1
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Lozano-Rodríguez R, Avendaño-Ortíz J, Montalbán-Hernández K, Ruiz-Rodríguez JC, Ferrer R, Martín-Quirós A, Maroun-Eid C, González-López JJ, Fàbrega A, Terrón-Arcos V, Gutiérrez-Fernández M, Alonso-López E, Cubillos-Zapata C, Fernández-Velasco M, Pérez de Diego R, Pelegrin P, García-Palenciano C, Cueto FJ, Del Fresno C, López-Collazo E. The prognostic impact of SIGLEC5-induced impairment of CD8 + T cell activation in sepsis. EBioMedicine 2023; 97:104841. [PMID: 37890368 PMCID: PMC10630607 DOI: 10.1016/j.ebiom.2023.104841] [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: 06/21/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Sepsis is associated with T-cell exhaustion, which significantly reduces patient outcomes. Therefore, targeting of immune checkpoints (ICs) is deemed necessary for effective sepsis management. Here, we evaluated the role of SIGLEC5 as an IC ligand and explored its potential as a biomarker for sepsis. METHODS In vitro and in vivo assays were conducted to both analyse SIGLEC5's role as an IC ligand, as well as assess its impact on survival in sepsis. A multicentre prospective cohort study was conducted to evaluate the plasmatic soluble SIGLEC5 (sSIGLEC5) as a mortality predictor in the first 60 days after admission in sepsis patients. Recruitment included sepsis patients (n = 346), controls with systemic inflammatory response syndrome (n = 80), aneurism (n = 11), stroke (n = 16), and healthy volunteers (HVs, n = 100). FINDINGS SIGLEC5 expression on monocytes was increased by HIF1α and was higher in septic patients than in healthy volunteers after ex vivo LPS challenge. Furthermore, SIGLEC5-PSGL1 interaction inhibited CD8+ T-cell proliferation. Administration of sSIGLEC5r (0.8 mg/kg) had adverse effects in mouse endotoxemia models. Additionally, plasma sSIGLEC5 levels of septic patients were higher than HVs and ROC analysis revealed it as a mortality marker with an AUC of 0.713 (95% CI, 0.656-0.769; p < 0.0001). Kaplan-Meier survival curve showed a significant decrease in survival above the calculated cut-off (HR of 3.418, 95% CI, 2.380-4.907, p < 0.0001 by log-rank test) estimated by Youden Index (523.6 ng/mL). INTERPRETATION SIGLEC5 displays the hallmarks of an IC ligand, and plasma levels of sSIGLEC5 have been linked with increased mortality in septic patients. FUNDING Instituto de Salud Carlos III (ISCIII) and "Fondos FEDER" to ELC (PIE15/00065, PI18/00148, PI14/01234, PI21/00869), CDF (PI21/01178), RLR (FI19/00334) and JAO (CD21/00059).
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Affiliation(s)
- Roberto Lozano-Rodríguez
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; Tumour Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - José Avendaño-Ortíz
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; Tumour Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; CIBER of Respiratory Diseases (CIBERES), Avenida de Monforte de Lemos, 3-5, Madrid 28029, Spain
| | - Karla Montalbán-Hernández
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; Tumour Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Juan Carlos Ruiz-Rodríguez
- Intensive Care Department, Vall d'Hebron University Hospital, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Institute of Research and Medicine Department, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Ricardo Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Institute of Research and Medicine Department, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Alejandro Martín-Quirós
- Emergency Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Charbel Maroun-Eid
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; Emergency Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Juan José González-López
- Microbiology Department, Vall d'Hebron University Hospital and Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Anna Fàbrega
- Microbiology Department, Vall d'Hebron University Hospital and Faculty of Health Sciences, University of Vic - Central University of Catalonia (UVic-UCC), Manresa, Spain
| | - Verónica Terrón-Arcos
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; Tumour Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - María Gutiérrez-Fernández
- Department of Neurology and Stroke Centre, Neuroscience and Cerebrovascular Research Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Elisa Alonso-López
- Department of Neurology and Stroke Centre, Neuroscience and Cerebrovascular Research Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | | | - María Fernández-Velasco
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Rebeca Pérez de Diego
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Pablo Pelegrin
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), CIBERehd, Clinical University Hospital Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, El Palmar, Murcia 30120, Spain
| | - Carlos García-Palenciano
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), CIBERehd, Clinical University Hospital Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, El Palmar, Murcia 30120, Spain
| | - Francisco J Cueto
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; Tumour Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Carlos Del Fresno
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; Tumour Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Eduardo López-Collazo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; Tumour Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain; CIBER of Respiratory Diseases (CIBERES), Avenida de Monforte de Lemos, 3-5, Madrid 28029, Spain.
