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Brown S, McDonnell B, McRae D, Hallingberg B, Angel P, Khan I, James DH. Beliefs, behaviour, and blood pressure: preliminary analysis from a pharmacy-based hypertension visualisation intervention to support medication adherence. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.008] [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] [Indexed: 12/03/2022]
Abstract
Abstract
Introduction
Hypertension is the leading preventable risk factor for cardiovascular disease, with an estimated prevalence of 31% worldwide1. Antihypertensive medication reduces both blood pressure (BP) and cardiovascular risk; however, approximately 50% of patients become nonadherent to antihypertensives within a year of treatment initiation2. Nonadherence can be considered as either intentional or unintentional. Research suggests that rather than being a solely passive process, illness beliefs and treatment perceptions may influence nonintentional nonadherence3, highlighting the importance of considering patients’ beliefs when supporting adherence. The use of visuals is one method to aid understanding of complex health information and influence treatment beliefs.
Aim
To investigate the feasibility and acceptability of a community pharmacy-based visualisation intervention (ViSTA-BP) and explore the preliminary effect on patients’ perceptions of hypertension, medication adherence and blood pressure.
Methods
ViSTA-BP is a digital intervention that allows users, through real-time animations, to visualise both the condition that is hypertension and how blood pressure affects the circulatory system. The purpose of ViSTA-BP was to improve patients’ understanding of hypertension, increase perceived necessity of treatment and ultimately support medication adherence. A mixed-methods pre-post design pilot study was conducted. NHS Research Ethics Committee Wales Rec 5 (reference 20/WA/0280) and Cardiff Metropolitan University (reference PGR-3806) granted ethical approval. The intervention was consultation-based and researcher-facilitated. Outcomes were recorded at baseline, immediately post-intervention, and at three-months. Validated questionnaires were used to measure illness and treatment beliefs (Brief Illness Perception Questionnaire (B-IPQ)/Beliefs about Medicines Questionnaire (BMQ)), adherence captured using self-report measures (Medicines Adherence Rating Scale (MARS-5)/recent adherence questionnaire) and medication dispensing/collection data. BP was measured at baseline and 3-month follow-up. Semi-structured interviews with patients and pharmacists explored intervention acceptability.
Results
Pharmacists recruited 69 patients with hypertension across five community pharmacies (CP) in South Wales; 54 attended the three-month follow-up. The ease of participant recruitment and high retention rates demonstrated the feasibility of delivering ViSTA-BP in this setting. ViSTA-BP content and the CP location were acceptable to patients and pharmacists. Time to deliver the intervention was a concern for pharmacists but not patients. There was no statistically significant change in adherence outcomes at three-month follow-up; however, the median scores for both self-report questionnaires were maximal at baseline. Changes were seen in illness belief scores, with a significant improvement in total B-IPQ score over time (p=0.04). Significant changes in B-IPQ treatment control (p=0.01), illness coherence (p<0.001) and BMQ Necessity subscale scores (p=0.003) were reported at all time-points. There was a statistically significant improvement in both systolic (SBP) (p<0.01) and diastolic BP (DBP) (p=0.03) three-months post-intervention. At baseline, 31% of participants had SBP at or below the UK target; however, at three-month follow-up, 59% were at or below the UK target.
Discussion/Conclusion
ViSTA-BP was considered a feasible researcher-facilitated intervention in this CP setting. Improvements seen in blood pressure control, patients’ understanding of hypertension, and perceptions of utility and necessity of treatment highlight the potential for the ViSTA-BP intervention to help reduce cardiovascular risk in the future. While preliminary analysis shows promise, further adequately powered research studies are necessary to evaluate future ViSTA-BP impact.
References
1. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-237. doi:10.1038/s41581-019-0244-2
2. Vrijens B, Antoniou S, Burnier M, de la Sierra A, Volpe M. Current situation of medication adherence in hypertension. Front Pharmacol. 2017;8. doi:10.3389/fphar.2017.00100
3. Gadkari AS, McHorney CA. Unintentional non-adherence to chronic prescription medications: how unintentional is it really? BMC Health Serv Res. 2012;12(1):98. doi:10.1186/1472-6963-12-98
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Affiliation(s)
- S Brown
- School of Sport and Health Sciences, Cardiff Metropolitan University
| | - B McDonnell
- School of Sport and Health Sciences, Cardiff Metropolitan University
| | - D McRae
- Cwm Taf Morgannwg University Health Board
| | - B Hallingberg
- School of Sport and Health Sciences, Cardiff Metropolitan University
| | - P Angel
- School of Technologies, Cardiff Metropolitan University
| | - I Khan
- School of Technologies, Cardiff Metropolitan University
| | - D H James
- School of Sport and Health Sciences, Cardiff Metropolitan University
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O'Dwyer V, Russell NM, McDonnell B, Sharkey L, Mulcahy C, Higgins MF. Antenatal prediction of fetal macrosomia in pregnancies affected by maternal pre-gestational diabetes. J Matern Fetal Neonatal Med 2021; 35:7412-7416. [PMID: 34229553 DOI: 10.1080/14767058.2021.1949447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS Higher rates of fetal macrosomia may occur in infants of women with pre-gestational diabetes compared with non-diabetic controls. Antenatal predication of fetal macrosomia remains challenging. Ultrasound over-estimated fetal weight could result in over-classification of fetuses as macrosomic with corresponding inappropriate clinical interventions. Previously we had studied a measurement - the anterior abdominal wall measurement (AAW) - to predict fetal macrosomia in fetal estimation of weight. The purpose of the study was to study whether specific third trimester ultrasound measurements with measures of glycaemic control (HbA1c) predicted macrosomia in babies born to women with pre-gestational diabetes. In particular, a new variant of this measurement (fetal anterior abdominal wall thickness (AAW), abdominal circumference (AC) ratio: AAW:AC) was investigated. METHODS This was a prospective cohort study in a tertiary referral maternity hospital. Serial growth scans including measurement of AAW and AC: AAW ratio was performed at 30, 33- and 36-weeks' gestation. Birth-weight data was collected, and macrosomia was defined as >90th centile based on gestational age and gender of the baby. Serial HbA1c as measured at the first antenatal visit, 14, 20- and 36-weeks' gestation were reported for this study. RESULTS Of the 416 pregnancies analyzed, mean maternal age was 33.3 years. One in five women were primigravida's. The mean birthweight was 3548 g (+/- 581 g), of which 142 (34%) babies were classified as macrosomic. The median gestational age at delivery was 383 weeks (314 - 402 weeks). There were 37 (9%) babies born preterm at <37 weeks' gestation. Mean AC measurements in fetuses that would be born with macrosomia compared with those with a non-macrosomic birth weight were 282 mm vs. 266 mm at 30 weeks, 318.3 mm vs. 297 mm at 33 weeks and 350 mm vs. 325 mm at 36 weeks' gestation (all p < .001). Mean AAW measurements in macrosomic fetuses compared with normal size fetuses were 3.7 mm vs. 3.3 mm at 30 weeks, 4.9 mm vs 4.3 mm at 33 weeks and 5.9 mm vs. 5.3 mm at 36 weeks' gestation (all p < .001). The mean AC: AAW was 0.01 for both normal and macrosomic fetuses at 30 weeks. There was no clinical or statistical difference in AC:AAW ratios between non-macrosomic and macrosomic infants. Binary logistic regression showed that AC at 36 weeks was most predictive of macrosomia (76.5%), followed by AAW at 30 weeks (68.5%). Using a combination of HbA1c booking, 14, 20, 36 weeks and AAW 30, 33, 36 weeks and AC 30, 33, 36 weeks predicted macrosomia in 80.9%. The ratio of AC: AAW did not act as a useful antenatal clinical predictor of macrosomia at birth. CONCLUSIONS Abdominal circumference at 36 weeks was the single best predictor of fetal macrosomia. A combined model of HbA1c, AC and AAW was the best antenatal predictor of macrosomia, with intriguing clinical possibilities in the possible prevention of maternal and fetal complications of macrosomia.
