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Delcroix M, Belge C, Maleux G, Godinas L. Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:840-850. [PMID: 37567250 DOI: 10.1055/s-0043-1770122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. The reasons why clots do not resorb are incompletely understood, but the result is partial or complete fibrothrombotic obstruction of pulmonary arteries. A secondary microvasculopathy aggravates the pulmonary hypertension (PH) as a consequence of high flow and shear stress in the nonoccluded arteries. The treatment of CTEPH has long been purely surgical, but many patients were inoperable because of inaccessible lesions or severe comorbidities. Alternatives were developed, including medical therapy and more recently balloon pulmonary angioplasty (BPA). Depending on the generation of the obstructed vessels, the treatment will be surgical, up to the (sub)segmental level, or by BPA for more distal vessels. PH drugs are used to treat the microvasculopathy. The current paper describes the therapeutic management of inoperable patients: the medical approach with PH drugs used in mono- or combination therapy; the proper use of anticoagulants in CTEPH; the technique, indications, and results at short- and long-term of BPA; the multimodal approach for inoperable patients combining PH drugs and BPA; and the effects of rehabilitation. It shows the importance of a multidisciplinary approach to the disease.
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Affiliation(s)
- Marion Delcroix
- Clinical Department of Respiratory Diseases, Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven-University of Leuven, University Hospitals of Leuven, Leuven, Belgium
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Belgium
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven-University of Leuven, University Hospitals of Leuven, Leuven, Belgium
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Belgium
| | - Geert Maleux
- Clinical Department of Radiology, University Hospitals of Leuven, Leuven, Belgium
| | - Laurent Godinas
- Clinical Department of Respiratory Diseases, Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven-University of Leuven, University Hospitals of Leuven, Leuven, Belgium
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Belgium
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Montani D, Eichstaedt CA, Belge C, Chung WK, Gräf S, Grünig E, Humbert M, Quarck R, Tenorio-Castano JA, Soubrier F, Trembath RC, Morrell NW. [Genetic counselling and testing in pulmonary arterial hypertension - A consensus statement on behalf of the International Consortium for Genetic Studies in PAH - French version]. Rev Mal Respir 2023; 40:838-852. [PMID: 37923650 DOI: 10.1016/j.rmr.2023.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 11/07/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease that can be caused by (likely) pathogenic germline genomic variants. In addition to the most prevalent disease gene, BMPR2 (bone morphogenetic protein receptor 2), several genes, some belonging to distinct functional classes, are also now known to predispose to the development of PAH. As a consequence, specialist and non-specialist clinicians and healthcare professionals are increasingly faced with a range of questions regarding the need for, approaches to and benefits/risks of genetic testing for PAH patients and/or related family members. We provide a consensus-based approach to recommendations for genetic counselling and assessment of current best practice for disease gene testing. We provide a framework and the type of information to be provided to patients and relatives through the process of genetic counselling, and describe the presently known disease causal genes to be analysed. Benefits of including molecular genetic testing within the management protocol of patients with PAH include the identification of individuals misclassified by other diagnostic approaches, the optimisation of phenotypic characterisation for aggregation of outcome data, including in clinical trials, and importantly through cascade screening, the detection of healthy causal variant carriers, to whom regular assessment should be offered.
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Affiliation(s)
- D Montani
- French Referral Center for Pulmonary Hypertension, Pulmonary Department, hôpital de Bicêtre, AP-HP, université Paris-Saclay, Le Kremlin-Bicêtre, France; Inserm UMR_S999, hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
| | - C A Eichstaedt
- Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Allemagne; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Allemagne; Laboratory for Molecular Diagnostics, Institute of Human Genetics, Heidelberg University, Heidelberg, Allemagne
| | - C Belge
- Department of Chronic Diseases & Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals, Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), University of Leuven, 3000 Leuven, Belgique
| | - W K Chung
- Department of Pediatrics, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, États-Unis
| | - S Gräf
- Department of Medicine, University of Cambridge, Heart and Lung Research Institute, Cambridge Biomedical Campus, Cambridge CB2 0BB, Royaume-Uni; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0PT, Royaume-Uni; NIHR BioResource, for Translational Research - Rare Diseases, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, Royaume-Uni
| | - E Grünig
- Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Allemagne; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Allemagne
| | - M Humbert
- French Referral Center for Pulmonary Hypertension, Pulmonary Department, hôpital de Bicêtre, AP-HP, université Paris-Saclay, Le Kremlin-Bicêtre, France; Inserm UMR_S999, hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - R Quarck
- Department of Chronic Diseases & Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals, Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), University of Leuven, 3000 Leuven, Belgique
| | - J A Tenorio-Castano
- INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario La Paz, Madrid, Espagne; CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Espagne; ITHACA, European Reference Network, Brussels, Belgique
| | - F Soubrier
- Département de génétique, Inserm UMR_S1166, AP-HP, hôpital Pitié-Salpêtrière, Institute for Cardio-metabolism and Nutrition (ICAN), Sorbonne université, Paris, France
| | - R C Trembath
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London SE1 9RT, Royaume-Uni
| | - N W Morrell
- Department of Medicine, University of Cambridge, Heart and Lung Research Institute, Cambridge Biomedical Campus, Cambridge CB2 0BB, Royaume-Uni; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0PT, Royaume-Uni
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Testelmans D, Papadopoulos D, Kalkanis A, Jacobs A, Van Hende F, Vandebotermet M, Belge C, Buyse B. Telemonitoring-guided ambulatory fixed CPAP titration versus ambulatory APAP titration in moderate obstructive sleep apnea: A non-inferiority randomized controlled trial. J Sleep Res 2023; 32:e13887. [PMID: 36944532 DOI: 10.1111/jsr.13887] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
The present study aimed to evaluate whether titration of fixed continuous positive airway pressure at home using telemonitoring produces patient outcomes equal to auto-adjusting positive airway pressure titration at home for patients with moderate obstructive sleep apnea. Patients were randomized with a 1:1 allocation ratio to receive either auto-adjusting positive airway pressure titration based on the median of the 95th percentile pressure across seven nights or fixed continuous positive airway pressure titration based on a fixed calculated pressure and specific adaptations after telemonitoring of device data after 3 and 7 nights. The results of the ambulatory titration were evaluated with in-laboratory polysomnography after 2 weeks. We hypothesized that fixed continuous positive airway pressure titration would be non-inferior to auto-adjusting positive airway pressure titration in respect to continuous positive airway pressure adherence at a 3-month follow-up. A non-inferiority margin of -0.75 hr was prespecified. One-hundred and four patients were randomly allocated to fixed continuous positive airway pressure (n = 52) and auto-adjusting positive airway pressure (n = 52) titration. The mean difference and the 95% confidence intervals in continuous positive airway pressure adherence after 3 months between the two arms were 0.80 (-0.08, 1.69) hr. The non-inferiority hypothesis was confirmed as the lower one-sided 97.5% confidence interval for the mean difference was above the prespecified margin. Patients in the fixed continuous positive airway pressure titration arm were titrated at significantly lower pressure level and had a significantly lower amount of average leaks compared with auto-adjusting positive airway pressure-titrated patients, while there was no difference in residual obstructive apnea-hypopnea index on polysomnography. Telemonitoring enables ambulatory continuous positive airway pressure titration with fixed pressure that is non-inferior to ambulatory titration with auto-adjusting pressure in patients with moderate obstructive sleep apnea.
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Affiliation(s)
- D Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - D Papadopoulos
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - A Kalkanis
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - A Jacobs
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - F Van Hende
- Department of Pneumology, AZ St-Dimpna, Geel, Belgium
| | | | - C Belge
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - B Buyse
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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Tielemans B, Wagenaar A, Belge C, Delcroix M, Quarck R. Pulmonary arterial hypertension drugs can partially restore altered angiogenic capacities in bmpr2-silenced human lung microvascular endothelial cells. Pulm Circ 2023; 13:e12293. [PMID: 37790139 PMCID: PMC10543474 DOI: 10.1002/pul2.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/31/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
Mutations in the bone morphogenetic protein receptor type 2 (bmpr2) gene and signaling pathway impairment are observed in heritable and idiopathic pulmonary arterial hypertension (PAH). In PAH, endothelial dysfunction is currently handled by drugs targeting the endothelin-1 (ET-1), nitric oxide (NO), and prostacyclin (PGI2) pathways. The role of angiogenesis in the disease process and the effect of PAH therapies on dysregulated angiogenesis remain inconclusive. We aim to investigate in vitro whether (i) bmpr2 silencing can impair angiogenic capacity of human lung microvascular endothelial cells (HLMVECs) and (ii) PAH therapies can restore them. The effects of macitentan (ET-1), tadalafil (NO), and selexipag (PGI2), on BMPRII pathway activation, endothelial barrier function, and angiogenesis were investigated in bmpr2-silenced HLMVECs. Stable bmpr2 silencing resulted in impaired migration and tube formation in vitro capacity. Inhibition of ET-1 pathway was able to partially restore tube formation in bmpr2-silenced HLMVECs, whereas none of the therapies was able to restore endothelial barrier function, no deleterious effects were observed. Our findings highlight the potential role of BMPRII signaling pathway in driving pulmonary endothelial cell angiogenesis. In addition, PAH drugs display limited effects on endothelial function when BMPRII is impaired, suggesting that innovative therapeutic strategies targeting BMPRII signaling are needed to better rescue endothelial dysfunction in PAH.
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Affiliation(s)
- Birger Tielemans
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA) & Biomedical MRI, Department of Imaging and PathologyUniversity of LeuvenLeuvenBelgium
| | - Allard Wagenaar
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA)University of LeuvenLeuvenBelgium
| | - Catharina Belge
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA) & Clinical Department of Respiratory Diseases, University HospitalsUniversity of LeuvenLeuvenBelgium
| | - Marion Delcroix
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA) & Clinical Department of Respiratory Diseases, University HospitalsUniversity of LeuvenLeuvenBelgium
| | - Rozenn Quarck
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA) & Clinical Department of Respiratory Diseases, University HospitalsUniversity of LeuvenLeuvenBelgium
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Swinnen K, Verstraete K, Baratto C, Hardy L, De Vos M, Topalovic M, Claessen G, Quarck R, Belge C, Vachiery JL, Janssens W, Delcroix M. Machine learning to differentiate pulmonary hypertension due to left heart disease from pulmonary arterial hypertension. ERJ Open Res 2023; 9:00229-2023. [PMID: 37727672 PMCID: PMC10505948 DOI: 10.1183/23120541.00229-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/04/2023] [Indexed: 09/21/2023] Open
Abstract
Background and aims Pulmonary hypertension due to left heart disease (PH-LHD) is the most frequent form of PH. As differential diagnosis with pulmonary arterial hypertension (PAH) has therapeutic implications, it is important to accurately and noninvasively differentiate PH-LHD from PAH before referral to PH centres. The aim was to develop and validate a machine learning (ML) model to improve prediction of PH-LHD in a population of PAH and PH-LHD patients. Methods Noninvasive PH-LHD predictors from 172 PAH and 172 PH-LHD patients from the PH centre database at the University Hospitals of Leuven (Leuven, Belgium) were used to develop an ML model. The Jacobs score was used as performance benchmark. The dataset was split into a training and test set (70:30) and the best model was selected after 10-fold cross-validation on the training dataset (n=240). The final model was externally validated using 165 patients (91 PAH, 74 PH-LHD) from Erasme Hospital (Brussels, Belgium). Results In the internal test dataset (n=104), a random forest-based model correctly diagnosed 70% of PH-LHD patients (sensitivity: n=35/50), with 100% positive predicted value, 78% negative predicted value and 100% specificity. The model outperformed the Jacobs score, which identified 18% (n=9/50) of the patients with PH-LHD without false positives. In external validation, the model had 64% sensitivity at 100% specificity, while the Jacobs score had a sensitivity of 3% for no false positives. Conclusions ML significantly improves the sensitivity of PH-LHD prediction at 100% specificity. Such a model may substantially reduce the number of patients referred for invasive diagnostics without missing PAH diagnoses.
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Affiliation(s)
- Katleen Swinnen
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
- These authors contributed equally
| | - Kenneth Verstraete
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
- STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
- These authors contributed equally
| | - Claudia Baratto
- Department of Cardiology, Ospedale San Luca IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Hardy
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Maarten De Vos
- STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Guido Claessen
- Department of Cardiology, University Hospitals of Leuven, Leuven, Belgium
| | - Rozenn Quarck
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, BREATHE, CHROMETA, KU Leuven, Leuven, Belgium
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, BREATHE, CHROMETA, KU Leuven, Leuven, Belgium
| | - Jean-Luc Vachiery
- Department of Cardiology, Ospedale San Luca IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Wim Janssens
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, BREATHE, CHROMETA, KU Leuven, Leuven, Belgium
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, BREATHE, CHROMETA, KU Leuven, Leuven, Belgium
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Van Genechten S, Meyns B, Godinas L, Maleux G, Everaerts S, Van Beersel D, Belge C, Weynand B, Delcroix M, Verbelen T. Anthracofibrosis mimicking chronic thromboembolic pulmonary hypertension. Pulm Circ 2023; 13:e12263. [PMID: 37427089 PMCID: PMC10323163 DOI: 10.1002/pul2.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/04/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023] Open
Abstract
We present the case of a 78-year-old female undergoing pulmonary endarterectomy (PEA) because of suspected chronic thromboembolic pulmonary hypertension (CTEPH). During surgery firm black masses were encountered in the aortopulmonary window and on the cranial part of the right pulmonary artery (PA). After PA arteriotomy we visualized intraluminal black firm stenosing plaques at the orifices of the three right and of the left lingular and lower lobar branches. Since no dissection plane could be obtained the procedure was discontinued. Subsequent bronchoscopy visualized a submucosal dark black-blue discoloration in both main bronchi. Pathological analysis revealed anthracofibrosis, which could be explained by biomass smoke exposure in the past. We are the first to provide intravascular pictures and pathologic images of this very rare entity. Moreover, we report stenoses at the orifices of the three right-sided lobar and of the left-sided lingular and lower lobe arteries, in contrast to three previous reports that report on single locations caused by extrinsic PA compression from lymphadenopathy. Our case, however, suggests extension of fibrosis with anthracotic pigment into the PA wall. We conclude that in the absence of a clear history of exposure to carbon smoke and with consequently no diagnostic bronchoscopy, anthracofibrosis of the lungs may mimic CTEPH not only by external compression but also by extension into pulmonary vascular structures. PEA-surgery should not be attempted in these cases.
