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Routila E, Mahran R, Salminen S, Irjala H, Haapio E, Kytö E, Ventelä S, Petterson K, Routila J, Gidwani K, Leivo J. Identification of stemness-related glycosylation changes in head and neck squamous cell carcinoma. BMC Cancer 2024; 24:443. [PMID: 38600440 PMCID: PMC11005150 DOI: 10.1186/s12885-024-12161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Altered glycosylation is a hallmark of cancer associated with therapy resistance and tumor behavior. In this study, we investigated the glycosylation profile of stemness-related proteins OCT4, CIP2A, MET, and LIMA1 in HNSCC tumors. METHODS Tumor, adjacent normal tissue, and blood samples of 25 patients were collected together with clinical details. After tissue processing, lectin-based glycovariant screens were performed. RESULTS Strong correlation between glycosylation profiles of all four stemness-related proteins was observed in tumor tissue, whereas glycosylation in tumor tissue, adjacent normal tissue, and serum was differential. CONCLUSIONS A mannose- and galactose-rich glycosylation niche associated with stemness-related proteins was identified.
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Affiliation(s)
- E Routila
- Department of Life Technologies, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland.
- InFLAMES Research Flagship, University of Turku, 20014, Turku, Finland.
- FICAN West Cancer Centre, Turku, Finland.
| | - R Mahran
- Department of Life Technologies, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
- FICAN West Cancer Centre, Turku, Finland
- Department of Chemistry, University of Turku, Henrikinkatu 2, 20500, Turku, Finland
| | - S Salminen
- Department of Life Technologies, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
- FICAN West Cancer Centre, Turku, Finland
| | - H Irjala
- Department for Otorhinolaryngology- Head and Neck surgery, University of Turku and Turku University Hospital, Savitehtaankatu 5, 20520, Turku, Finland
| | - E Haapio
- Department for Otorhinolaryngology- Head and Neck surgery, University of Turku and Turku University Hospital, Savitehtaankatu 5, 20520, Turku, Finland
| | - E Kytö
- Department for Otorhinolaryngology- Head and Neck surgery, University of Turku and Turku University Hospital, Savitehtaankatu 5, 20520, Turku, Finland
| | - S Ventelä
- FICAN West Cancer Centre, Turku, Finland
- Department for Otorhinolaryngology- Head and Neck surgery, University of Turku and Turku University Hospital, Savitehtaankatu 5, 20520, Turku, Finland
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Tykistökatu 6, 20520, Turku, Finland
| | - K Petterson
- Department of Life Technologies, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - J Routila
- FICAN West Cancer Centre, Turku, Finland
- Department for Otorhinolaryngology- Head and Neck surgery, University of Turku and Turku University Hospital, Savitehtaankatu 5, 20520, Turku, Finland
| | - K Gidwani
- Department of Life Technologies, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - J Leivo
- Department of Life Technologies, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
- InFLAMES Research Flagship, University of Turku, 20014, Turku, Finland
- FICAN West Cancer Centre, Turku, Finland
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Sirén M, Leivo J, Anttonen E, Jolly SS, Dzavik V, Koivumäki J, Tahvanainen M, Koivula K, Wang J, Cairns JA, Niemelä K, Eskola M, Nikus KC, Hernesniemi J. The prognostic significance of single-lead ST-segment resolution in ST-segment elevation myocardial infarction patients treated with primary PCI - A substudy of the randomized TOTAL trial. Am Heart J 2024; 269:149-157. [PMID: 38109987 DOI: 10.1016/j.ahj.2023.12.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality worldwide. Simple electrocardiogram (ECG) tools, including ST-segment resolution (STR) have been developed to identify high-risk STEMI patients after primary percutaneous coronary intervention (PCI). SUBJECTS AND METHODS We evaluated the prognostic impact of STR in the ECG lead with maximal baseline ST-segment elevation (STE) 30-60 minutes after primary PCI in 7,654 STEMI patients included in the TOTAL trial. Incomplete or no STR was defined as < 70% STR and complete STR as ≥ 70% STR. The primary outcome was the composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or new or worsening New York Heart Association (NYHA) class IV heart failure at 1-year follow-up. RESULTS Of 7,654 patients, 42.9% had incomplete or no STR and 57.1% had complete STR. The primary outcome occurred in 341 patients (10.4%) in the incomplete or no STR group and in 234 patients (5.4%) in the complete STR group. In Cox regression analysis, adjusted hazard ratio for STR < 70% to predict the primary outcome was 1.56 (95% confidence interval 1.32-1.89; P < .001) (model adjusted for all baseline comorbidities, clinical status during hospitalization, angiographic findings, and procedural techniques). CONCLUSION In a large international study of STEMI patients, STR < 70% 30-60 minutes post primary PCI in the ECG lead with the greatest STE at admission was associated with an increased rate of the composite of cardiovascular death, recurrent MI, cardiogenic shock, or new or worsening NYHA class IV heart failure at 1-year follow-up. Clinicians should pay attention to this simple ECG finding.