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2
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Avendaño-Ortiz J, Lozano-Rodríguez R, Martín-Quirós A, Terrón V, Maroun-Eid C, Montalbán-Hernández K, Valentín-Quiroga J, García-Garrido MÁ, Del Val EM, Del Balzo-Castillo Á, Peinado M, Gómez L, Herrero-Benito C, Rubio C, Casalvilla-Dueñas JC, Gómez-Campelo P, Pascual-Iglesias A, Del Fresno C, Aguirre LA, López-Collazo E. The immune checkpoints storm in COVID-19: Role as severity markers at emergency department admission. Clin Transl Med 2021; 11:e573. [PMID: 34709745 PMCID: PMC8521292 DOI: 10.1002/ctm2.573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/13/2021] [Accepted: 09/02/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- José Avendaño-Ortiz
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Roberto Lozano-Rodríguez
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Alejandro Martín-Quirós
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Verónica Terrón
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Charbel Maroun-Eid
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Karla Montalbán-Hernández
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Jaime Valentín-Quiroga
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Miguel Ángel García-Garrido
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Elena Muñoz Del Val
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Álvaro Del Balzo-Castillo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - María Peinado
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Laura Gómez
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Carmen Herrero-Benito
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Carolina Rubio
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - José Carlos Casalvilla-Dueñas
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Paloma Gómez-Campelo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Biobank Platform, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Alejandro Pascual-Iglesias
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Carlos Del Fresno
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Luis A Aguirre
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Eduardo López-Collazo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain.,CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
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3
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Núñez-Gil IJ, Olier I, Feltes G, Viana-Llamas MC, Maroun-Eid C, Romero R, Fernández-Rozas I, Uribarri A, Becerra-Muñoz VM, Alfonso-Rodriguez E, García-Aguado M, Elola J, Castro-Mejía A, Pepe M, Garcia-Prieto JF, Gonzalez A, Ugo F, Cerrato E, Bondia E, Raposeiras-Roubin S, Mendez JLJ, Espejo C, López-Masjuan Á, Marin F, López-Pais J, Abumayyaleh M, Corbi-Pascual M, Liebetrau C, Ramakrishna H, Estrada V, Macaya C, Fernandez-Ortiz A. Renin-angiotensin system inhibitors effect before and during hospitalization in COVID-19 outcomes: Final analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID-19) registry. Am Heart J 2021; 237:104-115. [PMID: 33845032 PMCID: PMC8047303 DOI: 10.1016/j.ahj.2021.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The use of Renin-Angiotensin system inhibitors (RASi) in patients with coronavirus disease 2019 (COVID-19) has been questioned because both share a target receptor site. METHODS HOPE-COVID-19 (NCT04334291) is an international investigator-initiated registry. Patients are eligible when discharged after an in-hospital stay with COVID-19, dead or alive. Here, we analyze the impact of previous and continued in-hospital treatment with RASi in all-cause mortality and the development of in-stay complications. RESULTS We included 6503 patients, over 18 years, from Spain and Italy with data on their RASi status. Of those, 36.8% were receiving any RASi before admission. RASi patients were older, more frequently male, with more comorbidities and frailer. Their probability of death and ICU admission was higher. However, after adjustment, these differences disappeared. Regarding RASi in-hospital use, those who continued the treatment were younger, with balanced comorbidities but with less severe COVID19. Raw mortality and secondary events were less frequent in RASi. After adjustment, patients receiving RASi still presented significantly better outcomes, with less mortality, ICU admissions, respiratory insufficiency, need for mechanical ventilation or prone, sepsis, SIRS and renal failure (p<0.05 for all). However, we did not find differences regarding the hospital use of RASi and the development of heart failure. CONCLUSION RASi historic use, at admission, is not related to an adjusted worse prognosis in hospitalized COVID-19 patients, although it points out a high-risk population. In this setting, the in-hospital prescription of RASi is associated with improved survival and fewer short-term complications.
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Affiliation(s)
- Iván J Núñez-Gil
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Iván Olier
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, United Kingdom
| | | | | | - Charbel Maroun-Eid
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Rodolfo Romero
- Hospital Universitario Getafe, Universidad Europea de Madrid, Madrid, Spain
| | | | - Aitor Uribarri
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Victor M Becerra-Muñoz
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | | | | | - Javier Elola
- Instituto para la Mejora de la Asistencia Sanitaria, IMAS, Madrid, Spain
| | - Alex Castro-Mejía
- Hospital General del norte de Guayaquil IESS Los Ceibos, Guayaquil, Ecuador
| | - Martino Pepe
- Azienda ospedaliero-universitaria consorziale policlinico di Bari, Bari, Italy
| | | | - Adelina Gonzalez
- Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
| | | | - Enrico Cerrato
- San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (Turin), Italy
| | - Elvira Bondia
- Hospital Clínico Universitario, Incliva, Universidad de Valencia, Valencia, Spain
| | - Sergio Raposeiras-Roubin
- Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
| | | | - Carolina Espejo
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | | | - Francisco Marin
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, CIBERCV, Murcia, Spain
| | - Javier López-Pais
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain
| | - Mohammad Abumayyaleh
- University Medical Center Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | | | | | | | - Vicente Estrada
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Macaya
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Antonio Fernandez-Ortiz
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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4
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Avendaño-Ortiz J, Lozano-Rodríguez R, Martín-Quirós A, Maroun-Eid C, Terrón-Arcos V, Montalbán-Hernández K, Valentín J, Muñoz Del Val E, García-Garrido MA, Del Balzo-Castillo Á, Casalvilla-Dueñas JC, Peinado M, Gómez L, Herrero-Benito C, Rubio C, Cubillos-Zapata C, Pascual-Iglesias A, Del Fresno C, Aguirre LA, López-Collazo E. SARS-CoV-2 Proteins Induce Endotoxin Tolerance Hallmarks: A Demonstration in Patients with COVID-19. J Immunol 2021; 207:162-174. [PMID: 34183364 DOI: 10.4049/jimmunol.2001449] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/16/2021] [Indexed: 01/08/2023]
Abstract
According to a large number of reported cohorts, sepsis has been observed in nearly all deceased patients with COVID-19. We and others have described sepsis, among other pathologies, to be an endotoxin tolerance (ET)-related disease. In this study, we demonstrate that the culture of human blood cells from healthy volunteers in the presence of SARS-CoV-2 proteins induced ET hallmarks, including impairment of proinflammatory cytokine production, low MHC class II (HLA-DR) expression, poor T cell proliferation, and enhancing of both phagocytosis and tissue remodeling. Moreover, we report the presence of SARS-CoV-2 blood circulating proteins in patients with COVID-19 and how these levels correlate with an ET status, the viral RNA presence of SARS-CoV-2 in plasma, as well as with an increase in the proportion of patients with secondary infections.
