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Jaeger P, Toskas I, Henes JK, Shcherbyna S, Schwarz F, Euper M, Seizer P, Langer H, May AE, Geisler T, Gawaz M, Schreieck J, Rath D. Impact of pulmonary hypertension on outcomes after TEER in patients suffering from mitral regurgitation. Clin Res Cardiol 2024:10.1007/s00392-024-02442-1. [PMID: 38565712 DOI: 10.1007/s00392-024-02442-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
AIM Data on associations of invasively determined hemodynamic parameters with procedural success and outcomes in patients suffering from mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair of the mitral valve (M-TEER) is limited. METHODS AND RESULTS We enrolled 239 patients with symptomatic MR of grade 2 + , who received M-TEER. All patients underwent extensive pre-interventional invasive hemodynamic measurements via right heart catheterization (mean pulmonary arterial pressure (mPAP), systolic- (PAPsys) and diastolic pulmonary arterial pressure (PAPdia), pulmonary arterial wedge pressure (PAWP), a-wave, v-wave, pulmonary vascular resistance (PVR), transpulmonary pressure gradient (TPG), cardiac index (CI), stroke volume index (SVI)). mPAP and PAWP at baseline were neither associated with procedural success, immediate reduction of MR, nor residual MR after 6 months of follow-up. The composite outcome (All-cause mortality (ACM) and/or heart failure induced rehospitalization (HFH)) and HFH differed significantly after M-TEER when stratified according to mPAP, PAWP, PAPdia, a-wave and v-wave. ACM was not associated with the afore mentioned parameters. Neither PVR, TPG, CI nor SVI were associated with the composite outcome and HFH, respectively. In multivariable analyses, PAWP was independently associated with the composite outcome and HFH. PVR and SVI were not associated with outcomes. CONCLUSION PAWP at baseline was significantly and independently associated with HFH and might serve as a valuable parameter for identifying patients at high risk for HFH after M-TEER. ACM and procedural success were not affected by pulmonary arterial pressure before M-TEER. We suggest that the post-capillary component of PH serves as the driving force behind the risk of HFH.
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Affiliation(s)
- Philippa Jaeger
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Ioannis Toskas
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Jessica-Kristin Henes
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Serhii Shcherbyna
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Frederic Schwarz
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Miriam Euper
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Seizer
- Departmen of Cardiology and Angiology, Ostalb-Klinikum, Aalen, Germany
| | - Harald Langer
- Department of Medicine, Cardiology, Angiology, Hemostasis and Intensive Care Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Andreas E May
- Medizinische Klinik I, Klinikum Memmingen, Mannheim, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Jürgen Schreieck
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Dominik Rath
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany.
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2
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Seizer P, von Ungern-Sternberg SNI, Haug V, Dicenta V, Rosa A, Butt E, Nöthel M, Rohlfing AK, Sigle M, Nawroth PP, Nussbaum C, Sperandio M, Kusch C, Meub M, Sauer M, Münzer P, Bieber K, Stanger A, Mack AF, Huber R, Brand K, Lehners M, Feil R, Poso A, Krutzke K, Schäffer TE, Nieswandt B, Borst O, May AE, Zernecke A, Gawaz M, Heinzmann D. Cyclophilin A is a ligand for RAGE in thrombo-inflammation. Cardiovasc Res 2024; 120:385-402. [PMID: 38175781 DOI: 10.1093/cvr/cvad189] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/08/2023] [Accepted: 10/20/2023] [Indexed: 01/06/2024] Open
Abstract
AIMS Cyclophilin A (CyPA) induces leucocyte recruitment and platelet activation upon release into the extracellular space. Extracellular CyPA therefore plays a critical role in immuno-inflammatory responses in tissue injury and thrombosis upon platelet activation. To date, CD147 (EMMPRIN) has been described as the primary receptor mediating extracellular effects of CyPA in platelets and leucocytes. The receptor for advanced glycation end products (RAGE) shares inflammatory and prothrombotic properties and has also been found to have similar ligands as CD147. In this study, we investigated the role of RAGE as a previously unknown interaction partner for CyPA. METHODS AND RESULTS Confocal imaging, proximity ligation, co-immunoprecipitation, and atomic force microscopy were performed and demonstrated an interaction of CyPA with RAGE on the cell surface. Static and dynamic cell adhesion and chemotaxis assays towards extracellular CyPA using human leucocytes and leucocytes from RAGE-deficient Ager-/- mice were conducted. Inhibition of RAGE abrogated CyPA-induced effects on leucocyte adhesion and chemotaxis in vitro. Accordingly, Ager-/- mice showed reduced leucocyte recruitment and endothelial adhesion towards CyPA in vivo. In wild-type mice, we observed a downregulation of RAGE on leucocytes when endogenous extracellular CyPA was reduced. We furthermore evaluated the role of RAGE for platelet activation and thrombus formation upon CyPA stimulation. CyPA-induced activation of platelets was found to be dependent on RAGE, as inhibition of RAGE, as well as platelets from Ager-/- mice showed a diminished activation and thrombus formation upon CyPA stimulation. CyPA-induced signalling through RAGE was found to involve central signalling pathways including the adaptor protein MyD88, intracellular Ca2+ signalling, and NF-κB activation. CONCLUSION We propose RAGE as a hitherto unknown receptor for CyPA mediating leucocyte as well as platelet activation. The CyPA-RAGE interaction thus represents a novel mechanism in thrombo-inflammation.
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Affiliation(s)
- Peter Seizer
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
- Department of Cardiology and Angiology, Ostalbklinikum Aalen, Aalen, Germany
| | - Saskia N I von Ungern-Sternberg
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Verena Haug
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Valerie Dicenta
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Annabelle Rosa
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Elke Butt
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Moritz Nöthel
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Bonn, Germany
| | - Anne-Katrin Rohlfing
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Manuel Sigle
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Peter P Nawroth
- Department of Internal Medicine 1 and Clinical Chemistry, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Joint Heidelberg-ICD Translational Diabetes Program, Helmholtz-Zentrum, Munich, Germany
| | - Claudia Nussbaum
- Division of Neonatology, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Markus Sperandio
- Institute of Cardiovascular Physiology and Pathophysiology, Ludwig-Maximilians University Munich, Munich, Germany
- German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Munich Heart Alliance Partner Site, Munich, Germany
| | - Charly Kusch
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Mara Meub
- Department of Biotechnology und Biophysics, Julius-Maximilians University, Würzburg, Germany
| | - Markus Sauer
- Department of Biotechnology und Biophysics, Julius-Maximilians University, Würzburg, Germany
| | - Patrick Münzer
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
- DFG Heisenberg Group Cardiovascular Thromboinflammation and Translational Thrombocardiology, University of Tübingen, Tübingen, Germany
| | - Kristin Bieber
- Department of Hematology, Oncology, Immunology und Pulmonology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Anna Stanger
- Department of Hematology, Oncology, Immunology und Pulmonology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Andreas F Mack
- Institute of Clinical Anatomy and Cell Analytics, Eberhard Karls University Tübingen, Tübingen, Germany
| | - René Huber
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Korbinian Brand
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Moritz Lehners
- Interfakultäres Institut für Biochemie, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Robert Feil
- Interfakultäres Institut für Biochemie, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Antti Poso
- Department of Internal Medicine VIII, University Hospital of Tübingen, Tübingen, Germany
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmaceutical Sciences, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmaceutical Sciences, Eberhard Karls University, Tübingen, Germany
- Tübingen Center for Academic Drug Discovery & Development (TüCAD2), Tübingen, Germany
- Excellence Cluster 'Controlling Microbes to Fight Infections' (CMFI), Tübingen, Germany
| | - Konstantin Krutzke
- Institute of Applied Physics, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Tilman E Schäffer
- Institute of Applied Physics, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
- Rudolf Virchow Center, University of Würzburg, Würzburg, Germany
| | - Oliver Borst
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
- DFG Heisenberg Group Cardiovascular Thromboinflammation and Translational Thrombocardiology, University of Tübingen, Tübingen, Germany
| | - Andreas E May
- Department of Cardiology, Innere Medizin I, Klinikum Memmingen, Memmingen, Germany
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - David Heinzmann
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
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Siry M, Duymaz B, Biesenberger S, Siry D, Kammerer V, May AE. Self-Expanding Versus Balloon Expanding Coronary Stents in Intervention of the Degenerated Saphenous Vein Graft: Memmingen Coronary Artery Bypass Stenosis Trial (MECAST). J Interv Cardiol 2023; 2023:9412132. [PMID: 37064643 PMCID: PMC10101740 DOI: 10.1155/2023/9412132] [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] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 04/08/2023] Open
Abstract
Objectives. The aim of this retrospective analysis was to compare the patient outcome after interventional therapy of saphenous vein graft (SVG) stenoses in an all-comers population receiving either self-expanding drug-eluting stents (SExS) or balloon expanding drug-eluting stents (BExS). Background. The interventional therapy of degenerated SVGs remains challenging. Diameter variations of stenotic segments and friable plaques can lead to malapposition and distal embolization with increased major adverse cardiac event (MACE) rates. Methods. 107 patients with a total of 130 SVG interventions were separated into two groups according to either SExS (n = 51) or BExS (n = 56) treatment. Primary endpoint was the MACE rate, which is defined as the composite of cardiac death, myocardial infarction (MI), target vessel (TVR), and target lesion revascularization (TLR) at 30 days and at one-year follow-up. Results. Both patient groups did not differ significantly regarding patient characteristics. The patient outcome was significantly better in the SExS patient group: the MACE rate at 30 days was 1/51 (2.0%) in group SExS vs. 7/56 (12.5%) in group BExS;
. At one-year follow-up, the MACE rate remained significantly lower in the SExS group 8/51(15.7%) vs. 20/56 (35.7%) in the BExS group,
. Additionally, cardiac death occurred significantly later within the SExS patient group compared to the BExS group (
). A better overall outcome of patients with de novo SVG-stenosis compared to patients with previous CABG (coronary artery bypass graft) intervention was noted in both groups. Conclusion. Our findings demonstrate that SVG treatment with SExS is safe and provides clinical benefits by comparatively improving short and especially long-term patient outcomes.