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Affiliation(s)
- Marko Sirén
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland.
| | - Joonas Leivo
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | | | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Hamilton Health Sciences, Hamilton, Canada
| | - Vladimir Dzavik
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Jyri Koivumäki
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Minna Tahvanainen
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Kimmo Koivula
- Internal medicine, South Karelia Central Hospital, Lappeenranta, Finland
| | - Jia Wang
- Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Canada
| | - John A Cairns
- The University of British Columbia, Vancouver, Canada
| | - Kari Niemelä
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Kjell C Nikus
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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Nilsson N, Leivo J, Collin P, Koskinen I, Kaukinen K, Huhtala H, Palmio J, Reunala T, Hervonen K, Salmi T, Pasternack C. Risk of vascular diseases in patients with dermatitis herpetiformis and coeliac disease: a long-term cohort study. Ann Med 2023; 55:2227423. [PMID: 37378421 DOI: 10.1080/07853890.2023.2227423] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Increased cardiovascular morbidity has been reported in coeliac disease, but in DH only little is known about this. In this cohort study with a long-term follow-up, the risk for vascular diseases in patients with dermatitis herpetiformis (DH) and coeliac disease was assessed. METHODS The study consisted of 368 DH and 1072 coeliac disease patients with biopsy-proven diagnosis performed between 1966 and 2000. For each DH and coeliac disease patient three matched reference individuals were obtained from the population register. Data regarding all outpatient and inpatient treatment periods between 1970 and 2015 were reviewed for diagnostic codes of vascular diseases from the Care Register for Health Care. Cox proportional hazard model was used to assess the risks for the diseases studied and the HRs were adjusted for diabetes mellitus (aHR). RESULTS The median follow-up time of DH and coeliac disease patients was 46 years. The risk for cardiovascular diseases did not differ between DH patients and their references (aHR 1.16, 95% CI 0.91-1.47), but among coeliac disease patients, the risk was increased (aHR 1.36, 95% CI 1.16-1.59). The risk for cerebrovascular diseases was found to be decreased in DH patients when compared with references (aHR 0.68, 95% CI 0.47-0.99) and increased in coeliac disease patients (aHR 1.33, 95% CI 1.07-1.66). The risk for venous thrombosis was increased in coeliac disease patients (aHR 1.62, 95% CI 1.22-2.16) but not in DH. CONCLUSIONS The risk for vascular complications appears to differ between DH and coeliac disease. In DH the risk for cerebrovascular diseases seems to be decreased, while in coeliac disease an elevated risk for cerebrovascular and cardiovascular diseases was observed. These differing vascular risk profiles between the two manifestations of the same disease merit further investigation.
