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Pare JR, Gjesteby LA, Tonelli M, Leo MM, Muruganandan KM, Choudhary G, Brattain LJ. Transfer Learning-Based B-Line Assessment of Lung Ultrasound for Acute Heart Failure. Ultrasound Med Biol 2024; 50:825-832. [PMID: 38423896 DOI: 10.1016/j.ultrasmedbio.2024.02.004] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE B-lines assessed by lung ultrasound (LUS) outperform physical exam, chest radiograph, and biomarkers for the associated diagnosis of acute heart failure (AHF) in the emergent setting. The use of LUS is however limited to trained professionals and suffers from interpretation variability. The objective was to utilize transfer learning to create an AI-enabled software that can aid novice users to automate LUS B-line interpretation. METHODS Data from an observational AHF LUS study provided standardized cine clips for AI model development and evaluation. A total of 49,952 LUS frames from 30 patients were hand scored and trained on a convolutional neural network (CNN) to interpret B-lines at the frame level. A random independent evaluation set of 476 LUS clips from 60 unique patients assessed model performance. The AI models scored the clips on both a binary and ordinal 0-4 multiclass assessment. RESULTS A multiclassification AI algorithm had the best performance at the binary level when applied to the independent evaluation set, AUC of 0.967 (95% CI 0.965-0.970) for detecting pathologic conditions. When compared to expert blinded reviewer, the 0-4 multiclassification AI algorithm scale had a reported linear weighted kappa of 0.839 (95% CI 0.804-0.871). CONCLUSIONS The multiclassification AI algorithm is a robust and well performing model at both binary and ordinal multiclass B-line evaluation. This algorithm has the potential to be integrated into clinical workflows to assist users with quantitative and objective B-line assessment for evaluation of AHF.
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Affiliation(s)
- Joseph R Pare
- Alpert Medical School of Brown University, Providence, RI, USA; Lifespan, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA; Boston University, Boston, MA, USA.
| | - Lars A Gjesteby
- Human Health & Performance Systems Group, MIT Lincoln Laboratory, Lexington, MA, USA
| | | | | | | | - Gaurav Choudhary
- Alpert Medical School of Brown University, Providence, RI, USA; Lifespan, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Laura J Brattain
- Human Health & Performance Systems Group, MIT Lincoln Laboratory, Lexington, MA, USA
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Zhang P, Da Silva Goncalves Bos D, Vang A, Feord J, McCullough DJ, Zimmer A, D'Silva N, Clements RT, Choudhary G. Reduced exercise capacity occurs before intrinsic skeletal muscle dysfunction in experimental rat models of pulmonary hypertension. Pulm Circ 2024; 14:e12358. [PMID: 38576776 PMCID: PMC10993156 DOI: 10.1002/pul2.12358] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
Reduced exercise capacity in pulmonary hypertension (PH) significantly impacts quality of life. However, the cause of reduced exercise capacity in PH remains unclear. The objective of this study was to investigate whether intrinsic skeletal muscle changes are causative in reduced exercise capacity in PH using preclinical PH rat models with different PH severity. PH was induced in adult Sprague-Dawley (SD) or Fischer (CDF) rats with one dose of SU5416 (20 mg/kg) injection, followed by 3 weeks of hypoxia and additional 0-4 weeks of normoxia exposure. Control s rats were injected with vehicle and housed in normoxia. Echocardiography was performed to assess cardiac function. Exercise capacity was assessed by VO2 max. Skeletal muscle structural changes (atrophy, fiber type switching, and capillary density), mitochondrial function, isometric force, and fatigue profile were assessed. In SD rats, right ventricular systolic dysfunction is associated with reduced exercise capacity in PH rats at 7-week timepoint in comparison to control rats, while no changes were observed in skeletal muscle structure, mitochondrial function, isometric force, or fatigue profile. CDF rats at 4-week timepoint developed a more severe PH and, in addition to right ventricular dysfunction, the reduced exercise capacity in these rats is associated with skeletal muscle atrophy; however, mitochondrial function, isometric force, and fatigue profile in skeletal muscle remain unchanged. Our data suggest that cardiopulmonary impairments in PH are the primary cause of reduced exercise capacity, which occurs before intrinsic skeletal muscle dysfunction.
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Affiliation(s)
- Peng Zhang
- Vascular Research LaboratoryProvidence VA Medical CenterProvidenceRhode IslandUSA
- Division of Cardiology, Department of MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Denielli Da Silva Goncalves Bos
- Vascular Research LaboratoryProvidence VA Medical CenterProvidenceRhode IslandUSA
- Division of Cardiology, Department of MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Pulmonary Division, Heart InstituteUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Alexander Vang
- Vascular Research LaboratoryProvidence VA Medical CenterProvidenceRhode IslandUSA
| | - Julia Feord
- Vascular Research LaboratoryProvidence VA Medical CenterProvidenceRhode IslandUSA
| | | | - Alexsandra Zimmer
- Vascular Research LaboratoryProvidence VA Medical CenterProvidenceRhode IslandUSA
- Division of Cardiology, Department of MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Natalie D'Silva
- Vascular Research LaboratoryProvidence VA Medical CenterProvidenceRhode IslandUSA
- Division of Cardiology, Department of MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Richard T. Clements
- Vascular Research LaboratoryProvidence VA Medical CenterProvidenceRhode IslandUSA
- Biomedical and Pharmaceutical SciencesUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Gaurav Choudhary
- Vascular Research LaboratoryProvidence VA Medical CenterProvidenceRhode IslandUSA
- Division of Cardiology, Department of MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Choudhary G, Dhariwal J, Saha M, Trivedi S, Banjare MK, Kanaoujiya R, Behera K. Ionic liquids: environmentally sustainable materials for energy conversion and storage applications. Environ Sci Pollut Res Int 2024; 31:10296-10316. [PMID: 36719584 DOI: 10.1007/s11356-023-25468-w] [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] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
Ionic liquids (ILs), often known as green designer solvents, have demonstrated immense application potential in numerous scientific and technological domains. ILs possess high boiling point and low volatility that make them suitable environmentally benign candidates for many potential applications. The more important aspect associated with ILs is that their physicochemical properties can be effectively changed for desired applications just by tuning the structure of the cationic and/or anionic part of ILs. Furthermore, these eco-friendly designer materials can function as electrolytes or solvents depending on the application. Owing to the distinctive properties such as low volatility, high thermal and electrochemical stability, and better ionic conductivity, ILs are nowadays immensely used in a variety of energy applications, particularly in the development of green and sustainable energy storage and conversion devices. Suitable ILs are designed for specific purposes to be used as electrolytes and/or solvents for fuel cells, lithium-ion batteries, supercapacitors (SCs), and solar cells. Herein, we have highlighted the utilization of ILs as unique green designer materials in Li-batteries, fuel cells, SCs, and solar cells. This review will enlighten the promising prospects of these unique, environmentally sustainable materials for next-generation green energy conversion and storage devices. Ionic liquids have much to offer in the field of energy sciences regarding fixing some of the world's most serious issues. However, most of the discoveries discussed in this review article are still at the laboratory research scale for further development. This review article will inspire researchers and readers about how ILs can be effectively applied in energy sectors for various applications as mentioned above.
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Affiliation(s)
- Gaurav Choudhary
- Department of Applied Chemistry (CBFS - ASAS), Amity University Gurugram, Manesar, Panchgaon, Haryana, 122413, Gurugram, India
| | - Jyoti Dhariwal
- Department of Applied Chemistry (CBFS - ASAS), Amity University Gurugram, Manesar, Panchgaon, Haryana, 122413, Gurugram, India
| | - Moumita Saha
- Department of Chemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, U.P., India
| | - Shruti Trivedi
- Department of Chemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, U.P., India
| | - Manoj K Banjare
- MATS School of Sciences, MATS University, Pagaria Complex, Pandri, Raipur (C.G.), 492 004, India
| | - Rahul Kanaoujiya
- Department of Chemistry, Faculty of Science, University of Allahabad, Prayagraj, U.P., 211002, India
| | - Kamalakanta Behera
- Department of Applied Chemistry (CBFS - ASAS), Amity University Gurugram, Manesar, Panchgaon, Haryana, 122413, Gurugram, India.
- Department of Chemistry, Faculty of Science, University of Allahabad, Prayagraj, U.P., 211002, India.
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Imran TF, Ataklte F, Khalid M, Lopez D, Mohebali D, Bello NA, Gaziano JM, Djousse L, Arany Z, Sabe MA, French K, Poppas A, Wu W, Choudhary G. Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy. ESC Heart Fail 2024; 11:422-432. [PMID: 38030384 PMCID: PMC10804155 DOI: 10.1002/ehf2.14583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS We sought to identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) and association with adverse outcomes in peripartum cardiomyopathy (PPCM). METHODS AND RESULTS We conducted a multi-centre cohort study to identify subjects with PPCM with the following criteria: left ventricular ejection fraction (LVEF) < 40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included a composite of (i) major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or (ii) recurrent heart failure hospitalization. RV function was obtained from echocardiogram reports. In total, 229 women (1993-2017) met criteria for PPCM. Mean age was 32.4 ± 6.8 years, 28% were of African descent, 50 (22%) had RV dysfunction, and 38 (17%) had PASP ≥ 30 mmHg. After a median follow-up of 3.4 years (interquartile range 1.0-8.8), 58 (25%) experienced the composite outcome of adverse events. African descent, family history of cardiomyopathy, LVEF, and PASP were significant predictors of RV dysfunction. Using Cox proportional hazards models, we found that women with RV dysfunction were three times more likely to experience the adverse composite outcome: hazard ratio 3.21 (95% confidence interval: 1.11-9.28), P = 0.03, in a multivariable model adjusting for age, race, body mass index, preeclampsia, hypertension, diabetes, kidney disease, and LVEF. Women with PASP ≥ 30 mmHg had a lower probability of survival free from adverse events (log-rank P = 0.04). CONCLUSIONS African descent and family history of cardiomyopathy were significant predictors of RV dysfunction. RV dysfunction and elevated PASP were significantly associated with a composite of major adverse cardiac events. This at-risk group may prompt closer monitoring or early referral for advanced therapies.
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Affiliation(s)
- Tasnim F. Imran
- Providence VA Medical CenterWarren Alpert Medical School of Brown University830 Chalkstone AveProvidenceRI02809USA
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Feven Ataklte
- Providence VA Medical CenterWarren Alpert Medical School of Brown University830 Chalkstone AveProvidenceRI02809USA
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Mahnoor Khalid
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Diana Lopez
- Brigham and Women's Hospital and the VA Boston Healthcare SystemHarvard Medical SchoolBostonMAUSA
| | | | - Natalie A. Bello
- Smidt Heart InstituteCedars Sinai Medical CenterLos AngelesCAUSA
| | - J. Michael Gaziano
- Brigham and Women's Hospital and the VA Boston Healthcare SystemHarvard Medical SchoolBostonMAUSA
| | - Luc Djousse
- Brigham and Women's Hospital and the VA Boston Healthcare SystemHarvard Medical SchoolBostonMAUSA
| | - Zolt Arany
- Cardiovascular Institute, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Marwa A. Sabe
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
| | - Katharine French
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Athena Poppas
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Wen‐Chih Wu
- Providence VA Medical CenterWarren Alpert Medical School of Brown University830 Chalkstone AveProvidenceRI02809USA
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Gaurav Choudhary
- Providence VA Medical CenterWarren Alpert Medical School of Brown University830 Chalkstone AveProvidenceRI02809USA
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
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Imran TF, Khan AA, Has P, Jacobson A, Bogin S, Khalid M, Khan A, Kim S, Erqou S, Choudhary G, Aspry K, Wu WC. Proprotein convertase subtilisn/kexin type 9 inhibitors and small interfering RNA therapy for cardiovascular risk reduction: A systematic review and meta-analysis. PLoS One 2023; 18:e0295359. [PMID: 38055686 PMCID: PMC10699593 DOI: 10.1371/journal.pone.0295359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide. Atherosclerosis occurs due to accumulation of low-density lipoprotein cholesterol (LDL-c) in the arterial system. Thus, lipid lowering therapy is essential for both primary and secondary prevention. Proprotein convertase subtilisn/kexin type 9 (PCSK9) inhibitors (Evolocumab, Alirocumab) and small interfering RNA (siRNA) therapy (Inclisiran) have been demonstrated to lower LDL-c and ASCVD events in conjunction with maximally tolerated statin therapy. However, the degree of LDL-c reduction and the impact on reducing major adverse cardiac events, including their impact on mortality, remains unclear. OBJECTIVE The purpose of this study is to examine the effects of PCSK9 inhibitors and small interfering RNA (siRNA) therapy on LDL-c reduction and major adverse cardiac events (MACE) and mortality by conducting a meta-analysis of randomized controlled trials. METHODS Using Pubmed, Embase, Cochrane Library and clinicaltrials.gov until April 2023, we extracted randomized controlled trials (RCTs) of PCSK9 inhibitors (Evolocumab, Alirocumab) and siRNA therapy (Inclisiran) for lipid lowering and risk of MACE. Using random-effects models, we pooled the relative risks and 95% CIs and weighted least-squares mean difference in LDL-c levels. We estimated odds ratios with 95% CIs among MACE subtypes and all-cause mortality. Fixed-effect model was used, and heterogeneity was assessed using the I2 statistic. RESULTS In all, 54 studies with 87,669 participants (142,262 person-years) met criteria for inclusion. LDL-c percent change was reported in 47 studies (n = 62,634) evaluating two PCSK9 inhibitors and siRNA therapy. Of those, 21 studies (n = 41,361) included treatment with Evolocumab (140mg), 22 (n = 11,751) included Alirocumab (75mg), and 4 studies (n = 9,522) included Inclisiran (284mg and 300mg). Compared with placebo, after a median of 24 weeks (IQR 12-52), Evolocumab reduced LDL-c by -61.09% (95% CI: -64.81, -57.38, p<0.01) and Alirocumab reduced LDL-c by -46.35% (95% CI: -51.75, -41.13, p<0.01). Inclisiran 284mg reduced LDL-c by -54.83% (95% CI: -59.04, -50.62, p = 0.05) and Inclisiran 300mg reduced LDL-c by -43.11% (95% CI: -52.42, -33.80, p = 0.01). After a median of 8 months (IQR 6-15), Evolocumab reduced the risk of myocardial infarction (MI), OR 0.72 (95% CI: 0.64, 0.81, p<0.01), coronary revascularization, 0.77 (95% CI: 0.70, 0.84, p<0.01), stroke, 0.79 (95% CI: 0.66, 0.94, p = 0.01) and overall MACE 0.85 (95% CI: 0.80, 0.89, p<0.01). Alirocumab reduced MI, 0.57 (0.38, 0.86, p = 0.01), cardiovascular mortality 0.35 (95% CI: 0.16, 0.77, p = 0.01), all-cause mortality 0.60 (95% CI: 0.43, 0.84, p<0.01), and overall MACE 0.35 (0.16, 0.77, p = 0.01). CONCLUSION PCSK9 inhibitors (Evolocumab, Alirocumab) and siRNA therapy (Inclisiran) significantly reduced LDL-c by >40% in high-risk individuals. Additionally, both Alirocumab and Evolocumab reduced the risk of MACE, and Alirocumab reduced cardiovascular and all-cause mortality.