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Affiliation(s)
- José Avendaño-Ortiz
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Roberto Lozano-Rodríguez
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Alejandro Martín-Quirós
- Emergency Department and Emergent Pathology Research Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain; and
| | - Charbel Maroun-Eid
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Verónica Terrón-Arcos
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Karla Montalbán-Hernández
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Jaime Valentín
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Elena Muñoz Del Val
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Emergency Department and Emergent Pathology Research Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain; and
| | - Miguel A García-Garrido
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Álvaro Del Balzo-Castillo
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Emergency Department and Emergent Pathology Research Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain; and
| | - José Carlos Casalvilla-Dueñas
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - María Peinado
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Emergency Department and Emergent Pathology Research Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain; and
| | - Laura Gómez
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Emergency Department and Emergent Pathology Research Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain; and
| | - Carmen Herrero-Benito
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Carolina Rubio
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | | | - Alejandro Pascual-Iglesias
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Carlos Del Fresno
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Luis A Aguirre
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Eduardo López-Collazo
- Innate Immunity Group, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain; .,Tumor Immunology Laboratory, Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain.,Center for Biomedical Research Network, Madrid, Spain
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5
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Martín-Quirós A, Maroun-Eid C, Avendaño-Ortiz J, Lozano-Rodríguez R, Valentín Quiroga J, Terrón V, Montalbán-Hernández K, García-Garrido MA, Muñoz Del Val E, Del Balzo-Castillo Á, Rubio C, Cubillos-Zapata C, Aguirre LA, López-Collazo E. Potential Role of the Galectin-9/TIM-3 Axis in the Disparate Progression of SARS-CoV-2 in a Married Couple: A Case Report. Biomed Hub 2021; 6:48-58. [PMID: 34046413 PMCID: PMC8089458 DOI: 10.1159/000514727] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
We report the disparate clinical progression of a couple infected by SARS-CoV-2 based on their immune checkpoint (IC) levels and immune cell distribution in blood from admission to exitus in patient 1 and from admission to discharge and recovery in patient 2. A detailed clinical follow-up accompanied by a longitudinal analysis of immune phenotypes and IC levels is shown. The continuous increase in the soluble IC ligand galectin-9 (Gal-9) and the increment in T-cell immunoglobulin and mucin domain-containing 3 (TIM-3) protein in T cells in patient 1 suggests an activation of the Gal-9/TIM-3 axis and, subsequently, a potential cell exhaustion in this patient that did not occur in patient 2. Our data indicate that the Gal-9/TIM-3 axis could be a potential target in this clinical setting, along with a patent effector memory T-cell reduction.
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Affiliation(s)
- Alejandro Martín-Quirós
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Charbel Maroun-Eid
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - José Avendaño-Ortiz
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Roberto Lozano-Rodríguez
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Jaime Valentín Quiroga
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Verónica Terrón
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Karla Montalbán-Hernández
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Miguel A García-Garrido
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Elena Muñoz Del Val
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Madrid, Spain
| | - Álvaro Del Balzo-Castillo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Carolina Rubio
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | | | - Luis A Aguirre
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Eduardo López-Collazo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
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6
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Avendaño-Ortiz J, Lozano-Rodríguez R, Martín-Quirós A, Maroun-Eid C, Terrón V, Valentín J, Montalbán-Hernández K, Ruiz de la Bastida F, García-Garrido MA, Cubillos-Zapata C, del Balzo-Castillo Á, Aguirre LA, López-Collazo E. Proteins from SARS-CoV-2 reduce T cell proliferation: A mirror image of sepsis. Heliyon 2020; 6:e05635. [PMID: 33283062 PMCID: PMC7703472 DOI: 10.1016/j.heliyon.2020.e05635] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/04/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023] Open
Abstract
Increased cytokine levels, acute phase reactants and immune checkpoint expression changes have been described in patients with Coronavirus Disease 2019 (COVID-19). Here, we have reported a monocyte polarization towards a low HLA-DR and high PD-L1 expression after long exposure to proteins from SARS-CoV-2. Moreover, CD86 expression was also reduced over SARS-CoV-2 proteins exposure. Additionally, T-cells proliferation was significantly reduced after stimulation with these proteins. Eventually, patients with long-term SARS-CoV-2 infection also exhibited a significant blockade of T-cells proliferation.