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Affiliation(s)
- Noora Nilsson
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Joonas Leivo
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Inka Koskinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Gastroenterology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Health Sciences, Tampere University, Tampere, Finland
| | - Johanna Palmio
- Department of Neurology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Timo Reunala
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kaisa Hervonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Teea Salmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Leivo J, Anttonen E, Jolly SS, Džavík V, Koivumäki J, Tahvanainen M, Koivula K, Nikus K, Wang J, Cairns JA, Niemelä K, Eskola M. The prognostic significance of Q waves and T wave inversions in the ECG of patients with STEMI: A substudy of the TOTAL trial. J Electrocardiol 2023; 80:99-105. [PMID: 37295167 DOI: 10.1016/j.jelectrocard.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The prognostic significance of Q waves and T-wave inversions (TWI) combined and separately in STEMI patients undergoing primary PCI has not been well established in previous studies. METHODS We included 7,831 patients from the TOTAL trial and divided the patients into categories based on Q waves and TWIs in the presenting ECG. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock or new or worsening NYHA class IV heart failure within one year. The study evaluated the effect of Q waves and TWI on the risk of primary outcome and all-cause death, and whether patient benefit of aspiration thrombectomy differed between the ECG categories. RESULTS Patients with Q+TWI+ (Q wave and TWI) pattern had higher risk of primary outcome compared to patients with Q-TWI- pattern [33 (10.5%) vs. 221 (4.2%); adjusted hazard ratio (aHR) 2.10; 95% CI, 1.45-3.04; p<0.001] within 40-days' period. When analyzed separately, patients with Q waves had a higher risk for the primary outcome compared to patients with no Q waves in the first 40 days [aHR 1.80; 95% CI, 1.48-2.19; p<0.001] but there was no additive risk after 40 days. Patients with TWI had a higher risk for primary outcome only after 40 days when compared to patients with no TWI [aHR 1.63; 95% CI, 1.04-2.55; p=0.033]. There was a trend towards a benefit of thrombectomy in patients with the Q+TWI+ pattern. CONCLUSIONS Q waves and TWI combined (Q+TWI+ pattern) in the presenting ECG is associated with unfavourable outcome within 40-days. Q waves tend to affect short-term outcome, while TWI has more effect on long-term outcome.
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Affiliation(s)
- Joonas Leivo
- Heart Hospital, Tampere University Hospital, Tays Sydänsairaala, PL 2000, 33521 Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Eero Anttonen
- Päijät-sote, Primary Health Care, Keskussairaalankatu 7, 15850 Lahti, Finland
| | - Sanjit S Jolly
- Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada; Hamilton Health Sciences, P.O. Box 2000, Hamilton, ON L8N 3Z5, Canada
| | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, 6-246A EN, Toronto General Hospital, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Jyri Koivumäki
- Heart Hospital, Tampere University Hospital, Tays Sydänsairaala, PL 2000, 33521 Tampere, Finland
| | - Minna Tahvanainen
- Heart Hospital, Tampere University Hospital, Tays Sydänsairaala, PL 2000, 33521 Tampere, Finland
| | - Kimmo Koivula
- Internal Medicine, South Karelia Central Hospital, Valto Käkelän katu 1, 53130 Lappeenranta, Finland
| | - Kjell Nikus
- Heart Hospital, Tampere University Hospital, Tays Sydänsairaala, PL 2000, 33521 Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Jia Wang
- Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada; David Braley Cardiac, Vascular and Stroke Research Institute, Faculty of Health Sciences, 1280 Main St. W., Hamilton, Ontario L8S4K1, Canada
| | - John A Cairns
- The University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T1Z4, Canada
| | - Kari Niemelä
- Heart Hospital, Tampere University Hospital, Tays Sydänsairaala, PL 2000, 33521 Tampere, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Tays Sydänsairaala, PL 2000, 33521 Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Arvo Ylpön katu 34, 33520 Tampere, Finland
