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Langer HF. An unexpected cellular fountain of youth: platelets provide factors rejuvenating brain functions. Signal Transduct Target Ther 2023; 8:461. [PMID: 38155168 PMCID: PMC10754843 DOI: 10.1038/s41392-023-01716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/19/2023] [Accepted: 11/19/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
- Harald F Langer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Cardiovascular systems biology, Medical Clinic I, University Heart Center Lübeck, Lübeck, Germany.
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2
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Nording H, Baron L, Sauter M, Lübken A, Rawish E, Szepanowski R, von Esebeck J, Sun Y, Emami H, Meusel M, Saraei R, Schanze N, Gorantla SP, von Bubnoff N, Geisler T, von Hundelshausen P, Stellos K, Marquardt J, Sadik CD, Köhl J, Duerschmied D, Kleinschnitz C, Langer HF. Platelets regulate ischemia-induced revascularization and angiogenesis by secretion of growth factor-modulating factors. Blood Adv 2023; 7:6411-6427. [PMID: 37257194 PMCID: PMC10598500 DOI: 10.1182/bloodadvances.2021006891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/16/2023] [Accepted: 02/26/2023] [Indexed: 06/02/2023] Open
Abstract
In ischemic tissue, platelets can modulate angiogenesis. The specific factors influencing this function, however, are poorly understood. Here, we characterized the complement anaphylatoxin C5a-mediated activation of C5a receptor 1 (C5aR1) expressed on platelets as a potent regulator of ischemia-driven revascularization. We assessed the relevance of the anaphylatoxin receptor C5aR1 on platelets in patients with coronary artery disease as well as those with peripheral artery disease and used genetic mouse models to characterize its significance for ischemia and growth factor-driven revascularization. The presence of C5aR1-expressing platelets was increased in the hindlimb ischemia model. Ischemia-driven angiogenesis was significantly improved in C5aR1-/- mice but not in C5-/- mice, suggesting a specific role of C5aR1. Experiments using the supernatant of C5a-stimulated platelets suggested a paracrine mechanism of angiogenesis inhibition by platelets by means of antiangiogenic CXC chemokine ligand 4 (CXCL4, PF4). Lineage-specific C5aR1 deletion verified that the secretion of CXCL4 depends on C5aR1 ligation on platelets. Using C5aR1-/-CXCL4-/- mice, we observed no additional effect in the revascularization response, underscoring a strong dependence of CXCL4 secretion on the C5a-C5aR1-axis. We identified a novel mechanism for inhibition of neovascularization via platelet C5aR1, which was mediated by the release of antiangiogenic CXCL4.
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Affiliation(s)
- Henry Nording
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany
| | - Lasse Baron
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Manuela Sauter
- Cardioimmunology Group, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Antje Lübken
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Elias Rawish
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Rebecca Szepanowski
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Jacob von Esebeck
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Ying Sun
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Hossein Emami
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Moritz Meusel
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Roza Saraei
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Nancy Schanze
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sivahari Prasad Gorantla
- Department of Hematology and Oncology, Medical Center, University of Schleswig-Holstein, Lübeck, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, Medical Center, University of Schleswig-Holstein, Lübeck, Germany
| | - Tobias Geisler
- Department of Cardiovascular Medicine, University Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Philipp von Hundelshausen
- Institute for Cardiovascular Prevention, Ludwig Maximilians University Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Konstantinos Stellos
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jens Marquardt
- First Department of Medicine, University of Schleswig-Holstein, Lübeck, Germany
| | | | - Jörg Köhl
- Institute for Systemic Inflammation Research, University of Schleswig-Holstein, Lübeck, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Harald F. Langer
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany
- Cardioimmunology Group, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Georgiopoulos G, Kraler S, Mueller-Hennessen M, Delialis D, Mavraganis G, Sopova K, Wenzl FA, Räber L, Biener M, Stähli BE, Maneta E, Spray L, Iglesias JF, Coelho-Lima J, Tual-Chalot S, Muller O, Mach F, Frey N, Duerschmied D, Langer HF, Katus H, Roffi M, Camici GG, Mueller C, Giannitsis E, Spyridopoulos I, Lüscher TF, Stellos K, Stamatelopoulos K. Modification of the GRACE Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes. JAMA Cardiol 2023; 8:946-956. [PMID: 37647046 PMCID: PMC10469286 DOI: 10.1001/jamacardio.2023.2741] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023]
Abstract
Importance The Global Registry of Acute Coronary Events (GRACE) risk score, a guideline-recommended risk stratification tool for patients presenting with acute coronary syndromes (ACS), does not consider the extent of myocardial injury. Objective To assess the incremental predictive value of a modified GRACE score incorporating high-sensitivity cardiac troponin (hs-cTn) T at presentation, a surrogate of the extent of myocardial injury. Design, Setting, and Participants This retrospectively designed longitudinal cohort study examined 3 independent cohorts of 9803 patients with ACS enrolled from September 2009 to December 2017; 2 ACS derivation cohorts (Heidelberg ACS cohort and Newcastle STEMI cohort) and an ACS validation cohort (SPUM-ACS study). The Heidelberg ACS cohort included 2535 and the SPUM-ACS study 4288 consecutive patients presenting with a working diagnosis of ACS. The Newcastle STEMI cohort included 2980 consecutive patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Data were analyzed from March to June 2023. Exposures In-hospital, 30-day, and 1-year mortality risk estimates derived from an updated risk score that incorporates continuous hs-cTn T at presentation (modified GRACE). Main Outcomes and Measures The predictive value of continuous hs-cTn T and modified GRACE risk score compared with the original GRACE risk score. Study end points were all-cause mortality during hospitalization and at 30 days and 1 year after the index event. Results Of 9450 included patients, 7313 (77.4%) were male, and the mean (SD) age at presentation was 64.2 (12.6) years. Using continuous rather than binary hs-cTn T conferred improved discrimination and reclassification compared with the original GRACE score (in-hospital mortality: area under the receiver operating characteristic curve [AUC], 0.835 vs 0.741; continuous net reclassification improvement [NRI], 0.208; 30-day mortality: AUC, 0.828 vs 0.740; NRI, 0.312; 1-year mortality: AUC, 0.785 vs 0.778; NRI, 0.078) in the derivation cohort. These findings were confirmed in the validation cohort. In the pooled population of 9450 patients, modified GRACE risk score showed superior performance compared with the original GRACE risk score in terms of reclassification and discrimination for in-hospital mortality end point (AUC, 0.878 vs 0.780; NRI, 0.097), 30-day mortality end point (AUC, 0.858 vs 0.771; NRI, 0.08), and 1-year mortality end point (AUC, 0.813 vs 0.797; NRI, 0.056). Conclusions and Relevance In this study, using continuous rather than binary hs-cTn T at presentation, a proxy of the extent of myocardial injury, in the GRACE risk score improved the mortality risk prediction in patients with ACS.
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Affiliation(s)
- Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Matthias Mueller-Hennessen
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kateryna Sopova
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Florian A. Wenzl
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Swiss Heart Center, Inselspital Bern, Bern, Switzerland
| | - Moritz Biener
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Barbara E. Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Eleni Maneta
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Luke Spray
- Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Juan F. Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jose Coelho-Lima
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simon Tual-Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Olivier Muller
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - François Mach
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Norbert Frey
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Daniel Duerschmied
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Harald F. Langer
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hugo Katus
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Giovanni G. Camici
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland
| | - Evangelos Giannitsis
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ioakim Spyridopoulos
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Royal Brompton and Harefield Hospitals and Imperial College and Kings College, London, United Kingdom
| | - Konstantinos Stellos
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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4
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Nording H, Baron L, Lübken A, Emami H, von Esebeck J, Meusel M, Sadik C, Schanze N, Duerschmied D, Köhl J, Münch G, Langer HF. The Platelet Anaphylatoxin Receptor C5aR1 (CD88) Is a Promising Target for Modulating Vessel Growth in Response to Ischemia a. TH Open 2023; 7:e289-e293. [PMID: 37868192 PMCID: PMC10586890 DOI: 10.1055/a-2156-8048] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
- Henry Nording
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany
| | - Lasse Baron
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Antje Lübken
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Hossein Emami
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Jacob von Esebeck
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Moritz Meusel
- Medical Clinic II, University Hospital, University Heart Center Lübeck, Lübeck, Germany
| | - Christian Sadik
- Clinic for Dermatology, University of Lübeck, University Hospital, Lübeck, Germany
| | - Nancy Schanze
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jörg Köhl
- ISEF, University of Lübeck, Lübeck, Germany
| | | | - Harald F. Langer
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany
- Clinic for Dermatology, University of Lübeck, University Hospital, Lübeck, Germany
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Germany
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5
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Lee C, Chen R, Sun G, Liu X, Lin X, He C, Xing L, Liu L, Jensen LD, Kumar A, Langer HF, Ren X, Zhang J, Huang L, Yin X, Kim J, Zhu J, Huang G, Li J, Lu W, Chen W, Liu J, Hu J, Sun Q, Lu W, Fang L, Wang S, Kuang H, Zhang Y, Tian G, Mi J, Kang BA, Narazaki M, Prodeus A, Schoonjans L, Ornitz DM, Gariepy J, Eelen G, Dewerchin M, Yang Y, Ou JS, Mora A, Yao J, Zhao C, Liu Y, Carmeliet P, Cao Y, Li X. VEGF-B prevents excessive angiogenesis by inhibiting FGF2/FGFR1 pathway. Signal Transduct Target Ther 2023; 8:305. [PMID: 37591843 PMCID: PMC10435562 DOI: 10.1038/s41392-023-01539-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/01/2022] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 08/19/2023] Open
Abstract
Although VEGF-B was discovered as a VEGF-A homolog a long time ago, the angiogenic effect of VEGF-B remains poorly understood with limited and diverse findings from different groups. Notwithstanding, drugs that inhibit VEGF-B together with other VEGF family members are being used to treat patients with various neovascular diseases. It is therefore critical to have a better understanding of the angiogenic effect of VEGF-B and the underlying mechanisms. Using comprehensive in vitro and in vivo methods and models, we reveal here for the first time an unexpected and surprising function of VEGF-B as an endogenous inhibitor of angiogenesis by inhibiting the FGF2/FGFR1 pathway when the latter is abundantly expressed. Mechanistically, we unveil that VEGF-B binds to FGFR1, induces FGFR1/VEGFR1 complex formation, and suppresses FGF2-induced Erk activation, and inhibits FGF2-driven angiogenesis and tumor growth. Our work uncovers a previously unrecognized novel function of VEGF-B in tethering the FGF2/FGFR1 pathway. Given the anti-angiogenic nature of VEGF-B under conditions of high FGF2/FGFR1 levels, caution is warranted when modulating VEGF-B activity to treat neovascular diseases.
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Affiliation(s)
- Chunsik Lee
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Rongyuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Guangli Sun
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Xialin Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Xianchai Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Chang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Liying Xing
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases,Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lixian Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Lasse D Jensen
- Department of Health, Medical and Caring Sciences, Division of Diagnostics and Specialist Medicine, Linköping University, 581 83, Linköping, Sweden
| | - Anil Kumar
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Harald F Langer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), partner site Mannheim/ Heidelberg, Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Xiangrong Ren
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Jianing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Lijuan Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Xiangke Yin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - JongKyong Kim
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Juanhua Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Guanqun Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Jiani Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Weiwei Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Wei Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Juanxi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Jiaxin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Qihang Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Weisi Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Lekun Fang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangdong Research Institute of Gastroenterology, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shasha Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Haiqing Kuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Yihan Zhang
- Eye Institute, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Key Laboratory of Myopia of State Health Ministry (Fudan University) and Shanghai Key Laboratory of Visual Impairment and Restoration, 200031, Shanghai, China
| | - Geng Tian
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003, P. R. China
| | - Jia Mi
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003, P. R. China
| | - Bi-Ang Kang
- Division of Cardiac Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, NHC key Laboratory of Assisted Circulation (Sun Yat-sen University), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Masashi Narazaki
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, 565-0871, Japan
| | - Aaron Prodeus
- Physical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Luc Schoonjans
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, B-3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology (CCB), VIB, Leuven, B-3000, Belgium
| | - David M Ornitz
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jean Gariepy
- Physical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Guy Eelen
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, B-3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology (CCB), VIB, Leuven, B-3000, Belgium
| | - Mieke Dewerchin
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, B-3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology (CCB), VIB, Leuven, B-3000, Belgium
| | - Yunlong Yang
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jing-Song Ou
- Division of Cardiac Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, NHC key Laboratory of Assisted Circulation (Sun Yat-sen University), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Antonio Mora
- Joint School of Life Sciences, Guangzhou Medical University and Guangzhou Institutes of Biomedicine and Health (Chinese Academy of Sciences), Xinzao, Panyu district, Guangzhou, 511436, Guangdong, China
| | - Jin Yao
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Chen Zhao
- Eye Institute, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Key Laboratory of Myopia of State Health Ministry (Fudan University) and Shanghai Key Laboratory of Visual Impairment and Restoration, 200031, Shanghai, China.
