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Niyonzima N, Bakke SS, Gregersen I, Holm S, Sandanger Ø, Orrem HL, Sporsheim B, Ryan L, Kong XY, Dahl TB, Skjelland M, Sørensen KK, Rokstad AM, Yndestad A, Latz E, Gullestad L, Andersen GØ, Damås JK, Aukrust P, Mollnes TE, Halvorsen B, Espevik T. Cholesterol crystals use complement to increase NLRP3 signaling pathways in coronary and carotid atherosclerosis. EBioMedicine 2020; 60:102985. [PMID: 32927275 PMCID: PMC7494683 DOI: 10.1016/j.ebiom.2020.102985] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 02/27/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND During atherogenesis, cholesterol precipitates into cholesterol crystals (CC) in the vessel wall, which trigger plaque inflammation by activating the NACHT, LRR and PYD domains-containing protein 3 (NLRP3) inflammasome. We investigated the relationship between CC, complement and NLRP3 in patients with cardiovascular disease. METHODS We analysed plasma, peripheral blood mononuclear cells (PBMC) and carotid plaques from patients with advanced atherosclerosis applying ELISAs, multiplex cytokine assay, qPCR, immunohistochemistry, and gene profiling. FINDINGS Transcripts of interleukin (IL)-1beta(β) and NLRP3 were increased and correlated in PBMC from patients with acute coronary syndrome (ACS). Priming of these cells with complement factor 5a (C5a) and tumour necrosis factor (TNF) before incubation with CC resulted in increased IL-1β protein when compared to healthy controls. As opposed to healthy controls, systemic complement was significantly increased in patients with stable angina pectoris or ACS. In carotid plaques, complement C1q and C5b-9 complex accumulated around CC-clefts, and complement receptors C5aR1, C5aR2 and C3aR1 were higher in carotid plaques compared to control arteries. Priming human carotid plaques with C5a followed by CC incubation resulted in pronounced release of IL-1β, IL-18 and IL-1α. Additionally, mRNA profiling demonstrated that C5a and TNF priming followed by CC incubation upregulated plaque expression of NLRP3 inflammasome components. INTERPRETATION We demonstrate that CC are important local- and systemic complement activators, and we reveal that the interaction between CC and complement could exert its effect by activating the NLRP3 inflammasome, thus promoting the progression of atherosclerosis.
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Affiliation(s)
- Nathalie Niyonzima
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Siril S Bakke
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital, Norway
| | - Øystein Sandanger
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Hilde L Orrem
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Bjørnar Sporsheim
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Liv Ryan
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital, Norway
| | | | - Mona Skjelland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Neurology, Oslo University Hospital, Norway
| | - Kirsten Krohg Sørensen
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Anne Mari Rokstad
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Eicke Latz
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway; Institute of Innate Immunity, Biomedical Center, University of Bonn, Germany
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Norway; KG Jebsen Center for Cardiac Research, and Center for Heart Failure Research, Oslo University Hospital, Norway
| | | | - Jan Kristian Damås
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Norway
| | - Tom E Mollnes
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway; Department of Immunology, Oslo University Hospital, Norway; KG Jebsen TREC, Department of Clinical Medicine, University of Tromsø, Norway; Research Laboratory, Norland Hospital, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway; The Central Norway Regional Health Authority, St. Olavs Hospital HF, Norway.