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Anttonen E, Punkka O, Leivo J, Jolly SS, Džavík V, Koivumäki J, Tahvanainen M, Koivula K, Nikus K, Wang J, Cairns JA, Niemelä K, Eskola M. The Association of Atrial Fibrillation Before Percutaneous Coronary Intervention With 1-Year Outcome in ST-Elevation Myocardial Infarction Patients. CJC Open 2021; 3:1221-1229. [PMID: 34888505 PMCID: PMC8636243 DOI: 10.1016/j.cjco.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to determine the association of atrial fibrillation (AF) with 1-year outcome in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Methods Patients (n = 8830) enrolled in the Trial of Routine Aspiration Thrombectomy with PCI vs PCI Alone in Patients With STEMI (TOTAL) were followed for 1 year. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening class IV heart failure. The presence or absence of AF was determined from a single pre-PCI electrocardiogram. Results Patients with AF (n = 437; 4.9%) were older, and more often had a history of stroke, hypertension, or myocardial infarction. The rate of the primary outcome was higher in the AF group than in the sinus rhythm (SR) group (17.4% vs 7.4%, P < 0.001), as was the rate of cardiovascular death (9.8% vs 3.3%, P < 0.001). In multivariable analysis, AF was independently predictive of the primary outcome (adjusted hazard ratio [aHR] 1.68; 95% confidence interval [CI], 1.30-2.16, P < 0.001), cardiovascular death (aHR 1.69; 95% CI, 1.19-2.40, P = 0.003), all-cause mortality (aHR 1.63; 95% CI, 1.18-2.24, P = 0.003), and severe heart failure (aHR 1.96; 95% CI, 1.25-3.07, P = 0.003). Among patients who were in SR, the primary outcome occurred in 307 of 4252 (7.2%) in the thrombectomy group and 310 of 4141 (7.5%) in the PCI alone group, and among those with AF, these rates were respectively 42 of 218 (19.3%) and 34 of 219 (15.5%) (Pinteraction = 0.26). Conclusions In STEMI patients, AF on the pre-PCI electrocardiogram is associated with a higher risk of the primary composite cardiovascular outcome, all-cause and cardiovascular death, and severe heart failure during 1-year follow-up than it is in patients with SR.
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Affiliation(s)
- Eero Anttonen
- Heart Centre, Department of Cardiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Olli Punkka
- Heart Centre, Department of Cardiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Corresponding author: Olli Punkka, MD, Faculty of Medicine and Health Technology, University of Tampere, Finland, Arvo Ylpön katu 34, Tampere 33520, Finland. Tel.: +358505294566.
| | - Joonas Leivo
- Heart Centre, Department of Cardiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Sanjit S. Jolly
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jyri Koivumäki
- Heart Centre, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Minna Tahvanainen
- Heart Centre, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Kimmo Koivula
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Internal Medicine Department, Helsinki University Hospital, Helsinki, Finland
| | - Kjell Nikus
- Heart Centre, Department of Cardiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Jia Wang
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John A. Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kari Niemelä
- Heart Centre, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Markku Eskola
- Heart Centre, Department of Cardiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
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Leivo J, Anttonen E, Jolly SS, Dzavik V, Koivumäki J, Tahvanainen M, Koivula K, Nikus K, Wang J, Cairns JA, Niemelä K, Eskola M. The prognostic significance of grade of ischemia in the ECG in patients with ST-elevation myocardial infarction: A substudy of the randomized trial of primary PCI with or without routine manual thrombectomy (TOTAL trial). J Electrocardiol 2021; 68:65-71. [PMID: 34365136 DOI: 10.1016/j.jelectrocard.2021.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The importance of the grade of ischemia (GI) ECG classification in the risk assessment of patients with STEMI has been shown previously. Grade 3 ischemia (G3I) is defined as ST-elevation with distortion of the terminal portion of the QRS complex in two or more adjacent leads, while Grade 2 ischemia (G2I) is defined as ST-elevation without QRS distortion. Our aim was to evaluate the prognostic impact of the GI classification on the outcome in patients with STEMI. METHODS 7,211 patients from the TOTAL trial were included in our study. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year. RESULTS The primary outcome occurred in 153 of 1,563 patients (9.8%) in the G3I group vs. 364 of 5,648 patients (6.4%) in the G2I group (adjusted HR 1.27; 95% CI, 1.04 - 1.55; p=0.022). The rate of cardiovascular death (4.8% vs. 2.5%; adjusted HR 1.48; 95% CI 1.09 - 2.00; p=0.013) was also higher in patients with G3I. CONCLUSIONS G3I in the presenting ECG was associated with an increased rate of the composite of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure within one year compared to patients with G2I. Patients with G3I also had a higher cardiovascular death compared to patients with G2I.