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, B-3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology (CCB), VIB, Leuven, B-3000, Belgium
- Laboratory of Angiogenesis and Vascular Heterogeneity, Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Yihai Cao
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, 171 77, Stockholm, Sweden.
| | - Xuri Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, P. R. China.
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6
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Sopova K, Tual-Chalot S, Mueller-Hennessen M, Vlachogiannis NI, Georgiopoulos G, Biener M, Sachse M, Turchinovich A, Polycarpou-Schwarz M, Spray L, Maneta E, Bennaceur K, Mohammad A, Richardson GD, Gatsiou A, Langer HF, Frey N, Stamatelopoulos K, Heineke J, Duerschmied D, Giannitsis E, Spyridopoulos I, Stellos K. Effector T cell chemokine IP-10 predicts cardiac recovery and clinical outcomes post-myocardial infarction. Front Immunol 2023; 14:1177467. [PMID: 37426649 PMCID: PMC10326041 DOI: 10.3389/fimmu.2023.1177467] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
Background and aims Preclinical data suggest that activation of the adaptive immune system is critical for myocardial repair processes in acute myocardial infarction. The aim of the present study was to determine the clinical value of baseline effector T cell chemokine IP-10 blood levels in the acute phase of ST-segment elevation myocardial infarction (STEMI) for the prediction of the left ventricular function changes and cardiovascular outcomes after STEMI. Methods Serum IP-10 levels were retrospectively quantified in two independent cohorts of STEMI patients undergoing primary percutaneous coronary intervention. Results We report a biphasic response of the effector T cell trafficking chemokine IP-10 characterized by an initial increase of its serum levels in the acute phase of STEMI followed by a rapid reduction at 90min post reperfusion. Patients at the highest IP-10 tertile presented also with more CD4 effector memory T cells (CD4 TEM cells), but not other T cell subtypes, in blood. In the Newcastle cohort (n=47), patients in the highest IP-10 tertile or CD4 TEM cells at admission exhibited an improved cardiac systolic function 12 weeks after STEMI compared to patients in the lowest IP-10 tertile. In the Heidelberg cohort (n=331), STEMI patients were followed for a median of 540 days for major adverse cardiovascular events (MACE). Patients presenting with higher serum IP-10 levels at admission had a lower risk for MACE after adjustment for traditional risk factors, CRP and high-sensitivity troponin-T levels (highest vs. rest quarters: HR [95% CI]=0.420 [0.218-0.808]). Conclusion Increased serum levels of IP-10 in the acute phase of STEMI predict a better recovery in cardiac systolic function and less adverse events in patients after STEMI.
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Affiliation(s)
- Kateryna Sopova
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiology, Royal Victoria Infirmary (RVI) and Freeman Hospitals, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle Upon Tyne, United Kingdom
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
| | - Simon Tual-Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Matthias Mueller-Hennessen
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nikolaos I. Vlachogiannis
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Moritz Biener
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marco Sachse
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
| | - Andrey Turchinovich
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
| | - Maria Polycarpou-Schwarz
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
| | - Luke Spray
- Department of Cardiology, Royal Victoria Infirmary (RVI) and Freeman Hospitals, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle Upon Tyne, United Kingdom
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Eleni Maneta
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Karim Bennaceur
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Ashfaq Mohammad
- Department of Cardiology, Royal Victoria Infirmary (RVI) and Freeman Hospitals, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle Upon Tyne, United Kingdom
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Gavin David Richardson
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Aikaterini Gatsiou
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Harald F. Langer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Norbert Frey
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kimon Stamatelopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Joerg Heineke
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiovascular Physiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ioakim Spyridopoulos
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Cardiology, Royal Victoria Infirmary (RVI) and Freeman Hospitals, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Konstantinos Stellos
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Cardiovascular Physiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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7
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Sauter R, Lin C, Magunia H, Schreieck J, Dürschmied D, Gawaz M, Patzelt J, Langer HF. Improved mid-term stability of MR reduction with an increased number of clips after percutaneous mitral valve repair in functional MR. Int J Cardiol Heart Vasc 2023; 45:101190. [PMID: 36941997 PMCID: PMC10024191 DOI: 10.1016/j.ijcha.2023.101190] [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] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Background Percutaneous mitral valve repair (PMVR) has evolved to be a standard procedure in suitable patients with mitral regurgitation (MR) not accessible for open surgery. Here, we analyzed the influence of the number and positioning of the clips implanted during the procedure on MR reduction analyzing also sub-collectives of functional and degenerative MR (DMR). Results We included 410 patients with severe MR undergoing PMVR using the MitraClip® System. MR and reduction of MR were analyzed by TEE at the beginning and at the end of the PMVR procedure. To specify the clip localization, we sub-divided segment 2 into 3 sub-segments using the segmental classification of the mitral valve. Results We found an enhanced reduction of MR predominantly in DMR patients who received more than one clip. Implantation of only one clip led to a higher MR reduction in patients with functional MR (FMR) in comparison to patients with DMR. No significant differences concerning pressure gradients could be observed in degenerative MR patients regardless of the number of clips implanted. A deterioration of half a grade of the achieved MR reduction was observed 6 months post-PMVR independent of the number of implanted clips with a better stability in FMR patients, who got 3 clips compared to patients with only one clip. Conclusions In patients with FMR, after 6 months the reduction of MR was more stable with an increased number of implanted clips, which suggests that this specific patient collective may benefit from a higher number of clips.
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Key Words
- CO, cardiac output
- COe, cardiac output echocardiographically determinded by combination of TTE and TEE parameters
- COi, invasively determined cardiac output
- Clips
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FMR, functional mitral regurgitation
- Heart failure
- Heart geometry
- Hemodynamics
- ICE, intracardiac echocardiography
- IVUS, intravascular ultrasound
- Interventional cardiology
- Interventional therapy
- LA, left atrium
- LV, left ventricle
- LVEDD, left ventricular end diastolic diameter
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association
- PA, pulmonary artery
- PAP, pulmonary artery pressure
- PASP, pulmonary artery systolic pressure
- PCW, pulmonary capillary wedge
- PCWP, pulmonary capillary wedge pressure
- PHT, pulmonary hypertension
- PMVR
- PMVR, percutaneous mitral valve repair
- RV, right ventricle
- SD, standard deviation
- Structural heart disease
- Surgery
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard Sauter
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Chaolan Lin
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Dürschmied
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F. Langer
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
- Corresponding author at: Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, 68167 Mannheim, Germany.
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8
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Huseynov A, Reinhardt J, Chandra L, Dürschmied D, Langer HF. Novel Aspects Targeting Platelets in Atherosclerotic Cardiovascular Disease—A Translational Perspective. Int J Mol Sci 2023; 24:ijms24076280. [PMID: 37047253 PMCID: PMC10093962 DOI: 10.3390/ijms24076280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Platelets are important cellular targets in cardiovascular disease. Based on insights from basic science, translational approaches and clinical studies, a distinguished anti-platelet drug treatment regimen for cardiovascular patients could be established. Furthermore, platelets are increasingly considered as cells mediating effects “beyond thrombosis”, including vascular inflammation, tissue remodeling and healing of vascular and tissue lesions. This review has its focus on the functions and interactions of platelets with potential translational and clinical relevance. The role of platelets for the development of atherosclerosis and therapeutic modalities for primary and secondary prevention of atherosclerotic disease are addressed. Furthermore, novel therapeutic options for inhibiting platelet function and the use of platelets in regenerative medicine are considered.
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9
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Steubing RD, Szepanowski F, David C, Mohamud Yusuf A, Mencl S, Mausberg AK, Langer HF, Sauter M, Deuschl C, Forsting M, Fender AC, Hermann DM, Casas AI, Langhauser F, Kleinschnitz C. Platelet depletion does not alter long-term functional outcome after cerebral ischaemia in mice. Brain Behav Immun Health 2022; 24:100493. [PMID: 35928516 PMCID: PMC9343933 DOI: 10.1016/j.bbih.2022.100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/12/2022] Open
Abstract
Platelets are key mediators of thrombus formation and inflammation during the acute phase of ischaemic stroke. Particularly, the platelet glycoprotein (GP) receptors GPIbα and GPVI have been shown to mediate platelet adhesion and activation in the ischaemic brain. GPIbα and GPVI blockade could reduce infarct volumes and improve functional outcome in mouse models of acute ischaemic stroke, without concomitantly increasing intracerebral haemorrhage. However, the functional role of platelets during long-term stroke recovery has not been elucidated so far. Thus, we here examined the impact of platelet depletion on post-stroke recovery after transient middle cerebral artery occlusion (tMCAO) in adult male mice. Platelet depleting antibodies or isotype control were applied from day 3–28 after tMCAO in mice matched for infarct size. Long-term functional recovery was assessed over the course of 28 days by behavioural testing encompassing motor and sensorimotorical functions, as well as anxiety-like or spontaneous behaviour. Whole brain flow cytometry and light sheet fluorescent microscopy were used to identify resident and infiltrated immune cell types, and to determine the effects of platelet depletion on the cerebral vascular architecture, respectively. We found that delayed platelet depletion does not improve long-term functional outcome in the tMCAO stroke model. Immune cell abundance, the extent of thrombosis and the organisation of the cerebral vasculature were also comparable between platelet-depleted and control mice. Our study demonstrates that, despite their critical role in the acute stroke setting, platelets appear to contribute only marginally to tissue reorganisation and functional recovery at later stroke stages. Stable and safe global platelet depletion can be achieved for a prolonged period. Platelets only play a minor role in neurological recovery during the chronic phase. Platelet depletion after infarct maturation does not alter inflammatory response. Cerebral architecture after stroke is not influenced by delayed platelet depletion.
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10
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Sauter M, Sauter RJ, Olbrich M, Thunemann M, Feil S, Feil R, Langer HF. Protocol to visualize CD11c+ cells in atherosclerosis using LacZ reporter mice. STAR Protoc 2022; 3:101645. [PMID: 36042879 PMCID: PMC9420394 DOI: 10.1016/j.xpro.2022.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Here, we describe an in vivo approach to visualize CD11c+ cells in atherosclerosis. In particular, we use a protocol for X-Gal staining of immune cells within atherosclerotic plaques, which can be used as an alternative to analyze plaque composition and cell-specific molecules in atherogenesis. LacZ knockin mice have to be bred to mice carrying the CD11ccre recombinase—both brought onto an ApoE−/− background—to be able to visualize this cell type of interest in the plaques by X-Gal staining. With this approach, different immune cells in atherogenesis can be examined. For complete details on the use and execution of this protocol, please refer to Sauter et al. (2021). Detailed protocol to generate CD11c reporter mice via specific expression of LacZ Detailed description of X-Gal staining in aortae of atherosclerotic CD11c-LacZ mice Quantify LacZ-positive cells in atherosclerotic plaques
Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.
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11
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Nording H, Sauter M, Lin C, Steubing R, Geisler S, Sun Y, Niethammer J, Emschermann F, Wang Y, Zieger B, Nieswandt B, Kleinschnitz C, Simon DI, Langer HF. Activated Platelets Upregulate β 2 Integrin Mac-1 (CD11b/CD18) on Dendritic Cells, Which Mediates Heterotypic Cell-Cell Interaction. J Immunol 2022; 208:1729-1741. [PMID: 35277420 DOI: 10.4049/jimmunol.2100557] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/11/2022] [Indexed: 12/30/2022]
Abstract
Recent evidence suggests interaction of platelets with dendritic cells (DCs), while the molecular mechanisms mediating this heterotypic cell cross-talk are largely unknown. We evaluated the role of integrin Mac-1 (αMβ2, CD11b/CD18) on DCs as a counterreceptor for platelet glycoprotein (GP) Ibα. In a dynamic coincubation model, we observed interaction of human platelets with monocyte-derived DCs, but also that platelet activation induced a sharp increase in heterotypic cell binding. Inhibition of CD11b or GPIbα led to significant reduction of DC adhesion to platelets in vitro independent of GPIIbIIIa, which we confirmed using platelets from Glanzmann thrombasthenia patients and transgenic mouse lines on C57BL/6 background (GPIbα-/-, IL4R-GPIbα-tg, and muMac1 mice). In vivo, inhibition or genetic deletion of CD11b and GPIbα induced a significant reduction of platelet-mediated DC adhesion to the injured arterial wall. Interestingly, only intravascular antiCD11b inhibited DC recruitment, suggesting a dynamic DC-platelet interaction. Indeed, we could show that activated platelets induced CD11b upregulation on Mg2+-preactivated DCs, which was related to protein kinase B (Akt) and dependent on P-selectin and P-selectin glycoprotein ligand 1. Importantly, specific pharmacological targeting of the GPIbα-Mac-1 interaction site blocked DC-platelet interaction in vitro and in vivo. These results demonstrate that cross-talk of platelets with DCs is mediated by GPIbα and Mac-1, which is upregulated on DCs by activated platelets in a P-selectin glycoprotein ligand 1-dependent manner.