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Affiliation(s)
| | - Bart Meyns
- Department of Cardiac SurgeryUniversity Hospitals LeuvenLeuvenBelgium
| | - Laurent Godinas
- Department of PneumologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Geert Maleux
- Department of RadiologyUniversity Hospitals LeuvenLeuvenBelgium
| | | | | | - Catharina Belge
- Department of PneumologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Birgit Weynand
- Department of PathologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Marion Delcroix
- Department of PneumologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Tom Verbelen
- Department of Cardiac SurgeryUniversity Hospitals LeuvenLeuvenBelgium
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Quarck R, Willems L, Tielemans B, Stoian L, Ronisz A, Wagenaar A, Perros F, Claessen G, Ciarka A, Godinas L, Belge C, Jacquemin M, Delcroix M. Impairment of Angiogenesis-Driven Clot Resolution Is a Key Event in the Progression to Chronic Thromboembolic Pulmonary Hypertension: Validation in a Novel Rabbit Model. Arterioscler Thromb Vasc Biol 2023. [PMID: 37165875 DOI: 10.1161/atvbaha.122.317262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening condition and rare complication of acute pulmonary embolism. Mechanisms underlying impaired clot resolution and in sustained fibrothrombotic obstruction of the pulmonary arterial bed remain poorly understood. Since defective angiogenesis correlated to defective clot resolution based on observations in surgical material from patients with CTEPH, we aimed to validate its crucial pathogenic role by intrathrombus inhibition of angiogenesis in a novel CTEPH rabbit model. METHODS We aimed to compare whether intrathrombus administration of an antifibrinolytic agent, tranexamic acid, or an inhibitor of angiogenesis, SU5416, would contribute to CTEPH progression. Both products were administered on a weekly basis by autologous clot embolization in rabbits. Right ventricular pressure was monitored by telemetry, right ventricular function by transthoracic echocardiography, and a complete pulmonary hemodynamic evaluation was obtained through right heart catheterization. Markers of inflammation, endothelial dysfunction, heart failure, and fibrinolysis were measured in plasma. Pulmonary vessel remodeling was analyzed by immunohistochemistry. RESULTS Impairing intrathrombus angiogenesis by repeatedly embolizing autologous blood clots containing SU5416 resulted in elevated mean pulmonary arterial pressure (38 mm Hg), increased indexed pulmonary vascular resistance, and enhanced right ventricular hypertrophy (80%, 1.9-fold, 36%, respectively, compared with rabbits embolized with clots containing an antifibrinolytic agent). This was caused by both obstruction of large pulmonary arteries with fibrothrombotic material and muscularization of pulmonary microvessels, and accompanied by inflammatory cell infiltration and increased circulating endothelin-1. CONCLUSIONS The key role of angiogenesis-driven clot resolution was validated in a reliable small-animal model reproducing the major pathophysiological hallmarks of CTEPH.
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Affiliation(s)
- Rozenn Quarck
- Clinical Department of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), KU Leuven, University of Leuven, Belgium. (R.Q., L.G., C.B., M.D.)
| | - Lynn Willems
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, University of Leuven, Belgium. (L.W., B.T. L.S., A.R., A.W.)
| | - Birger Tielemans
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, University of Leuven, Belgium. (L.W., B.T. L.S., A.R., A.W.)
- Department of Imaging and Pathology, KU Leuven, University of Leuven, Belgium. (B.T., A.R.)
| | - Leanda Stoian
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, University of Leuven, Belgium. (L.W., B.T. L.S., A.R., A.W.)
| | - Alicja Ronisz
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, University of Leuven, Belgium. (L.W., B.T. L.S., A.R., A.W.)
- Department of Imaging and Pathology, KU Leuven, University of Leuven, Belgium. (B.T., A.R.)
| | - Allard Wagenaar
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, University of Leuven, Belgium. (L.W., B.T. L.S., A.R., A.W.)
| | - Frédéric Perros
- CarMen Laboratory, INSERM 1060, University Lyon 1, Pierre Benite, France (F.P.)
| | - Guido Claessen
- Cardiology, University Hospitals Leuven & Cardiology Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Belgium. (G.C., A.C.)
| | - Agnieszka Ciarka
- Cardiology, University Hospitals Leuven & Cardiology Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Belgium. (G.C., A.C.)
| | - Laurent Godinas
- Clinical Department of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), KU Leuven, University of Leuven, Belgium. (R.Q., L.G., C.B., M.D.)
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), KU Leuven, University of Leuven, Belgium. (R.Q., L.G., C.B., M.D.)
| | - Marc Jacquemin
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Belgium. (M.J.)
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), KU Leuven, University of Leuven, Belgium. (R.Q., L.G., C.B., M.D.)
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Eichstaedt CA, Belge C, Chung WK, Gräf S, Grünig E, Montani D, Quarck R, Tenorio-Castano JA, Soubrier F, Trembath RC, Morrell NW. Genetic counselling and testing in pulmonary arterial hypertension: a consensus statement on behalf of the International Consortium for Genetic Studies in PAH. Eur Respir J 2023; 61:2201471. [PMID: 36302552 PMCID: PMC9947314 DOI: 10.1183/13993003.01471-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease that can be caused by (likely) pathogenic germline genomic variants. In addition to the most prevalent disease gene, BMPR2 (bone morphogenetic protein receptor 2), several genes, some belonging to distinct functional classes, are also now known to predispose to the development of PAH. As a consequence, specialist and non-specialist clinicians and healthcare professionals are increasingly faced with a range of questions regarding the need for, approaches to and benefits/risks of genetic testing for PAH patients and/or related family members. We provide a consensus-based approach to recommendations for genetic counselling and assessment of current best practice for disease gene testing. We provide a framework and the type of information to be provided to patients and relatives through the process of genetic counselling, and describe the presently known disease causal genes to be analysed. Benefits of including molecular genetic testing within the management protocol of patients with PAH include the identification of individuals misclassified by other diagnostic approaches, the optimisation of phenotypic characterisation for aggregation of outcome data, including in clinical trials, and importantly through cascade screening, the detection of healthy causal variant carriers, to whom regular assessment should be offered.
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Affiliation(s)
- Christina A Eichstaedt
- Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Laboratory for Molecular Genetic Diagnostics, Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Catharina Belge
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals, University of Leuven, Leuven, Belgium
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Stefan Gräf
- Department of Medicine, Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
- NIHR BioResource for Translational Research - Rare Diseases, University of Cambridge, Cambridge, UK
| | - Ekkehard Grünig
- Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - David Montani
- Université Paris-Saclay, AP-HP, French Referral Center for Pulmonary Hypertension, Pulmonary Department, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Rozenn Quarck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals, University of Leuven, Leuven, Belgium
| | - Jair A Tenorio-Castano
- INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
- CIBERER (Centro de Investigación Biomédica en Red de Enfermedades Raras), Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Florent Soubrier
- Sorbonne Université, AP-HP, Département de Génétique, INSERM UMR_S1166, Sorbonne Université, Institute for Cardiometabolism and Nutrition (ICAN), Hôpital Pitié-Salpêtrière, Paris, France
| | - Richard C Trembath
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nicholas W Morrell
- Department of Medicine, Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
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9
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Buyse B, Nguyen PAH, Leemans J, Verhaeghe V, Peters M, Strobbe S, Van Valckenborgh I, Belge C, Testelmans D. Short-term positive effects of a mandibular advancement device in a selected phenotype of patients with moderate obstructive sleep apnea: a prospective study. J Clin Sleep Med 2023; 19:5-16. [PMID: 35962942 PMCID: PMC9806777 DOI: 10.5664/jcsm.10232] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES To evaluate (determinants of) treatment success of mandibular advancement device application in a selected phenotype of patients with obstructive sleep apnea (OSA). METHODS Ninety nonobese patients with moderate OSA (obstructive apnea-hypopnea index [OAHI] ≥ 15 and < 30 events/h) without comorbidities were prospectively included. Polysomnography was performed at baseline and with a mandibular advancement device. A drug-induced sleep endoscopy with jaw thrust was performed in 83%. RESULTS OAHI reduction ≥ 50% was observed in 73%, OAHI reduction ≥ 50% with OAHI < 10 events/h in 70%, and complete OSA resolution (OAHI < 5 events/h) in 40%. Patients with nonpositional OSA showed a significantly higher rate of complete OSA resolution: Posttest probability increased to 67%. In patients with total disappearance of collapse at velum level and at all levels during drug-induced sleep endoscopy with jaw thrust, the drop in OAHI was impressive with an infinitively high positive likelihood ratio. However, the proportion of patients having nonpositional OSA or the drug-induced sleep endoscopy characteristics as described above was < 20%. The change in snoring disturbance based on a visual analog scale was 76% (interquartile range 40-89%, P < .001) and a statistically significant amelioration in Epworth Sleepiness Scale (especially in somnolent subjects) was observed. High adherence was reported. CONCLUSIONS In this predefined OSA phenotype, a mandibular advancement device was effective in reduction of OAHI and in amelioration of symptoms. Stratification by nonpositional OSA and findings on drug-induced sleep endoscopy with jaw thrust increased treatment success defined as reduction in OAHI. However, the clinical relevance can be questioned because only a small number of patients demonstrated these characteristics. CITATION Buyse B, Nguyen PAH, Leemans J, et al. Short-term positive effects of a mandibular advancement device in a selected phenotype of patients with moderate obstructive sleep apnea: a prospective study. J Clin Sleep Med. 2023;19(1):5-16.
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Affiliation(s)
- Bertien Buyse
- Department of Pulmonology, Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg, Leuven, Belgium
- Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven University, Leuven, Belgium
| | - Pham Anh Hong Nguyen
- Department of Pulmonology, Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg, Leuven, Belgium
| | - Joke Leemans
- Department of Pulmonology, Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Simon Strobbe
- ENT, Head and Neck Surgery, UZ Leuven, Leuven, Belgium
| | | | - Catharina Belge
- Department of Pulmonology, Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg, Leuven, Belgium
- Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven University, Leuven, Belgium
| | - Dries Testelmans
- Department of Pulmonology, Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg, Leuven, Belgium
- Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven University, Leuven, Belgium
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10
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Swinnen K, Bijnens E, Casas L, Nawrot TS, Delcroix M, Quarck R, Belge C. Health effects of exposure to residential air pollution in patients with pulmonary arterial hypertension: A cohort study in Belgium. Eur Respir J 2022; 60:13993003.02335-2021. [PMID: 35618275 DOI: 10.1183/13993003.02335-2021] [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] [Received: 08/25/2021] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Katleen Swinnen
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Esmée Bijnens
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Lidia Casas
- Social Epidemiology and Health Policy (SEHPO), Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Belgium.,Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Marion Delcroix
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.,Centre of Pulmonary Vascular Diseases, Clinical Department of Respiratory Diseases, University Hospitals of Leuven; Leuven, Belgium
| | - Rozenn Quarck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.,Centre of Pulmonary Vascular Diseases, Clinical Department of Respiratory Diseases, University Hospitals of Leuven; Leuven, Belgium.,Joint last authorship
| | - Catharina Belge
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, Leuven, Belgium .,Centre of Pulmonary Vascular Diseases, Clinical Department of Respiratory Diseases, University Hospitals of Leuven; Leuven, Belgium.,Joint last authorship
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11
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D'Haenens A, Vanwalleghem L, Quarck R, Belge C, Claessen G, Kuypers D, De Vlieger G, Verbelen T, Ceulemans L, Van Raemdonck D, Verleden G, Vos R, Neyrinck A, Delcroix M, Godinas L. Outcomes After Lung or Combined Heart Lung Transplantation for PAH and CTEPH According to Baseline Kidney Function. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Verbelen T, Godinas L, Maleux G, Coolen J, Claessen G, Belge C, Meyns B, Delcroix M. Chronic thromboembolic pulmonary hypertension: diagnosis, operability assessment and patient selection for pulmonary endarterectomy. Ann Cardiothorac Surg 2022; 11:82-97. [PMID: 35433370 PMCID: PMC9012197 DOI: 10.21037/acs-2021-pte-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/08/2021] [Indexed: 07/30/2023]
Abstract
Healthcare providers outside pulmonary hypertension (PH) centers having misinformation or insufficient education, and a general lack of treatment awareness contribute to a massive underdiagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), diagnostic delay and refusal of surgery by patients. Together with the subjective operability assessment, this leads to too few patients undergoing pulmonary endarterectomy (PEA); even though this surgery results in improved survival and exercise capacity. Acute pulmonary embolism (PE) survivors should undergo a CTEPH screening strategy. Patients screened positive and those with CTEPH symptoms (with or without history of PE), should undergo transthoracic echocardiography (TTE) to determine the probability of PH. High PH probability patients should undergo a ventilation/perfusion (V/Q) scan. A negative scan rules out CTEPH. Patients with a positive V/Q scan, but also patients with findings suggestive for CTEPH on computed tomography pulmonary angiography (CTPA) to diagnose acute PE, should be referred to a CTEPH center. Further diagnostic work-up currently consists of catheter based pulmonary angiography, CTPA and right heart catheterization. However, new imaging technologies might replace them in the near future, with one single imaging tool to screen, diagnose and assess operability as the ultimate goal. Operability assessment should be performed by a multidisciplinary CTEPH team. PEA surgery should be organized in a single center per country or for each forty to fifty million inhabitants in order to offer the highest level of expertise. Informing patients about PEA should preferably be done by the treating surgeon. Based on the estimated incidence of CTEPH and with a better education of patients and healthcare providers, despite the advent of new interventional and medical therapies for CTEPH, the number of PEA surgeries performed should still have the potential to grow significantly.