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Affiliation(s)
- José Avendaño-Ortiz
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Roberto Lozano-Rodríguez
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Alejandro Martín-Quirós
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Charbel Maroun-Eid
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Verónica Terrón
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Jaime Valentín
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Karla Montalbán-Hernández
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Fátima Ruiz de la Bastida
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Miguel A. García-Garrido
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Carolina Cubillos-Zapata
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Álvaro del Balzo-Castillo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Luis A. Aguirre
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Eduardo López-Collazo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
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7
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Ruiz-Sánchez JG, Núñez-Gil IJ, Cuesta M, Rubio MA, Maroun-Eid C, Arroyo-Espliguero R, Romero R, Becerra-Muñoz VM, Uribarri A, Feltes G, Trabattoni D, Molina M, García Aguado M, Pepe M, Cerrato E, Alfonso E, Castro Mejía AF, Roubin SR, Buzón L, Bondia E, Marin F, López Pais J, Abumayyaleh M, D’Ascenzo F, Rondano E, Huang J, Fernandez-Perez C, Macaya C, de Miguel Novoa P, Calle-Pascual AL, Estrada Perez V, Runkle I. Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis. Front Endocrinol (Lausanne) 2020; 11:599255. [PMID: 33329400 PMCID: PMC7734292 DOI: 10.3389/fendo.2020.599255] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Dysnatremia is associated with increased mortality in patients with community-acquired pneumonia. SARS-COV2 (Severe-acute-respiratory syndrome caused by Coronavirus-type 2) pneumonia can be fatal. The aim of this study was to ascertain whether admittance dysnatremia is associated with mortality, sepsis, or intensive therapy (IT) in patients hospitalized with SARS-COV2 pneumonia. This is a retrospective study of the HOPE-COVID-19 registry, with data collected from January 1th through April 31th, 2020. We selected all hospitalized adult patients with RT-PCR-confirmed SARS-COV2 pneumonia and a registered admission serum sodium level (SNa). Patients were classified as hyponatremic (SNa <135 mmol/L), eunatremic (SNa 135-145 mmol/L), or hypernatremic (SNa >145 mmol/L). Multivariable analyses were performed to elucidate independent relationships of admission hyponatremia and hypernatremia, with mortality, sepsis, or IT during hospitalization. Four thousand six hundred sixty-four patients were analyzed, median age 66 (52-77), 58% males. Death occurred in 988 (21.2%) patients, sepsis was diagnosed in 551 (12%) and IT in 838 (18.4%). Hyponatremia was present in 957/4,664 (20.5%) patients, and hypernatremia in 174/4,664 (3.7%). Both hyponatremia and hypernatremia were associated with mortality and sepsis. Only hyponatremia was associated with IT. In conclusion, hyponatremia and hypernatremia at admission are factors independently associated with mortality and sepsis in patients hospitalized with SARS-COV2 pneumonia. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04334291, NCT04334291.