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Affiliation(s)
- Henry Nording
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Research Centre for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany.,University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Manuela Sauter
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Chaolan Lin
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Rebecca Steubing
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Sven Geisler
- Cell Analysis Core Facility, University of Lübeck, Lübeck, Germany
| | - Ying Sun
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Joel Niethammer
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Fréderic Emschermann
- Department of Cardiovascular Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Barbara Zieger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University Hospital and Rudolf Virchow Center, University of Würzburg, Würzburg, Germany; and
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Daniel I Simon
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.,University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Harald F Langer
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; .,German Research Centre for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany.,University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
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12
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Abstract
The brain and spinal cord are immune-privileged organs, but in the disease state protection mechanisms such as the blood brain barrier (BBB) are ineffective or overcome by pathological processes. In neuroinflammatory diseases, microglia cells and other resident immune cells contribute to local vascular inflammation and potentially a systemic inflammatory response taking place in parallel. Microglia cells interact with other cells impacting on the integrity of the BBB and propagate the inflammatory response through the release of inflammatory signals. Here, we discuss the activation and response mechanisms of innate and adaptive immune processes in response to neuroinflammation. Furthermore, the clinical importance of neuroinflammatory mediators and a potential translational relevance of involved mechanisms are addressed also with focus on non-classical immune cells including microglia cells or platelets. As illustrative examples, novel agents such as Anfibatide or Revacept, which result in reduced recruitment and activation of platelets, a subsequently blunted activation of the coagulation cascade and further inflammatory process, demonstrating that mechanisms of neuroinflammation and thrombosis are interconnected and should be further subject to in depth clinical and basic research.
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Affiliation(s)
- Ying Sun
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Harald F. Langer
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany
- *Correspondence: Harald F. Langer,
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13
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Sauter M, Sauter RJ, Nording H, Lin C, Olbrich M, Autenrieth S, Gleissner C, Thunemann M, Otero N, Lutgens E, Aherrahrou Z, Wolf D, Zender L, Meuth S, Feil R, Langer HF. Apolipoprotein E derived from CD11c + cells ameliorates atherosclerosis. iScience 2022; 25:103677. [PMID: 35036868 PMCID: PMC8749187 DOI: 10.1016/j.isci.2021.103677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Atherosclerosis is studied in models with dysfunctional lipid homeostasis—predominantly the ApoE−/− mouse. The role of antigen-presenting cells (APCs) for lipid homeostasis is not clear. Using a LacZ reporter mouse, we showed that CD11c+ cells were enriched in aortae of ApoE−/− mice. Systemic long-term depletion of CD11c+ cells in ApoE−/− mice resulted in significantly increased plaque formation associated with reduced serum ApoE levels. In CD11ccre+ApoEfl/fl and Albumincre+ApoEfl/fl mice, we could show that ≈70% of ApoE is liver-derived and ≈25% originates from CD11c+ cells associated with significantly increased atherosclerotic plaque burden in both strains. Exposure to acLDL promoted cholesterol efflux from CD11c+ cells and cell-specific deletion of ApoE resulted in increased inflammation reflected by increased IL-1β serum levels. Our results determined for the first time the level of ApoE originating from CD11c+ cells and demonstrated that CD11c+ cells ameliorate atherosclerosis by the secretion of ApoE. CD11c+ cells are enriched in aortae of high cholesterol-fed ApoE−/- mice Depletion of CD11c+ cells increases plaque size in ApoE−/- mice ≈ 20% of serum ApoE derives from CD11c+ cells ApoE from CD11c+ cells contributes to protection from atherosclerosis
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Affiliation(s)
- Manuela Sauter
- Department of Cardiology, University Hospital, Medical Clinic II, University Heart Center Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Reinhard J Sauter
- Department of Cardiology, University Hospital, Medical Clinic II, University Heart Center Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Henry Nording
- Department of Cardiology, University Hospital, Medical Clinic II, University Heart Center Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.,DZHK (German Research Centre for Cardiovascular Research), Partner Site Hamburg/Luebeck/Kiel, 23562 Luebeck, Germany
| | - Chaolan Lin
- Department of Cardiology, University Hospital, Medical Clinic II, University Heart Center Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Marcus Olbrich
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Stella Autenrieth
- University Hospital, Department of Hematology and Oncology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Christian Gleissner
- University Hospital, Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Martin Thunemann
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Nadia Otero
- Philipps University Marburg, Faculty of Medicine, 35043 Marburg, Germany
| | - Esther Lutgens
- University Hospital Munich, Institute for Prophylaxis and Epidemiology of Circulatory Diseases, Ludwig-Maximilians-University Munich, 80336 Munich, Germany
| | - Zouhair Aherrahrou
- University of Luebeck, Institute of Cardiogenetics, 23538 Luebeck, Germany
| | - Dennis Wolf
- University Hospital, Department of Cardiology and Angiology, University Heart Center Freiburg - Bad Krozingen, 79106 Freiburg, Germany
| | - Lars Zender
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tuebingen, 72076 Tuebingen, Germany.,DFG Cluster of Excellence 2180 'Image-guided and Functional Instructed Tumor Therapy' (IFIT), University of Tuebingen, 72076 Tuebingen, Germany.,German Cancer Research Consortium (DKTK), Partner Site Tübingen, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sven Meuth
- University Hospital, Department of Neurology, University of Duesseldorf, 40225 Duesseldorf, Germany
| | - Robert Feil
- Interfaculty Institute of Biochemistry, University of Tuebingen, 72076 Tuebingen, Germany
| | - Harald F Langer
- Department of Cardiology, University Hospital, Medical Clinic II, University Heart Center Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
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14
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Langer HF. Chronic inflammation in atherosclerosis-The CD40L/CD40 axis belongs to dendritic cells and T cells, not platelets. J Thromb Haemost 2022; 20:3-5. [PMID: 34796641 DOI: 10.1111/jth.15591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Harald F Langer
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
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15
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Nording H, Baron L, Haberthür D, Emschermann F, Mezger M, Sauter M, Sauter R, Patzelt J, Knoepp K, Nording A, Meusel M, Meyer-Saraei R, Hlushchuk R, Sedding D, Borst O, Eitel I, Karsten CM, Feil R, Pichler B, Erdmann J, Verschoor A, Chavakis E, Chavakis T, von Hundelshausen P, Köhl J, Gawaz M, Langer HF. The C5a/C5a receptor 1 axis controls tissue neovascularization through CXCL4 release from platelets. Nat Commun 2021; 12:3352. [PMID: 34099640 PMCID: PMC8185003 DOI: 10.1038/s41467-021-23499-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 06/09/2019] [Accepted: 03/28/2021] [Indexed: 02/05/2023] Open
Abstract
Platelets contribute to the regulation of tissue neovascularization, although the specific factors underlying this function are unknown. Here, we identified the complement anaphylatoxin C5a-mediated activation of C5a receptor 1 (C5aR1) on platelets as a negative regulatory mechanism of vessel formation. We showed that platelets expressing C5aR1 exert an inhibitory effect on endothelial cell functions such as migration and 2D and 3D tube formation. Growth factor- and hypoxia-driven vascularization was markedly increased in C5ar1-/- mice. Platelet-specific deletion of C5aR1 resulted in a proangiogenic phenotype with increased collateralization, capillarization and improved pericyte coverage. Mechanistically, we found that C5a induced preferential release of CXC chemokine ligand 4 (CXCL4, PF4) from platelets as an important antiangiogenic paracrine effector molecule. Interfering with the C5aR1-CXCL4 axis reversed the antiangiogenic effect of platelets both in vitro and in vivo.In conclusion, we identified a mechanism for the control of tissue neovascularization through C5a/C5aR1 axis activation in platelets and subsequent induction of the antiangiogenic factor CXCL4.
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Affiliation(s)
- Henry Nording
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany
| | - Lasse Baron
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - David Haberthür
- grid.5734.50000 0001 0726 5157Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Frederic Emschermann
- grid.10392.390000 0001 2190 1447University Hospital, Department of Cardiovascular Medicine, Eberhard Karls University, Tübingen, Germany
| | - Matthias Mezger
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Manuela Sauter
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Reinhard Sauter
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Johannes Patzelt
- grid.412468.d0000 0004 0646 2097University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Kai Knoepp
- grid.9018.00000 0001 0679 2801Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Martin-Luther-University Halle (Saale), Halle (Saale), Germany
| | - Anne Nording
- grid.10392.390000 0001 2190 1447Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, Tübingen, Germany
| | - Moritz Meusel
- grid.412468.d0000 0004 0646 2097University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Roza Meyer-Saraei
- grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany ,grid.412468.d0000 0004 0646 2097University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Ruslan Hlushchuk
- grid.5734.50000 0001 0726 5157Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Daniel Sedding
- grid.9018.00000 0001 0679 2801Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Martin-Luther-University Halle (Saale), Halle (Saale), Germany
| | - Oliver Borst
- grid.10392.390000 0001 2190 1447University Hospital, Department of Cardiovascular Medicine, Eberhard Karls University, Tübingen, Germany
| | - Ingo Eitel
- grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany ,grid.412468.d0000 0004 0646 2097University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Christian M. Karsten
- grid.4562.50000 0001 0057 2672Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Robert Feil
- grid.10392.390000 0001 2190 1447Interfaculty Institute of Biochemistry, University of Tübingen, Tübingen, Germany
| | - Bernd Pichler
- grid.10392.390000 0001 2190 1447Institute for Preclinical Imaging, Eberhard Karls University, Tübingen, Germany
| | - Jeanette Erdmann
- grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany ,grid.4562.50000 0001 0057 2672Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Admar Verschoor
- grid.4562.50000 0001 0057 2672Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Emmanouil Chavakis
- grid.411088.40000 0004 0578 8220Department for Internal Medicine III/Cardiology, University Hospital of the Johann-Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Triantafyllos Chavakis
- grid.4488.00000 0001 2111 7257Department of Clinical Pathobiochemistry, Institute of Clinical Chemistry and Laboratory Medicine, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Philipp von Hundelshausen
- grid.5252.00000 0004 1936 973XInstitute for Cardiovascular Prevention, Ludwig Maximilians University Munich, Munich, Germany
| | - Jörg Köhl
- grid.4562.50000 0001 0057 2672Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany ,grid.239573.90000 0000 9025 8099Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Meinrad Gawaz
- grid.10392.390000 0001 2190 1447University Hospital, Department of Cardiovascular Medicine, Eberhard Karls University, Tübingen, Germany
| | - Harald F. Langer
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany ,grid.412468.d0000 0004 0646 2097University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
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16
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Rawish E, Sauter M, Sauter R, Nording H, Langer HF. Complement, inflammation and thrombosis. Br J Pharmacol 2021; 178:2892-2904. [PMID: 33817781 DOI: 10.1111/bph.15476] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/30/2020] [Accepted: 01/09/2021] [Indexed: 12/14/2022] Open
Abstract
A mutual relationship exists between immune activation and mechanisms of thrombus formation. In particular, elements of the innate immune response such as the complement system can modulate platelet activation and subsequently thrombus formation. Several components of the complement system including C3 or the membrane attack complex have been reported to be associated with platelets and become functionally active in the micromilieu of platelet activation. The exact mechanisms how this interplay is regulated and its consequences for tissue inflammation, damage or recovery remain to be defined. This review addresses the current state of knowledge on this topic and puts it into context with diseases featuring both thrombosis and complement activation. LINKED ARTICLES: This article is part of a themed issue on Canonical and non-canonical functions of the complement system in health and disease. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.14/issuetoc.
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Affiliation(s)
- Elias Rawish
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany.,University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Manuela Sauter
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Reinhard Sauter
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Henry Nording
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany
| | - Harald F Langer
- Cardioimmunology Group, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany.,University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
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17
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Abstract
Beyond platelets function in hemostasis, there is emerging evidence to suggest that platelets contribute crucially to inflammation and immune responses. Therefore, considering the detrimental role of inflammatory conditions in severe neurological disorders such as multiple sclerosis or stroke, this review outlines platelets involvement in neuroinflammation. For this, distinct mechanisms of platelet-mediated thrombosis and inflammation are portrayed, focusing on the interaction of platelet receptors with other immune cells as well as brain endothelial cells. Furthermore, we draw attention to the intimate interplay between platelets and the complement system as well as between platelets and plasmatic coagulation factors in the course of neuroinflammation. Following the thorough exposition of preclinical approaches which aim at ameliorating disease severity after inducing experimental autoimmune encephalomyelitis (a counterpart of multiple sclerosis in mice) or brain ischemia-reperfusion injury, the clinical relevance of platelet-mediated neuroinflammation is addressed. Thus, current as well as future propitious translational and clinical strategies for the treatment of neuro-inflammatory diseases by affecting platelet function are illustrated, emphasizing that targeting platelet-mediated neuroinflammation could become an efficient adjunct therapy to mitigate disease severity of multiple sclerosis or stroke associated brain injury.
