed three random experiments: bouts of vigorous and moderate intensity cycling and control. Subjects wore an ambulatory BP monitor for 19 h. We performed deep-targeted exon sequencing using the Illumina TruSeq Custom Amplicon kit. Variant genotypes were coded as number of minor alleles (#MA) and selected for further statistical analysis based upon Bonferonni or Benjamini-Yekutieli multiple testing corrected p-values under time adjusted linear models for 19 hourly BP measurements per subject. After vigorous intensity over 19 h among ACE, AGTR1, CYP11B2, and ADD1 variants passing multiple testing thresholds, as the #MA increased, systolic (SBP) and/or diastolic BP decreased 12 mmHg (P = 4.5E-05) to 30 mmHg (P = 6.4E-04) among AF only. In contrast, after moderate intensity over 19 h among ACE and CYP11B2 variants passing multiple testing thresholds, as the #MA increased, SBP increased 21 mmHg (P = 8.0E-04) to 22 mmHg (P = 8.2E-04) among AF only. In this replication study, ACE, AGTR1, CYP11B2, and ADD1 variants exhibited associations with PEH after vigorous, but not moderate intensity exercise among AF only. Renal variants should be explored further with a multi-level "omics" approach for associations with PEH among a large, ethnically diverse sample of adults with hypertension.
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Affiliation(s)
- Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut
| | | | - Garrett I Ash
- School of Nursing, Yale University, New Haven, Connecticut
| | - Gregory A Panza
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Lauren Lamberti
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Ved Deshpande
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Paulo Farinatti
- Department of Physical Activity Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Beth A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Paul D Thompson
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
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16
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Pescatello LS, Schifano E, Ash GI, Panza GA, Lamberti L, Chen MH, Deshpande V, Zaleski A, Farinatti P, Taylor BA, Thompson PD. Deep-Targeted Exon Sequencing Reveals Angiotensinogen (AGT) loci on Chr 1q42.2 Associate with Postexercise Hypotension among Caucasians. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000488060.72063.76] [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: 11/21/2022]
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17
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Melnyk J, Panza G, Zaleski A, Taylor B. Awareness and Knowledge of Cardiovascular Risk Through Blood Pressure and Cholesterol Testing in College Freshmen. American Journal of Health Education 2015. [DOI: 10.1080/19325037.2015.1023474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - G. Panza
- Henry Low Heart Center, Hartford Hospital
| | - A. Zaleski
- Henry Low Heart Center, Hartford Hospital
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18
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Zaleski A, Capizzi J, Ballard KD, Troyanos C, Baggish A, D'Hemecourt P, Thompson PD, Parker B. Statins Attenuate the Increase in P-Selectin Produced by Prolonged Exercise. J Sports Med (Hindawi Publ Corp) 2013; 2013:487567. [PMID: 26464882 PMCID: PMC4590908 DOI: 10.1155/2013/487567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/15/2013] [Indexed: 02/08/2023]
Abstract
Strenuous endurance exercise increases inflammatory markers and acutely increases cardiovascular risk; however, statins may mitigate this response. We measured serum levels of p-selectin in 37 runners treated with statins and in 43 nonstatin treated controls running the 2011 Boston Marathon. Venous blood samples were obtained the day before (PRE) as well as within 1 hour after (FINISH) and 24 hours after (POST) the race. The increase in p-selectin immediately after exercise was lower in statin users (PRE to FINISH: 20.5 ± 19.4 ng/mL) than controls (PRE to FINISH: 30.9 ± 27.1 ng/mL; P < 0.001). The increase in p-selectin 24 hours after exercise was also lower in statin users (PRE to POST: 21.5 ± 26.6 ng/mL) than controls (PRE to POST: 29.3 ± 31.9 ng/mL; P < 0.001). Furthermore, LDL-C was positively correlated with p-selectin at FINISH and POST (P < 0.01 and P < 0.05, resp.), irrespective of drug treatment, suggesting that lower levels of LDL-C are associated with a reduced inflammatory response to exercise. We conclude that statins blunt the exercise-induced increase in p-selectin following a marathon and that the inflammatory response to a marathon varies directly with LDL-C levels.