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Affiliation(s)
- Jorge Gabriel Ruiz-Sánchez
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- *Correspondence: Jorge Gabriel Ruiz-Sánchez,
| | - Ivan J. Núñez-Gil
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Martin Cuesta
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Miguel A. Rubio
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Charbel Maroun-Eid
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | - Rodolfo Romero
- Hospital Universitario Getafe, Universidad Europea de Madrid, Madrid, Spain
| | | | - Aitor Uribarri
- Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - María Molina
- Hospital Universitario Severo Ochoa, Madrid, Spain
| | | | - Martino Pepe
- Azienda ospedaliero-universitaria consorziale policlinico di Bari, Bari, Italy
| | - Enrico Cerrato
- San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Emilio Alfonso
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
| | | | | | - Luis Buzón
- Hospital Universitario de Burgos, Burgos, Spain
| | - Elvira Bondia
- Hospital Clínico Universitario, Incliva, Universidad de Valencia, Valencia, Spain
| | | | | | - Mohammad Abumayyaleh
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany, DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | | | | | - Jia Huang
- The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Cristina Fernandez-Perez
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Macaya
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Paz de Miguel Novoa
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alfonso L. Calle-Pascual
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Vicente Estrada Perez
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Isabelle Runkle
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - HOPE COVID-19 investigators
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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8
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Lorente-Sorolla C, Garcia-Gomez A, Català-Moll F, Toledano V, Ciudad L, Avendaño-Ortiz J, Maroun-Eid C, Martín-Quirós A, Martínez-Gallo M, Ruiz-Sanmartín A, Del Campo ÁG, Ferrer-Roca R, Ruiz-Rodriguez JC, Álvarez-Errico D, López-Collazo E, Ballestar E. Inflammatory cytokines and organ dysfunction associate with the aberrant DNA methylome of monocytes in sepsis. Genome Med 2019; 11:66. [PMID: 31665078 PMCID: PMC6820973 DOI: 10.1186/s13073-019-0674-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/07/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Sepsis, a life-threatening organ dysfunction caused by a dysregulated systemic immune response to infection, associates with reduced responsiveness to subsequent infections. How such tolerance is acquired is not well understood but is known to involve epigenetic and transcriptional dysregulation. METHODS Bead arrays were used to compare global DNA methylation changes in patients with sepsis, non-infectious systemic inflammatory response syndrome, and healthy controls. Bioinformatic analyses were performed to dissect functional reprogramming and signaling pathways related to the acquisition of these specific DNA methylation alterations. Finally, in vitro experiments using human monocytes were performed to test the induction of similar DNA methylation reprogramming. RESULTS Here, we focused on DNA methylation changes associated with sepsis, given their potential role in stabilizing altered phenotypes. Tolerized monocytes from patients with sepsis display changes in their DNA methylomes with respect to those from healthy controls, affecting critical monocyte-related genes. DNA methylation profiles correlate with IL-10 and IL-6 levels, significantly increased in monocytes in sepsis, as well as with the Sequential Organ Failure Assessment score; the observed changes associate with TFs and pathways downstream to toll-like receptors and inflammatory cytokines. In fact, in vitro stimulation of toll-like receptors in monocytes results in similar gains and losses of methylation together with the acquisition of tolerance. CONCLUSION We have identified a DNA methylation signature associated with sepsis that is downstream to the response of monocytes to inflammatory signals associated with the acquisition of a tolerized phenotype and organic dysfunction.
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Affiliation(s)
- Clara Lorente-Sorolla
- Epigenetics and Immune Disease Group, Josep Carreras Research Institute (IJC), 08916, Barcelona, Spain.,Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Antonio Garcia-Gomez
- Epigenetics and Immune Disease Group, Josep Carreras Research Institute (IJC), 08916, Barcelona, Spain.,Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Francesc Català-Moll
- Epigenetics and Immune Disease Group, Josep Carreras Research Institute (IJC), 08916, Barcelona, Spain.,Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Víctor Toledano
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, 28046, Madrid, Spain.,Emergency Department, IdiPAZ, La Paz University Hospital, 28046, Madrid, Spain
| | - Laura Ciudad
- Epigenetics and Immune Disease Group, Josep Carreras Research Institute (IJC), 08916, Barcelona, Spain.,Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - José Avendaño-Ortiz
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, 28046, Madrid, Spain.,Emergency Department, IdiPAZ, La Paz University Hospital, 28046, Madrid, Spain
| | - Charbel Maroun-Eid
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, 28046, Madrid, Spain
| | | | - Mónica Martínez-Gallo
- Immunology Division, Vall d'Hebron University Hospital and Diagnostic Immunology Research Group Vall d'Hebron Research Institute (VHIR), 08035, Barcelona, Spain
| | - Adolfo Ruiz-Sanmartín
- Intensive Care Department, Vall d'Hebron University Hospital, Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d' Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, 08035, Barcelona, Spain
| | - Álvaro García Del Campo
- Cardiac Post-Surgery Unit (UPCC), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Ricard Ferrer-Roca
- Intensive Care Department, Vall d'Hebron University Hospital, Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d' Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, 08035, Barcelona, Spain
| | - Juan Carlos Ruiz-Rodriguez
- Intensive Care Department, Vall d'Hebron University Hospital, Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d' Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, 08035, Barcelona, Spain
| | - Damiana Álvarez-Errico
- Epigenetics and Immune Disease Group, Josep Carreras Research Institute (IJC), 08916, Barcelona, Spain
| | - Eduardo López-Collazo
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, 28046, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, 28046, Madrid, Spain.,Center for Biomedical Research Network, CIBEres, Madrid, Spain
| | - Esteban Ballestar
- Epigenetics and Immune Disease Group, Josep Carreras Research Institute (IJC), 08916, Barcelona, Spain. .,Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908, Barcelona, Spain.
