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Choi B, Liu GY, Sheng Q, Amancherla K, Perry A, Huang X, San José Estépar R, Ash SY, Guan W, Jacobs DR, Martinez FJ, Rosas IO, Bowler RP, Kropski JA, Banovich NE, Khan SS, San José Estépar R, Shah R, Thyagarajan B, Kalhan R, Washko GR. Proteomic Biomarkers of Quantitative Interstitial Abnormalities in COPDGene and CARDIA Lung Study. Am J Respir Crit Care Med 2024; 209:1091-1100. [PMID: 38285918 DOI: 10.1164/rccm.202307-1129oc] [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: 07/03/2023] [Accepted: 01/29/2024] [Indexed: 01/31/2024] Open
Abstract
Rationale: Quantitative interstitial abnormalities (QIAs) are early measures of lung injury automatically detected on chest computed tomography scans. QIAs are associated with impaired respiratory health and share features with advanced lung diseases, but their biological underpinnings are not well understood. Objectives: To identify novel protein biomarkers of QIAs using high-throughput plasma proteomic panels within two multicenter cohorts. Methods: We measured the plasma proteomics of 4,383 participants in an older, ever-smoker cohort (COPDGene [Genetic Epidemiology of Chronic Obstructive Pulmonary Disease]) and 2,925 participants in a younger population cohort (CARDIA [Coronary Artery Disease Risk in Young Adults]) using the SomaLogic SomaScan assays. We measured QIAs using a local density histogram method. We assessed the associations between proteomic biomarker concentrations and QIAs using multivariable linear regression models adjusted for age, sex, body mass index, smoking status, and study center (Benjamini-Hochberg false discovery rate-corrected P ⩽ 0.05). Measurements and Main Results: In total, 852 proteins were significantly associated with QIAs in COPDGene and 185 in CARDIA. Of the 144 proteins that overlapped between COPDGene and CARDIA, all but one shared directionalities and magnitudes. These proteins were enriched for 49 Gene Ontology pathways, including biological processes in inflammatory response, cell adhesion, immune response, ERK1/2 regulation, and signaling; cellular components in extracellular regions; and molecular functions including calcium ion and heparin binding. Conclusions: We identified the proteomic biomarkers of QIAs in an older, smoking population with a higher prevalence of pulmonary disease and in a younger, healthier community cohort. These proteomics features may be markers of early precursors of advanced lung diseases.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Applied Chest Imaging Laboratory, and
| | - Gabrielle Y Liu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California Davis, Sacramento, California
| | | | | | | | - Xiaoning Huang
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ruben San José Estépar
- Applied Chest Imaging Laboratory, and
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Samuel Y Ash
- Department of Critical Care, South Shore Hospital, South Weymouth, Massachusetts
| | | | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, and
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ivan O Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Jonathan A Kropski
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, and
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine and
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Applied Chest Imaging Laboratory, and
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Lindley KJ, Perry A, Jacobs M, Petty L, Amancherla K, Zhao S, Barker C, Davila-Roman VG, Khan SS, Osmundson SS, Tanriverdi K, Freedman JE, Below J, Shah RV, Laurent LC. Differences in Cardiometabolic Proteins in Pregnancy Prioritize Relevant Targets of Preeclampsia. Arterioscler Thromb Vasc Biol 2024. [PMID: 38385288 DOI: 10.1161/atvbaha.124.320737] [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: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Preeclampsia is a hypertensive disorder of pregnancy characterized by widespread vascular inflammation. It occurs frequently in pregnancy, often without known risk factors, and has high rates of maternal and fetal morbidity and mortality. Identification of biomarkers that predict preeclampsia and its cardiovascular sequelae before clinical onset, or even before pregnancy, is a critical unmet need for the prevention of adverse pregnancy outcomes. METHODS We explored differences in cardiovascular proteomics (Olink Explore 384) in 256 diverse pregnant persons across 2 centers (26% Hispanic, 21% Black). RESULTS We identified significant differences in plasma abundance of markers associated with angiogenesis, blood pressure, cell adhesion, inflammation, and metabolism between individuals delivering with preeclampsia and controls, some of which have not been widely described previously and are not represented in the preeclampsia placental transcriptome. While we observed a broadly similar pattern in early (<34 weeks) versus late (≥34 weeks) preeclampsia, several proteins related to hemodynamic stress, hemostasis, and immune response appeared to be more highly dysregulated in early preeclampsia relative to late preeclampsia. CONCLUSIONS These results demonstrate the value of performing targeted proteomics using a panel of cardiovascular biomarkers to identify biomarkers relevant to preeclampsia pathophysiology and highlight the need for larger multiomic studies to define modifiable pathways of surveillance and intervention upstream to preeclampsia diagnosis.
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Affiliation(s)
- Kathryn J Lindley
- Vanderbilt Translational and Clinical Research Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., A.P., K.A., S.Z., K.T., J.E.F., R.V.S.)
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., S.S.O.)
| | - Andrew Perry
- Vanderbilt Translational and Clinical Research Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., A.P., K.A., S.Z., K.T., J.E.F., R.V.S.)
| | - Marni Jacobs
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal Fetal Medicine, University of California San Diego (M.J.)
| | - Lauren Petty
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN. (L.P., J.B.)
| | - Kaushik Amancherla
- Vanderbilt Translational and Clinical Research Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., A.P., K.A., S.Z., K.T., J.E.F., R.V.S.)
| | - Shilin Zhao
- Vanderbilt Translational and Clinical Research Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., A.P., K.A., S.Z., K.T., J.E.F., R.V.S.)
| | - Claire Barker
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (C.B., V.G.D.-R.)
| | - Victor G Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (C.B., V.G.D.-R.)
| | - Sadiya S Khan
- Cardiovascular Division, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S.K.)
| | - Sarah S Osmundson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., S.S.O.)
| | - Kahraman Tanriverdi
- Vanderbilt Translational and Clinical Research Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., A.P., K.A., S.Z., K.T., J.E.F., R.V.S.)
| | - Jane E Freedman
- Vanderbilt Translational and Clinical Research Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., A.P., K.A., S.Z., K.T., J.E.F., R.V.S.)
| | - Jennifer Below
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN. (L.P., J.B.)
| | - Ravi V Shah
- Vanderbilt Translational and Clinical Research Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN. (K.J.L., A.P., K.A., S.Z., K.T., J.E.F., R.V.S.)