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2
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Orrem HL, Nilsson PH, Pischke SE, Kleveland O, Yndestad A, Ekholt K, Damås JK, Espevik T, Bendz B, Halvorsen B, Gregersen I, Wiseth R, Andersen GØ, Ueland T, Gullestad L, Aukrust P, Barratt-Due A, Mollnes TE. IL-6 Receptor Inhibition by Tocilizumab Attenuated Expression of C5a Receptor 1 and 2 in Non-ST-Elevation Myocardial Infarction. Front Immunol 2018; 9:2035. [PMID: 30258440 PMCID: PMC6143659 DOI: 10.3389/fimmu.2018.02035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/17/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Elevated interleukin-6 (IL-6) and complement activation are associated with detrimental effects of inflammation in coronary artery disease (CAD). The complement anaphylatoxins C5a and C3a interact with their receptors; the highly inflammatory C5aR1, and the C5aR2 and C3aR. We evaluated the effect of the IL-6 receptor (IL-6R)-antagonist tocilizumab on the expression of the anaphylatoxin receptors in whole blood from non-ST-elevation myocardial infarction (NSTEMI) patients. Separately, anaphylatoxin receptor expression in peripheral blood mononuclear cells (PBMC) from patients with different entities of CAD was investigated. Materials and Methods: NSTEMI patients were randomized to one dose of tocilizumab (n = 28) or placebo (n = 32) and observed for 6 months. Whole blood samples drawn at inclusion, at day 2, 3 and after 6 months were used for mRNA isolation. Plasma was prepared for analysis of complement activation measured as sC5b-9 by ELISA. Furthermore, patients with different CAD entities comprising stable angina pectoris (SAP, n = 22), non-ST-elevation acute coronary syndrome (NSTE-ACS, n = 21) and ST-elevation myocardial infarction (STEMI, n = 20) were included. PBMC was isolated from blood samples obtained at admission to hospital and mRNA isolated. Anaphylatoxin-receptor-expression was analyzed with qPCR using mRNA from whole blood and PBMC, respectively. Results: Our main findings were (i) Tocilizumab decreased C5aR1 and C5aR2 mRNA expression significantly (p < 0.001) and substantially (>50%) at day 2 and 3, whereas C3aR expression was unaffected. (ii) Tocilizumab did not affect complement activation. (iii) In analyzes of different CAD entities, C5aR1 expression was significantly increased in all CAD subgroups compared to controls with the highest level in the STEMI patients (p < 0.001). For C5aR2 and C3aR the expression compared to controls were more moderate with increased expression of C5aR2 in the STEMI group (p < 0.05) and C3aR in the NSTE-ACS group (p < 0.05). Conclusion: Expression of C5aR1 and C5aR2 in whole blood was significantly attenuated by IL-6R-inhibition in NSTEMI patients. These receptors were significantly upregulated in PBMC CAD patients with particularly high levels of C5aR1 in STEMI patients.
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Affiliation(s)
- Hilde L Orrem
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Oslo, Norway.,Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Per H Nilsson
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Oslo, Norway.,KG Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.,Linnaeus Centre for Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden
| | - Søren E Pischke
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Oslo, Norway.,Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ola Kleveland
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Yndestad
- KG Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Karin Ekholt
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Jan K Damås
- Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bente Halvorsen
- KG Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Rune Wiseth
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Ø Andersen
- Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway.,Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Thor Ueland
- KG Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Lars Gullestad
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pål Aukrust
- KG Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Andreas Barratt-Due
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Oslo, Norway.,Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Tom E Mollnes
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Oslo, Norway.,KG Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.,Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Research Laboratory, Nordland Hospital, Bodø, Norway.,K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
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3
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Orrem HL, Nilsson PH, Pischke SE, Grindheim G, Garred P, Seljeflot I, Husebye T, Aukrust P, Yndestad A, Andersen GØ, Barratt‐Due A, Mollnes TE. Acute heart failure following myocardial infarction: complement activation correlates with the severity of heart failure in patients developing cardiogenic shock. ESC Heart Fail 2018; 5:292-301. [PMID: 29424484 PMCID: PMC5933968 DOI: 10.1002/ehf2.12266] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/22/2017] [Indexed: 02/06/2023] Open
Abstract
AIMS Heart failure (HF) is an impending complication to myocardial infarction. We hypothesized that the degree of complement activation reflects severity of HF following acute myocardial infarction. METHODS AND RESULTS The LEAF trial (LEvosimendan in Acute heart Failure following myocardial infarction) evaluating 61 patients developing HF within 48 h after percutaneous coronary intervention-treated ST-elevation myocardial infarction herein underwent a post hoc analysis. Blood samples were drawn from inclusion to Day 5 and at 42 day follow-up, and biomarkers were measured with enzyme immunoassays. Regional myocardial contractility was measured by echocardiography as wall motion score index (WMSI). The cardiogenic shock group (n = 9) was compared with the non-shock group (n = 52). Controls (n = 44) were age-matched and sex-matched healthy individuals. C4bc, C3bc, C3bBbP, and sC5b-9 were elevated in patients at inclusion compared with controls (P < 0.01). The shock group had higher levels compared with the non-shock group for all activation products except C3bBbP (P < 0.05). At Day 42, all products were higher in the shock group (P < 0.05). In the shock group, sC5b-9 correlated significantly with WMSI at baseline (r = 0.68; P = 0.045) and at Day 42 (r = 0.84; P = 0.036). Peak sC5b-9 level correlated strongly with WMSI at Day 42 (r = 0.98; P = 0.005). Circulating endothelial cell activation markers sICAM-1 and sVCAM-1 were higher in the shock group during the acute phase (P < 0.01), and their peak levels correlated with sC5b-9 peak level in the whole HF population (r = 0.32; P = 0.014 and r = 0.30; P = 0.022, respectively). CONCLUSIONS Complement activation discriminated cardiogenic shock from non-shock in acute ST-elevation myocardial infarction complicated by HF and correlated with regional contractility and endothelial cell activation, suggesting a pathogenic role of complement in this condition.