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Affiliation(s)
- Marcus Siry
- Medizinische Klinik I, Klinikum Memmingen, Memmingen, Germany
| | - Burak Duymaz
- Medizinische Klinik I, Klinikum Memmingen, Memmingen, Germany
| | | | - Deborah Siry
- University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany
| | | | - Andreas E. May
- Medizinische Klinik I, Klinikum Memmingen, Memmingen, Germany
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4
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Bauer A, Schreinlechner M, Sappler N, Dolejsi T, Tilg H, Aulinger BA, Weiss G, Bellmann-Weiler R, Adolf C, Wolf D, Pirklbauer M, Graziadei I, Gänzer H, von Bary C, May AE, Wöll E, von Scheidt W, Rassaf T, Duerschmied D, Brenner C, Kääb S, Metzler B, Joannidis M, Kain HU, Kaiser N, Schwinger R, Witzenbichler B, Alber H, Straube F, Hartmann N, Achenbach S, von Bergwelt-Baildon M, von Stülpnagel L, Schoenherr S, Forer L, Embacher-Aichhorn S, Mansmann U, Rizas KD, Massberg S. Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomised, controlled, open-label trial. Lancet Respir Med 2021; 9:863-872. [PMID: 34126053 PMCID: PMC8195495 DOI: 10.1016/s2213-2600(21)00214-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/18/2022]
Abstract
Background SARS-CoV-2 entry in human cells depends on angiotensin-converting enzyme 2, which can be upregulated by inhibitors of the renin–angiotensin system (RAS). We aimed to test our hypothesis that discontinuation of chronic treatment with ACE-inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) mitigates the course o\f recent-onset COVID-19. Methods ACEI-COVID was a parallel group, randomised, controlled, open-label trial done at 35 centres in Austria and Germany. Patients aged 18 years and older were enrolled if they presented with recent symptomatic SARS-CoV-2 infection and were chronically treated with ACEIs or ARBs. Patients were randomly assigned 1:1 to discontinuation or continuation of RAS inhibition for 30 days. Primary outcome was the maximum sequential organ failure assessment (SOFA) score within 30 days, where death was scored with the maximum achievable SOFA score. Secondary endpoints were area under the death-adjusted SOFA score (AUCSOFA), mean SOFA score, admission to the intensive care unit, mechanical ventilation, and death. Analyses were done on a modified intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT04353596. Findings Between April 20, 2020, and Jan 20, 2021, 204 patients (median age 75 years [IQR 66–80], 37% females) were randomly assigned to discontinue (n=104) or continue (n=100) RAS inhibition. Within 30 days, eight (8%) of 104 died in the discontinuation group and 12 (12%) of 100 patients died in the continuation group (p=0·42). There was no significant difference in the primary endpoint between the discontinuation and continuation group (median [IQR] maximum SOFA score 0·00 (0·00–2·00) vs 1·00 (0·00–3·00); p=0·12). Discontinuation was associated with a significantly lower AUCSOFA (0·00 [0·00–9·25] vs 3·50 [0·00–23·50]; p=0·040), mean SOFA score (0·00 [0·00–0·31] vs 0·12 [0·00–0·78]; p=0·040), and 30-day SOFA score (0·00 [10–90th percentile, 0·00–1·20] vs 0·00 [0·00–24·00]; p=0·023). At 30 days, 11 (11%) in the discontinuation group and 23 (23%) in the continuation group had signs of organ dysfunction (SOFA score ≥1) or were dead (p=0·017). There were no significant differences for mechanical ventilation (10 (10%) vs 8 (8%), p=0·87) and admission to intensive care unit (20 [19%] vs 18 [18%], p=0·96) between the discontinuation and continuation group. Interpretation Discontinuation of RAS-inhibition in COVID-19 had no significant effect on the maximum severity of COVID-19 but may lead to a faster and better recovery. The decision to continue or discontinue should be made on an individual basis, considering the risk profile, the indication for RAS inhibition, and the availability of alternative therapies and outpatient monitoring options. Funding Austrian Science Fund and German Center for Cardiovascular Research.
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Affiliation(s)
- Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Michael Schreinlechner
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolay Sappler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Theresa Dolejsi
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benedikt A Aulinger
- Medizinische Klinik und Poliklinik II, LMU University Hospital Munich, Munich, Germany
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology and Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology and Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, LMU University Hospital Munich, Munich, Germany
| | - Dominik Wolf
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Pirklbauer
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivo Graziadei
- Department of Internal Medicine, Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Hannes Gänzer
- Department of Internal Medicine, Hospital Schwaz, Schwaz, Austria
| | - Christian von Bary
- Department of Internal Medicine I, Rotkreuzklinikum Munich, Munich, Germany
| | - Andreas E May
- Department of Internal Medicine, Hospital Memmingen, Memmingen, Germany
| | - Ewald Wöll
- Department of Internal Medicine, Hospital Zams, Zams, Austria
| | - Wolfgang von Scheidt
- Department of Internal Medicine I, University Hospital Augsburg, Augsburg, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Daniel Duerschmied
- University Heart Center Freiburg, Department of Cardiology and Angiology I, University of Freiburg, Freiburg, Germany
| | - Christoph Brenner
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kääb
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Bernhard Metzler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Hans-Ulrich Kain
- Department of Internal Medicine, Hospital Mühldorf, Mühldorf, Germany
| | - Norbert Kaiser
- Department of Internal Medicine, Hospital St Johann in Tirol, St Johann in Tirol, Austria
| | - Robert Schwinger
- Department of Internal Medicine, Hospital Weiden, Weiden, Germany
| | | | - Hannes Alber
- Department of Internal Medicine and Cardiology, Klinikum Klagenfurt am Woerthersee, Klagenfurt, Austria
| | - Florian Straube
- Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen and Schwabing, Munich, Germany
| | - Niels Hartmann
- Department of Internal Medicine I (Cardiology), University Hospital Aachen, Aachen, Germany
| | - Stephan Achenbach
- Department of Cardiology and Angiology, University Hospital Erlangen, Erlangen, Germany
| | | | - Lukas von Stülpnagel
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria; Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Sebastian Schoenherr
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Forer
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Germany
| | - Konstantinos D Rizas
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany.
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Heinzmann D, Noethel M, von Ungern-Sternberg S, Mitroulis I, Gawaz M, Chavakis T, May AE, Seizer P. CD147 is a Novel Interaction Partner of Integrin αMβ2 Mediating Leukocyte and Platelet Adhesion. Biomolecules 2020; 10:biom10040541. [PMID: 32252487 PMCID: PMC7226095 DOI: 10.3390/biom10040541] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 02/23/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 01/16/2023] Open
Abstract
Surface receptor-mediated adhesion is a fundamental step in the recruitment of leukocytes and platelets, as well as platelet-leukocyte interactions. The surface receptor CD147 is crucially involved in host defense against self-derived and invading targets, as well as in thrombosis. In the current study, we describe the previously unknown interaction of CD147 with integrin αMβ2 (Mac-1) in this context. Using binding assays, we were able to show a stable interaction of CD147 with Mac-1 in vitro. Leukocytes from Mac-1-/- and CD147+/- mice showed a markedly reduced static adhesion to CD147- and Mac-1-coated surfaces, respectively, compared to wild-type mice. Similarly, we observed reduced rolling and adhesion of monocytes under flow conditions when cells were pre-treated with antibodies against Mac-1 or CD147. Additionally, as assessed by antibody inhibition experiments, CD147 mediated the dynamic adhesion of platelets to Mac-1-coated surfaces. The interaction of CD147 with Mac-1 is a previously undescribed mechanism facilitating the adhesion of leukocytes and platelets.
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Affiliation(s)
- David Heinzmann
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
- Correspondence:
| | - Moritz Noethel
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
| | - Saskia von Ungern-Sternberg
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
| | - Ioannis Mitroulis
- Institute for Clinical Chemistry and Laboratory Medicine, University Clinic and Faculty of Medicine Carl-Gustav-Carus, TU Dresden, 01397 Dresden, Germany
| | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
| | - Triantafyllos Chavakis
- Institute for Clinical Chemistry and Laboratory Medicine, University Clinic and Faculty of Medicine Carl-Gustav-Carus, TU Dresden, 01397 Dresden, Germany
| | - Andreas E. May
- Department of Cardiology, Innere Medizin I, Klinikum Memmingen, 87700 Memmingen, Germany
| | - Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
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Puls M, Huenlich M, Boekstegers P, Lubos E, Bardeleben RS, May AE, Nickenig G, Baldus S, Sievert H, Ouarrak T, Senges J, Schillinger W. Implantation of one versus two MitraClips in the German TRAMI registry: Is more always better? Catheter Cardiovasc Interv 2019; 96:E360-E368. [DOI: 10.1002/ccd.28613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 07/31/2019] [Accepted: 11/12/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Miriam Puls
- Herzzentrum GöttingenUniversitätsmedizin Göttingen Göttingen Germany
| | - Mark Huenlich
- Herzzentrum GöttingenUniversitätsmedizin Göttingen Göttingen Germany
| | - Peter Boekstegers
- Klinik für Kardiologie und Angiologie, Helios Klinikum Siegburg Siegburg, Germany
| | - Edith Lubos
- Universitäres Herzzentrum Eppendorf Hamburg Germany
| | | | - Andreas E. May
- Innere Medizin III, Universitätsklinikum Tübingen, Tübingen Germany
- Innere Medizin I, Klinikum Memmingen, Memmingen Germany
| | - Georg Nickenig
- Medizinische Klinik II, Universitätsklinikum Bonn, Bonn Germany
| | - Stefan Baldus
- Herzzentrum, Universitätsklinikum Köln, Köln Germany
| | - Horst Sievert
- Cardio Vascular Center Frankfurt CVC, Frankfurt a.M. Germany
| | | | - Jochen Senges
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Wolfgang Schillinger
- Herzzentrum GöttingenUniversitätsmedizin Göttingen Göttingen Germany
- Klinik für Kardiologie, Helios Albert‐Schweitzer‐Klinik Northeim Northeim, Germany
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7
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Aradi D, Gross L, Trenk D, Geisler T, Merkely B, Kiss RG, Komócsi A, Dézsi CA, Ruzsa Z, Ungi I, Rizas KD, May AE, Mügge A, Zeiher AM, Holdt L, Huber K, Neumann FJ, Koltowski L, Huczek Z, Hadamitzky M, Massberg S, Sibbing D. Platelet reactivity and clinical outcomes in acute coronary syndrome patients treated with prasugrel and clopidogrel: a pre-specified exploratory analysis from the TROPICAL-ACS trial. Eur Heart J 2019; 40:1942-1951. [DOI: 10.1093/eurheartj/ehz202] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 11/19/2018] [Revised: 01/31/2019] [Accepted: 04/17/2019] [Indexed: 01/18/2023] Open
Abstract
Abstract
Aims
The value of platelet function testing (PFT) in predicting clinical outcomes and guiding P2Y12-inhibitor treatment is uncertain. In a pre-specified sub-study of the TROPICAL-ACS trial, we assessed ischaemic and bleeding risks according to high platelet reactivity (HPR) and low platelet reactivity (LPR) to ADP in patients receiving uniform prasugrel vs. PFT-guided clopidogrel or prasugrel.
Methods and results
Acute coronary syndrome patients with PFT done 14 days after hospital discharge were included with prior randomization to uniform prasugrel for 12 months (control group, no treatment modification) vs. early de-escalation from prasugrel to clopidogrel and PFT-guided maintenance treatment (HPR: switch-back to prasugrel, non-HPR: clopidogrel). The composite ischaemic endpoint included cardiovascular death, myocardial infarction, or stroke, while key safety outcome was Bleeding Academic Research Consortium (BARC) 2–5 bleeding, from PFT until 12 months. We identified 2527 patients with PFT results available: 1266 were randomized to the guided and 1261 to the control group. Before treatment adjustment, HPR was more prevalent in the guided group (40% vs. 15%), while LPR was more common in control patients (27% vs. 11%). Compared to control patients without HPR on prasugrel (n = 1073), similar outcomes were observed in guided patients kept on clopidogrel [n = 755, hazard ratio (HR): 1.06 (0.57–1.95), P = 0.86] and also in patients with HPR on clopidogrel switched to prasugrel [n = 511, HR: 0.96 (0.47–1.96), P = 0.91]. In contrast, HPR on prasugrel was associated with a higher risk for ischaemic events in control patients [n = 188, HR: 2.16 (1.01–4.65), P = 0.049]. Low platelet reactivity was an independent predictor of bleeding [HR: 1.74 (1.18–2.56), P = 0.005], without interaction (Pint = 0.76) between study groups.