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Amancherla K, Schlendorf KH, Vlasschaert C, Lowery BD, Wells QS, See SB, Zorn E, Colombo PC, Reilly MP, Lindenfeld J, Uriel N, Shah RV, Freedman JE, Moslehi J, Bick AG, Clerkin K. Genetic Interleukin-6 Receptor Variant Is Not Associated With Rejection and Mortality After Heart Transplantation. J Card Fail 2024:S1071-9164(24)00038-1. [PMID: 38367904 DOI: 10.1016/j.cardfail.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Kaushik Amancherla
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Kelly H Schlendorf
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Brandon D Lowery
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Quinn S Wells
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah B See
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Muredach P Reilly
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Joann Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nir Uriel
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Ravi V Shah
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jane E Freedman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Javid Moslehi
- Section of Cardio-Oncology and Immunology (JM), University of California San Francisco, San Francisco, California
| | - Alex G Bick
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin Clerkin
- Division of Cardiology, Columbia University Medical Center, New York, New York
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Perry AS, Hadad N, Chatterjee E, Ramos MJ, Farber-Eger E, Roshani R, Stolze LK, Zhao S, Martens L, Kendall TJ, Thone T, Amancherla K, Bailin S, Gabriel CL, Koethe J, Carr JJ, Terry JG, Freedman J, Tanriverdi K, Alsop E, Keuren-Jensen KV, Sauld JFK, Mahajan G, Khan S, Colangelo L, Nayor M, Fisher-Hoch S, McCormick J, North KE, Below J, Wells Q, Abel D, Kalhan R, Scott C, Guilliams M, Fallowfield JA, Banovich NE, Das S, Shah R. A prognostic molecular signature of hepatic steatosis is spatially heterogeneous and dynamic in human liver. medRxiv 2024:2024.01.26.24301828. [PMID: 38352394 PMCID: PMC10863022 DOI: 10.1101/2024.01.26.24301828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence is increasing in parallel with an obesity pandemic, calling for novel strategies for prevention and treatment. We defined a circulating proteome of human MASLD across ≈7000 proteins in ≈5000 individuals from diverse, at-risk populations across the metabolic health spectrum, demonstrating reproducible diagnostic performance and specifying both known and novel metabolic pathways relevant to MASLD (central carbon and amino acid metabolism, hepatocyte regeneration, inflammation, fibrosis, insulin sensitivity). A parsimonious proteomic signature of MASLD was associated with a protection from MASLD and its related multi-system metabolic consequences in >26000 free-living individuals, with an additive effect to polygenic risk. The MASLD proteome was encoded by genes that demonstrated transcriptional enrichment in liver, with spatial transcriptional activity in areas of steatosis in human liver biopsy and dynamicity for select targets in human liver across stages of steatosis. We replicated several top relations from proteomics and spatial tissue transcriptomics in a humanized "liver-on-a-chip" model of MASLD, highlighting the power of a full translational approach to discovery in MASLD. Collectively, these results underscore utility of blood-based proteomics as a dynamic "liquid biopsy" of human liver relevant to clinical biomarker and mechanistic applications.
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Ma P, Liu J, Qin J, Lai L, Heo GS, Luehmann H, Sultan D, Bredemeyer A, Bajapa G, Feng G, Jimenez J, He R, Parks A, Amrute J, Villanueva A, Liu Y, Lin CY, Mack M, Amancherla K, Moslehi J, Lavine KJ. Expansion of Pathogenic Cardiac Macrophages in Immune Checkpoint Inhibitor Myocarditis. Circulation 2024; 149:48-66. [PMID: 37746718 DOI: 10.1161/circulationaha.122.062551] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 08/28/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs), antibodies targeting PD-1 (programmed cell death protein 1)/PD-L1 (programmed death-ligand 1) or CTLA4 (cytotoxic T-lymphocyte-associated protein 4), have revolutionized cancer management but are associated with devastating immune-related adverse events including myocarditis. The main risk factor for ICI myocarditis is the use of combination PD-1 and CTLA4 inhibition. ICI myocarditis is often fulminant and is pathologically characterized by myocardial infiltration of T lymphocytes and macrophages. Although much has been learned about the role of T-cells in ICI myocarditis, little is understood about the identity, transcriptional diversity, and functions of infiltrating macrophages. METHODS We used an established murine ICI myocarditis model (Ctla4+/-Pdcd1-/- mice) to explore the cardiac immune landscape using single-cell RNA-sequencing, immunostaining, flow cytometry, in situ RNA hybridization, molecular imaging, and antibody neutralization studies. RESULTS We observed marked increases in CCR2 (C-C chemokine receptor type 2)+ monocyte-derived macrophages and CD8+ T-cells in this model. The macrophage compartment was heterogeneous and displayed marked enrichment in an inflammatory CCR2+ subpopulation highly expressing Cxcl9 (chemokine [C-X-C motif] ligand 9), Cxcl10 (chemokine [C-X-C motif] ligand 10), Gbp2b (interferon-induced guanylate-binding protein 2b), and Fcgr4 (Fc receptor, IgG, low affinity IV) that originated from CCR2+ monocytes. It is important that a similar macrophage population expressing CXCL9, CXCL10, and CD16α (human homologue of mouse FcgR4) was expanded in patients with ICI myocarditis. In silico prediction of cell-cell communication suggested interactions between T-cells and Cxcl9+Cxcl10+ macrophages via IFN-γ (interferon gamma) and CXCR3 (CXC chemokine receptor 3) signaling pathways. Depleting CD8+ T-cells or macrophages and blockade of IFN-γ signaling blunted the expansion of Cxcl9+Cxcl10+ macrophages in the heart and attenuated myocarditis, suggesting that this interaction was necessary for disease pathogenesis. CONCLUSIONS These data demonstrate that ICI myocarditis is associated with the expansion of a specific population of IFN-γ-induced inflammatory macrophages and suggest the possibility that IFN-γ blockade may be considered as a treatment option for this devastating condition.