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Affiliation(s)
- Joonas Leivo
- Internal medicine, Kanta-Häme Central Hospital, Hämeenlinna, Ahvenistontie 20, 13530 Hämeenlinna, Finland; Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Eero Anttonen
- Päijät-sote, Primary health care, Lahti, Keskussairaalankatu 7, 15850 Lahti, Finland
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Department of Medicine, McMaster University, Hamilton, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada; Hamilton Health Sciences, Hamilton, P.O. Box 2000, Hamilton, ON L8N 3Z5, Canada
| | - Vladimir Dzavik
- Peter Munk Cardiac Centre, University Health Network, Toronto, R. Fraser Elliott Building, 1st Floor 190 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Jyri Koivumäki
- Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| | - Minna Tahvanainen
- Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| | - Kimmo Koivula
- Internal medicine, South Karelia Central Hospital, Valto Käkelän katu 1, Lappeenranta 53130, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| | - Jia Wang
- Population Health Research Institute, Hamilton, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Department of Medicine, McMaster University, Hamilton, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada; David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Faculty of Health Sciences, 1280 Main St. W., Hamilton, Ontario L8S4K1, Canada
| | - John A Cairns
- The University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T1Z4, Canada
| | - Kari Niemelä
- Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
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Leivo J, Anttonen E, Jolly SS, Dzavik V, Koivumäki J, Tahvanainen M, Koivula K, Nikus K, Wang J, Cairns JA, Niemelä K, Eskola MJ. The high-risk ECG pattern of ST-elevation myocardial infarction: A substudy of the randomized trial of primary PCI with or without routine manual thrombectomy (TOTAL trial). Int J Cardiol 2020; 319:40-45. [PMID: 32470531 DOI: 10.1016/j.ijcard.2020.05.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Useful tools for risk assessment in patients with STEMI are needed. We evaluated the prognostic impact of the evolving myocardial infarction (EMI) and the preinfarction syndrome (PIS) ECG patterns and determined their correlation with angiographic findings and treatment strategy. METHODS This substudy of the randomized Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL) included 7860 patients with STEMI and either the EMI or the PIS ECG pattern. The primary outcome was a composite of death from cardiovascular causes, recurrent MI, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year. RESULTS The primary outcome occurred in 271 of 2618 patients (10.4%) in the EMI group vs. 322 of 5242 patients (6.1%) in the PIS group [AdjustedHR, 1.54; 95% CI, 1.30 to 1.82; p < .001]. The primary outcome occurred in the thrombectomy and PCI alone groups in 131 of 1306 (10.0%) and 140 of 1312 (10.7%) patients with EMI [HR 0.94; 95% CI, 0.74-1.19] and 162 of 2633 (6.2%) and 160 of 2609 (6.1%) patients with PIS [HR 1.00; 95% CI, 0.81-1.25], respectively (pinteraction = 0.679). CONCLUSIONS Patients with the EMI ECG pattern proved to have an increased rate of the primary outcome within one year compared to the PIS pattern. Routine manual thrombectomy did not reduce the risk of primary outcome within the different dynamic ECG patterns. The PIS/EMI dynamic ECG classification could help to triage patients in case of simultaneous STEMI patients with immediate need for pPCI.
