1
|
Totani L, Amore C, Piccoli A, Dell'Elba G, Di Santo A, Plebani R, Pecce R, Martelli N, Rossi A, Ranucci S, De Fino I, Moretti P, Bragonzi A, Romano M, Evangelista V. Type-4 Phosphodiesterase (PDE4) Blockade Reduces NETosis in Cystic Fibrosis. Front Pharmacol 2021; 12:702677. [PMID: 34566635 PMCID: PMC8456009 DOI: 10.3389/fphar.2021.702677] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022] Open
Abstract
Neutrophilic inflammation is a key determinant of cystic fibrosis (CF) lung disease. Neutrophil-derived free DNA, released in the form of extracellular traps (NETs), significantly correlates with impaired lung function in patients with CF, underlying their pathogenetic role in CF lung disease. Thus, specific approaches to control NETosis of neutrophils migrated into the lungs may be clinically relevant in CF. We investigated the efficacy of phosphodiesterase (PDE) type-4 inhibitors, in vitro, on NET release by neutrophils from healthy volunteers and individuals with CF, and in vivo, on NET accumulation and lung inflammation in mice infected with Pseudomonas aeruginosa. PDE4 blockade curbed endotoxin-induced NET production and preserved cellular integrity and apoptosis in neutrophils, from healthy subjects and patients with CF, challenged with endotoxin, in vitro. The pharmacological effects of PDE4 inhibitors were significantly more evident on CF neutrophils. In a mouse model of Pseudomonas aeruginosa chronic infection, aerosol treatment with roflumilast, a selective PDE4 inhibitor, gave a significant reduction in free DNA in the BALF. This was accompanied by reduced citrullination of histone H3 in neutrophils migrated into the airways. Roflumilast-treated mice showed a significant improvement in weight recovery. Our study provides the first evidence that PDE4 blockade controls NETosis in vitro and in vivo, in CF-relevant models. Since selective PDE4 inhibitors have been recently approved for the treatment of COPD and psoriasis, our present results encourage clinical trials to test the efficacy of this class of drugs in CF.
Collapse
Affiliation(s)
- Licia Totani
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Mozzagrogna, Italy
| | - Concetta Amore
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Mozzagrogna, Italy
| | - Antonio Piccoli
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Mozzagrogna, Italy
| | - Giuseppe Dell'Elba
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Mozzagrogna, Italy
| | - Angelo Di Santo
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Mozzagrogna, Italy
| | - Roberto Plebani
- Laboratory of Molecular Medicine, Centre for Advanced Studies and Technology (CAST), Department of Medical Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Romina Pecce
- Laboratory of Molecular Medicine, Centre for Advanced Studies and Technology (CAST), Department of Medical Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Nicola Martelli
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Mozzagrogna, Italy
| | - Alice Rossi
- Infection and Cystic Fibrosis Unit, Division of Immunology Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Ranucci
- Infection and Cystic Fibrosis Unit, Division of Immunology Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ida De Fino
- Infection and Cystic Fibrosis Unit, Division of Immunology Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Moretti
- Cystic Fibrosis Centre, S. Liberatore Hospital, Atri, Italy
| | - Alessandra Bragonzi
- Infection and Cystic Fibrosis Unit, Division of Immunology Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Romano
- Laboratory of Molecular Medicine, Centre for Advanced Studies and Technology (CAST), Department of Medical Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Virgilio Evangelista
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Mozzagrogna, Italy
| |
Collapse
|
2
|
Totani L, Plebani R, Piccoli A, Di Silvestre S, Lanuti P, Recchiuti A, Cianci E, Dell'Elba G, Sacchetti S, Patruno S, Guarnieri S, Mariggiò MA, Mari VC, Anile M, Venuta F, Del Porto P, Moretti P, Prioletta M, Mucilli F, Marchisio M, Pandolfi A, Evangelista V, Romano M. Mechanisms of endothelial cell dysfunction in cystic fibrosis. Biochim Biophys Acta Mol Basis Dis 2017; 1863:3243-3253. [PMID: 28847515 DOI: 10.1016/j.bbadis.2017.08.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/24/2017] [Accepted: 08/13/2017] [Indexed: 12/18/2022]
Abstract
Although cystic fibrosis (CF) patients exhibit signs of endothelial perturbation, the functions of the cystic fibrosis conductance regulator (CFTR) in vascular endothelial cells (EC) are poorly defined. We sought to uncover biological activities of endothelial CFTR, relevant for vascular homeostasis and inflammation. We examined cells from human umbilical cords (HUVEC) and pulmonary artery isolated from non-cystic fibrosis (PAEC) and CF human lungs (CF-PAEC), under static conditions or physiological shear. CFTR activity, clearly detected in HUVEC and PAEC, was markedly reduced in CF-PAEC. CFTR blockade increased endothelial permeability to macromolecules and reduced trans‑endothelial electrical resistance (TEER). Consistent with this, CF-PAEC displayed lower TEER compared to PAEC. Under shear, CFTR blockade reduced VE-cadherin and p120 catenin membrane expression and triggered the formation of paxillin- and vinculin-enriched membrane blebs that evolved in shrinking of the cell body and disruption of cell-cell contacts. These changes were accompanied by enhanced release of microvesicles, which displayed reduced capability to stimulate proliferation in recipient EC. CFTR blockade also suppressed insulin-induced NO generation by EC, likely by inhibiting eNOS and AKT phosphorylation, whereas it enhanced IL-8 release. Remarkably, phosphodiesterase inhibitors in combination with a β2 adrenergic receptor agonist corrected functional and morphological changes triggered by CFTR dysfunction in EC. Our results uncover regulatory functions of CFTR in EC, suggesting a physiological role of CFTR in the maintenance EC homeostasis and its involvement in pathogenetic aspects of CF. Moreover, our findings open avenues for novel pharmacology to control endothelial dysfunction and its consequences in CF.