Conclusion
Based on this substudy of a randomized trial, selecting prasugrel or clopidogrel based on PFT resulted in similar ischaemic outcomes as uniform prasugrel therapy without HPR. Although infrequent, HPR on prasugrel was associated with increased risk of ischaemic events. Low platelet reactivity was a strong and independent predictor of bleeding both on prasugrel and clopidogrel.
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Affiliation(s)
- Dániel Aradi
- Department of Active Cardiology, Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University Budapest, 2 Gyógy Tér, Balatonfüred, Hungary
- Department of Cardiology, Heart and Vascular Centre, Semmelweis University Budapest, Budapest, Hungary
| | - Lisa Gross
- Department of Cardiology, LMU München, Munich, Germany
- Partner Site Munich Heart Alliance, DZHK (German Center for Cardiovascular Research), Munich, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, Tübingen, Germany
| | - Béla Merkely
- Department of Cardiology, Heart and Vascular Centre, Semmelweis University Budapest, Budapest, Hungary
| | | | - András Komócsi
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - Csaba András Dézsi
- Department of Cardiology, Petz Aladár County Hospital Győr, Győr, Hungary
| | - Zoltán Ruzsa
- Department of Cardiology, Heart and Vascular Centre, Semmelweis University Budapest, Budapest, Hungary
| | - Imre Ungi
- Department of Cardiology, University of Szeged, Szeged, Hungary
| | - Konstantinos D Rizas
- Department of Cardiology, LMU München, Munich, Germany
- Partner Site Munich Heart Alliance, DZHK (German Center for Cardiovascular Research), Munich, Germany
| | - Andreas E May
- Department of Cardiology, Innere Medizin I, Klinikum Memmingen, Memmingen, Germany
| | - Andreas Mügge
- Department of Cardiology, Katholisches Klinikum Bochum, St. Josef Hospital, Bochum, Germany
| | - Andreas M Zeiher
- Department of Cardiology, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Sigmund Freud Private University, Medical School, Wien, Austria
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Lukasz Koltowski
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Huczek
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, LMU München, Munich, Germany
- Partner Site Munich Heart Alliance, DZHK (German Center for Cardiovascular Research), Munich, Germany
| | - Dirk Sibbing
- Department of Cardiology, LMU München, Munich, Germany
- Partner Site Munich Heart Alliance, DZHK (German Center for Cardiovascular Research), Munich, Germany
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8
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Kalbacher D, Schäfer U, v. Bardeleben RS, Eggebrecht H, Sievert H, Nickenig G, Butter C, May AE, Bekeredjian R, Ouarrak T, Kuck KH, Plicht B, Zahn R, Baldus S, Ince H, Schillinger W, Boekstegers P, Senges J, Lubos E. Long-term outcome, survival and predictors of mortality after MitraClip therapy: Results from the German Transcatheter Mitral Valve Interventions (TRAMI) registry. Int J Cardiol 2019; 277:35-41. [DOI: 10.1016/j.ijcard.2018.08.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/19/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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9
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Preissner KT, May AE, Wohn KD, Germer M, Kanse SM. Molecular Crosstalk Between Adhesion Receptors and Proteolytic Cascades in Vascular Remodelling. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657507] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - A E May
- Max-Planck-lnstitut, Bad Nauheim, Germany
| | - K D Wohn
- Max-Planck-lnstitut, Bad Nauheim, Germany
| | - M Germer
- Max-Planck-lnstitut, Bad Nauheim, Germany
| | - S M Kanse
- Max-Planck-lnstitut, Bad Nauheim, Germany
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10
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May AE, Schmidt R, Bülbül BO, Hölderle M, Walther F, Schömig A, Gawaz M, Klouche M. Plasminogen and matrix metalloproteinase activation by enzymatically modified low density lipoproteins in monocytes and smooth muscle cells. Thromb Haemost 2017; 93:710-5. [PMID: 15841317 DOI: 10.1160/th04-11-0720] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryProtease activity promotes the progression and rupture of atherosclerotic plaques. LDL has been described to become enzymatically modified within the vessel wall yielding an atherogenic moiety (E-LDL). We studied the effect of E-LDL on the activation of plasminogen and matrix metalloproteinases (MMPs) in mono-cytes and vascular smooth muscle cells (VSMCs) as well as on MMP activation during cellular interactions. Human monocytes, monocytic MonoMac6 cells and human VSMCs were incubated with human native LDL (n-LDL) or E-LDL for 24 hours. E-LDL in contrast to n-LDL induced substantial activation of the plasminogen activation system as well as of the MMP system in monocytic cells, as measured by enhanced cell surface expression of the urokinase receptor (uPAR), the extracellular matrix metalloproteinase Inducer (EMMPRIN) and the membrane type-1 MMPs (MT1-MMP, MMP-14), as well as by secretion of active uPA, and of MMP-9. Consistently, E-LDL-treated monocytes exhibited increased transmigration through “matrigel”, which was specifically abrogated by the MMP inhibitor galardin or the plasmin inhibitor aprotinin. In VSMCs, E-LDL induced MMP-1 and MMP-2 secretion. Moreover, monocyte incubation with supernatants of E-LDL-treated (but not n-LDL-treated)VSMCs strongly induced MMP-9 in monoytes, which was inhibited by blocking mAb anti-TNF-α. Together, enzymatical modification of LDL allows a direct activation of MMP expression in monocytes and VSMCs, and indirectly promotes the induction of paracrine, cytokine-mediated intercellular activation processes. Thereby, E-LDL may contribute to atheroprogression, inflammation and plaque rupture.
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Affiliation(s)
- Andreas E May
- Medizinische Klinik und Poliklinik III, Universität Tübingen, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany.
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11
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Abstract
SummaryMatrix metalloproteinases (MMPs) and their inhibitors essentially contribute to a variety of pathophysiologies by modulating cell migration, tissue degradation and inflammation. Platelet-associated MMP activity appears to play a major role in these processes. First, platelets can concentrate leukocyte-derived MMP activity to sites of vascular injury by leukocyte recruitment. Second, platelets stimulate MMP production in e.g. leukocytes, endothelial cells, or tumour cells by direct receptor interaction or/and by paracrine pathways. Third, platelets synthesise and secrete a variety of MMPs including MMP-1, MMP-2, MMP-3, and MMP-14 (MT1-MMP), and potentially MMP-9 as well as the tissue inhibitors of metalloproteinase (TIMPs). This review focuses on platelet-derived and platelet-induced MMPs and their inhibitors.
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12
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Alexaki VI, May AE, Fujii C, Mund C, Gawaz M, Ungern-Sternberg SNIV, Chavakis T, Seizer P. S100A9 induces monocyte/ macrophage migration via EMMPRIN. Thromb Haemost 2017; 117:636-639. [DOI: 10.1160/th16-06-0434] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/16/2016] [Indexed: 01/26/2023]
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13
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Schueler R, Nickenig G, May AE, Schillinger W, Bekeredjian R, Ouarrak T, Schofer J, Hehrlein C, Sievert H, Boekstegers P, Lubos E, Hoffmann R, Baldus S, Senges J, Hammerstingl C. Predictors for short-term outcomes of patients undergoing transcatheter mitral valve interventions: analysis of 778 prospective patients from the German TRAMI registry focusing on baseline renal function. EUROINTERVENTION 2017; 12:508-14. [PMID: 26348678 DOI: 10.4244/eijy15m09_07] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 11/23/2022]
Abstract
AIMS Factors predicting outcomes after MitraClip implantation are not well defined. We aimed to report the influence of baseline renal function on short-term outcomes of patients enrolled in the investigator-initiated German transcatheter mitral valve interventions (TRAMI) registry. METHODS AND RESULTS Twenty participating German centres prospectively included 778 patients (mean age 76.0 years [71-81], 38.8% female gender) at high surgical risk (mean logistic EuroSCORE 20% [12-32%]) undergoing TMVR with the MitraClip for the treatment of symptomatic functional (70%) or degenerative (30%) mitral valve regurgitation (FMR, DMR). The patients were stratified according to renal function before clip implantation. The prevalence of moderate to severe renal impairment (glomerular filtration rate [GFR] <60 ml/min) was 62.7% (37.3%, normal renal function [GFR >60 ml/min]; 49.6%, moderate renal impairment [GFR 30-60 ml/min]; 13.1%, severe renal impairment [GFR <30 ml/min]). TMVR was successfully completed in 98.2% of cases; acute procedural failure, in-hospital and 30-day mortality rates were 1.8%, 2.3% and 4.4%, respectively. Acute procedural failure and mortality rates (in-hospital, 30-day) were significantly higher in patients with severe renal impairment (5.9%, 7.8%, 14.1%), as compared to patients with moderately (1%, 1.3%, 3.0%) or mildly impaired to normal (1.4%, 1.7%, 2.9%) renal function (p<0.0001). Following Cox regression analysis, the prevalence of severe renal impairment at the time of TMVR was the only predictor for increased 30-day mortality rates (hazard ratio 3.42, 95% confidence interval 1.88-6.2; p<0.0001). CONCLUSIONS Renal function at the time of interventional mitral valve repair with the MitraClip system is a strong predictor for procedural outcomes. Patients with severe renal impairment have a more than threefold increased risk for acute procedural failure, in-hospital death and 30-day mortality.