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Affiliation(s)
- Pan Ma
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Jing Liu
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Juan Qin
- Division of Cardiology, Department of Medicine, University of California San Francisco (J.Q., J.M.)
| | - Lulu Lai
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Gyu Seong Heo
- Mallinckrodt Institute of Radiology (G.S.H., H.L., D.S., Y.L.), Washington University School of Medicine, St Louis, MO
| | - Hannah Luehmann
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Deborah Sultan
- Mallinckrodt Institute of Radiology (G.S.H., H.L., D.S., Y.L.), Washington University School of Medicine, St Louis, MO
| | - Andrea Bredemeyer
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Geetika Bajapa
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Guoshuai Feng
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Jesus Jimenez
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Ruijun He
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Antanisha Parks
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Junedh Amrute
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Ana Villanueva
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Yongjian Liu
- Mallinckrodt Institute of Radiology (G.S.H., H.L., D.S., Y.L.), Washington University School of Medicine, St Louis, MO
| | - Chieh-Yu Lin
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Matthias Mack
- Department of Internal Medicine II - Nephrology, Universitatsklinikum Regensburg Klinik und Poliklinik Innere Medizin II, Regensburg, Germany (M.M.)
| | - Kaushik Amancherla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (K.A.)
| | - Javid Moslehi
- Division of Cardiology, Department of Medicine, University of California San Francisco (J.Q., J.M.)
| | - Kory J Lavine
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
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6
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Amancherla K, Feurer ID, Rega SA, Cluckey A, Salih M, Davis J, Pedrotty D, Ooi H, Rali AS, Siddiqi HK, Menachem J, Brinkley DM, Punnoose L, Sacks SB, Zalawadiya SK, Wigger M, Balsara K, Trahanas J, McMaster WG, Hoffman J, Pasrija C, Lindenfeld J, Shah AS, Schlendorf KH. Early Assessment of Cardiac Allograft Vasculopathy Risk Among Recipients of Hepatitis C Virus-infected Donors in the Current Era. J Card Fail 2023:S1071-9164(23)00381-0. [PMID: 37907147 PMCID: PMC11056484 DOI: 10.1016/j.cardfail.2023.09.015] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Transplantation of hearts from hepatitis C virus (HCV)-positive donors has increased substantially in recent years following development of highly effective direct-acting antiviral therapies for treatment and cure of HCV. Although historical data from the pre-direct-acting antiviral era demonstrated an association between HCV-positive donors and accelerated cardiac allograft vasculopathy (CAV) in recipients, the relationship between the use of HCV nucleic acid test-positive (NAT+) donors and the development of CAV in the direct-acting antiviral era remains unclear. METHODS AND RESULTS We performed a retrospective, single-center observational study comparing coronary angiographic CAV outcomes during the first year after transplant in 84 heart transplant recipients of HCV NAT+ donors and 231 recipients of HCV NAT- donors. Additionally, in a subsample of 149 patients (including 55 in the NAT+ cohort and 94 in the NAT- cohort) who had serial adjunctive intravascular ultrasound examination performed, we compared development of rapidly progressive CAV, defined as an increase in maximal intimal thickening of ≥0.5 mm in matched vessel segments during the first year post-transplant. In an unadjusted analysis, recipients of HCV NAT+ hearts had reduced survival free of CAV ≥1 over the first year after heart transplant compared with recipients of HCV NAT- hearts. After adjustment for known CAV risk factors, however, there was no significant difference between cohorts in the likelihood of the primary outcome, nor was there a difference in development of rapidly progressive CAV. CONCLUSIONS These findings support larger, longer-term follow-up studies to better elucidate CAV outcomes in recipients of HCV NAT+ hearts and to inform post-transplant management strategies.
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Affiliation(s)
- Kaushik Amancherla
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Irene D Feurer
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott A Rega
- Vanderbilt Transplant Center, Nashville, Tennessee
| | - Andrew Cluckey
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamed Salih
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Davis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dawn Pedrotty
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry Ooi
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aniket S Rali
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hasan K Siddiqi
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Menachem
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas M Brinkley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynn Punnoose
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Suzanne B Sacks
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandip K Zalawadiya
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark Wigger
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Keki Balsara
- Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, DC
| | - John Trahanas
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William G McMaster
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jordan Hoffman
- Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado
| | - Chetan Pasrija
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joann Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly H Schlendorf
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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7
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Siddiqi HK, Trahanas J, Xu M, Wells Q, Farber-Eger E, Pasrija C, Amancherla K, Debose-Scarlett A, Brinkley DM, Lindenfeld J, Menachem JN, Ooi H, Pedrotty D, Punnoose L, Rali AS, Sacks S, Wigger M, Zalawadiya S, McMaster W, Devries S, Shah A, Schlendorf K. Outcomes of Heart Transplant Donation After Circulatory Death. J Am Coll Cardiol 2023; 82:1512-1520. [PMID: 37793748 DOI: 10.1016/j.jacc.2023.08.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Heart transplantation using donation after circulatory death (DCD) allografts is increasingly common, expanding the donor pool and reducing transplant wait times. However, data remain limited on clinical outcomes. OBJECTIVES We sought to compare 6-month and 1-year clinical outcomes between recipients of DCD hearts, most of them recovered with the use of normothermic regional perfusion (NRP), and recipients of donation after brain death (DBD) hearts. METHODS We conducted a single-center retrospective observational study of all adult heart-only transplants from January 2020 to January 2023. Recipient and donor data were abstracted from medical records and the United Network for Organ Sharing registry, respectively. Survival analysis and Cox regression were used to compare the groups. RESULTS During the study period, 385 adults (median age 57.4 years [IQR: 48.0-63.7 years]) underwent heart-only transplantation, including 122 (32%) from DCD donors, 83% of which were recovered with the use of NRP. DCD donors were younger and had fewer comorbidities than DBD donors. DCD recipients were less often hospitalized before transplantation and less likely to require pretransplantation temporary mechanical circulatory support compared with DBD recipients. There were no significant differences between groups in 1-year survival, incidence of severe primary graft dysfunction, treated rejection during the first year, or likelihood of cardiac allograft vasculopathy at 1 year after transplantation. CONCLUSIONS In the largest single-center comparison of DCD and DBD heart transplantations to date, outcomes among DCD recipients are noninferior to those of DBD recipients. This study adds to the published data supporting DCD donors as a safe means to expand the heart donor pool.