Collapse
Affiliation(s)
- Licia Totani
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Italy
| | - Roberto Plebani
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy; Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy
| | - Antonio Piccoli
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Italy
| | - Sara Di Silvestre
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy; Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy
| | - Paola Lanuti
- Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy; Department of Medicine and Aging Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Antonio Recchiuti
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy; Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy
| | - Eleonora Cianci
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy; Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy
| | - Giuseppe Dell'Elba
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Italy
| | - Silvio Sacchetti
- Center for Synaptic Neuroscience, Italian Institute of Technology, Genoa, Italy
| | - Sara Patruno
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy; Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy
| | - Simone Guarnieri
- Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy; Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Maria A Mariggiò
- Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy; Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Veronica C Mari
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy; Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy
| | - Marco Anile
- Department of Thoracic Surgery, University of Rome "Sapienza", Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, University of Rome "Sapienza", Rome, Italy
| | - Paola Del Porto
- Department of Biology and Biotechnology "Charles Darwin", Sapienza University, Rome, Italy
| | - Paolo Moretti
- Cystic Fibrosis Center, S. Liberatore Hospital, Atri, TE, Italy
| | - Marco Prioletta
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Felice Mucilli
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Marco Marchisio
- Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy; Department of Medicine and Aging Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Assunta Pandolfi
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy; Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy
| | - Virgilio Evangelista
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Italy
| | - Mario Romano
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy; Center on Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti-Pescara, Italy.
| |
Collapse
|
3
|
Totani L, Amore C, Di Santo A, Dell'Elba G, Piccoli A, Martelli N, Tenor H, Beume R, Evangelista V. Roflumilast inhibits leukocyte-platelet interactions and prevents the prothrombotic functions of polymorphonuclear leukocytes and monocytes. J Thromb Haemost 2016; 14:191-204. [PMID: 26484898 DOI: 10.1111/jth.13173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 09/16/2014] [Accepted: 10/04/2015] [Indexed: 12/12/2022]
Abstract
UNLABELLED ESSENTIALS: Thrombosis is a major comorbidity in patients with chronic obstructive pulmonary disease (COPD). Roflumilast is a selective phosphodiesterase type-4 (PDE4) inhibitor approved for treatment of severe COPD. PDE4 blockade by roflumilast inhibits prothrombotic functions of neutrophils and monocytes. PDE4 inhibitors may reduce thrombotic risk in COPD as well as in other vascular diseases. BACKGROUND Roflumilast, an oral selective phosphodiesterase type 4 inhibitor, is approved for the treatment of severe chronic obstructive pulmonary disease (COPD). A recent meta-analysis of trials on COPD revealed that treatment with roflumilast was associated with a significant reduction in the rate of major cardiovascular events. The mechanisms of this effect remain unknown. OBJECTIVES We tested the hypothesis that roflumilast N-oxide (RNO), the active metabolite of roflumilast, curbs the molecular mechanisms required for leukocyte-platelet (PLT) interactions and prevents the prothrombotic functions of polymorphonuclear leukocytes (PMNs) and monocytes (MNs). METHODS Using well-characterized in vitro models, we analysed the effects of RNO on: (i) PMN adhesiveness; (ii) the release of neutrophil extracellular traps (NETs); and (iii) tissue factor expression in MNs. Key biochemical events underlying the inhibitory effects of RNO were defined. RESULTS AND CONCLUSIONS In PMNs, RNO prevented phosphoinositide 3-kinase (PI3K)-dependent phosphorylation of Akt on Ser473, and Src family kinase (SFK)-mediated Pyk2 phosphorylation on Tyr579-580, while inducing protein kinase A-mediated phosphorylation of C-terminal Src kinase, the major negative regulator of SFKs. Modulation of these signaling pathways by RNO resulted in a significant impairment of PMN adhesion to activated PLTs or human umbilical vein endothelial cells, mainly mediated by inhibition of the adhesive function of Mac-1. Moreover RNO curbed SFK/PI3K-mediated NET release by PMNs adherent on fibrinogen-coated surfaces. In MNs interacting with activated PLTs, RNO curbed PI3K-mediated expression of tissue factor. The efficacy of RNO was significantly potentiated by formoterol, a long acting β-adrenergic receptor agonist. This study reveals novel antithrombotic activities by which roflumilast may exert protective effects against cardiovascular comorbodities in COPD.
Collapse
Affiliation(s)
- L Totani
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - C Amore
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - A Di Santo
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - G Dell'Elba
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - A Piccoli
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - N Martelli
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - H Tenor
- Takeda Pharmaceuticals International GmbH, Glattpark-Opfikon, Switzerland
| | - R Beume
- Takeda Pharmaceuticals International GmbH, Glattpark-Opfikon, Switzerland
| | - V Evangelista
- Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| |
Collapse
|
4
|
Totani L, Piccoli A, Dell'Elba G, Concetta A, Di Santo A, Martelli N, Federico L, Pamuklar Z, Smyth SS, Evangelista V. Phosphodiesterase type 4 blockade prevents platelet-mediated neutrophil recruitment at the site of vascular injury. Arterioscler Thromb Vasc Biol 2014; 34:1689-96. [PMID: 24925970 DOI: 10.1161/atvbaha.114.303939] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Platelet-neutrophil interactions play a key role in cardiovascular disease and inflammatory processes. Src family kinases mediate P-selectin glycoprotein ligand-1-Mac-1 cross talk necessary for firm platelet-neutrophil adhesion. Because Src family kinase activity can be regulated by cAMP-dependent pathways, in this work, we evaluated the role of phosphodiesterases in the signaling events that are required to sustain platelet-neutrophil interactions and neutrophil recruitment at the site of vascular injury. APPROACH AND RESULTS In neutrophils exposed to P-selectin, selective phosphodiesterase 4 (PDE4) inhibition prevented Src family kinase-mediated phosphorylation of the proline-rich tyrosine kinase 2 on Tyr579/Tyr580. The effects of PDE4 inhibition required protein kinase A, likely through protein kinase A-mediated activation of COOH-terminal Src kinase, a major negative regulator of Src family kinases. PDE4, but not other phosphodiesterase inhibitors, reduced platelet-neutrophil conjugates as well as neutrophil firm adhesion on spread platelets under flow conditions. The effect of PDE4 inhibition on neutrophil adhesion was primarily mediated by downregulation of P-selectin-induced activation of Mac-1. In a murine model of endovascular injury, selective inhibition of PDE4 significantly reduced neutrophil recruitment at the site of vascular damage. CONCLUSIONS This study identifies PDE4 as a central node in the signaling network that mediates platelet-neutrophil adhesion and suggests that pharmacological inhibition of PDE4 may represent a novel therapeutic avenue for the treatment of cardiovascular disease.