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Affiliation(s)
- Tasnim F. Imran
- Providence VA Medical Center, Providence, Rhode Island, United States of America
- Lifespan Cardiovascular Institute, Rhode Island and Miriam Hospitals, Providence, Rhode Island, United States of America
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Ali A. Khan
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Phinnara Has
- Lifespan Cardiovascular Institute, Rhode Island and Miriam Hospitals, Providence, Rhode Island, United States of America
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Alexis Jacobson
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Stephanie Bogin
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Mahnoor Khalid
- Lifespan Cardiovascular Institute, Rhode Island and Miriam Hospitals, Providence, Rhode Island, United States of America
| | - Asim Khan
- Northwestern University, Evanston, Illinois, United States of America
| | - Samuel Kim
- Weil Cornell College of Medicine, New York, New York, United States of America
| | - Sebhat Erqou
- Providence VA Medical Center, Providence, Rhode Island, United States of America
- Lifespan Cardiovascular Institute, Rhode Island and Miriam Hospitals, Providence, Rhode Island, United States of America
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Gaurav Choudhary
- Providence VA Medical Center, Providence, Rhode Island, United States of America
- Lifespan Cardiovascular Institute, Rhode Island and Miriam Hospitals, Providence, Rhode Island, United States of America
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Karen Aspry
- Lifespan Cardiovascular Institute, Rhode Island and Miriam Hospitals, Providence, Rhode Island, United States of America
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Wen-Chih Wu
- Providence VA Medical Center, Providence, Rhode Island, United States of America
- Lifespan Cardiovascular Institute, Rhode Island and Miriam Hospitals, Providence, Rhode Island, United States of America
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
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Winans T, Oaks Z, Choudhary G, Patel A, Huang N, Faludi T, Krakko D, Nolan J, Lewis J, Blair S, Lai Z, Landas SK, Middleton F, Asara JM, Chung SK, Wyman B, Azadi P, Banki K, Perl A. mTOR-dependent loss of PON1 secretion and antiphospholipid autoantibody production underlie autoimmunity-mediated cirrhosis in transaldolase deficiency. J Autoimmun 2023; 140:103112. [PMID: 37742509 PMCID: PMC10957505 DOI: 10.1016/j.jaut.2023.103112] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
Transaldolase deficiency predisposes to chronic liver disease progressing from cirrhosis to hepatocellular carcinoma (HCC). Transition from cirrhosis to hepatocarcinogenesis depends on mitochondrial oxidative stress, as controlled by cytosolic aldose metabolism through the pentose phosphate pathway (PPP). Progression to HCC is critically dependent on NADPH depletion and polyol buildup by aldose reductase (AR), while this enzyme protects from carbon trapping in the PPP and growth restriction in TAL deficiency. Although AR inactivation blocked susceptibility to hepatocarcinogenesis, it enhanced growth restriction, carbon trapping in the non-oxidative branch of the PPP and failed to reverse the depletion of glucose 6-phosphate (G6P) and liver cirrhosis. Here, we show that inactivation of the TAL-AR axis results in metabolic stress characterized by reduced mitophagy, enhanced overall autophagy, activation of the mechanistic target of rapamycin (mTOR), diminished glycosylation and secretion of paraoxonase 1 (PON1), production of antiphospholipid autoantibodies (aPL), loss of CD161+ NK cells, and expansion of CD38+ Ito cells, which are responsive to treatment with rapamycin in vivo. The present study thus identifies glycosylation and secretion of PON1 and aPL production as mTOR-dependent regulatory checkpoints of autoimmunity underlying liver cirrhosis in TAL deficiency.
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Affiliation(s)
- T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J Nolan
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Sarah Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Z Lai
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - F Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau
| | - B Wyman
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - P Azadi
- University of Georgia, Athens, GA 30602, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA.
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Kholdani CA, Choudhary G, Furfaro DM, Markson LJ, Manning WJ, Strom JB. Echocardiographic Progression of Peak Tricuspid Regurgitant Velocity Among Medicare Beneficiaries. JACC Adv 2023; 2:100579. [PMID: 37854952 PMCID: PMC10583835 DOI: 10.1016/j.jacadv.2023.100579] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Peak tricuspid regurgitant velocity (TRV) on transthoracic echocardiography (TTE) is a commonly obtained parameter and robust predictor of subsequent adverse clinical outcomes. OBJECTIVES The purpose of this study was to determine the predictors and clinical significance of TRV progression. METHODS We retrospectively linked consecutive outpatient TTE reports from our institution to 2005 to 2017 Medicare claims. Individuals with prior tricuspid surgery, endocarditis, tricuspid stenosis, missing TRV values, TTEs performed during inpatient hospitalization, or <2 TTEs were excluded. RESULTS A total of 4,572 patients (mean age 67.8 ± 11.9 years, 50.4% female) received 13,273 TTEs over a median follow-up of 7.4 (IQR: 4.5-6.9) years. TRV increased by a mean of 0.23 (95% CI: 0.22 to 0.23 m/s/y, P < 0.001) (range, 0.01-0.80 m/s/y). Older age, depressed left ventricular ejection fraction, diabetes, hypertension, hyperlipidemia, atrial fibrillation, heart failure, and chronic kidney disease were associated with faster progression (all P < 0.05). Accounting for 23 demographic, clinical, and TTE variables, faster TRV progression was associated with a stepwise increased risk of all-cause mortality (TRV progression quartile 4 vs 1; adjusted HR: 2.17; 95% CI: 1.74-2.71; P < 0.001). Those with regression of TRV (n = 384 [8.4%]) had a lower mortality risk (adjusted HR: 0.40; 95% CI: 0.28-0.57; P < 0.001). CONCLUSIONS In this large, multidecade study of Medicare beneficiaries with serial TTEs performed in the outpatient setting, the mean rate of TRV progression was 0.23 m/s/y. Older age, left heart disease, and adverse metabolic features were associated with faster progression. Faster progression was associated with a graded risk for all-cause mortality.
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Affiliation(s)
- Cyrus A. Kholdani
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Gaurav Choudhary
- Lifespan Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - David M. Furfaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence J. Markson
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Warren J. Manning
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jordan B. Strom
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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8
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Wang RS, Huang S, Waldo SW, Hess E, Gokhale M, Johnson SW, Zeder K, Choudhary G, Leopold JA, Oldham WM, Kovacs G, Freiberg MS, Tedford RJ, Maron BA, Brittain EL. Elevated Pulmonary Arterial Compliance Is Associated with Survival in Pulmonary Hypertension: Results from a Novel Network Medicine Analysis. Am J Respir Crit Care Med 2023; 208:312-321. [PMID: 37276608 PMCID: PMC10395727 DOI: 10.1164/rccm.202211-2097oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
Rationale: Predictors of adverse outcome in pulmonary hypertension (PH) are well established; however, data that inform survival are lacking. Objectives: We aim to identify clinical markers and therapeutic targets that inform the survival in PH. Methods: We included data from patients with elevated mean pulmonary artery pressure (mPAP) diagnosed by right heart catheterization in the U.S. Veterans Affairs system (October 1, 2006-September 30, 2018). Network medicine framework was used to subgroup patients when considering an N of 79 variables per patient. The results informed outcome analyses in the discovery cohort and a sex-balanced validation right heart catheterization cohort from Vanderbilt University (September 24, 1998-December 20, 2013). Measurements and Main Results: From an N of 4,737 complete case patients with mPAP of 19-24 mm Hg, there were 21 distinct subgroups (network modules) (all-cause mortality range = 15.9-61.2% per module). Pulmonary arterial compliance (PAC) drove patient assignment to modules characterized by increased survival. When modeled continuously in patients with mPAP ⩾19 mm Hg (N = 37,744; age, 67.2 yr [range = 61.7-73.8 yr]; 96.7% male; median follow-up time, 1,236 d [range = 570-1,971 d]), the adjusted all-cause mortality hazard ratio was <1.0 beginning at PAC ⩾3.0 ml/mm Hg and decreased progressively to ∼7 ml/mm Hg. A protective association between PAC ⩾3.0 ml/mm Hg and mortality was also observed in the validation cohort (N = 1,514; age, 60.2 yr [range = 49.2-69.1 yr]; 48.0% male; median follow-up time, 2,485 d [range = 671-3,580 d]). The association was strongest in patients with precapillary PH at the time of catheterization, in whom 41% (95% confidence interval, 0.55-0.62; P < 0.001) and 49% (95% confidence interval, 0.38-0.69; P < 0.001) improvements in survival were observed for PAC ⩾3.0 versus <3.0 ml/mm Hg in the discovery and validation cohorts, respectively. Conclusions: These data identify elevated PAC as an important parameter associated with survival in PH. Prospective studies are warranted that consider PAC ⩾3.0 ml/mm Hg as a therapeutic target to achieve through proven interventions.
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Affiliation(s)
- Rui-Sheng Wang
- Division of Cardiovascular Medicine
- Channing Division of Network Medicine, and
| | | | - Stephen W. Waldo
- Department of Medicine, Cardiology Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, Veterans Health Administration Office of Quality and Patient Safety, Washington, DC
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Edward Hess
- Department of Medicine, Cardiology Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Madhura Gokhale
- Department of Medicine, Cardiology Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Shelsey W. Johnson
- Department of Pulmonary and Critical Care, Boston Medical Center, Boston, Massachusetts
| | - Katarina Zeder
- Department of Pulmonology, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Gaurav Choudhary
- Providence Veterans Affairs Medical Center and Division of Cardiovascular Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - William M. Oldham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gabor Kovacs
- Department of Pulmonology, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Matthew S. Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Ryan J. Tedford
- Division of Cardiology, Medical Department of Medicine, University of South Carolina, Charleston, South Carolina; and
| | - Bradley A. Maron
- Division of Cardiovascular Medicine
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Evan L. Brittain
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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9
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Ngamdu KS, Ghosalkar DS, Chung HE, Christensen JL, Lee C, Butler CA, Ho T, Chu A, Heath JR, Baig M, Wu WC, Choudhary G, Morrison AR. Long-term statin therapy is associated with severe coronary artery calcification. PLoS One 2023; 18:e0289111. [PMID: 37498869 PMCID: PMC10374064 DOI: 10.1371/journal.pone.0289111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Atherosclerosis and consequent risk of cardiovascular events or mortality can be accurately assessed by quantifying coronary artery calcium score (CACS) derived from computed tomography. HMG-CoA-reductase inhibitors (statins) are the primary pharmacotherapy used to reduce cardiovascular events, yet there is growing data that support statin use may increase coronary calcification. We set out to determine the likelihood of severe CACS in the context of chronic statin therapy. METHODS We established a retrospective, case-control study of 1,181 U.S. veterans without coronary artery disease (CAD) from a single site, the Providence VA Medical Center. Duration of statin therapy for primary prevention was divided into 5-year categorical increments. The primary outcome was CACS derived from low-dose lung cancer screening computed tomography (LCSCT), stratified by CACs severity (none = 0; mild = 1-99; moderate = 100-399; and severe ≥400 AU). Statin duration of zero served as the referent control. Ordinal logistic regression analysis determined the association between duration of statin use and CACS categories. Proportional odds assumption was tested using likelihood ratio test. Atherosclerotic cardiovascular disease (ASCVD) risk score, body mass index, and CKD (glomerular filtration rate of <60 ml/min/1.73 m2) were included in the adjustment models. RESULTS The mean age of the study population was 64.7±7.2 years, and 706 (60%) patients were prescribed a statin at baseline. Duration of statin therapy was associated with greater odds of having increased CACS (>0-5 years, OR: 1.71 [CI: 1.34-2.18], p<0.001; >5-10 years, OR: 2.80 [CI: 2.01-3.90], p<0.001; >10 years, OR: 5.30 [CI: 3.23-8.70], p<0.001), and the relationship between statin duration and CACS remained significant after multivariate adjustment (>0-5 years, OR: 1.49 [CI: 1.16-1.92], p = 0.002; >5-10 years, OR: 2.38 [CI: 1.7-3.35], p<0.001; >10 years, OR: 4.48 [CI: 2.7-7.43], p<0.001). CONCLUSIONS Long-term use of statins is associated with increased likelihood of severe CACS in patients with significant smoking history. The use of CACS to interpret cardiovascular event risk may require adjustment in the context of chronic statin therapy.