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Affiliation(s)
- V O'Dwyer
- Obstetrics and Gynecology, National Maternity Hospital, Dublin, Ireland
| | - N M Russell
- Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - B McDonnell
- UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - L Sharkey
- UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - C Mulcahy
- Midwifery, National Maternity Hospital, Dublin, Ireland
| | - M F Higgins
- Obstetrics and Gynecology, National Maternity Hospital, Dublin, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Stöhr E, Ji R, Akiyama K, Castagna F, Pinsino A, Cockcroft J, Uriel N, Yuzefpolskaya M, Garan R, Topkara V, Takayama H, Takeda K, Naka Y, Joshua W, McDonnell B, Colombo P. HM3 Patients Do Not Have an Increased Pulsatility in Large, Muscular or Microcirculatory Arteries. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1051] [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: 10/24/2022] Open
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Pinsino A, Mondellini G, Castagna F, Gaudig A, Yuzefpolskaya M, Uriel N, Sayer G, Takeda K, Naka Y, Cockcroft J, Stohr E, McDonnell B, Colombo P. Estimation of Mean Arterial Pressure Using Doppler and Pump Parameters in HeartMate 3 Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ji R, Stohr E, Akiyama K, Amlani A, Mondellini G, Castagna F, Pinsino A, Cockcroft J, Yuzefpolskaya M, Topkara V, Takayama H, Takeda K, Naka Y, Uriel N, Colombo P, McDonnell B, Willey J. Assessment of Cerebrovascular Reserve in the Heart Failure Patients Supported with the HeartMate3. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.945] [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: 10/24/2022] Open
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Buchanan C, Kanwar M, Cockcroft JR, McDonnell B, Stöhr EJ, Cornwell WK. Bionic women and men - Part 4: Cardiovascular, cerebrovascular and exercise responses among patients supported with left ventricular assist devices. Exp Physiol 2020; 105:763-766. [PMID: 32105385 DOI: 10.1113/ep088325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/26/2020] [Indexed: 01/08/2023]
Abstract
NEW FINDINGS LVAD patients are predisposed to hypertension which may increase the risk of stroke. Hypertension may result from markedly elevated levels of sympathetic nerve activity, which occurs through a baroreceptor-mediated pathway in response to chronic exposure to a non-physiologic (and reduced) pulse. Cerebral autoregulatory processes appear to be preserved in the absence of a physiologic pulse. Nevertheless, the rate of ischemic/embolic and hemorrhagic stroke is unacceptably high and is a major cause of morbidity and mortality in these patients. Despite normalization of a resting cardiac output, LVAD patients suffer from persistent, severe reductions in functional capacity. ABSTRACT Current generation left ventricular assist devices (LVADs) have led to significant improvements in survival compared to medical therapy alone, when used for management of patients with advanced heart failure. However, there are a number of side-effects associated with LVAD use, including hypertension, gastrointestinal bleeding, stroke, as well as persistent and severe limitations in functional capacity despite normalization of a resting cardiac output. These issues are, in large part, related to chronic exposure to a non-physiologic pulse, which contributes to a hyperadrenergic environment characterized by markedly elevated levels of sympathetic nerve activity through a baroreceptor-mediated pathway. In addition, these machines are unable to participate in, or contribute to, normal cardiovascular/autonomic reflexes that attempt to modulate flow through the body. Efforts to advance device technology and develop biologically sensitive devices may resolve these issues, and lead to further improvements in quality-of-life, functional capacity, and ultimately, survival, for the patients they support.
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Affiliation(s)
- Cullen Buchanan
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Manreet Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA, USA
| | - John R Cockcroft
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK
| | - Barry McDonnell
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK
| | - Eric J Stöhr
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK.,Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, NY, USA
| | - William K Cornwell
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Wassertheurer S, Protogerou A, Sharman J, Rodilla Sala E, Jankowski P, Muiesan ML, Giannattasio C, Hametner B, Pascual JM, Zweiker R, Argyris A, Paini A, Wilkinson I, Czarnecka D, Salvetti M, Maloberti A, McEniery C, Li Y, Nemcsik J, Pucci G, Ablasser C, Blacher J, Valleé A, de la Sierra A, Zhang Y, Ji H, McDonnell B, Mota M, Paiva A, Brandao A, Weber T. P34 24-Hour Ambulatory Brachial Versus Aortic Systolic Blood Pressure: Relationship with Left Ventricular Mass Significantly Differs. Pooled Results from the International 24 Hour Aortic Blood Pressure Consortium (i24ABC). Artery Res 2020. [DOI: 10.2991/artres.k.191224.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Brown C, Al Shezawi M, Watkeys L, Munnery M, Pugh C, Stöhr E, McDonnell B. P59 Marked Differences in Cerebral Haemodynamics Obtained with Transcranial Doppler vs. 2-D Angle-corrected Ultrasound. Artery Res 2020. [DOI: 10.2991/artres.k.191224.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Al Shezawi M, Munnery M, Cockcroft J, Watkeys L, Stohr E, Gale N, McDonnell B. P80 Predictors of Middle Cerebral Artery Pulsatility Index in Chronic Obstructive Pulmonary Disease and Healthy Controls; Data from the ACRADE Study. Artery Res 2020. [DOI: 10.2991/artres.k.191224.110] [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: 10/31/2022] Open
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10
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Yu S, McDonnell B, Maki-Petaja K, Cockcroft J, Wilkinson I, McEniery C. 5.3 Sex Differences in Blood Pressure in Young Adults: is it all About Body Size? Artery Res 2020. [DOI: 10.2991/artres.k.191224.032] [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: 10/31/2022] Open
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11
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Ji R, Akiyama K, Castagna F, Pinsino A, Cockcroft J, Yuzefpolskaya M, Garan A, Topkara V, Pineda M, Takayama H, Takeda K, Naka Y, Colombo P, McDonnell B, Stöhr E, Willey J. Metabolic Vasoreactivity in the Middle Cerebral Artery of Heart Failure Patients with and without Continuous-Flow Left Ventricular Support. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.576] [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: 12/01/2022] Open
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Pinsino A, Castagna F, Zuver AM, Royzman EA, Nasiri M, Stöhr EJ, Cagliostro B, McDonnell B, Cockcroft JR, Garan AR, Topkara VK, Schulze PC, Takeda K, Takayama H, Naka Y, Demmer RT, Willey JZ, Yuzefpolskaya M, Colombo PC. Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device. J Heart Lung Transplant 2018; 38:396-405. [PMID: 30559034 DOI: 10.1016/j.healun.2018.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/09/2018] [Revised: 10/06/2018] [Accepted: 11/09/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. METHODS We retrospectively studied 220 HMII patients. Serial outpatient BP measurements were averaged. Patients were categorized by: (1) mean arterial pressure (MAP), high (>90 mm Hg) vs intermediate (80 mm Hg ≤ MAP ≤ 90 mm Hg) vs low (<80 mm Hg); (2) systolic BP (SBP), high (≥101 mm Hg, median) vs low; and (3) pulse pressure (PP), high (≥22 mm Hg, median) vs low. To assess visit-to-visit BP variability, patients were divided in quartiles of standard deviation of MAP and SBP. The primary end-point was the composite of stroke or suspected pump thrombosis. RESULTS The risk for the primary end-point was increased in the high MAP group (adjusted hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.49 to 5.05, vs intermediate MAP; and 6.73, 1.9 to 23.9, vs low MAP). MAP had higher predictive value for the primary end-point compared with SBP (p = 0.05). Patients with high SBP had a higher rate of stroke (HR 2.8, 95% CI 1.09 to 7.17, vs low SBP). The combination of high SBP and low PP was associated with the highest risk for stroke. The lowest quartile of visit-to-visit MAP variability was associated with the highest risk for the primary end-point. CONCLUSIONS Elevated outpatient BP is associated with increased risk for stroke or suspected pump thrombosis in HMII recipients. Reduced PP and low visit-to-visit BP variability may confer additional risk.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Francesco Castagna
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA; Department of Medicine, Yale New Haven Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Amelia M Zuver
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Eugene A Royzman
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Mojdeh Nasiri
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Eric J Stöhr
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA; Cardiff Metropolitan University, Cardiff, UK
| | - Barbara Cagliostro
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | | | - John R Cockcroft
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - A Reshad Garan
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - P Christian Schulze
- Department of Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich Schiller University Jena, University Hospital Jena, Jena, Germany
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Joshua Z Willey
- Department of Neurology, Columbia University, New York, New York, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
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Ennis S, McGregor G, Shave R, McDonnell B, Thompson A, Banerjee P, Jones H. Low frequency electrical muscle stimulation and endothelial function in advanced heart failure patients. ESC Heart Fail 2018; 5:727-731. [PMID: 29971969 PMCID: PMC6073028 DOI: 10.1002/ehf2.12293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/18/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022] Open
Abstract
Aim Obtain initial estimates of the change in brachial artery endothelial function and maximal oxygen uptake (VO2peak) with 8 weeks of low‐frequency electrical muscle stimulation (LF‐EMS) or sham in patients with advanced chronic heart failure. Methods and results Using a double blind, randomized design, 35 patients with chronic heart failure (New York Heart Association class III–IV) were assigned to 8 weeks (5 × 60 min per week) of either LF‐EMS (4 Hz, continuous) or sham (skin level stimulation only) of the quadriceps and hamstrings muscles. Four of the five sessions were at home and one under supervision. Ultrasound images of resting brachial artery diameter and post 5 min occlusion to determine flow‐mediated dilation (FMD), a marker of vascular function and peak oxygen uptake (VO2peak) during cardiopulmonary exercise test, were measured before and after LF‐EMS (n = 20) and sham (n = 15) interventions. FMD improved by 2.56% (95% confidence interval: 0.69 to 3.80) with LF‐EMS compared with sham (P = 0.07). There were no notable changes in VO2peak. Conclusions Improvements in FMD with LF‐EMS may have a clinically meaningful effect as higher FMD is associated with better prognosis. This is a preliminary finding, and a larger trial is warranted.