Collapse
Affiliation(s)
- Licia Totani
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Antonio Piccoli
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Giuseppe Dell'Elba
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Amore Concetta
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Angelomaria Di Santo
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Nicola Martelli
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Lorenzo Federico
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Zehra Pamuklar
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Susan S Smyth
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.)
| | - Virgilio Evangelista
- From the Department of Translational Pharmacology, Laboratory of Vascular Biology and Pharmacology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy (L.T., A.P., G.D., A.C., A.D.S., N.M., V.E.); Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, KY (L.F., Z.P., S.S.S.); and VA Medical Center, Lexington, KY (S.S.S.).
| |
Collapse
|
5
|
Genovese S, De Berardis G, Nicolucci A, Mannucci E, Evangelista V, Totani L, Pellegrini F, Ceriello A. Effect of pioglitazone versus metformin on cardiovascular risk markers in type 2 diabetes. Adv Ther 2013; 30:190-202. [PMID: 23359066 DOI: 10.1007/s12325-013-0003-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Besides its critical role in metabolic homeostasis, peroxisome proliferator-activated receptor (PPAR)-γ modulates several cellular responses involved in atherothrombosis. This multicenter, double-blind, randomized study investigated the effects of two oral hypoglycemic agents on markers of inflammation, platelet activation, thrombogenesis, and oxidative stress in patients with type 2 diabetes. METHODS AND RESULTS The primary objective of this study was to evaluate the effect on C-reactive protein (CRP) after a 16-week treatment period with either pioglitazone or metformin. Additionally, markers of vascular inflammatory response, platelet activation, thrombogenesis, oxidative stress, glucose, and lipid metabolism, as well as liver function, were measured. In total, 50 patients completed the study. Pioglitazone-treated patients were found to have statistically significantly larger decreases in mean CRP levels (-0.4 mg/dL) compared to those treated with metformin (-0.2 mg/dL) (P=0.04), as well as greater reductions in levels of mean fasting plasma glucose (-27 vs. -9 mg/dL; P=0.01), serum insulin (-2 vs. -1.9 mU/L; P=0.014), homeostatic model assessment (HOMA) (-1.2 vs. -0.9; P=0.015), and E-selectin (-12.4 vs. +3.4 μg/mL; P=0.01). Mean glycated hemoglobin (HbA1c) levels decreased in both treatment groups from baseline to week 16 (-0.4% in the pioglitazone group, -0.2% in the metformin group; P=0.36). Pioglitazone treatment was also found to be associated with a statistically significant increase in total cholesterol levels (+10 mg/dL in the pioglitazone arm, -3 mg/dL in the metformin arm; P=0.05) and a decrease in liver enzyme levels. CONCLUSIONS The favorable changes in markers of systemic and vascular inflammatory response with pioglitazone suggest that it may positively influence the atherothrombotic process in type 2 diabetes.
Collapse
Affiliation(s)
- Stefano Genovese
- Cardiovascular and Metabolic Department, IRCCS MultiMedica Sesto San Giovanni, Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Totani L, Dell'Elba G, Martelli N, Di Santo A, Piccoli A, Amore C, Evangelista V. Prasugrel inhibits platelet-leukocyte interaction and reduces inflammatory markers in a model of endotoxic shock in the mouse. Thromb Haemost 2012; 107:1130-40. [PMID: 22436970 DOI: 10.1160/th11-12-0867] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 02/27/2012] [Indexed: 01/20/2023]
Abstract
Prasugrel, through its active metabolite, reduces atherothrombosis and its clinical manifestations by inhibiting platelet activation and aggregation. Platelets also contribute to inflammation through interaction with different classes of leukocytes. We investigated whether the inhibitory effect of prasugrel on platelets also counteract inflammatory responses. The effect of prasugrel active metabolite, R-138727, was investigated on platelet P-selectin expression, platelet adhesion to polymorphonuclear leukocytes (PMN) and monocytes (MN) and Mac-1 expression in PMN and MN, in vitro, in human cells. The ex vivo effect of prasugrel administration on P-selectin, thromboxane (TXB)2 formation, platelet-PMN conjugates and Mac-1 expression in PMN triggered by PAR-4 agonist peptide was examined in whole blood from healthy mice as well as from mice in which an acute inflammatory reaction was induced by treatment with endotoxin. The effect of prasugrel on inflammatory markers in endotoxin-treated animals was also tested in vivo. R-138727 inhibited agonist-stimulated expression of platelet P-selectin, platelet-PMN and platelet-MN adhesion and platelet-dependent Mac-1 expression in leukocytes. Addition of aspirin did not modify the inhibitory effect elicited by R-138727. Treatment of mice with prasugrel resulted in a profound inhibition of platelet P-selectin expression, TXB2 production, platelet-PMN adhesion and Mac-1 expression in PMN induced by ex vivo stimulation with PAR-4 agonist peptide of whole blood from healthy or endotoxin-treated mice. Measurement of markers revealed that prasugrel reduced TXB2 and tumour necrosis factor-α synthesis and increased nitric oxide metabolites in endotoxin-treated mice in vivo. In conclusion, prasugrel reduces platelet interactions with PMN and MN. Through these effects prasugrel may curb platelet-mediated inflammatory responses.
Collapse
Affiliation(s)
- Licia Totani
- Laboratory of Vascular Biology and Pharmacology, Consorzio Mario Negri Sud, Via Nazionale 8/A, 66030 Santa Maria Imbaro, Italy
| | | | | | | | | | | | | |
Collapse
|
7
|
Marcantoni E, Di Francesco L, Totani L, Piccoli A, Evangelista V, Tacconelli S, Patrignani P. Effects of estrogen on endothelial prostanoid production and cyclooxygenase-2 and heme oxygenase-1 expression. Prostaglandins Other Lipid Mediat 2012; 98:122-8. [PMID: 22330859 DOI: 10.1016/j.prostaglandins.2012.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 01/18/2012] [Accepted: 01/27/2012] [Indexed: 11/25/2022]
Abstract
We studied the effects of 17β-estradiol (E₂) (10, 40 nM) on 2 vasoprotective pathways, i.e. cyclooxygenase-2 (COX-2)-dependent prostanoids and the antioxidant heme oxygenase-1 (HO-1), in human umbilical vein endothelial cells (HUVEC) exposed for 6h to steady laminar shear stress (LSS, 10 dyn/cm²), characteristic of atherosclerotic lesion-protected areas. COX-2 was induced by LSS versus static condition (SC). E₂ did not significantly affect COX-2 expression in HUVEC cultured in SC or exposed to LSS. Prostacyclin (PGI₂) and prostaglandin (PG)E₂ were induced while PGF(2α) was reduced by LSS. E₂ caused no effect or a small reduction of prostanoid biosynthesis. In HUVEC cultured in SC or exposed to LSS, E₂ 10 nM caused a comparable HO-1 induction (35-45%) while E₂ 40 nM was 5-fold more potent in LSS-exposed HUVEC than in SC (290% and 58%, respectively). PGI₂ receptor antagonist RO3244794 did not affect HO-1 induction by E₂. In conclusion, E₂ may restrain oxidant stress in the endothelium through HO-1 induction by a mechanism independent on PGI₂ signaling.