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Affiliation(s)
- Joonas Leivo
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland.
| | - Eero Anttonen
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Hamilton Health Sciences, Hamilton, Canada
| | - Vladimir Dzavik
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Jyri Koivumäki
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| | - Minna Tahvanainen
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| | - Kimmo Koivula
- Faculty of Medicine and Health Technology, Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland; Internal medicine, Helsinki University Hospital, Finland
| | - Kjell Nikus
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland
| | - Jia Wang
- Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Canada
| | | | - Kari Niemelä
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| | - Markku J Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland
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8
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Leivo J, Anttonen E, Jolly SS, Dzavik V, Koivumaki J, Tahvanainen M, Koivula K, Nikus K, Wang J, Cairns JA, Niemela K, Eskola M. 3037The prognostic significance of grade of ischemia in patients with STEMI: a substudy of the randomized trial of primary PCI with or without routine manual thrombectomy (TOTAL trial). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The importance of grade of ischemia (GI) classification in the risk assessment of patients with ST-elevation myocardial infarction has been shown previously. Grade 3 ischemia (G3I) is defined by the Sclarovsky-Birnbaum grading system as ECG with ST-elevation and distortion of the terminal portion of the QRS complex in two or more adjacent leads, while grade 2 ischemia (G2I) is defined as ECG with ST-elevation without QRS distortion.
Methods
In a substudy of the international, multicenter, prospective, randomized Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL), we studied the prognostic impact of the grade of ischemia classification on the outcome in patients with STEMI (n=7,211). The primary outcome was a composite of death from cardiovascular causes, recurrent MI, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year.
Results
The primary outcome occurred in 153 of 1,563 patients (9.8%) in the G3I group vs. 364 of 5,648 patients (6.4%) in the G2I group (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.29 to 1.88; p<0.001). The rates of cardiovascular death (4.8% with G3I vs. 2.5% with G2I; HR, 1.92; 95% CI, 1.45 to 2.54; p<0.001) and all-cause mortality (5.2% with G3I vs. 3.3% with G2I; HR, 1.62; 95% CI, 1.25 to 2.10; p<0.001) were also higher in patients with G3I. The rate of stroke or TIA were similar within the two groups (1.1% with G3I vs. 1.0% with G2I; HR, 1.13; 95% CI, 0.66 to 1.95; p=0.650). The grade of ischemia (G3I vs G2I) was shown to be an independent predictor of primary outcome in adjusted multivariable analysis (adjusted HR, 1.43; 95% CI, 1.18 to 1.74; p<0.001).
Conclusions
STEMI patients with G3I in the presenting ECG proved to have an increased rate of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure within one year compared to patients with G2I.
Acknowledgement/Funding
Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital, The unit of Heart Center Co. [Z60064]
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Affiliation(s)
- J Leivo
- University of Tampere, Faculty of Medicine and Health Technology, Tampere, Finland
| | - E Anttonen
- University of Tampere, Faculty of Medicine and Health Technology, Tampere, Finland
| | - S S Jolly
- Population Health Research Institute, Hamilton, Canada
| | - V Dzavik
- University Health Network, Peter Munk Cardiac Centre, Toronto, Canada
| | - J Koivumaki
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
| | - M Tahvanainen
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
| | - K Koivula
- Helsinki University Central Hospital, Helsinki, Finland
| | - K Nikus
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
| | - J Wang
- Population Health Research Institute, Hamilton, Canada
| | - J A Cairns
- University of British Columbia, Vancouver, Canada
| | - K Niemela
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
| | - M Eskola
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