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Affiliation(s)
- Elias Rawish
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Henry Nording
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Münte
- University Hospital Schleswig-Holstein, Clinic for Neurology, Lübeck, Germany
| | - Harald F Langer
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
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18
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Nording H, Baron L, Langer HF. Platelets as therapeutic targets to prevent atherosclerosis. Atherosclerosis 2020; 307:97-108. [DOI: 10.1016/j.atherosclerosis.2020.05.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/30/2020] [Accepted: 05/27/2020] [Indexed: 12/11/2022]
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19
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Reil JC, Reil GH, Kovács Á, Sequeira V, Waddingham MT, Lodi M, Herwig M, Ghaderi S, Kreusser MM, Papp Z, Voigt N, Dobrev D, Meyhöfer S, Langer HF, Maier LS, Linz D, Mügge A, Hohl M, Steendijk P, Hamdani N. CaMKII activity contributes to homeometric autoregulation of the heart: A novel mechanism for the Anrep effect. J Physiol 2020; 598:3129-3153. [PMID: 32394454 DOI: 10.1113/jp279607] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 01/27/2020] [Accepted: 05/04/2020] [Indexed: 01/14/2023] Open
Abstract
KEY POINTS The Anrep effect represents the alteration of left ventricular (LV) contractility to acutely enhanced afterload in a few seconds, thereby preserving stroke volume (SV) at constant preload. As a result of the missing preload stretch in our model, the Anrep effect differs from the slow force response and has a different mechanism. The Anrep effect demonstrated two different phases. First, the sudden increased afterload was momentary equilibrated by the enhanced LV contractility as a result of higher power strokes of strongly-bound myosin cross-bridges. Second, the slightly delayed recovery of SV is perhaps dependent on Ca2+ /calmodulin-dependent protein kinase II activation caused by oxidation and myofilament phosphorylation (cardiac myosin-binding protein-C, myosin light chain 2), maximizing the recruitment of available strongly-bound myosin cross-bridges. Short-lived oxidative stress might present a new facet of subcellular signalling with respect to cardiovascular regulation. Relevance for human physiology was demonstrated by echocardiography disclosing the Anrep effect in humans during handgrip exercise. ABSTRACT The present study investigated whether oxidative stress and Ca2+ /calmodulin-dependent protein kinase II (CaMKII) activity are involved in triggering the Anrep effect. LV pressure-volume (PV) analyses of isolated, preload controlled working hearts were performed at two afterload levels (60 and 100 mmHg) in C57BL/6N wild-type (WT) and CaMKII-double knockout mice (DKOCaMKII ). In snap-frozen WT hearts, force-pCa relationship, H2 O2 generation, CaMKII oxidation and phosphorylation of myofilament and Ca2+ handling proteins were assessed. Acutely raised afterload showed significantly increased wall stress, H2 O2 generation and LV contractility in the PV diagram with an initial decrease and recovery of stroke volume, whereas end-diastolic pressure and volume, as well as heart rate, remained constant. Afterload induced increase in LV contractility was blunted in DKOCaMKII -hearts. Force development of single WT cardiomyocytes was greater with elevated afterload at submaximal Ca2+ concentration and associated with increases in CaMKII oxidation and phosphorylation of cardiac-myosin binding protein-C, myosin light chain and Ca2+ handling proteins. CaMKII activity is involved in the regulation of the Anrep effect and associates with stimulation of oxidative stress, presumably starting a cascade of CaMKII oxidation with downstream phosphorylation of myofilament and Ca2+ handling proteins. These mechanisms improve LV inotropy and preserve stroke volume within few seconds.
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Affiliation(s)
- Jan-Christian Reil
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Gert-Hinrich Reil
- Klinik für Kardiologie, Klinikum Oldenburg, Innere Medizin I, Oldenburg, Germany
| | - Árpád Kovács
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany
| | - Vasco Sequeira
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Germany
| | - Mark T Waddingham
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maria Lodi
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany
| | - Melissa Herwig
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany
| | - Shahrooz Ghaderi
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Michael M Kreusser
- Departments of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Niels Voigt
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.,Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Svenja Meyhöfer
- Institute for Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany and German Center for Diabetes Research, Neuherberg, Germany
| | - Harald F Langer
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lars S Maier
- Klinik und Poliklinik für innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Dominik Linz
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Andreas Mügge
- Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Paul Steendijk
- Departments of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nazha Hamdani
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany.,Department Clinical Pharmacology, Ruhr University of Bochum, Bochum, Germany
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20
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Saad M, Meyer-Saraei R, de Waha-Thiele S, Stiermaier T, Graf T, Fuernau G, Langer HF, Kurz T, Pöss J, Barkhausen J, Desch S, Eitel I, Thiele H. Impact of Morphine Treatment With and Without Metoclopramide Coadministration on Ticagrelor-Induced Platelet Inhibition in Acute Myocardial Infarction: The Randomized MonAMI Trial. Circulation 2020; 141:1354-1356. [PMID: 32310699 DOI: 10.1161/circulationaha.119.042816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohammed Saad
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Roza Meyer-Saraei
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Suzanne de Waha-Thiele
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Tobias Graf
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Georg Fuernau
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Harald F Langer
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Thomas Kurz
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Janine Pöss
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Jörg Barkhausen
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Germany (J.B.)
| | - Steffen Desch
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.).,Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Germany (S.D., H.T.)
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., I.E.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (M.S., R.M.-S., S.d.W.-T., T.S., T.G., G.F., H.F.L., T.K., J.P., S.D., I.E.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Germany (S.D., H.T.)
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21
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Köhler D, Granja T, Volz J, Koeppen M, Langer HF, Hansmann G, Legchenko E, Geisler T, Bakchoul T, Eggstein C, Häberle HA, Nieswandt B, Rosenberger P. Red blood cell-derived semaphorin 7A promotes thrombo-inflammation in myocardial ischemia-reperfusion injury through platelet GPIb. Nat Commun 2020; 11:1315. [PMID: 32161256 PMCID: PMC7066172 DOI: 10.1038/s41467-020-14958-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 02/09/2020] [Indexed: 02/07/2023] Open
Abstract
Myocardial ischemia is one of the leading health problems worldwide. Therapy consists of the restitution of coronary perfusion which is followed by myocardial inflammation. Platelet–neutrophil interaction is a crucial process during inflammation, yet its consequences are not fully understood. Here, we show that platelet–neutrophil complexes (PNCs) are increased in patients with acute myocardial infarction and that this is associated with increased levels of neuronal guidance protein semaphorin 7A (SEMA7A). To investigate this further, we injected WT animals with Sema7a and found increased infarct size with increased numbers of PNCs. Experiments in genetically modified animals identify Sema7a on red blood cells to be crucial for this condition. Further studies revealed that Sema7a interacts with the platelet receptor glycoprotein Ib (GPIb). Treatment with anti-Sema7a antibody protected from myocardial tissue injury. In summary, we show that Sema7a binds to platelet GPIb and enhances platelet thrombo-inflammatory activity, aggravating post-ischemic myocardial tissue injury. Reperfusion injury following myocardial ischemia is aggravated by inflammation and platelet–neutrophil complex formation. Here the authors show that semaphorin 7A binds to platelet GPIb, enhancing platelet–neutrophil interaction and increasing post-ischemic myocardial tissue injury, and that blockage of semaphorin 7A is protective.
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Affiliation(s)
- David Köhler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Tiago Granja
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Julia Volz
- Institute of Experimental Biomedicine and Rudolf Virchow Center, Würzburg, Germany
| | - Michael Koeppen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Harald F Langer
- Department of Cardiology, University Hospital Lübeck, Lübeck, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology, Hannover Medical School, Lübeck, Germany
| | - Ekaterina Legchenko
- Department of Pediatric Cardiology, Hannover Medical School, Lübeck, Germany
| | - Tobias Geisler
- Department of Cardiology, University Hospital, Tübingen, Germany
| | - Tamam Bakchoul
- Center for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Claudia Eggstein
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Helene A Häberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine and Rudolf Virchow Center, Würzburg, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany.
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22
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Reil JC, Reil GH, Borer JS, Hecker N, Aboud A, Schaefers HS, Langer HF, Sievers HH, Ensminger S. P1421 Patients with severe aortic regurgitation showed systolic dysfunction and increased stroke work despite preserved EF; clues for reconsidering optimal time point of surgery. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.852] [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: 11/12/2022] Open
Abstract
Abstract
Background
Current guidelines recommend surgery in patients with severe aortic regurgitation (AR) with clinical symptoms or subnormal ejection fraction (EF). Furthermore, surgery should be considered in patients with severe AR, preserved EF and increased left ventricular diameters (LVEDD >70mm, LVESD >50mm). The aim of the study was to investigate LV systolic function as well as mechanical energetics using non-invasive pressure-volume- and strain analysis in patients with severe AR and preserved EF as well as moderately dilated ventricles (LVEDD <70mm).
Methods and Results
Echocardiographic strain and single beat pressure-volume analyses were performed in patients with severe AR and moderately increased ventricular size (LVEDD < 70mm, EF >50% n = 39) as well as healthy, age-matched controls (n = 20) using echo-derived volume and arm-cuff blood pressure measurements. Load independent parameters of systolic contractile function like end-systolic elastance (Ees) and end-systolic volume at 100mmHg (ESV100) were calculated as well as stroke work ((SW) and total pressure volume area (PVA = SW + potential energy). Patients with AR demonstrated significant depression of systolic function beyond ejection fraction: global longitudinal strain was reduced compared to controls (-16 ±2.5% vs. -21.5 ±2%; p < 0.001). Accordingly load independent parameters of LV contractility like Ees (1.5mmHg/ml ±0.7 vs. 2.25mmHg/ml ±0.7; p < 0.001), ESV100 (65.7ml ±19.4 vs. 42.4ml ±19.8; p < 0.05) were reduced despite comparable ejection fractions (EF: 0.56% ±0.05 vs. 0.60% ±0.07 p = 0,10). End-diastolic volume of AR patients was markedly elevated (236ml ±90 vs. 136ml ±30; p < 0.001), while PVA (20470mmHg x ml ±10400 vs. 11907mmHg x ml ±2877; p < 0.01) and stroke work (13200mmHg x ml ±5700 vs. 7606 mmHG x ml ±2048; p< 0.01) were markedly elevated indicating waste of energy.
Conclusion
Patients with severe AR and moderately enhanced LV showed depressed values of contractility and waste of energy using more advanced parameters of LV systolic function although EF was preserved. The data may demonstrate that surgery is performed too late in many of those patients and may give clues for reconsidering guidelines to meet the optimal time point of surgery.
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Affiliation(s)
- J C Reil
- University of Lubeck, Luebeck, Germany
| | - G-H Reil
- Oldenburg Hospital, Cardiology, Oldenburg, Germany
| | - J S Borer
- State University of New York Downstate Medical Center, The Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular , New York, United States of America
| | - N Hecker
- University of Lubeck, Luebeck, Germany
| | - A Aboud
- University of Lubeck, Luebeck, Germany
| | - H-S Schaefers
- University Hospital Saarland, heart surgery, Homburg, Germany
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23
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Jobs A, De Waha-Thiele S, Ledwoch J, Sievert H, Rassaf T, Luedike P, Kelm M, Hellhammer K, Horn P, Westenfeld R, Patzelt J, Langer HF, Desch S, Eitel I, Thiele H. P4714Individual patient data meta-analysis comparing general anesthesia and deep sedation on safety and length of intensive care unit stay in patients undergoing percutaneous mitral valve repair. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1094] [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: 11/12/2022] Open
Abstract
Abstract
Background
Percutaneous edge-to-edge mitral valve repair (PMVR) has emerged as a treatment option for patients with severe mitral regurgitation not considered suitable candidates for surgery. The procedure can be performed in general anesthesia (GA) or deep sedation (DS) without mechanical ventilation. However, debate remains about the optimal approach.
Purpose
To compare the impact of the anesthetic method on efficacy, safety, and length of intensive care stay.