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Affiliation(s)
- Hasan K Siddiqi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - John Trahanas
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Quinn Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Farber-Eger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chetan Pasrija
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kaushik Amancherla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexandra Debose-Scarlett
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - D Marshall Brinkley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan N Menachem
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Henry Ooi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Dawn Pedrotty
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Lynn Punnoose
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aniket S Rali
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Suzanne Sacks
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark Wigger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sandip Zalawadiya
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William McMaster
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven Devries
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashish Shah
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly Schlendorf
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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8
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Amancherla K, Schlendorf KH, Vlasschaert C, Lowery BD, Wells QS, See SB, Zorn E, Colombo PC, Reilly MP, Lindenfeld J, Uriel N, Freedman JE, Shah RV, Moslehi J, Bick AG, Clerkin K. Clonal hematopoiesis of indeterminate potential and outcomes after heart transplantation: A multicenter study. Am J Transplant 2023; 23:1256-1263. [PMID: 37156299 PMCID: PMC10524751 DOI: 10.1016/j.ajt.2023.04.028] [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: 10/27/2022] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
Cardiac allograft vasculopathy (CAV) is a leading cause of late graft failure and mortality after heart transplantation (HT). Sharing some features with atherosclerosis, CAV results in diffuse narrowing of the epicardial coronaries and microvasculature, with consequent graft ischemia. Recently, clonal hematopoiesis of indeterminate potential (CHIP) has emerged as a risk factor for cardiovascular disease and mortality. We aimed to investigate the relationship between CHIP and posttransplant outcomes, including CAV. We analyzed 479 HT recipients with stored DNA samples at 2 high-volume transplant centers, Vanderbilt University Medical Center and Columbia University Irving Medical Center. We explored the association between the presence of CHIP mutations with CAV and mortality after HT. In this case-control analysis, carriers of CHIP mutations were not at increased risk of CAV or mortality after HT. In a large multicenter genomics study of the heart transplant population, the presence of CHIP mutations was not associated with an increased risk of CAV or posttransplant mortality.
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Affiliation(s)
- Kaushik Amancherla
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Kelly H Schlendorf
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Brandon D Lowery
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Quinn S Wells
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah B See
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York City, New York City, USA
| | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York City, New York City, USA
| | - Paolo C Colombo
- Division of Cardiology, Columbia University Medical Center, New York City, New York City, USA
| | - Muredach P Reilly
- Division of Cardiology, Columbia University Medical Center, New York City, New York City, USA
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University Medical Center, New York City, New York City, USA
| | - Jane E Freedman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ravi V Shah
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Javid Moslehi
- Section of Cardio-Oncology and Immunology, University of California San Francisco, San Francisco, California, USA
| | - Alexander G Bick
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin Clerkin
- Division of Cardiology, Columbia University Medical Center, New York City, New York City, USA
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9
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Kittleson MM, Panjrath GS, Amancherla K, Davis LL, Deswal A, Dixon DL, Januzzi JL, Yancy CW. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2023; 81:1835-1878. [PMID: 37137593 DOI: 10.1016/j.jacc.2023.03.393] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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10
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Ma P, Liu J, Qin J, Lai L, Heo GS, Luehmann H, Sultan D, Bredemeyer A, Bajapa G, Feng G, Jimenez J, Parks A, Amrute J, Villanueva A, Liu Y, Lin CY, Mack M, Amancherla K, Moslehi J, Lavine KJ. Expansion of Disease Specific Cardiac Macrophages in Immune Checkpoint Inhibitor Myocarditis. bioRxiv 2023:2023.04.28.538426. [PMID: 37162929 PMCID: PMC10168426 DOI: 10.1101/2023.04.28.538426] [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] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Immune checkpoint inhibitors (ICIs), antibodies targeting PD-1/PD-L1 or CTLA4 have revolutionized cancer management but are associated with devastating immune-related adverse events (irAEs) including myocarditis. The main risk factor for ICI myocarditis is the use of combination PD-1 and CTLA4 inhibition. ICI-myocarditis is often fulminant and is pathologically characterized by myocardial infiltration of T lymphocytes and macrophages. While much has been learned regarding the role of T-cells in ICI-myocarditis, little is understood regarding the identity, transcriptional diversity, and functions of infiltrating macrophages. Methods We employed an established murine ICI myocarditis model ( Ctla4 +/- Pdcd1 -/- mice) to explore the cardiac immune landscape using single-cell RNA-sequencing, immunostaining, flow cytometry, in situ RNA hybridization and molecular imaging and antibody neutralization studies. Results We observed marked increases in CCR2 + monocyte-derived macrophages and CD8 + T-cells in this model. The macrophage compartment was heterogeneous and displayed marked enrichment in an inflammatory CCR2 + subpopulation highly expressing Cxcl9 , Cxcl10 , Gbp2b , and Fcgr4 that originated from CCR2 + monocytes. Importantly, a similar macrophage population expressing CXCL9 , CXCL10 , and CD16α (human homologue of mouse FcgR4) was found selectively expanded in patients with ICI myocarditis compared to other forms of heart failure and myocarditis. In silico prediction of cell-cell communication suggested interactions between T-cells and Cxcl9 + Cxcl10 + macrophages via IFN-γ and CXCR3 signaling pathways. Depleting CD8 + T-cells, macrophages, and blockade of IFN-γ signaling blunted the expansion of Cxcl9 + Cxcl10 + macrophages in the heart and attenuated myocarditis suggesting that this interaction was necessary for disease pathogenesis. Conclusion These data demonstrate that ICI-myocarditis is associated with the expansion of a specific population of IFN-γ induced inflammatory macrophages and suggest the possibility that IFN-γ blockade may be considered as a treatment option for this devastating condition.