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Sanmark H, Perez S, Leivo J, Kivimäki L, Batra G, Lilja H, Lamminmäki U. Synthetic antibody phage libraries as tools for generating antibodies against difficult analytes. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leivo J, Anttonen E, Jolly SS, Dzavik V, Koivumaki J, Tahvanainen M, Koivula K, Nikus K, Wang J, Cairns JA, Niemela K, Eskola MJ. P3680The high-risk ECG pattern of ST-elevation myocardial infarction: a substudy of the randomized trial of primary PCI with or without routine manual thrombectomy (TOTAL trial). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3680] [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: 11/12/2022] Open
Affiliation(s)
- J Leivo
- University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - E Anttonen
- University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - S S Jolly
- Population Health Research Institute, Hamilton, Canada
| | - V Dzavik
- Peter Munk Cardiac Centre, Toronto, Canada
| | - J Koivumaki
- Heart Center, Tampere University Hospital, Tampere, Finland
| | - M Tahvanainen
- Heart Center, Tampere University Hospital, Tampere, Finland
| | - K Koivula
- Helsinki University Central Hospital, Helsinki, Finland
| | - K Nikus
- Heart Center, Tampere University Hospital, Tampere, Finland
| | - J Wang
- Population Health Research Institute, Hamilton, Canada
| | - J A Cairns
- University of British Columbia, Vancouver, Canada
| | - K Niemela
- Heart Center, Tampere University Hospital, Tampere, Finland
| | - M J Eskola
- Heart Center, Tampere University Hospital, Tampere, Finland
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Anttonen EMJ, Leivo J, Jolly SS, Dzavik V, Koivumaeki JK, Tahvanainen M, Koivula K, Nikus K, Wang J, Cairns JA, Niemelae K, Eskola M. P1494The prognostic significance of atrial fibrillation in patients with ST-elevation myocardial infarction: a sub-study of the randomized TOTAL trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1494] [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: 11/12/2022] Open
Affiliation(s)
| | - J Leivo
- University of Tampere, Tampere, Finland
| | - S S Jolly
- McMaster University, Hamilton, Canada
| | - V Dzavik
- University Health Network, Toronto, Canada
| | - J K Koivumaeki
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
| | - M Tahvanainen
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
| | - K Koivula
- Helsinki University Central Hospital, Helsinki, Finland
| | - K Nikus
- University of Tampere, Tampere, Finland
| | - J Wang
- Population Health Research Institute, Hamilton, Canada
| | - J A Cairns
- University of British Columbia, Vancouver, Canada
| | - K Niemelae
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
| | - M Eskola
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
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Nikus KC, Eskola M, Leivo J, Anttonen E, Koivula K, Koivumäki J, Dzavik V, Niemela K, Jolly S. THE PROGNOSTIC SIGNIFICANCE OF ST RESOLUTION AND TEMPORAL ECG FEATURES IN PRIMARY PCI PATIENTS: A SUBSTUDY OF THE TOTAL TRIAL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Koivumäki JK, Nikus KC, Huhtala H, Ryödi E, Leivo J, Zhou SH, Gregg RE, Selvester RH, Eskola MJ. Agreement between cardiologists and fellows in interpretation of ischemic electrocardiographic changes in acute myocardial infarction. J Electrocardiol 2014; 48:213-7. [PMID: 25576457 DOI: 10.1016/j.jelectrocard.2014.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Time from symptom onset may not be the best indicator for choosing reperfusion therapy for patients presenting with acute ST-elevation myocardial infarction (STEMI); consequently ECG-based methods have been developed. METHODS This study evaluated the inter-observer agreement between experienced cardiologists and junior doctors in identifying the ECG findings of the pre-infarction syndrome (PIS) and evolving myocardial infarction (EMI). The ECGs of 353 STEMI patients were independently analyzed by two cardiologists, one fellow in cardiology, one fellow in internal medicine and a medical student. The last two were given a half-hour introduction of the PIS/EMI-algorithm. RESULTS The inter-observer reliability between all the investigators was found to be good according to kappa statistics (κ 0.632-0.790) for the whole study population. When divided into different subgroups, the inter-observer agreements were from good to very good between the cardiologists and the fellow in cardiology (κ 0.652 -0.813) and from moderate to good (κ 0.464-0.784) between the fellow in internal medicine, medical student and the others. CONCLUSIONS The PIS and EMI ECG patterns are reliably identified by experienced cardiologists and can be easily adopted by junior doctors.