Collapse
Affiliation(s)
- Emanuela Marcantoni
- Department of Medicine and Aging, "G. d'Annunzio" University, School of Medicine, 66100 Chieti, Italy
| | | | | | | | | | | | | |
Collapse
|
8
|
Croci DO, Cumashi A, Ushakova NA, Preobrazhenskaya ME, Piccoli A, Totani L, Ustyuzhanina NE, Bilan MI, Usov AI, Grachev AA, Morozevich GE, Berman AE, Sanderson CJ, Kelly M, Di Gregorio P, Rossi C, Tinari N, Iacobelli S, Rabinovich GA, Nifantiev NE. Fucans, but not fucomannoglucuronans, determine the biological activities of sulfated polysaccharides from Laminaria saccharina brown seaweed. PLoS One 2011; 6:e17283. [PMID: 21387013 PMCID: PMC3046160 DOI: 10.1371/journal.pone.0017283] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 01/27/2011] [Indexed: 11/27/2022] Open
Abstract
Sulfated polysaccharides from Laminaria saccharina (new name: Saccharina latissima) brown seaweed show promising activity for the treatment of inflammation, thrombosis, and cancer; yet the molecular mechanisms underlying these properties remain poorly understood. The aim of this work was to characterize, using in vitro and in vivo strategies, the anti-inflammatory, anti-coagulant, anti-angiogenic, and anti-tumor activities of two main sulfated polysaccharide fractions obtained from L. saccharina: a) L.s.-1.0 fraction mainly consisting of O-sulfated mannoglucuronofucans and b) L.s.-1.25 fraction mainly composed of sulfated fucans. Both fractions inhibited leukocyte recruitment in a model of inflammation in rats, although L.s.-1.25 appeared to be more active than L.s.-1.0. Also, these fractions inhibited neutrophil adhesion to platelets under flow. Only fraction L.s.-1.25, but not L.s.-1.0, displayed anticoagulant activity as measured by the activated partial thromboplastin time. Investigation of these fractions in angiogenesis settings revealed that only L.s.-1.25 strongly inhibited fetal bovine serum (FBS) induced in vitro tubulogenesis. This effect correlated with a reduction in plasminogen activator inhibitor-1 (PAI-1) levels in L.s.-1.25-treated endothelial cells. Furthermore, only parent sulfated polysaccharides from L. saccharina (L.s.-P) and its fraction L.s.-1.25 were powerful inhibitors of basic fibroblast growth factor (bFGF) induced pathways. Consistently, the L.s.-1.25 fraction as well as L.s.-P successfully interfered with fibroblast binding to human bFGF. The incorporation of L.s.-P or L.s.-1.25, but not L.s.-1.0 into Matrigel plugs containing melanoma cells induced a significant reduction in hemoglobin content as well in the frequency of tumor-associated blood vessels. Moreover, i.p. administrations of L.s.-1.25, as well as L.s.-P, but not L.s.-1.0, resulted in a significant reduction of tumor growth when inoculated into syngeneic mice. Finally, L.s.-1.25 markedly inhibited breast cancer cell adhesion to human platelet-coated surfaces. Thus, sulfated fucans are mainly responsible for the anti-inflammatory, anticoagulant, antiangiogenic, and antitumor activities of sulfated polysaccharides from L. saccharina brown seaweed.
Collapse
Affiliation(s)
- Diego O. Croci
- Laboratorio de Inmunopatología, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Albana Cumashi
- Department of Oncology and Neurosciences, University G. D'Annunzio Medical School and Foundation, Chieti, Italy
| | - Natalia A. Ushakova
- V.N. Orekhovich Research Institute of Biomedical Chemistry, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Marina E. Preobrazhenskaya
- V.N. Orekhovich Research Institute of Biomedical Chemistry, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Antonio Piccoli
- Consorzio Mario Negri Sud, Laboratory of Vascular Biology and Pharmacology, Santa Maria Imbaro, Chieti, Italy
| | - Licia Totani
- Consorzio Mario Negri Sud, Laboratory of Vascular Biology and Pharmacology, Santa Maria Imbaro, Chieti, Italy
| | - Nadezhda E. Ustyuzhanina
- Laboratory of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russian Federation
| | - Maria I. Bilan
- Laboratory of Plant Polysaccharides, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russian Federation
| | - Anatolii I. Usov
- Laboratory of Plant Polysaccharides, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russian Federation
| | - Alexey A. Grachev
- Laboratory of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russian Federation
| | - Galina E. Morozevich
- V.N. Orekhovich Research Institute of Biomedical Chemistry, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Albert E. Berman
- V.N. Orekhovich Research Institute of Biomedical Chemistry, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Craig J. Sanderson
- Scottish Association for Marine Sciences, Oban, Argyll, Scotland, United Kingdom
| | - Maeve Kelly
- Scottish Association for Marine Sciences, Oban, Argyll, Scotland, United Kingdom
| | - Patrizia Di Gregorio
- S.S. Annunziata Hospital, School of Medicine, University G. D'Annunzio, Chieti, Italy
| | - Cosmo Rossi
- Department of Oncology and Neurosciences, University G. D'Annunzio Medical School and Foundation, Chieti, Italy
| | - Nicola Tinari
- Department of Oncology and Neurosciences, University G. D'Annunzio Medical School and Foundation, Chieti, Italy
| | - Stefano Iacobelli
- Department of Oncology and Neurosciences, University G. D'Annunzio Medical School and Foundation, Chieti, Italy
| | - Gabriel A. Rabinovich
- Laboratorio de Inmunopatología, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Nikolay E. Nifantiev
- Laboratory of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russian Federation
| | | |
Collapse
|
9
|
Abstract
Platelet-leukocyte interactions define a basic cell process that is characterized by the exchange of signals between platelets and different types of leukocytes and that bridges 2 fundamental pathophysiological events: atherothrombosis and inflammatory immune reactions. When this process takes place at the site of atherosclerotic plaque development or at the site of endothelial injury, platelet-dependent leukocyte recruitment and activation contributes to the inflammatory reaction of the vessel wall, which accounts for the exacerbation of atherosclerosis and for intimal hyperplasia and plaque instability. Moreover, platelet-leukocyte interactions may have a key role in modulating a wide array of responses of both the innate and adaptive immune systems, thus contributing to the pathogenesis of inflammatory diseases and tissue damage, as well as to host defense.