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Affiliation(s)
- Stuart Ennis
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Cardiff Metropolitan University, Cardiff, UK
| | - Gordon McGregor
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,University of Coventry, Coventry, UK
| | | | | | | | - Prithwish Banerjee
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,University of Warwick, Coventry, UK.,University of Coventry, Coventry, UK
| | - Helen Jones
- Liverpool John Moores University, Liverpool, UK
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Avery LB, Wade J, Wang M, Tam A, King A, Piche-Nicholas N, Kavosi MS, Penn S, Cirelli D, Kurz JC, Zhang M, Cunningham O, Jones R, Fennell BJ, McDonnell B, Sakorafas P, Apgar J, Finlay WJ, Lin L, Bloom L, O'Hara DM. Establishing in vitro in vivo correlations to screen monoclonal antibodies for physicochemical properties related to favorable human pharmacokinetics. MAbs 2018; 10:244-255. [PMID: 29271699 DOI: 10.1080/19420862.2017.1417718] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 12/21/2022] Open
Abstract
Implementation of in vitro assays that correlate with in vivo human pharmacokinetics (PK) would provide desirable preclinical tools for the early selection of therapeutic monoclonal antibody (mAb) candidates with minimal non-target-related PK risk. Use of these tools minimizes the likelihood that mAbs with unfavorable PK would be advanced into costly preclinical and clinical development. In total, 42 mAbs varying in isotype and soluble versus membrane targets were tested in in vitro and in vivo studies. MAb physicochemical properties were assessed by measuring non-specific interactions (DNA- and insulin-binding ELISA), self-association (affinity-capture self-interaction nanoparticle spectroscopy) and binding to matrix-immobilized human FcRn (surface plasmon resonance and column chromatography). The range of scores obtained from each in vitro assay trended well with in vivo clearance (CL) using both human FcRn transgenic (Tg32) mouse allometrically projected human CL and observed human CL, where mAbs with high in vitro scores resulted in rapid CL in vivo. Establishing a threshold value for mAb CL in human of 0.32 mL/hr/kg enabled refinement of thresholds for each in vitro assay parameter, and using a combinatorial triage approach enabled the successful differentiation of mAbs at high risk for rapid CL (unfavorable PK) from those with low risk (favorable PK), which allowed mAbs requiring further characterization to be identified. Correlating in vitro parameters with in vivo human CL resulted in a set of in vitro tools for use in early testing that would enable selection of mAbs with the greatest likelihood of success in the clinic, allowing costly late-stage failures related to an inadequate exposure profile, toxicity or lack of efficacy to be avoided.
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Affiliation(s)
| | - Jason Wade
- b BioMedicine Design, Pfizer Inc. , Cambridge , MA , USA
| | - Mengmeng Wang
- a BioMedicine Design, Pfizer Inc. , Andover , MA , USA
| | - Amy Tam
- b BioMedicine Design, Pfizer Inc. , Cambridge , MA , USA
| | - Amy King
- b BioMedicine Design, Pfizer Inc. , Cambridge , MA , USA
| | | | | | - Steve Penn
- a BioMedicine Design, Pfizer Inc. , Andover , MA , USA.,c Medicine Design, Pfizer Inc. , Cambridge , MA , USA
| | - David Cirelli
- d Pharmaceutical Sciences, Pfizer Inc. , Andover , MA , USA
| | | | - Minlei Zhang
- a BioMedicine Design, Pfizer Inc. , Andover , MA , USA
| | | | - Rhys Jones
- b BioMedicine Design, Pfizer Inc. , Cambridge , MA , USA.,f Currently Medicine Design, Pfizer Inc. , La Jolla , CA , USA
| | | | | | - Paul Sakorafas
- d Pharmaceutical Sciences, Pfizer Inc. , Andover , MA , USA
| | - James Apgar
- b BioMedicine Design, Pfizer Inc. , Cambridge , MA , USA
| | - William J Finlay
- e Biomedicine Design, Pfizer Inc. , Dublin , Ireland.,g Currently CodeBase , Edinburgh , UK
| | - Laura Lin
- b BioMedicine Design, Pfizer Inc. , Cambridge , MA , USA
| | - Laird Bloom
- b BioMedicine Design, Pfizer Inc. , Cambridge , MA , USA
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Al Shezawi M, Cockcroft J, Munnery M, Watkeys L, Gale N, McDonnell B. P93 RELATIONSHIP BETWEEN AORTIC PULSE WAVE VELOCITY AND MID CEREBRAL ARTERY PULSATILITY INDEX IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE; PILOT DATA FROM THE ARCADE STUDY. Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.146] [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: 10/27/2022] Open
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16
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Nardin C, Maki-Petaja K, Yasmin Y, McDonnell B, Cockcroft JR, Wilkinson IB, McEniery CM. P116 CARDIAC OUTPUT IS INCREASED IN YOUNG PEOPLE WITH ELEVATED BP. Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.169] [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: 10/27/2022] Open
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Castagna F, Pinsino A, Stöhr E, McDonnell B, Yuzefpolskaya M, Flannery M, Brunjes D, Akter N, Te-Frey R, Pineda M, Royzman E, Topkara V, Garan A, Takayama H, Takeda K, Naka Y, Cockcroft J, Colombo P. Circadian Variation of Blood Pressure and Hemodynamics in Outpatients with Heart Mate II. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.209] [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: 10/19/2022] Open
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Pinsino A, Castagna F, Stöhr E, McDonnell B, Yuzefpolskaya M, Clemons A, Tiburcio M, Pineda M, Ross K, Topkara V, Garan A, Takayama H, Takeda K, Naka Y, Cockcroft J, Colombo P. Circadian Variation in Hemodynamics and Device Parameters in HeartMate II Patients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Stöhr E, Castagna F, Pearson J, Watkeys L, Trocio S, Zatvarska O, Crimmins T, Pinsino A, Colombo P, Yuzefpolskaya M, Garan R, Topkara V, Takayama H, Takeda K, Naka Y, Cockcroft J, Willey J, McDonnell B. 4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES. Artery Res 2017. [DOI: 10.1016/j.artres.2017.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Cunningham-Sabo L, Baker S, McDonnell B, Clifford J, Lohse B, Smith S. Challenges and Opportunities for Integrating Cooking Experiences into EFNEP and SNAP-Ed Nutrition Education for Children and Youth. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Namasivayam M, McEniery C, Wilkinson I, McDonnell B, Cockroft J, Hayward C, Feneley M, Adji A, O’Rourke M. Changes in Large Arterial Function and Vascular Ventricular Interaction Predispose to Myocardial Ischaemia in Healthy Ageing Women more than Men: Ischaemic Predisposition Beyond the Coronary Artery Lumen. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Earley B, McDonnell B, O'Riordan EG. Effect of floor type on the performance, physiological and behavioural responses of finishing beef steers. Acta Vet Scand 2015; 57:73. [PMID: 26520781 PMCID: PMC4628257 DOI: 10.1186/s13028-015-0162-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study objective was to investigate the effect of bare concrete slats (Control), two types of mats [(Easyfix mats (mat 1) and Irish Custom Extruder mats (mat 2)] fitted on top of concrete slats, and wood-chip to simulate deep bedding (wood-chip placed on top of a plastic membrane overlying the concrete slats) on performance, physiological and behavioral responses of finishing beef steers. One-hundred and forty-four finishing steers (503 kg; standard deviation 51.8 kg) were randomly assigned according to their breed (124 Continental cross and 20 Holstein-Friesian) and body weight to one of four treatments for 148 days. All steers were subjected to the same weighing, blood sampling (jugular venipuncture), dirt and hoof scoring pre study (day 0) and on days 23, 45, 65, 86, 107, 128 and 148 of the study. Cameras were fitted over each pen for 72 h recording over five periods and subsequent 10 min sampling scans were analysed. RESULTS Live weight gain and carcass characteristics were similar among treatments. The number of lesions on the hooves of the animals was greater (P < 0.05) on mats 1 and 2 and wood-chip treatments compared with the animals on the slats. Dirt scores were similar for the mat and slat treatments while the wood-chip treatment had greater dirt scores. Animals housed on either slats or wood-chip had similar lying times. The percent of animals lying was greater for animals housed on mat 1 and mat 2 compared with those housed on concrete slats and wood chips. Physiological variables showed no significant difference among treatments. CONCLUSIONS In this exploratory study, the performance or welfare of steers was not adversely affected by slats, differing mat types or wood-chip as underfoot material.