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Affiliation(s)
- Jyri K Koivumäki
- Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland.
| | - Kjell C Nikus
- Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland
| | - Heini Huhtala
- University of Tampere, School of Public Health, Tampere Finland
| | - Essi Ryödi
- Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland
| | - Joonas Leivo
- Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland
| | - Sophia H Zhou
- Clinical Decision Support Solution Department, Philips Research North America, Briarcliff Manor, NY
| | - Richard E Gregg
- Advanced Algorithm Research Center, Philips Healthcare, Andover, MA
| | | | - Markku J Eskola
- Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland
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Brockmann EC, Akter S, Savukoski T, Huovinen T, Lehmusvuori A, Leivo J, Saavalainen O, Azhayev A, Lövgren T, Hellman J, Lamminmäki U. Synthetic single-framework antibody library integrated with rapid affinity maturation by VL shuffling. Protein Eng Des Sel 2011; 24:691-700. [PMID: 21680620 DOI: 10.1093/protein/gzr023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Affinity maturation is often applied to improve the properties of antibodies isolated from universal antibody libraries in vitro. A synthetic human scFv antibody library was constructed in single immunoglobulin framework to enable rapid affinity maturation by updated Kunkel's mutagenesis. The initial diversity was generated predominantly in the V(H) domain combined with only 36 V(L) domain variants yielding 3 × 10(10) unique members in the phage-displayed library. After three rounds of panning the enriched V(H) genes from the primary library selections against lysozyme were incorporated into a ready-made circular single-stranded affinity maturation library containing 7 × 10(8) V(L) gene variants. Several unique antibodies with 0.8-10 nM (K(d), dissociation constant) affinities against lysozyme were found after panning from the affinity maturation library, contrasted by only one anti-lysozyme scFv clone with K(d) <20 nM among the clones panned from the primary universal library. The presented single-framework strategy provides a way to convey significant amount of functional V(H) domain diversity to affinity maturation without bimolecular ligation leading to a diverse set of antibodies with binding affinities in the low nanomolar range.
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Affiliation(s)
- E-C Brockmann
- Department of Biotechnology, University of Turku, Turku, Finland.
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Huet AC, Charlier C, Singh G, Godefroy SB, Leivo J, Vehniäinen M, Nielen MWF, Weigel S, Delahaut P. Development of an optical surface plasmon resonance biosensor assay for (fluoro)quinolones in egg, fish, and poultry meat. Anal Chim Acta 2008; 623:195-203. [PMID: 18620924 DOI: 10.1016/j.aca.2008.06.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 05/27/2008] [Accepted: 06/03/2008] [Indexed: 11/25/2022]
Abstract
The aim of this study was to develop an optical biosensor inhibition immunoassay, based on the surface plasmon resonance (SPR) principle, for use as a screening test for 13 (fluoro)quinolones, including flumequine, used as veterinary drugs in food-producing animals. For this, we immobilised various quinolone derivatives on the sensor chip and tested binding of a range of different antibodies (polyclonal and one engineered antibody) in the presence and absence of free (fluoro)quinolones. The main challenge was to detect flumequine in an assay giving good results for the other compounds. One antigen-antibody combination proved satisfactory: polyclonal antibodies raised against a dual immunogen and, on the sensor chip, a fluoroquinolone derivative. It was the first time that this concept of the bi-active antibody was described in the literature. The assay, optimised for detection in three matrices (poultry muscle, fish, and egg), was tested on incurred samples prepared by liquid extraction followed by two washing steps. This rapid, simple method proved adequate for detecting at least 13 (fluoro)quinolones at concentrations below established maximum residue levels (MRLs). The reference molecule norfloxacin could be detected in the range of 0.1-10 microg kg(-1) in extracts of egg and poultry meat and in the range of 0.1-100 microg kg(-1) in extracts of fish. The determined midpoints of these calibration curves were about 1, 1.5 and 3 microg kg(-1) in poultry meat, egg and fish, respectively.
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Affiliation(s)
- A-C Huet
- CER Groupe, Laboratoire d'Hormonologie, Rue Point du Jour 8, 6900 Marloie, Belgium.
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