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Affiliation(s)
- Hilde L. Orrem
- Department of ImmunologyOslo University Hospital, RikshospitaletOsloNorway
| | - Per H. Nilsson
- Department of ImmunologyOslo University Hospital, RikshospitaletOsloNorway
- K.G. Jebsen Inflammatory Research CentreUniversity of OsloOsloNorway
- Linnaeus Centre for Biomaterials ChemistryLinnaeus UniversityKalmarSweden
| | - Søren E. Pischke
- Department of ImmunologyOslo University Hospital, RikshospitaletOsloNorway
- Division of Emergencies and Critical Care, Department of Anesthesiology, RikshospitaletOslo University HospitalOsloNorway
| | - Guro Grindheim
- Division of Emergencies and Critical Care, Department of Anesthesiology, RikshospitaletOslo University HospitalOsloNorway
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Rigshospitalet, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Ingebjørg Seljeflot
- Center for Clinical Heart ResearchOslo University Hospital, UllevålOsloNorway
- Department of CardiologyOslo University Hospital, UllevålOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Trygve Husebye
- Department of CardiologyOslo University Hospital, UllevålOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Center of Heart Failure ResearchUniversity of OsloOsloNorway
| | - Pål Aukrust
- K.G. Jebsen Inflammatory Research CentreUniversity of OsloOsloNorway
- Research Institute of Internal MedicineOslo University HospitalOsloNorway
- Section of Clinical Immunology and Infectious DiseasesOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Arne Yndestad
- K.G. Jebsen Inflammatory Research CentreUniversity of OsloOsloNorway
- Research Institute of Internal MedicineOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Center of Heart Failure ResearchUniversity of OsloOsloNorway
| | - Geir Ø. Andersen
- Center for Clinical Heart ResearchOslo University Hospital, UllevålOsloNorway
- Department of CardiologyOslo University Hospital, UllevålOsloNorway
- Center of Heart Failure ResearchUniversity of OsloOsloNorway
| | - Andreas Barratt‐Due
- Department of ImmunologyOslo University Hospital, RikshospitaletOsloNorway
- Division of Emergencies and Critical Care, Department of Anesthesiology, RikshospitaletOslo University HospitalOsloNorway
| | - Tom E. Mollnes
- Department of ImmunologyOslo University Hospital, RikshospitaletOsloNorway
- K.G. Jebsen Inflammatory Research CentreUniversity of OsloOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Research Laboratory Nordland Hospital, Bodø and K.G. Jebsen TRECUniversity of TromsøTromsøNorway
- Centre of Molecular Inflammation ResearchNorwegian University of Science and TechnologyTrondheimNorway
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4
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Orrem HL, Shetelig C, Ueland T, Limalanathan S, Nilsson PH, Husebye T, Aukrust P, Seljeflot I, Hoffmann P, Eritsland J, Mollnes TE, Andersen GØ, Yndestad A. Soluble IL-1 receptor 2 is associated with left ventricular remodelling in patients with ST-elevation myocardial infarction. Int J Cardiol 2018; 268:187-192. [PMID: 29853279 DOI: 10.1016/j.ijcard.2018.05.