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Affiliation(s)
- Kyari Sumayin Ngamdu
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Dhairyasheel S. Ghosalkar
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Hojune E. Chung
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Jared L. Christensen
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Cadence Lee
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Celia A. Butler
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Tiffany Ho
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Alice Chu
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Jacob R. Heath
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Muhammad Baig
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Wen-Chih Wu
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Gaurav Choudhary
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Alan R. Morrison
- Departments of Research and Medicine, Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Research, Ocean State Research Institute, Inc., Providence, Rhode Island, United States of America
- Department of Medicine, Section of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
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10
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Kakati H, Giri S, Patra A, Taye SJ, Agarwalla D, Boruah H, Choudhary G, Kalita B, K Mukherjee A. A retrospective analysis of epidemiology, clinical features of envenomation, and in-patient management of snakebites in a model secondary hospital of Assam, North-east India. Toxicon 2023; 230:107175. [PMID: 37257518 DOI: 10.1016/j.toxicon.2023.107175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/26/2023] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
Assam, a Northeastern State of India, is inhabited by several venomous snake species causing substantial morbidity and mortality. The data on the epidemiology of snakebites and their management is underreported in this region. Hence, a secondary health-based retrospective study was carried out at Demow Model Hospital, Sivasagar, Assam, to evaluate the clinical and epidemiological profile of snakebite cases reported in this rural hospital and their management. Snakebites occurring between April 2018 to August 2022 were reviewed based on socio-demographic details of the patient, clinical symptoms, and treatment using a standard questionnaire. Out of the 1011 registered snakebite cases, 139 patients (13.7%) counted for venomous bites, among which 92 patients (66.19%) accounted for viper bites (green pit viper and Salazar's pit viper), and 30 patients (21.5%) were bitten by elapid snakes (Indian monocled Cobra, banded krait, and greater/lesser black krait). A maximum number of snakebite cases (80.5%) were reported from the interior rural villages and documented from July to September (51.3%). Elapid snake envenomed patients, except one, were successfully treated with commercial antivenom, neostigmine, and glycopyrrolate. Because commercial polyvalent antivenom against "Big Four" venomous snakes of India showed poor neutralization of pit-vipers envenomation; therefore, pit-viper bite patients were treated with repurposed drugs magnesium sulfate and glycerin compression dressing. Adverse serum reactions were reported only in 3 (11.1%) cases. The preventive measures and facilities adopted at the Demow Model Hospital significantly reduce snakebite death and morbidity; therefore, they can be s practised across various states in India as a prototype.
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Affiliation(s)
- Hirakjyoti Kakati
- Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India
| | - Surajit Giri
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India.
| | - Aparup Patra
- Institute of Advanced Studies in Science and Technology, Vigyan Path Garchuk, Paschim Boragaon, Guwahati, 781035, Assam, India
| | - Simanta J Taye
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Deepak Agarwalla
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Hridoy Boruah
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Gaurav Choudhary
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Bhargab Kalita
- Amrita School of Nanosciences and Molecular Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, 682041, Kerala, India
| | - Ashis K Mukherjee
- Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India; Institute of Advanced Studies in Science and Technology, Vigyan Path Garchuk, Paschim Boragaon, Guwahati, 781035, Assam, India.
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11
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Khetpal V, Berkowitz J, Jiang L, Menon A, Shah N, Heffernan DS, Choudhary G, Rudolph JL, Wu WC, Erqou S. Long-Term Outcomes of Veterans With a Diagnosis of Heart Failure After COVID-19. JACC Adv 2023:100381. [PMID: 37359237 PMCID: PMC10246602 DOI: 10.1016/j.jacadv.2023.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
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12
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Usman M, Mendiola EA, Mukherjee T, Mehdi RR, Ohayon J, Alluri PG, Sadayappan S, Choudhary G, Avazmohammadi R. On the possibility of estimating myocardial fiber architecture from cardiac strains. Funct Imaging Model Heart 2023; 13958:74-83. [PMID: 37671365 PMCID: PMC10478796 DOI: 10.1007/978-3-031-35302-4_8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The myocardium is composed of a complex network of contractile myofibers that are organized in such a way as to produce efficient contraction and relaxation of the heart. The myofiber architecture in the myocardium is a key determinant of cardiac motion and the global or organ-level function of the heart. Reports of architectural remodeling in cardiac diseases, such as pulmonary hypertension and myocardial infarction, potentially contributing to cardiac dysfunction call for the inclusion of an architectural marker for an improved assessment of cardiac function. However, the in-vivo quantification of three-dimensional myo-architecture has proven challenging. In this work, we examine the sensitivity of cardiac strains to varying myofiber orientation using a multiscale finite-element model of the LV. Additionally, we present an inverse modeling approach to predict the myocardium fiber structure from cardiac strains. Our results indicate a strong correlation between fiber orientation and LV kinematics, corroborating that the fiber structure is a principal determinant of LV contractile behavior. Our inverse model was capable of accurately predicting the myocardial fiber range and regional fiber angles from strain measures. A concrete understanding of the link between LV myofiber structure and motion, and the development of non-invasive and feasible means of characterizing the myocardium architecture is expected to lead to advanced LV functional metrics and improved prognostic assessment of structural heart disease.
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Affiliation(s)
- Muhammad Usman
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Emilio A Mendiola
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Tanmay Mukherjee
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Rana Raza Mehdi
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Jacques Ohayon
- Savoie Mont-Blanc University, Polytech Annecy-Chambéry, Le Bourget du Lac, France
- Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX 77030, USA
| | - Prasanna G Alluri
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sakthivel Sadayappan
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Gaurav Choudhary
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Reza Avazmohammadi
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
- Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX 77030, USA
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA
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13
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Joseph J, Pajewski NM, Dolor RJ, Ann Sellers M, Perdue LH, Peeples SR, Henrie AM, Woolard N, Jones WS, Benziger CP, Orkaby AR, Mixon AS, VanWormer JJ, Shapiro MD, Kistler CE, Polonsky TS, Chatterjee R, Chamberlain AM, Forman DE, Knowlton KU, Gill TM, Newby LK, Hammill BG, Cicek MS, Williams NA, Decker JE, Ou J, Rubinstein J, Choudhary G, Gazmuri RJ, Schmader KE, Roumie CL, Vaughan CP, Effron MB, Cooper-DeHoff RM, Supiano MA, Shah RC, Whittle JC, Hernandez AF, Ambrosius WT, Williamson JD, Alexander KP. Pragmatic evaluation of events and benefits of lipid lowering in older adults (PREVENTABLE): Trial design and rationale. J Am Geriatr Soc 2023; 71:1701-1713. [PMID: 37082807 PMCID: PMC10258159 DOI: 10.1111/jgs.18312] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 04/22/2023]
Abstract
Whether initiation of statins could increase survival free of dementia and disability in adults aged ≥75 years is unknown. PREVENTABLE, a double-blind, placebo-controlled randomized pragmatic clinical trial, will compare high-intensity statin therapy (atorvastatin 40 mg) with placebo in 20,000 community-dwelling adults aged ≥75 years without cardiovascular disease, disability, or dementia at baseline. Exclusion criteria include statin use in the prior year or for >5 years and inability to take a statin. Potential participants are identified using computable phenotypes derived from the electronic health record and local referrals from the community. Participants will undergo baseline cognitive testing, with physical testing and a blinded lipid panel if feasible. Cognitive testing and disability screening will be conducted annually. Multiple data sources will be queried for cardiovascular events, dementia, and disability; survival is site-reported and supplemented by a National Death Index search. The primary outcome is survival free of new dementia or persisting disability. Co-secondary outcomes are a composite of cardiovascular death, hospitalization for unstable angina or myocardial infarction, heart failure, stroke, or coronary revascularization; and a composite of mild cognitive impairment or dementia. Ancillary studies will offer mechanistic insights into the effects of statins on key outcomes. Biorepository samples are obtained and stored for future study. These results will inform the benefit of statins for increasing survival free of dementia and disability among older adults. This is a pioneering pragmatic study testing important questions with low participant burden to align with the needs of the growing population of older adults.
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Affiliation(s)
| | | | - Rowena J. Dolor
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Mary Ann Sellers
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Adam M. Henrie
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Albuquerque, NM
| | - Nancy Woolard
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Ariela R. Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, and Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Amanda S. Mixon
- Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
| | | | | | - Christine E. Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
| | | | - Ranee Chatterjee
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Daniel E. Forman
- Department of Medicine, Sections of Geriatrics and Cardiology, University of Pittsburgh; Pittsburgh GRECC, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | | | - L. Kristin Newby
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Bradley G. Hammill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Jake E. Decker
- Section of Primary Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jiafu Ou
- Cardiology Division, John Cochran VA Medical Center and Cardiology Division, Washington University School of Medicine, St. Louis, MO
| | - Jack Rubinstein
- Division of Cardiology, Cincinnati VAMC and Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Gaurav Choudhary
- Providence VA Medical Center, and Lifespan Cardiovascular Institute, and Alpert Medical School of Brown University, Providence RI
| | - Raúl J. Gazmuri
- Captain James A. Lovell Federal Health Care Center and Rosalind Franklin University of Medicine and Science, Chicago, IL
| | | | - Christianne L. Roumie
- Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
| | - Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, and Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA
| | - Mark B. Effron
- John Ochsner Heart and Vascular Institute, The University of Queensland Ochsner Clinical School, New Orleans, LA
| | | | | | - Raj C. Shah
- Family & Preventive Medicine and the Rush Alzheimer’s Disease Center, Rush University, Chicago, IL
| | | | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Karen P. Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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14
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Thakkar A, Pradhan K, Duva B, Carreno JM, Sahu S, Thiruthuvanathan V, Campbell S, Gallego S, Bhagat TD, Rivera J, Choudhary G, Olea R, Sabalza M, Shapiro LC, Lee M, Quinn R, Mantzaris I, Chu E, Will B, Pirofski LA, Krammer F, Verma AK, Halmos B. Study of efficacy and longevity of immune response to 3 rd and 4 th doses of COVID-19 vaccines in patients with cancer: a single arm clinical trial. eLife 2023; 12:83694. [PMID: 36975207 PMCID: PMC10129324 DOI: 10.7554/elife.83694] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/05/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Cancer patients show increased morbidity with COVID-19 and need effective immunization strategies. Many healthcare regulatory agencies recommend administering 'booster' doses of COVID-19 vaccines beyond the standard 2-dose series, for this group of patients. Therefore, studying the efficacy of these additional vaccine doses against SARS-CoV-2 and variants of concern is of utmost importance in this immunocompromised patient population. Methods: We conducted a prospective single arm clinical trial enrolling patients with cancer that had received two doses of mRNA or one dose of AD26.CoV2.S vaccine and administered a 3rd dose of mRNA vaccine. We further enrolled patients that had no or low responses to three mRNA COVID vaccines and assessed the efficacy of a 4th dose of mRNA vaccine. Efficacy was assessed by changes in anti-spike antibody, T-cell activity and neutralization activity were again assessed at baseline and 4 weeks. Results: We demonstrate that a 3rd dose of COVID-19 vaccine leads to seroconversion in 57% of patients that were seronegative after primary vaccination series. The immune response is durable as assessed by anti-S antibody titers, T-cell activity and neutralization activity against wild-type SARS-CoV2 and BA1.1.529 at 6 months of follow up. A subset of severely immunocompromised hematologic malignancy patients that were unable to mount an adequate immune response (titer <1000 AU/mL) after the 3rd dose and were treated with a 4th dose in a prospective clinical trial which led to adequate immune-boost in 67% of patients. Low baseline IgM levels and CD19 counts were associated with inadequate seroconversion. Booster doses induced limited neutralization activity against the Omicron variant. Conclusions: These results indicate that 3rd dose of COVID vaccine induces durable immunity in cancer patients and an additional dose can further stimulate immunity in a subset of patients with inadequate response. Funding: Leukemia lymphoma society, National Cancer Institute. Clinical trial identifier: NCT05016622.
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Affiliation(s)
- Astha Thakkar
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Kith Pradhan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, United States
| | - Benjamin Duva
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Juan Manuel Carreno
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Srabani Sahu
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | | | - Sean Campbell
- Department of Pathology, Montefiore Medical Center, Bronx, United States
| | - Sonia Gallego
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Tushar D Bhagat
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Johanna Rivera
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Gaurav Choudhary
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Raul Olea
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | | | - Lauren C Shapiro
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Matthew Lee
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Ryann Quinn
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Ioannis Mantzaris
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Edward Chu
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Britta Will
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Liise-Anne Pirofski
- Department of Medicine, Albert Einstein College of Medicine, Bronx, United States
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Amit K Verma
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
| | - Balazs Halmos
- Department of Oncology, Albert Einstein College of Medicine, Bronx, United States
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15
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Konopleva M, DiNardo C, Bhagat T, Baran N, Lodi A, Saxena K, Cai T, Su X, Skwarska A, Guerra V, Kuruvilla V, Konoplev S, Gordon-Mitchell S, Pradhan K, Aluri S, Collins M, Sweeney S, Busquet J, Rathore A, Deng Q, Green M, Grant S, Demo S, Choudhary G, Sahu S, Agarwal B, Spodek M, Thiruthuvanathan V, Will B, Steidl U, Tippett G, Burger J, Borthakur G, Jabbour E, Pemmaraju N, Kadia T, Komblau S, Daver N, Naqvi K, Short N, Garcia-Manero G, Tiziani S, Verma A. Glutaminase inhibition in combination with azacytidine in myelodysplastic syndromes: Clinical efficacy and correlative analyses. Res Sq 2023:rs.3.rs-2518774. [PMID: 36865338 PMCID: PMC9980221 DOI: 10.21203/rs.3.rs-2518774/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Malignancies can become reliant on glutamine as an alternative energy source and as a facilitator of aberrant DNA methylation, thus implicating glutaminase (GLS) as a potential therapeutic target. We demonstrate preclinical synergy of telaglenastat (CB-839), a selective GLS inhibitor, when combined with azacytidine (AZA), in vitro and in vivo, followed by a phase Ib/II study of the combination in patients with advanced MDS. Treatment with telaglenastat/AZA led to an ORR of 70% with CR/mCRs in 53% patients and a median overall survival of 11.6 months. scRNAseq and flow cytometry demonstrated a myeloid differentiation program at the stem cell level in clinical responders. Expression of non-canonical glutamine transporter, SLC38A1, was found to be overexpressed in MDS stem cells; was associated with clinical responses to telaglenastat/AZA and predictive of worse prognosis in a large MDS cohort. These data demonstrate the safety and efficacy of a combined metabolic and epigenetic approach in MDS.