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Affiliation(s)
- Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Godinas
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Johan Coolen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marion Delcroix
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
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13
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Tielemans B, Stoian L, Wagenaar A, Leys M, Belge C, Delcroix M, Quarck R. Incremental Experience in In Vitro Primary Culture of Human Pulmonary Arterial Endothelial Cells Harvested from Swan-Ganz Pulmonary Arterial Catheters. Cells 2021; 10:cells10113229. [PMID: 34831453 PMCID: PMC8618201 DOI: 10.3390/cells10113229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/31/2021] [Accepted: 11/14/2021] [Indexed: 11/23/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a devastating condition affecting the pulmonary microvascular wall and endothelium, resulting in their partial or total obstruction. Despite a combination of expensive vasodilatory therapies, mortality remains high. Personalized therapeutic approaches, based on access to patient material to unravel patient specificities, could move the field forward. An innovative technique involving harvesting pulmonary arterial endothelial cells (PAECs) at the time of diagnosis was recently described. The aim of the present study was to fine-tune the initial technique and to phenotype the evolution of PAECs in vitro subcultures. PAECs were harvested from Swan-Ganz pulmonary arterial catheters during routine diagnostic or follow up right heart catheterization. Collected PAECs were phenotyped by flow cytometry and immunofluorescence focusing on endothelial-specific markers. We highlight the ability to harvest patients’ PAECs and to maintain them for up to 7–12 subcultures. By tracking the endothelial phenotype, we observed that PAECs could maintain an endothelial phenotype for several weeks in culture. The present study highlights the unique opportunity to obtain homogeneous subcultures of primary PAECs from patients at diagnosis and follow-up. In addition, it opens promising perspectives regarding tailored precision medicine for patients suffering from rare pulmonary vascular diseases.
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Affiliation(s)
- Birger Tielemans
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA) & Biomedical MRI, Department of Imaging and Pathology, University of Leuven, 3000 Leuven, Belgium;
| | - Leanda Stoian
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), University of Leuven, 3000 Leuven, Belgium; (L.S.); (A.W.)
| | - Allard Wagenaar
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), University of Leuven, 3000 Leuven, Belgium; (L.S.); (A.W.)
| | - Mathias Leys
- Clinical Department of Respiratory Diseases, University Hospitals, University of Leuven, 3000 Leuven, Belgium;
| | - Catharina Belge
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals, University of Leuven, 3000 Leuven, Belgium; (C.B.); (M.D.)
| | - Marion Delcroix
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals, University of Leuven, 3000 Leuven, Belgium; (C.B.); (M.D.)
| | - Rozenn Quarck
- Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals, University of Leuven, 3000 Leuven, Belgium; (C.B.); (M.D.)
- Correspondence: ; Tel.: +32-16-33-01-89
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14
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Bogaert J, Claessen G, Dresselaers T, Masci PG, Belge C, Delcroix M, Symons R. Magnetic resonance relaxometry of the liver - a new imaging biomarker to assess right heart failure in pulmonary hypertension. J Heart Lung Transplant 2021; 41:86-94. [PMID: 34686407 DOI: 10.1016/j.healun.2021.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/22/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Right heart failure (RHF) in pulmonary hypertension (PH) patients is manifested by increased right atrial (RA) pressure. We hypothesized liver relaxation times measured at cardiovascular magnetic resonance (CMR) can be used to noninvasively assess increased right-sided filling pressure. METHODS Forty-five consecutive patients, that is, 37 PH patients and 8 chronic thromboembolic pulmonary disease patients without PH underwent right heart catheterization and CMR. CMR findings were compared to 40 control subjects. Native T1, T2, and extracellular volume (ECV) liver values were measured on the cardiac maps. RESULTS Patients with increased RA pressure (i.e.,≥8 mm Hg)(n = 19, RA+ group) showed higher NT-proBNP and CRP values, lower LVEF, MAPSE values, larger atrial size, and higher native T1 and T2 values of the myocardium than patients with normal RA pressure (RA- group, n = 26). Liver T1, T2 and ECV was significantly higher in RA+ than RA- patients and controls, that is, T1: 684 ± 129 ms vs 563 ± 72 ms and 540 ± 34 ms; T2: 60 ± 10 ms vs 49 ± 6 ms and 46 ± 4 ms; ECV: 36 ± 8% vs 29 ± 4% and 30 ± 3%. A positive correlation was found between liver T1, T2 and ECV and RA pressure, that is, r2 of 0.61, 0.82, and 0.58, respectively (p < 0.001). ROC analysis to depict increased RA pressure showed an AUC of 0.847, 0.904, 0.816, and 0.645 for liver T1, T2, NT-proNBP and gamma-glutamyl transpeptidase, respectively. Excellent intra- and inter-observer agreement was found for assessment of T1/T2/ECV liver values. CONCLUSIONS Assessment of liver relaxation times as part of a comprehensive CMR exam in PH patients may provide valuable information with regard to the presence of passive liver congestion.
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Affiliation(s)
- Jan Bogaert
- Dept of Imaging and Pathology, KU Leuven and Dept of Radiology, University Hospitals Leuven, Leuven, Belgium.
| | - Guido Claessen
- Dpt of Cardiovascular Sciences, KU Leuven and Dept of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Dept of Imaging and Pathology, KU Leuven and Dept of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium; BREATHE, department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium; BREATHE, department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Rolf Symons
- Dept of Imaging and Pathology, KU Leuven and Dept of Radiology, University Hospitals Leuven, Leuven, Belgium
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15
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Swinnen K, Bijnens E, Casas L, Nawrot TS, Delcroix M, Quarck R, Belge C. Residential air pollution increases the risk for persistent pulmonary hypertension after pulmonary endarterectomy. Eur Respir J 2021; 57:13993003.02680-2020. [PMID: 33479106 DOI: 10.1183/13993003.02680-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/02/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Katleen Swinnen
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Dept of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Esmée Bijnens
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Lidia Casas
- Centre for Environment and Health, Dept of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Social Epidemiology and Health Policy, Dept of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Centre for Environment and Health, Dept of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Marion Delcroix
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Dept of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.,Clinical Dept of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium
| | - Rozenn Quarck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Dept of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.,Clinical Dept of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium.,Joint last authorship
| | - Catharina Belge
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Dept of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium .,Clinical Dept of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium.,Joint last authorship
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16
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Testelmans D, Spruit MA, Vrijsen B, Sastry M, Belge C, Kalkanis A, Gaffron S, Wouters EFM, Buyse B. Comorbidity clusters in patients with moderate-to-severe OSA. Sleep Breath 2021; 26:195-204. [PMID: 33942208 DOI: 10.1007/s11325-021-02390-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a prevalent and multifaceted disease. To date, the presence and severity of objectively identified comorbidities and their association with specific OSA phenotypes, CPAP adherence, and survival remain to be elucidated. The aim of this study is to cluster patients with OSA based on 10 clinically important objectively identified comorbidities, and to characterize the comorbidity clusters in terms of clinical and polysomnographic characteristics, CPAP adherence, and survival. STUDY DESIGN AND METHODS Seven hundred ten consecutive patients starting CPAP for moderate-to-severe OSA were included. Comorbidities were based on generally accepted cutoffs identified in the peer-reviewed literature. Self-organizing maps were used to order patients based on presence and severity of their comorbidities and to generate clusters. RESULTS The majority of patients were men (80%). They were generally middle-aged (52 years) and obese (BMI: 31.5 kg/m2). Mean apnea-hypopnea index (AHI) was 41 ± 20 per h of sleep. More than 94% of the patients had one or more comorbidities with arterial hypertension, dyslipidemia, and obesity being the most prevalent. Nine comorbidity clusters were identified. The clinical relevance of these comorbidity clusters was highlighted by the difference in symptoms, PSG parameters, and cardiovascular risk. Also, differences in CPAP adherence, improvements in ESS, and long-term survival were present between the clusters. CONCLUSION Comorbidity prevalence in patients with OSA is high, and different comorbidity clusters, demonstrating differences in cardiovascular risk, CPAP adherence, and survival, can be identified. These results further substantiate the need for a comprehensive assessment of patients with OSA beyond the AHI.
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Affiliation(s)
- Dries Testelmans
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium.
| | - M A Spruit
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - B Vrijsen
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - M Sastry
- Academic Sleep Centre, CIRO, Horn, The Netherlands
| | - C Belge
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - A Kalkanis
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - S Gaffron
- Analytics, Viscovery Software GmbH, Vienna, Austria
| | - E F M Wouters
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - B Buyse
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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17
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Godinas L, Iyer K, Meszaros G, Quarck R, Escribano-Subias P, Vonk Noordegraaf A, Jansa P, D'Alto M, Luknar M, Milutinov Ilic S, Belge C, Sitbon O, Reis A, Rosenkranz S, Pepke-Zaba J, Humbert M, Delcroix M. PH CARE COVID survey: an international patient survey on the care for pulmonary hypertension patients during the early phase of the COVID-19 pandemic. Orphanet J Rare Dis 2021; 16:196. [PMID: 33933110 PMCID: PMC8087873 DOI: 10.1186/s13023-021-01752-1] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background During the COVID-19 pandemic, most of the health care systems suspended their non-urgent activities. This included the cancellation of consultations for patients with rare diseases, such as severe pulmonary hypertension (PH), resulting in potential medication shortage and loss of follow-up. Thus, the aim of the study was to evaluate PH patient health status evolution, access to health care and mental health experience during the early phase of the pandemic. Methods We conducted an online patient survey, available in 16 languages, between 22/05/2020 and 28/06/2020. The survey included questions corresponding to demographic, COVID-19 and PH related information. Results 1073 patients (or relatives, 27%) from 52 countries all over the world participated in the survey. Seventy-seven percent (77%) of responders reported a diagnosis of pulmonary arterial hypertension and 15% of chronic thromboembolic PH. The COVID-19 related events were few: only 1% of all responders reported a diagnosis of COVID-19. However, 8% of patients reported health deterioration possibly related to PH, and 4% hospitalization for PH. Besides, 11% of the patients reported difficulties to access their PH expert centre, and 3% interruption of treatment due to shortage of medication. Anxiety or depression was reported by 67% of the participants. Conclusion Although COVID-19 incidence in PH patients was low, PH related problems occurred frequently as the pandemic progressed, including difficulties to have access to specialized care. The importance of primary health care was emphasized. Further studies are needed to evaluate the long-term consequences of COVID-related PH care disruption. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01752-1.
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Affiliation(s)
- Laurent Godinas
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium. .,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium.
| | - Keerthana Iyer
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de L'Hypertension Pulmonaire, ERN-LUNG, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | | | - Rozenn Quarck
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Pilar Escribano-Subias
- Cardiology Department and Spanish Cardiovascular Research Network (CIBER-CV), Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Anton Vonk Noordegraaf
- Departement of Pulmonary Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands
| | - Pavel Jansa
- Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Milan Luknar
- National Cardiovascular Institute, Comenius University School of Medicine, Pod Krasnou Horkou 1, Bratislava, Slovakia
| | | | - Catharina Belge
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Olivier Sitbon
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de L'Hypertension Pulmonaire, ERN-LUNG, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Abílio Reis
- Medicine Department, Pulmonary Vascular Diseases Unit, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - Stephan Rosenkranz
- Department III of Internal Medicine and, Cologne Cardiovascular Research Center (CCRC), Cologne University Heart Center, Cologne, Germany
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Marc Humbert
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de L'Hypertension Pulmonaire, ERN-LUNG, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Marion Delcroix
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
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18
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Howden EJ, Ruiz-Carmona S, Claeys M, De Bosscher R, Willems R, Meyns B, Verbelen T, Maleux G, Godinas L, Belge C, Bogaert J, Claus P, La Gerche A, Delcroix M, Claessen G. Oxygen Pathway Limitations in Patients With Chronic Thromboembolic Pulmonary Hypertension. Circulation 2021; 143:2061-2073. [PMID: 33853383 DOI: 10.1161/circulationaha.120.052899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exertional intolerance is a limiting and often crippling symptom in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Traditionally the pathogenesis has been attributed to central factors, including ventilation/perfusion mismatch, increased pulmonary vascular resistance, and right heart dysfunction and uncoupling. Pulmonary endarterectomy and balloon pulmonary angioplasty provide substantial improvement of functional status and hemodynamics. However, despite normalization of pulmonary hemodynamics, exercise capacity often does not return to age-predicted levels. By systematically evaluating the oxygen pathway, we aimed to elucidate the causes of functional limitations in patients with CTEPH before and after pulmonary vascular intervention. METHODS Using exercise cardiac magnetic resonance imaging with simultaneous invasive hemodynamic monitoring, we sought to quantify the steps of the O2 transport cascade from the mouth to the mitochondria in patients with CTEPH (n=20) as compared with healthy participants (n=10). Furthermore, we evaluated the effect of pulmonary vascular intervention (pulmonary endarterectomy or balloon angioplasty) on the individual components of the cascade (n=10). RESULTS Peak Vo2 (oxygen uptake) was significantly reduced in patients with CTEPH relative to controls (56±17 versus 112±20% of predicted; P<0.0001). The difference was attributable to impairments in multiple steps of the O2 cascade, including O2 delivery (product of cardiac output and arterial O2 content), skeletal muscle diffusion capacity, and pulmonary diffusion. The total O2 extracted in the periphery (ie, ΔAVo2 [arteriovenous O2 content difference]) was not different. After pulmonary vascular intervention, peak Vo2 increased significantly (from 12.5±4.0 to 17.8±7.5 mL/[kg·min]; P=0.036) but remained below age-predicted levels (70±11%). The O2 delivery was improved owing to an increase in peak cardiac output and lung diffusion capacity. However, peak exercise ΔAVo2 was unchanged, as was skeletal muscle diffusion capacity. CONCLUSIONS We demonstrated that patients with CTEPH have significant impairment of all steps in the O2 use cascade, resulting in markedly impaired exercise capacity. Pulmonary vascular intervention increased peak Vo2 by partly correcting O2 delivery but had no effect on abnormalities in peripheral O2 extraction. This suggests that current interventions only partially address patients' limitations and that additional therapies may improve functional capacity.