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Affiliation(s)
- Bernadette Earley
- Animal and Bioscience Research Department, Animal and Grassland Research and Innovation Centre, Teagasc, Grange, Dunsany, Co. Meath, Ireland.
| | - Barry McDonnell
- Animal and Bioscience Research Department, Animal and Grassland Research and Innovation Centre, Teagasc, Grange, Dunsany, Co. Meath, Ireland.
- College of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Edward G O'Riordan
- Livestock Systems Research Department, Teagasc, Animal and Grassland Research and Innovation Centre, Grange, Dunsany, Co. Meath, Ireland.
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Retallick C, Whitcombe D, Davies B, McDonnell B, Munnery M, Cockcroft J, Williams S. Increased arterial stiffness is associated with overweight and obesity and low physical fitness in children. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.134] [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: 10/24/2022]
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Thomas* J, Chapman N, Watkeys L, Kearney M, King S, Stohr E, Cockcroft J, Munnery M, McEniery C, McDonnell B. P6.10 ALCOHOL INTAKE IS ASSOCIATED WITH 24-HOUR AORTIC BLOOD PRESSURE IN A YOUNG HEALTHY STUDENT COHORT. Artery Res 2015. [DOI: 10.1016/j.artres.2015.10.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Armstrong* M, Singh C, Watkeys L, Thekkemuriyil L, Tucker J, Marshall Z, Webb R, McDonnell B. P1.11 SOLUBLE IL-6 RECEPTOR CONCENTRATIONS ARE ASSOCIATED WITH AUGMENTATION INDEX IN HEALTHY YOUNG MALES. Artery Res 2015. [DOI: 10.1016/j.artres.2015.10.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pearson J, Schlader Z, Rivas E, Crandall C, McDonnell B. Inverse relationship between cutaneous vascular conductance and augmentation index after administration of nitroglycerin (1156.9). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1156.9] [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: 11/11/2022]
Affiliation(s)
- James Pearson
- School of Health Sciences Cardiff Metropolitan UniversityCardiffUnited Kingdom
| | - Zachary Schlader
- UT Southwestern Medical Center and Institute for Exercise and Environmental MedicineDallasTXUnited States
| | - Eric Rivas
- Texas Woman's UniversityDentonTXUnited States
- UT Southwestern Medical Center and Institute for Exercise and Environmental MedicineDallasTXUnited States
| | - Craig Crandall
- UT Southwestern Medical Center and Institute for Exercise and Environmental MedicineDallasTXUnited States
| | - Barry McDonnell
- School of Health Sciences Cardiff Metropolitan UniversityCardiffUnited Kingdom
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McEniery C, Cocks A, McDonnell B, Yasmin Y, Cockcroft J, Wilkinson I. P4.1 IMPACT OF AGE AND GENDER ON THE DETERMINANTS OF PULSE PRESSURE AND ISOLATED SYSTOLIC HYPERTENSION. Artery Res 2014. [DOI: 10.1016/j.artres.2014.09.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Softley I, Kier E, Cooke S, Bowes M, Watkeys L, Gale N, Cockcroft J, McDonnell B. P6.4 THE DIFFERENTIAL EFFECTS OF RESISTANCE TRAINING AND ENDURANCE TRAINING ON AUGMENTATION INDEX: A PILOT STUDY. Artery Res 2014. [DOI: 10.1016/j.artres.2014.09.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fennell BJ, McDonnell B, Tam ASP, Chang L, Steven J, Broadbent ID, Gao H, Kieras E, Alley J, Luxenberg D, Edmonds J, Fitz LJ, Miao W, Whitters MJ, Medley QG, Guo YJ, Darmanin-Sheehan A, Autin B, Shúilleabháin DN, Cummins E, King A, Krebs MRH, Grace C, Hickling TP, Boisvert A, Zhong X, McKenna M, Francis C, Olland S, Bloom L, Paulsen J, Somers W, Jensen A, Lin L, Finlay WJJ, Cunningham O. CDR-restricted engineering of native human scFvs creates highly stable and soluble bifunctional antibodies for subcutaneous delivery. MAbs 2013; 5:882-95. [PMID: 23995618 PMCID: PMC3896602 DOI: 10.4161/mabs.26201] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
While myriad molecular formats for bispecific antibodies have been examined to date, the simplest structures are often based on the scFv. Issues with stability and manufacturability in scFv-based bispecific molecules, however, have been a significant hindrance to their development, particularly for high-concentration, stable formulations that allow subcutaneous delivery. Our aim was to generate a tetravalent bispecific molecule targeting two inflammatory mediators for synergistic immune modulation. We focused on an scFv-Fc-scFv format, with a flexible (A4T)3 linker coupling an additional scFv to the C-terminus of an scFv-Fc. While one of the lead scFvs isolated directly from a naïve library was well-behaved and sufficiently potent, the parental anti-CXCL13 scFv 3B4 required optimization for affinity, stability, and cynomolgus ortholog cross-reactivity. To achieve this, we eschewed framework-based stabilizing mutations in favor of complementarity-determining region (CDR) mutagenesis and re-selection for simultaneous improvements in both affinity and thermal stability. Phage-displayed 3B4 CDR-mutant libraries were used in an aggressive "hammer-hug" selection strategy that incorporated thermal challenge, functional, and biophysical screening. This approach identified leads with improved stability and>18-fold, and 4,100-fold higher affinity for both human and cynomolgus CXCL13, respectively. Improvements were exclusively mediated through only 4 mutations in VL-CDR3. Lead scFvs were reformatted into scFv-Fc-scFvs and their biophysical properties ranked. Our final candidate could be formulated in a standard biopharmaceutical platform buffer at 100 mg/ml with<2% high molecular weight species present after 7 weeks at 4 °C and viscosity<15 cP. This workflow has facilitated the identification of a truly manufacturable scFv-based bispecific therapeutic suitable for subcutaneous administration.