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Affiliation(s)
| | | | | | | | - Alessia Lodi
- College of Natural Sciences, The University of Texas at Austin
| | - Kapil Saxena
- The University of Texas, MD Anderson Cancer Center
| | - Tianyu Cai
- The University of Texas, MD Anderson Cancer Center
| | - Xiaoping Su
- Dan L. Duncan Cancer Center and , Baylor College of Medicine
| | - Anna Skwarska
- Albert Einstein College of Medicine-Montefiore Medical Center
| | | | | | | | | | | | | | - Meghan Collins
- College of Natural Sciences, The University of Texas at Austin
| | - Shannon Sweeney
- Department of Nutritional Sciences, Dell Pediatric Research Institute, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | | | - Atul Rathore
- Dell Medical School, The University of Texas at Austin
| | - Qing Deng
- The University of Texas MD Anderson Cancer Cent
| | | | - Steven Grant
- Department of Medicine, Virginia Commonwealth University
| | | | | | | | | | - Mason Spodek
- Albert Einstein College of Medicine-Montefiore Medical Center
| | | | | | | | | | | | | | | | | | - Tapan Kadia
- The University of Texas MD Anderson Cancer Center
| | | | - Naval Daver
- The University of Texas MD Anderson Cancer Center
| | - Kiran Naqvi
- The University of Texas, MD Anderson Cancer Center
| | | | | | - Stefano Tiziani
- Department of Nutritional Sciences, Dell Pediatric Research Institute, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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16
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Oaks Z, Patel A, Huang N, Choudhary G, Winans T, Faludi T, Krakko D, Duarte M, Lewis J, Beckford M, Blair S, Kelly R, Landas SK, Middleton FA, Asara JM, Chung SK, Fernandez DR, Banki K, Perl A. Publisher Correction: Cytosolic aldose metabolism contributes to progression from cirrhosis to hepatocarcinogenesis. Nat Metab 2023; 5:349. [PMID: 36755183 DOI: 10.1038/s42255-023-00752-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Duarte
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Beckford
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - R Kelly
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - F A Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, China
| | - D R Fernandez
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
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17
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Mukherjee T, Neelakantan S, Choudhary G, Avazmohammadi R. Improved right ventricular strain estimation in rats using anisotropic diffusion filtering. Proc SPIE Int Soc Opt Eng 2023; 12470:124700Y. [PMID: 37584008 PMCID: PMC10427118 DOI: 10.1117/12.2654100] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Calculating cardiac strains through speckle tracking echocardiography (STE) has shown promise as prognostic markers linked to functional indices and disease outcomes. However, the presence of acoustic shadowing often challenges the accuracy of STE in small animals such as rodents. The shadowing arises due to the complex anatomy of rodents, with operator dexterity playing a significant role in image quality. The effects of the semi-transparent shadows are further exacerbated in right ventricular (RV) imaging due to the thinness and rapid motion of the RV free wall (RVFW). The movement of the RVFW across the shadows distorts speckle tracking and produces unnatural and non-physical strains. The objective of this study was to minimize the effects of shadowing on STE by distinguishing "out-of-shadow" motion and identifying speckles in and out of shadow. Parasternal 2D echocardiography was performed, and short-axis B-mode (SA) images of the RVFW were acquired for a rodent model of pulmonary hypertension (n = 1). Following image acquisition, a denoising algorithm using edge-enhancing anisotropic diffusion (EED) was implemented, and the ensuing effects on strain analysis were visualized using a custom STE pipeline. Speckles in the shadowed regions were identified through a correlation between the filtered image and the original acquisition. Thus, pixel movement across the boundary was identified by enhancing the distinction between the shadows and the cardiac wall, and non-physical strains were suppressed. The strains obtained through STE showed expected patterns with enhanced circumferential contractions in the central region of the RVFW in contrast to smaller and nearly uniform strains derived from the unprocessed images.
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Affiliation(s)
- Tanmay Mukherjee
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Sunder Neelakantan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Gaurav Choudhary
- Providence Veterans Affairs Medical Center, Providence, RI 02908, USA
- Warren Alpert Medical School, Brown University Providence, RI 02908, USA
| | - Reza Avazmohammadi
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843, USA
- Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX 77030, USA
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18
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Rahmadika S, Astillo PV, Choudhary G, Duguma DG, Sharma V, You I. Blockchain-Based Privacy Preservation Scheme for Misbehavior Detection in Lightweight IoMT Devices. IEEE J Biomed Health Inform 2023; 27:710-721. [PMID: 35763469 DOI: 10.1109/jbhi.2022.3187037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The Internet of Medical Things (IoMT) has risen to prominence as a possible backbone in the health sector, with the ability to improve quality of life by broadening user experience while enabling crucial solutions such as near real-time remote diagnostics. However, privacy and security problems remain largely unresolved in the safety area. Various rule-based methods have been considered to recognize aberrant behaviors in IoMT and have demonstrated high accuracy of misbehavior detection appropriate for lightweight IoT devices. However, most of these solutions have privacy concerns, especially when giving context during misbehavior analysis. Moreover, falsified or modified context generates a high percentage of false positives and sometimes causes a by-pass in misbehavior detection. Relying on the recent powerful consolidation of blockchain and federated learning (FL), we propose an efficient privacy-preserving framework for secure misbehavior detection in lightweight IoMT devices, particularly in the artificial pancreas system (APS). The proposed approach employs privacy-preserving bidirectional long-short term memory (BiLSTM) and augments the security through integrating blockchain technology based on Ethereum smart contract environment. The effectiveness of the proposed model is bench-marked empirically in terms of sustainable privacy preservation, commensurate incentive scheme with an untraceability feature, exhaustiveness, and the compact results of a variant neural network approach. As a result, the proposed model has a 99.93% recall rate, showing that it can detect virtually all possible malicious events in the targeted use case. Furthermore, given an initial ether value of 100, the solution's average gas consumption and Ether spent are 84,456.5 and 0.03157625, respectively.
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19
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Mendiola EA, da Silva Gonçalves Bos D, Leichter DM, Vang A, Zhang P, Leary OP, Gilbert RJ, Avazmohammadi R, Choudhary G. Right Ventricular Architectural Remodeling and Functional Adaptation in Pulmonary Hypertension. Circ Heart Fail 2023; 16:e009768. [PMID: 36748476 PMCID: PMC9974595 DOI: 10.1161/circheartfailure.122.009768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Global indices of right ventricle (RV) function provide limited insights into mechanisms underlying RV remodeling in pulmonary hypertension (PH). While RV myocardial architectural remodeling has been observed in PH, its effect on RV adaptation is poorly understood. METHODS Hemodynamic assessments were performed in 2 rodent models of PH. RV free wall myoarchitecture was quantified using generalized Q-space imaging and tractography analyses. Computational models were developed to predict RV wall strains. Data from animal studies were analyzed to determine the correlations between hemodynamic measurements, RV strains, and structural measures. RESULTS In contrast to the PH rats with severe RV maladaptation, PH rats with mild RV maladaptation showed a decrease in helical range of fiber orientation in the RV free wall (139º versus 97º; P=0.029), preserved global circumferential strain, and exhibited less reduction in right ventricular-pulmonary arterial coupling (0.029 versus 0.017 mm/mm Hg; P=0.037). Helical range correlated positively with coupling (P=0.036) and stroke volume index (P<0.01). Coupling correlated with global circumferential strain (P<0.01) and global radial strain (P<0.01) but not global longitudinal strain. CONCLUSIONS Data analysis suggests that adaptive RV architectural remodeling could improve RV function in PH. Our findings suggest the need to assess RV architecture within routine screenings of PH patients to improve our understanding of its prognostic and therapeutic significance in PH.
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Affiliation(s)
- Emilio A. Mendiola
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Denielli da Silva Gonçalves Bos
- Pulmonary Division–Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Alexander Vang
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA
- Ocean State Research Institute, Providence, Rhode Island, USA
| | - Peng Zhang
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Ocean State Research Institute, Providence, Rhode Island, USA
| | - Owen P. Leary
- Ocean State Research Institute, Providence, Rhode Island, USA
| | | | - Reza Avazmohammadi
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
- Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX, 77030, USA
- J. Mike Walker ‘66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Gaurav Choudhary
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Ocean State Research Institute, Providence, Rhode Island, USA
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20
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Oaks Z, Patel A, Huang N, Choudhary G, Winans T, Faludi T, Krakko D, Duarte M, Lewis J, Beckford M, Blair S, Kelly R, Landas SK, Middleton FA, Asara JM, Chung SK, Fernandez DR, Banki K, Perl A. Cytosolic aldose metabolism contributes to progression from cirrhosis to hepatocarcinogenesis. Nat Metab 2023; 5:41-60. [PMID: 36658399 PMCID: PMC9892301 DOI: 10.1038/s42255-022-00711-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/11/2022] [Indexed: 01/21/2023]
Abstract
Oxidative stress modulates carcinogenesis in the liver; however, direct evidence for metabolic control of oxidative stress during pathogenesis, particularly, of progression from cirrhosis to hepatocellular carcinoma (HCC), has been lacking. Deficiency of transaldolase (TAL), a rate-limiting enzyme of the non-oxidative branch of the pentose phosphate pathway (PPP), restricts growth and predisposes to cirrhosis and HCC in mice and humans. Here, we show that mitochondrial oxidative stress and progression from cirrhosis to HCC and acetaminophen-induced liver necrosis are critically dependent on NADPH depletion and polyol buildup by aldose reductase (AR), while this enzyme protects from carbon trapping in the PPP and growth restriction in TAL deficiency. Both TAL and AR are confined to the cytosol; however, their inactivation distorts mitochondrial redox homeostasis in opposite directions. The results suggest that AR acts as a rheostat of carbon recycling and NADPH output of the PPP with broad implications for disease progression from cirrhosis to HCC.
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Affiliation(s)
- Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Duarte
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Beckford
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - R Kelly
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - F A Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, China
| | - D R Fernandez
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
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21
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Choudhary G, Dhariwal J, Saha M, Trivedi S, Banjare MK, Kanaoujiya R, Behera K. Ionic Liquids: Environmentally Sustainable Materials for Energy Conversion and Storage Applications.. [DOI: 10.21203/rs.3.rs-2212222/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Abstract
Ionic liquids (ILs), known as green designer solvents, have shown tremendous application potential in various fields of science and technology. Their unusual and unique physicochemical properties have attracted researchers worldwide from interdisciplinary research areas. ILs possess high boiling point and low volatility, that makes them suitable environmentally benign candidates for many potential applications. The more important aspect associated with ILs is their physicochemical properties can be effectively changed for desired applications just by tuning the structure of the cationic and/or anionic part of ILs. Furthermore, these environmentally benign designer materials can be used as both electrolytes as well as solvents depending on the requirement. Owing to thedistinctive properties such as low volatility, high thermal and electrochemical stability, better ionic conductivity, ILs are nowadays immensely used in variety of energy applications, particularly in the development of green and sustainable energy storage and conversion devices. Suitable ILs are designed for specific purposesto be used as electrolytes and/or solvents for fuel cells, lithium-ion batteries, supercapacitors(SCs) and solar cells. Herein, we have highlighted the utilization of ILs as unique green designer materials in Li-batteries, fuel cells,SCs and solar cells. This review will enlighten the promising prospects of these unique environmentally sustainable materials for next-generation green energy conversion and storage devices.
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22
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Okoye-Okafor UC, Javarappa KK, Tsallos D, Saad J, Yang D, Zhang C, Benard L, Thiruthuvanathan VJ, Cole S, Ruiz S, Tatiparthy M, Choudhary G, DeFronzo S, Bartholdy BA, Pallaud C, Ramos PM, Shastri A, Verma A, Heckman CA, Will B. Megakaryopoiesis impairment through acute innate immune signaling activation by azacitidine. J Exp Med 2022; 219:e20212228. [PMID: 36053753 PMCID: PMC9441716 DOI: 10.1084/jem.20212228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/01/2021] [Revised: 04/02/2022] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
Thrombocytopenia, prevalent in the majority of patients with myeloid malignancies, such as myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML), is an independent adverse prognostic factor. Azacitidine (AZA), a mainstay therapeutic agent for stem cell transplant-ineligible patients with MDS/AML, often transiently induces or further aggravates disease-associated thrombocytopenia by an unknown mechanism. Here, we uncover the critical role of an acute type-I interferon (IFN-I) signaling activation in suppressing megakaryopoiesis in AZA-mediated thrombocytopenia. We demonstrate that megakaryocytic lineage-primed progenitors present IFN-I receptors and, upon AZA exposure, engage STAT1/SOCS1-dependent downstream signaling prematurely attenuating thrombopoietin receptor (TPO-R) signaling and constraining megakaryocytic progenitor cell growth and differentiation following TPO-R stimulation. Our findings directly implicate RNA demethylation and IFN-I signal activation as a root cause for AZA-mediated thrombocytopenia and suggest mitigation of TPO-R inhibitory innate immune signaling as a suitable therapeutic strategy to support platelet production, particularly during the early phases of AZA therapy.