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Affiliation(s)
- Erin J Howden
- Baker Heart and Diabetes Institute (E.J.H., S.R.-C., A.L.G., G.C.), Melbourne, Australia
| | - Sergio Ruiz-Carmona
- Cambridge Baker Systems Genomics Initiative (S.R.-C.), Melbourne, Australia.,Baker Heart and Diabetes Institute (E.J.H., S.R.-C., A.L.G., G.C.), Melbourne, Australia
| | - Mathias Claeys
- Departments of Cardiovascular Sciences (M.C., R.D.B., R.W., B.M., T.V., P.C., A.L.G., G.C.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Ruben De Bosscher
- Departments of Cardiovascular Sciences (M.C., R.D.B., R.W., B.M., T.V., P.C., A.L.G., G.C.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Rik Willems
- Departments of Cardiovascular Sciences (M.C., R.D.B., R.W., B.M., T.V., P.C., A.L.G., G.C.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Bart Meyns
- Departments of Cardiovascular Sciences (M.C., R.D.B., R.W., B.M., T.V., P.C., A.L.G., G.C.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Tom Verbelen
- Departments of Cardiovascular Sciences (M.C., R.D.B., R.W., B.M., T.V., P.C., A.L.G., G.C.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Geert Maleux
- Imaging & Pathology (G.M., J.B.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Laurent Godinas
- Chronic Diseases and Metabolism (L.G., C.B., M.D.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Catharina Belge
- Chronic Diseases and Metabolism (L.G., C.B., M.D.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Jan Bogaert
- Imaging & Pathology (G.M., J.B.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Piet Claus
- Departments of Cardiovascular Sciences (M.C., R.D.B., R.W., B.M., T.V., P.C., A.L.G., G.C.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Andre La Gerche
- Baker Heart and Diabetes Institute (E.J.H., S.R.-C., A.L.G., G.C.), Melbourne, Australia.,Departments of Cardiovascular Sciences (M.C., R.D.B., R.W., B.M., T.V., P.C., A.L.G., G.C.), KU Leuven, Belgium
| | - Marion Delcroix
- Chronic Diseases and Metabolism (L.G., C.B., M.D.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
| | - Guido Claessen
- Baker Heart and Diabetes Institute (E.J.H., S.R.-C., A.L.G., G.C.), Melbourne, Australia.,Departments of Cardiovascular Sciences (M.C., R.D.B., R.W., B.M., T.V., P.C., A.L.G., G.C.), KU Leuven, Belgium.,University Hospitals Leuven, Belgium (M.C., R.D.B., R.W., B.M., T.V., G.M., L.G., C.B., J.B., P.C., M.D., G.C.)
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19
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Testelmans D, Schoovaerts K, Belge C, Verleden SE, Vos R, Verleden GM, Buyse B. Sleep-disordered breathing after lung transplantation: An observational cohort study. Am J Transplant 2021; 21:281-290. [PMID: 32519458 DOI: 10.1111/ajt.16130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 01/25/2023]
Abstract
Data concerning sleep-disordered breathing (SDB) after lung transplantation (LTX) are scarce. This study aims to analyze prevalence, associated factors, and impact on survival of moderate to severe SDB in a large cohort of consecutive LTX patients (n = 219). Patients underwent a diagnostic polysomnography 1 year after LTX. Moderate to severe SDB was present in 57.5% of patients, with the highest prevalence in chronic obstructive pulmonary disease/emphysema (71.1%) and pulmonary fibrosis (65.1%). SDB patients were older, mostly male, and had higher body mass index and neck circumference. Nocturnal diastolic and 24-hour blood pressures were higher in SDB patients. In 45 patients, polysomnography was also performed pre-LTX. Compared to pre-LTX, mean apnea/hypopnea index (AHI) increased significantly after LTX. A significant correlation was seen between lung function parameters and AHI, suggesting a role of decreased caudal traction on the pharynx. Presence of SDB had no impact on mortality or prevalence of chronic lung allograft dysfunction. However, survival was better in continuous positive airway pressure (CPAP) compliant SDB patients compared to SDB patients without CPAP treatment. These findings may be pertinent for systematic screening of SDB after LTX.
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Affiliation(s)
- Dries Testelmans
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Kathleen Schoovaerts
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE) Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Bertien Buyse
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
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20
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Belge C, Quarck R, Godinas L, Montani D, Escribano Subias P, Vachiéry JL, Nashat H, Pepke-Zaba J, Humbert M, Delcroix M. COVID-19 in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a reference centre survey. ERJ Open Res 2020; 6:00520-2020. [PMID: 33263061 PMCID: PMC7682715 DOI: 10.1183/23120541.00520-2020] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022] Open
Abstract
According to the US Centers for Disease Control and Prevention (CDC), patients with underlying health conditions, including all types of lung and cardiovascular diseases, have an increased risk of developing serious disease when infected by SARS-CoV-2 [1]. Based on prior publications on the effects of acute right heart failure superimposed on systemic infection [2–5], Ryanet al. [6] suggested that right heart failure and concomitant COVID-19 infection may result in increased mortality in pulmonary arterial hypertension (PAH) patients. Surprisingly, the number of hospitalised PAH-COVID-19 patients remained rather low in Italy and the USA so far [7]. In late March 2020, experts from over 32 US PH expert centres answered a query endorsed by the US Pulmonary Hypertension Association. COVID-19 infection was reported in 13 PAH patients, among whom three required intubation and one died. This is consequently raising the question whether and why PAH patients appear to be at lower risk of developing severe COVID-19 [7]. This international survey highlights that a limited number of PAH and CTEPH patients suffered from severe #COVID19 infectionhttps://bit.ly/3jGuBQq
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Affiliation(s)
- Catharina Belge
- Clinical Dept of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Dept of Chronic Diseases & Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium.,These authors contributed equally
| | - Rozenn Quarck
- Clinical Dept of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Dept of Chronic Diseases & Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium.,These authors contributed equally
| | - Laurent Godinas
- Clinical Dept of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Dept of Chronic Diseases & Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - David Montani
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Pilar Escribano Subias
- Cardiology Dept and Spanish Cardiovascular Research Network (CIBER-CV), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jean-Luc Vachiéry
- Dept of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium
| | - Heba Nashat
- National Pulmonary Hypertension Service at Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, Imperial College London, London, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Marc Humbert
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Marion Delcroix
- Clinical Dept of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Dept of Chronic Diseases & Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
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21
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Swinnen K, Quarck R, Godinas L, Belge C, Delcroix M. Learning from registries in pulmonary arterial hypertension: pitfalls and recommendations. Eur Respir Rev 2019; 28:28/154/190050. [PMID: 31852746 DOI: 10.1183/16000617.0050-2019] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/20/2019] [Indexed: 12/31/2022] Open
Abstract
Pulmonary arterial hypertension is a rare and incurable chronic disease characterised by a progressive increase in pulmonary vascular resistance and right heart failure. Patient registries collecting observational data can be of great value in the understanding of clinical problems. While clinical trials provide data in selected patient populations, registries better depict real-life practice. This review aims to reflect the input of patient registries in the general knowledge of the disease. Advances in epidemiology of the different subgroups, including data on incidence and/or prevalence, increasing age at presentation and stagnating diagnostic delay are reported. The importance of haemodynamic definition criteria and cardiac comorbidities are underscored. The review also shows the major transformation that pulmonary arterial hypertension therapeutic management has undergone, with still insufficient use of combination therapies; consecutive improvement in outcome; upcoming evidence in disfavour of anticoagulation; and validity of the available risk-stratification tools derived from large registries. Product registries are also briefly presented. Finally, the benefits of registries and methodological aspects are discussed, including immortal time bias, registry data quality and recommendations from EU organisations (EUCERD and PARENT).
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Affiliation(s)
- Katleen Swinnen
- Respiratory Division, Dept of Chronic Diseases, Metabolism & Ageing, KU Leuven - University of Leuven, Leuven, Belgium
| | - Rozenn Quarck
- Respiratory Division, Dept of Chronic Diseases, Metabolism & Ageing, KU Leuven - University of Leuven, Leuven, Belgium.,Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Godinas
- Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Respiratory Division, Dept of Chronic Diseases, Metabolism & Ageing, KU Leuven - University of Leuven, Leuven, Belgium.,Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Marion Delcroix
- Respiratory Division, Dept of Chronic Diseases, Metabolism & Ageing, KU Leuven - University of Leuven, Leuven, Belgium .,Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
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22
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Buyse B, Ciordas S, Hoet F, Belge C, Testelmans D. Positional obstructive sleep apnoea: challenging findings in consecutive patients treated with a vibrating position trainer. Acta Clin Belg 2019; 74:405-413. [PMID: 30433857 DOI: 10.1080/17843286.2018.1545374] [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: 10/27/2022]
Abstract
OBJECTIVES Last years, vibrating devices were introduced to treat positional sleep apnoea (POSA). However, few data exist on determinants of effectiveness and adherence in clinical settings. Methods: The NightBalance Sleep Position Trainer (SPT) analyses the patient's position during the first 2 nights, starts to build up vibrations during the following 7 and is 100% performant from night 10 on; and, reports on %supine, usage time, number of (responses on) vibrations. The device was started for a 28-day try-out period in a clinical cohort of 51 consecutive patients with POSA. SPT-stored data were studied on different time points: first 2 nights without vibrations (baseline), first 2 nights on SPT 100% performance (short term) and 2 later nights after having used the full performant device for 14 days (long term). Results: Only 27 patients used the device throughout the long-term period. The baseline %supine was lower than during polysomnography: 22.9 ± 16.2 versus 40.7 ± 20.0% (p = 0.0005). Apnoea-hypopnoea index calculation taking into account the %supine on SPT revealed that 2/27 patients would not have obstructive sleep apnoea at home. The baseline %supine dropped (p < 0.0001) on short term without further change on long term. Ten patients could be considered cured and demonstrated higher response on vibrations. Only 29 patients could be considered as adherent, and they demonstrated higher response on vibrations and less side effects; only 13 wanted to purchase the SPT. Conclusion: On polysomnography, the %supine is overestimated. The efficacy and low adherence are influenced by differences in response to vibrations. The training effect is already presented on short term.
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Affiliation(s)
- Bertien Buyse
- Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Simona Ciordas
- Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Filip Hoet
- Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Dries Testelmans
- Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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23
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Tielemans B, Stoian L, Gijsbers R, Michiels A, Wagenaar A, Farre Marti R, Belge C, Delcroix M, Quarck R. Cytokines trigger disruption of endothelium barrier function and p38 MAP kinase activation in BMPR2-silenced human lung microvascular endothelial cells. Pulm Circ 2019; 9:2045894019883607. [PMID: 31692724 PMCID: PMC6811766 DOI: 10.1177/2045894019883607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/24/2019] [Indexed: 12/21/2022] Open
Abstract
The bone morphogenetic protein receptor II (BMPRII) signaling pathway is impaired
in pulmonary arterial hypertension and mutations in the BMPR2
gene have been observed in both heritable and idiopathic pulmonary arterial
hypertension. However, all BMPR2 mutation carriers do not
develop pulmonary arterial hypertension, and inflammation could trigger the
development of the disease in BMPR2 mutation carriers.
Circulating levels and/or lung tissue expression of cytokines such as tumor
necrosis factor-α or interleukin-18 are elevated in patients with pulmonary
arterial hypertension and could be involved in the pathogenesis of pulmonary
arterial hypertension. We consequently hypothesized that cytokines could trigger
endothelial dysfunction in addition to impaired BMPRII signaling. Our aim was to
determine whether impairment of BMPRII signaling might affect endothelium
barrier function and adhesiveness to monocytes, in response to cytokines.
BMPR2 was silenced in human lung microvascular endothelial
cells (HLMVECs) using lentiviral vectors encoding microRNA-based hairpins.
Effects of tumor necrosis factor-α and interleukin-18 on HLMVEC adhesiveness to
the human monocyte cell line THP-1, adhesion molecule expression, endothelial
barrier function and activation of P38MAPK were investigated in vitro. Stable
BMPR2 silencing in HLMVECs resulted in impaired endothelial
barrier function and constitutive activation of P38MAPK. Adhesiveness of
BMPR2-silenced HLMVECs to THP-1 cells was enhanced by tumor
necrosis factor-α and interleukin-18 through ICAM-1 adhesion molecule.
Interestingly, tumor necrosis factor-α induced activation of P38MAPK and
disrupted endothelial barrier function in BMPR2-silenced
HLMVECs. Altogether, our findings showed that stable BMPR2
silencing resulted in impaired endothelial barrier function and activation of
P38MAPK in HLMVECs. In BMPR2-silenced HLMVECs, cytokines
enhanced adhesiveness capacities, activation of P38MAPK and impaired endothelial
barrier function suggesting that cytokines could trigger the development of
pulmonary arterial hypertension in a context of impaired BMPRII signaling
pathway.
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Affiliation(s)
- Birger Tielemans
- Division of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Leanda Stoian
- Division of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Rik Gijsbers
- Molecular Virology and Gene Therapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Neurobiology and Gene Therapy, Department of Neurosciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Annelies Michiels
- Neurobiology and Gene Therapy, Department of Neurosciences, KU Leuven - University of Leuven, Leuven, Belgium.,Leuven Viral Vector Core, KU Leuven - University of Leuven, Leuven, Belgium
| | - Allard Wagenaar
- Division of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Ricard Farre Marti
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Catharina Belge
- Division of Respiratory Diseases, University Hospitals and Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Marion Delcroix
- Division of Respiratory Diseases, University Hospitals and Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Rozenn Quarck
- Division of Respiratory Diseases, University Hospitals and Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
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Belge C, Delcroix M. Treatment of pulmonary arterial hypertension with the dual endothelin receptor antagonist macitentan: clinical evidence and experience. Ther Adv Respir Dis 2019; 13:1753466618823440. [PMID: 30736726 PMCID: PMC6376529 DOI: 10.1177/1753466618823440] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/18/2022] Open
Abstract
Macitentan (10 mg once daily orally), a dual endothelin receptor antagonist (ERA) developed by modifying the structure of bosentan to increase the efficacity and safety, is approved for the treatment of pulmonary arterial hypertension (PAH). The pivotal SERAPHIN trial, (a landmark trial in the history of PAH trials because of the large number of included patients, the long-term follow up and the first trial with morbidity/mortality as the primary endpoint) showed a reduction of the risk of a morbidity or mortality event by 45% over the treatment time compared with placebo. The positive effect on the primary endpoint was observed whether or not the patient was already on PAH therapy. There has been no direct comparison between macitentan and other ERAs, which were approved based on improved exercise capacity, but preclinical and clinical data suggest better pharmacological and safety profiles. Further analyses of the SERAPHIN trial investigated the predictive value of different indices and events on long-term outcome and mortality. The efficacy in children, the long-term effects and safety of macitentan and its place in combination therapy compared with other ERAs are still under investigation. This review presents the preclinical evidence of superiority of macitentan compared with other ERAs, and the available clinical trial data. The place of macitentan in the therapeutic algorithm for PAH treatment, post-marketing experience and future perspectives are discussed.