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9
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Avendaño-Ortiz J, Maroun-Eid C, Martín-Quirós A, Toledano V, Cubillos-Zapata C, Gómez-Campelo P, Varela-Serrano A, Casas-Martin J, Llanos-González E, Alvarez E, García-Río F, Aguirre LA, Hernández-Jiménez E, López-Collazo E. PD-L1 Overexpression During Endotoxin Tolerance Impairs the Adaptive Immune Response in Septic Patients via HIF1α. J Infect Dis 2019; 217:393-404. [PMID: 28973671 DOI: 10.1093/infdis/jix279] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 01/10/2017] [Accepted: 06/06/2017] [Indexed: 12/20/2022] Open
Abstract
Sepsis, among other pathologies, is an endotoxin tolerance (ET)-related disease. On admission, we classified 48 patients with sepsis into 3 subgroups according to the ex vivo response to lipopolysaccharide. This response correlates with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the ET degree. Moreover, the ET-related classification determines the outcome of these patients. Programmed cell death-ligand 1 (PD-L1) expression on septic monocytes is also linked with ET status. In addition to the regulation of cytokine production, one of the hallmarks of ET that significantly affects patients with sepsis is T-cell proliferation impairment or a poor switch to the adaptive response. PD-L1/programmed cell death-1 (PD-1) blocking and knockdown assays on tolerant monocytes from both patients with sepsis and the in vitro model reverted the impaired adaptive response. Mechanistically, the transcription factor hypoxia-inducible factor-1α (HIF1α) has been translocated into the nucleus and drives PD-L1 expression during ET in human monocytes. This fact, together with patient classification according to the ex vivo lipopolysaccharide response, opens an interesting field of study and potential personalized clinical applications, not only for sepsis but also for all ET-associated pathologies.
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Affiliation(s)
- José Avendaño-Ortiz
- Innate Immunity Group.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital.,Biomedical Research Networking Center on Respiratory Diseases (CIBEres)
| | | | | | - Víctor Toledano
- Innate Immunity Group.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital
| | - Carolina Cubillos-Zapata
- Innate Immunity Group.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital.,Biomedical Research Networking Center on Respiratory Diseases (CIBEres)
| | | | | | - Jose Casas-Martin
- Innate Immunity Group.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital
| | | | | | | | - Luis A Aguirre
- Innate Immunity Group.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital
| | - Enrique Hernández-Jiménez
- Innate Immunity Group.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital.,Biomedical Research Networking Center on Respiratory Diseases (CIBEres)
| | - Eduardo López-Collazo
- Innate Immunity Group.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital.,Biomedical Research Networking Center on Respiratory Diseases (CIBEres)
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10
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Avendaño-Ortiz J, Maroun-Eid C, Martín-Quirós A, Lozano-Rodríguez R, Llanos-González E, Toledano V, Gómez-Campelo P, Montalbán-Hernández K, Carballo-Cardona C, Aguirre LA, López-Collazo E. Oxygen Saturation on Admission Is a Predictive Biomarker for PD-L1 Expression on Circulating Monocytes and Impaired Immune Response in Patients With Sepsis. Front Immunol 2018; 9:2008. [PMID: 30233593 PMCID: PMC6131191 DOI: 10.3389/fimmu.2018.02008] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022] Open
Abstract
Sepsis is a pathology in which patients suffer from a proinflammatory response and a dysregulated immune response, including T cell exhaustion. A number of therapeutic strategies to treat human sepsis, which are different from antimicrobial and fluid resuscitation treatments, have failed in clinical trials, and solid biomarkers for sepsis are still lacking. Herein, we classified 85 patients with sepsis into two groups according to their blood oxygen saturation (SaO2): group I (SaO2 ≤ 92%, n = 42) and group II (SaO2 > 92%, n = 43). Blood samples were taken before any treatment, and the immune response after ex vivo LPS challenge was analyzed, as well as basal expression of PD-L1 on monocytes and levels of sPD-L1 in sera. The patients were followed up for 1 month. Taking into account reinfection and exitus frequency, a significantly poorer evolution was observed in patients from group I. The analysis of HLA-DR expression on monocytes, T cell proliferation and cytokine profile after ex vivo LPS stimulation confirmed an impaired immune response in group I. In addition, these patients showed both, high levels of PD-L1 on monocytes and sPD-L1 in serum, resulting in a down-regulation of the adaptive response. A blocking assay using an anti-PD-1 antibody reverted the impaired response. Our data indicated that SaO2 levels on admission have emerged as a potential signature for immune status, including PD-L1 expression. An anti-PD-1 therapy could restore the T cell response in hypoxemic sepsis patients with SaO2 ≤ 92% and high PD-L1 levels.