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Affiliation(s)
- Amanda Zaleski
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
| | - Jeffrey Capizzi
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
| | - Kevin D. Ballard
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Paul D. Thompson
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
| | - Beth Parker
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
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19
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Orlińska N, Zaleski A, Paszula JM, Wokulski Z. Preparation and characterization of superconducting MgB2 rods. Cryst Res Technol 2007. [DOI: 10.1002/crat.200711016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Kuz’micheva GM, Kostyleva IE, Khlybov EP, Zaleski A, Bogacheva LN. Solid solutions (Ru,Nb)Sr2(Sm1.4Ce0.6)Cu2O10−δ: Synthesis, structure, and properties. RUSS J INORG CHEM+ 2007. [DOI: 10.1134/s0036023607060058] [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: 11/22/2022]
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21
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Greiner LL, Watanabe H, Phillips NJ, Shao J, Morgan A, Zaleski A, Gibson BW, Apicella MA. Nontypeable Haemophilus influenzae strain 2019 produces a biofilm containing N-acetylneuraminic acid that may mimic sialylated O-linked glycans. Infect Immun 2004; 72:4249-60. [PMID: 15213170 PMCID: PMC427468 DOI: 10.1128/iai.72.7.4249-4260.2004] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Previous studies suggested that nontypeable Haemophilus influenzae (NTHI) can form biofilms during human and chinchilla middle ear infections. Microscopic analysis of a 5-day biofilm of NTHI strain 2019 grown in a continuous-flow chamber revealed that the biofilm had a diffuse matrix interlaced with multiple water channels. Our studies showed that biofilm production was significantly decreased when a chemically defined medium lacking N-acetylneuraminic acid (sialic acid) was used. Based on these observations, we examined mutations in seven NTHI strain 2019 genes involved in carbohydrate and lipooligosaccharide biosynthesis. NTHI strain 2019 with mutations in the genes encoding CMP-N-acetylneuraminic acid synthetase (siaB), one of the three NTHI sialyltransferases (siaA), and the undecaprenyl-phosphate alpha-N-acetylglucosaminyltransferase homolog (wecA) produced significantly smaller amounts of biofilm. NTHI strain 2019 with mutations in genes encoding phosphoglucomutase (pgm), UDP-galactose-4-epimerase, and two other NTHI sialyltransferases (lic3A and lsgB) produced biofilms that were equivalent to or larger than the biofilms produced by the parent strain. The biofilm formed by the NTHI strain 2019pgm mutant was studied with Maackia amurensis fluorescein isothiocyanate (FITC)-conjugated and Sambucus nigra tetramethyl rhodamine isocyanate (TRITC)-conjugated lectins. S. nigra TRITC-conjugated lectin bound to this biofilm, while M. amurensis FITC-conjugated lectin did not. S. nigra TRITC-conjugated lectin binding was inhibited by incubation with alpha2,6-neuraminyllactose and by pretreatment of the biofilm with Vibrio cholerae neuraminidase. Matrix-assisted laser desorption ionization-time of flight mass spectometry analysis of lipooligosaccharides isolated from a biofilm, the planktonic phase, and plate-grown organisms showed that the levels of most sialylated glycoforms were two- to fourfold greater when the lipooligosaccharide was derived from planktonic or biofilm organisms. Our data indicate that NTHI strain 2019 produces a biofilm containing alpha2,6-linked sialic acid and that the sialic acid content of the lipooligosaccharides increases concomitant with the transition of organisms to a biofilm form.
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Affiliation(s)
- L L Greiner
- Department of Microbiology, University of Iowa, 51 Newton Road, Iowa City, IA 52242, USA.