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Affiliation(s)
- Pan Ma
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jing Liu
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Juan Qin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lulu Lai
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Gyu Seong Heo
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hannah Luehmann
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Deborah Sultan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrea Bredemeyer
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Geetika Bajapa
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Guoshuai Feng
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jesus Jimenez
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Antanisha Parks
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Junedh Amrute
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ana Villanueva
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Yongjian Liu
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Matthias Mack
- Department of Internal Medicine II – Nephrology, Universitatsklinikum Regensburg Klinik und Poliklinik Innere Medizin II, Regensburg, Bayern, Germany
| | - Kaushik Amancherla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Javid Moslehi
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kory J. Lavine
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
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11
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Elkholey K, Schlendorf K, Biaggioni I, Amancherla K, Brinkley D, Lindenfeld J, Menachem J, Ooi H, Pedrotty D, Punnoose L, Rali A, Sacks S, Wigger M, Zalawadiya S, Siddiqi H. Outcomes and Characteristics of Heart Transplant Recipients Requiring Oral Vasopressor Agents. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.759] [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: 04/05/2023] Open
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12
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Pasrija C, DeBose-Scarlett A, Keck C, Scholl S, Siddiqi H, Amancherla K, Brinkley D, Lindenfeld J, Menachem J, Ooi H, Pedrotty D, Punnoose L, Rali A, Sacks S, Wigger M, Zalawadiya S, McMaster W, Shah A, Schlendorf K, Trahanas J. Prolonged Warm Ischemic Time is Safe for Cardiac Donation after Circulatory Death. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.208] [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: 04/05/2023] Open
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13
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Siddiqi H, DeBose-Scarlett A, Trahanas J, Pasrija C, Amancherla K, Brinkley D, Lindenfeld J, Menachem J, Ooi H, Pedrotty D, Punnoose L, Rali A, Sacks S, Wigger M, Zalawadiya S, McMaster W, Shah A, Schlendorf K. Characteristics and Outcomes Among Recipients of Dcd Versus Dbd Heart Transplantation - The Vanderbilt Experience. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1609] [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: 04/05/2023] Open
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14
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Trahanas J, DeBose-Scarlett A, Siddiqi H, Amancherla K, Brinkley D, Lindenfeld J, Menachem J, Ooi H, Pedrotty D, Punnoose L, Rali A, Sacks S, Wigger M, Zalawadiya S, Hoffman J, McMaster W, Shah A, Schlendorf K, Pasrija C. Normothermic Regional Perfusion Versus Direct Procurement and Preservation: Is There a Difference for DCD Heart Recipients? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.157] [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: 04/05/2023] Open
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15
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Amancherla K, Qin J, Hulke ML, Pfeiffer RD, Agrawal V, Sheng Q, Xu Y, Schlendorf KH, Lindenfeld J, Shah RV, Freedman JE, Tucker NR, Moslehi J. Single-Nuclear RNA Sequencing of Endomyocardial Biopsies Identifies Persistence of Donor-Recipient Chimerism With Distinct Signatures in Severe Cardiac Allograft Vasculopathy. Circ Heart Fail 2023; 16:e010119. [PMID: 36524467 PMCID: PMC9852032 DOI: 10.1161/circheartfailure.122.010119] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kaushik Amancherla
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | - Juan Qin
- Section of Cardio-Oncology & Immunology, University of California San Francisco
| | | | | | - Vineet Agrawal
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Kelly H Schlendorf
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | - Ravi V Shah
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | - Jane E Freedman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | | | - Javid Moslehi
- Section of Cardio-Oncology & Immunology, University of California San Francisco
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16
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Zhang Y, Sun C, Li Y, Qin J, Amancherla K, Jing Y, Hu Q, Liang K, Zhang Z, Ye Y, Huang LA, Nguyen TK, Egranov SD, Zhao Z, Wu A, Xi Y, Yao J, Hung MC, Calin GA, Cheng J, Lim B, Lehmann LH, Salem JE, Johnson DB, Curran MA, Yu D, Han L, Darabi R, Yang L, Moslehi JJ, Lin C. Hormonal therapies up-regulate MANF and overcome female susceptibility to immune checkpoint inhibitor myocarditis. Sci Transl Med 2022; 14:eabo1981. [PMID: 36322628 PMCID: PMC9809130 DOI: 10.1126/scitranslmed.abo1981] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have been increasingly used in combination for cancer treatment but are associated with myocarditis. Here, we report that tumor-bearing mice exhibited response to treatment with combinatorial anti-programmed cell death 1 and anti-cytotoxic T lymphocyte antigen-4 antibodies but also presented with cardiovascular toxicities observed clinically with ICI therapy, including myocarditis and arrhythmia. Female mice were preferentially affected with myocarditis compared to male mice, consistent with a previously described genetic model of ICI myocarditis and emerging clinical data. Mechanistically, myocardial tissue from ICI-treated mice, the genetic mouse model, and human heart tissue from affected patients with ICI myocarditis all exhibited down-regulation of MANF (mesencephalic astrocyte-derived neurotrophic factor) and HSPA5 (heat shock 70-kDa protein 5) in the heart; this down-regulation was particularly notable in female mice. ICI myocarditis was amplified by heart-specific genetic deletion of mouse Manf and was attenuated by administration of recombinant MANF protein, suggesting a causal role. Ironically, both MANF and HSPA5 were transcriptionally induced by liganded estrogen receptor β and inhibited by androgen receptor. However, ICI treatment reduced serum estradiol concentration to a greater extent in female compared to male mice. Treatment with an estrogen receptor β-specific agonist and androgen depletion therapy attenuated ICI-associated cardiac effects. Together, our data suggest that ICI treatment inhibits estradiol-dependent expression of MANF/HSPA5 in the heart, curtailing the cardiomyocyte response to immune injury. This endocrine-cardiac-immune pathway offers new insights into the mechanisms of sex differences in cardiac disease and may offer treatment strategies for ICI myocarditis.