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/24/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The inflammatory response following myocardial infarction (MI) is prerequisite for proper healing of infarcted tissue, but can also have detrimental effects on cardiac function. Interleukin (IL)-1α and IL-1β are potent inflammatory mediators and their bioactivity is tightly regulated by IL-1 receptor antagonist (IL-1ra) and soluble (s) IL-1 receptors (R). We aimed to examine whether levels of soluble regulators of IL-1 signalling are changed during ST-elevation MI (STEMI) and their associations with parameters of cardiac injury and ventricular remodelling. METHODS Plasma levels of IL-1Ra, sIL-1R1, sIL-1R2 and sIL-1R accessory protein (sIL-1RAcP) were measured by immunoassays in repeated samples from patients with STEMI (n = 255) and compared to healthy controls (n = 65). RESULTS IL-1Ra, sIL-1R1 and sIL-1R2 levels were all significantly elevated after STEMI, while levels of sIL-1RAcP were lower compared to controls. sIL-1R2 levels (at different time points) correlated positively with C-reactive protein, myocardial infarct size and change in indexed left ventricular end-diastolic and end-systolic volume (LVEDVi and LVESVi) measured by cardiac MR acutely and after 4 months, and negatively with LV ejection fraction. Patients with >median levels of sIL-1R2 in the acute phase were more likely to have increased change in LVEDVi and LVESVi. Importantly, sIL-1R2 remained significantly associated with change in LVEDVi and LVESVi also after adjustment for clinical covariates. CONCLUSION Levels of sIL-1R2 are independently associated with parameters of LV adverse remodelling following STEMI.
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Affiliation(s)
- Hilde L Orrem
- Department of Immunology, Oslo University Hospital Rikshospitalet, Norway; Department of Anesthesiology, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Christian Shetelig
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Norway; Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
| | - Shanmuganathan Limalanathan
- Department of Cardiology, Oslo University Hospital Ullevål, Norway; Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway; Feiring Heart Clinic, Feiring, Norway
| | - Per H Nilsson
- K.G. Jebsen Inflammatory Research Centre, University of Oslo, Norway; Linnaeus Centre for Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden
| | - Trygve Husebye
- Department of Cardiology, Oslo University Hospital Ullevål, Norway; Center of Heart Failure Research, University of Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; K.G. Jebsen Inflammatory Research Centre, University of Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | - Ingebjørg Seljeflot
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Norway; Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway; Center of Heart Failure Research, University of Oslo, Norway
| | - Pavel Hoffmann
- Institute of Clinical Medicine, University of Oslo, Norway; Section of Interventional Cardiology, Oslo University Hospital Ullevål, Norway
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital Ullevål, Norway; Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway
| | - Tom E Mollnes
- Department of Immunology, Oslo University Hospital Rikshospitalet, Norway; K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway; K.G. Jebsen Inflammatory Research Centre, University of Oslo, Norway; Research Laboratory, Nordland Hospital, Bodø, Norway; Centre of Molecular Inflammation Research, Norwegian University of Science, Trondheim, Norway
| | - Geir Øystein Andersen
- Department of Cardiology, Oslo University Hospital Ullevål, Norway; Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway; Center of Heart Failure Research, University of Oslo, Norway
| | - Arne Yndestad
- Institute of Clinical Medicine, University of Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; K.G. Jebsen Inflammatory Research Centre, University of Oslo, Norway; Center of Heart Failure Research, University of Oslo, Norway.