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14
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Wollert KC, Meyer GP, Müller-Ehmsen J, Tschöpe C, Bonarjee V, Larsen AI, May AE, Empen K, Chorianopoulos E, Tebbe U, Waltenberger J, Mahrholdt H, Ritter B, Pirr J, Fischer D, Korf-Klingebiel M, Arseniev L, Heuft HG, Brinchmann JE, Messinger D, Hertenstein B, Ganser A, Katus HA, Felix SB, Gawaz MP, Dickstein K, Schultheiss HP, Ladage D, Greulich S, Bauersachs J. Intracoronary autologous bone marrow cell transfer after myocardial infarction: the BOOST-2 randomised placebo-controlled clinical trial. Eur Heart J 2017; 38:2936-2943. [DOI: 10.1093/eurheartj/ehx188] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/23/2017] [Indexed: 01/21/2023] Open
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15
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Scheffold N, Herkommer B, Kandolf R, May AE. Lyme carditis--diagnosis, treatment and prognosis. Dtsch Arztebl Int 2016; 112:202-8. [PMID: 25838022 DOI: 10.3238/arztebl.2015.0202] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND There are 60,000 to 100,000 new cases of borreliosis in Germany each year. This infectious disease most commonly affects the skin, joints, and nervous system. Lyme carditis is a rare manifestation with potentially lethal complications. METHODS This review is based on selected publications on the clinical manifestations, diagnosis, and treatment of Lyme carditis, and on the authors' scientific and clinical experience. RESULTS Lyme carditis is seen in 4% to 10% of all patients with Lyme borreliosis. Whenever the clinical suspicion of Lyme carditis arises, an ECG is mandatory for the detection or exclusion of an atrioventricular conduction block. Patients with a PQ interval longer than 300 ms need continuous ECG monitoring. 90% of patients with Lyme carditis develop cardiac conduction abnormalities, and 60% develop signs of perimyocarditis. Borrelia serology (ELISA) may still be negative in the early phase of the condition, but is always positive in later phases. Cardiac MRI can be used to confirm the diagnosis and to monitor the patient's subsequent course. The treatment of choice is with antibiotics, preferably ceftriaxone. The cardiac conduction disturbances are usually reversible, and the implantation of a permanent pacemaker is only exceptionally necessary. There is no clear evidence at present for an association between borreliosis and the later development of a dilated cardiomyopathy. When Lyme carditis is treated according to the current guidelines, its prognosis is highly favorable. CONCLUSION Lyme carditis is among the rarer manifestations of Lyme borreliosis but must nevertheless be considered prominently in differential diagnosis because of the potentially severe cardiac arrhythmias that it can cause.
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Affiliation(s)
- Norbert Scheffold
- Internal Medicine Department I, Department of Cardiology, Memmingen Medical Center, affiliated teaching center of the LMU Munich, Internal Medicine Department I, Department of Cardiology, München-Pasing Medical Center, affiliated teaching center of the LMU Munich, Department of Molecular Pathology, Institute of Pathology and Neuropathology, University Hospital of Tübingen
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16
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Seizer P, Fuchs C, Ungern-Sternberg SNIV, Heinzmann D, Langer H, Gawaz M, May AE, Geisler T. Platelet-bound cyclophilin A in patients with stable coronary artery disease and acute myocardial infarction. Platelets 2015; 27:155-8. [PMID: 26084004 DOI: 10.3109/09537104.2015.1051466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/13/2022]
Abstract
OBJECTIVE Recently, we reported that extracellular cyclophilin A (CyPA) is an important agonist for platelets. Whereas soluble CyPA-levels have been associated with cardiovascular risk factors, cell-bound CyPA has not been investigated yet. In this study, we analyzed for the first time platelet-bound CyPA in patients with symptomatic coronary artery disease (CAD). METHODS AND RESULTS blood was obtained from 388 consecutive patients: 204 with stable CAD and 184 with acute coronary syndrome (76 with unstable angina, 78 with non ST-elevation myocardial infarction (NSTEMI), and 30 with STEMI). In vitro stimulation of platelets with classical agonists revealed an enhanced expression of CyPA on the platelet surface. In patients with stable CAD, platelet-bound CyPA correlated excellently with platelet activity measured by P-selectin exposure in flow cytometry. The analysis of classical risk factors for atherosclerosis revealed that patients with hypertension and hypercholesterolemia had significantly enhanced platelet-bound CyPA, whereas diabetes and smoking were not associated with enhanced CyPA-binding to the platelet surface. In multivariate analysis, hypercholesterolemia was the only significant predictor of enhanced platelet-bound CyPA. Interestingly, in patients with acute myocardial infarction (AMI) platelet-bound CyPA was significantly decreased compared with patients with stable CAD. CONCLUSIONS Enhanced platelet-bound CyPA is associated with hypertension and hypercholesterolemia in stable CAD patients. In patients with AMI platelet-bound CyPA is significantly decreased.
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Affiliation(s)
- Peter Seizer
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Christian Fuchs
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | | | - David Heinzmann
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Harald Langer
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Meinrad Gawaz
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Andreas E May
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Tobias Geisler
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
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17
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Heinzmann D, Bangert A, Müller AM, von Ungern-Sternberg SNI, Emschermann F, Schönberger T, Chatterjee M, Mack AF, Klingel K, Kandolf R, Malesevic M, Borst O, Gawaz M, Langer HF, Katus H, Fischer G, May AE, Kaya Z, Seizer P. The Novel Extracellular Cyclophilin A (CyPA) - Inhibitor MM284 Reduces Myocardial Inflammation and Remodeling in a Mouse Model of Troponin I -Induced Myocarditis. PLoS One 2015; 10:e0124606. [PMID: 25894208 PMCID: PMC4404136 DOI: 10.1371/journal.pone.0124606] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/05/2015] [Indexed: 01/16/2023] Open
Abstract
Cyclophilins are a group of highly conserved cytosolic enzymes that have a peptidylprolyl cis/trans isomerase activity. Cyclophilin A (CyPA) can be secreted in the extracellular space by inflammatory cells and upon cell death. The presence of CyPA in patients with non-ischemic cardiomyopathy is associated with poor clinical prognosis. Here, we investigated the inhibition of extracellular CyPA in a mouse model of troponin I-induced autoimmune myocarditis using the strictly extracellular CyPA-inhibitor MM284. Since A/J mice develop severe inflammation and fibrosis after immunization with murine cardiac troponin I (mcTn I), we used this model to analyze the effects of an extracellular CyPA inhibition. As extracellular CyPA-inhibitor we used the recently described CsA-derivate MM284. In vitro studies confirmed that MM284 inhibits CyPA-induced monocytic migration and adhesion. A/J mice immunized with mcTnI were treated with MM284 or vehicle every second day. After 28 days, we found a considerable reduction of myocardial injury and fibrosis. Further analysis revealed a reduced myocardial presence of T-cells and macrophages compared to control treated animals. Whereas MMP-9 expression was reduced significantly by MM284, we observed no significant reduction of inflammatory cytokines such as IL-6 or TNFα. Extracellular CyPA plays an important role in autoimmune myocarditis for myocardial damage and fibrosis. Our data suggest a new pharmacological approach for the treatment of myocardial inflammation and reduction of cardiac fibrosis by inhibition of extracellular CyPA.
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Affiliation(s)
- David Heinzmann
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Anna Bangert
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Anna-Maria Müller
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | | | - Frederic Emschermann
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Tanja Schönberger
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Madhumita Chatterjee
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Andreas F. Mack
- Institute of Anatomy, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, Department of Molecular Pathology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Reinhard Kandolf
- Institute for Pathology and Neuropathology, Department of Molecular Pathology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Miroslav Malesevic
- Martin-Luther-Universität Halle-Wittenberg, Institut für Biochemie, Abteilung Enzymologie, Projektgruppe gFP5, Halle (Saale), Germany
| | - Oliver Borst
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Harald F. Langer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Hugo Katus
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Gunter Fischer
- Max-Planck-Institut für Biophysikalische Chemie Göttingen, BO Halle (Saale), Göttingen, Germany
| | - Andreas E. May
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Ziya Kaya
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
- * E-mail:
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Sturhan H, Ungern-Sternberg SNIV, Langer H, Gawaz M, Geisler T, May AE, Seizer P. Regulation of EMMPRIN (CD147) on monocyte subsets in patients with symptomatic coronary artery disease. Thromb Res 2015; 135:1160-4. [PMID: 25824988 DOI: 10.1016/j.thromres.2015.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 09/19/2014] [Revised: 02/23/2015] [Accepted: 03/13/2015] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The role of individual monocyte subsets in inflammatory cardiovascular diseases is insufficiently understood. Although the Extracellular Matrix Metalloproteinase Inducer (EMMPRIN) regulates important processes for inflammation such as MMP-release, its expression and regulation on monocyte subsets has not been characterized. MATERIALS AND METHODS In this clinical study, blood was obtained from 80 patients with stable coronary artery disease (CAD), 49 with acute myocardial infarction (AMI) and 34 healthy controls. Monocytes were divided into 3 subsets: CD14(++)CD16(-) (low), CD14(++)CD16(+) (intermediate), CD14(+)CD16(++) (high) according to phenotypic markers analyzed by flow cytometry. Surface expression of EMMPRIN was evaluated and compared with CD36 and CD47 expression. RESULTS In all patients, EMMPRIN expression was significantly different among monocyte subsets with the highest expression on "classical" CD14(++)CD16(-) monocytes. EMMPRIN was upregulated on all monocyte subsets in patients with AMI as compared to patients with stable CAD. Notably, neither CD47 nor CD36 revealed a significant difference in patients with AMI compared to patients with stable CAD. CONCLUSION EMMPRIN could serve as a marker for classical monocytes, which is upregulated in patients with acute myocardial infarction.
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Affiliation(s)
- Henrik Sturhan
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Germany
| | | | - Harald Langer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Germany
| | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Germany
| | - Tobias Geisler
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Germany
| | - Andreas E May
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Germany
| | - Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Germany.
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Eggebrecht H, Schelle S, Puls M, Plicht B, von Bardeleben RS, Butter C, May AE, Lubos E, Boekstegers P, Ouarrak T, Senges J, Schmermund A. Risk and outcomes of complications during and after MitraClip implantation: Experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry. Catheter Cardiovasc Interv 2015; 86:728-35. [DOI: 10.1002/ccd.25838] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/05/2015] [Accepted: 01/10/2015] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Miriam Puls
- Department of Cardiology; University Medical Centre Göttingen; Göttingen
| | - Björn Plicht
- Department of Cardiology; West-German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen; Essen
| | | | | | - Andreas E. May
- Department of Cardiology; Eberhard-Karls-University Tuebingen; Tuebingen Germany
| | - Edith Lubos
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Peter Boekstegers
- Department for Cardiology and Angiology; Helios Heart Center; Siegburg Germany
| | - Taoufik Ouarrak
- Institute of Myocardial Infarction Research; Ludwigshafen Germany
| | - Jochen Senges
- Institute of Myocardial Infarction Research; Ludwigshafen Germany
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Klumpp B, Miller S, Seeger A, May AE, Gawaz MP, Claussen CD, Kramer U. Is the diagnostic yield of myocardial stress perfusion MRI impaired by three-vessel coronary artery disease? Acta Radiol 2015; 56:143-51. [PMID: 24523361 DOI: 10.1177/0284185114523758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/17/2022]
Abstract
BACKGROUND Three-vessel coronary artery disease (CAD) comes along with globally reduced myocardial perfusion potentially restricting the demarcation of regional hypoperfusion in stress perfusion cardiac magnetic resonance imaging (MRI). PURPOSE To evaluate whether stress perfusion cardiac MRI is capable of detecting myocardial hypoperfusion in patients with 3-vessel CAD reliably. MATERIAL AND METHODS Two hundred and five patients with symptoms of CAD were included. The examination protocol comprised imaging of myocardial perfusion at stress (0.14 mg/kg/min adenosine for 4 min) using a 2D saturation recovery gradient echo sequence after administration of gadobutrol (0.1 mmol/kg body weight). Perfusion sequences were assessed qualitatively by two experienced observers. Coronary angiography served as standard of reference. RESULTS Sensitivity and specificity for hemodynamically relevant stenoses in patients with 0-, 1-, 2-, 3-vessel coronary artery disease were 100%/91%, 91%/73%, 90%/71%, 92%/64%; positive/negative predictive value, 67%/100%, 91%/73%, 83%/81%, 93%/58%; diagnostic accuracy, 93%/87%/83%/87%, respectively. The negative predictive value in patients with 3-vessel CAD was lower than in patients with 0- and 2-vessel CAD and the specificity lower than in patients with no CAD whereas the positive predictive value was higher than in patients with no CAD. The other proportions did not differ significantly between the groups. CONCLUSION The diagnostic value of stress perfusion cardiac MRI in patients with 3-vessel CAD is comparable to results in patients with 1- or 2-vessel CAD. In the rare event that stress perfusion images do not depict regional hypoperfusion in patients with severe 3-vessel CAD, myocardial ischemia could be identified by reduced semi-quantitative perfusion parameters.