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22
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Giardina PC, Gioannini T, Buscher BA, Zaleski A, Zheng DS, Stoll L, Teghanemt A, Apicella MA, Weiss J. Construction of acetate auxotrophs of Neisseria meningitidis to study host-meningococcal endotoxin interactions. J Biol Chem 2001; 276:5883-91. [PMID: 11084043 DOI: 10.1074/jbc.m009273200] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To facilitate studies of the molecular determinants of host-meningococcal lipooligosaccharide (endotoxin) interactions at patho-physiologically relevant endotoxin concentrations (i.e. < or =10 ng/ml), we have generated acetate auxotrophs NMBACE1 from encapsulated Neisseria meningitidis (serogroup B, strain NMB) and NMBACE2 from an isogenic bacterial mutant lacking the polysialic acid capsule. Growth of the auxotrophs in medium containing [(14)C]acetate yielded (14)C-lipooligosaccharides containing approximately 600 cpm/ng. Gel sieving resolved 14C-lipooligosaccharide-containing aggregates with an estimated molecular mass of > or =20 x 10(6) Da (peak A) and approximately 1 x 10(6) Da (peak B) from both strains. Lipooligosaccharides in peaks A and B had the same fatty acid composition and SDS-polyacrylamide gel electrophoresis profile. 14C-Labeled capsule copurified with (14)C-lipooligosaccharides in peak B from NMBACE1, whereas the other aggregates contained only 14C-lipooligosaccharide. For all aggregates, lipopolysaccharide-binding protein and soluble CD14-induced delivery of lipooligosaccharides to endothelial cells and cell activation correlated with disaggregation of lipooligosaccharides. These processes were inhibited by the presence of capsule but unaffected by the size of the aggregates. In contrast, endotoxin activation of cells containing membrane CD14 was unaffected by capsule but diminished when endotoxin was presented in larger aggregates. These findings demonstrate that the physical presentation of lipooligosaccharide, including possible interactions with capsule, affect the ability of meningococcal endotoxin to interact with and activate specific host targets.
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Affiliation(s)
- P C Giardina
- Department of Microbiology, The Inflammation Program, University of Iowa and Veterans' Administration Medical Center, Iowa City, Iowa 52242, USA
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23
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Zaleski A, Scheffler NK, Densen P, Lee FK, Campagnari AA, Gibson BW, Apicella MA. Lipooligosaccharide P(k) (Galalpha1-4Galbeta1-4Glc) epitope of moraxella catarrhalis is a factor in resistance to bactericidal activity mediated by normal human serum. Infect Immun 2000; 68:5261-8. [PMID: 10948153 PMCID: PMC101787 DOI: 10.1128/iai.68.9.5261-5268.2000] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Moraxella catarrhalis is a respiratory pathogen responsible for acute bacterial otitis media in children and exacerbation of chronic bronchitis in adults. M. catarrhalis strains are frequently resistant to the bactericidal activity of normal human serum. In order to determine if the lipooligosaccharide (LOS) of M. catarrhalis has a role in serum resistance, the UDP-glucose-4-epimerase (galE) gene was identified, cloned, and sequenced and a deletion/insertion mutation was introduced into M. catarrhalis strain 2951. GalE enzymatic activity, measured in whole-cell lysates, was ablated in M. catarrhalis 2951 galE. Mass spectrometric analysis of LOS isolated with hot phenol-water confirmed that strain 2951 produced a type A LOS. These studies showed that the LOS from 2951 galE had lost two hexose residues due to the galE mutation and that the resultant LOS structure lacked the (Galalpha1-4Galbeta1-4Glc) P(k) epitope found on M. catarrhalis 2951. Wild-type M. catarrhalis 2951 is resistant to complement-mediated serum bactericidal activity. In contrast, a greater than 2-log(10)-unit reduction in CFU occurred after incubation of 2951 galE in either 50 or 25% pooled human serum (PNHS), and CFU in 10% PNHS decreased by about 1 log(10) unit. These studies suggest that the P(k) epitope of the LOS may be an important factor in the resistance of M. catarrhalis to the complement-mediated bactericidal effect of normal human serum.