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Affiliation(s)
- Catharina Belge
- Department of respiratory diseases, University Hospitals Leuven, Herestraat 49, B3000 Leuven, Leuven, Belgium
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25
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Godinas L, Bonne L, Budts W, Belge C, Leys M, Delcroix M, Maleux G. Balloon Pulmonary Angioplasty for the Treatment of Nonoperable Chronic Thromboembolic Pulmonary Hypertension: Single-Center Experience with Low Initial Complication Rate. J Vasc Interv Radiol 2019; 30:1265-1272. [DOI: 10.1016/j.jvir.2019.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/25/2019] [Accepted: 03/17/2019] [Indexed: 01/15/2023] Open
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26
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Claeys M, Claessen G, La Gerche A, Petit T, Belge C, Meyns B, Bogaert J, Willems R, Claus P, Delcroix M. Impaired Cardiac Reserve and Abnormal Vascular Load Limit Exercise Capacity in Chronic Thromboembolic Disease. JACC Cardiovasc Imaging 2019; 12:1444-1456. [DOI: 10.1016/j.jcmg.2018.07.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 01/14/2023]
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Abstract
OBJECTIVES In the last decade significant research has focused on the relationship between physical activity (PA), exercise and obstructive sleep apnea (OSA). The purpose of this study is to provide an overview and interpretation of different studies regarding this subject. METHODS PubMed, Embase and Cochrane Library databases were searched for English articles published before August 21, 2017. Search terms were 'Sleep Apnea, Obstructive' and 'Exercise'. RESULTS Low levels of PA are associated with higher odds of OSA. A negative correlation between PA level and OSA severity is shown, even after adjusting for baseline differences. OSA also impairs the aerobic exercise capacity significantly. OSA patients have a poor hemodynamic response to exercise, which is related to OSA severity. Findings on the influence of continuous positive airway pressure (CPAP) on PA in OSA are inconsistent in terms of statistical significance. A regular and predominantly aerobic exercise training significantly reduces OSA severity, even without a significant decrease in body weight. CONCLUSION The available evidence suggests that further research is necessary to explore the relationships between PA, exercise and OSA and to examine the efficacy of exercise as alternative or additional treatment for OSA.
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Affiliation(s)
| | - Bart Vrijsen
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Pulmonary Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Bertien Buyse
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Dries Testelmans
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
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28
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Brouckaert J, Verleden SE, Verbelen T, Coosemans W, Decaluwé H, De Leyn P, Depypere L, Nafteux P, Van Veer H, Meyns B, Rega F, Van De Velde M, Poortmans G, Rex S, Neyrinck A, Van den Berghe G, Vlasselaers D, Van Cleemput J, Budts W, Vos R, Quarck R, Belge C, Delcroix M, Verleden GM, Van Raemdonck D. Double-lung versus heart-lung transplantation for precapillary pulmonary arterial hypertension: a 24-year single-center retrospective study. Transpl Int 2019; 32:717-729. [PMID: 30735591 DOI: 10.1111/tri.13409] [Citation(s) in RCA: 24] [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] [Received: 08/02/2018] [Revised: 10/18/2018] [Accepted: 02/03/2019] [Indexed: 11/30/2022]
Abstract
Transplant type for end-stage pulmonary vascular disease remains debatable. We compared recipient outcome after heart-lung (HLT) versus double-lung (DLT) transplantation. Single-center analysis (38 HLT-30 DLT; 1991-2014) for different causes of precapillary pulmonary hypertension (PH): idiopathic (22); heritable (two); drug-induced (nine); hepato-portal (one); connective tissue disease (four); congenital heart disease (CHD) (24); chronic thromboembolic PH (six). HLT decreased from 91.7% [1991-1995] to 21.4% [2010-2014]. Re-intervention for bleeding was higher after HLT; (P = 0.06) while primary graft dysfunction grades 2 and 3 occurred more after DLT; (P < 0.0001). Graft survival at 90 days, 1, 5, 10, and 15 years was 93%, 83%, 70%, 47%, and 35% for DLT vs. 82%, 74%, 61%, 48%, and 30% for HLT, respectively (log-rank P = 0.89). Graft survival improved over time: 100%, 93%, 87%, 72%, and 72% in [2010-2014] vs. 75%, 58%, 42%, 33%, and 33% in [1991-1995], respectively; P = 0.03. No difference in chronic lung allograft dysfunction (CLAD)-free survival was observed: 80% & 28% for DLT vs. 75% & 28% for HLT after 5 and 10 years, respectively; P = 0.49. Primary graft dysfunction in PH patients was lower after HLT compared to DLT. Nonetheless, overall graft and CLAD-free survival were comparable and improved over time with growing experience. DLT remains our preferred procedure for all forms of precapillary PH, except in patients with complex CHD.
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Affiliation(s)
- Janne Brouckaert
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Marc Van De Velde
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Gert Poortmans
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Greet Van den Berghe
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, Catholic University Leuven, Leuven, Belgium
| | - Dirk Vlasselaers
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, Catholic University Leuven, Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Heart and Vessel Disease, University Hospitals Leuven, Leuven, Belgium
| | - Werner Budts
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Heart and Vessel Disease, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Rozenn Quarck
- Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
| | - Catharina Belge
- Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Marion Delcroix
- Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium
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Tielemans B, Delcroix M, Belge C, Quarck R. TGFβ and BMPRII signalling pathways in the pathogenesis of pulmonary arterial hypertension. Drug Discov Today 2019; 24:703-716. [DOI: 10.1016/j.drudis.2018.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/06/2018] [Accepted: 12/04/2018] [Indexed: 01/23/2023]
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30
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De Muynck B, Leys M, Cuypers J, Vanderschueren D, Delcroix M, Belge C. Hypocalcemia after Denosumab in a Pulmonary Hypertension Patient Receiving Epoprostenol. Respiration 2018; 95:139-142. [PMID: 29485420 DOI: 10.1159/000481713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 09/20/2017] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 50-year-old woman with anorexigen-induced pulmonary arterial hypertension treated with epoprostenol, who presented with Trousseau's sign, leading to the diagnosis of severe hypocalcemia for which substitution was started (initially orally, followed by intravenous substitution). After further analysis, we assume that epoprostenol-induced diarrhea caused malabsorption (as other reasons were excluded), leading to nutritional osteomalacia with secondary hyperparathyroidism. We discovered that even more severe hypocalcemia was induced by the treatment with the anti-osteoporotic drug denosumab, which was started after the diagnosis of osteoporosis on bone densitometry. In our opinion, clinicians have to be aware that in patients with malabsorption, antiresorptive therapy can induce dangerous and even life-threatening hypocalcemia, even in patients with normal renal function.
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Affiliation(s)
- Benedicte De Muynck
- Department of Respiratory Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Mathias Leys
- Department of Respiratory Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium.,Department of Respiratory Diseases, AZ Groeninge, Kortrijk, Belgium
| | - Joke Cuypers
- Department of Endocrinology, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Department of Endocrinology, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Marion Delcroix
- Department of Respiratory Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Department of Respiratory Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
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31
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Claeys M, Claessen G, La Gerche A, Petit T, Belge C, Claus P, Bogaert J, Willems R, Delcroix M. P724Peak oxygen consumption in chronic thromboembolic pulmonary vascular disease is determined predominately by cardiac reserve and not by dead space ventilation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Vrijsen B, Buyse B, Belge C, Vanpee G, Van Damme P, Testelmans D. Randomized cross-over trial of ventilator modes during non-invasive ventilation titration in amyotrophic lateral sclerosis. Respirology 2017; 22:1212-1218. [DOI: 10.1111/resp.13046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Bart Vrijsen
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Faculty of Kinesiology and Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Bertien Buyse
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
| | - Catharina Belge
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
| | - Goele Vanpee
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Faculty of Kinesiology and Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Philip Van Damme
- Department of Neurology; University Hospitals Leuven; Leuven Belgium
- Department of Neurosciences; KU Leuven - University of Leuven, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND); Leuven Belgium
| | - Dries Testelmans
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
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Vandoorne E, Vrijsen B, Belge C, Testelmans D, Buyse B. Noninvasive ventilation in amyotrophic lateral sclerosis: effects on sleep quality and quality of life. Acta Clin Belg 2016; 71:389-394. [PMID: 27112318 DOI: 10.1080/17843286.2016.1173941] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Little is known about the effects of noninvasive ventilation (NIV) on sleep quality in amyotrophic lateral sclerosis (ALS). We aim to evaluate the long-term effects of NIV on sleep quality and quality of life in patients with ALS. METHODS In this prospective observational study, 13 ALS patients were followed for one year after initiating NIV. We evaluated sleep quality, quality of life and functional status with several questionnaires: Epworth sleepiness Scale (ESS), Pittsburg sleep quality index (PSQI), Short Form 36 Health Questionnaire (SF-36), McGill Quality of Life questionnaire (McGillQoL) and revised Amyotrophic Lateral Sclerosis Functional Rating Scale scores (ALSFRS-R). RESULTS Median and interquartile range (IQR) at the start of NIV was 59 (53-65) years. The ALSFRS-R at start was 30 (24-37) (median, IQR), with three patients having severe bulbar impairment (ALSFRS-R-bulbar ≤ 9). The PaCO2 at start of NIV treatment was 48 (43-52) mmHg (median, IQR). During the one-year follow-up period, a significant decrease in the ALSFRS-R was observed. The impact of NIV in a short term (1 month) revealed a statistically significant decrease in ESS, decrease in total PSQI and of four PSQI subscales and improvement of almost all subscales of the McGill questionnaire. Long-term analyses (9 months to 1 year) revealed that amelioration in ESS and total PSQI was sustained. CONCLUSION We conclude that accurately titrated NIV in ALS patients can stabilize sleep quality and quality of life for at least one year, despite significant disease progression.
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Delanote I, Borzée P, Belge C, Buyse B, Testelmans D. Adherence to CPAP therapy: comparing the effect of three educational approaches in patients with obstructive sleep apnoea. Clin Respir J 2016; 12:91-96. [DOI: 10.1111/crj.12491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/19/2016] [Accepted: 04/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Isabelle Delanote
- Department of Pulmonology; University Hospital Gasthuisberg Leuven; Leuven Belgium
| | - Pascal Borzée
- Department of Pulmonology; University Hospital Gasthuisberg Leuven; Leuven Belgium
- Department of Pulmonology; Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg Leuven; Leuven Belgium
| | - Catharina Belge
- Department of Pulmonology; University Hospital Gasthuisberg Leuven; Leuven Belgium
- Department of Pulmonology; Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg Leuven; Leuven Belgium
| | - Bertien Buyse
- Department of Pulmonology; University Hospital Gasthuisberg Leuven; Leuven Belgium
- Department of Pulmonology; Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg Leuven; Leuven Belgium
| | - Dries Testelmans
- Department of Pulmonology; University Hospital Gasthuisberg Leuven; Leuven Belgium
- Department of Pulmonology; Louvain University Center for Sleep and wake disorders (LUCS), University Hospital Gasthuisberg Leuven; Leuven Belgium
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35
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Vrijsen B, Testelmans D, Belge C, Vanpee G, Van Damme P, Buyse B. Patient-ventilator asynchrony, leaks and sleep in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:343-50. [DOI: 10.3109/21678421.2016.1170149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Bart Vrijsen
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Faculty of Kinesiology and Rehabilitation Sciences – KU Leuven,
| | - Dries Testelmans
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
| | - Catharina Belge
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
| | - Goele Vanpee
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Faculty of Kinesiology and Rehabilitation Sciences – KU Leuven,
| | - Philip Van Damme
- Department of Neurology – University Hospitals Leuven,
- Department of Neurosciences, KU Leuven – University of Leuven, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), and
- Laboratory of Neurobiology, Vesalius Research Centre, VIB, Leuven, Belgium
| | - Bertien Buyse
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
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36
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Buyse B, Van Damme P, Belge C, Testelmans D. Possible influence of AMPD1 on cholinergic neurotransmission and sleep. J Sleep Res 2015; 25:124-6. [PMID: 26439223 DOI: 10.1111/jsr.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022]
Abstract
It is known that adenosine excess due to monophosphate deaminase deficiency (AMPD1) can be linked to muscle problems. Recently, Perumal et al., 2014 reported a first case of possible impact of AMPD1 on sleep, REM sleep and cholinergic neurotransmission. We report a second patient with similar sleep complaints: long sleep duration with residual daytime sleepiness and a need to sleep after exercise. On polysomnography we observed a long sleep duration, with high sleep efficiency and a SOREMP; on MSLT a shortened sleep latency and 4 SOREMPS were observed. Frequency power spectral heart rate analysis during slow wave sleep, REM sleep and wakefulness revealed an increased parasympathetic tone. In conclusion, AMPD1 could have a profound influence on cholinergic neurotransmission and sleep; further studies are mandatory.