Collapse
Affiliation(s)
- Licia Totani
- Laboratory of Vascular Biology and Pharmacology, Consorzio Mario Negri Sud, Via Nazionale 8/A, 66030 Santa Maria Imbaro, Italy
| | | |
Collapse
|
10
|
Di Francesco L, Totani L, Dovizio M, Piccoli A, Di Francesco A, Salvatore T, Pandolfi A, Evangelista V, Dercho RA, Seta F, Patrignani P. Induction of Prostacyclin by Steady Laminar Shear Stress Suppresses Tumor Necrosis Factor-α Biosynthesis via Heme Oxygenase-1 in Human Endothelial Cells. Circ Res 2009; 104:506-13. [DOI: 10.1161/circresaha.108.191114] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [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: 02/02/2023]
Abstract
Cyclooxygenase (COX)-2 is among the endothelial genes upregulated by uniform laminar shear stress (LSS), characteristically associated with atherosclerotic lesion-protected areas. We have addressed whether the induction of COX-2–dependent prostanoids in endothelial cells by LSS plays a role in restraining endothelial tumor necrosis factor (TNF)-α generation, a proatherogenic cytokine, through the induction of heme oxygenase-1 (HO)-1, an antioxidant enzyme. In human umbilical vein endothelial cells (HUVECs) exposed to steady LSS of 10 dyn/cm
2
for 6 hours, COX-2 protein was significantly induced, whereas COX-1 and the downstream synthases were not significantly modulated. This was associated with significant (
P
<0.05) increase of 6-keto-prostaglandin (PG)F
1α
(the hydrolysis product of prostacyclin), PGE
2
, and PGD
2
. In contrast, TNF-α released in the medium in 6 hours (3633±882 pg) or detected in cells lysates (1091±270 pg) was significantly (
P
<0.05) reduced versus static condition (9100±2158 and 2208±300 pg, respectively). Coincident induction of HO-1 was detected. The finding that LSS-dependent reduction of TNF-α generation and HO-1 induction were abrogated by the selective inhibitor of COX-2 NS-398, the nonselective COX inhibitor aspirin, or the specific prostacyclin receptor (IP) antagonist RO3244794 illuminates the central role played by LSS-induced COX-2–dependent prostacyclin in restraining endothelial inflammation. Carbacyclin, an agonist of IP, induced HO-1. Similarly to inhibition of prostacyclin biosynthesis or activity, the novel imidazole-based HO-1 inhibitor QC15 reversed TNF-α reduction by LSS. These findings suggest that inhibition of COX-2–dependent prostacyclin might contribute to acceleration of atherogenesis in patients taking traditional nonsteroidal antiinflammatory drugs (NSAIDs) and NSAIDs selective for COX-2 through downregulation of HO-1, which halts TNF-α generation in human endothelial cells.
Collapse
Affiliation(s)
- Luigia Di Francesco
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Licia Totani
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Melania Dovizio
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Antonio Piccoli
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Andrea Di Francesco
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Tania Salvatore
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Assunta Pandolfi
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Virgilio Evangelista
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Ryan A. Dercho
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Francesca Seta
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| | - Paola Patrignani
- From the Department of Medicine and Aging (L.D.F., M.D., A.D.F., T.S., P.P.), “G. d’Annunzio” University, Chieti, Italy; CeSI (L.D.F., M.D., A.D.F., T.S., A. Pandolfi, P.P.), Chieti, Italy; Mario Negri Sud (L.T., A. Piccoli, V.E.), Santa Maria Imbaro, Chieti, Italy; and Departments of Pharmacology and Toxicology (R.A.D.) and Physiology and Biochemistry (F.S.), Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
11
|
Evangelista V, de Berardis G, Totani L, Avanzini F, Giorda CB, Brero L, Levantesi G, Marelli G, Pupillo M, Iacuitti G, Pozzoli G, di Summa P, Nada E, de Simone G, Dell'Elba G, Amore C, Manarini S, Pecce R, Maione A, Tognoni G, Nicolucci A. Persistent platelet activation in patients with type 2 diabetes treated with low doses of aspirin. J Thromb Haemost 2007; 5:2197-203. [PMID: 17697141 DOI: 10.1111/j.1538-7836.2007.02728.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The percentage of diabetic patients who do not benefit from the protective effect of aspirin is larger than in other populations at cardiovascular risk. OBJECTIVE We compared the ability of aspirin to suppress TxA2 and platelet activation in vivo, in type-2 diabetics vs. high-risk non-diabetic patients. METHODS Urinary 11-dehydro-TXB2, plasma sCD40 L, and sP-selectin were measured, together with indices of low-grade inflammation, glycemic control, and lipid profile, in 82 patients with type-2 diabetes and 39 without diabetes, treated with low doses of aspirin. RESULTS Urinary 11-dehydro-TxB2, plasma sCD40L and sP-selectin were significantly higher in diabetics than in controls: [38.9 (27.8-63.3) vs. 28.5 (22.5-43.9) ng mmol(-1) of creatinine, P = 0.02], [1.06 (0.42-3.06) vs. 0.35 (0.22-0.95) ng mL(-1); P = 0.0001], [37.0 (16.8-85.6) vs. 20.0 (11.2-35.6) ng mL(-1), P = 0.0001], respectively. The proportion of individuals with diabetes increased across quartiles of 11-dehydro-TxB2, sCD40L, and sP-selectin, with the highest quartiles of 11-dehydro-TxB2, sCD40L and sP-selectin, including 66%, 93.3%, and 93.3% of individuals with diabetes. Markers of platelet activation positively correlated with indices of glycemic control but not with markers of low-grade inflammation. CONCLUSIONS Platelet dysfunction associated with insufficient glycemic control, may mediate persistent platelet activation under aspirin treatment.