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Affiliation(s)
- A Zaleski
- Department of Microbiology, The University of Iowa, Iowa City, Iowa 52242, USA
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24
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Lee FK, Gibson BW, Melaugh W, Zaleski A, Apicella MA. Relationship between UDP-glucose 4-epimerase activity and oligoglucose glycoforms in two strains of Neisseria meningitidis. Infect Immun 1999; 67:1405-14. [PMID: 10024588 PMCID: PMC96474 DOI: 10.1128/iai.67.3.1405-1414.1999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sodium dodecyl sulfate-polyacrylamide gel analysis of lipooligosaccharide (LOS) from Neisseria meningitidis has demonstrated considerable microheterogeneity in the variable region of LOS due to the presence of novel glycoforms. As a step toward understanding the basis for the expression of these novel glycoforms, we have examined the LOS structures and UDP-glucose 4-epimerase (epimerase) activity levels in two strains (NMB and MA-1) and their respective galE mutants. Strain NMB was found to have low epimerase activity and to contain multiple glycoforms, some of which appear to contain only glucose sugars. The galE mutant had only the oligoglucose glycoforms. Strain MA-1 had higher epimerase activity at both log and stationary phases (2- and 12.5-fold, respectively) and one glycoform with a putative lactosyl structure. Strain MA-1 galE had two glycoforms that contained one or two glucose residues. To understand the molecular basis for the different epimerase activities, we examined the predicted amino acid sequences of the respective galE open reading frames and determined the relative amounts of GalE protein. We found no significant differences between the predicted amino acid sequence of the GalE protein in NMB and that in MA-1. We observed no significant differences in the level of GalE protein between MA-1 and NMB at exponential or stationary phase. We also observed an 8.2-fold drop in epimerase activity in NMB between the log and stationary phases that was not due to the GalE protein level or low glucose levels.
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Affiliation(s)
- F K Lee
- Department of Microbiology, University of Iowa, Iowa City, Iowa 52242, USA
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25
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Zaleska M, Trebicka J, Zaleski A, Trykozko U, Derlatka P, Fattah AA. [Antibiotic-resistant cystitis in the course of urinary bladder calculi after vesicoureteral reflux operation many years ago]. Pol Merkur Lekarski 1997; 2:217-8. [PMID: 10907034] [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: 02/17/2023]
Abstract
This is the introduction of chronic cystitis in course of urinary bladder calculi, 12 years after vesicoureteral reflux operation. The nucleus of the calculus (3 x 3 x 4 cm) were unresorbed dexon sutures left after the surgical treatment. Inaccuracy of radiological and ultrasonography examination delayed the settlement of the diagnosis about 18 months, and patient was caused of many months antibacterial therapy. After removal the calculus from the urinary bladder, dysuric disorders abated quickly and than after 8 weeks antibacterial therapy pathological changes in urine analysis disappeared, urine culture was sterile.
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Affiliation(s)
- M Zaleska
- Kliniki Chorób Wewnetrznych A.M. w Warszawie
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26
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Danton MC, Zaleski A, Nichols WL, Olson JD. Monoclonal antibodies to platelet glycoproteins Ib and IIb/IIIa inhibit adhesion of platelets to purified solid-phase von Willebrand factor. J Lab Clin Med 1994; 124:274-82. [PMID: 8051492] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Platelet membrane glycoproteins Ib (GPIb) and IIb/IIIa (GPIIb/IIIa) bind soluble von Willebrand factor (vWf) after stimulation with ristocetin (GPIb) or with thrombin or ADP (GPIIb/IIIa). In fluid-phase, vWf does not bind to these platelet receptors without stimulation. In contrast, platelets adhere to solid-phase vWf without stimulation by ristocetin, adenosine diphosphate (ADP), or thrombin, and adhesion increases after stimulation by these agonists. The effect of monoclonal antibodies specific