Methods
We identified studies comparing GA versus DS in patients undergoing PMVR by searching PubMed and CENTRAL. We included studies for which investigators agreed to provide individual patient data. Analyzed outcomes were a composite safety endpoint comprising all-cause death, stroke, pneumonia, and major to life-threating bleeding as well as length of intensive care unit stay. We performed an one-stage and two-stage meta-analysis on each outcome after multiple imputation of missing data. For two-stage meta-analysis, between-study heterogeneity was estimated according to Paule-Mandel and confidence intervals were derived using the method proposed by Hartung and Knapp.
Results
We included five observational studies (n=647 patients). Procedural success was achieved in 618 of 647 (95.5%) patients. The composite safety endpoint occurred in 92 of 647 (14.2%) patients with no difference between patients treated with GA or DS. In this regard, risk ratio was 0.78 (95% confidence interval, 0.53 to 1.14; P=0.20) following the one-stage approach and 0.73 (95% confidence interval, 0.30 to 1.80; P=0.39) following the two-stage approach. Length of intensive care stay was longer after GA as compared to DS (adjusted mixed linear regression model, 1.94 days, 95% confidence interval, 1.29 to 2.59 days, P<0.001; random effects model pooling study-specific estimates from adjusted linear models 1.40 days, 95% confidence interval, 0.54 to 2.22 days, P=0.0104).
Conclusion
Both, DS and GA offer good procedural success rates and a similar safety profile. However, length of intensive care stay is shorter after DS.
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Affiliation(s)
- A Jobs
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, Lübeck, Germany
| | - J Ledwoch
- Klinikum rechts der Isar, Technical University of Munich, Division of Cardiology, Munich, Germany
| | - H Sievert
- Sankt Katharinen Hospital, CardioVascular Center Frankfurt, Frankfurt, Germany
| | - T Rassaf
- University Hospital of Essen (Ruhr), Department of Cardiology and Vascular Medicine, Essen, Germany
| | - P Luedike
- University Hospital of Essen (Ruhr), Department of Cardiology and Vascular Medicine, Essen, Germany
| | - M Kelm
- Medical Faculty of the Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Düsseldorf, Germany
| | - K Hellhammer
- Medical Faculty of the Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Düsseldorf, Germany
| | - P Horn
- Medical Faculty of the Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Düsseldorf, Germany
| | - R Westenfeld
- Medical Faculty of the Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Düsseldorf, Germany
| | - J Patzelt
- University Hospital, Eberhard Karls University, Department of Cardiology and Cardiovascular Medicine, Tübingen, Germany
| | - H F Langer
- University Hospital, Eberhard Karls University, Department of Cardiology and Cardiovascular Medicine, Tübingen, Germany
| | - S Desch
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, Lübeck, Germany
| | - H Thiele
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
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24
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Patzelt J, Zhang W, Sauter R, Mezger M, Nording H, Becker AS, Rudolph V, Saad M, Eitel I, Schlensak C, Gawaz M, Boekstegers P, Schreieck J, Seizer P, Langer HF. P4724Elevated mitral valve pressure gradient is predictive for long-term outcome after percutaneous edge-to-edge mitral valve repair (PMVR) in patients with degenerative MR, but not in functional MR. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1101] [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: 11/14/2022] Open
Abstract
Abstract
Background
To analyze the effects of residual mitral regurgitation (MR) and mean mitral valve pressure gradient (MVPG) after percutaneous edge-to-edge mitral valve repair (PMVR) using the MitraClip-system on long term outcome.
Methods and results
Two hundred fifty-five patients who underwent PMVR were analyzed. Kaplan-Meier and Cox regression analyses were performed to evaluate the impact of residual MR and MVPG on clinical outcome. A combined clinical endpoint (all-cause mortality, MV surgery, redo procedure, implantation of a left ventricular assist device) was used.
After PMVR, mean MVPG increased from 1.6±1.0 mmHg to 3.1±1.5 mmHg (p<0.001). Reduction of MR severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual MR was predictive for the combined endpoint while elevated MVPG >4.4 mmHg was not according to Kaplan-Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional MR separately to account for these different entities.In the cohort with degenerative MR, elevated MVPG was associated with increased occurrence of the primary endpoint, whereas this was not observed in the cohort with functional MR.
Conclusions
MVPG >4.4 mmHg after MitraClip-implantation was predictive for clinical outcome in the patient cohort with degenerative MR. In the patient cohort with functional MR, MVPG >4.4 mmHg was not associated with increased clinical events.
Acknowledgement/Funding
This study was supported by grants from the German Research Foundation (KFO 274), the Volkswagen Foundation (Lichtenberg Program) and the German Heart
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Affiliation(s)
- J Patzelt
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - W Zhang
- The Affiliated Hospital of Medical College Qingdao University, Department of Cardiology, Angiology, and Intensive Care Medicine, Qingdao, China
| | - R Sauter
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - M Mezger
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - H Nording
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - A S Becker
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Tuebingen, Germany
| | - V Rudolph
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - M Saad
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - I Eitel
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - C Schlensak
- University Hospital, Department of Cardiovascular Surgery, Tuebingen, Germany
| | - M Gawaz
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Tuebingen, Germany
| | | | - J Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Tuebingen, Germany
| | - P Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Tuebingen, Germany
| | - H F Langer
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
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25
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Sauter RJ, Sauter M, Reis ES, Emschermann FN, Nording H, Ebenhöch S, Kraft P, Münzer P, Mauler M, Rheinlaender J, Madlung J, Edlich F, Schäffer TE, Meuth SG, Duerschmied D, Geisler T, Borst O, Gawaz M, Kleinschnitz C, Lambris JD, Langer HF. Functional Relevance of the Anaphylatoxin Receptor C3aR for Platelet Function and Arterial Thrombus Formation Marks an Intersection Point Between Innate Immunity and Thrombosis. Circulation 2019; 138:1720-1735. [PMID: 29802205 DOI: 10.1161/circulationaha.118.034600] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Platelets have distinct roles in the vascular system in that they are the major mediator of thrombosis, critical for restoration of tissue integrity, and players in vascular inflammatory conditions. In close spatiotemporal proximity, the complement system acts as the first line of defense against invading microorganisms and is a key mediator of inflammation. Whereas the fluid phase cross-talk between the complement and coagulation systems is well appreciated, the understanding of the pathophysiological implications of such interactions is still scant. METHODS We analyzed coexpression of the anaphylatoxin receptor C3aR with activated glycoprotein IIb/IIIa on platelets of 501 patients with coronary artery disease using flow cytometry; detected C3aR expression in human or murine specimen by polymerase chain reaction, immunofluorescence, Western blotting, or flow cytometry; and examined the importance of platelet C3aR by various in vitro platelet function tests, in vivo bleeding time, and intravital microscopy. The pathophysiological relevance of C3aR was scrutinized with the use of disease models of myocardial infarction and stroke. To approach underlying molecular mechanisms, we identified the platelet small GTPase Rap1b using nanoscale liquid chromatography coupled to tandem mass spectrometry. RESULTS We found a strong positive correlation of platelet complement C3aR expression with activated glycoprotein IIb/IIIa in patients with coronary artery disease and coexpression of C3aR with glycoprotein IIb/IIIa in thrombi obtained from patients with myocardial infarction. Our results demonstrate that the C3a/C3aR axis on platelets regulates distinct steps of thrombus formation such as platelet adhesion, spreading, and Ca2+ influx. Using C3aR-/- mice or C3-/- mice with reinjection of C3a, we uncovered that the complement activation fragment C3a regulates bleeding time after tail injury and thrombosis. Notably, C3aR-/- mice were less prone to experimental stroke and myocardial infarction. Furthermore, reconstitution of C3aR-/- mice with C3aR+/+ platelets and platelet depletion experiments demonstrated that the observed effects on thrombosis, myocardial infarction, and stroke were specifically caused by platelet C3aR. Mechanistically, C3aR-mediated signaling regulates the activation of Rap1b and thereby bleeding arrest after injury and in vivo thrombus formation. CONCLUSIONS Overall, our findings uncover a novel function of the anaphylatoxin C3a for platelet function and thrombus formation, highlighting a detrimental role of imbalanced complement activation in cardiovascular diseases.
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Affiliation(s)
- Reinhard J Sauter
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany.,Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Manuela Sauter
- Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Edimara S Reis
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia (E.S.R., J.D.L.)
| | - Frederic N Emschermann
- Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Henry Nording
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany.,Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Sonja Ebenhöch
- Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Peter Kraft
- Department of Neurology, University of Würzburg, Germany (P.K.)
| | - Patrick Münzer
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Maximilian Mauler
- Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine (M.M., D.D.), University of Freiburg, Germany
| | - Johannes Rheinlaender
- Institute of Applied Physics (J.R., T.E.S.), Eberhard Karls-University Tübingen, Germany
| | - Johannes Madlung
- Proteom Center, Interfaculty Institute for Cell Biology (J.M.), Eberhard Karls-University Tübingen, Germany
| | - Frank Edlich
- Institute of Biochemistry (F.E.), University of Freiburg, Germany.,Institute for Biochemistry and Molecular Biology, University of Freiburg, Germany (F.E.).,BIOSS, Centre for Biological Signaling Studies, University of Freiburg, Germany (F.E.)
| | - Tilman E Schäffer
- Institute of Applied Physics (J.R., T.E.S.), Eberhard Karls-University Tübingen, Germany
| | - Sven G Meuth
- Department of Neurology, University of Münster, Germany (S.G.M.)
| | - Daniel Duerschmied
- Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine (M.M., D.D.), University of Freiburg, Germany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Oliver Borst
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | | | - John D Lambris
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia (E.S.R., J.D.L.)
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany.,Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
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26
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Bo H, Heinzmann D, Grasshoff C, Rosenberger P, Schlensak C, Gawaz M, Schreieck J, Langer HF, Patzelt J, Seizer P. ECG changes after percutaneous edge-to-edge mitral valve repair. Clin Cardiol 2019; 42:1094-1099. [PMID: 31497886 PMCID: PMC6837028 DOI: 10.1002/clc.23258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/17/2019] [Accepted: 08/27/2019] [Indexed: 01/22/2023] Open
Abstract
Background Mitral regurgitation (MR) has a severe impact on hemodynamics and induces severe structural changes in the left atrium. Atrial remodeling is known to alter excitability and conduction in the atrium facilitating atrial fibrillation and atrial flutter. PMVR is a feasible and highly effective procedure to reduce MR in high‐risk patients, which are likely to suffer from atrial rhythm disturbances. So far, electroanatomical changes after PMVR have not been studied. Hypothesis In the current study, we investigated changes in surface electrocardiograms (ECGs) of patients undergoing PMVR for reduction of MR. Methods We evaluated 104 surface ECGs from patients in sinus rhythm undergoing PMVR. P wave duration, P wave amplitude, PR interval, QRS duration, QRS axis, and QT interval were evaluated before and after PMVR and at follow‐up. Results We found no changes in QRS duration, QRS axis, and QT interval after successful PMVR. However, P wave duration, amplitude, and PR interval were significantly decreased after reduction of MR through PMVR (P < .05, respectively). Conclusion The data we provide offers insight into changes in atrial conduction after reduction of MR using PMVR in patients with sinus rhythm.
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Affiliation(s)
- Hou Bo
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - David Heinzmann
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Grasshoff
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jürgen Schreieck
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Harald F Langer
- Medical Clinic II, Universitäres Herzzentrum Lübeck, University Hospital Schleswig-Holstein, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Johannes Patzelt
- Medical Clinic II, Universitäres Herzzentrum Lübeck, University Hospital Schleswig-Holstein, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Peter Seizer
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
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27
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Sauter RJ, Patzelt J, Mezger M, Nording H, Reil JC, Saad M, Seizer P, Schreieck J, Rosenberger P, Langer HF, Magunia H. Conventional echocardiographic parameters or three-dimensional echocardiography to evaluate right ventricular function in percutaneous edge-to-edge mitral valve repair (PMVR). Int J Cardiol Heart Vasc 2019; 24:100413. [PMID: 31508480 PMCID: PMC6723083 DOI: 10.1016/j.ijcha.2019.100413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Introduction In this study, we evaluated right ventricular (RV) function before and after percutaneous mitral valve repair (PMVR) using conventional echocardiographic parameters and novel 3DE data sets acquired prior to and directly after the procedure. Patients and methods Observational study on 45 patients undergoing PMVR at an university hospital. Results In the overall collective, the 3D RV-EF before and after PMVR showed no significant change (p = 0.16). While there was a significant increase of the fractional area change (FAC, from 23 [19–29] % to 28 [24–33] %, p = 0.001), no significant change of the tricuspid annular plane systolic excursion (TAPSE, from 17 ± 6 mm to 18 ± 5 mm (standard deviation), p = 0.33) was observed. Regarding patients with a reduced RV-EF (< 35%), a significant RV-EF improvement was observed (from 27 [23–34] % to 32.5 [30–39] % (p = 0.001). 71.4% of patients had an improved clinical outcome (improvement in 6-minute walk test and/or improvement in NYHA class of more than one grade), whereas clinical outcome did not improve in 28.6% of patients. Using univariate logistic regression analysis, the post-PMVR RV-EF (OR 1.15: 95% CI 1.02–1.29; p = 0.02) and the change in RV-EF (OR 1.13: 95% CI 1.02–1.25; p = 0.02) were significant predictors for improved clinical outcome at 6 months follow up. Conclusion Thus, RV function may be an important non-invasive parameter to add to the predictive parameters indicating a potential clinical benefit from treatment of severe mitral regurgitation using PMVR.