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Affiliation(s)
- Brian J Fennell
- Pfizer; Global Biotherapeutics Technologies; Dublin, Ireland
| | - Barry McDonnell
- Pfizer; Global Biotherapeutics Technologies; Dublin, Ireland
| | - Amy Sze Pui Tam
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Lijun Chang
- Pfizer; Global Biotherapeutics Technologies, Foresterhill; Aberdeen, UK
| | - John Steven
- Pfizer; Global Biotherapeutics Technologies, Foresterhill; Aberdeen, UK
| | - Ian D Broadbent
- Pfizer; Global Biotherapeutics Technologies, Foresterhill; Aberdeen, UK
| | - Huilan Gao
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | | | | | | | | | | | | | | | | | - Yongjing J Guo
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | | | - Bénédicte Autin
- Pfizer; Global Biotherapeutics Technologies; Dublin, Ireland
| | | | - Emma Cummins
- Pfizer; Global Biotherapeutics Technologies; Dublin, Ireland
| | - Amy King
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Mark R H Krebs
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | | | | | - Angela Boisvert
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Xiaotian Zhong
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Matthew McKenna
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | | | - Stephane Olland
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Laird Bloom
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Janet Paulsen
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Will Somers
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Allan Jensen
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | - Laura Lin
- Pfizer; Global Biotherapeutics Technologies; Cambridge, MA USA
| | | | - Orla Cunningham
- Pfizer; Global Biotherapeutics Technologies; Dublin, Ireland
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Stöhr EJ, McDonnell B, Thompson J, Stone K, Bull T, Houston R, Cockcroft J, Shave R. Left ventricular mechanics in humans with high aerobic fitness: adaptation independent of structural remodelling, arterial haemodynamics and heart rate. J Physiol 2012; 590:2107-19. [PMID: 22431336 DOI: 10.1113/jphysiol.2012.227850] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [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] Open
Abstract
Individuals with high aerobic fitness have lower systolic left ventricular strain, rotation and twist (‘left ventricular (LV) mechanics’) at rest, suggesting a beneficial reduction in LV myofibre stress and more efficient systolic function. However, the mechanisms responsible for this functional adaptation are not known and the influence of aerobic fitness on LV mechanics during dynamic exercise has never been studied. We assessed LV mechanics, LV wall thickness and dimensions, central augmentation index (AIx), aortic pulse wave velocity (aPWV), blood pressure and heart rate in 28 males (age: 21±2 years SD) with a consistent physical activity level (no change>6 months). Individuals were examined at rest and during exercise (40% peak exercise capacity) and separated post hoc into a moderate and high aerobic fitness group (˙V(O2peak): 49 ± 5 and 63 ± 7ml kg−1 min−1, respectively, P <0.0001). At rest and during exercise, there were no significant differences in gross LVstructure, AIx, blood pressure or heart rate (P >0.05).However, for the same AIx, the high ˙V(O2peak) group had significantly lower LV apical rotation (P =0.002) and LV twist (P =0.003) while basal rotation and strain indices did not differ between groups (P >0.05).We conclude that young males with high aerobic fitness have lower LVapical rotation at rest and during submaximal exercise that can occur without changes in gross LV structure, arterial haemodynamics or heart rate. The findings suggest a previously unknown type of physiological adaptation of the left ventricle that may have important implications for exercise training in older individuals and patient populations in which exercise training has previously failed to show clear benefits for LV function.
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Earley B, McDonnell B, Murray M, Prendiville D, Crowe M. The effect of sea transport from Ireland to the Lebanon on inflammatory, adrenocortical, metabolic and behavioural responses of bulls. Res Vet Sci 2011; 91:454-64. [DOI: 10.1016/j.rvsc.2010.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/14/2010] [Accepted: 09/28/2010] [Indexed: 11/24/2022]
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Franklin ZJ, McDonnell B, Montgomery IA, Flatt PR, Irwin N. Dual modulation of GIP and glucagon action by the low molecular weight compound 4-hydroxybenzoic acid 2-bromobenzylidene hydrazide. Diabetes Obes Metab 2011; 13:742-9. [PMID: 21418501 DOI: 10.1111/j.1463-1326.2011.01401.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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] [Indexed: 11/29/2022]
Abstract
AIM The presence of functional gastric inhibitory polypeptide (GIP) receptors on adipocytes and knowledge that GIP plays a key role in fat deposition suggests a beneficial effect of GIP receptor antagonism in obesity and insulin resistance. GIP receptor antagonists studied to date are peptidic GIP analogues that must be administered by injection. METHODS The present study has examined in vitro and in vivo metabolic actions of a low molecular weight GIP receptor modulator 4-hydroxybenzoic acid 2-bromobenzylidene hydrazide (4H2BH), suitable for oral administration. RESULTS 4H2BH alone had no significant effect on cAMP production or insulin secretion from BRIN-BD11 cells. However, 4H2BH significantly inhibited GIP-mediated cAMP production and insulin secretion in vitro. 4H2BH also suppressed (p < 0.05 to p < 0.001) glucagon-induced elevations of cAMP generation and insulin secretion in BRIN-BD11 cells. However, 4H2BH had no effect on glucagon-like peptide-1 (GLP-1) mediated insulinotropic actions. Administration of 4H2BH to mice in combination with glucose and GIP significantly annulled the glucose-lowering actions of GIP. In agreement with this, 4H2BH completely annulled GIP-mediated insulin secretion. Combined injection of 4H2BH with glucagon also partially (p < 0.05 to p < 0.001) impaired glucagon-induced elevations in blood glucose and plasma insulin. 4H2BH had no effect on blood glucose or insulin levels when administered alone. CONCLUSION These results indicate that 4H2BH has a dual effect of inhibiting GIP and glucagon-mediated biological actions. Given that hyperglucagonaemia is also a cardinal feature of type 2 diabetes, 4H2BH and related low molecular weight compounds appear worthy of further evaluation for therapeutic potential in obesity diabetes.
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Affiliation(s)
- Z J Franklin
- SAAD Centre for Pharmacy and Diabetes, School of Biomedical Sciences, University of Ulster, Coleraine, UK
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Gubala V, Lynam CCN, Nooney R, Hearty S, McDonnell B, Heydon K, O'Kennedy R, MacCraith BD, Williams DE. Kinetics of immunoassays with particles as labels: effect of antibody coupling using dendrimers as linkers. Analyst 2011; 136:2533-41. [PMID: 21541412 DOI: 10.1039/c1an15017k] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In this article, we report on poly(amidoamine) dendrimers (PAMAM) as coupling agents for recombinant single-chain (ScFv) antibodies to nanoparticle (NP) labels, for use in immunoassay. We present a simple theory for the kinetics of particle capture onto a surface by means of an antibody-antigen reaction, in which the important parameter is the fraction of the particle surface that is active for reaction. We describe how increasing the generation number of the linking dendrimers significantly increased the fraction of the NP surface that is active for antigen binding and consequently also increased the assay kinetic rates. Use of dendrimers for conjugation of the NP to the antibody resulted in a significantly higher surface coverage of active antibody, in comparison with mono-valent linker chemistry. As a direct consequence, the increase in effective avidity significantly out-weighed any effect of a decreased diffusion coefficient due to the NP, when compared to that of a molecular dye-labelled antibody. The signal to noise ratio of the G4.5 dendrimer-sensitised nanoparticles out-performed the dye-labelled antibody by approximately four-fold. Particle aggregation experiments with the multi-valent antigen CRP demonstrated reaction-limited aggregation whose rate increased significantly with increasing generation number of the dendrimer linker.
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Affiliation(s)
- Vladimir Gubala
- Biomedical Diagnostics Institute Dublin City University, Glasnevin, Ireland.