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Affiliation(s)
- Yaohua Zhang
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 10069, China.,Corresponding author. (Y.Z.); (L.Y.); (J.J.M.); and (C.L.)
| | - Chengcao Sun
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Yajuan Li
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Current address: Incyte Corporation, Wilmington, DE 19803, USA
| | - Juan Qin
- Section of Cardio-Oncology & Immunology, Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Kaushik Amancherla
- Department of Medicine, Vanderbilt University of Medical Center, Nashville, TN 37232
| | - Ying Jing
- Department of Biochemistry and Molecular Biology, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX 77030, USA
| | - Qingsong Hu
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Current address: The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, P.R. China
| | - Ke Liang
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Zhao Zhang
- Department of Biochemistry and Molecular Biology, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX 77030, USA
| | - Youqiong Ye
- Department of Biochemistry and Molecular Biology, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX 77030, USA
| | - Lisa A. Huang
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Tina K. Nguyen
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sergey D. Egranov
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Zilong Zhao
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Andrew Wu
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Yutao Xi
- Texas Heart Institute, St. Luke’s Hospital, Houston, TX 77030, USA
| | - Jun Yao
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Mien-Chie Hung
- Graduate Institute of Biomedical Sciences, Research Center for Cancer Biology, and Center for Molecular Medicine, China Medical University, Taichung 404, Taiwan.,Department of Biotechnology, Asia University, Taichung 413, Taiwan
| | - George A. Calin
- Department of Experimental Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Jie Cheng
- Texas Heart Institute, St. Luke’s Hospital, Houston, TX 77030, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lorenz H. Lehmann
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany; Cardio-Oncology Unit, Heidelberg University Hospital, Heidelberg, Germany; German Cardiovascular Research Center (DZHK), partner site Heidelberg/Mannheim, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joe-Elie Salem
- Deprtment of Pharmacology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, INSERM, CIC-1901, UNICO-GRECO Cardiooncology Program, Paris, France
| | - Douglas B. Johnson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Michael A. Curran
- Department of Immunology and Scientific Director of the Oncology Research for Biologics and Immunotherapy Translation (ORBIT), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dihua Yu
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,The Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Leng Han
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX, 77030, USA
| | - Radbod Darabi
- Center for Stem Cell and Regenerative Medicine (CSCRM), The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Liuqing Yang
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,The Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Corresponding author. (Y.Z.); (L.Y.); (J.J.M.); and (C.L.)
| | - Javid J. Moslehi
- Section of Cardio-Oncology & Immunology, Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, 94143, USA,Corresponding author. (Y.Z.); (L.Y.); (J.J.M.); and (C.L.)
| | - Chunru Lin
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,The Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Corresponding author. (Y.Z.); (L.Y.); (J.J.M.); and (C.L.)
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17
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Axelrod ML, Meijers WC, Screever EM, Qin J, Carroll MG, Sun X, Tannous E, Zhang Y, Sugiura A, Taylor BC, Hanna A, Zhang S, Amancherla K, Tai W, Wright JJ, Wei SC, Opalenik SR, Toren AL, Rathmell JC, Ferrell PB, Phillips EJ, Mallal S, Johnson DB, Allison JP, Moslehi JJ, Balko JM. T cells specific for α-myosin drive immunotherapy-related myocarditis. Nature 2022; 611:818-826. [PMID: 36385524 PMCID: PMC9930174 DOI: 10.1038/s41586-022-05432-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/07/2022] [Indexed: 11/17/2022]
Abstract
Immune-related adverse events, particularly severe toxicities such as myocarditis, are major challenges to the utility of immune checkpoint inhibitors (ICIs) in anticancer therapy1. The pathogenesis of ICI-associated myocarditis (ICI-MC) is poorly understood. Pdcd1-/-Ctla4+/- mice recapitulate clinicopathological features of ICI-MC, including myocardial T cell infiltration2. Here, using single-cell RNA and T cell receptor (TCR) sequencing of cardiac immune infiltrates from Pdcd1-/-Ctla4+/- mice, we identify clonal effector CD8+ T cells as the dominant cell population. Treatment with anti-CD8-depleting, but not anti-CD4-depleting, antibodies improved the survival of Pdcd1-/-Ctla4+/- mice. Adoptive transfer of immune cells from mice with myocarditis induced fatal myocarditis in recipients, which required CD8+ T cells. The cardiac-specific protein α-myosin, which is absent from the thymus3,4, was identified as the cognate antigen source for three major histocompatibility complex class I-restricted TCRs derived from mice with fulminant myocarditis. Peripheral blood T cells from three patients with ICI-MC were expanded by α-myosin peptides. Moreover, these α-myosin-expanded T cells shared TCR clonotypes with diseased heart and skeletal muscle, which indicates that α-myosin may be a clinically important autoantigen in ICI-MC. These studies underscore the crucial role for cytotoxic CD8+ T cells, identify a candidate autoantigen in ICI-MC and yield new insights into the pathogenesis of ICI toxicity.
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Affiliation(s)
- Margaret L Axelrod
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wouter C Meijers
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Elles M Screever
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Juan Qin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Section of Cardio-Oncology and Immunology, Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Mary Grace Carroll
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xiaopeng Sun
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elie Tannous
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yueli Zhang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ayaka Sugiura
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brandie C Taylor
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Hanna
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shaoyi Zhang
- Section of Cardio-Oncology and Immunology, Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Kaushik Amancherla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Warren Tai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Cardiology, University of California, Los Angeles, CA, USA
| | - Jordan J Wright
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Spencer C Wei
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan R Opalenik
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Abigail L Toren
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey C Rathmell
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Immunobiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P Brent Ferrell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Australia
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Simon Mallal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Australia
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James P Allison
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Parker Institute for Cancer Immunotherapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Javid J Moslehi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Section of Cardio-Oncology and Immunology, Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
| | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
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18
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Abstract
Somatic mutations in hematopoietic stem cells are common with aging and can result in expansion of clones harboring mutations, termed clonal hematopoiesis. This results in an increased risk of blood cancers but has also been linked with chronic inflammatory disease states. In recent years, clonal hematopoiesis has been established to have a causative role in atherogenesis and cardiovascular disease. Additionally, as the effector cells have been identified to be immune cells, there is ongoing interest in assessing whether dysregulated immune function plays a role in other chronic inflammatory conditions such as rheumatologic disease. Here, we summarize current understanding of clonal hematopoiesis with a focus on cardiovascular disease and inflammation while outlining the potential, yet unexplored, relationship between clonal hematopoiesis and autoimmune disease. Hematopoietic stem cells (HSCs) continually regenerate blood cells. Acquisition of a somatic mutation that provides a selective advantage, a driver mutation, can result in clonal expansion. Clonal hematopoiesis of indeterminate potential, where somatic mutations in certain cancer-associated genes result in clonal expansion in the absence of overt malignancy, can result in atherosclerotic cardiovascular disease in multiple vascular beds, inflammation, and may also contribute to the pathogenesis of autoimmune disease. Many questions remain unanswered regarding the relationship between clonal hematopoiesis and inflammatory disorders.