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Key Words
- 3D-echocardiography
- 3DE, 3D-echocardiography
- ACE, angiotensin converting enzyme
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FAC, fractional area change
- FMR, functional mitral regurgitation
- LA, left atrium
- LV, left ventricle
- LVOT, left ventricular outflow tract
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association functional classification
- Outcome
- PAMP, pulmonary artery mean pressure
- PASP, pulmonary artery systolic pressure
- PCWP, pulmonary capillary wedge pressure
- PMVR, percutaneous mitral valve repair
- Percutaneous mitral valve repair
- RV function
- RV, right ventricle
- TAPSE, tricuspid annular plane systolic excursion
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard J Sauter
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Matthias Mezger
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Henry Nording
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Jan-Christian Reil
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Mohammed Saad
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Peter Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Peter Rosenberger
- University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Harald F Langer
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
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Mezger M, Nording H, Sauter R, Graf T, Heim C, von Bubnoff N, Ensminger SM, Langer HF. Platelets and Immune Responses During Thromboinflammation. Front Immunol 2019; 10:1731. [PMID: 31402914 PMCID: PMC6676797 DOI: 10.3389/fimmu.2019.01731] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022] Open
Abstract
Besides mediating hemostatic functions, platelets are increasingly recognized as important players of inflammation. Data from experiments in mice and men revealed various intersection points between thrombosis, hemostasis, and inflammation, which are addressed and discussed in this review in detail. One such example is the intrinsic coagulation cascade that is initiated after platelet activation thereby further propagating and re-enforcing wound healing or thrombus formation but also contributing to the pathophysiology of severe diseases. FXII of the intrinsic pathway connects platelet activation with the coagulation cascade during immune reactions. It can activate the contact system thereby either creating an inflammatory state or accelerating inflammation. Recent insights into platelet biology could show that platelets are equipped with complement receptors. Platelets are important for tissue remodeling after injury has been inflicted to the endothelial barrier and to the subendothelial tissue. Thus, platelets are increasingly recognized as more than just cells relevant for bleeding arrest. Future insights into platelet biology are to be expected. This research will potentially offer novel opportunities for therapeutic intervention in diseases featuring platelet abundance.
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Affiliation(s)
- Matthias Mezger
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Henry Nording
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,DZHK (German Research Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany
| | - Reinhard Sauter
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Tobias Graf
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Christian Heim
- Department of Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, Medical Center, University of Schleswig-Holstein, Lübeck, Germany
| | - Stephan M Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, Lübeck, Germany
| | - Harald F Langer
- University Hospital, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,DZHK (German Research Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany
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Patzelt J, Zhang W, Sauter R, Mezger M, Nording H, Ulrich M, Becker A, Patzelt T, Rudolph V, Eitel I, Saad M, Bamberg F, Schlensak C, Gawaz M, Boekstegers P, Schreieck J, Seizer P, Langer HF. Elevated Mitral Valve Pressure Gradient Is Predictive of Long-Term Outcome After Percutaneous Edge-to-Edge Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation ( MR ), But Not in Functional MR. J Am Heart Assoc 2019; 8:e011366. [PMID: 31248323 PMCID: PMC6662353 DOI: 10.1161/jaha.118.011366] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study analyzed the effects on long-term outcome of residual mitral regurgitation ( MR ) and mean mitral valve pressure gradient ( MVPG ) after percutaneous edge-to-edge mitral valve repair using the MitraClip system. Methods and Results Two hundred fifty-five patients who underwent percutaneous edge-to-edge mitral valve repair were analyzed. Kaplan-Meier and Cox regression analyses were performed to evaluate the impact of residual MR and MVPG on clinical outcome. A combined clinical end point (all-cause mortality, MV surgery, redo procedure, implantation of a left ventricular assist device) was used. After percutaneous edge-to-edge mitral valve repair, mean MVPG increased from 1.6±1.0 to 3.1±1.5 mm Hg ( P<0.001). Reduction of MR severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual MR was predictive of the combined end point while elevated MVPG >4.4 mm Hg was not according to Kaplan-Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional MR separately to account for these different entities. In the cohort with degenerative MR , elevated MVPG was associated with increased occurrence of the primary end point, whereas this was not observed in the cohort with functional MR . Conclusions MVPG >4.4 mm Hg after MitraClip implantation was predictive of clinical outcome in the patient cohort with degenerative MR . In the patient cohort with functional MR , MVPG >4.4 mm Hg was not associated with increased clinical events.
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Affiliation(s)
- Johannes Patzelt
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Wenzhong Zhang
- 3 Department of Cardiology Affiliated Hospital of Qingdao University Qingdao Shandong China
| | - Reinhard Sauter
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Matthias Mezger
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Henry Nording
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Miriam Ulrich
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Annika Becker
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | | | | | - Ingo Eitel
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Mohammed Saad
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Fabian Bamberg
- 7 Department of Diagnostic and Interventional Radiology University Hospital Freiburg Germany
| | - Christian Schlensak
- 8 Department of Cardiovascular Surgery University Hospital Eberhard Karls University Tübingen Tübingen Germany
| | - Meinrad Gawaz
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Peter Boekstegers
- 9 Klinik für Kardiologie und Angiologie Klinikum Siegburg Siegburg Germany
| | - Juergen Schreieck
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Peter Seizer
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Harald F Langer
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
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30
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Götz N, Schreieck J, Langer HF, Patzelt J. Treatment of a patient with primary mitral regurgitation using the Cardioband® system. Eur Heart J Case Rep 2019; 3:5489331. [PMID: 31449652 PMCID: PMC6601195 DOI: 10.1093/ehjcr/ytz028] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/02/2019] [Indexed: 11/21/2022]
Affiliation(s)
- Nina Götz
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University, Otfried-Müller-Str. 10, Tübingen, Germany
| | - Jürgen Schreieck
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University, Otfried-Müller-Str. 10, Tübingen, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University, Otfried-Müller-Str. 10, Tübingen, Germany
| | - Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University, Otfried-Müller-Str. 10, Tübingen, Germany
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31
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Patzelt J, Zhang Y, Magunia H, Ulrich M, Jorbenadze R, Droppa M, Zhang W, Lausberg H, Walker T, Rosenberger P, Seizer P, Gawaz M, Langer HF. Improved mitral valve coaptation and reduced mitral valve annular size after percutaneous mitral valve repair (PMVR) using the MitraClip system. Eur Heart J Cardiovasc Imaging 2019; 19:785-791. [PMID: 28977372 DOI: 10.1093/ehjci/jex173] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/13/2017] [Indexed: 12/24/2022] Open
Abstract
Aims Improved mitral valve leaflet coaptation with consecutive reduction of mitral regurgitation (MR) is a central goal of percutaneous mitral valve repair (PMVR) with the MitraClip® system. As influences of PMVR on mitral valve geometry have been suggested before, we examined the effect of the procedure on mitral annular size in relation to procedural outcome. Methods and results Geometry of the mitral valve annulus was evaluated in 183 patients undergoing PMVR using echocardiography before and after the procedure and at follow-up. Mitral valve annular anterior-posterior (ap) diameter decreased from 34.0 ± 4.3 to 31.3 ± 4.9 mm (P < 0.001), and medio-lateral (ml) diameter from 33.2 ± 4.8 to 32.4 ± 4.9 mm (P < 0.001). Accordingly, we observed an increase in MV leaflet coaptation after PMVR. The reduction of mitral valve ap diameter showed a significant inverse correlation with residual MR. Importantly, the reduction of mitral valve ap diameter persisted at follow-up (31.3 ± 4.9 mm post PMVR, 28.4 ± 5.3 mm at follow-up). Conclusion This study demonstrates mechanical approximation of both mitral valve annulus edges with improved mitral valve annular coaptation by PMVR using the MitraClip® system, which correlates with residual MR in patients with MR.
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Affiliation(s)
- Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Yingying Zhang
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Harry Magunia
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Miriam Ulrich
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Rezo Jorbenadze
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Michal Droppa
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Wenzhong Zhang
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Henning Lausberg
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Tobias Walker
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Peter Seizer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
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Sauter RJ, Sauter M, Obrich M, Emschermann FN, Nording H, Patzelt J, Wendel HP, Reil JC, Edlich F, Langer HF. Anaphylatoxin Receptor C3aR Contributes to Platelet Function, Thrombus Formation and In Vivo Haemostasis. Thromb Haemost 2018; 119:179-182. [PMID: 30597512 DOI: 10.1055/s-0038-1676349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Reinhard J Sauter
- Department of Cardiology and Cardiovascular Medicine, University Clinic, Eberhard Karls University of Tübingen, Tübingen, Germany.,Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Manuela Sauter
- Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Marcus Obrich
- Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | | | - Henry Nording
- Department of Cardiology and Cardiovascular Medicine, University Clinic, Eberhard Karls University of Tübingen, Tübingen, Germany.,Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Clinic, Eberhard Karls University of Tübingen, Tübingen, Germany.,Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Hans Peter Wendel
- Department of Thoracic and Cardiovascular Surgery, University Clinic, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Jan-Christian Reil
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Frank Edlich
- Institute for Biochemistry and Molecular Biology, University of Freiburg, Freiburg, Germany.,BIOSS, Centre for Biological Signaling Studies, University of Freiburg, Freiburg, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Clinic, Eberhard Karls University of Tübingen, Tübingen, Germany.,Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
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Abstract
In recent years, various studies have increasingly explained platelet functions not only in their central role as a regulator in cellular hemostasis and coagulation. In fact, there is growing evidence that under specific conditions, platelets act as a mediator between the vascular system, hemostasis, and the immune system. Therefore, they are essential in many processes involved in tissue remodeling and tissue reorganization after injury or inflammatory responses. These processes include the promotion of inflammatory processes, the contribution to innate and adaptive immune responses during bacterial and viral infections, the modulation of angiogenesis, and the regulation of cell apoptosis in steady-state tissue homeostasis or after tissue breakdown. All in all platelets may contribute to the control of tissue homeostasis much more than generally assumed. This review summarizes the current knowledge of platelets as part of the tissue remodeling network and seeks to provide possible translational implications for clinical therapy.
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Affiliation(s)
- Felix Eisinger
- Section for Cardioimmunology, Department of Cardiovascular Medicine, University of Tuebingen, Tübingen, Germany
| | - Johannes Patzelt
- University Clinic for Cardiovascular Medicine, University of Tuebingen, Tübingen, Germany
| | - Harald F. Langer
- Section for Cardioimmunology, Department of Cardiovascular Medicine, University of Tuebingen, Tübingen, Germany
- University Clinic for Cardiovascular Medicine, University of Tuebingen, Tübingen, Germany
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Mueller KAL, Patzelt J, Sauter M, Maier P, Gekeler S, Klingel K, Kandolf R, Seizer P, Gawaz M, Geisler T, Langer HF. Myocardial expression of the anaphylatoxin receptor C3aR is associated with cardiac inflammation and prognosis in patients with non-ischaemic heart failure. ESC Heart Fail 2018; 5:846-857. [PMID: 30168657 PMCID: PMC6165948 DOI: 10.1002/ehf2.12298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/07/2018] [Indexed: 01/24/2023] Open
Abstract
Aim The aim of this study is to analyse the prognostic value of complement anaphylatoxin receptors in patients with non‐ischaemic cardiomyopathy undergoing endomyocardial biopsy. Methods and results In 102 patients (72.5% male patients, median age 54 years) with non‐ischaemic cardiomyopathy, myocardial expression of C3aR was assessed among other parameters. The primary study endpoint was a composite of death, heart transplantation, heart failure‐related re‐hospitalization, and deterioration of left ventricular ejection fraction within a mean follow‐up of 11.9 months. The number of cells, which stained positive for C3aR, was significantly increased in patients with inflammatory compared with non‐inflammatory cardiomyopathy (1.75 ± 0.31 cells in inflammatory cardiomyopathy vs. 0.94 ± 0.26 in non‐inflammatory cardiomyopathy, P = 0.049). Subsequently, positive expression for C3aR was judged based on a semi‐quantitative scoring system. Significantly, more patients with positive MHCII and CD68 expression showed an increased number of C3aR‐positive cells. C3aR expression based on this score was more pronounced in patients with human herpesvirus 6 viral genome detection. Kaplan–Meier curves illustrate that the C3aR‐negative group reached the primary endpoint significantly more often (mean follow‐up 11.9 months, log rank 5.963, P = 0.015). Lack of C3aR expression was a strong independent predictor for the primary endpoint in Cox regression analysis [hazard ratio 0.46 (0.26–0.82, P = 0.009)]. Conclusions C3aR‐positive cells are found more often in patients with inflammatory cardiomyopathy. The relevance of C3aR‐positive cells in patients with non‐ischaemic cardiomyopathy should be further evaluated as potential predictors or modulators of adverse cardiac remodelling, the substrate of progressive heart failure.