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McDonnell B, Hearty S, Finlay WJJ, O'Kennedy R. A high-affinity recombinant antibody permits rapid and sensitive direct detection of myeloperoxidase. Anal Biochem 2010; 410:1-6. [PMID: 20920456 DOI: 10.1016/j.ab.2010.09.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 09/15/2010] [Accepted: 09/27/2010] [Indexed: 11/29/2022]
Abstract
Over the past 10 years, a growing field of research supporting the value of myeloperoxidase (MPO) as a prognostic indicator in acute cardiac pathophysiologies has emerged. The availability of a rapid and disposable MPO detection platform would enable research clinicians to more readily assess MPO indications for guiding therapy and also facilitate clinicians at the patient interface to readily adopt MPO testing and potentially drive more informed prognoses. Here we describe the isolation of a high-affinity avian MPO-specific recombinant antibody panel using phage display. Rapid isolation of a suitable single-chain variable fragment (scFv) antibody was facilitated using a surface plasmon resonance (SPR)-based "off-rate ranking" screening process. The selected scFv was then successfully incorporated into a rapid, simple, and sensitive one-step lateral flow immunoassay (LFIA) for the detection of MPO. This "one-step" feature of the developed assay was made possible by the scFv's strong affinity for MPO, obviating the need for sandwich signal enhancement steps. The assay's rapid performance was also further enhanced by exploiting the intrinsic enzymatic properties of MPO in its final detection. Use of the optimized LFIA facilitated the sensitive detection of MPO in MPO-depleted serum within clinically relevant reference ranges.
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Affiliation(s)
- Barry McDonnell
- Biomedical Diagnostics Institute (BDI), Dublin City University, Dublin 9, Ireland
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McEniery C, Miles K, McDonnell B, Yasmin Y, Cockcroft J, Wilkinson I. HYPERTENSION IN NORMAL-WEIGHT VERSUS OBESE INDIVIDUALS IS ASSOCIATED WITH DIFFERENT HAEMODYNAMIC MECHANISMS: PP.8.311. J Hypertens 2010. [DOI: 10.1097/01.hjh.0000378635.05343.d7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Molloy ES, Morgan MP, Doherty GA, McDonnell B, O'Byrne J, Fitzgerald DJ, McCarthy GM. Microsomal prostaglandin E2 synthase 1 expression in basic calcium phosphate crystal-stimulated fibroblasts: role of prostaglandin E2 and the EP4 receptor. Osteoarthritis Cartilage 2009; 17:686-92. [PMID: 19010065 DOI: 10.1016/j.joca.2008.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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] [Received: 04/04/2008] [Accepted: 09/30/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Basic calcium phosphate (BCP) crystals have been implicated in the pathogenesis of osteoarthritis (OA), in part because of their ability to upregulate cyclooxygenase and prostaglandin E(2) (PGE(2)) production. The aim of this work was to investigate the expression of terminal PGE(2) synthases and PGE(2) receptors (EP) in BCP crystal-stimulated fibroblasts. METHODS Cultured fibroblasts were stimulated with BCP crystals in vitro. mRNA expression was measured by real-time polymerase chain reaction, and protein production by western blotting. RESULTS Basal expression of microsomal prostaglandin E(2) synthase 1 (mPGES1) in osteoarthritic synovial fibroblasts (OASF) was found to be 30-fold higher than in human foreskin fibroblasts (HFF). BCP crystals increased mPGES1 expression fourfold in HFF, but not in OASF. EP4 expression was downregulated twofold by BCP crystals in OASF, but not in HFF. Exogenous PGE(2) also downregulated EP4 expression; this effect was blocked by co-administration of L-161,982, a selective EP4 antagonist. While administration of exogenous PGE(2) significantly upregulated mPGES1 expression in OASF, mPGES1 expression was threefold higher in the OASF treated with BCP crystals and PGE(2) as compared with OASF treated with PGE(2) alone. CONCLUSIONS The differing effects of BCP crystals on mPGES1 expression in HFF and OASF may be explained by BCP crystal-induced EP4 downregulation in OASF, likely mediated via PGE(2). These data underline the complexity of the pathways regulating PGE(2) synthesis and suggest the existence of a compensatory mechanism whereby mPGES1 expression can be diminished, potentially reducing the stimulus for further PGE(2) production.
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Affiliation(s)
- E S Molloy
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.
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McDonnell B, Hearty S, Leonard P, O'Kennedy R. Cardiac biomarkers and the case for point-of-care testing. Clin Biochem 2009; 42:549-61. [DOI: 10.1016/j.clinbiochem.2009.01.019] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 01/23/2009] [Accepted: 01/28/2009] [Indexed: 11/26/2022]
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Molloy ES, Morgan MP, Doherty GA, McDonnell B, Hilliard M, O'Byrne J, Fitzgerald DJ, McCarthy GM. Mechanism of basic calcium phosphate crystal-stimulated cyclo-oxygenase-1 up-regulation in osteoarthritic synovial fibroblasts. Rheumatology (Oxford) 2008; 47:965-71. [DOI: 10.1093/rheumatology/ken144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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McEniery CM, Yasmin, McDonnell B, Munnery M, Wallace SM, Rowe CV, Cockcroft JR, Wilkinson IB. Central pressure: variability and impact of cardiovascular risk factors: the Anglo-Cardiff Collaborative Trial II. Hypertension 2008; 51:1476-82. [PMID: 18426997 DOI: 10.1161/hypertensionaha.107.105445] [Citation(s) in RCA: 311] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pulse pressure varies throughout the arterial tree, resulting in a gradient between central and peripheral pressure. Factors such as age, heart rate, and height influence this gradient. However, the relative impact of cardiovascular risk factors and atheromatous disease on central pressure and the normal variation in central pressure in healthy individuals are unclear. Seated peripheral (brachial) and central (aortic) blood pressures were assessed, and the ratio between aortic and brachial pulse pressure (pulse pressure ratio, ie, 1/amplification) was calculated in healthy individuals, diabetic subjects, patients with cardiovascular disease, and in individuals with only 1 of the following: hypertension, hypercholesterolemia, or smoking. The age range was 18 to 101 years, and data from 10 613 individuals were analyzed. Compared with healthy individuals, pulse pressure ratio was significantly increased (ie, central systolic pressure was relatively higher) in individuals with risk factors or disease (P<0.01 for all of the comparisons). Although aging was associated with an increased pulse pressure ratio, there was still an average+/-SD difference between brachial and aortic systolic pressure of 11+/-4 and 8+/-3 mm Hg for men and women aged >80 years, respectively. Finally, stratifying individuals by brachial pressure revealed considerable overlap in aortic pressure, such that >70% of individuals with high-normal brachial pressure had similar aortic pressures as those with stage 1 hypertension. These data demonstrate that cardiovascular risk factors affect the pulse pressure ratio, and that central pressure cannot be reliably inferred from peripheral pressure. However, assessment of central pressure may improve the identification and management of patients with elevated cardiovascular risk.
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Affiliation(s)
- Carmel M McEniery
- Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital Box 110, Cambridge CB2 2QQ, United Kingdom.
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Molloy ES, Morgan MP, Doherty GA, McDonnell B, O'Byrne J, Fitzgerald DJ, McCarthy GM. Mechanism of basic calcium phosphate crystal-stimulated matrix metalloproteinase-13 expression by osteoarthritic synovial fibroblasts: inhibition by prostaglandin E2. Ann Rheum Dis 2008; 67:1773-9. [PMID: 18223264 DOI: 10.1136/ard.2007.079582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the mechanism of matrix metalloproteinase (MMP)-13 upregulation in osteoarthritic synovial fibroblasts (OASF) in response to stimulation with basic calcium phosphate (BCP) crystals and to investigate the effect of prostaglandin (PG)E2 on BCP crystal-stimulated MMP expression. METHODS Primary OASF were stimulated with BCP crystals; mRNA expression was measured by real-time reverse transcription-polymerase chain reaction and protein levels were assessed by Western blotting. RESULTS BCP crystals upregulated MMP-13 mRNA expression over 20-fold and increased MMP-13 protein production in OASF. BCP crystal-stimulated MMP-13 mRNA expression was blocked by inhibition of the extracellular regulated kinase (ERK1/2) and p38 mitogen activated protein kinase (MAPK) pathways and inhibition of the activation of nuclear factor kappaB. Addition of exogenous PGE2 downregulated BCP crystal-stimulated MMP-13 expression. In contrast, PGE2 upregulated, and had no effect, on BCP crystal stimulated MMP-3 and MMP-1 mRNA expression, respectively. These effects of PGE2 were diminished by L-161,982, a selective EP4 receptor antagonist, and mimicked by CAY10399, a selective EP2 receptor agonist, and forskolin, an adenylate cyclase activator. CONCLUSIONS These data suggest that BCP crystal induction of MMP-13 expression may involve the ERK1/2 and p38 MAPK pathways and activation of nuclear factor kappaB; this upregulation of MMP-13 may contribute to the accelerated cartilage breakdown in BCP crystal-associated osteoarthritis. PGE2 had contrasting effects on BCP crystal-stimulated MMP-3 and MMP-13 mRNA expression, mediated in an EP2/EP4/cAMP-dependent manner, suggesting that PGE2 may have beneficial as well as deleterious effects in BCP crystal-associated osteoarthritis.