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37
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Vrijsen B, Buyse B, Belge C, Robberecht W, Van Damme P, Decramer M, Testelmans D. Noninvasive ventilation improves sleep in amyotrophic lateral sclerosis: a prospective polysomnographic study. J Clin Sleep Med 2015; 11:559-66. [PMID: 25766713 DOI: 10.5664/jcsm.4704] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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: 09/18/2014] [Accepted: 01/26/2015] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of noninvasive ventilation (NIV) on sleep in patients with amyotrophic lateral sclerosis (ALS) after meticulous titration with polysomnography (PSG). METHODS In this prospective observational study, 24 ALS patients were admitted to the sleep laboratory during 4 nights for in-hospital NIV titration with PSG and nocturnal capnography. Questionnaires were used to assess subjective sleep quality and quality of life (QoL). Patients were readmitted after one month. RESULTS In the total group, slow wave sleep and REM sleep increased and the arousal-awakening index improved. The group without bulbar involvement (non-bulbar) showed the same improvements, together with an increase in sleep efficiency. Nocturnal oxygen and carbon dioxide levels improved in the total and non-bulbar group. Except for oxygen saturation during REM sleep, no improvement in respiratory function or sleep structure was found in bulbar patients. However, these patients showed less room for improvement. Patient-reported outcomes showed improvement in sleep quality and QoL for the total and non-bulbar group, while bulbar patients only reported improvements in very few subscores. CONCLUSIONS This study shows an improvement of sleep architecture, carbon dioxide, and nocturnal oxygen saturation at the end of NIV titration and after one month of NIV in ALS patients. More studies are needed to identify the appropriate time to start NIV in bulbar patients. Our results suggest that accurate titration of NIV by PSG improves sleep quality. COMMENTARY A commentary on this article appears in this issue on page 511.
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Affiliation(s)
- Bart Vrijsen
- Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.,Department of Pulmonology, University of Leuven, Belgium
| | - Bertien Buyse
- Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.,Department of Pulmonology, University of Leuven, Belgium
| | - Catharina Belge
- Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.,Department of Pulmonology, University of Leuven, Belgium
| | - Wim Robberecht
- Department of Neurology, University of Leuven, Belgium.,Experimental Neurology (Department of Neurosciences) and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven (KU Leuven), Belgium
| | - Philip Van Damme
- Department of Neurology, University of Leuven, Belgium.,Experimental Neurology (Department of Neurosciences) and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven (KU Leuven), Belgium.,Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium
| | - Marc Decramer
- Department of Pulmonology, University of Leuven, Belgium
| | - Dries Testelmans
- Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.,Department of Pulmonology, University of Leuven, Belgiumd
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38
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Vrijsen B, Buyse B, Belge C, Testelmans D. Upper airway obstruction during noninvasive ventilation induced by the use of an oronasal mask. J Clin Sleep Med 2014; 10:1033-5. [PMID: 25142771 DOI: 10.5664/jcsm.4046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In patients with neuromuscular disorders, no randomized studies have been performed whether nasal or oronasal masks should be preferred. Oronasal masks are often used in acute respiratory failure, while nasal masks are preferred in patients with chronic respiratory failure. However, the use of nasal masks can result in mouth leaks with implications on sleep quality. To reduce these leaks, oronasal masks have been applied during home noninvasive ventilation (NIV). Until now, upper airway obstruction during NIV has been thought to be induced by nasal obstruction, pharyngeal collapse, and/or glottis closure. We report a case indicating another cause of upper airway obstruction: use of an oronasal mask can induce obstructive events in the upper airways, possibly resulting in sleep fragmentation and decreased efficiency of NIV.
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M M Vanhoof J, Delcroix M, Vandevelde E, Denhaerynck K, Wuyts W, Belge C, Dobbels F. Emotional symptoms and quality of life in patients with pulmonary arterial hypertension. J Heart Lung Transplant 2014; 33:800-8. [PMID: 24854567 DOI: 10.1016/j.healun.2014.04.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/05/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited evidence exists on the nature and degree of emotional problems in pulmonary arterial hypertension (PAH) and their association with patients' health-related quality of life (HRQOL). METHODS This cross-sectional study examined the presence of depression, anxiety, and stress symptoms, and their association with disease-specific and generic HRQOL. A total of 101 patients (73% women) with PAH (age, 55.4 ± 16.4 years; 42.6% in New York Heart Association [NYHA] class II) completed the Depression, Anxiety, and Stress Scale, the generic Medical Outcomes Study Short-Form 36-Item (SF-36) Health Survey, and the disease-specific Minnesota Living With Heart Failure Questionnaire (MLHFQ) HRQOL instrument. The association between emotional problems and HRQOL was determined using multivariable linear regression analyses, controlling for demographic and disease-related characteristics. RESULTS Of the patients, 32.6%, 48%, and 27.6% experienced depressive, anxiety or stress symptoms, respectively. HRQOL was >1 standard deviation below population norms for the SF-36 Physical Component Summary. Depressive symptoms, NYHA class, and being disabled explained 46% of the total variance of the MLHFQ. Emotional problems did not contribute to the SF-36 Physical Component Summary but explained part of the variance of the physical sub-scales of the SF-36 role limitations due to physical problems, bodily pain, and general health. CONCLUSIONS The high presence of emotional problems warrants regular screening and appropriate psychotherapeutic and/or pharmacological treatment. Which strategies could improve PAH patients' HRQOL remains to be investigated.
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Affiliation(s)
- Jasper M M Vanhoof
- Health Services and Nursing Research, Department of Public Health and Primary Care
| | - Marion Delcroix
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Ellen Vandevelde
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | | | - Wim Wuyts
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Catharina Belge
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Fabienne Dobbels
- Health Services and Nursing Research, Department of Public Health and Primary Care.
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Belge C, Hammond J, Dubois-Deruy E, Manoury B, Hamelet J, Beauloye C, Markl A, Pouleur AC, Bertrand L, Esfahani H, Jnaoui K, Götz KR, Nikolaev VO, Vanderper A, Herijgers P, Lobysheva I, Iaccarino G, Hilfiker-Kleiner D, Tavernier G, Langin D, Dessy C, Balligand JL. Enhanced expression of β3-adrenoceptors in cardiac myocytes attenuates neurohormone-induced hypertrophic remodeling through nitric oxide synthase. Circulation 2013; 129:451-62. [PMID: 24190960 DOI: 10.1161/circulationaha.113.004940] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND β1-2-adrenergic receptors (AR) are key regulators of cardiac contractility and remodeling in response to catecholamines. β3-AR expression is enhanced in diseased human myocardium, but its impact on remodeling is unknown. METHODS AND RESULTS Mice with cardiac myocyte-specific expression of human β3-AR (β3-TG) and wild-type (WT) littermates were used to compare myocardial remodeling in response to isoproterenol (Iso) or Angiotensin II (Ang II). β3-TG and WT had similar morphometric and hemodynamic parameters at baseline. β3-AR colocalized with caveolin-3, endothelial nitric oxide synthase (NOS) and neuronal NOS in adult transgenic myocytes, which constitutively produced more cyclic GMP, detected with a new transgenic FRET sensor. Iso and Ang II produced hypertrophy and fibrosis in WT mice, but not in β3-TG mice, which also had less re-expression of fetal genes and transforming growth factor β1. Protection from Iso-induced hypertrophy was reversed by nonspecific NOS inhibition at low dose Iso, and by preferential neuronal NOS inhibition at high-dose Iso. Adenoviral overexpression of β3-AR in isolated cardiac myocytes also increased NO production and attenuated hypertrophy to Iso and phenylephrine. Hypertrophy was restored on NOS or protein kinase G inhibition. Mechanistically, β3-AR overexpression inhibited phenylephrine-induced nuclear factor of activated T-cell activation. CONCLUSIONS Cardiac-specific overexpression of β3-AR does not affect cardiac morphology at baseline but inhibits the hypertrophic response to neurohormonal stimulation in vivo and in vitro, through a NOS-mediated mechanism. Activation of the cardiac β3-AR pathway may provide future therapeutic avenues for the modulation of hypertrophic remodeling.
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Affiliation(s)
- Catharina Belge
- Institut de Recherche Expérimentale et Clinique (IREC), Pole of Pharmacology and Therapeutics (FATH), Université Catholique de Louvain, Brussels, Belgium (C.B., J. Hammond, E.D.-D., B.M., J. Hamelet, A.M., H.E., K.J., I.L., C.D., J.-L.B.); Pole of Cardiovascular Pathology and Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium (C.B., A.-C.P., L.B.); the Division of Cardiology and Pneumology, University of Goettingen, Goettingen, Germany (K.R.G., V.O.N.); the Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (A.V., P.H.); the Department of Medicine and Surgery, University of Salerno and RCCS "Multimedica," Milano, Italy (G.I.); Molecular Cardiology, Medizinische Hochschule Hannover, Germany (D.H.-K.); and Université Paul Sabatier, Inserm UMR 1048 - I2MC, Hôpitaux de Toulouse, France (G.T., D.L.)
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Muyldermans S, Vrijsen B, Decramer M, Belge C, Testelmans D, Buyse B. Pathological breathing patterns after pneumococcal rhombencephalitis. Respir Care 2013; 59:e84-8. [PMID: 24026190 DOI: 10.4187/respcare.02510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sophie Muyldermans
- Department of Pulmonary and Sleep Medicine, University Hospitals Leuven, Leuven, Belgium
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Declerck S, Testelmans D, Nafteux P, Coosemans W, Belge C, Decramer M, Buyse B, Buyse B. Diaphragm plication for unilateral diaphragm paralysis: a case report and review of the literature. Acta Clin Belg 2013; 68:311-5. [PMID: 24455805 DOI: 10.2143/acb.3307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/18/2022]
Abstract
Unilateral diaphragm paralysis is an often not recognised cause of dyspnoea. We present a patient with a unilateral phrenic nerve paralysis treated with diaphragmatic plication. Patient presented with life-style limiting dyspnoea and pulmonary function showed a decrease in FVC when lying down. Since there was no improvement after respiratory muscle training, plication of the hemidiaphragm was performed by a small thoracotomy. The patient improved with regard to respiratory complaints and lung function. Furthermore, we also demonstrate for the first time a significant improvement in exercise capacity with accompanying striking amelioration of quality of life. The patient is now in follow up up for more than 2 years and the impressive improvement in exercise capacity remains present. Surgical treatment of unilateral diaphragm paralysis has been described in case reports and in small series since 1985. Although comparison of the available data is difficult a diaphragm plication seems an effective and safe procedure for patients with symptomatic, acquired unilateral diaphragm paralysis. Improvement of dyspnoea is present in the majority of patients and we even observed an impressive amelioration in exercise capacity. Consequently, it seems appropriate to propose plication to patients with clear symptoms from the moment spontaneous recovery seems unlikely; yet, prospective randomised controlled studies are needed to prove this.
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Affiliation(s)
- S Declerck
- Respiratory Division, University of Leuven, Leuven, Belgium.