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Affiliation(s)
- Ujunwa Cynthia Okoye-Okafor
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
- Albert Einstein College of Medicine/Montefiore Medical Center, Cancer Stem Cell Pharmacodynamics Unit, Bronx, NY
| | - Komal K. Javarappa
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Dimitrios Tsallos
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Joseph Saad
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Daozheng Yang
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
| | - Chi Zhang
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
| | - Lumie Benard
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
- Albert Einstein College of Medicine/Montefiore Medical Center, Cancer Stem Cell Pharmacodynamics Unit, Bronx, NY
| | - Victor J. Thiruthuvanathan
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
- Albert Einstein College of Medicine/Montefiore Medical Center, Cancer Stem Cell Pharmacodynamics Unit, Bronx, NY
| | - Sally Cole
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
- Albert Einstein College of Medicine/Montefiore Medical Center, Cancer Stem Cell Pharmacodynamics Unit, Bronx, NY
| | - Stephen Ruiz
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
- Albert Einstein College of Medicine/Montefiore Medical Center, Cancer Stem Cell Pharmacodynamics Unit, Bronx, NY
| | - Madhuri Tatiparthy
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
- Albert Einstein College of Medicine/Montefiore Medical Center, Cancer Stem Cell Pharmacodynamics Unit, Bronx, NY
| | - Gaurav Choudhary
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine (Oncology), Bronx, NY
| | - Stefanie DeFronzo
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
| | - Boris A. Bartholdy
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
| | | | | | - Aditi Shastri
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine (Oncology), Bronx, NY
| | - Amit Verma
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine (Oncology), Bronx, NY
| | - Caroline A. Heckman
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Britta Will
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Cell Biology, Bronx, NY
- Albert Einstein College of Medicine/Montefiore Medical Center, Cancer Stem Cell Pharmacodynamics Unit, Bronx, NY
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine (Oncology), Bronx, NY
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23
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White A, Wang Z, Wang X, King M, Guo C, Mantsounga C, Ayala A, Morrison AR, Choudhary G, Sellke F, Chambers E, Ware LB, Rounds S, Lu Q. NLRP3 inflammasome activation in cigarette smoke priming for Pseudomonas aeruginosa-induced acute lung injury. Redox Biol 2022; 57:102467. [PMID: 36175355 PMCID: PMC9618465 DOI: 10.1016/j.redox.2022.102467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/01/2021] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023] Open
Abstract
It is increasingly recognized that cigarette smoke (CS) exposure increases the incidence and severity of acute respiratory distress syndrome (ARDS) in critical ill humans and animals. However, the mechanism(s) is not well understood. This study aims to investigate mechanism underlying the priming effect of CS on Pseudomonas aeruginosa-triggered acute lung injury, by using pre-clinic animal models and genetically modified mice. We demonstrated that CS impaired P. aeruginosa-induced mitophagy flux, promoted p62 accumulation, and exacerbated P. aeruginosa-triggered mitochondrial damage and NLRP3 inflammasome activation in alveolar macrophages; an effect associated with increased acute lung injury and mortality. Pharmacological inhibition of caspase-1, a component of inflammasome, attenuated CS primed P. aeruginosa-triggered acute lung injury and improved animal survival. Global or myeloid-specific knockout of IL-1β, a downstream component of inflammasome activation, also attenuated CS primed P. aeruginosa-triggered acute lung injury. Our results suggest that NLRP3 inflammasome activation is an important mechanism for CS primed P. aeruginosa-triggered acute lung injury. (total words: 155).
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Affiliation(s)
- Alexis White
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Zhengke Wang
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Xing Wang
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Michelle King
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Cynthia Guo
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Chris Mantsounga
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Alfred Ayala
- Department of Surgery, The Warren Alpert Medical School of Brown University and Lifespan-Rhode Island Hospital, Providence, RI, USA
| | - Alan R. Morrison
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA,Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gaurav Choudhary
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA,Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Frank Sellke
- Cardiothoracic Surgery, The Warren Alpert Medical School of Brown University and Lifespan-Rhode Island Hospital, Providence, RI, USA
| | - Eboni Chambers
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sharon Rounds
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA,Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Qing Lu
- Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Providence, RI, USA,Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA,Corresponding author.National Heart, Lung, and Blood Institute, NIH, USA.
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24
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Khetpal V, Berkowitz J, Vijayakumar S, Choudhary G, Mukand JA, Rudolph JL, Wu WC, Erqou S. Long-term Cardiovascular Manifestations and Complications of COVID-19: Spectrum and Approach to Diagnosis and Management. R I Med J (2013) 2022; 105:16-22. [PMID: 35930485] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Survivors of coronavirus disease 2019 (COVID-19) may experience persistent symptoms, abnormal diagnostic test findings, incident disease in specific organ systems, or progression of existing disease. Post-acute COVID-19 syndrome (PACS) is defined by persistent, recurrent, or new symptoms, findings, or diagnoses beyond four weeks after the initial infection. PACS has been characterized as a multi-organ syndrome, often with cardiopulmonary symptoms that include fatigue, dyspnea, chest pain, and palpitations. Cardiovascular pathologies in PACS include new-onset arrhythmia, myocarditis, unmasked coronary artery disease, and diastolic dysfunction as well as abnormal findings on electrocardiogram, troponin testing, and cardiac magnetic resonance imaging. In this review, we discuss the cardiovascular symptoms, pathophysiology, clinical investigation, and management strategies for cardiopulmonary symptoms of PACS. We offer a treatment algorithm for primary care clinicians encountering patients with cardiopulmonary PACS and discuss ongoing research on this topic.
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Affiliation(s)
- Vishal Khetpal
- Department of Medicine, Brown University, Providence, RI
| | | | | | - Gaurav Choudhary
- Department of Medicine, Brown University, Providence, RI; Department of Medicine, Providence VA Medical Center, Providence, RI
| | - Jon A Mukand
- Rehab Medicine Life Care Plans; Clinical Assistant Professor of Orthopaedics, Alpert Medical School of Brown University, Providence, RI
| | - James L Rudolph
- Department of Medicine, Brown University, Providence, RI; Department of Medicine, Providence VA Medical Center, Providence, RI; Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI; School of Public Health, Brown University, Providence, RI
| | - Wen-Chih Wu
- Department of Medicine, Brown University, Providence, RI; Department of Medicine, Providence VA Medical Center, Providence, RI; Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI; School of Public Health, Brown University, Providence, RI
| | - Sebhat Erqou
- Department of Medicine, Brown University, Providence, RI; Department of Medicine, Providence VA Medical Center, Providence, RI; Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI
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25
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Sun X, Nakajima E, Norbrun C, Sorkhdini P, Yang AX, Yang D, Ventetuolo CE, Braza J, Vang A, Aliotta J, Banerjee D, Pereira M, Baird G, Lu Q, Harrington EO, Rounds S, Lee CG, Yao H, Choudhary G, Klinger JR, Zhou Y. Chitinase 3-like-1 contributes to the development of pulmonary vascular remodeling in pulmonary hypertension. JCI Insight 2022; 7:159578. [PMID: 35951428 DOI: 10.1172/jci.insight.159578] [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: 02/22/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Chitinase 3-like 1 (CHI3L1) is the prototypic chitinase-like protein mediating inflammation, cell proliferation, and tissue remodeling. Limited data suggests CHI3L1 is elevated in human pulmonary arterial hypertension (PAH) and is associated with disease severity. Despite its importance as a regulator of injury/repair responses, the relationship between CHI3L1 and pulmonary vascular remodeling is not well understood. We hypothesize that CHI3L1 and its signaling pathways contribute to the vascular remodeling responses that occur in pulmonary hypertension (PH). We examined the relationship of plasma CHI3L1 levels and severity of PH in patients with various forms of PH, including Group 1 PAH and Group 3 PH, and found that circulating levels of serum CHI3L1 were associated with worse hemodynamics and correlated directly with mean pulmonary artery pressure and pulmonary vascular resistance. We also used transgenic mice with constitutive knockout and inducible overexpression of CHI3L1 to examine its role in hypoxia-, monocrotaline-, and bleomycin-induced models of pulmonary vascular disease. In all 3 mouse models of pulmonary vascular disease, pulmonary hypertensive responses were mitigated in CHI3L1 null mice and accentuated in transgenic mice that overexpress CHI3L1. Finally, CHI3L1 alone was sufficient to induce pulmonary arterial smooth muscle cell proliferation, inhibit pulmonary vascular endothelial cell apoptosis, induce the loss of endothelial barrier function, and induce endothelial-to-mesenchymal transition. These findings demonstrate that CHI3L1 and its receptors play an integral role in pulmonary vascular disease pathobiology and may offer a novel target for the treatment PAH and PH associated with fibrotic lung disease.
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Affiliation(s)
- Xiuna Sun
- Department of Molecular Microbiology and Immunology, Brown University, Providence, United States of America
| | - Erika Nakajima
- Department of Molecular Microbiology and Immunology, Brown University, Providence, United States of America
| | - Carmelissa Norbrun
- Department of Molecular Microbiology and Immunology, Brown University, Providence, United States of America
| | - Parand Sorkhdini
- Department of Molecular Microbiology and Immunology, Brown University, Providence, United States of America
| | - Alina Xiaoyu Yang
- Department of Molecular Microbiology and Immunology, Brown University, Providence, United States of America
| | - Dongqin Yang
- Department of Molecular Microbiology and Immunology, Brown University, Providence, United States of America
| | - Corey E Ventetuolo
- Department of Medicine, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, United States of America
| | - Julie Braza
- Providence VA Medical Center, Providence, United States of America
| | - Alexander Vang
- Research, Providence VA Medical Center, Providence, United States of America
| | - Jason Aliotta
- Department of Medicine, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, United States of America
| | - Debasree Banerjee
- Department of Internal Medicine, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, United States of America
| | - Mandy Pereira
- Department of Hematology/Oncology, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, United States of America
| | - Grayson Baird
- Department of DIagnostic Imaging, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, United States of America
| | - Qing Lu
- Department of Medicine, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, United States of America
| | | | - Sharon Rounds
- Providence VA Medical Center, Providence, United States of America
| | - Chun Geun Lee
- Department of Molecular Microbiology and Immunology, Brown University, Providence, United States of America
| | - Hongwei Yao
- Department of Molecular Biology, Cell Biology, and Biochemistry,, Brown University, Providence, United States of America
| | - Gaurav Choudhary
- Providence VA Medical Center, Providence, United States of America
| | - James R Klinger
- Department of Pulmonary, Sleep, and Critical Care Medicine, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, United States of America
| | - Yang Zhou
- Department of Molecular Microbiology and Immunology, Brown University, Providence, United States of America
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26
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Mantsounga CS, Sharma S, Lee C, Neverson J, Carley R, Choudhary G, Morrison AR. Abstract P2066: Age-related Changes In Posttranscriptional Regulation Of Macrophage VEGF As A Mechanism Of Impaired Inflammatory Arteriogenesis. Circ Res 2022. [DOI: 10.1161/res.131.suppl_1.p2066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aging and age-related diseases like peripheral arterial disease are associated with impaired inflammatoryarteriogenesis in response to injury. During ischemia, macrophage recruitment and macrophage pro-angiogenic VEGF-A isoform expression contribute to post developmental arteriogenesis. Preliminary datafrom bone marrow-derived macrophages (BMDMs) demonstrated decreased VEGF-A level by both mRNAand protein in aged (52-week-old) and advanced aged (104-week-old) mice when compared to young (12-week-old). Moreover, VEGF-A165a which is VEGF-A proangiogenic splice variant was also reduced inmacrophages from aged and advanced aged mice. The anti-angiogenic VEGF-A165b variant wassignificantly increased in advanced aged mice. We sought to determine the mechanisms which cancontribute to the reduction of pro-angiogenic VEGF-A and consequently reduced inflammatory-mediatedarteriogenesis response in the context of aging. In a hindlimb ischemia model of angio/arteriogenesis, wefound decreased blood flow recovery in aged mice. Moreover, small arterial angiography by microCTconfirmed decreased arteriogenesis. Loss of functional arteriogenesis was associated with decreased muscletissue VEGF-A and VEGF-A165a levels despite adequate macrophage recruitment to the muscle tissue.Moreover, VEGF-A165b was increased in ischemic tissue from advanced aged mice. The mechanism ofreduced macrophage pro-angiogenic VEGF-A165a expression involved decreased mRNA stability withdecreased association of VEGF-A165a mRNA with the RNA-stabilizing protein HuR. In fact, aged BMDMsdemonstrated a loss of HuR binding to VEGF-A165a mRNA with decreased VEGF-A165a mRNA half-life,and consequently decreased inflammatory angio/arteriogenesis.