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Affiliation(s)
- E S Molloy
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, National Orthopaedic Hospital, Dublin, Ireland.
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Leonard P, Säfsten P, Hearty S, McDonnell B, Finlay W, O'Kennedy R. High throughput ranking of recombinant avian scFv antibody fragments from crude lysates using the Biacore A100. J Immunol Methods 2007; 323:172-9. [PMID: 17532001 DOI: 10.1016/j.jim.2007.04.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [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: 01/26/2007] [Revised: 04/05/2007] [Accepted: 04/18/2007] [Indexed: 01/26/2023]
Abstract
Advances in molecular evolution strategies have made it possible to identify antibodies with exquisite specificities and also to fine-tune their biophysical properties for practically any specified application. Depending on the desired function, antibody/antigen interactions can be long-lived or short-lived and, therefore, particular attention is needed when seeking to identify antibodies with specific reaction-rate and affinity properties. Surface plasmon resonance (SPR) biosensors routinely generate sensitive and reliable kinetic data from antibody/antigen interactions for both therapeutic and diagnostic applications. However, many kinetic-based screening assays require rigorous sample preparation and purification prior to analysis. To ameliorate this problem, we developed a rapid and reliable assay for characterising recombinant scFv antibody fragments, directly from crude bacterial lysates. Ninety-six scFv antibodies derived from chickens immunised with C-reactive protein (CRP) were selected by phage display and evaluated using the Biacore A100 protein interaction array system. Antibodies were captured from crude bacterial extracts on the sensor chip surface and ranked based on the percentage of the complex left (% left) after dissociation in buffer. Kinetic rate constants (k(a) and k(d)) and affinity (K(D)) data were obtained for six clones that bound monomeric CRP across a broad affinity range (2.54 x 10(-8) to 3.53 x 10(-10) M). Using this assay format the A100 biosensor yielded high quality kinetic data, permitting the screening of nearly 400 antibody clones per day.
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Affiliation(s)
- Paul Leonard
- Biomedical Diagnostics Institute, Dublin City University, Dublin 9, Ireland
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Molloy ES, Morgan MP, McDonnell B, O'Byrne J, McCarthy GM. BCP crystals increase prostacyclin production and upregulate the prostacyclin receptor in OA synovial fibroblasts: potential effects on mPGES1 and MMP-13. Osteoarthritis Cartilage 2007; 15:414-20. [PMID: 17123841 DOI: 10.1016/j.joca.2006.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Accepted: 10/04/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the potential involvement of prostacyclin in basic calcium phosphate (BCP) crystal-induced responses in osteoarthritic synovial fibroblasts (OASF). METHODS OASF grown in culture were stimulated with BCP crystals. Prostacyclin production was measured by enzyme immunoassay. Expression of messenger RNA (mRNA) transcripts was assessed by real-time polymerase chain reaction (PCR). Expression of prostacyclin synthase (PGIS) and the prostacyclin (IP) receptor was measured. The effects of iloprost, a prostacyclin analogue, on expression of genes implicated in osteoarthritis such as microsomal prostaglandin E2 synthase 1 (mPGES1) and matrix metalloproteinases (MMPs) were also studied. FPT inhibitor II, a farnesyl transferase inhibitor, was used to antagonize iloprost-induced responses. RESULTS BCP crystal stimulation led to a five-fold increase in prostacyclin production in OASF compared to untreated cells. This induction was attenuated by cyclooxygenase (COX)-2 and COX-1 inhibition at 4 and 32h, respectively. PGIS and IP receptor transcripts were constitutively expressed in OASF. BCP crystals upregulated IP receptor expression two-fold. While iloprost diminished BCP crystal-stimulated IP receptor upregulation, the inhibitory effect of iloprost was blocked by the farnesyl transferase inhibitor. In addition, iloprost upregulated mPGES1 and downregulated MMP-13 expression in BCP crystal-stimulated OASF, effects that were not influenced by the farnesyl transferase inhibitor. CONCLUSIONS These data showed for the first time that BCP crystals can increase prostacyclin production and upregulate expression of the IP receptor in OASF. The potential of prostacyclin to influence BCP crystal-stimulated responses was supported by the effects of iloprost on the expression of the IP receptor, mPGES1 and MMP-13. These data demonstrate the potential involvement of prostacyclin in BCP crystal-associated osteoarthritis (OA) and suggest that inhibition of PG synthesis with non-steroidal anti-inflammatory drugs may have both deleterious and beneficial effects in BCP crystal-associated OA.
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Affiliation(s)
- E S Molloy
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons of Ireland, and National Orthopaedic Hospital, Dublin, Ireland.
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Smith JC, McDonnell B, Retallick C, McEniery C, Carey C, Davies JS, Barrett T, Cockcroft JR, Paisey R. Is arterial stiffening in Alström syndrome linked to the development of cardiomyopathy? Eur J Clin Invest 2007; 37:99-105. [PMID: 17217374 DOI: 10.1111/j.1365-2362.2007.01759.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Alström syndrome (AS) is a rare autosomal recessive condition characterized by retinal degeneration, childhood obesity, and severe insulin resistance. Dilated cardiomyopathy of unknown aetiology is a well-recognized and potentially lethal complication. The aim of this study was to investigate the relationship between vascular function, hyperinsulinaemia and cardiac performance in AS. MATERIALS AND METHODS Fifteen subjects with AS (mean age 21 years, range 10-35) were studied and compared with age-, sex-, and blood pressure-matched healthy controls. Large artery stiffness and wave reflections were assessed in both groups by measuring aortic and brachial pulse wave velocity (PWV) (carotid-femoral and carotid-radial) and augmentation index (AIX) (Sphygmocor). In AS subjects, left ventricular function was assessed by echocardiography and metabolic parameters including fasting insulin, glucose, lipids and brain natriuretic peptide were also measured. RESULTS Comparing AS subjects vs. controls (mean +/- SD), AIX was elevated in AS subjects (18 +/- 9% vs. 3 +/- 11%, P < 0.0001). No significant changes in brachial PWV (8.1 +/- 1.3 m s(-1) vs. 7.3 +/- 1.1 m s(-1), P = 0.14) or aortic PWV (6.5 +/- 1.1 m s(-1) vs. 6.0 +/- 1.0 m s(-1), P = 0.26) were observed. AS subjects were hyperinsulinaemic and had disturbances in lipid profiles relative to controls. No correlations were observed between vascular, metabolic and echocardiographic parameters. CONCLUSIONS In AS there are alterations in the shape of the central arterial pressure waveform associated with augmented aortic systolic pressure and indicative of increased wave reflection. Unfavourable central arterial haemodynamics in AS may contribute to the development of cardiomyopathy but other aetiological factors are probably involved.