for GPIb (6D1) and GPIIb/IIIa (10E5 and HP1-1D) on platelet adhesion to solid-phase vWF was studied. Adhesion of radiolabeled, washed platelets (with washed red blood cells) aspirated at a constant wall shear rate of 1000 sec-1 through glass capillary tubes coated with purified human vWf was quantified. Unstimulated platelet adhesion was decreased 80% to 90% by blocking either the GPIb site or the GPIIb/IIIa site with 6D1 or 10E5, respectively, or with 6D1 and 10E5 together. Adhesion was not reduced significantly by HP1-1D (anti-GPIIb/IIIa). After stimulation with ADP or thrombin, the platelet adhesion was reduced by prior incubation with saturating concentrations of either 6D1 (61% reduction) or 10E5 (80% reduction), as well as with both 6D1 and 10E5 (80% reduction). After stimulation with ristocetin, the adhesion was reduced with either 6D1 (90% reduction) or 10E5 (90% reduction) or both 6D1 and 10E5 (90% reduction). Prior incubation with HP1-1D had minimal effect on platelet adhesion to vWF after stimulation with thrombin, ADP, or ristocetin.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M C Danton
- Department of Pathology, University of Iowa, Iowa City
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28
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Olson JD, Zaleski A, Herrmann D, Flood PA. Adhesion of platelets to purified solid-phase von Willebrand factor: effects of wall shear rate, ADP, thrombin, and ristocetin. J Lab Clin Med 1989; 114:6-18. [PMID: 2786916] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
When platelets are stimulated with adenosine diphosphate (ADP), thrombin, or ristocetin, they bind soluble von Willebrand factor (vWF). In contrast, platelets adhere to solid-phase vWF without apparent stimulus. This work characterizes the adhesion of washed human platelets to highly purified solid-phase human vWF. VWF (iodine 125-labeled vWF) was demonstrated to bind in a quantifiable fashion to the internal surfaces of glass capillary tubes, saturating at a surface density of 3.0 mg/ml. The multimeric structure of bound vWF was the same as that of normal vWF. Platelets were washed, labeled with indium 111, and resuspended with washed red blood cells (RBCs) in balanced salt solution containing Ca++, Mg++, and apyrase. The washed platelet RBC suspension was aspirated through capillary tubes to which vWF was adsorbed. Adhesion of platelets to adsorbed vWF was directly dependent on the surface density of vWF. Increasing wall shear rate (100 to 5000 sec-1) produced increasing platelet adhesion to maximum reached at 2500 sec-1. Platelets bound to the solid-phase vWF in an irreversible fashion, and, as demonstrated with scanning electron microscopy, they spread on the surface. When used to stimulate the platelets, ADP, thrombin, and ristocetin all increased the platelet adhesion to solid-phase vWF. ADP- and thrombin-stimulated reactions were inhibited by prior treatment of the platelets with 5'-p-fluorosulfonylbenzoyl adenosine. This inhibitor of ADP binding had no effect on the baseline platelet adhesion reaction (without ADP or thrombin). Adenosine in concentration up to 1 mmol/L failed to inhibit adhesion. The data demonstrate that washed platelets adhere to solid-phase vWF without added agonists, that the reaction is dependent on surface density vWF and wall shear rate, that they bind irreversibly, and that they demonstrate surface spreading. In addition, these platelets can be stimulated to increase their adherence to vWF by using ADP, thrombin, and ristocetin.
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Affiliation(s)
- J D Olson
- Department of Pathology, University of Iowa College of Medicine, Iowa City 52242
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Abstract
Multiple assays have been described which quantify von Willebrand Factor (vWF) in plasma or other specimens. An assay using a modification of the microtitre method(1) is described. Washed platelets fixed in formalin and frozen in dimethylsulfoxide are substrate for the reaction. Platelets, ristocetin and the specimen to be assayed are combined in the wells of a microtitre plate. The reaction is mixed for defined times and agglutination of platelets read visually. By adjusting the concentration of platelets, concentration of ristocetin and time, the sensitivity can be adjusted over a wide range.