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Affiliation(s)
- Bernhard Klumpp
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany
| | - S Miller
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany
| | - A Seeger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany
| | - A E May
- Department of Cardiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - M P Gawaz
- Department of Cardiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - C D Claussen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany
| | - U Kramer
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany
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21
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Seizer P, Ungern-Sternberg SNIV, Schönberger T, Borst O, Münzer P, Schmidt EM, Mack AF, Heinzmann D, Chatterjee M, Langer H, Malešević M, Lang F, Gawaz M, Fischer G, May AE. Extracellular cyclophilin A activates platelets via EMMPRIN (CD147) and PI3K/Akt signaling, which promotes platelet adhesion and thrombus formation in vitro and in vivo. Arterioscler Thromb Vasc Biol 2014; 35:655-63. [PMID: 25550208 DOI: 10.1161/atvbaha.114.305112] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [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: 11/16/2022]
Abstract
OBJECTIVE Cyclophilin A (CyPA) is secreted under inflammatory conditions by various cell types. Whereas the important role of intracellular CyPA for platelet function has been reported, the effect of extracellular CyPA on platelet function has not been investigated yet. APPROACH AND RESULTS Inhibition of extracellular CyPA through a novel specific inhibitor MM284 reduced thrombus after ferric chloride-induced injury in vivo. In vitro extracellular CyPA enhanced thrombus formation even in CyPA(-/-) platelets. Treatment of isolated platelets with recombinant CyPA resulted in platelet degranulation in a time- and dose-dependent manner. Inhibition of the platelet surface receptor extracellular matrix metalloproteinase inducer (cluster of differentiation 147) by an anticluster of differentiation 147 monoclonal antibody significantly reduced CyPA-dependent platelet degranulation. Pretreatment of platelets with CyPA enhanced their recruitment to mouse carotid arteries after arterial injury, which could be inhibited by an anticluster of differentiation 147 monoclonal antibody (intravital microscopy). The role of extracellular CyPA in adhesion could be confirmed by infusing CyPA(-/-) platelets in CyPA(+/+) mice and by infusing CyPA(+/+) platelets in CyPA(-/-) mice. Stimulation of platelets with CyPA induced phosphorylation of Akt, which could in turn be inhibited in the presence of phosphoinositid-3-kinase inhibitors. Akt-1(-/-) platelets revealed a markedly decreased degranulation on CyPA stimulation. Finally, ADP-induced platelet aggregation was attenuated by MM284, as well as by inhibiting paracrine-secreted CyPA without directly affecting Ca(2+)-signaling. CONCLUSIONS Extracellular CyPA activates platelets via cluster of differentiation 147-mediated phosphoinositid-3-kinase/Akt-signaling, leading to enhanced adhesion and thrombus formation independently of intracellular CyPA. Targeting extracellular CyPA via a specific inhibitor may be a promising strategy for platelet inhibition without affecting critical functions of intracellular CyPA.
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Affiliation(s)
- Peter Seizer
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.).
| | - Saskia N I V Ungern-Sternberg
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Tanja Schönberger
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Oliver Borst
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Patrick Münzer
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Eva-Maria Schmidt
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Andreas F Mack
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - David Heinzmann
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Madhumita Chatterjee
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Harald Langer
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Miroslav Malešević
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Florian Lang
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Meinrad Gawaz
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Gunter Fischer
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Andreas E May
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
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22
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Wiebe J, Franke J, Lubos E, Boekstegers P, Schillinger W, Ouarrak T, May AE, Eggebrecht H, Kuck KH, Baldus S, Senges J, Sievert H. Percutaneous mitral valve repair with the MitraClip system according to the predicted risk by the logistic EuroSCORE: preliminary results from the German Transcatheter Mitral Valve Interventions (TRAMI) Registry. Catheter Cardiovasc Interv 2014; 84:591-8. [PMID: 24664460 DOI: 10.1002/ccd.25493] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/12/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate in-hospital and short-term outcomes of percutaneous mitral valve repair according to patients' logistic EuroSCORE (logEuroSCORE) in a multicenter registry BACKGROUND The logEuroSCORE is an established tool to predict the risk of mortality during cardiac surgery. In high-risk patients percutaneous mitral valve repair with the MitraClip system represents a less-invasive alternative METHODS Data from 1002 patients, who underwent percutaneous mitral valve repair with the MitraClip system, were analyzed in the German Transcatheter Mitral Valve Interventions (TRAMI) Registry. A logEuroSCORE (mortality risk in %) ≥ 20 was considered high risk RESULTS Of all patients, 557 (55.6%) had a logEuroSCORE ≥ 20. Implantation of the MitraClip was successful in 95.5 % (942/986) patients. Moderate residual mitral valve regurgitation was more often detected in patients with a logEuroSCORE ≥ 20 (23.8% vs. 17.1%, respectively, P < 0.05). In patients with a logEuroSCORE ≥ 20 the procedural complication rate was 8.9% (vs. 6.4, n.s.) and the in-hospital MACCE rate 4.9% (vs. 1.4% P < 0.01). The in-hospital mortality rate in patients with a logEuroSCORE ≥ 20 and logEuroSCORE < 20 was 4.3 and 1.1%, respectively (P ≤ 0.01) CONCLUSION: Percutaneous mitral valve repair with the MitraClip system is feasible in patients with a logEuroSCORE ≥ 20 with similar procedural results compared to patients with lower predicted risk. Although mortality was four times higher than in patients with logEuroSCORE < 20, mortality in high risk patients was lower than predicted. In those with a logEuroSCORE ≥ 20, moderate residual mitral valve regurgitation was more frequent.
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Affiliation(s)
- Jens Wiebe
- CardioVascular Center Frankfurt, Germany
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Chatterjee M, Seizer P, Borst O, Schönberger T, Mack A, Geisler T, Langer HF, May AE, Vogel S, Lang F, Gawaz M. SDF-1α induces differential trafficking of CXCR4-CXCR7 involving cyclophilin A, CXCR7 ubiquitination and promotes platelet survival. FASEB J 2014; 28:2864-78. [PMID: 24668750 DOI: 10.1096/fj.14-249730] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 01/11/2023]
Abstract
Platelet-derived SDF-1α (CXCL12) mediates inflammatory and regenerative mechanisms. The present study characterizes the effect of SDF-1α ligation in platelets. SDF-1α (0-100 μM) dose and time dependently caused internalization of its receptor CXCR4 (28.9 ± 1.6 vs. 16.1 ± 1.9 in SDF-1α-treated platelets), coupled to the surface externalization of CXCR7 (65.5 ± 8 vs. 162.8 ± 27.6 following SDF-1α treatment), both in vitro and in vivo. This was inhibited in the presence of AMD3100 (100 μM), CXCR4 blocking and vesicular transport inhibitors (brefeldin A, 10 μM; rapamycin, 100 nM). SDF-1α/CXCR-4-mediated CXCR7 translocation was significantly reduced by inhibitors of ERK1/2-(U0126-10 μM) and cyclophilinA (CyPA)-(NIM811-10 μM) by 28 and 46%, respectively. Further, SDF-1α-induced downstream phosphorylation of Erk1/2 led to CyPA-dependent ubiquitination of CXCR7, which is essential for its surface translocation. CyPA-PPIase-activity inhibitor NIM-811, Erk1/2, and E1-ligase inhibitor-(PYR-41-25 μM) significantly abolished SDF-1α-driven CXCR7 ubiquitination and subsequent surface translocation. SDF-1α induced CXCR7 ubiquitination, and its surface exposure was observed in wild-type murine platelets, but not in CyPA-deficient platelets. SDF-1α/CXCR4-CyPA-dependent CXCR7 translocation and its subsequent ligation attenuated activation-induced apoptosis both in vitro and when administered in vivo. This antiapoptotic effect of SDF-1α was abrogated by blocking CXCR7, also significantly affected in Cypa(-/-) platelets. Thus, we decipher a novel mechanism, whereby SDF-1α regulates relative receptor availability in circulating platelets and exerts its prosurvival benefits.-Chatterjee, M., Seizer, P., Borst, O., Schönberger, T., Mack, A., Geisler, T., Langer, H. F., May, A. E., Vogel, S., Lang, F., Gawaz, M. SDF-1α induces differential trafficking of CXCR4-CXCR7 involving cyclophilin A, CXCR7 ubiquitination and promotes platelet survival.
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Affiliation(s)
| | - Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen
| | - Oliver Borst
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen
| | | | - Andreas Mack
- Institute of Anatomy, Universität Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen
| | - Harald F Langer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen
| | - Andreas E May
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen
| | - Sebastian Vogel
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen
| | | | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen,
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Riahi A, Kharrat M, Ghourabi ME, Khomsi F, Gamoudi A, Lariani I, May AE, Rahal K, Chaabouni-Bouhamed H. Mutation spectrum and prevalence of BRCA1 and BRCA2 genes in patients with familial and early-onset breast/ovarian cancer from Tunisia. Clin Genet 2014; 87:155-60. [PMID: 24372583 DOI: 10.1111/cge.12337] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 09/25/2013] [Revised: 11/26/2013] [Accepted: 12/24/2013] [Indexed: 01/22/2023]
Abstract
The contribution of BRCA1/BRCA2 mutations to hereditary breast cancer in the Tunisian population has not been accurately estimated. The purpose of our study was to estimate the incidence and spectrum of pathogenic mutations in BRCA1/2 genes in early onset and familial breast/ovarian cancer among Tunisian women. To identify predictive factors for BRCA1/2 mutations, we screened the entire coding sequences and intron/exon boundaries of BRCA1/BRCA2 genes in 48 patients by direct sequencing. Twelve pathogenic mutations were detected (25%); three in BRCA1 (c.211dupA in four families, c.5266dupC in three families and c.1504_1508delTTAAA in one family) and two novel mutations in BRCA2 (c.1313dupT in two families and c.7654dupT in two families). We also identified 23 different polymorphisms and unclassified variants. These results indicate that our population has a spectrum of recurrent BRCA mutations.