| | - D Testelmans
- Respiratory Division, University of Leuven, Leuven, Belgium
| | - Ph Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - W Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - C Belge
- Respiratory Division, University of Leuven, Leuven, Belgium
| | - M Decramer
- Respiratory Division, University of Leuven, Leuven, Belgium
| | - B Buyse
- Respiratory Division, University of Leuven, Leuven, Belgium
| | - B Buyse
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Vrijsen B, Testelmans D, Belge C, Robberecht W, Van Damme P, Buyse B. Non-invasive ventilation in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:85-95. [DOI: 10.3109/21678421.2012.745568] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Belge C, Delguste P, Mouchart F, Rodenstein D, Mwenge B. Obstructive apneas during continuous positive airway pressure: unexpected finding with nasal pillow interface. Am J Respir Crit Care Med 2012; 185:112-4. [PMID: 22210795 DOI: 10.1164/ajrccm.185.1.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schuchardt M, Toelle M, Huang T, Wiedon A, Van Der Giet M, Mill C, George S, Jeremy J, Santulli G, Illario M, Cipolletta E, Sorriento D, Del Giudice C, Anastasio A, Trimarco B, Iaccarino G, Jobs A, Wagner C, Kurtz A, De Wit C, Koller A, Suvorava T, Weber M, Dao V, Kojda G, Tsaousi A, Lyon C, Williams H, George S, Barth N, Loot A, Fleming I, Keul P, Lucke S, Graeler M, Heusch G, Levkau B, Biessen E, De Jager S, Bermudez-Pulgarin B, Bot I, Abia R, Van Berkel T, Renger A, Noack C, Zafiriou M, Dietz R, Bergmann M, Zelarayan L, Hammond J, Hamelet J, Van Assche T, Belge C, Vanderper A, Langin D, Herijgers P, Balligand J, Perrot A, Neubert M, Dietz R, Posch M, Oezcelik C, Posch M, Waldmuller S, Perrot A, Berger F, Scheffold T, Bouvagnet P, Ozcelik C, Lebreiro A, Martins E, Lourenco P, Cruz C, Martins M, Bettencourt P, Maciel M, Abreu-Lima C, Pilichou K, Bauce B, Rampazzo A, Carturan E, Corrado D, Thiene G, Basso C, Piccini I, Fortmueller L, Kuhlmann M, Schaefers M, Carmeliet P, Kirchhof P, Fabritz L, Sanchez J, Rodriguez-Sinovas A, Agullo E, Garcia-Dorado D, Lymperopoulos A, Rengo G, Gao E, Zincarelli C, Koch W, Fontes-Sousa A, Silva S, Gomes M, Ferreira P, Leite-Moreira A, Capuano V, Ferron L, Ruchon Y, Ben Mohamed F, Renaud JF, Morgan P, Falcao-Pires I, Goncalves N, Gavina C, Pinho S, Moura C, Amorim M, Pinho P, Leite-Moreira A, Christ T, Molenaar P, Diez A, Ravens U, Kaumann A, Kletsiou E, Giannakopoulou M, Bozas E, Iliodromitis E, Anastasiou-Nana M, Papathanassoglou E, Chottova Dvorakova M, Mistrova E, Perez N, Slavikova J, Hynie S, Sida P, Klenerova V, Massaro M, Scoditti E, Carluccio M, Storelli C, Distante A, De Caterina R, Cingolani H, Zakrzewicz A, Hoffmann C, Hohberg M, Chlench S, Maroski J, Drab M, Siegel G, Pries A, Farrell K, Holt C, Zahradnikova A, Schrot G, Ibatov A, Wilck N, Fechner M, Arias A, Meiners S, Baumann G, Stangl V, Stangl K, Ludwig A, Polakova E, Christ A, Eijgelaar W, Daemen M, Li X, Penfold M, Schall T, Weber C, Schober A, Hintenberger R, Kaun C, Zahradnik I, Pfaffenberger S, Maurer G, Huber K, Wojta J, Demyanets S, Titov V, Nazari-Jahantigh M, Weber C, Schober A, Chin-Dusting J, Zahradnikova A, Vaisman B, Khong S, Remaley A, Andrews K, Hoeper A, Khalid A, Fuglested B, Aasum E, Larsen T, Titov V, Fluschnik N, Carluccio M, Scoditti E, Massaro M, Storelli C, Distante A, De Caterina R, Diebold I, Petry A, Djordjevic T, Belaiba R, Sossalla S, Fratz S, Hess J, Kietzmann T, Goerlach A, O'shea K, Chess D, Khairallah R, Walsh K, Stanley W, Falcao-Pires I, Ort K, Goncalves N, Van Der Velden J, Moreira-Goncalves D, Paulus W, Niessen H, Perlini S, Leite-Moreira A, Azibani F, Tournoux F, Fazal L, Neef S, Polidano E, Merval R, Chatziantoniou C, Samuel J, Delcayre C, Azibani F, Tournoux F, Fazal L, Polidano E, Merval R, Hasenfuss G, Chatziantoniou C, Samuel J, Delcayre C, Mgandela P, Brooksbank R, Maswanganyi T, Woodiwiss A, Norton G, Makaula S, Sartiani L, Maier L, Bucciantini M, Spinelli V, Coppini R, Russo E, Mugelli A, Cerbai E, Stefani M, Sukumaran V, Watanabe K, Ma M, Weinert S, Thandavarayan R, Azrozal W, Sari F, Shimazaki H, Kobayashi Y, Roleder T, Golba K, Deja M, Malinowski M, Wos S, Poitz D, Stieger P, Grebe M, Tillmanns H, Preissner K, Sedding D, Ercan E, Guven A, Asgun F, Ickin M, Ercan F, Herold J, Kaplan A, Yavuz O, Bagla S, Yang Y, Ma Y, Liu F, Li X, Huang Y, Kuka J, Vilskersts R, Schmeisser A, Vavers E, Liepins E, Dambrova M, Mariero L, Rutkovskiy A, Stenslokken K, Vaage J, Duerr G, Suchan G, Heuft T, Strasser J, Klaas T, Zimmer A, Welz A, Fleischmann B, Dewald O, Voelkl J, Haubner B, Kremser C, Mayr A, Klug G, Braun-Dullaeus R, Reiner M, Pachinger O, Metzler B, Pisarenko O, Shulzhenko V, Pelogeykina Y, Khatri D, Studneva I, Barnucz E, Loganathan S, Nazari-Jahantigh M, Hirschberg K, Korkmaz S, Merkely B, Karck M, Szabo G, Bencsik P, Gorbe A, Kocsis G, Csonka C, Csont T, Weber C, Shamloo M, Woodburn K, Ferdinandy P, Szucs G, Kupai K, Csonka C, Csont C, Ferdinandy P, Kocsisne Fodor G, Bencsik P, Schober A, Fekete V, Varga Z, Monostori P, Turi S, Ferdinandy P, Csont T, Leuner A, Eichhorn B, Ravens U, Morawietz H, Babes E, Babes V, Popescu M, Ardelean A, Rus M, Bustea C, Gwozdz P, Csanyi G, Luzak B, Gajda M, Mateuszuk L, Chmura-Skirlinska A, Watala C, Chlopicki S, Kierzkowska I, Sulicka J, Kwater A, Strach M, Surdacki A, Siedlar M, Grodzicki T, Olieslagers S, Pardali L, Tchaikovski V, Ten Dijke P, Waltenberger J, Renner M, Redwan B, Winter M, Panzenboeck A, Jakowitsch J, Sadushi-Kolici R, Bonderman D, Lang I, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Oliviero C, Bellandi F, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Casprini P, Bellandi F, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Amato M, Bellandi F, Molins B, Pena E, Badimon L, Ferreiro Gutierrez J, Ueno M, Alissa R, Dharmashankar K, Capodanno D, Desai B, Bass T, Angiolillo D, Chabielska E, Gromotowicz A, Szemraj J, Stankiewicz A, Zakrzeska A, Mohammed S, Molla F, Soldo A, Russo I, Germano G, Balconi G, Staszewsky L, Latini R, Lynch F, Austin C, Prendergast B, Keenan D, Malik R, Izzard A, Heagerty A, Czikora A, Lizanecz E, Rutkai I, Boczan J, Porszasz R, Papp Z, Edes I, Toth A, Colantuoni A, Vagnani S, Lapi D, Maroz-Vadalazhskaya N, Koslov I, Shumavetz V, Glibovskaya T, Ostrovskiy Y, Koutsiaris A, Tachmitzi S, Kotoula M, Giannoukas A, Tsironi E, Rutkai I, Czikora A, Darago A, Orosz P, Megyesi Z, Edes I, Papp Z, Toth A, Eichhorn B, Schudeja S, Matschke K, Deussen A, Ravens U, Castro M, Cena J, Walsh M, Schulz R, Poddar K, Rha S, Ramasamy S, Park J, Choi C, Seo H, Park C, Oh D, Lebreiro A, Martins E, Almeida J, Pimenta S, Bernardes J, Machado J, Abreu-Lima C, Sabatasso S, Laissue J, Hlushchuk R, Brauer-Krisch E, Bravin A, Blattmann H, Michaud K, Djonov V, Hirschberg K, Tarcea V, Pali S, Korkmaz S, Loganathan S, Merkely B, Karck M, Szabo G, Pagliani L, Faggin E, Rattazzi M, Puato M, Presta M, Grego F, Deriu G, Pauletto P, Kaiser R, Albrecht K, Schgoer W, Theurl M, Beer A, Wiedemann D, Steger C, Bonaros N, Kirchmair R, Kharlamov A, Cabaravdic M, Breuss J, Uhrin P, Binder B, Fiordaliso F, Balconi G, Mohammed S, Maggioni M, Biondi A, Masson S, Cervo L, Latini R, Francke A, Herold J, Soenke W, Strasser R, Braun-Dullaeus R, Hecht N, Vajkoczy P, Woitzik J, Hackbusch D, Gatzke N, Duelsner A, Tsuprykov O, Slavic S, Buschmann I, Kappert K, Massaro M, Scoditti E, Carluccio M, Storelli C, Distante A, De Caterina R, Barandi L, Harmati G, Simko J, Horvath B, Szentandrassy N, Banyasz T, Magyar J, Nanasi P, Kaya A, Uzunhasan I, Yildiz A, Yigit Z, Turkoglu C, Doisne N, Zannad N, Hivert B, Cosnay P, Maupoil V, Findlay I, Virag L, Kristof A, Koncz I, Szel T, Jost N, Biliczki P, Papp J, Varro A, Bukowska A, Skopp K, Hammwoehner M, Huth C, Bode-Boeger S, Goette A, Workman A, Dempster J, Marshall G, Rankin A, Revnic C, Ginghina C, Revnic F, Yakushev S, Petrushanko I, Makhro A, Segato Komniski M, Mitkevich V, Makarov A, Gassmann M, Bogdanova A, Rutkovskiy A, Mariero L, Stenslokken K, Valen G, Vaage J, Dizayee S, Kaestner S, Kuck F, Piekorz R, Hein P, Matthes J, Nurnberg B, Herzig S, Hertel F, Switalski A, Bender K, Kienitz MC, Pott L, Fornai L, Angelini A, Erika Amstalden Van Hove E, Fedrigo M, Thiene G, Heeren R, Kruse M, Pongs O, Lehmann H, Martens-Lobenhoffer J, Hammwoehner M, Roehl F, Bukowska A, Bode-Boeger S, Goette A, Radicke S, Cotella C, Sblattero D, Schaefer M, Ravens U, Wettwer E, Santoro C, Seyler C, Kulzer M, Zitron E, Scholz E, Welke F, Thomas D, Karle C, Schmidt K, Radicke S, Dobrev D, Ravens U, Wettwer E, Houshmand N, Menesi D, Ravens U, Wettwer E, Cotella D, Papp J, Varro A, Szuts V, Szuts V, Houshmand N, Puskas L, Jost N, Virag L, Kiss I, Deak F, Varro A, Tereshchenko S, Gladyshev M, Kalachova G, Syshchik N, Gogolashvili N, Dedok E, Evert L, Wenzel J, Brandenburger M, Bogdan R, Richardt D, Reppel M, Hescheler J, Dendorfer A, Terlau H, Wiegerinck R, Galvez-Monton C, Jorge E, Martinez R, Ricart E, Cinca J, Bagavananthem Andavan G, Lemmens Gruber R, Brack K, Coote J, Ng G, Daimi H, Haj Khelil A, Neji A, Ben Hamda K, Maaoui S, Aranega A, Chibani J, Franco Jaime D, Tanko AS, Brack K, Coote J, Ng G, Doisne N, Hivert B, Cosnay P, Findlay I, Maupoil V, Daniel JM, Bielenberg W, Stieger P, Tillmanns H, Sedding D, Fortini C, Toffoletto B, Fucili A, Beltrami A, Fiorelli V, Francolini G, Ferrari R, Beltrami C, Castellani C, Ravara B, Tavano R, Thiene G, Vettor R, De Coppi P, Papini E, Angelini A, Molla F, Soldo A, Biondi A, Staszewsky L, Russo I, Gunetti M, Fagioli F, Latini R, Suffredini S, Sartiani L, Stillitano F, Mugelli A, Cerbai E, Krausgrill B, Halbach M, Soemantri S, Schenk K, Lange N, Hescheler J, Saric T, Muller-Ehmsen J, Kavanagh D, Zhao Y, Yemm A, Kalia N, Wright E, Farrell K, Wallrapp C, Geigle P, Lewis A, Stratford P, Malik N, Holt C, Krausgrill B, Raths M, Halbach M, Schenk K, Hescheler J, Muller-Ehmsen J, Zagallo M, Luni C, Serena E, Cimetta E, Zatti S, Giobbe G, Elvassore N, Serena E, Cimetta E, Zaglia T, Zatti S, Zambon A, Gordon K, Elvassore N, Mioulane M, Foldes G, Ali N, Harding S, Gorbe A, Szunyog A, Varga Z, Pirity M, Rungaruniert S, Dinnyes A, Csont T, Ferdinandy P, Foldes G, Mioulane M, Iqbal A, Schneider MD, Ali N, Harding S, Babes E, Babes V, Khodjaeva E, Ibadov R, Khalikulov K, Mansurov A, Astvatsatryan A, Senan M, Astvatsatryan A, Senan M, Nemeth A, Lenkey Z, Ajtay Z, Cziraki A, Sulyok E, Horvath I, Lobenhoffer J, Bode-Boger S, Li J, He Y, Yang X, Wang F, Xu H, Li X, Zhao X, Lin Y, Juszynski M, Ciszek B, Jablonska A, Stachurska E, Ratajska A, Atkinson A, Inada S, Li J, Sleiman R, Zhang H, Boyett M, Dobrzynski H, Fedorenko O, Hao G, Atkinson A, Yanni J, Buckley D, Anderson R, Boyett M, Dobrzynski H, Ma Y, Ma X, Hu Y, Yang Y, Huang D, Liu F, Huang Y, Liu C, Jedrzejczyk T, Balwicki L, Wierucki L, Zdrojewski T, Makhro A, Agarkova I, Vogel J, Gassmann M, Bogdanova A, Korybalska K, Pyda M, Witowski J, Ibatov A, Sozmen N, Seymen A, Tuncay E, Turan B, Huang Y, Ma Y, Yang Y, Liu F, Chen B, Li X, Houston-Feenstra L, Chiong JR, Jutzy K, Furundzija V, Kaufmann J, Kappert K, Meyborg H, Fleck E, Stawowy P, Ksiezycka-Majczynska E, Lubiszewska B, Kruk M, Kurjata P, Ruzyllo W, Ibatov A, Driesen R, Coenen T, Fagard R, Sipido K, Petrov V, Aksentijevic D, Lygate C, Makinen K, Sebag-Montefiore L, Medway D, Schneider J, Neubauer S, Gasser R, Holzwart E, Rainer P, Von Lewinski D, Maechler H, Gasser S, Roessl U, Pieske B, Krueger J, Kintscher U, Kappert K, Podramagi T, Paju K, Piirsoo A, Roosimaa M, Kadaja L, Orlova E, Ruusalepp A, Seppet E, Auquier J, Ginion A, Hue L, Horman S, Beauloye C, Vanoverschelde J, Bertrand L, Fekete V, Zvara A, Pipis J, Konya C, Csonka C, Puskas L, Csont T, Ferdinandy P, Gasser S, Rainer P, Holzwart E, Roessl U, Kraigher-Krainer E, Von Lewinksi D, Pieske B, Gasser R, Gonzalez-Loyola A, Barba I, Rodriguez-Sinovas A, Fernandez-Sanz C, Agullo E, Ruiz-Meana M, Garcia-Dorado D, Forteza M, Bodi Peris V, Monleon D, Mainar L, Morales J, Moratal D, Trapero I, Chorro F, Leszek P, Sochanowicz B, Szperl M, Kolsut P, Piotrowski W, Rywik T, Danko B, Kruszewski M, Stanley W, Khairallah R, Khanna N, O'shea K, Kristian T, Hecker P, Des Rosiers R, Fiskum G, Fernandez-Alfonso M, Guzman-Ruiz R, Somoza B, Gil-Ortega M, Attane C, Castan-Laurell I, Valet P, Ruiz-Gayo M, Maroz-Vadalazhskaya N, Denissevich T, Shumavetz V, Ostrovskiy Y, Schrepper A, Schwarzer M, Amorim P, Schoepe M, Mohr F, Doenst T, Chiellini G, Ghelardoni S, Saba A, Marchini M, Frascarelli S, Raffaelli A, Scanlan T, Zucchi R, Van Den Akker N, Molin D, Kolk F, Jeukens F, Olde Engberink R, Waltenberger J, Post M, Van Den Akker N, Molin D, Verbruggen S, Schulten H, Post M, Waltenberger J, Rochais F, Kelly R, Aberg M, Johnell M, Wickstrom M, Siegbahn A, Dimitrakis P, Groppalli V, Ott D, Seifriz F, Suter T, Zuppinger C, Kashcheyeu Y, Mueller R, Wiesen M, Saric T, Gruendemann D, Hescheler J, Herzig S, Falcao-Pires I, Fontes-Sousa A, Lopes-Conceicao L, Bras-Silva