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27
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Zhang Y, Chen X, Wang H, Gordon-Mitchell S, Sahu S, Bhagat TD, Choudhary G, Aluri S, Pradhan K, Sahu P, Carbajal M, Zhang H, Agarwal B, Shastri A, Martell R, Starczynowski D, Steidl U, Maitra A, Verma A. Correction: Innate immune mediator, Interleukin-1 receptor accessory protein (IL1RAP), is expressed and pro-tumorigenic in pancreatic cancer. J Hematol Oncol 2022; 15:100. [PMID: 35883108 PMCID: PMC9327144 DOI: 10.1186/s13045-022-01321-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yang Zhang
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Xiaoyi Chen
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Huamin Wang
- Departments of Anatomical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shanisha Gordon-Mitchell
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Srabani Sahu
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Tushar D Bhagat
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Gaurav Choudhary
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Srinivas Aluri
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kith Pradhan
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Plabani Sahu
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Milagros Carbajal
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Hui Zhang
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | | | - Aditi Shastri
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | | | | | - Ulrich Steidl
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Anirban Maitra
- Departments of Anatomical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Amit Verma
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
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28
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Imran TF, Mohebali D, Lopez D, Goli RR, DeFilippis EM, Truong S, Bello NA, Gaziano JM, Djousse L, Coglianese EE, Feinberg L, Wu WC, Choudhary G, Arany Z, Kociol R, Sabe MA. NT-proBNP and predictors of event free survival and left ventricular systolic function recovery in peripartum cardiomyopathy. Int J Cardiol 2022; 357:48-54. [PMID: 35358637 PMCID: PMC10007968 DOI: 10.1016/j.ijcard.2022.03.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/12/2022] [Accepted: 03/24/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine predictors of adverse outcomes in peripartum cardiomyopathy (PPCM). METHODS AND RESULTS We conducted a multi-center cohort study across four centers to identify subjects with PPCM with the following criteria: LVEF <40%, development of heart failure within the last month of pregnancy or within 5 months of delivery and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included 1) survival free from major adverse events (need for extra-corporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation or death) and 2) LVEF recovery ≥ 50%. Using a univariate logistic regression analysis, we identified significant clinical predictors of these outcomes, which were then used to create multivariable models. NT-proBNP at the time of diagnosis was examined both as a continuous variable (log transformed) in logistic regression and as a dichotomous variable (values above and below the median) using the log-rank test. In all, 237 women (1993 to 2017) with 736.4 person-years of follow-up, met criteria for PPCM. Participants had a mean age of 32.4 ± 6.7 years, mean BMI 30.6 ± 7.8 kg/m2; 63% were White. After median follow-up of 3.6 years (IQR 1.1-7.8), 113 (67%) had LVEF recovery, and 222 (94%) had survival free from adverse events. Significant predictors included gestational age, gravidity, systolic blood pressure, smoking, heart rate, initial LVEF, and diuretic use. In a subset of 110 patients with measured NTproBNP levels, we found a higher event free survival for women with NTproBNP <2585 pg/ml (median) as compared to women with NTproBNP ≥2585 pg/ml (log-rank test p-value 0.018). CONCLUSION Gestational age, gravidity, current or past tobacco use, systolic blood pressure, heart rate, initial LVEF and diuretic requirement at the time of diagnosis were associated with survival free from adverse events and LVEF recovery. Initial NT-proBNP was significantly associated with event free survival.
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Affiliation(s)
- Tasnim F Imran
- Warren Alpert Medical School of Brown University, Section of Cardiology, Rhode Island and Miriam Hospitals, and Providence VA Medical Center, Providence, RI 02809, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital and the VA Boston Healthcare System, Harvard Medical School, Boston, MA 02120, USA.
| | - Donya Mohebali
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Diana Lopez
- Department of Medicine, Division of Aging, Brigham and Women's Hospital and the VA Boston Healthcare System, Harvard Medical School, Boston, MA 02120, USA
| | - Rahul R Goli
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Aging, Brigham and Women's Hospital and the VA Boston Healthcare System, Harvard Medical School, Boston, MA 02120, USA; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sandy Truong
- Department of Medicine, Division of Aging, Brigham and Women's Hospital and the VA Boston Healthcare System, Harvard Medical School, Boston, MA 02120, USA
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - J Michael Gaziano
- Department of Medicine, Division of Aging, Brigham and Women's Hospital and the VA Boston Healthcare System, Harvard Medical School, Boston, MA 02120, USA
| | - Luc Djousse
- Department of Medicine, Division of Aging, Brigham and Women's Hospital and the VA Boston Healthcare System, Harvard Medical School, Boston, MA 02120, USA
| | - Erin E Coglianese
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Loryn Feinberg
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Wen-Chih Wu
- Warren Alpert Medical School of Brown University, Section of Cardiology, Rhode Island and Miriam Hospitals, and Providence VA Medical Center, Providence, RI 02809, USA
| | - Gaurav Choudhary
- Warren Alpert Medical School of Brown University, Section of Cardiology, Rhode Island and Miriam Hospitals, and Providence VA Medical Center, Providence, RI 02809, USA
| | - Zoltan Arany
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robb Kociol
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marwa A Sabe
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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29
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Zhang Y, Chen X, Wang H, Gordon-Mitchell S, Sahu S, Bhagat TD, Choudhary G, Aluri S, Pradhan K, Sahu P, Carbajal M, Zhang H, Agarwal B, Shastri A, Martell R, Starczynowski D, Steidl U, Maitra A, Verma A. Innate immune mediator, Interleukin-1 receptor accessory protein (IL1RAP), is expressed and pro-tumorigenic in pancreatic cancer. J Hematol Oncol 2022; 15:70. [PMID: 35606824 PMCID: PMC9128118 DOI: 10.1186/s13045-022-01286-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Advanced pancreatic ductal adenocarcinoma (PDAC) is usually an incurable malignancy that needs newer therapeutic targets. Interleukin-1 receptor accessory protein (IL1RAP) is an innate immune mediator that regulates activation of pro-inflammatory and mitogenic signaling pathways. Immunohistochemistry on tissue microarrays demonstrated expression of IL1RAP in majority of human PDAC specimens and in murine pancreatic tumors from K-RasG122D/p53R172H/PDXCre (KPC) mice. Single cell RNA-Seq analysis of human primary pre-neoplastic lesions and adenocarcinoma specimens indicated that overexpression occurs during carcinogenesis. IL1RAP overexpression was associated with worse overall survival. IL1RAP knockdown significantly reduced cell viability, invasiveness, and clonogenic growth in pancreatic cancer cell lines. Inhibition of the downstream interleukin-1 receptor-associated kinase 4 (IRAK4) using two pharmacologic inhibitors, CA-4948 and PF06650833, resulted in reduced growth in pancreatic cancer cell lines and in xenograft models.
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Affiliation(s)
- Yang Zhang
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Xiaoyi Chen
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Huamin Wang
- Departments of Anatomical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shanisha Gordon-Mitchell
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Srabani Sahu
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Tushar D Bhagat
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Gaurav Choudhary
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Srinivas Aluri
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kith Pradhan
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Plabani Sahu
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Milagros Carbajal
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Hui Zhang
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | | | - Aditi Shastri
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | | | | | - Ulrich Steidl
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Anirban Maitra
- Departments of Anatomical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Amit Verma
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
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30
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D'Silva NM, Wang ER, Fernandez‐Nicolas A, Vang A, Yano N, Zimmer A, Fedulov AV, Zhang P, Choudhary G. Epigenetic regulation of Anoctamin1 in pulmonary arterial hypertension. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Eric R. Wang
- Vascular Research LaboratoryProvidence Veterans Affairs Medical CenterProvidenceRI
| | - Ana Fernandez‐Nicolas
- MedicineBrown UniversityProvidenceRI
- Vascular Research LaboratoryBrown UniversityProvidenceRI
| | - Alexander Vang
- Vascular Research LaboratoryProvidence Veterans Affairs Medical CenterProvidenceRI
| | - Naohiro Yano
- MedicineBrown UniversityProvidenceRI
- SurgeryBrown UniversityProvidenceRI
| | - Alexsandra Zimmer
- MedicineBrown UniversityProvidenceRI
- Vascular Research LaboratoryBrown UniversityProvidenceRI
| | - Alexey V. Fedulov
- MedicineBrown UniversityProvidenceRI
- SurgeryBrown UniversityProvidenceRI
| | - Peng Zhang
- MedicineBrown UniversityProvidenceRI
- Vascular Research LaboratoryBrown UniversityProvidenceRI
| | - Gaurav Choudhary
- MedicineBrown UniversityProvidenceRI
- Vascular Research LaboratoryBrown UniversityProvidenceRI
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31
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Chaput I, Cypress MW, Landherr M, Polina I, Yoon Y, Jhun BS, Choudhary G, O‐Uchi J. A Ca
2+
‐activated Cl
‐
Channel Anoctamin‐1 Regulates Mitochondrial Morphology. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Yisang Yoon
- PhysiologyMedical College of Georgia, Augusta UniversityAugustaGA
| | | | - Gaurav Choudhary
- MedicineAlpert Medical School of Brown UniversityProvidenceRI
- Providence VA Medical CenterProvidenceRI
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32
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Zhou X, Adhikari N, Cypress MW, Polina I, Landherr M, Chaput I, Suckow MA, Choudhary G, O‐Uchi J, Jhun BS. Mitochondrial PKD Activates Mitochondrial Fission and Proliferative Signaling in Cardiac Fibroblasts. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r6274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Xiaoxu Zhou
- MedicineUniversity of MinnesotaMinneapolisMN
| | - Neeta Adhikari
- MedicineUniversity of MinnesotaMinneapolisMN
- University of North DakotaGrand ForksND
| | | | | | | | | | | | - Gaurav Choudhary
- MedicineAlpert Medical School of Brown UniversityProvidenceRI
- Providence VA Medical CenterProvidenceRI
| | - Jin O‐Uchi
- MedicineUniversity of MinnesotaMinneapolisMN
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33
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Lee C, Carley RT, Mantsounga CS, Sharma S, Neverson J, Butler C, Choudhary G, Morrison AR. Abstract 205: Macrophage Rac1-IL-1β Signaling Axis Promotes Atherosclerotic Calcification. Arterioscler Thromb Vasc Biol 2022. [DOI: 10.1161/atvb.42.suppl_1.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Coronary artery disease caused by atherosclerosis is a major cause of morbidity and mortality worldwide. Calcification of atherosclerotic plaque is a marker of atherosclerotic burden and worsening cardiovascular outcomes. Inflammation plays a role in both atherosclerotic progression and calcification, but the mechanisms of calcification are not entirely well-defined. We sought to understand the role of macrophage Rac1 signaling in the natural progression of atherosclerotic calcification in the context of an experimental model of hyperlipidemia. We developed a tamoxifen-inducible, myeloid specific
Rac1
-deletion model (
Csf1r
mercremer
Rac1
fl/fl
ApoE
-/-
) to evaluate the impact of macrophage-specific Rac1 on atherosclerotic calcification. After 20 weeks of
ad libitum
feeding on a cholesterol-supplemented high fat diet,
Rac1
-deleted animals demonstrated significantly decreased atherosclerotic calcification compared to wild-type mice, irrespective of modest changes in lipid metabolism as demonstrated by plasma analysis. Mechanistically,
Rac1
-deleted bone marrow derived macrophages demonstrated reduced expression of the potent inflammatory cytokine, IL-1β, in response to a cholesterol-based inflammasome activation.
Rac1
-deleted macrophages also demonstrated decreased nuclear NF-κB activity and lost binding of NF-κB to its seed site in the IL-1β promoter as evaluated by chromatin immunoprecipitation. We further demonstrated that Rac1 and NF-κB form a complex with each other upon innate inflammatory signaling activation using a proximity ligation assay. We confirmed the important functional role of the Rac1 nuclear localization sequence in the expression of IL-1β, which together with the proximity ligation assay, suggests a role for Rac1 in chaperoning NF-κB to the IL-1β promoter. The interaction between macrophage Rac1 and NF-κB may have implications on numerous inflammatory disease processes, and uncovers a novel signaling contribution of Rac1 as a transcriptional co-factor for IL-1β in the progression of atherosclerosis. Targeted inhibition of Rac1 may have potential as a therapeutic treatment to mitigate progression of vascular calcification.
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Sharma S, Mantsounga CS, Neverson J, Lee C, Carley RT, Butler C, Choudhary G, Morrison AR. Abstract 335: Macrophage Interleukin-1 Beta Dependent Angiogenesis During Wound Healing. Arterioscler Thromb Vasc Biol 2022. [DOI: 10.1161/atvb.42.suppl_1.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Angiogenesis during wound healing is thought to require an inflammation suppressed state. However, there is growing evidence that early infiltrating inflammatory macrophages may play an important role in setting the stage for angiogenesis. Here we sought to understand the relationship between the potent inflammatory cytokine, IL-1β, and vascular endothelial growth factor-A (VEFG-A) in the context of two experimental models of angiogenesis-dependent healing: skin punch biopsy and hind limb ischemia. We established a macrophage-specific
IL-1
β
-deletion model (
mIL-1
β
) to study the relationship between IL-1β and VEGF-A in the context of these models. Using a punch biopsy model, wounds were quantified, showing remarked expansion of the wounds in
mIL-1
β
-deleted mice on day 2 of the healing process, resulting in slower wound closure. Analysis from
mIL-1
β
-deleted mice confirmed decreased macrophage expression of IL-1β and VEGF-A early at day two post-wounding by punch biopsy. In our second approach, we used femoral artery ligation to demonstrate hind limb ischemia. We hypothesized that
mIL-1
β
-deleted mice would exhibit reduced blood flow recovery due to impaired angiogenesis. Analysis from
mIL-1
β
-deleted mice indicates reduced IL-1β and VEGF-A expression. In establishing a pathway of IL-1β-dependent macrophage VEGF-A upregulation in the acute injury state, we examined transcriptional factors STAT3 and NF-κB. Constitutively active STAT3 and IKK-2 (NF-κB activator) appear to increase VEGF-A expression, while inhibition of STAT3 and NF-κB exhibits a dose-dependent reduction of VEGF-A expression. In summary, two models of angiogenesis-dependent healing from injury indicate that macrophage VEGF-A expression is dependent on IL-1β expression during early inflammation. Strategies to alleviate impaired wound healing where VEGF-A levels may not be sufficient could require upregulation of the downstream effectors of IL-1β to restore macrophage VEGF-A expression levels required for adequate angiogenesis.