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Affiliation(s)
- A Riahi
- Laboratoire Génétique Humaine, Faculté de Médecine de Tunis, University Tunis El manar, Tunis, Tunisia
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Abstract
Cyclophilin A (CyPA) is an abundantly expressed intracellular protein. It exerts a variety of functions due to its peptidyl-prolyl cis-trans isomerase (PPIase) activity. When released into the extracellular space, CyPA binds to its extracellular receptor CD147 (EMMPRIN) and thereby initiates a cascade of inflammatory processes. Recent data indicate that both extra- and intracellular CyPA significantly contribute to cardiovascular inflammation, myocardial ischaemia and reperfusion injury, and myocardial remodelling processes. Thus, CyPA appears to represent a novel target to treat vascular and myocardial inflammation.
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Affiliation(s)
- Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Otfried-Müller Str.10, Tübingen 72076, Germany
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Affiliation(s)
- Andreas E May
- Department of Cardiology, University Hospital Tübingen, Eberhard Karls-University, 72076 Tübingen, Germany.
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Münzer P, Borst O, Walker B, Schmid E, Feijge MAH, Cosemans JMEM, Chatterjee M, Schmidt EM, Schmidt S, Towhid ST, Leibrock C, Elvers M, Schaller M, Seizer P, Ferlinz K, May AE, Gulbins E, Heemskerk JWM, Gawaz M, Lang F. Acid sphingomyelinase regulates platelet cell membrane scrambling, secretion, and thrombus formation. Arterioscler Thromb Vasc Biol 2013; 34:61-71. [PMID: 24233488 DOI: 10.1161/atvbaha.112.300210] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Platelet activation is essential for primary hemostasis and acute thrombotic vascular occlusions. On activation, platelets release their prothrombotic granules and expose phosphatidylserine, thus fostering thrombin generation and thrombus formation. In other cell types, both degranulation and phosphatidylserine exposure are modified by sphingomyelinase-dependent formation of ceramide. The present study thus explored whether acid sphingomyelinase participates in the regulation of platelet secretion, phosphatidylserine exposure, and thrombus formation. APPROACH AND RESULTS Collagen-related peptide-induced or thrombin-induced ATP release and P-selectin exposure were significantly blunted in platelets from Asm-deficient mice (Smpd1(-/-)) when compared with platelets from wild-type mice (Smpd1(+/+)). Moreover, phosphatidylserine exposure and thrombin generation were significantly less pronounced in Smpd1(-/-) platelets than in Smpd1(+/+) platelets. In contrast, platelet integrin αIIbβ3 activation and aggregation, as well as activation-dependent Ca(2+) flux, were not significantly different between Smpd1(-/-) and Smpd1(+/+) platelets. In vitro thrombus formation at shear rates of 1700 s(-1) and in vivo thrombus formation after FeCl3 injury were significantly blunted in Smpd1(-/-) mice while bleeding time was unaffected. Asm-deficient platelets showed significantly reduced activation-dependent ceramide formation, whereas exogenous ceramide rescued diminished platelet secretion and thrombus formation caused by Asm deficiency. Treatment of Smpd1(+/+) platelets with bacterial sphingomyelinase (0.01 U/mL) increased, whereas treatment with functional acid sphingomyelinase-inhibitors, amitriptyline or fluoxetine (5 μmol/L), blunted activation-dependent platelet degranulation, phosphatidylserine exposure, and thrombus formation. Impaired degranulation and thrombus formation of Smpd1(-/-) platelets were again overcome by exogenous bacterial sphingomyelinase. CONCLUSIONS Acid sphingomyelinase is a completely novel element in the regulation of platelet plasma membrane properties, secretion, and thrombus formation.
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Affiliation(s)
- Patrick Münzer
- From the Departments of Physiology (P.M., O.B., B.W., E.S., E.-M.S., S.S., S.T.T., C.L., F.L.), Cardiology and Cardiovascular Medicine (O.B., M.C., M.E., P.S., A.E.M., M.G.), and Dermatology (M.S.), University of Tübingen, Germany; Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands (M.A. H.F., J.M.E.M.C., J.W.M.H.); Bristol-Myers Squibb GmbH&CoKGaA, Munich, Germany (K.F.); Institute of Molecular Biology, University of Duisburg-Essen, Essen, Germany (E.G.); and Department of Clinical and Experimental Hemostasis, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (M.E.)
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Zuern CS, Krumm P, Wurster T, Kramer U, Schreieck J, Henning A, Bauer A, Gawaz M, May AE. Reverse left ventricular remodeling after percutaneous mitral valve repair: Strain analysis by speckle tracking echocardiography and cardiac magnetic resonance imaging. Int J Cardiol 2013; 168:4983-5. [DOI: 10.1016/j.ijcard.2013.07.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
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Kramer U, May AE, Mangold S, Krumm P, Claussen CD. [Cardiac magnetic resonance tomography in the diagnostics of restrictive and unclassified cardiopathies]. Radiologe 2013; 53:45-53. [PMID: 23160570 DOI: 10.1007/s00117-012-2384-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
CLINICAL/METHODICAL ISSUE Besides ischemic heart disease cardiomyopathies are common causes of heart failure and sudden cardiac death. STANDARD RADIOLOGICAL METHODS The diagnostic spectrum in cardiomyopathies comprises non-invasive and invasive examination techniques. METHODICAL INNOVATIONS The exact verification of certain cardiomyopathies necessitates knowledge of the latest classification of cardiomyopathies as well as dedicated examination protocols. PERFORMANCE Modern imaging modalities, such as echocardiography and cardiac magnetic resonance imaging (MRI) have emerged as useful imaging tools in the investigation of patients suspected of having many different types of cardiomyopathies. ACHIEVEMENTS Based on a better understanding of the underlying pathophysiology several diagnostic criteria have been defined using cardiac MRI. In particular there is an increasing importance of cardiac MRI in the description of patients with restrictive and unclassified cardiomyopathies. PRACTICAL RECOMMENDATIONS Echocardiography still remains the modality of choice in the diagnostics of unclear left ventricular heart failure. Further diagnostic work-up should include cardiac MRI in case of any lack of clarity.
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Affiliation(s)
- U Kramer
- Abteilung für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universität Tübingen, Deutschland.
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Joghetaei N, Stein A, Byrne RA, Schulz C, King L, May AE, Schmidt R. The Extracellular Matrix Metalloproteinase Inducer (EMMPRIN, CD147) - a potential novel target in atherothrombosis prevention? Thromb Res 2013; 131:474-80. [DOI: 10.1016/j.thromres.2013.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/10/2013] [Accepted: 04/16/2013] [Indexed: 11/17/2022]
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Krumm P, Zürn CS, Wurster TH, Seeger A, Mangold S, Bretschneider C, Klumpp B, May AE, Claussen CD, Kramer U. Prä- und postinterventionelle Analyse des Myokardialen Strains mittels KardioMRT bei Patienten mit Mitralklappen-Clipping. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346296] [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: 10/26/2022]
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Seizer P, May AE. Therapeutic potential and strategies against leukocyte-platelet interaction in atherosclerosis. Curr Vasc Pharmacol 2013; 10:550-4. [PMID: 22338569 DOI: 10.2174/157016112801784585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 11/03/2011] [Accepted: 01/05/2012] [Indexed: 11/22/2022]
Abstract
Leukocyte rolling, adhesion, transmigration and activation are features of vascular inflammation leading to atherosclerosis. In particular the interaction between platelets and leukocytes is a key process for adhesion of inflammatory cells to the vascular wall. The various mechanisms of the specific platelet-leukocyte interaction may provide a powerful target to prevent initiation and/or progression of atherosclerotic lesions.
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Affiliation(s)
- Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tubingen,Germany.
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Zuern CS, Müller KAL, Seizer P, Geisler T, Banya W, Klingel K, Kandolf R, Bauer A, Gawaz M, May AE. Cyclophilin A predicts clinical outcome in patients with congestive heart failure undergoing endomyocardial biopsy. Eur J Heart Fail 2012; 15:176-84. [PMID: 23243067 DOI: 10.1093/eurjhf/hfs185] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [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: 12/16/2022] Open
Abstract
AIMS Cyclophilin A (CyPA) represents a ubiquitous intracellular protein, which is secreted by inflammatory and by dying/necrotic cells. The aim of this study was to evaluate the prognostic relevance of CyPA expression in endomyocardial biopsies of consecutive patients with congestive heart failure. METHODS AND RESULTS A total of 227 unselected patients (age 53.9 ± 15 years) with congestive heart failure undergoing endomyocardial biopsy for diagnostic reasons were enrolled. Biopsies were analysed using established histopathological and immunohistological criteria together with CyPA staining. Virus genome was studied by polymerase chain reaction. CyPA was significantly enhanced in patients with inflammatory cardiomyopathy (n = 127) as compared with patients with non-inflammatory cardiomyopathy (n = 100, P < 0.0001). During a mean follow-up of 16.3 months, 60 patients (26.4%) reached the primary endpoint, a composite of all-cause death, heart transplantation, malignant arrhythmia, and heart failure-related rehospitalization. Of all clinical (ejection fraction, New York Heart Association functional class), laboratory (brain natriuretic peptide), and immunohistological parameters (CyPA, extracellular matrix metalloproteinase inducer, CD68, CD3, major hisocompatibility complex II, and virus genome) tested, only CyPA was identified as an independent predictor for the composite endpoint [hazard ratio (HR) 2.4; 95% confidence interval (CI) 1.2-5.2; P = 0.019] as well as for all-cause death and heart transplantation alone (HR 4.7; 95% CI 1.1-19.8; P = 0.036). Subgroup analysis revealed CyPA as a predictor in patients with non-inflammatory cardiomyopathy for the composite endpoint (HR 3.0; 95% CI 1.3-6.6; P = 0.007) as well as all-cause death or heart transplantation alone (HR 6.4; 95% CI 1.4-28.1; P = 0.014). CONCLUSIONS CyPA is an independent predictor of clinical outcome in patients with congestive heart failure undergoing endomyocardial biopsy.
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Affiliation(s)
- Christine S Zuern
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Germany
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Borst O, Münzer P, Gatidis S, Schmidt EM, Schönberger T, Schmid E, Towhid ST, Stellos K, Seizer P, May AE, Lang F, Gawaz M. The Inflammatory Chemokine CXC Motif Ligand 16 Triggers Platelet Activation and Adhesion Via CXC Motif Receptor 6–Dependent Phosphatidylinositide 3-Kinase/Akt Signaling. Circ Res 2012; 111:1297-307. [DOI: 10.1161/circresaha.112.276444] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [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: 01/28/2023]
Abstract
Rationale:
The recently discovered chemokine CXC motif ligand 16 (CXCL16) is highly expressed in atherosclerotic lesions and is a potential pathogenic mediator in coronary artery disease.
Objective:
The aim of this study was to test the role of CXCL16 on platelet activation and vascular adhesion, as well as the underlying mechanism and signaling pathway.