C, Leite-Moreira A, Bukauskas F, Palacios-Prado N, Norheim F, Raastad T, Thiede B, Drevon C, Haugen F, Lindner D, Westermann D, Zietsch C, Schultheiss HP, Tschoepe C, Horn M, Graham H, Hall M, Richards M, Clarke J, Dibb K, Trafford A, Cheng CF, Lin H, Eigeldiger-Berthou S, Buntschu P, Frobert A, Flueck M, Tevaearai H, Kadner A, Mikhailov A, Torrado M, Centeno A, Lopez E, Lourido L, Castro Beiras A, Popov T, Srdanovic I, Petrovic M, Canji T, Kovacevic M, Jovelic A, Sladojevic M, Panic G, Kararigas G, Fliegner D, Regitz-Zagrosek V, De La Rosa Sanchez A, Dominguez J, Sedmera D, Franco D, Aranega A, Medunjanin S, Burgbacher F, Schmeisser A, Strasser R, Braun-Dullaeus R, Li X, Ma Y, Yang Y, Liu F, Han W, Chen B, Zhang J, Gao X, Bayliss C, Song W, Stuckey D, Dyer E, Leung MC, Monserrat L, Marston S, Sorriento D, Santulli G, Fusco A, Trimarco B, Iaccarino G, Revnic C, Ginghina C, Revnic F, Paillard M, Liang J, Strub G, Gomez L, Hait N, Allegood J, Lesnefsky E, Spiegel S, Zuchi C, Coiro S, Bettini M, Ciliberti G, Mancini I, Tritto I, Becker L, Ambrosio G, Adam T, Sharp S, Opie L, Lecour S, Khaliulin I, Parker J, Halestrap A, Kandasamy A, Schulz R, Schoepe M, Schwarzer M, Schrepper A, Osterholt M, Amorim P, Mohr F, Doenst T, Fernandez-Sanz C, Ruiz-Meana M, Miro-Casas E, Agullo E, Boengler K, Schulz R, Garcia-Dorado D, Menazza S, Canton M, Sheeran F, Di Lisa F, Pepe S, Borchi E, Manni M, Bargelli V, Giordano C, D'amati G, Cerbai E, Nediani C, Raimondi L, Micova P, Balkova P, Kolar F, Neckar J, Novak F, Novakova O, Schuchardt M, Toelle M, Pruefer N, Pruefer J, Jankowski V, Jankowski J, Van Der Giet M, Han W, Su Y, Zervou S, Aksentijevic D, Lygate C, Neubauer S, Seidel B, Korkmaz S, Radovits T, Hirschberg K, Loganathan S, Barnucz E, Karck M, Szabo G, Aggeli I, Kefaloyianni E, Beis I, Gaitanaki C, Lacerda L, Somers S, Opie L, Lecour S, Brack K, Coote J, Ng G, Paur H, Nikolaev V, Lyon A, Harding S, Bras-Silva C. Sunday, 18 July 2010. Cardiovasc Res 2010. [DOI: 10.1093/cvr/cvq176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moniotte S, Belge C, Sekkali B, Massion PB, Rozec B, Dessy C, Balligand JL. Sepsis is associated with an upregulation of functional beta3 adrenoceptors in the myocardium. Eur J Heart Fail 2007; 9:1163-71. [PMID: 17999941 DOI: 10.1016/j.ejheart.2007.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 03/08/2007] [Revised: 09/21/2007] [Accepted: 10/18/2007] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To analyze the implication of the beta3-adrenoceptor (beta3-AR) pathway in human septic myocardium and a murine model of sepsis, a condition associated with myocardial depression. METHODS AND RESULTS beta3-AR and eNOS protein abundance were increased (332+/-66.4% and 218+/-39.3; P<0.05) in hearts from septic patients. The effect of BRL37344, a beta3-AR-preferential agonist, was analyzed by videomicroscopy on the contractility of neonatal mouse ventricular myocytes (NMVM) incubated with conditioned medium from LPS-stimulated cultured macrophages (Mc-LPS+ medium). Stimulation of untreated NMVM with BRL37344 dose-dependently decreased the amplitude of contractile shortening (P<0.05). This response was abolished by L-NAME (NOS inhibitor). Incubation in Mc-LPS+ medium potentiated the depressing effect of BRL37344 (P<0.05) as well as of SR58611A (P<0.05) in wild-type myocytes. Importantly, the contractile depression was abrogated in cardiomyocytes from beta3-AR KO mice. CONCLUSIONS beta3-AR are upregulated during sepsis in the human myocardium and by cytokines in murine cardiomyocytes, where they mediate an increased negative inotropic response to beta3 agonists. Activation of the beta3-AR pathway by catecholamines may contribute to the myocardial dysfunction in sepsis.
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Affiliation(s)
- S Moniotte
- Unit of Pharmacology and Therapeutics, FATH 5349, Université Catholique de Louvain, Brussels, Belgium
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Dessy C, Saliez J, Ghisdal P, Daneau G, Lobysheva II, Frérart F, Belge C, Jnaoui K, Noirhomme P, Feron O, Balligand JL. Endothelial beta3-adrenoreceptors mediate nitric oxide-dependent vasorelaxation of coronary microvessels in response to the third-generation beta-blocker nebivolol. Circulation 2006; 112:1198-205. [PMID: 16116070 DOI: 10.1161/circulationaha.104.532960] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [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: 12/20/2022]
Abstract
BACKGROUND The therapeutic effects of nonspecific beta-blockers are limited by vasoconstriction, thus justifying the interest in molecules with ancillary vasodilating properties. Nebivolol is a selective beta1-adrenoreceptor antagonist that releases nitric oxide (NO) through incompletely characterized mechanisms. We identified endothelial beta3-adrenoreceptors in human coronary microarteries that mediate endothelium- and NO-dependent relaxation and hypothesized that nebivolol activates these beta3-adrenoreceptors. METHODS AND RESULTS Nebivolol dose-dependently relaxed rodent coronary resistance microarteries studied by videomicroscopy (10 micromol/L, -86+/-6% of prostaglandin F2alpha contraction); this was sensitive to NO synthase (NOS) inhibition, unaffected by the beta(1-2)-blocker nadolol, and prevented by the beta(1-2-3)-blocker bupranolol (P<0.05; n=3 to 8). Importantly, nebivolol failed to relax microarteries from beta3-adrenoreceptor-deficient mice. Nebivolol (10 micromol/L) also relaxed human coronary microvessels (-71+/-5% of KCl contraction); this was dependent on a functional endothelium and NO synthase but insensitive to beta(1-2)-blockade (all P<0.05). In a mouse aortic ring assay of neoangiogenesis, nebivolol induced neocapillary tube formation in rings from wild-type but not beta3-adrenoreceptor- or endothelial NOS-deficient mice. In cultured endothelial cells, 10 micromol/L nebivolol increased NO release by 200% as measured by electron paramagnetic spin trapping, which was also reversed by NOS inhibition. In parallel, endothelial NOS was dephosphorylated on threonine(495), and fura-2 calcium fluorescence increased by 91.8+/-23.7%; this effect was unaffected by beta(1-2)-blockade but abrogated by beta(1-2-3)-blockade (all P<0.05). CONCLUSIONS Nebivolol dilates human and rodent coronary resistance microarteries through an agonist effect on endothelial beta3-adrenoreceptors to release NO and promote neoangiogenesis. These properties may prove particularly beneficial for the treatment of ischemic and cardiac failure diseases through preservation of coronary reserve.
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Affiliation(s)
- Chantal Dessy
- Université Catholique de Louvain Medical School, Brussels, Belgium
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Abstract
The role of nitric oxide (NO) as a regulator of cardiac contraction was suggested in the early nineties, but a consensual view of its main functions in cardiac physiology has only recently emerged with the help of experiments using genetic deletion or overexpression of the three nitric oxide synthase (NOS) isoforms in cardiomyocytes. Contrary to the effects of exogenous, pharmacologic NO donors, signaling by endogenous NO is restricted to intracellular effectors co-localized with NOS in specific subcellular compartments. This both ensures coordinate signaling by the three NOS isoforms on different aspects of the cardiomyocyte function and helps to reconcile previous apparently contradictory observations based on the use of non-isoform-specific NOS inhibitors. This review will emphasize the role of NOS on excitation-contraction coupling in the normal and diseased heart. Endothelial NOS and neuronal NOS contribute to maintain an adequate balance between adrenergic and vagal input to the myocardium and participate in the early and late phases of the Frank-Starling adaptation of the heart. At the early phases of cardiac diseases, inducible NOS reinforces these effects, which may become maladaptive as disease progresses.
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Affiliation(s)
- C Belge
- Department of Pharmacology and Therapeutics, Université Catholique de Louvain, Brussels 1200, Belgium
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Massion PB, Pelat M, Belge C, Balligand JL. Regulation of the mammalian heart function by nitric oxide. Comp Biochem Physiol A Mol Integr Physiol 2005; 142:144-50. [PMID: 15985381 DOI: 10.1016/j.cbpb.2005.05.048] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 05/24/2005] [Accepted: 05/24/2005] [Indexed: 11/23/2022]
Abstract
The mammalian heart expresses all three isoforms of nitric oxide synthases (NOS) in diverse cell types of the myocardium. Despite their apparent promiscuity, the NOS isoforms support specific signaling because of their subcellular compartmentation with colocalized effectors and limited diffusibility of NO in muscle cells. eNOS and nNOS sustain normal EC coupling and contribute to the early and late phases of the Frank-Starling mechanism of the heart. They also attenuate the beta1-/beta2-adrenergic increase in inotropy and chronotropy, and reinforce the pre- and post-synaptic vagal control of cardiac contraction. By doing so, the NOS protect the heart against excessive stimulation by catecholamines, just as an "endogenous beta-blocker". In the ischemic and failing myocardium, induced iNOS further reinforces this effect, as does eNOS coupled to overexpressed beta3-adrenoceptors. nNOS expression also increases in the aging and infarcted heart, but its role (compensatory or deleterious) is less clear. In addition to their direct regulation of contractility, the NOS modulate oxygen consumption, substrate utilization, sensitivity to apoptosis, hypertrophy and regenerative potential, all of which illustrate the pleiotropic effects of this radical on the cardiac cell biology.
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Affiliation(s)
- Paul B Massion
- Unit of Pharmacology and Therapeutics, FATH 5349, Université catholique de Louvain, Tour Pasteur +2, 53 Avenue E. Mounier, 1200 Brussels, Belgium
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Massion PB, Dessy C, Desjardins F, Pelat M, Havaux X, Belge C, Moulin P, Guiot Y, Feron O, Janssens S, Balligand JL. Cardiomyocyte-restricted overexpression of endothelial nitric oxide synthase (NOS3) attenuates beta-adrenergic stimulation and reinforces vagal inhibition of cardiac contraction. Circulation 2004; 110:2666-72. [PMID: 15492314 DOI: 10.1161/01.cir.0000145608.80855.bc] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [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: 11/16/2022]
Abstract
BACKGROUND In the heart, nitric oxide synthases (NOS) modulate cardiac contraction in an isoform-specific manner, which is critically dependent on their cellular and subcellular localization. Defective NO production by NOS3 (endothelial NOS [eNOS]) in the failing heart may precipitate cardiac failure, which could be reversed by overexpression of NOS3 in the myocardium. METHODS AND RESULTS We studied the influence of NOS3 in relation to its subcellular localization on the function of cardiomyocytes isolated from transgenic mice overexpressing NOS3 under the alpha-myosin heavy chain promoter (NOS3-TG). Immunoblot analysis demonstrated moderate (5-fold) NOS3 overexpression in cardiomyocytes from NOS3-TG heterozygotes. Caveolar localization of transgenic eNOS was demonstrated by immunofluorescence, coimmunoprecipitation with caveolin-3, sucrose gradient fractionation, and immunogold staining revealed by electron microscopy. Compared with wild-type littermate, contractility of NOS3-TG cardiomyocytes analyzed by videomicroscopy revealed a lower incidence of spontaneous arrhythmic contractions (n=32, P<0.001); an attenuation of the beta-adrenergic positive inotropic response (isoproterenol, 10(-7) mol/L: 62.1+/-7.8% versus 90.8+/-8.0% of maximum Ca2+ response; n=10 to 17; P<0.05); a potentiation of the muscarinic negative chronotropic response (carbamylcholine, 3.10(-8) mol/L: -63.9+/-14% versus -27.7+/-5.6% of basal rate; n=8 to 10; P<0.05), confirmed by telemetry in vivo; and an attenuation of the accentuated antagonism of beta-adrenergically stimulated contraction (-14.6+/-1.5% versus -3.5+/-1.5; n=7 to 11; P<0.05). Cardiomyocyte NOS inhibition reversed all 4 effects (P<0.05). CONCLUSIONS Moderate overexpression of NOS3, targeted to caveolae in murine cardiomyocytes, potentiates the postsynaptic muscarinic response and attenuates the effect of high concentrations of catecholamines. Cardiomyocyte NOS3 may represent a promising therapeutic target to restore the sympathovagal balance and protect the heart against arrhythmia.
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Affiliation(s)
- Paul B Massion
- Unit of Pharmacology and Therapeutics, Université Catholique de Louvain, Brussels, Belgium
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