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Affiliation(s)
- A Zaleski
- Department of Pathology, University of Iowa College of Medicine, Iowa City 52242
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Mianowska A, Zaleski A, Wasiutyński A. [The etiology of the uremic lung. Etiology of pulmonary changes in rats after administration of concentrated post-hemodialysis fluid]. Pol Arch Med Wewn 1981; 66:201-21. [PMID: 7322932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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32
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Swiderska-Kulikowa B, Zaleski A. [Treatment of urinary tract infections with penicillin Hx]. Pol Arch Med Wewn 1981; 66:155-60. [PMID: 6275370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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33
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Henriksen RA, Kisker CT, Lachenbruch PA, Hart KP, Zaleski A. The factor VIII:C level is lower in daughters of hemophilia A subjects. Blood 1981; 57:376. [PMID: 6778540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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34
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Galus K, Schreyer K, Zaleski A. [Effect of 1 alpha-hydroxycholecalciferol (1 alpha-/OH/D3) on bone regeneration in dogs with vitamin D deficiency]. Pol Arch Med Wewn 1980; 63:335-47. [PMID: 7413463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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35
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Abstract
The present study was undertaken to evaluate the effects of 1 alpha-hydroxyvitamin D3 and 24R,25-dihydroxyvitamin D3 on bone remodeling in dogs with osteomalacia induced by vitamin D depletion. To assess the rates of skeletal remodeling, intravital tetracycline labeling and morphometry of surface pattern were employed. Either vitamin D3 derivative accelerated the appositional growth rate, increased the percentage of osteoid seams labeled, and decreased the number, width, and perimeter of new osteoid seams. But the derivatives differed in bone resorbing activity: 1 alpha-hydroxyvitamin D3 increased the number and perimeter of resorption sites whereas 24R,25-dihydroxyvitamin D3 decreased them. Thus the results show that the former is a better bone remodeler while the latter may be useful in treating osteoporosis.
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Zaleski A, Wasiutyński A, Mianowska A. [Studies on the etiopathogenesis of uremic lung. I. Effect of concentrated dialysate obtained from uremic patients on the development of pulmonary changes in rats]. Pol Arch Med Wewn 1979; 62:533-49. [PMID: 530874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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37
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Zaleski A, Wasiutyński A, Mianowska A. [Studies on the etiopathogenesis of uremic lung. II. Effect of fraction of concentrated dialysate obtained from uremic patients on the development of pulmonary changes in rats]. Pol Arch Med Wewn 1979; 62:551-8. [PMID: 530875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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38
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Mianowska A, Wasiutyński A, Zaleski A. [Uremic lung]. Pol Arch Med Wewn 1979; 61:227-33. [PMID: 440989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Fryczkowski M, Załuczkowski K, Delebiński B, Zaleski A. [Radiological and clinical pattern of rupture of large hydronephros (author's transl)]. Pol Przegl Radiol Med Nukl 1979; 43:43-7. [PMID: 450745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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40
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Jackson GL, Kuehl D, McDowell K, Zaleski A. Effect of hypothalamic deafferentation on secretion of luteinizing hormone in the ewe. Biol Reprod 1978; 18:808-19. [PMID: 667265 DOI: 10.1095/biolreprod18.5.808] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Starzewski J, Zaleski A, Blecharz A, Szerszeń J. [Uterophlebography as a rare complication of hysterosalpingography]. Ginekol Pol 1977; 48:575-7. [PMID: 885369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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42
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Spinner M, Zaleski A, Weiner E. Osteoid osteoma of the hamate. Bull Hosp Joint Dis 1972; 33:8-14. [PMID: 5025924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Zaleski A, Shokeir MK, Gerrard JW. Enuresis: familial incidence and relationship to allergic disorders. Can Med Assoc J 1972; 106:30-1. [PMID: 5009034 PMCID: PMC1931351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
An analysis is made of the incidence of allergic diseases in 105 enuretic boys and girls, in their parents and siblings, and in matched controls. There is an increased incidence of hay fever, urticaria and food and drug allergies in enuretic boys. There is an increased incidence of enuresis in the parents of enuretic children. Enuretic children and their fathers are significantly more prone to develop urinary infections than are controls; there is also an increased incidence in urinary infections in their mothers, but numbers are insufficient to indicate that this is significant.
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Gerrard JW, Jones B, Shokier MK, Zaleski A. Allergy and urinary infections: is there an association? Pediatrics 1971; 48:994-5. [PMID: 5129462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Lao M, Zaleski A. [Comparative evaluation of the effect of diuretics in renal diseases]. Pol Arch Med Wewn 1970; 44:659-66. [PMID: 5449807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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