Methods and Results:
Reverse-transcriptase polymerase chain reaction, Western blotting, confocal microscopy, and flow cytometry revealed that CXCL16-specific receptor, CXC motif receptor 6, is highly expressed in platelets. According to flow cytometry and confocal microscopy, stimulation of platelets with CXCL16 induced platelet degranulation, integrin α
IIb
β
3
activation, and shape change. CXCL16 increased Akt phosphorylation (Thr
308
/Ser
473
), an effect abrogated by phosphatidylinositide 3-kinase inhibitors wortmannin (100 nmol/L) and LY294002 (25 µmol/L). The phosphatidylinositide 3-kinase inhibitors and Akt inhibitor SH-6 (20 µmol/L) further diminished CXCL16-induced platelet activation. CXCL16-mediated platelet degranulation, integrin α
IIb
β
3
activation, and Akt phosphorylation were blunted in platelets lacking CXCL16-specific receptor CXC motif receptor 6. CXCL16-induced platelet activation was abrogated in Akt1- or Akt2-deficient platelets. CXCL16 enhanced platelet adhesion to endothelium in vitro after high arterial shear stress (2000
−s
) and to injured vascular wall in vivo after carotid ligation. CXCL16-induced stimulation of platelet adhesion again was prevented by phosphatidylinositide 3-kinase and Akt inhibitors. Apyrase and antagonists of platelet purinergic receptors P
2
Y
1
(MRS2179, 100 µmol/L) and especially P
2
Y
12
(Cangrelor, 10 µmol/L) blunted CXCL16-triggered platelet activation as well as CXCL16-induced platelet adhesion under high arterial shear stress in vitro and after carotid ligation in vivo.
Conclusions:
The inflammatory chemokine CXCL16 triggers platelet activation and adhesion via CXC motif receptor 6–dependent phosphatidylinositide 3-kinase/Akt signaling and paracrine activation, suggesting a decisive role for CXCL16 in linking vascular inflammation and thrombo-occlusive diseases.
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Affiliation(s)
- Oliver Borst
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Patrick Münzer
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Sergios Gatidis
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Eva-Maria Schmidt
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Tanja Schönberger
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Evi Schmid
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Syeda T. Towhid
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Konstantinos Stellos
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Peter Seizer
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Andreas E. May
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Florian Lang
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- From the Medizinische Klinik III, Department of Cardiology and Cardiovascular Medicine (O.B., T.S., K.S., P.S., A.E.M., M.G.) and Department of Physiology (O.B., P.M., S.G., E-M.S., E.S., S.T.T., F.L.), University of Tübingen, Tübingen, Germany
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Abstract
Atopaxar, also known as E 5555 is a novel reversible protease-activated receptor-1 (PAR-1) thrombin receptor antagonist. To date, Atopaxar has been investigated in phase II trials with focus on safety and tolerability in patients with acute coronary syndromes or stable coronary artery disease on top of standard antiplatelet therapy. Atopaxar was generally well tolerated, however a rise in liver enzymes and prolongation of the QTcF interval were observed. The data suggest, that atopaxar administration may promote some minor bleeding complications, but does not seem to significantly increase the risk of major bleeding. Although not powered for efficacy, the currently available data suggest potential benefits in patients at high risk for recurrent ischemic events on top of standard antiplatelet therapy. In conclusion, more studies (e.g. phase III) are needed to evaluate efficacy and safety of atopaxar.
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Affiliation(s)
- T Wurster
- Medizinische Klinik III, Eberhard-Karls-Universität Tübingen, Germany
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36
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Seizer P, Klingel K, Sauter M, Westermann D, Ochmann C, Schönberger T, Schleicher R, Stellos K, Schmidt EM, Borst O, Bigalke B, Kandolf R, Langer H, Gawaz M, May AE. Cyclophilin A affects inflammation, virus elimination and myocardial fibrosis in coxsackievirus B3-induced myocarditis. J Mol Cell Cardiol 2012; 53:6-14. [PMID: 22446162 DOI: 10.1016/j.yjmcc.2012.03.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [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: 09/18/2011] [Revised: 03/04/2012] [Accepted: 03/08/2012] [Indexed: 01/19/2023]
Abstract
Extracellular cyclophilin A (CyPA) and its receptor Extracellular Matrix Metalloproteinase Inducer (EMMPRIN, CD147) modulate inflammatory processes beyond metalloproteinase (MMP) activity. Recently, we have shown that CyPA and CD147 are upregulated in patients with inflammatory cardiomyopathy. Here we investigate the role of CyPA and CD147 in murine coxsackievirus B3 (CVB3)-induced myocarditis. CVB3-infected CyPA(-/-) mice (129S6/SvEv) revealed a significantly reduced T-cell and macrophage recruitment at 8 days p.i. compared to wild-type mice. In A.BY/SnJ mice, treatment with the cyclophilin-inhibitor NIM811 was associated with a reduction of inflammatory lesions and MMP-9 expression but with enhanced virus replication 8 days p.i. At 28 days p.i. the extent of lesion areas was not affected bei NIM811, whereas the collagen content was reduced. Initiation of NIM811-treatment on day 12 (after an effective virus defense) resulted in an even more pronounced reduction of myocardial fibrosis. In conclusion, in CVB3-induced myocarditis CyPA is important for macrophage and T cell recruitment and effective virus defense and may represent a pharmacological target to modulate myocardial remodeling in myocarditis.
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Affiliation(s)
- Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Germany
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Henning A, Schreieck J, Riessen R, Gawaz M, May AE. Successful bridge to recovery using a microaxial blood pump in a patient with electrical storm and cardiogenic shock. Med Klin Intensivmed Notfmed 2011; 106:132-6. [PMID: 22038638 DOI: 10.1007/s00063-011-0047-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 03/21/2011] [Indexed: 11/24/2022]
Abstract
A 59-year-old patient with dilated cardiomyopathy and incessant ventricular tachycardia leading to progressive cardiogenic shock is presented. Due to hemodynamic instability, high dose catecholamines were required in addition to the implantation of an intraaortic balloon pump (IABP), which, however, appeared to further augment the frequency and duration of ventricular tachycardias. The implantation of a microaxial blood pump allowed catecholamine administration to be terminated, thereby, ending this vicious circle of catecholamine-driven electrical storm. Within 5 days, the patient was hemodynamically stabilized and kidney and liver function recovered with the support of intensive antiarrhythmic therapy (amiodarone, mexiletine, sotalol). During a 24-month follow-up, the patient had no further ICD shocks and no rehospitalization was required for treatment of congestive heart failure.
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Affiliation(s)
- A Henning
- Medizinische Klinik, Universitaetsklinikum Tuebingen, Germany.
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38
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May AE. [Mitral insufficiency: mitral valve clip]. Dtsch Med Wochenschr 2011; 136:1964. [PMID: 21935857 DOI: 10.1055/s-0031-1286371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A E May
- Medizinische Klinik III (Kardiologie und Kreislauferkrankungen), Universitätsklinik Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen.
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Lutz SZ, Schmalzing M, Vogel-Claussen J, Adam P, May AE. [Recurrent pericardial effusion as first manifestation of Erdheim-Chester disease]. Dtsch Med Wochenschr 2011; 136:1952-6. [PMID: 21935854 DOI: 10.1055/s-0031-1286368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 65-year-old woman presented with reduced general condition and dyspnoea that was progressive over the last months. Clinical findings revealed an exophthalmus on the right, xanthelasm and mild peripheral oedema. Previously, a pericardiocentesis had been performed due to a large pericardial effusion. A previous CT scan showed a mass attached to the pericardium extending through the atrio-ventricular groove and a thickened aorta. In addition, a retroperitoneal fibrosis and an occlusion of both Aa. iliacae internae were found. INVESTIGATIONS The ECG showed sinus rhythm. Laboratory findings demonstrated a microcytic anemia and a renal failure. Chest radiography showed a large cardiac silhouette, while the transthoracic echocardiography revealed a recurrent large pericardial effusion. A PET/CT scan of the chest and abdomen showed a tissue infiltration of the retroperitoneal structures, a mass surrounding the right coronary artery and the right orbita. Finally, a femur biopsy confirmed the diagnosis of Erdheim-Chester disease. DIAGNOSIS, TREATMENT AND COURSE With the diagnosis Erdheim-Chester disease we started a high dose immunsuppressive therapy using glucocorticoids and interferon-a. Tumour size slightly decreased during the following 2 months, however the patient developed a severe urosepsis and died from multiorgan failure. CONCLUSIONS We report a case of an Erdheim-Chester disease with cardiovascular involvement primarily diagnosed due to a recurrent large pericardial effusion. In case of cardial tumors with interatrial septum or coronary artery involvement together with cerebral manifestations, an Erdheim-Chester disease should be taken into account.
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Affiliation(s)
- S Z Lutz
- Abteilung für Endokrinologie, Diabetes, Nephrologie, Angiologie und Klinische Chemie, Medizinische Universitätsklinik, Eberhard-Karls-Universität, Tübingen.
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40
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Bültmann A, Li Z, Wagner S, Gawaz M, Ungerer M, Langer H, May AE, Münch G. Loss of protease activity of ADAM15 abolishes protective effects on plaque progression in atherosclerosis. Int J Cardiol 2011; 152:382-5. [PMID: 21908061 DOI: 10.1016/j.ijcard.2011.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 08/13/2011] [Indexed: 12/01/2022]
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41
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Bigalke B, Stellos K, Geisler T, Kremmer E, Seizer P, May AE, Lindemann S, Gawaz M. Glycoprotein VI for diagnosis of acute coronary syndrome when ECG is ambiguous. Int J Cardiol 2011; 149:164-168. [DOI: 10.1016/j.ijcard.2009.12.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 10/26/2009] [Accepted: 12/19/2009] [Indexed: 10/20/2022]
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42
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Zuern CS, Schreieck J, Weig HJ, Gawaz M, May AE. Percutaneous mitral valve repair using the MitraClip in acute cardiogenic shock. Clin Res Cardiol 2011; 100:719-21. [PMID: 21607532 DOI: 10.1007/s00392-011-0324-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 05/12/2011] [Indexed: 12/22/2022]
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Seizer P, Stellos K, Selhorst G, Krämer BF, Lang MR, Gawaz M, May AE. CXCL16 is a novel scavenger receptor on platelets and is associated with acute coronary syndrome. Thromb Haemost 2011; 105:1112-4. [PMID: 21505717 DOI: 10.1160/th10-10-0689] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 02/25/2011] [Indexed: 11/05/2022]
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Seizer P, Ochmann C, Schönberger T, Zach S, Rose M, Borst O, Klingel K, Kandolf R, MacDonald HR, Nowak RA, Engelhardt S, Lang F, Gawaz M, May AE. Disrupting the EMMPRIN (CD147)-cyclophilin A interaction reduces infarct size and preserves systolic function after myocardial ischemia and reperfusion. Arterioscler Thromb Vasc Biol 2011; 31:1377-86. [PMID: 21441138 DOI: 10.1161/atvbaha.111.225771] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Inflammation and proteolysis crucially contribute to myocardial ischemia and reperfusion injury. The extracellular matrix metalloproteinase inducer EMMPRIN (CD147) and its ligand cyclophilin A (CyPA) may be involved in both processes. The aim of the study was to characterize the role of the CD147 and CyPA interplay in myocardial ischemia/reperfusion (I/R) injury. METHODS AND RESULTS Immunohistochemistry showed enhanced expression of CD147 and CyPA in myocardial sections from human autopsies of patients who had died from acute myocardial infarction and from mice at 24 hours after I/R. At 24 hours and 7 days after I/R, the infarct size was reduced in CD147(+/-) mice vs CD147(+/+) mice (C57Bl/6), in mice (C57Bl/6) treated with monoclonal antibody anti-CD147 vs control monoclonal antibody, and in CyPA(-/-) mice vs CyPA(+/+) mice (129S6/SvEv), all of which are associated with reduced monocyte and neutrophil recruitment at 24 hours and with a preserved systolic function at 7 days. The combination of CyPA(-/-) mice with anti-CD147 treatment did not yield further protection compared with either inhibition strategy alone. In vitro, treatment with CyPA induced monocyte chemotaxis in a CD147- and phosphatidylinositol 3-kinase-dependent manner and induced monocyte rolling and adhesion to endothelium (human umbilical vein endothelial cells) under flow in a CD147-dependent manner. CONCLUSION CD147 and its ligand CyPA are inflammatory mediators after myocardial ischemia and reperfusion and represent potential targets to prevent myocardial I/R injury.