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Affiliation(s)
- Kaushik Amancherla
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John A Wells
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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19
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Choudhary A, Brinkley DM, Besharati S, Meijers WC, Atkinson JB, Amancherla K, Zhu Q, Huang S, Nguyen LS, Salem JE, Ammirati E, Lindenfeld J, Anders RA, Moslehi J. PD-L1 (Programmed Death Ligand 1) as a Marker of Acute Cellular Rejection After Heart Transplantation. Circ Heart Fail 2021; 14:e008563. [PMID: 34558299 DOI: 10.1161/circheartfailure.121.008563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/18/2022]
Affiliation(s)
- Arrush Choudhary
- Division of Cardiology (A.C., D.M.B., W.C.M., K.A., J.-E.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN.,Cardio-Oncology Program (A.C., W.C.M., K.A., J.-E.S., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | - D Marshall Brinkley
- Division of Cardiology (A.C., D.M.B., W.C.M., K.A., J.-E.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Sepideh Besharati
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD (S.B., Q.Z., R.A.A.)
| | - Wouter C Meijers
- Division of Cardiology (A.C., D.M.B., W.C.M., K.A., J.-E.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN.,Cardio-Oncology Program (A.C., W.C.M., K.A., J.-E.S., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | - James B Atkinson
- Department of Pathology (J.B.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Kaushik Amancherla
- Division of Cardiology (A.C., D.M.B., W.C.M., K.A., J.-E.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN.,Cardio-Oncology Program (A.C., W.C.M., K.A., J.-E.S., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Qingfeng Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD (S.B., Q.Z., R.A.A.)
| | - Shi Huang
- Department of Biostatistics (S.H.), Vanderbilt University Medical Center, Nashville, TN
| | - Lee S Nguyen
- Department of Pharmacology, Sorbonne University, National Institute of Health and Medical Research, CIC-1901, Public Hospitals of Paris, UNICO-GRECO, Paris, France (L.S.N., J.-E.S.).,Department of Pharmacology, Sorbonne Cardio-Oncology Program, Pitié-Salpêtrière Hospital, Paris, France (L.S.N., J.-E.S.).,Recherche et Innovation, Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France (L.S.N.)
| | - Joe-Elie Salem
- Division of Cardiology (A.C., D.M.B., W.C.M., K.A., J.-E.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN.,Cardio-Oncology Program (A.C., W.C.M., K.A., J.-E.S., J.M.), Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology, Sorbonne University, National Institute of Health and Medical Research, CIC-1901, Public Hospitals of Paris, UNICO-GRECO, Paris, France (L.S.N., J.-E.S.).,Department of Pharmacology, Sorbonne Cardio-Oncology Program, Pitié-Salpêtrière Hospital, Paris, France (L.S.N., J.-E.S.)
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy (E.A.)
| | - JoAnn Lindenfeld
- Division of Cardiology (A.C., D.M.B., W.C.M., K.A., J.-E.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Robert A Anders
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD (S.B., Q.Z., R.A.A.)
| | - Javid Moslehi
- Division of Cardiology (A.C., D.M.B., W.C.M., K.A., J.-E.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN.,Cardio-Oncology Program (A.C., W.C.M., K.A., J.-E.S., J.M.), Vanderbilt University Medical Center, Nashville, TN
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20
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Amancherla K, Qin J, Wang Y, Axelrod ML, Balko JM, Schlendorf KH, Hoffman RD, Xu Y, Lindenfeld J, Moslehi J. RNA-Sequencing Reveals a Distinct Transcriptomic Signature for Giant Cell Myocarditis and Identifies Novel Druggable Targets. Circ Res 2021; 129:451-453. [PMID: 34126013 DOI: 10.1161/circresaha.121.319317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Kaushik Amancherla
- Division of Cardiovascular Medicine (K.A., J.Q., K.H.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Juan Qin
- Division of Cardiovascular Medicine (K.A., J.Q., K.H.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Yu Wang
- Department of Pathology, Microbiology, and Immunology, and Department of Biostatistics (Y.W., Y.X.), Vanderbilt University Medical Center, Nashville, TN
| | - Margaret L Axelrod
- Department of Medicine (M.L.A., J.M.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Justin M Balko
- Department of Medicine (M.L.A., J.M.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Kelly H Schlendorf
- Division of Cardiovascular Medicine (K.A., J.Q., K.H.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | | | - Yaomin Xu
- Department of Pathology, Microbiology, and Immunology, and Department of Biostatistics (Y.W., Y.X.), Vanderbilt University Medical Center, Nashville, TN
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine (K.A., J.Q., K.H.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Javid Moslehi
- Division of Cardiovascular Medicine (K.A., J.Q., K.H.S., J.L., J.M.), Vanderbilt University Medical Center, Nashville, TN
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21
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Amancherla K, Menachem JN, Shah AS, Lindenfeld J, O'leary J. Limited Balloon Atrial Septostomy for Left Ventricular Unloading in Peripheral Extracorporeal Membrane Oxygenation. J Card Fail 2021; 27:501-504. [PMID: 33358956 DOI: 10.1016/j.cardfail.2020.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/22/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study describes the authors' experience with a limited balloon atrial septostomy technique, using a median balloon size of 15 mm, as a left ventricular (LV) unloading strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO). There has been increasing use of VA-ECMO in cardiogenic shock. Although LV unloading strategies have been suggested to improve outcomes, it is unclear which strategy is optimal. METHODS AND RESULTS We performed a retrospective study of patients who underwent a limited balloon atrial septostomy for LV unloading in peripheral VA-ECMO at a single center. The goal of this study was to define the procedural outcomes and clinical characteristics of these patients. Of the 12 patients identified, none had complications related to the procedure. There was a significant decrease in the mean left atrial pressure and the majority of patients had radiologic improvement in pulmonary vascular congestion. Of the 12 patients, 58.3% survived to discharge. CONCLUSIONS Limited BAS is an elegant and safe method for unloading the LV in peripheral VA-ECMO.