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Affiliation(s)
- José Avendaño-Ortiz
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Center for Biomedical Research Network, CIBERES, Madrid, Spain
| | | | | | - Roberto Lozano-Rodríguez
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Emilio Llanos-González
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Víctor Toledano
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Paloma Gómez-Campelo
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Karla Montalbán-Hernández
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | | | - Luis A Aguirre
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Eduardo López-Collazo
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Lab, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Center for Biomedical Research Network, CIBERES, Madrid, Spain
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11
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Maroun-Eid C, Ortega-Hernández A, Modrego J, Abad-Cardiel M, García-Donaire JA, Reinares L, Martell-Claros N, Gómez-Garre D. Effect of intensive multifactorial treatment on vascular progenitor cells in hypertensive patients. PLoS One 2018; 13:e0190494. [PMID: 29304136 PMCID: PMC5755814 DOI: 10.1371/journal.pone.0190494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/24/2017] [Indexed: 12/16/2022] Open
Abstract
Background Most hypertensive patients, despite a proper control of their cardiovascular risk factors, have cardiovascular complications, evidencing the importance of controlling and/or reversing target-organ damage. In this sense, endothelial dysfunction has been associated with the presence of cardiovascular risk factors and related cardiovascular outcomes. Since hypertension often clusters with other risk factors such as dyslipemia, diabetes and obesity, in this study we have investigated the effect of intensive multifactorial treatment on circulating vascular progenitor cell levels on high-risk hypertensive patients. Design We included108 hypertensive patients receiving intensive multifactorial pharmacologic treatment and dietary recommendations targeting blood pressure, dyslipemia, hyperglycemia and weight for 12 months. After the treatment period, blood samples were collected and circulating levels of endothelial (CD34+/KDR+, CD34+/VE-cadherin+) and smooth muscle (CD14+/endoglin+) progenitor cells were identified by flow cytometry. Additionally, plasma concentration of vascular endothelial growth factor (VEGF) was determined by ELISA. Results Most hypertensive patients (61±12 years, 47% men) showed cardiovascular parameters within normal ranges at baseline. Moreover, body mass index and the majority of the biochemical parameters (systolic and diastolic blood pressure, fasting glucose, total cholesterol, HDL-c, LDL-c, creatinine and hs-CRP) significantly decreased overtime. After 12 months of intensive treatment, CD34+/KDR+ and CD14+/endoglin+ levels did not change, but CD34+/VE-cadherin+ cells increased significantly at month 12 [0.9(0.05–0.14)% vs 0.05(0.02–0.09)% P<0.05]. However, VEGF plasma concentration decreased significantly overtime [89.1(53.9–218.7) vs [66.2(47.5–104.6) pg/mL, P<0.05]. Conclusions Long-term intensive treatment in hypertensive patients further improves cardiovascular risk and increases circulating EPCs, suggesting that these cells could be a therapeutic target.
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Affiliation(s)
- Charbel Maroun-Eid
- Unit of Hypertension, Área de Prevención Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Adriana Ortega-Hernández
- Vascular Biology Research Laboratory, Hospital Clínico San Carlos-IdISSC, Madrid, Spain
- Biomedical Research Networking Center in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Javier Modrego
- Vascular Biology Research Laboratory, Hospital Clínico San Carlos-IdISSC, Madrid, Spain
| | - María Abad-Cardiel
- Unit of Hypertension, Área de Prevención Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Antonio García-Donaire
- Unit of Hypertension, Área de Prevención Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Leonardo Reinares
- Unit of Lipids, Área de Prevención Cardiovascular, Hospital Clínico San Carlos-IdISSC, Madrid, Spain
| | - Nieves Martell-Claros
- Unit of Hypertension, Área de Prevención Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Dulcenombre Gómez-Garre
- Vascular Biology Research Laboratory, Hospital Clínico San Carlos-IdISSC, Madrid, Spain
- Biomedical Research Networking Center in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- * E-mail:
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12
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Álvarez E, Toledano V, Morilla F, Hernández-Jiménez E, Cubillos-Zapata C, Varela-Serrano A, Casas-Martín J, Avendaño-Ortiz J, Aguirre LA, Arnalich F, Maroun-Eid C, Martín-Quirós A, Quintana Díaz M, López-Collazo E. A System Dynamics Model to Predict the Human Monocyte Response to Endotoxins. Front Immunol 2017; 8:915. [PMID: 28824640 PMCID: PMC5540970 DOI: 10.3389/fimmu.2017.00915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/18/2017] [Indexed: 11/13/2022] Open
Abstract
System dynamics is a powerful tool that allows modeling of complex and highly networked systems such as those found in the human immune system. We have developed a model that reproduces how the exposure of human monocytes to lipopolysaccharides (LPSs) induces an inflammatory state characterized by high production of tumor necrosis factor alpha (TNFα), which is rapidly modulated to enter into a tolerant state, known as endotoxin tolerance (ET). The model contains two subsystems with a total of six states, seven flows, two auxiliary variables, and 14 parameters that interact through six differential and nine algebraic equations. The parameters were estimated and optimized to obtain a model that fits the experimental data obtained from human monocytes treated with various LPS doses. In contrast to publications on other animal models, stimulation of human monocytes with super-low-dose LPSs did not alter the response to a second LPSs challenge, neither inducing ET, nor enhancing the inflammatory response. Moreover, the model confirms the low production of TNFα and increased levels of C-C motif ligand 2 when monocytes exhibit a tolerant state similar to that of patients with sepsis. At present, the model can help us better understand the ET response and might offer new insights on sepsis diagnostics and prognosis by examining the monocyte response to endotoxins in patients with sepsis.