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Affiliation(s)
- Karin A L Mueller
- Department of Cardiovascular Medicine, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Johannes Patzelt
- Department of Cardiovascular Medicine, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Manuela Sauter
- Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Philipp Maier
- Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Sarah Gekeler
- Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Karin Klingel
- Department for Molecular Pathology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Reinhard Kandolf
- Department for Molecular Pathology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Peter Seizer
- Department of Cardiovascular Medicine, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiovascular Medicine, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiovascular Medicine, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Harald F Langer
- Department of Cardiovascular Medicine, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany.,Section for Cardioimmunology, Eberhard Karls University of Tübingen, Tübingen, Germany
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Patzelt J, Ulrich M, Magunia HF, Sauter R, Droppa M, Jorbenadze R, Becker AS, Walker T, Von Bardeleben RS, Grasshoff C, Rosenberger P, Gawaz M, Seizer P, Langer HF. P2575Comparison of deep sedation with general anesthesia in patients undergoing percutaneous mitral valve repair (PMVR). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2575] [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: 11/13/2022] Open
Affiliation(s)
- J Patzelt
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - M Ulrich
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - H F Magunia
- university hospital, department of anaesthesiology and intensive care medicine, Tuebingen, Germany
| | - R Sauter
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - M Droppa
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - R Jorbenadze
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - A S Becker
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - T Walker
- university hospital, department of cardiovascular surgery, Tuebingen, Germany
| | - R S Von Bardeleben
- University Hospital, Johannes Gutenberg-University, Cardiology, Mainz, Germany
| | - C Grasshoff
- university hospital, department of anaesthesiology and intensive care medicine, Tuebingen, Germany
| | - P Rosenberger
- university hospital, department of anaesthesiology and intensive care medicine, Tuebingen, Germany
| | - M Gawaz
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - P Seizer
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - H F Langer
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
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Jorbenadze R, Schreieck J, Barthel C, Seizer P, Schlensak C, Gawaz M, Patzelt J, Langer HF. Percutaneous Edge-to-Edge Mitral Valve Repair Using the New MitraClip XTR System. JACC Cardiovasc Interv 2018; 11:e93-e95. [DOI: 10.1016/j.jcin.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 10/16/2022]
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Patzelt J, Ulrich M, Magunia H, Sauter R, Droppa M, Jorbenadze R, Becker AS, Walker T, von Bardeleben RS, Grasshoff C, Rosenberger P, Gawaz M, Seizer P, Langer HF. Comparison of Deep Sedation With General Anesthesia in Patients Undergoing Percutaneous Mitral Valve Repair. J Am Heart Assoc 2017; 6:JAHA.117.007485. [PMID: 29197832 PMCID: PMC5779052 DOI: 10.1161/jaha.117.007485] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous edge-to-edge mitral valve repair (PMVR) has become an established treatment option for mitral regurgitation in patients not eligible for surgical repair. Currently, most procedures are performed under general anesthesia (GA). An increasing number of centers, however, are performing the procedure under deep sedation (DS). Here, we compared patients undergoing PMVR with GA or DS. METHODS AND RESULTS A total of 271 consecutive patients underwent PMVR at our institution between May 2014 and December 2016. Seventy-two procedures were performed under GA and 199 procedures under DS. We observed that in the DS group, doses of propofol (743±228 mg for GA versus 369±230 mg for DS, P<0.001) and norepinephrine (1.1±1.6 mg for GA versus 0.2±0.3 mg for DS, P<0.001) were significantly lower. Procedure time, fluoroscopy time, and dose area product were significantly higher in the GA group. There was no significant difference between GA and DS with respect to overall bleeding complications, postinterventional pneumonia (4% for GA versus 5% for DS), or C-reactive protein levels (361±351 nmol/L for GA versus 278±239 nmol/L for DS). Significantly fewer patients with DS needed a postinterventional stay in the intensive care unit (96% for GA versus 19% for DS, P<0.001). Importantly, there was no significant difference between DS and GA regarding intrahospital or 6-month mortality. CONCLUSIONS DS for PMVR is safe and feasible. No disadvantages with respect to procedural outcome or complications in comparison to GA were observed. Applying DS may simplify the PMVR procedure.
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Affiliation(s)
- Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Miriam Ulrich
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- Department of Anesthesiology, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Reinhard Sauter
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Michal Droppa
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Rezo Jorbenadze
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Annika S Becker
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Tobias Walker
- Department of Cardiovascular Surgery, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | | | - Christian Grasshoff
- Department of Anesthesiology, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Seizer
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
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Langer HF, Verschoor A. Crosstalk between platelets and the complement system in immune protection and disease. Thromb Haemost 2017; 110:910-9. [DOI: 10.1160/th13-02-0102] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 07/15/2013] [Indexed: 12/22/2022]
Abstract
SummaryPlatelets have a central function in repairing vascular damage and stopping acute blood loss. They are equally central to thrombus formation in cardiovascular diseases such as myocardial infarction and ischaemic stroke. Beyond these classical prothrombotic diseases, immune mediated pathologies such as haemolytic uraemic syndrome (HUS) or paroxysmal nocturnal haemoglobinuria (PNH) also feature an increased tendency to form thrombi in various tissues. It has become increasingly clear that the complement system, part of the innate immune system, has an important role in the pathophysiology of these diseases. Not only does complement influence prothrombotic disease, it is equally involved in idiopathic thrombocytopenic purpura (ITP), an autoimmune disease characterised by thrombocytopenia. Thus, there are complex interrelationships between the haemostatic and immune systems, and platelets and complement in particular. Not only does complement influence platelet diseases such as ITP, HUS and PNH, it also mediates interaction between microbes and platelets during systemic infection, influencing the course of infection and development of protective immunity. This review aims to provide an integrative overview of the mechanisms underlying the interactions between complement and platelets in health and disease.
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Kraft P, Schleicher R, Olbrich M, Schuhmann MK, Blanz K, Emschermann F, Ebenhoech S, Hilgendorf I, Meuth SG, Edlich F, Kleinschnitz C, Starz C, Langer HF. Platelet derived FasL contributes to apoptosis in stroke. Thromb Haemost 2017; 116:998-1000. [DOI: 10.1160/th16-06-0447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/07/2016] [Indexed: 01/23/2023]
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Rupprecht B, Wolf D, Hergeth S, Hoppe N, Dufner B, Schulte L, Michel N, Bukosza N, Marchini T, Jäckel M, Stachon P, Hilgendorf I, Zeschky K, Schleicher R, Langer HF, von zur Muhlen C, Bode C, Peter K, Willecke F, Tiwari S, Zirlik A. Interruption of classic CD40L-CD40 signalling but not of the novel CD40L-Mac-1 interaction limits arterial neointima formation in mice. Thromb Haemost 2017; 112:379-89. [DOI: 10.1160/th13-08-0653] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 02/26/2014] [Indexed: 11/05/2022]
Abstract
SummaryThe co-stimulatory immune molecule CD40L figures prominently in a variety of inflammatory conditions including arterial disease. Recently, we made the surprising finding that CD40L mediates atherogenesis independently of its classic receptor CD40 via a novel interaction with the leukocyte integrin Mac-1. Here, we hypothesised that selective blockade of the CD40L-Mac-1 interaction may also retard restenosis. We induced neointima formation in C57/BL6 mice by ligation of the left carotid artery. Mice were randomised to daily intraperitoneal injections of either cM7, a small peptide selectively inhibiting the CD40L-Mac-1 interaction, scM7, a scrambled control peptide, or saline for 28 days. Interestingly, cM7-treated mice developed neointima of similar size compared with mice receiving the control peptide or saline as assessed by computer-assisted analysis of histological cross sections. These data demonstrate that the CD40L-Mac-1 interaction is not required for the development of restenosis. In contrast, CD40-deficient mice subjected to carotid ligation in parallel, developed significantly reduced neointimal lesions compared with respective wild-type controls (2872 ± 843 µm² vs 35469 ± 11870 µm²). Flow cytometry in CD40-deficient mice revealed reduced formation of platelet-granulocyte and platelet-inflammatory monocyte-aggregates. In vitro, supernatants of CD40-deficient platelet-leukocyte aggregates attenuated proliferation and increased apoptosis of smooth muscle cells. Unlike in the setting of atherosclerosis, CD40L mediates neointima formation via its classic receptor CD40 rather than via its recently described novel interaction with Mac-1. Therefore, selective targeting of CD40L-Mac-1 binding does not appear to be a favorable strategy to fight restenosis.
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41
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Zhang Y, Bauersachs J, Langer HF. Immune mechanisms in heart failure. Eur J Heart Fail 2017; 19:1379-1389. [DOI: 10.1002/ejhf.942] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/26/2017] [Accepted: 06/19/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Yingying Zhang
- University Hospital, Department of Cardiology and Cardiovascular Medicine; Eberhard Karls University Tuebingen; Tuebingen Germany
- Section for Cardioimmunology; Eberhard Karls University Tuebingen; Tübingen Germany
- Affiliated Hospital of Qingdao University, Department of Cardiology and Cardiovascular Medicine; Qingdao University; Qingdao China
| | - Johann Bauersachs
- Department of Cardiology and Angiology; Hannover Medical School; Hannover Germany
| | - Harald F. Langer
- University Hospital, Department of Cardiology and Cardiovascular Medicine; Eberhard Karls University Tuebingen; Tuebingen Germany
- Section for Cardioimmunology; Eberhard Karls University Tuebingen; Tübingen Germany
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Thunemann M, Schörg BF, Feil S, Lin Y, Voelkl J, Golla M, Vachaviolos A, Kohlhofer U, Quintanilla-Martinez L, Olbrich M, Ehrlichmann W, Reischl G, Griessinger CM, Langer HF, Gawaz M, Lang F, Schäfers M, Kneilling M, Pichler BJ, Feil R. Cre/lox-assisted non-invasive in vivo tracking of specific cell populations by positron emission tomography. Nat Commun 2017; 8:444. [PMID: 28874662 PMCID: PMC5585248 DOI: 10.1038/s41467-017-00482-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 07/03/2017] [Indexed: 01/15/2023] Open
Abstract
Many pathophysiological processes are associated with proliferation, migration or death of distinct cell populations. Monitoring specific cell types and their progeny in a non-invasive, longitudinal and quantitative manner is still challenging. Here we show a novel cell-tracking system that combines Cre/lox-assisted cell fate mapping with a thymidine kinase (sr39tk) reporter gene for cell detection by positron emission tomography (PET). We generate Rosa26-mT/sr39tk PET reporter mice and induce sr39tk expression in platelets, T lymphocytes or cardiomyocytes. As proof of concept, we demonstrate that our mouse model permits longitudinal PET imaging and quantification of T-cell homing during inflammation and cardiomyocyte viability after myocardial infarction. Moreover, Rosa26-mT/sr39tk mice are useful for whole-body characterization of transgenic Cre mice and to detect previously unknown Cre activity. We anticipate that the Cre-switchable PET reporter mice will be broadly applicable for non-invasive long-term tracking of selected cell populations in vivo.Non-invasive cell tracking is a powerful method to visualize cells in vivo under physiological and pathophysiological conditions. Here Thunemann et al. generate a mouse model for in vivo tracking and quantification of specific cell types by combining a PET reporter gene with Cre-dependent activation that can be exploited for any cell population for which a Cre mouse line is available.