Collapse
Affiliation(s)
- V Evangelista
- Department of Translational Pharmacology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Cumashi A, Ushakova NA, Preobrazhenskaya ME, D'Incecco A, Piccoli A, Totani L, Tinari N, Morozevich GE, Berman AE, Bilan MI, Usov AI, Ustyuzhanina NE, Grachev AA, Sanderson CJ, Kelly M, Rabinovich GA, Iacobelli S, Nifantiev NE. A comparative study of the anti-inflammatory, anticoagulant, antiangiogenic, and antiadhesive activities of nine different fucoidans from brown seaweeds. Glycobiology 2007; 17:541-52. [PMID: 17296677 DOI: 10.1093/glycob/cwm014] [Citation(s) in RCA: 628] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The anti-inflammatory, antiangiogenic, anticoagulant, and antiadhesive properties of fucoidans obtained from nine species of brown algae were studied in order to examine the influence of fucoidan origin and composition on their biological activities. All fucoidans inhibited leucocyte recruitment in an inflammation model in rats, and neither the content of fucose and sulfate nor other structural features of their polysaccharide backbones significantly affected the efficacy of fucoidans in this model. In vitro evaluation of P-selectin-mediated neutrophil adhesion to platelets under flow conditions revealed that only polysaccharides from Laminaria saccharina, L. digitata, Fucus evanescens, F. serratus, F. distichus, F. spiralis, and Ascophyllum nodosum could serve as P-selectin inhibitors. All fucoidans, except that from Cladosiphon okamuranus carrying substantial levels of 2-O-alpha-D-glucuronopyranosyl branches in the linear (1-->3)-linked poly-alpha-fucopyranoside chain, exhibited anticoagulant activity as measured by activated partial thromboplastin time whereas only fucoidans from L. saccharina, L. digitata, F. serratus, F. distichus, and F. evanescens displayed strong antithrombin activity in a platelet aggregation test. The last fucoidans potently inhibited human umbilical vein endothelial cell (HUVEC) tubulogenesis in vitro and this property correlated with decreased levels of plasminogen-activator inhibitor-1 in HUVEC supernatants, suggesting a possible mechanism of fucoidan-induced inhibition of tubulogenesis. Finally, fucoidans from L. saccharina, L. digitata, F. serratus, F. distichus, and F. vesiculosus strongly blocked MDA-MB-231 breast carcinoma cell adhesion to platelets, an effect which might have critical implications in tumor metastasis. The data presented herein provide a new rationale for the development of potential drugs for thrombosis, inflammation, and tumor progression.
Collapse
Affiliation(s)
- Albana Cumashi
- Department of Oncology and Neurosciences, University G. D'Annunzio Medical School & Foundation, 66013 Chieti, Italy, and Division of Immunogenetics, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Evangelista V, Pamuklar Z, Piccoli A, Manarini S, Dell'elba G, Pecce R, Martelli N, Federico L, Rojas M, Berton G, Lowell CA, Totani L, Smyth SS. Src family kinases mediate neutrophil adhesion to adherent platelets. Blood 2006; 109:2461-9. [PMID: 17095622 PMCID: PMC1852189 DOI: 10.1182/blood-2006-06-029082] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [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] [Indexed: 11/20/2022] Open
Abstract
Polymorphonuclear leukocyte (PMN)-platelet interactions at sites of vascular damage contribute to local and systemic inflammation. We sought to determine the role of "outside-in" signaling by Src-family tyrosine kinases (SFKs) in the regulation of alphaMbeta2-integrin-dependent PMN recruitment by activated platelets under (patho)physiologic conditions. Activation-dependent epitopes in beta2 integrin were exposed at the contact sites between PMNs and platelets and were abolished by SFK inhibitors. PMNs from alphaMbeta2(-/-), hck(-/-)fgr(-/-), and hck(-/-)fgr(-/-)lyn(-/-) mice had an impaired capacity to adhere with activated platelets in suspension. Phosphorylation of Pyk2 accompanied PMN adhesion to platelets and was blocked by inhibition as well as by genetic deletion of alphaMbeta2 integrin and SFKs. A Pyk2 inhibitor reduced platelet-PMN adhesion, indicating that Pyk2 may be a downstream effector of SFKs. Analysis of PMN-platelet interactions under flow revealed that SFK signaling was required for alphaMbeta2-mediated shear-resistant adhesion of PMNs to adherent platelets, but was dispensable for P-selectin-PSGL-1-mediated recruitment and rolling. Finally, SFK activity was required to support PMN accumulation along adherent platelets at the site of vascular injury, in vivo. These results definitely establish a role for SFKs in PMN recruitment by activated platelets and suggest novel targets to disrupt the pathophysiologic consequences of platelet-leukocyte interactions in vascular disease.
Collapse
Affiliation(s)
- Virgilio Evangelista
- Laboratory of Vascular Biology and Pharmacology, Consorzio Mario Negri Sud, Via Nazionale 8/A, 66030 Santa Maria Imbaro, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Totani L, Piccoli A, Manarini S, Federico L, Pecce R, Martelli N, Cerletti C, Piccardoni P, Lowell CA, Smyth SS, Berton G, Evangelista V. Src-family kinases mediate an outside-in signal necessary for beta2 integrins to achieve full activation and sustain firm adhesion of polymorphonuclear leucocytes tethered on E-selectin. Biochem J 2006; 396:89-98. [PMID: 16433632 PMCID: PMC1449987 DOI: 10.1042/bj20051924] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [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] [Indexed: 11/17/2022]
Abstract
In cell suspensions subjected to high-shear rotatory motion, human PMN (polymorphonuclear cells) adhered to E-selectin-expressing CHO (Chinese-hamster ovary) cells (CHO-E), and formed homotypic aggregates when challenged by E-selectin-IgG fusion protein, by a mechanism that involved beta2 integrins. Both heterotypic and homotypic PMN adhesion was accompanied by tyrosine phosphorylation of a 110 kDa protein (P110). This event was prevented by blocking anti-(beta2 integrin) antibodies and by inhibitors of Src-family kinases, suggesting that it was part of an 'outside-in' signalling that was initiated by integrin engagement. Interestingly, Src-family kinase inhibitors prevented beta2-integrin-mediated (i) homotypic PMN adhesion triggered by E-selectin-IgG, (ii) heterotypic CHO-E/PMN adhesion in mixed-cell suspensions, and (iii) firm adhesion of PMN to CHO-E monolayers under physiological flow. Similarly to PMN treated with Src-family kinase inhibitors, PMN from hck-/-fgr-/- and hck-/-fgr-/-lyn-/- mice showed significant impairment of beta2-integrin-mediated adhesion to CHO-E. Moreover, the expression of beta2 integrin activation epitopes at the sites of cell-cell contact in CHO-E/PMN conjugates was abolished by Src-family kinase inhibitors. One component of P110 was identified as the FAK (focal adhesion kinase) Pyk2 (proline-rich tyrosine kinase 2), which was phosphorylated in a beta2 integrin- and Src-family-kinase-dependent manner. Thus, Src-family kinases, and perhaps Pyk2, mediate a signal necessary for beta2 integrin function in PMN tethered by E-selectin.