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Velumani R, Sudalaimuthu H, Choudhary G, Bama S, Jose MV, Dragoni N. Secured Secret Sharing of QR Codes Based on Nonnegative Matrix Factorization and Regularized Super Resolution Convolutional Neural Network. Sensors 2022; 22:s22082959. [PMID: 35458944 PMCID: PMC9029129 DOI: 10.3390/s22082959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022]
Abstract
Advances in information technology have harnessed the application of Quick Response (QR) codes in day-to-day activities, simplifying information exchange. QR codes are witnessed almost everywhere, on consumables, newspapers, information bulletins, etc. The simplicity of QR code creation and ease of scanning with free software have tremendously influenced their wide usage, and since QR codes place information on an object they are a tool for the IoT. Many healthcare IoT applications are deployed with QR codes for data-labeling and quick transfer of clinical data for rapid diagnosis. However, these codes can be duplicated and tampered with easily, attributed to open- source QR code generators and scanners. This paper presents a novel (n,n) secret-sharing scheme based on Nonnegative Matrix Factorization (NMF) for secured transfer of QR codes as multiple shares and their reconstruction with a regularized Super Resolution Convolutional Neural Network (SRCNN). This scheme is an alternative to the existing polynomial and visual cryptography-based schemes, exploiting NMF in part-based data representation and structural regularized SRCNN to capture the structural elements of the QR code in the super-resolved image. The experimental results and theoretical analyses show that the proposed method is a potential solution for secured exchange of QR codes with different error correction levels. The security of the proposed approach is evaluated with the difficulty in launching security attacks to recover and decode the secret QR code. The experimental results show that an adversary must try 258 additional combinations of shares and perform 3 × 288 additional computations, compared to a representative approach, to compromise the proposed system.
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Affiliation(s)
- Ramesh Velumani
- Institute of Electrical and Electronics Engineers (IEEE), Aruppukottai 626101, India;
| | | | - Gaurav Choudhary
- DTU Compute, Technical University of Denmark (DTU), 2800 Lyngby, Denmark;
| | - Srinivasan Bama
- Kalasalingam Academy of Research and Education Krishnankovil, Srivilliputtur 626128, India;
| | | | - Nicola Dragoni
- DTU Compute, Technical University of Denmark (DTU), 2800 Lyngby, Denmark;
- Correspondence:
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Khetpal V, Berkowitz J, Jiang L, Vijayakumar S, Ahmad K, Tcheugui JE, Menon A, Heffernan DS, Choudhary G, Rudolph J, Wu WC, Erqou S. LONG-TERM OUTCOMES OF VETERANS WITH A DIAGNOSIS OF HEART FAILURE AFTER CORONAVIRUS-2019 (COVID-19) INFECTION. J Am Coll Cardiol 2022. [PMCID: PMC8972592 DOI: 10.1016/s0735-1097(22)03146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Chung H, Ghosalkar D, Chu A, Heath JR, Ho T, Wu WC, Choudhary G, Morrison A. PULMONARY ARTERY TO AORTA RATIO DERIVED FROM LUNG CANCER SCREENING CT IS ASSOCIATED WITH COPD HOSPITALIZATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02242-2] [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: 11/28/2022]
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38
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Singh J, Thukral CL, Singh P, Pahwa S, Choudhary G. Utility of sonographic transcerebellar diameter in the assessment of gestational age in normal and intrauterine growth-retarded fetuses. Niger J Clin Pract 2022; 25:167-172. [PMID: 35170442 DOI: 10.4103/njcp.njcp_594_20] [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: 11/04/2022]
Abstract
Background The fetal cerebellum has been shown to be least affected by external pressures and molding during pregnancy and therefore might provide more accurate estimation of GA. Aims To study the utility of transcerebellar diameter (TCD) measured by ultrasound for the detection of GA in normal and intrauterine growth-retarded (IUGR) fetuses. Subjects and Methods This cross-sectional study comprised 500 antenatal patients with a GA between 14 and 39 weeks and who were certain of their last menstrual periods. The TCD was measured ultrasonographically and the corresponding GA was determined. The GA was also determined with other customarily used sonographic parameters such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) and compared with TCD. Data of normal pregnancy patients was used to formulate nomograms by taking the 5th, 50th, and 95th percentile measurements. TCD to AC ratio was also calculated in both normal (n = 424) and IUGR pregnancies (n = 76). Results TCD showed significant correlation with gestational age (GA) measured by last menstrual period (LMP) as well as with GA calculated with other biometric fetal parameters. TCD also showed significant correlation with GA in normal (R2 = 0.979) as well as with IUGR pregnancies (R2 = 0.942). TCD to AC ratio remained fairly constant in normal pregnancies while it was increased in IUGR pregnancies. Conclusions TCD and TCD/AC ratio can be employed as an objective parameter to establish the GA in normal as well as IUGR pregnancy cases.
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Affiliation(s)
- J Singh
- Department of Radiodiagnosis, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - C L Thukral
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - P Singh
- Department of Radiology, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - S Pahwa
- Department of Obstetrics and Gynaecology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - G Choudhary
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Ma W, Vang A, Huck S, Muller CC, Mancini T, Nicely P, Zhang P, Choudhary G, Clements RT. Reduction in activity and abundance of mitochondrial supercomplexes in right ventricle of pulmonary hypertension rats. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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40
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Maron BA, Choudhary G, Goldstein RL, Garshick E, Jankowich M, Tucker TJS, LaCerda KA, Hattler B, Dempsey EC, Sadikot RT, Shapiro S, Rounds SI, Goldstein RH. Tadalafil for veterans with chronic obstructive pulmonary disease-pulmonary hypertension: A multicenter, placebo-controlled randomized trial. Pulm Circ 2022; 12:e12043. [PMID: 35506072 PMCID: PMC9053004 DOI: 10.1002/pul2.12043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/11/2022] Open
Abstract
Treating Veterans with chronic obstructive pulmonary disease complicated by pulmonary hypertension (COPD-PH) using phosphodiesterase type-5 inhibitor pharmacotherapy is common, but efficacy data are lacking. To address this further, patients with COPD-PH from five Department of Veterans Affairs hospitals were randomized (1∶1) to receive placebo or oral tadalafil (40 mg/day) for 12 months. The primary endpoint was changed from baseline in 6-min walk distance at 12 months. Secondary endpoints included change from baseline in pulmonary vascular resistance, mean pulmonary artery pressure, and symptom burden by the University of California San Diego shortness of breath questionnaire scale at 6 months. A total of 42 subjects (all male; 68 ± 7.6 years old) were randomized to placebo (N = 14) or tadalafil (N = 28). The group imbalance was related to under-enrollment. Compared to placebo, no significant difference was observed in the tadalafil group for change from the primary endpoint or change in mean pulmonary artery pressure or pulmonary vascular resistance from baseline at 6 months. A clinically meaningful improvement was observed in the secondary endpoint of shortness of breath questionnaire score in the tadalafil versus placebo group at 6 months. There was no significant difference in major adverse events between treatment groups, and tadalafil was well tolerated overall. For Veterans with COPD-PH enrolled in this study, once-daily treatment with tadalafil did not improve 6-min walk distance or cardiopulmonary hemodynamics although a decrease in shortness of breath was observed. Under-enrollment and imbalanced randomization confound interpreting conclusions from this clinical trial and limit the generalization of our findings.
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Affiliation(s)
- Bradley A. Maron
- Department of Medicine, Section of Cardiology and Division of Pulmonary, Allergy, Sleep, and Critical Care MedicineVeterans Affairs Boston Healthcare SystemBostonMassachusettsUSA
- Division of Cardiovascular MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Gaurav Choudhary
- Department of MedicineProvidence Veterans Affairs Medical CenterProvidenceRhode IslandUSA
- Department of MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Rebekah L. Goldstein
- Research and Development ServiceVeterans Affairs Boston Healthcare SystemBostonMassachusettsUSA
| | - Eric Garshick
- Department of Medicine, Research and Development Service, Pulmonary, Allergy, Sleep, and Critical Care Medicine SectionVeterans Affairs Boston Healthcare SystemBostonMassachusettsUSA
- Channing Division of Network MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Matthew Jankowich
- Department of MedicineProvidence Veterans Affairs Medical CenterProvidenceRhode IslandUSA
- Department of MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Troo J. S. Tucker
- Department of MedicineProvidence Veterans Affairs Medical CenterProvidenceRhode IslandUSA
| | - Kathleen A. LaCerda
- Department of Medicine, Research and Development Service, Pulmonary, Allergy, Sleep, and Critical Care Medicine SectionVeterans Affairs Boston Healthcare SystemBostonMassachusettsUSA
| | - Brack Hattler
- Cardiology SectionRocky Mountain Regional Veterans Affairs Medical CenterAuroraColoradoUSA
| | - Edward C. Dempsey
- Cardiology SectionRocky Mountain Regional Veterans Affairs Medical CenterAuroraColoradoUSA
- Pulmonary Sciences and Critical Care Medicine SectionUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Ruxana T. Sadikot
- Department of MedicineAtlanta Veterans Affairs Medical CenterDecaturGeorgiaUSA
| | - Shelley Shapiro
- Department of Cardiology, Cardiology Section Greater Los AngelesVA Healthcare SystemLos AngelesCaliforniaUSA
- Division of Pulmonary Critical CareDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Sharon I. Rounds
- Department of MedicineProvidence Veterans Affairs Medical CenterProvidenceRhode IslandUSA
- Department of MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Ronald H. Goldstein
- Department of Medicine, Research and Development Service, Pulmonary, Allergy, Sleep, and Critical Care Medicine SectionVeterans Affairs Boston Healthcare SystemBostonMassachusettsUSA
- Department of MedicineBoston University School of MedicineBostonMassachusettsUSA
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41
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Dangi R, Lalwani P, Choudhary G, You I, Pau G. Study and Investigation on 5G Technology: A Systematic Review. Sensors (Basel) 2021; 22:s22010026. [PMID: 35009569 PMCID: PMC8747744 DOI: 10.3390/s22010026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
In wireless communication, Fifth Generation (5G) Technology is a recent generation of mobile networks. In this paper, evaluations in the field of mobile communication technology are presented. In each evolution, multiple challenges were faced that were captured with the help of next-generation mobile networks. Among all the previously existing mobile networks, 5G provides a high-speed internet facility, anytime, anywhere, for everyone. 5G is slightly different due to its novel features such as interconnecting people, controlling devices, objects, and machines. 5G mobile system will bring diverse levels of performance and capability, which will serve as new user experiences and connect new enterprises. Therefore, it is essential to know where the enterprise can utilize the benefits of 5G. In this research article, it was observed that extensive research and analysis unfolds different aspects, namely, millimeter wave (mmWave), massive multiple-input and multiple-output (Massive-MIMO), small cell, mobile edge computing (MEC), beamforming, different antenna technology, etc. This article’s main aim is to highlight some of the most recent enhancements made towards the 5G mobile system and discuss its future research objectives.
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Affiliation(s)
- Ramraj Dangi
- School of Computing Science and Engineering, VIT University Bhopal, Bhopal 466114, India; (R.D.); (P.L.)
| | - Praveen Lalwani
- School of Computing Science and Engineering, VIT University Bhopal, Bhopal 466114, India; (R.D.); (P.L.)
| | - Gaurav Choudhary
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Lyngby, Denmark;
| | - Ilsun You
- Department of Information Security Engineering, Soonchunhyang University, Asan-si 31538, Korea
- Correspondence:
| | - Giovanni Pau
- Faculty of Engineering and Architecture, Kore University of Enna, 94100 Enna, Italy;
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42
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Lam PH, Keramida K, Filippatos GS, Gupta N, Faselis C, Deedwania P, George B, Iskandrian A, Cleland JG, Choudhary G, Wu WC, Morgan CJ, Fonarow GC, Ahmed A. Right Ventricular Ejection Fraction and Beta-Blocker Effect in Heart Failure With Reduced Ejection Fraction. J Card Fail 2021; 28:65-70. [PMID: 34419597 DOI: 10.1016/j.cardfail.2021.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/12/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A low right ventricular ejection fraction (RVEF) is a marker of poor outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Beta-blockers improve outcomes in HFrEF, but whether this effect is modified by RVEF is unknown. METHODS AND RESULTS Of the 2798 patients in Beta-Blocker Evaluation of Survival Trial (BEST), 2008 had data on baseline RVEF (mean 35%, median 34%). Patients were categorized into an RVEF of less than 35% (n = 1012) and an RVEF of 35% or greater (n = 996). We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) within each RVEF subgroup and formally tested for interactions between bucindolol and RVEF. The effect of bucindolol on all-cause mortality in 2008 patients with baseline RVEF (HR 0.88, 95% CI 0.75-1.02) is consistent with that in 2798 patients in the main trial (HR 0.90, 95% CI 0.78-1.02). Bucindolol use was associated with a lower risk of all-cause mortality in patients with an RVEF of 35% or greater (HR 0.70, 95% CI 0.55-0.89), but not in those with an RVEF of less than 35% (HR 1.02, 95% CI 0.83-1.24, P for interaction = .022). Similar variations were observed for cardiovascular mortality (P for interaction = .009) and sudden cardiac death (P for interaction = .018), but not for pump failure death (P for interaction = .371) or HF hospitalization (P for interaction = .251). CONCLUSIONS The effect of bucindolol on mortality in patients with HFrEF was modified by the baseline RVEF. If these hypothesis-generating findings can be replicated using approved beta-blockers in contemporary patients with HFrEF, then RVEF may help to risk stratify patients with HFrEF for optimization of beta-blocker therapy.
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Affiliation(s)
- Phillip H Lam
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Cardiology, MedStar Washington Hospital Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC.
| | - Kalliopi Keramida
- Department of Cardiology, Attikon University Hospital, Athens, Greece; Department of Cardiology, National Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos S Filippatos
- Department of Cardiology, Attikon University Hospital, Athens, Greece; Department of Cardiology, National Kapodistrian University of Athens, Athens, Greece
| | - Neha Gupta
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Cardiology, MedStar Washington Hospital Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC
| | - Charles Faselis
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC; Uniformed Services University, Washington, DC
| | - Prakash Deedwania
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, University of California, San Francisco, California
| | - Brandon George
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ami Iskandrian
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow; National Heart & Lung Institute, Imperial College London, Glasgow, UK
| | - Gaurav Choudhary
- Department of Medicine, Veterans Affairs Medical Center, Providence, Rhode Island; Department of Medicine, Brown University, Providence, Rhode Island
| | - Wen-Chih Wu
- Department of Medicine, Veterans Affairs Medical Center, Providence, Rhode Island; Department of Medicine, Brown University, Providence, Rhode Island
| | - Charity J Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregg C Fonarow
- Department of Medicine, University of California, Los Angeles, California
| | - Ali Ahmed
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC.