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5
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Orrem HL, Nilsson PH, Pischke SE, Kleveland O, Ekholt K, Aukrust P, Halvorsen B, Gullestad L, Barratt-Due A, Mollnes TE. The IL-6 receptor inhibitor tocilizumab attenuated expression of C5a receptor 1 and 2 in patients with myocardial infarction. Mol Immunol 2017. [DOI: 10.1016/j.molimm.2017.06.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Pischke SE, Gustavsen A, Orrem HL, Egge KH, Courivaud F, Fontenelle H, Despont A, Bongoni AK, Rieben R, Tønnessen TI, Nunn MA, Scott H, Skulstad H, Barratt-Due A, Mollnes TE. Complement factor 5 blockade reduces porcine myocardial infarction size and improves immediate cardiac function. Basic Res Cardiol 2017; 112:20. [PMID: 28258298 PMCID: PMC5336537 DOI: 10.1007/s00395-017-0610-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/28/2017] [Indexed: 12/31/2022]
Abstract
Inhibition of complement factor 5 (C5) reduced myocardial infarction in animal studies, while no benefit was found in clinical studies. Due to lack of cross-reactivity of clinically used C5 antibodies, different inhibitors were used in animal and clinical studies. Coversin (Ornithodoros moubata complement inhibitor, OmCI) blocks C5 cleavage and binds leukotriene B4 in humans and pigs. We hypothesized that inhibition of C5 before reperfusion will decrease infarct size and improve ventricular function in a porcine model of myocardial infarction. In pigs (Sus scrofa), the left anterior descending coronary artery was occluded (40 min) and reperfused (240 min). Coversin or placebo was infused 20 min after occlusion and throughout reperfusion in 16 blindly randomized pigs. Coversin significantly reduced myocardial infarction in the area at risk by 39% (p = 0.03, triphenyl tetrazolium chloride staining) and by 19% (p = 0.02) using magnetic resonance imaging. The methods correlated significantly (R = 0.92, p < 0.01). Tissue Doppler echocardiography showed increased systolic displacement (31%, p < 0.01) and increased systolic velocity (29%, p = 0.01) in coversin treated pigs. Interleukin-1β in myocardial microdialysis fluid was significantly reduced (31%, p < 0.05) and tissue E-selectin expression was significantly reduced (p = 0.01) in the non-infarcted area at risk by coversin treatment. Coversin ablated plasma C5 activation throughout the reperfusion period and decreased myocardial C5b-9 deposition, while neither plasma nor myocardial LTB4 were significantly reduced. Coversin substantially reduced the size of infarction, improved ventricular function, and attenuated interleukin-1β and E-selectin in this porcine model by inhibiting C5. We conclude that inhibition of C5 in myocardial infarction should be reconsidered.
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Affiliation(s)
- Soeren E Pischke
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway.
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway.
- Intervention Centre, Oslo University Hospital, Oslo, Norway.
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
| | - A Gustavsen
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
| | - H L Orrem
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - K H Egge
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
| | - F Courivaud
- Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - H Fontenelle
- Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - A Despont
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - A K Bongoni
- Immunology Research Centre, St. Vincent's Hospital, Melbourne, VIC, Australia
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - R Rieben
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - T I Tønnessen
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - M A Nunn
- Akari Therapeutics Plc, London, UK
| | - H Scott
- Department of Pathology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - H Skulstad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - A Barratt-Due
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - T E Mollnes
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
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Hellerud BC, Orrem HL, Dybwik K, Pischke SE, Baratt-Due A, Castellheim A, Fure H, Bergseth G, Christiansen D, Nunn MA, Espevik T, Lau C, Brandtzæg P, Nielsen EW, Mollnes TE. Combined inhibition of C5 and CD14 efficiently attenuated the inflammatory response in a porcine model of meningococcal sepsis. J Intensive Care 2017; 5:21. [PMID: 28261486 PMCID: PMC5327570 DOI: 10.1186/s40560-017-0217-0] [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] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/21/2017] [Indexed: 02/05/2023] Open
Abstract
Background Fulminant meningococcal sepsis, characterized by overwhelming innate immune activation, mostly affects young people and causes high mortality. This study aimed to investigate the effect of targeting two key molecules of innate immunity, complement component C5, and co-receptor CD14 in the Toll-like receptor system, on the inflammatory response in meningococcal sepsis. Methods Meningococcal sepsis was simulated by continuous intravenous infusion of an escalating dose of heat-inactivated Neisseria meningitidis administered over 3 h. The piglets were randomized, blinded to the investigators, to a positive control group (n = 12) receiving saline and to an interventional group (n = 12) receiving a recombinant anti-CD14 monoclonal antibody together with the C5 inhibitor coversin. Results A substantial increase in plasma complement activation in the untreated group was completely abolished in the treatment group (p = 0.006). The following inflammatory mediators were substantially reduced in plasma in the treatment group: Interferon-γ by 75% (p = 0.0001), tumor necrosis factor by 50% (p = 0.01), Interleukin (IL)-8 by 50% (p = 0.03), IL-10 by 40% (p = 0.04), IL-12p40 by 50% (p = 0.03), and granulocyte CD11b (CR3) expression by 20% (p = 0.01). Conclusion Inhibition of C5 and CD14 may be beneficial in attenuating the detrimental effects of complement activation and modulating the cytokine storm in patients with fulminant meningococcal sepsis.