Collapse
Affiliation(s)
- Licia Totani
- Laboratory of Vascular Biology and Pharmacology, Consorzio Mario Negri Sud, 66030 Santa Maria Imbaro, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Evangelista V, Totani L, Rotondo S, Lorenzet R, Tognoni G, De Berardis G, Nicolucci A. Prevention of cardiovascular disease in type-2 diabetes: how to improve the clinical efficacy of aspirin. Thromb Haemost 2005; 93:8-16. [PMID: 15630484 DOI: 10.1160/th04-07-0453] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Atherosclerotic cardiovascular disease and its thrombotic complications are the principal causes of morbidity and mortality in patients with type-2 diabetes. Aspirin reduces the risk of thrombotic events in a broad range of patients with vascular disease and, in selected individuals, is beneficial for primary prevention. Although recommended by existing guidelines, in secondary and in primary prevention trials the clinical efficacy of low-dose aspirin in patients with diabetes appears to be substantially lower than in individuals without diabetes. In this review, we discuss possible mechanisms that may contribute to reduce the antithrombotic activity of aspirin in diabetes. We also discuss adjuvant therapies used in diabetic patients that may potentially improve the antithrombotic efficacy of aspirin.
Collapse
Affiliation(s)
- Virgilio Evangelista
- Laboratory of Vascular Biology and Pharmacology, Consorzio Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro, Chieti, Italy.
| | | | | | | | | | | | | |
Collapse
|
16
|
Piccardoni P, Manarini S, Federico L, Bagoly Z, Pecce R, Martelli N, Piccoli A, Totani L, Cerletti C, Evangelista V. SRC-dependent outside-in signalling is a key step in the process of autoregulation of beta2 integrins in polymorphonuclear cells. Biochem J 2004; 380:57-65. [PMID: 14969582 PMCID: PMC1224154 DOI: 10.1042/bj20040151] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Accepted: 02/18/2004] [Indexed: 01/04/2023]
Abstract
In human PMN (polymorphonuclear cells), challenged by P-selectin, the beta2-integrin Mac-1 (macrophage antigen-1) promoted the activation of the SRC (cellular homologue of Rous sarcoma virus oncogenic protein) family members HCK (haematopoietic cell kinase) and LYN (an SRC family protein tyrosine kinase) and phosphorylation of a P-110 (110 kDa protein). SRC kinase activity in turn was necessary for macrophage antigen-1-mediated adhesion [Piccardoni, Sideri, Manarini, Piccoli, Martelli, de Gaetano, Cerletti and Evangelista (2001) Blood 98, 108-116]. This suggested that an SRC-dependent outside-in signalling strengthens the beta2-integrin interaction with the ligand. To support this hypothesis further, in the present study, we used the monoclonal antibody KIM127 or manganese to lock beta2 integrins in a high-affinity state, and homotypic PMN adhesion was analysed to monitor beta2-integrin adhesive function. KIM127 or manganese induced PMN homotypic adhesion and P-110 phosphorylation. Both these processes were abolished by blocking antibodies against the common beta2 chain, by a combination of antibodies against alphaL and alphaM or by inhibitors of SRC activity. Confocal microscopy showed that activation epitopes were expressed by beta2 integrins co-localized with patches of F-actin at the adhesion sites. Blockade of SRC kinases or of actin polymerization prevented clustering of activated integrins as well as F-actin accumulation. FACS analysis showed that SRC inhibitors modified neither basal nor manganese-induced KIM127 binding. An SRC-dependent outside-in signalling initiated by beta2 integrins was also required for adhesion triggered by interleukin-8. These results confirm the hypothesis that an SRC-dependent outside-in signalling triggered by high affinity and ligand binding is necessary to stabilize beta2-integrin-mediated adhesion. Allowing clustering of activated integrins, SRC might link the high-affinity with the high-avidity state. Proline-rich tyrosine kinase-2 appears to be involved in this process.
Collapse
Affiliation(s)
- Paola Piccardoni
- Laboratory of Vascular Biology and Pharmacology, Consorzio Mario Negri Sud, Via Nazionale 1, 66030, Santa Maria Imbaro, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Evangelista V, Manarini S, Sideri R, Rotondo S, Martelli N, Piccoli A, Totani L, Piccardoni P, Vestweber D, de Gaetano G, Cerletti C. Platelet/polymorphonuclear leukocyte interaction: P-selectin triggers protein-tyrosine phosphorylation-dependent CD11b/CD18 adhesion: role of PSGL-1 as a signaling molecule. Blood 1999; 93:876-85. [PMID: 9920836] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Polymorphonuclear leukocyte (PMN) adhesion to activated platelets is important for the recruitment of PMN at sites of vascular damage and thrombus formation. We have recently shown that binding of activated platelets to PMN in mixed cell suspensions under shear involves P-selectin and the activated beta2-integrin CD11b/CD18. Integrin activation required signaling mechanisms that were sensitive to tyrosine kinase inhibitors.1 Here we show that mixing activated, paraformaldehyde (PFA)-fixed platelets with PMNs under shear conditions leads to rapid and fully reversible tyrosine phosphorylation of a prominent protein of 110 kD (P approximately 110). Phosphorylation was both Ca2+ and Mg2+ dependent and was blocked by antibodies against P-selectin or CD11b/CD18, suggesting that both adhesion molecules need to engage with their respective ligands to trigger phosphorylation of P approximately 110. The inhibition of P approximately 110 phosphorylation by tyrosine kinase inhibitors correlates with the inhibition of platelet/PMN aggregation. Similar effects were observed when platelets were substituted by P-selectin-transfected Chinese hamster ovary (CHO-P) cells or when PMN were stimulated with P-selectin-IgG fusion protein. CHO-P/PMN mixed-cell aggregation and P-selectin-IgG-triggered PMN/PMN aggregation as well as P approximately 110 phosphorylation were all blocked by antibodies against P-selectin or CD18. In each case PMN adhesion was sensitive to the tyrosine kinase inhibitor genistein. The antibody PL-1 against P-selectin glycoprotein ligand-1 (PSGL-1) blocked platelet/PMN aggregation, indicating that PSGL-1 was the major tethering ligand for P-selectin in this experimental system. Moreover, engagement of PSGL-1 with a nonadhesion blocking antibody triggered beta2-integrin-dependent genistein-sensitive aggregation as well as tyrosine phosphorylation in PMN. This study shows that binding of P-selectin to PSGL-1 triggers tyrosine kinase-dependent mechanisms that lead to CD11b/CD18 activation in PMN. The availability of the beta2-integrin to engage with its ligands on the neighboring cells is necessary for the tyrosine phosphorylation of P approximately 110.