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43
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Oldham WM, Hess E, Waldo SW, Humbert M, Choudhary G, Maron BA. Integrating haemodynamics identifies an extreme pulmonary hypertension phenotype. Eur Respir J 2021; 58:13993003.04625-2020. [PMID: 33833034 DOI: 10.1183/13993003.04625-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/27/2021] [Indexed: 11/05/2022]
Affiliation(s)
- William M Oldham
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward Hess
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | | | - Marc Humbert
- Université Paris-Saclay, Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (Assistance Publique-Hôpitaux de Paris), Le Kremlin-Bicêtre, France
| | - Gaurav Choudhary
- Providence Veterans Affairs Medical Center and Division of Cardiovascular Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Dept of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.,Veterans Affairs Boston Healthcare System, Boston, MA, USA
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44
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Vang A, da Silva Gonçalves Bos D, Fernandez-Nicolas A, Zhang P, Morrison AR, Mancini TJ, Clements RT, Polina I, Cypress MW, Jhun BS, Hawrot E, Mende U, O-Uchi J, Choudhary G. α7 Nicotinic acetylcholine receptor mediates right ventricular fibrosis and diastolic dysfunction in pulmonary hypertension. JCI Insight 2021; 6:142945. [PMID: 33974567 PMCID: PMC8262476 DOI: 10.1172/jci.insight.142945] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/10/2020] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
Right ventricular (RV) fibrosis is a key feature of maladaptive RV hypertrophy and dysfunction and is associated with poor outcomes in pulmonary hypertension (PH). However, mechanisms and therapeutic strategies to mitigate RV fibrosis remain unrealized. Previously, we identified that cardiac fibroblast α7 nicotinic acetylcholine receptor (α7 nAChR) drives smoking-induced RV fibrosis. Here, we sought to define the role of α7 nAChR in RV dysfunction and fibrosis in the settings of RV pressure overload as seen in PH. We show that RV tissue from PH patients has increased collagen content and ACh expression. Using an experimental rat model of PH, we demonstrate that RV fibrosis and dysfunction are associated with increases in ACh and α7 nAChR expression in the RV but not in the left ventricle (LV). In vitro studies show that α7 nAChR activation leads to an increase in adult ventricular fibroblast proliferation and collagen content mediated by a Ca2+/epidermal growth factor receptor (EGFR) signaling mechanism. Pharmacological antagonism of nAChR decreases RV collagen content and improves RV function in the PH model. Furthermore, mice lacking α7 nAChR exhibit improved RV diastolic function and have lower RV collagen content in response to persistently increased RV afterload, compared with WT controls. These finding indicate that enhanced α7 nAChR signaling is an important mechanism underlying RV fibrosis and dysfunction, and targeted inhibition of α7 nAChR is a potentially novel therapeutic strategy in the setting of increased RV afterload.
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Affiliation(s)
- Alexander Vang
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Denielli da Silva Gonçalves Bos
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ana Fernandez-Nicolas
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Peng Zhang
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan R. Morrison
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Thomas J. Mancini
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Richard T. Clements
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA.,Biomedical & Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Iuliia Polina
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael W. Cypress
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bong Sook Jhun
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Edward Hawrot
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ulrike Mende
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Cardiovascular Research Center, Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jin O-Uchi
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gaurav Choudhary
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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45
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Erqou S, Jiang L, Choudhary G, Lally M, Freiberg M, Lin NH, Shireman TI, Rudolph JL, Wu WC. Age at Diagnosis of Heart Failure in United States Veterans With and Without HIV Infection. J Am Heart Assoc 2021; 10:e018983. [PMID: 33998245 PMCID: PMC8483515 DOI: 10.1161/jaha.120.018983] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Although HIV is associated with increased risk of heart failure (HF), it is not known if people living with HIV develop HF at a younger age compared with individuals without HIV. Crude comparisons of age at diagnosis of HF between individuals with and without HIV does not account for differences in underlying age structures between the populations. Methods and Results We used Veterans Health Administration data to compare the age at HF diagnosis between veterans with and without HIV, with adjustment for difference in population age structure. Statistical weights, calculated for each 1‐year strata of veterans with HIV in each calendar year from 2000 to 2018, were applied to the veterans without HIV to standardize the age structure. We identified 5093 veterans with HIV (98% men, 34% White) with first HF episode recorded after HIV diagnosis (median age at incidence of HF, 58 years), and 1 425 987 veterans without HIV (98% men, 78% White) with HF (corresponding age, 72 years), with an absolute difference of 14 years. After accounting for difference in age structure, the adjusted median age at HF diagnosis for veterans without HIV was 63 years, 5 years difference with veterans with HIV (P<0.001). The age differences were consistent across important subgroups such as preserved versus reduced ejection fraction and inpatient versus outpatient index HF. Conclusions Veterans with HIV are diagnosed with HF at a significantly younger age compared with veterans without HIV. These findings may have implications for HF prevention in individuals with HIV. Future studies are needed to make the findings more generalizable.
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Affiliation(s)
- Sebhat Erqou
- Department of Medicine Providence VA Medical Center Providence RI.,Center of Innovation in Long Term Services and Supports Providence VA Medical Center Providence RI.,Department of Medicine Alpert Medical School of Brown University Providence RI
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports Providence VA Medical Center Providence RI
| | - Gaurav Choudhary
- Department of Medicine Providence VA Medical Center Providence RI.,Department of Medicine Alpert Medical School of Brown University Providence RI
| | - Michelle Lally
- Department of Medicine Providence VA Medical Center Providence RI.,Department of Medicine Alpert Medical School of Brown University Providence RI
| | | | - Nina H Lin
- Department of Medicine Boston University Boston MA
| | | | - James L Rudolph
- Department of Medicine Providence VA Medical Center Providence RI.,Center of Innovation in Long Term Services and Supports Providence VA Medical Center Providence RI.,Department of Medicine Alpert Medical School of Brown University Providence RI.,Brown University School of Public Health Providence RI
| | - Wen-Chih Wu
- Department of Medicine Providence VA Medical Center Providence RI.,Center of Innovation in Long Term Services and Supports Providence VA Medical Center Providence RI.,Department of Medicine Alpert Medical School of Brown University Providence RI.,Brown University School of Public Health Providence RI
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46
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Cypress M, Vang A, Zhou H, Fernandez‐Nicolas A, Mancini T, Jhun BS, Clements R, Choudhary G, O‐Uchi J. Ca
2+
‐Activated Cl‐ Channel Anoctamin‐1 Interacts with Mitochondrial Fusion Protein OPA1. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Hana Zhou
- MedicineUniversity of MinnesotaMinneapolisMN
| | | | | | | | | | - Gaurav Choudhary
- Providence Veterans Affairs Medical CenterProvidenceRI
- Brown UniversityProvidenceRI
| | - Jin O‐Uchi
- MedicineUniversity of MinnesotaMinneapolisMN
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47
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Chung H, Ghosalkar D, Chu A, Wu WC, Choudhary G, Morrison A. DURATION OF STATIN THERAPY IS ASSOCIATED WITH CORONARY ARTERY CALCIFICATION IN PATIENTS WITHOUT HISTORY OF OBSTRUCTIVE CAD. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02805-9] [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: 11/27/2022]
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48
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Chung H, Ramani M, Ghosalkar D, Chu A, Wu WC, Choudhary G, Morrison A. PULMONARY ARTERY TO AORTA DIAMETER RATIO DERIVED FROM LUNG CANCER SCREENING CT IS ASSOCIATED WITH ALL-CAUSE MORTALITY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02720-0] [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: 10/21/2022]
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49
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Chung HE, Chen J, Ghosalkar D, Christensen JL, Chu AJ, Mantsounga CS, Neverson J, Soares C, Shah NR, Wu WC, Choudhary G, Morrison AR. Aortic Valve Calcification Is Associated with Future Cognitive Impairment. J Alzheimers Dis Rep 2021; 5:337-343. [PMID: 34113789 PMCID: PMC8150250 DOI: 10.3233/adr-200253] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: While an association between atherosclerosis and dementia has been identified, few studies have assessed the longitudinal relationship between aortic valve calcification (AVC) and cognitive impairment (CI). Objective: We sought to determine whether AVC derived from lung cancer screening CT (LCSCT) was associated with CI in a moderate-to-high atherosclerotic risk cohort. Methods: This was a single site, retrospective analysis of 1401 U.S. veterans (65 years [IQI: 61, 68] years; 97%male) who underwent quantification of AVC from LCSCT indicated for smoking history. The primary outcome was new diagnosis of CI identified by objective testing (Mini-Mental Status Exam or Montreal Cognitive Assessment) or by ICD coding. Time-to-event analysis was carried out using AVC as a continuous variable. Results: Over 5 years, 110 patients (8%) were diagnosed with CI. AVC was associated with new diagnosis of CI using 3 Models for adjustment: 1) age (HR: 1.104; CI: 1.023–1.191; p = 0.011); 2) Model 1 plus hypertension, hyperlipidemia, diabetes, CKD stage 3 or higher (glomerular filtration rate < 60 mL/min) and CAD (HR: 1.097; CI: 1.014–1.186; p = 0.020); and 3) Model 2 plus CVA (HR: 1.094; CI: 1.011–1.182; p = 0.024). Sensitivity analysis demonstrated that the association between AVC and new diagnosis of CI remained significant upon exclusion of severe AVC (HR: 1.100 [1.013–1.194]; p = 0.023). Subgroup analysis demonstrated that this association remained significant when including education in the multivariate analysis (HR: 1.127 [1.030–1.233]; p = 0.009). Conclusion: This is the first study demonstrating that among mostly male individuals who underwent LCSCT, quantified aortic valve calcification is associated with new diagnosis of CI.
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Affiliation(s)
- Hojune E Chung
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA.,Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Jessica Chen
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Dhairyasheel Ghosalkar
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Jared L Christensen
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA.,Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Alice J Chu
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Chris S Mantsounga
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA.,Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Jade Neverson
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA.,Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Cullen Soares
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Nishant R Shah
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA.,Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Wen-Chih Wu
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA.,Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Gaurav Choudhary
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA.,Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Alan R Morrison
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA.,Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
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50
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Rumery K, Seo A, Jiang L, Choudhary G, Shah NR, Rudolph JL, Wu WC, Erqou S. Outcomes of coronavirus disease-2019 among veterans with pre-existing diagnosis of heart failure. ESC Heart Fail 2021; 8:2338-2344. [PMID: 33728800 PMCID: PMC8120381 DOI: 10.1002/ehf2.13291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/24/2021] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
Aims Pre‐existing cardiovascular disease in general and related risk factors have been associated with poor coronavirus disease‐2019 (COVID‐19) outcomes. However, data on outcomes of COVID‐19 among people with pre‐existing diagnosis of heart failure (HF) have not been studied in sufficient detail. We aimed to perform detailed characterization of the association of pre‐existing HF with COVID‐19 outcomes. Methods and results A retrospective cohort study based on Veterans Health Administration (VHA) data comparing 30 day mortality and hospital admission rates after COVID‐19 diagnosis among Veterans with and without pre‐existing diagnosis of HF. Cox‐regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) with adjustment for covariates. Among 31 051 veterans (97% male) with COVID‐19, 6148 had pre‐existing diagnosis of HF. The mean (SD) age of patients with HF was 70 (13) whereas the mean (SD) age of patients without HF was 57 (17). Within the HF group with available data on left ventricular ejection fraction (EF), 1844 patients (63.4%) had an EF of >45%, and 1063 patients (36.6%) had an EF of ≤45%. Patients in the HF cohort had higher 30 day mortality (5.4% vs. 1.5%) and admission (18.5% vs. 8.4%) rates after diagnosis of COVID‐19. After adjustment for age, sex, and race, HRs (95% CIs) for 30 day mortality and for 30 day hospital admissions were 1.87 (1.61–2.17) and 1.79 (1.66–1.93), respectively. After additional adjustment for medical comorbidities, HRs for 30 day mortality and for 30 day hospital admissions were 1.37 (1.15–1.64) and 1.27 (1.16–1.38), respectively. The findings were similar among HF patients with preserved vs. reduced EF, among those taking vs. not taking angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, and among those taking vs. not taking anticoagulants. Conclusions Patients with COVID‐19 and pre‐existing diagnosis of HF had a higher risk of 30 day mortality and hospital admissions compared to those without history of HF. The findings were similar by EF categories and by angiotensin‐converting enzyme inhibitors/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitors or anticoagulant use.
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Affiliation(s)
- Kyle Rumery
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Angie Seo
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- Department of Medicine, Providence VA Medical Center, Providence, RI, USA.,Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Gaurav Choudhary
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Providence VA Medical Center, Providence, RI, USA
| | - Nishant R Shah
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Providence VA Medical Center, Providence, RI, USA.,Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, RI, USA.,School of Public Health, Brown University, Providence, RI, USA
| | - James L Rudolph
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Providence VA Medical Center, Providence, RI, USA.,Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, RI, USA.,School of Public Health, Brown University, Providence, RI, USA
| | - Wen-Chih Wu
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Providence VA Medical Center, Providence, RI, USA.,Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, RI, USA.,School of Public Health, Brown University, Providence, RI, USA
| | - Sebhat Erqou
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Providence VA Medical Center, Providence, RI, USA.,Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, RI, USA
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