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Affiliation(s)
| | | | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jared O'leary
- Department of Medicine, Division of Cardiovascular Medicine.
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22
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Amancherla K, Moslehi J, Hoffman R, Lindenfeld J. Fulminant Giant Cell Myocarditis Is Associated With Poor Outcomes. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.110] [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: 10/23/2022]
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23
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Amancherla K, Lazzara G, Schlendorf K, O'Leary J, Zalawadiya S, Lindenfeld J, Menachem JN. An Assessment of Patient Selection for Impella Device Implantation in Cardiogenic Shock. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.449] [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: 11/16/2022]
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24
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Amancherla K, Menachem J, Laws J, Goel K, Ellis C, Shah A, O'Leary J. A Single-Center Experience with Balloon Atrial Septostomy as an Unloading Strategy in Patients on ECMO. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.197] [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: 10/24/2022] Open
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25
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Mullin CJ, Hsu S, Amancherla K, Wand A, Rhodes P, Leary PJ, Mukherjee M, Damico RL, Kolb TM, Mathai SC, Hassoun PM, Tedford RJ. Evaluation of criteria for exercise-induced pulmonary hypertension in patients with resting pulmonary hypertension. Eur Respir J 2017; 50:50/3/1700784. [PMID: 28931665 DOI: 10.1183/13993003.00784-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/17/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Christopher J Mullin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kaushik Amancherla
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison Wand
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Parker Rhodes
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter J Leary
- Division of Pulmonary and Critical Care, University of Washington Medicine Center, Seattle, WA, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan J Tedford
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA .,Division of Cardiology, Dept of Medicine, Medical University of South Carolina, Charleston, SC, USA
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26
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Abstract
Cranioplasty is routinely performed following decompressive craniectomy in both adult and pediatric populations. In adults, this procedure is associated with higher rates of complications than is elective cranial surgery. This study is a review of the literature describing risk factors for complications after cranioplasty surgery in pediatric patients. A systematic search of PubMed, Cochrane, and SCOPUS databases was undertaken. Articles were selected based on their titles and abstracts. Only studies that focused on a pediatric population were included; case reports were excluded. Studies in which the authors assessed bone flap storage method, timing of cranioplasty, material used (synthetic vs autogenous), skull defect size, and/or complication rates (bone resorption and surgical site infection) were selected for further analysis. Eleven studies that included a total of 441 cranioplasties performed in the pediatric population are included in this review. The findings are as follows: 1) Based on analysis of pooled data, using cryopreserved bone flaps during cranioplasty may lead to a higher rate of bone resorption and lower rate of infection than using bone flaps stored at room temperature. 2) In 3 of 4 articles describing the effect of time between craniectomy and cranioplasty on complication rate, the authors found no significant effect, while in 1 the authors found that the incidence of bone resorption was significantly lower in children who had undergone early cranioplasty. Pooling of data was not possible for this analysis. 3) There are insufficient data to assess the effect of cranioplasty material on complication rate when considering only cranioplasties performed to repair decompressive craniectomy defects. However, when considering cranioplasties performed for any indication, those in which freshly harvested autograft is used may have a lower rate of resorption than those in which stored autograft is used. 4) There is no appreciable effect of craniectomy defect size or patient age on complication rate. There is a paucity of articles describing outcomes and complications following cranioplasty in children and adolescents. However, based on the studies examined in this systematic review, there are reasons to suspect that method of flap preservation, timing of surgery, and material used may be significant. Larger prospective and retrospective studies are needed to shed more light on this important issue.
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Affiliation(s)
- Brandon G Rocque
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA
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27
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Mukherjee B, Tomimatsu N, Amancherla K, Camacho C, Burma S. Abstract 3745: The dual PI3K/mTOR inhibitor NVP-BEZ235 is a potent inhibitor of ATM- and DNA-PKcs-mediated DNA damage responses. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-3745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Inhibitors of PI3K/Akt signaling are being actively developed for tumor therapy due to the frequent mutational activation of the PI3K-Akt-mTORC1 pathway in many cancers, including glioblastomas (GBMs). NVP-BEZ235 is a novel and potent inhibitor of PI3K/Akt signaling that is currently in phase I/II clinical trials. BEZ235 is reported to specifically inhibit PI3Ks and mTOR with little effect on other kinases. However, we find that BEZ235 also potently inhibits the two major kinases responding to DNA double-strand breaks (DSBs), ATM and DNA-PKcs, both in vitro and in vivo. Consequently, BEZ235 blocks both non-homologous end joining (NHEJ) and homologous recombination (HR) DNA repair pathways, resulting in significant attenuation of DSB repair. Additionally, phosphorylation of ATM targets and implementation of the G2/M cell cycle checkpoint are also attenuated by this drug. The consequence is profound radiosensitization at very low concentrations (100 nM) of BEZ235. This radiosensitizing effect is significantly more potent than that seen with much higher concentrations (10 μm) of inhibitors of DNA-PKcs or ATM that are currently being optimized for clinical testing. Since radiotherapy is the standard of care for GBM, we investigated the potential utility of BEZ235 as a radiosensitizing agent in a panel of GBM lines. We find that BEZ235 treatment confers an extreme degree of radiosensitization and significantly attenuates DSB repair irrespective of Akt activation status in these lines. Finally, we show that BEZ235 also significantly impairs DSB repair in a mouse tumor model thereby validating the efficacy of this drug in vivo. Our results, showing that BEZ235 is a potent and novel inhibitor of ATM and DNA-PKcs, have important implications for the informed and rational design of clinical trials involving this drug and also reveal the potential clinical utility of BEZ235 as an effective radiosensitizer.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3745. doi:1538-7445.AM2012-3745
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28
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Amancherla K, Mukherjee B, McEllin B, Pichamoorthy N, Camacho C, Tomimatsu N, Bachoo R, Burma S. DNA Double-Strand Break Repair: Implications for Glioblastoma Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.052] [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: 11/26/2022]
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