Collapse
Affiliation(s)
- V Evangelista
- Istituto di Ricerche Farmacologiche Mario Negri, Unit of Biology of Cell Interactions, "Giulio Bizzozero" Laboratory of Platelet and Leucocyte Pharmacology, Maria Imbaro, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Totani L, Cumashi A, Piccoli A, Lorenzet R. Polymorphonuclear leukocytes induce PDGF release from IL-1beta-treated endothelial cells: role of adhesion molecules and serine proteases. Arterioscler Thromb Vasc Biol 1998; 18:1534-40. [PMID: 9763523 DOI: 10.1161/01.atv.18.10.1534] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Polymorphonuclear leukocytes (PMNs) and endothelial cells interact at sites of vascular injury during inflammatory response and during the development of atherosclerotic lesions. Such close proximity leads to the modulation of several of the biological functions of the 2 cell types. Because we have shown previously that PMNs enhance release of growth factors from resting endothelial cells, we decided to evaluate whether coincubation of PMNs with interleukin-1beta (IL-1beta)-stimulated human umbilical vein endothelial cells (HUVEC) could further modulate mitogen release from HUVEC. We found that PMN-HUVEC coincubation resulted in a 10-fold increase in mitogen release, compared with HUVEC alone (14+/-6 versus 1.3+/-0.1). When PMNs were incubated with IL-1beta-treated HUVEC, a further increase in mitogen release (up to 35-fold) was observed. The mitogenic activity was immunologically related to platelet-derived growth factor (PDGF) because the activity was abolished by an anti-PDGF antibody. PDGF-AB antigen, detected in low concentrations in conditioned medium from HUVEC alone, was increased 4-fold when IL-1beta or PMNs were incubated with HUVEC and dramatically upregulated (up to 40-fold) when PMNs were cocultured with IL-1beta-treated HUVEC. The presence of the protease inhibitor eglin C abolished mitogenic activity generation, suggesting a role for PMN-derived elastase and cathepsin G. Indeed, purified elastase and cathepsin G mimicked PMN-induced mitogen release from HUVEC. Because PMNs firmly adhered to IL-1beta-treated HUVEC, we investigated the role of cell-cell adhesion in mitogen release. Adhesion and PDGF release were inhibited by approximately 60% in the presence of anti-CD11a/CD18 and anti-intercellular adhesion molecule-1 monoclonal antibodies. This study suggests a new role for PMNs and their interaction with endothelium in pathological conditions in which intimal hyperplasia is a common feature.
Collapse
Affiliation(s)
- L Totani
- "Antonio Taticchi" Unit for Atherosclerosis and Thrombosis, Department of Vascular Medicine and Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
| | | | | | | |
Collapse
|
19
|
Totani L, Piccoli A, Pellegrini G, Di Santo A, Lorenzet R. Polymorphonuclear leukocytes enhance release of growth factors by cultured endothelial cells. Arterioscler Thromb 1994; 14:125-32. [PMID: 8274467 DOI: 10.1161/01.atv.14.1.125] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Porcine aortic endothelial cells (PAECs) in culture constitutively secrete polypeptide (endothelium-derived) growth factors (EDGFs) into the surrounding medium. Incubation of PAECs with human peripheral blood polymorphonuclear leukocytes (PMNs) caused a significant increase in EDGF release as assessed by [3H]thymidine incorporation into BALB/c 3T3 mouse fibroblasts and cell proliferation assay. The effect was time dependent and correlated with the number of PMNs, reaching a maximum with a 1:1 PAEC to PMN ratio. Generation of mitogenic activity was prevented by cycloheximide, indicating a requirement for de novo protein synthesis. Antibody-mediated inhibition assays suggested that mitogenic activity was due to platelet-derived growth factor and basic fibroblast growth factor. When supernatant from N-formyl-methionyl-leucyl-phenylalanine-stimulated PMNs was substituted for PMNs during incubation with PAECs, powerful mitogenic activity was generated, indicating the involvement of soluble mediators. A role for free oxygen radicals was ruled out by experiments in which superoxide dismutase and catalase did not prevent the increase in mitogenic activity. By contrast, serine protease inhibitors such as soybean trypsin inhibitor, alpha 1-antitrypsin, and eglin C reduced the PMN-stimulating activity by 70%, 80%, and 100%, respectively. The possible involvement of cathepsin G and elastase was investigated. Cathepsin G and elastase, when substituted for PMNs, increased the release of EDGFs in a dose-dependent fashion, mimicking the effect of PMNs. These findings suggest a new role for leukocyte-vessel wall interactions in the proliferative feature of atherosclerosis.
Collapse
Affiliation(s)
- L Totani
- Antonio Taticchi Unit for Atheroselerosis and Thrombosis Research, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
| | | | | | | | | |
Collapse
|
20
|
Pellegrini G, Totani L, Di Santo A, Piccoli A, Tacconi MT, Donati MB, Lorenzet R. Supplementation-induced changes in polyunsaturated fatty acid membrane and plasma composition do not modify mononuclear cell procoagulant activity. Thromb Res 1993; 71:95-101. [PMID: 8367839 DOI: 10.1016/0049-3848(93)90209-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- G Pellegrini
- Istituto di Ricerche Farmacologiche Mario Negri, Antonio Taticchi Unit for Atherosclerosis and Thrombosis Research, Consorzio Mario Negri Sud, Italy
| | | | | | | | | | | | | |
Collapse
|
21
|
Totani L, Donati MB. The Italian National Research Council project on homocystinuria. Haemostasis 1989; 19 Suppl 1:45-7. [PMID: 2807045 DOI: 10.1159/000216095] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The Italian National Research Council (CNR) has launched a special project aiming at gathering competences on rare diseases, their pathogenesis and their possible pharmacological management. The subproject on homocystinuria has three main objectives: to establish the prevalence and incidence of the disease in the Italian population, to develop sensitive assays of sulfated amino acids which allow discrimination of heterozygotes from normal subjects and to better define the complex interactions between homocystinuria and vascular complications.
Collapse
Affiliation(s)
- L Totani
- Istituto di Ricerche Farmacologiche Mario Negri, S. Maria Imbaro, Italia
| | | |
Collapse
|