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McDonnell B, So A, Bolton C, Munnery M, Williams S, Yasmin, Poole K, Evans W, McEniery C, Wilkinson I, Cockcroft J. P.069 OSTEOPOROSIS IS ASSOCIATED WITH INCREASED AORTIC PULSE WAVE VELOCITY. Artery Res 2007. [DOI: 10.1016/j.artres.2007.07.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Wallace S, McDonnell B, Munnery M, Maki-Petaja K, Cheriyan J, McEniery C, Hill S, Cockcroft J, Varty K, Wilkinson I. P.066 PERIPHERAL VASCULAR DISEASE IS ASSOCIATED WITH INCREASED AORTIC STIFFNESS. Artery Res 2007. [DOI: 10.1016/j.artres.2007.07.123] [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: 10/22/2022] Open
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McEniery CM, Wallace S, Mackenzie IS, McDonnell B, Newby DE, Cockcroft JR, Wilkinson IB. Endothelial function is associated with pulse pressure, pulse wave velocity, and augmentation index in healthy humans. Hypertension 2006; 48:602-8. [PMID: 16940223 DOI: 10.1161/01.hyp.0000239206.64270.5f] [Citation(s) in RCA: 283] [Impact Index Per Article: 15.7] [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: 12/15/2022]
Abstract
Arterial stiffness is an independent predictor of mortality and is regulated by a number of factors, including vascular smooth muscle tone. However, the relationship between endothelial function and definitive measures of arterial stiffness and wave reflections has not been described in healthy individuals. Therefore, we tested the hypothesis that endothelial function is inversely correlated with aortic pulse wave velocity (PWV), central pulse pressure, and augmentation index in healthy individuals. Peripheral and central pulse pressure and augmentation index were determined at rest, and global endothelial function was measured using pulse wave analysis and administration of sublingual nitroglycerin and inhaled albuterol. Aortic PWV was also determined at baseline in a subset of 89 subjects. In a separate group of subjects (n=89), aortic PWV was measured and brachial artery flow-mediated dilatation assessed as a measure of conduit artery endothelial function. Global endothelial function was significantly and inversely correlated with aortic PWV (r=-0.69; P<0.001), augmentation index (r=-0.59; P<0.001), and central (r=-0.34; P<0.001) and peripheral pulse pressure (r=-0.15; P=0.03). Moreover, there was a stronger correlation between central rather than peripheral pulse pressure. After adjusting for potential confounders, global endothelial function remained independently and inversely associated with aortic PWV and augmentation index. There was also a significant, inverse relationship between conduit artery endothelial function and aortic PWV (r=0.39, P<0.001), which remained independent after adjusting for confounding factors. In healthy individuals, a decline in endothelial function is associated with increased large artery stiffness, wave reflections, and central pulse pressure.
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Affiliation(s)
- Carmel M McEniery
- Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
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McEniery CM, O'Shaughnessy KM, Harnett P, Arshad A, Wallace S, Maki-Petaja K, McDonnell B, Ashby MJ, Brown J, Cockcroft JR, Wilkinson IB. Variation in the Human Matrix Metalloproteinase-9 Gene Is Associated With Arterial Stiffness in Healthy Individuals. Arterioscler Thromb Vasc Biol 2006; 26:1799-805. [PMID: 16709939 DOI: 10.1161/01.atv.0000227717.46157.32] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial stiffness is an important determinant of cardiovascular risk. Elastin is the main elastic component of the arterial wall and can be degraded by a number of enzymes including serine proteases and matrix metalloproteinases (MMPs). Serum MMP-9 levels correlate with arterial stiffness and predict cardiovascular risk. Polymorphisms in the MMP-9 gene are also associated with large artery function in subjects with coronary artery disease. Therefore, we investigated the influence of known MMP-9 (-1562C>T, R279Q) polymorphisms on arterial stiffness in a large cohort of healthy individuals (n=865). METHODS AND RESULTS Aortic pulse wave velocity (PWV) and augmentation index were assessed. Supine blood pressure, biochemical markers, MMP-9 levels, and serum elastase activity (SEA) were also determined. Genomic DNA was extracted and genotyping performed. Aortic PWV, serum MMP-9, and SEA were higher in carriers of the rare alleles for the -1562C>T and R279Q polymorphisms. These polymorphisms were also associated with aortic PWV after correction for other confounding factors. Stepwise regression models with known or likely determinants of arterial stiffness revealed that approximately 60% of the variability in aortic PWV was attributable to age, mean arterial pressure, and genetic variants (P<0.001). CONCLUSIONS We have demonstrated for the first time that aortic stiffness and elastase activity are influenced by MMP-9 gene polymorphisms. This suggests that the genetic variation in this protein may be involved in the process of large artery stiffening.
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McEniery CM, Wallace S, Maki-Petaja K, McDonnell B, Sharman JE, Retallick C, Franklin SS, Brown MJ, Lloyd RC, Cockcroft JR, Wilkinson IB. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension 2005; 46:221-6. [PMID: 15867140 DOI: 10.1161/01.hyp.0000165310.84801.e0] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.7] [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: 11/16/2022]
Abstract
Isolated systolic hypertension is a common condition in individuals aged older than 60 years. However, isolated systolic hypertension has also been described in young individuals, although the mechanisms are poorly understood. We hypothesized that in young adults, isolated systolic hypertension and essential hypertension have different hemodynamic mechanisms and the aim of this study was to test this hypothesis in a cohort of subjects from The ENIGMA Study. Peripheral and central blood pressure, aortic pulse wave velocity, cardiac output, stroke volume, and peripheral vascular resistance were determined in 1008 subjects, aged 17 to 27 years. Compared with normotensive subjects, those with isolated systolic hypertension had significantly higher peripheral, central, and mean blood pressure, aortic pulse wave velocity, cardiac output, and stroke volume (P<0.001 for all comparisons). However, there were no differences in pulse pressure amplification, heart rate, or peripheral vascular resistance between the two groups. Compared with subjects with essential hypertension, mean pressure, heart rate, and peripheral vascular resistance were all significantly lower in isolated systolic hypertensive subjects, but pulse pressure amplification, aortic pulse wave velocity, cardiac output, and stroke volume were higher (P<0.001 for all comparisons). We have demonstrated that in young adults, isolated systolic hypertension and essential hypertension arise from different hemodynamic mechanisms. Isolated systolic hypertension appears to result from an increased stroke volume and/or aortic stiffness, whereas the major hemodynamic abnormality underlying essential hypertension is an increased peripheral vascular resistance. Long-term follow-up of these individuals is now required to determine whether they are at increased risk compared with age-matched normotensive individuals.
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Affiliation(s)
- Carmel M McEniery
- Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
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Burd M, Humphreys H, Glynn G, Mitchell E, McDonald P, Johnson H, McDonnell B, Doyle D, Rossney A. Control and the prevention of methicillin-resistant Staphylococcus aureus in hospitals in Ireland: North/South Study of MRSA in Ireland 1999. J Hosp Infect 2003; 53:297-303. [PMID: 12660127 DOI: 10.1053/jhin.2002.1393] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [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: 11/11/2022]
Abstract
As part of an all-island survey of methicillin-resistant Staphylococcus aureus (MRSA) in the Republic of Ireland (the South), where there is a mixed public and private healthcare system, and Northern Ireland (the North), where the healthcare system is part of the UK National Health Service, a questionnaire was circulated to all participating hospitals on measures routinely taken to control MRSA. Response rates were 100% in the North and 89% in the South. Over 70% of hospitals screened particular groups of patients on admission to hospital. Ninety-five percent of hospitals in the North and 88% in the South attempted to eradicate MRSA from carriage sites. Most hospitals attempted to isolate or cohort positive patients. About a quarter of hospitals in both parts of Ireland screened new healthcare workers for the presence of MRSA. Terminal decontamination of the environment after the discharge of a patient positive for MRSA was the norm in over 90% of hospitals, however, 6% of hospitals in the South used inappropriate disinfectants for MRSA. All hospitals in the North, but a minority (41%) in the South, had written antibiotic prescribing policies, but only 65% of hospitals in the South had access to an infection control committee, acute hospitals having greater access than district hospitals. The prevention and control of spread of MRSA remains a major challenge in the North and in the South. Although most hospitals in the North and in the South implemented current recommended guidelines on the control of MRSA in hospitals, there was some variability that may be resource related. Policies need to be reviewed in the light of the changing epidemiology of MRSA.
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Affiliation(s)
- M Burd
- Midland Health Board, General Hospital, Tullamore, Co. Offaly, Ireland
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