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Affiliation(s)
- Enrique Álvarez
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,EMPIREO S.L., Madrid, Spain
| | - Víctor Toledano
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Center for Biomedical Research Network, CIBERES, Madrid, Spain
| | - Fernando Morilla
- Department of Information Technology and Automation, ETSI Information Technology, National University of Distance Learning UNED, Madrid, Spain
| | - Enrique Hernández-Jiménez
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Center for Biomedical Research Network, CIBERES, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Center for Biomedical Research Network, CIBERES, Madrid, Spain
| | - Aníbal Varela-Serrano
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - José Casas-Martín
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - José Avendaño-Ortiz
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Luis A Aguirre
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | - Eduardo López-Collazo
- Innate Immunity Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Madrid, Spain.,Center for Biomedical Research Network, CIBERES, Madrid, Spain
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13
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García-Martín Á, Maroun-Eid C, Campino-Villegas A, Oliva-Manuel B, Herrero-Ambrosio A, Quintana-Díaz M. Perception survey on the value of the hospital pharmacist at the emergency department. Farm Hosp 2017; 41:357-370. [PMID: 28478750 DOI: 10.7399/fh.2017.41.3.10687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the perception and evaluation of the Emergency pharmacist by the medical and nursing staff at the Emergency department. METHODS A multicenter study based on a survey sent to the Spanish Society of Hospital Pharmacists (SEFH) for Emergency pharmacists (EPh) to distribute among the Emergency staff. Descriptive statistics were used, with a 95% confidence interval. RESULTS 102 (12%) questionnaires were completed by 73 Emergency Physicians (71.6%) and 29 Emergency Nurses (28.4%), out of 835 surveys sent. The most common pharmaceutical activities, and perceived as more relevant for patient safety, were: consultation solution, prescription validation, and medication reconciliation. 63% of respondents supported the prospective review of high-risk medications, while 89% believed that the Pharmacist improves the quality of care. EPh are considered useful for training healthcare staff and patients, and 77% of respondents considered them as an integral member of the team. They would resort more to Pharmacists if they were present at the hospital department. CONCLUSIONS The results show the acceptance of Hospital Pharmacists in the Emergency Department; their functions are known and valued. They are considered an integral member of the team, who will provide safety and improve patient care. Medication reconciliation and prescription validation are highlighted because of their relevance in terms of safety. Further studies are needed to assess health outcomes and their economic impact.
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Affiliation(s)
- Ángeles García-Martín
- Pharmacy Department at the Hospital Universitario La Paz, IdiPaz®, Madrid, RedFastER Group of the Spanish Society of Hospital Pharmacy (SEFH)..
| | - Charbel Maroun-Eid
- Emergency Department at the Hospital Universitario La Paz, IdiPaz®, Madrid..
| | - Ainara Campino-Villegas
- Pharmacy Department, Hospital Universitario Cruces, Barakaldo- Bizkaia, RedFastER Group (SEFH)..
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14
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Maroun-Eid C, Ortega-Hernández A, Abad M, García-Donaire JA, Barbero A, Reinares L, Martell-Claros N, Gómez-Garre D. [Circulating endothelial progenitor cell levels in treated hypertensive patients]. Hipertens Riesgo Vasc 2015; 32:142-50. [PMID: 26486462 DOI: 10.1016/j.hipert.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/02/2015] [Accepted: 07/13/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Most optimally treated hypertensive patients still have an around 50% increased risk of any cardiovascular event, suggesting the possible existence of unidentified risk factors. In the last years there has been evidence of the essential role of circulating endothelial progenitor cells (EPCs) in the maintenance of endothelial integrity and function, increasing the interest in their involvement in cardiovascular disease. In this study, the circulating levels of EPCs and vascular endothelial growth factor (VEGF) are investigated in treated hypertensive patients with adequate control of blood pressure (BP). MATERIAL AND METHODS Blood samples were collected from treated hypertensive patients with controlled BP. Plasma levels of EPCs CD34+/KDR+ and CD34+/VE-cadherin+ were quantified by flow cytometry. Plasma concentration of VEGF was determined by ELISA. A group of healthy subjects without cardiovascular risk factors was included as controls. RESULTS A total of 108 hypertensive patients were included (61±12 years, 47.2% men) of which 82.4% showed BP<140/90 mmHg, 91.7% and 81.5% controlled diabetes (HbA1c <7%) and cLDL (<130 or 100 mg/dL), respectively, and 85.2% were non-smokers. Around 45% of them were obese. Although patients had cardiovascular parameters within normal ranges, they showed significantly lower levels of CD34+/KDR+ and CD34+/VE-cadherin+ compared with healthy control group, although plasma VEGF concentration was higher in patients than in controls. CONCLUSIONS Despite an optimal treatment, hypertensive patients show a decreased number of circulating EPCs that could be, at least in part, responsible for their residual cardiovascular risk, suggesting that these cells could be a therapeutic target.
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Affiliation(s)
- C Maroun-Eid
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - A Ortega-Hernández
- Laboratorio de Biología Vascular, Hospital Clínico San Carlos-IdISSC, Madrid, España
| | - M Abad
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - J A García-Donaire
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - A Barbero
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - L Reinares
- Unidad de Lípidos, Hospital Clínico San Carlos-IdISSC, Madrid, España
| | - N Martell-Claros
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - D Gómez-Garre
- Laboratorio de Biología Vascular, Hospital Clínico San Carlos-IdISSC, Madrid, España.
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