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Affiliation(s)
- Martin Thunemann
- Interfakultäres Institut für Biochemie, University of Tübingen, 72076 Tübingen, Germany.,Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Barbara F Schörg
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, 72076 Tübingen, Germany
| | - Susanne Feil
- Interfakultäres Institut für Biochemie, University of Tübingen, 72076 Tübingen, Germany
| | - Yun Lin
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, 72076 Tübingen, Germany
| | - Jakob Voelkl
- Physiologisches Institut I, University of Tübingen, 72076 Tübingen, Germany
| | - Matthias Golla
- Interfakultäres Institut für Biochemie, University of Tübingen, 72076 Tübingen, Germany
| | - Angelos Vachaviolos
- Interfakultäres Institut für Biochemie, University of Tübingen, 72076 Tübingen, Germany
| | - Ursula Kohlhofer
- Institute of Pathology and Neuropathology, University of Tübingen, and Comprehensive Cancer Center, University Hospital, 72076 Tübingen, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, University of Tübingen, and Comprehensive Cancer Center, University Hospital, 72076 Tübingen, Germany
| | - Marcus Olbrich
- Department of Cardiovascular Medicine, University Hospital, University of Tübingen, 72076 Tübingen, Germany
| | - Walter Ehrlichmann
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, 72076 Tübingen, Germany
| | - Gerald Reischl
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, 72076 Tübingen, Germany
| | - Christoph M Griessinger
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, 72076 Tübingen, Germany
| | - Harald F Langer
- Department of Cardiovascular Medicine, University Hospital, University of Tübingen, 72076 Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiovascular Medicine, University Hospital, University of Tübingen, 72076 Tübingen, Germany
| | - Florian Lang
- Physiologisches Institut I, University of Tübingen, 72076 Tübingen, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital, European Institute for Molecular Imaging & EXC 1003 Cells-in-Motion Cluster of Excellence, University of Münster, 48149 Münster, Germany
| | - Manfred Kneilling
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, 72076 Tübingen, Germany.,Department of Dermatology, University Hospital, University of Tübingen, 72076 Tübingen, Germany
| | - Bernd J Pichler
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, 72076 Tübingen, Germany
| | - Robert Feil
- Interfakultäres Institut für Biochemie, University of Tübingen, 72076 Tübingen, Germany.
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Rath D, Schaeffeler E, Winter S, Levertov S, Müller K, Droppa M, Stimpfle F, Langer HF, Gawaz M, Schwab M, Geisler T. GPla Polymorphisms Are Associated with Outcomes in Patients at High Cardiovascular Risk. Front Cardiovasc Med 2017; 4:52. [PMID: 28871283 PMCID: PMC5566565 DOI: 10.3389/fcvm.2017.00052] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/31/2017] [Indexed: 01/01/2023] Open
Abstract
Background Platelet membrane glycoprotein receptors mediate thrombus formation. GP Ia/IIa is an essential platelet integrin receptor. Single-nucleotide polymorphisms (SNPs) of the GP Ia/IIa gene alter GP Ia/IIa expression; however, their influence on cardiovascular disease remains unclear. This study aimed to investigate the effect of the GP Ia/IIa SNPs rs1126643 and rs1062535 on clinical outcomes in a large collective including high-risk patients with cardiovascular disease. Methods and results GP Ia SNP analysis was performed in 943 patients with symptomatic coronary artery disease. All patients were tracked for all-cause death, myocardial infarction, and ischemic stroke for 360 days. Homozygous carriers of the minor allele showed significantly worse event-free survival when compared with major allele carriers in the complete collective as well as in the subset of high-risk patients (carrying all of the following three risk factors: diabetes type II, hypertension, and hyperlipidemia). There was no significant difference in the subset of low-risk patients (carrying none of the three risk factors). Conclusions GPla SNPs are associated with cardiovascular prognosis especially in high-risk patients. Identification of GPIa SNPs is of importance to tailor therapies in patients at already high cardiovascular risk.
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Affiliation(s)
- Dominik Rath
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Elke Schaeffeler
- Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tuebingen, Tuebingen, Germany
| | - Stefan Winter
- Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tuebingen, Tuebingen, Germany
| | - Semjon Levertov
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Karin Müller
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Michal Droppa
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Fabian Stimpfle
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Harald F Langer
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Matthias Schwab
- Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tuebingen, Tuebingen, Germany.,Department of Clinical Pharmacology, University Hospital Tuebingen, Tuebingen, Germany.,Department of Pharmacy and Biochemistry, University of Tuebingen, Tuebingen, Germany
| | - Tobias Geisler
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
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Seizer P, Schibilsky D, Sauter R, Schreieck J, Lausberg H, Walker T, Gawaz M, Langer HF, Schlensak C. Percutaneous Mitral Valve Edge-to-Edge Repair Assisted by Hemodynamic Support Devices. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004051. [DOI: 10.1161/circheartfailure.117.004051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/12/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Seizer
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
| | - David Schibilsky
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
| | - Reinhard Sauter
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
| | - Jürgen Schreieck
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
| | - Henning Lausberg
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
| | - Tobias Walker
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
| | - Meinrad Gawaz
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
| | - Harald F. Langer
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
| | - Christian Schlensak
- From the University Hospital, Department of Cardiology and Cardiovascular Medicine (P.S., R.S., J.S., M.G., H.F.L.) and University Hospital, Department of Cardiovascular and Thoracic Surgery (D.S., H.L., T.W., C.S.), Eberhard Karls University of Tuebingen, Germany
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Müller K, Jorbenadze R, Walker T, Schüler R, Hammerstingl C, Schlensak C, Gawaz M, Langer HF, Seizer P. Percutaneous Transfemoral Tricuspid Valve Edge-to-Edge Repair: A Case Series. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.003965. [PMID: 28377441 DOI: 10.1161/circheartfailure.117.003965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/01/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Karin Müller
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Rezo Jorbenadze
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Tobias Walker
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Robert Schüler
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Christoph Hammerstingl
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Christian Schlensak
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Meinrad Gawaz
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Harald F Langer
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.).
| | - Peter Seizer
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.).
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Patzelt J, Schreieck J, Camus E, Gawaz M, Seizer P, Langer HF. Percutaneous Mitral Valve Edge-to-Edge Repair Using Volume Intracardiac Echocardiography-First in Human Experience. ACTA ACUST UNITED AC 2017; 1:41-43. [PMID: 30062239 PMCID: PMC6034481 DOI: 10.1016/j.case.2017.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Johannes Patzelt
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University, Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University, Tuebingen, Germany
| | | | - Meinrad Gawaz
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University, Tuebingen, Germany
| | - Peter Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University, Tuebingen, Germany
| | - Harald F Langer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University, Tuebingen, Germany
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47
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Patzelt J, Zhang Y, Magunia H, Jorbenadze R, Droppa M, Ulrich M, Cai S, Lausberg H, Walker T, Wengenmayer T, Rosenberger P, Schreieck J, Seizer P, Gawaz M, Langer HF. Immediate increase of cardiac output after percutaneous mitral valve repair (PMVR) determined by echocardiographic and invasive parameters: Patzelt: Increase of cardiac output after PMVR. Int J Cardiol 2017; 236:356-362. [PMID: 28185701 DOI: 10.1016/j.ijcard.2016.12.190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Successful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography. METHODS 101 patients with severe MR not eligible for conventional surgery underwent PMVR. Hemodynamic parameters were determined during and after the intervention. We evaluated changes in CO and pulmonary artery systolic pressure before and after PMVR. CO was determined with invasive parameters using the Fick method (COi) and by a combination of TTE and TEE (COe). RESULTS All patients had successful clip implantation, which was associated with increased COi (from 4.6±1.4l/min to 5.4±1.6l/min, p<0.001). Furthermore, pulmonary artery systolic pressure (PASP) showed a significant decrease after PMVR (47.6±16.1 before, 44.7±15.5mmHg after, p=0.01). In accordance with invasive measurements, COe increased significantly (COe from 4.3±1.7l/min to 4.8±1.7l/min, p=0.003). Comparing both methods to calculate CO, we observed good agreement between COi and COe using Bland Altman plots. CONCLUSIONS CO increased significantly after PMVR as determined by echocardiography based and invasive calculation of hemodynamics during PMVR. COe shows good agreement with COi before and after the intervention and, thus, represents a potential non-invasive method to determine CO in patients with MR not accessible by conventional surgery.
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Affiliation(s)
- Johannes Patzelt
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Yingying Zhang
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Rezo Jorbenadze
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Michal Droppa
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Miriam Ulrich
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Shanglang Cai
- University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China
| | - Henning Lausberg
- University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Tobias Walker
- University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology, Heart Center Freiburg University, 79106 Freiburg im Breisgau, Germany
| | - Peter Rosenberger
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Peter Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Harald F Langer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
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Nording H, Patzelt J, Walker T, Seizer P, Gawaz M, Schreieck J, Langer HF. A case of very late single leaflet detachment after percutaneous edge-to-edge mitral valve repair (PMVR). Int J Cardiol 2016; 221:419-21. [PMID: 27409566 DOI: 10.1016/j.ijcard.2016.06.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Henry Nording
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Tobias Walker
- University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Peter Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Jürgen Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Harald F Langer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
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Patzelt J, Seizer P, Zhang YY, Walker T, Schreieck J, Gawaz M, Langer HF. Percutaneous Mitral Valve Edge-to-Edge Repair With Simultaneous Biatrial Intracardiac Echocardiography: First-in-Human Experience. Circulation 2016; 133:1517-9. [PMID: 27067088 DOI: 10.1161/circulationaha.115.020923] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Affiliation(s)
- Johannes Patzelt
- From University Hospital, Department of Cardiology and Cardiovascular Medicine(J.P., P.S., Y.Y.Z., J.S., M.G., H.F.L.) and Department of Cardiovascular Surgery (T.W.), Eberhard Karls University Tuebingen, Germany
| | - Peter Seizer
- From University Hospital, Department of Cardiology and Cardiovascular Medicine(J.P., P.S., Y.Y.Z., J.S., M.G., H.F.L.) and Department of Cardiovascular Surgery (T.W.), Eberhard Karls University Tuebingen, Germany
| | - Ying Ying Zhang
- From University Hospital, Department of Cardiology and Cardiovascular Medicine(J.P., P.S., Y.Y.Z., J.S., M.G., H.F.L.) and Department of Cardiovascular Surgery (T.W.), Eberhard Karls University Tuebingen, Germany
| | - Tobias Walker
- From University Hospital, Department of Cardiology and Cardiovascular Medicine(J.P., P.S., Y.Y.Z., J.S., M.G., H.F.L.) and Department of Cardiovascular Surgery (T.W.), Eberhard Karls University Tuebingen, Germany
| | - Juergen Schreieck
- From University Hospital, Department of Cardiology and Cardiovascular Medicine(J.P., P.S., Y.Y.Z., J.S., M.G., H.F.L.) and Department of Cardiovascular Surgery (T.W.), Eberhard Karls University Tuebingen, Germany
| | - Meinrad Gawaz
- From University Hospital, Department of Cardiology and Cardiovascular Medicine(J.P., P.S., Y.Y.Z., J.S., M.G., H.F.L.) and Department of Cardiovascular Surgery (T.W.), Eberhard Karls University Tuebingen, Germany
| | - Harald F Langer
- From University Hospital, Department of Cardiology and Cardiovascular Medicine(J.P., P.S., Y.Y.Z., J.S., M.G., H.F.L.) and Department of Cardiovascular Surgery (T.W.), Eberhard Karls University Tuebingen, Germany.
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Emschermann F, Zuern CS, Patzelt J, Rizas KD, Jäger G, Eick C, Meuth SG, Gawaz M, Bauer A, Langer HF. Resistance to renal denervation therapy — Identification of underlying mechanisms by analysis of differential DNA methylation. IJC Heart & Vasculature 2016; 11:80-86. [PMID: 28616530 PMCID: PMC5462630 DOI: 10.1016/j.ijcha.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/10/2016] [Indexed: 11/18/2022]
Abstract
Background Factors causing resistance to renal denervation (RDN) for treatment of arterial hypertension are not known. In the current study, we sought to determine mechanisms involved in responsiveness to renal denervation therapy in patients with difficult-to-control and resistant hypertension. Methods and results We evaluated the differential CpG methylation of genes in blood samples isolated from patients of a recently described cohort of responders or non-responders to renal denervation using microarray technique and measured protein levels of identified downstream effectors in blood samples of these patients by ELISA. Our analysis revealed up to 6103 methylation sites differing significantly between non-responders and responders to renal denervation therapy. Software based analysis showed several of these loci to be relevant for arterial hypertension and sympathetic nervous activity. Particularly, genes involved in glutamate synthesis, degradation and glutamate signaling pathways were differently methylated between both groups. For instance, genes for glutamate dehydrogenase 1 and 2 central to glutamate metabolism, genes for ionotropic (AMPA, NMDA) and metabotropic glutamate receptors as well as glutamate transporters revealed significant differences in methylation correlating with responsiveness to RDN. To underline their potential relevance for responsiveness to RDN, we measured plasma protein levels of norepinephrine, a downstream effector of the glutamate receptor pathway, which were significantly lower in non-responders to RDN. Conclusions The present study describes novel molecular targets potentially contributing to reduction of blood pressure after RDN in some patients. Identifying patients with a high responsiveness to RDN could contribute to an individualized therapy in drug resistant hypertension.
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