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Affiliation(s)
- Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Germany
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Htun P, Fateh-Moghadam S, Bischofs C, Banya W, Müller K, Bigalke B, Stellos K, May AE, Flather M, Gawaz M, Geisler T. Low responsiveness to clopidogrel increases risk among CKD patients undergoing coronary intervention. J Am Soc Nephrol 2011; 22:627-33. [PMID: 21273381 DOI: 10.1681/asn.2010020220] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Patients with CKD are at higher risk for major events after percutaneous coronary intervention (PCI) compared with subjects with normal renal function. The aims of this study were to evaluate responsiveness to clopidogrel in patients with CKD and to examine the effect of antiplatelet drug response on post-PCI outcome. We retrospectively evaluated a consecutive cohort of 1567 patients with symptomatic coronary artery disease undergoing PCI, 648 (41%) of whom had stage 3 to 5 CKD. We assessed responsiveness to clopidogrel by ADP-induced platelet aggregation after oral administration of a 600-mg clopidogrel loading dose and 100 mg of aspirin. In a multivariate survival analysis that included 1335 (85%) of the cohort, stage 3 to 5 CKD and low response to clopidogrel were independent predictors of the primary end point (composite of myocardial infarction, ischemic stroke, and death within 1 year). In summary, a low response to clopidogrel might be an additional risk factor for the poorer outcomes in patients with stage 3 to 5 CKD compared with patients with better renal function.
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Affiliation(s)
- Patrik Htun
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum der Eberhard-Karls-Universität Tübingen, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany
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Seeger A, Hennemuth A, Klumpp B, Fenchel M, Kramer U, Bretschneider C, Mangold S, May AE, Claussen CD, Peitgen HO, Miller S. Fusion of MR coronary angiography and viability imaging: feasibility and clinical value for the assignment of myocardial infarctions. Eur J Radiol 2011; 81:71-6. [PMID: 21215542 DOI: 10.1016/j.ejrad.2010.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 11/25/2010] [Accepted: 12/01/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the feasibility of image fusion of MR-coronary angiography (MRCA) and delayed gadolinium enhancement imaging (LGE) and to assign areas of myocardial infarction to the corresponding supplying coronary arteries. MATERIALS AND METHODS An interactive segmentation of the coronary arteries was performed in MRCA data sets (n=25). The LGE slices were matched onto the vessel segmentation to perform a fused analysis of coronary artery anatomy and LGE. The results were compared to the segmental model recommended by the American Heart Association (AHA). Standard of reference was the identification of the culprit lesion in the invasive coronary angiography (CA) (n=20). RESULTS The fused analysis allowed the assignment of MI to the supplying coronary artery in 13/20 patients. The sensitivities/specificities for the assignment of MI to the three main vessels were: LAD 63%/100%, LCX 75%/100%, and RCA 56%/100%, respectively. Using the AHA segmental model the sensitivities/specificities for the correct assignment of MI to the three main vessels were: LAD 88%/58%, LCX 94%/75%, and RCA 77%/73%, respectively. CONCLUSION Fusion images of MRCA and LGE provides added diagnostic information in the effort to determine the epicardial vessels responsible for the postischemic myocardial injury and therefore might be helpful to establish appropriate future therapeutic steps.
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Affiliation(s)
- Achim Seeger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
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Müller K, Aichele S, Herkommer M, Bigalke B, Stellos K, Htun P, Fateh-Moghadam S, May AE, Flather M, Gawaz M, Geisler T. Impact of inflammatory markers on platelet inhibition and cardiovascular outcome including stent thrombosis in patients with symptomatic coronary artery disease. Atherosclerosis 2010; 213:256-62. [PMID: 20728084 DOI: 10.1016/j.atherosclerosis.2010.07.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/02/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Abstract
Surgery often requires the interruption of standard dual antiplatelet therapy using aspirin and clopidogrel. Here, we present three patients who underwent surgery and suffered from a perioperative stent thrombosis associated with premature discontinuation of dual antiplatelet therapy. Although there are missing evidence-based data and key guidelines, we suggest that patients who undergo surgery after coronary stenting may benefit from an individualized perioperative antiplatelet management strategy. After premature dual antiplatelet therapy discontinuation, when the bridging of the preoperative time interval with the use of a short acting intravenous glycoprotein (GP) IIb-IIIa inhibitor including a platelet function testing has been missed and a coronary stent thrombosis has occurred, the patients should be administered a GPIIb-IIIa inhibitor for 12–24 hours, followed by aspirin for one day and a dual antiplatelet treatment after 24–48 hours. Our patients benefited from this individualized practical approach.
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Affiliation(s)
- Boris Bigalke
- Medizinische Klinik III, Klinik für Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany.
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Seizer P, Borst O, Langer HF, Bültmann A, Münch G, Herouy Y, Stellos K, Krämer B, Bigalke B, Büchele B, Bachem MG, Vestweber D, Simmet T, Gawaz M, May AE. EMMPRIN (CD147) is a novel receptor for platelet GPVI and mediates platelet rolling via GPVI-EMMPRIN interaction. Thromb Haemost 2009; 101:682-6. [PMID: 19350111 DOI: 10.1160/th08-06-0368] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Extracellular Matrix Metalloproteinase Inducer (EMMPRIN, CD147, basigin) is an immunoglobulin-like receptor expressed in various cell types. During cellular interactions homotypic EMMPRIN-EMMPRIN interactions are known to induce the synthesis of matrix metalloproteinases. Recently, we have identified EMMPRIN as a novel receptor on platelets. To our knowledge EMMPRIN has not been shown to serve as adhesion receptor, yet. Here we characterise platelet glycoprotein VI (GPVI) as a novel adhesion receptor for EMMPRIN. Human platelets were prestimulated with ADP and perfused over immobilised recombinant EMMPRIN-Fc or Fc-fragments under arterial shear conditions. ADP-stimulated platelets showed significantly enhanced rolling (but not enhanced firm adhesion) on immobilised EMMPRIN-Fc compared to Fc. Pretreatment of platelets with blocking mAbs anti-EMMPRIN or anti-GPVI leads to a significant reduction of rolling platelets on immobilised EMMPRIN-Fc, whereas pretreatment with blocking mAbs anti-p-selectin, anti-alpha4-integrin or anti-GPIIb/IIIa complex (20 microg/ml each) had no effect. Consistently, chinese hamster ovary (CHO) cells stably transfected with GPVI showed enhanced rolling (but not adhesion) on immobilised EMMPRIN-Fc in comparison to non-transfected CHO cells. Similarly, CHO cells stably transfected with EMMPRIN showed enhanced rolling on immobilised GPVI-Fc (or EMMPRIN-Fc) compared to non transfected CHO-cells. Finally, specific binding of EMMPRIN to GPVI was demonstrated by a modified ELISA and surface plasmon resonance technology with a dissociation constant of 88 nM. Platelet GPVI is a novel receptor for EMMPRIN and can mediate platelet rolling via GPVI-EMMPRIN interaction.
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Affiliation(s)
- Peter Seizer
- Medizinische Klinik III, Universitätsklinikum Tübingen, Tübingen, Germany
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Doesch C, Seeger A, Doering J, Herdeg C, Burgstahler C, Claussen CD, Gawaz M, Miller S, May AE. Risk stratification by adenosine stress cardiac magnetic resonance in patients with coronary artery stenoses of intermediate angiographic severity. JACC Cardiovasc Imaging 2009; 2:424-33. [PMID: 19580724 DOI: 10.1016/j.jcmg.2008.11.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [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: 05/22/2008] [Revised: 11/05/2008] [Accepted: 11/10/2008] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the role of adenosine stress cardiac magnetic resonance (CMR) for risk stratification in patients with coronary artery stenoses of intermediate angiographic severity. BACKGROUND Coronary angiography only provides a morphological description of coronary lesions. As the patient's prognosis is closely related to the functional significance of angiographically detected coronary lesions, a functional assessment is desirable in patients with coronary artery stenoses of intermediate severity. METHODS Myocardial perfusion measurements at rest and adenosine stress were performed on 81 patients (75.6% male, mean age 64.2 years) with stable angina pectoris (AP) and coronary artery stenoses of intermediate angiographic severity (50% to 75%). Regardless of the CMR result, all patients were treated conservatively with an intensified medical treatment, and a follow-up was performed after 18 +/- 8 months and 30 +/- 8 months. The primary end point was defined as a major adverse cardiac event (MACE): all-cause death, stroke, acute coronary syndrome; the secondary end point was defined as target vessel revascularization. Furthermore, AP and dyspnea were evaluated. RESULTS After the follow-up period of 30 +/- 8 months, 9 patients with perfusion deficit (PD) suffered from MACE, whereas no MACE occurred among the 36 patients without PD (p = 0.014). Among patients who had MACE, the number of ischemic segments (2.3 +/- 1.6 vs. 1.4 +/- 1.6, p = 0.0025) was significantly higher, whereas the number of delayed enhancement segments did not differ (1.4 +/- 1.6 vs. 1.6 +/- 2.3, p = 0.4). Target vessel revascularization was required in 38% of patients with PD and 6% of patients without PD (p = 0.005). In addition, the percentage of freedom from AP and dyspnea at the follow-up after 18 +/- 8 months was significantly lower among patients without perfusion deficit (69.4% vs. 15.6%; p = 0.0001). After a follow-up period of 30 +/- 8 months, the rate of AP (11.1% vs. 8.3%, p = 0.33) as well as the percentage of patients free of symptoms was similar in both groups (77.8% vs. 88.9%, p = 0.82). CONCLUSIONS Adenosine stress CMR may help to identify patients at risk who benefit from intensified medical treatment and close follow-up.
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Affiliation(s)
- Christina Doesch
- Department of Cardiology, Eberhard Karls University, Tübingen, Germany
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