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Affiliation(s)
- Bernt C Hellerud
- Department of Immunology, Oslo University Hospital Rikshospitalet, and K.G. Jebsen IRC, University of Oslo, N-0027 Oslo, Norway.,Department of Pediatrics, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
| | - Hilde L Orrem
- Department of Immunology, Oslo University Hospital Rikshospitalet, and K.G. Jebsen IRC, University of Oslo, N-0027 Oslo, Norway
| | - Knut Dybwik
- Department of Anesthesiology, Nordland Hospital and Nord University, Bodø, Norway
| | - Søren E Pischke
- Department of Immunology, Oslo University Hospital Rikshospitalet, and K.G. Jebsen IRC, University of Oslo, N-0027 Oslo, Norway
| | - Andreas Baratt-Due
- Department of Immunology, Oslo University Hospital Rikshospitalet, and K.G. Jebsen IRC, University of Oslo, N-0027 Oslo, Norway
| | - Albert Castellheim
- Department of Anesthesiology and Intensive Care Unit, Institution of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hilde Fure
- Research Laboratory, Nordland Hospital, Bodø, Norway
| | | | | | | | - Terje Espevik
- Centre of Molecular Inflammation Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Corinna Lau
- Research Laboratory, Nordland Hospital, Bodø, Norway
| | - Petter Brandtzæg
- Department of Pediatrics, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erik W Nielsen
- Department of Anesthesiology, Nordland Hospital and Nord University, Bodø, Norway.,Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
| | - Tom E Mollnes
- Department of Immunology, Oslo University Hospital Rikshospitalet, and K.G. Jebsen IRC, University of Oslo, N-0027 Oslo, Norway.,Research Laboratory, Nordland Hospital, Bodø, Norway.,Centre of Molecular Inflammation Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
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Barratt-Due A, Fløisand Y, Orrem HL, Kvam AK, Holme PA, Bergseth G, Tjønnfjord GE, Mollnes TE. Complement activation is a crucial pathogenic factor in catastrophic antiphospholipid syndrome. Rheumatology (Oxford) 2016; 55:1337-9. [PMID: 27105662 PMCID: PMC4911539 DOI: 10.1093/rheumatology/kew040] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andreas Barratt-Due
- Department of Emergencies and Critical Care Department of Immunology, Oslo University Hospital K.G. Jebsen IRC, University of Oslo
| | | | - Hilde L Orrem
- Department of Immunology, Oslo University Hospital K.G. Jebsen IRC, University of Oslo
| | - Ann K Kvam
- Department of Haematology, Oslo University Hospital
| | - Pål A Holme
- Department of Haematology, Oslo University Hospital Institute of Clinical Medicine, University of Oslo, Oslo
| | - Grethe Bergseth
- Research Laboratory Nordland Hospital, Bodø K.G. Jebsen TREC, University of Tromsø, Tromsø and
| | - Geir E Tjønnfjord
- Department of Haematology, Oslo University Hospital Institute of Clinical Medicine, University of Oslo, Oslo
| | - Tom E Mollnes
- Department of Immunology, Oslo University Hospital K.G. Jebsen IRC, University of Oslo Research Laboratory Nordland Hospital, Bodø K.G. Jebsen TREC, University of Tromsø, Tromsø and Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
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