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De Michieli L, Knott J, Attia Z, Ola O, Akula A, Mehta R, Dworak M, Lobo R, Hodge D, Tak T, Cagin C, Friedman P, Gulati R, Jaffe A, Sandoval Y. Artificial intelligence-enabled electrocardiographic algorithm for the detection of left ventricular dysfunction in emergency department patients undergoing high-sensitivity cardiac troponin T. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Artificial intelligence-augmented electrocardiogram (AI-ECG) algorithms have been developed from the standard 12-lead ECG and validated for the recognition of left ventricular systolic dysfunction (LVSD), defined as LV ejection fraction (LVEF)≤35%. Whether AI-ECG facilitates identification of LVSD and is associated with adverse outcomes in emergency department (ED) patients undergoing high-sensitivity cardiac troponin (hs-cTnT) testing is uncertain.
Purpose
To investigate the diagnostic and prognostic performance of AI-ECG in ED patients undergoing hs-cTnT measurement.
Methods
Observational US cohort study of ED patients undergoing hs-cTnT measurement. Cases with hs-cTnT increases >sex-specific 99th percentiles were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Post-discharge major adverse cardiac events (MACE) included death, MI, heart failure (HF) hospitalization, stroke or transient ischemic attack, and new onset atrial fibrillation/flutter during 2-years follow-up. The AI-ECG network output, which is a continuous number between 0–1, that provides a probability of LVSD, was obtained for each patient from the first ECG during the index presentation. An AI-ECG threshold of ≥0.256 indicates a positive screen that correlates with a high probability of LVSD.
Results
Among 1977 patients, 1729 (87%) had a negative AI-ECG screen, while 248 (13%) had a positive AI-ECG screen. Patients with a positive AI-ECG screen were older and had more comorbidities. As compared to patients with hs-cTnT≤99th percentile in whom AI-ECG was positive in 5.8%, those with hs-cTnT>99th percentile had a positive AI-ECG in 22% of cases (p<0.0001). Based on adjudicated diagnoses, the frequency of a positive AI-ECG was 20% in myocardial injury, 38% in type 1 MI, and 20% in type 2 MI. At 2-years follow-up, as compared to patients with a negative AI-ECG, those with a positive AI-ECG had a higher risk for MACE (48% vs. 21%, p<0.0001, adjusted HR 1.39, 95% CI 1.11–1.75) (Figure 1), mainly because of more deaths (43% vs. 30%, p=0.004) and HF hospitalizations (36% vs. 13%, p<0.0001). A positive AI-ECG was associated with a higher risk for MACE (60% vs. 41%, p<0.0001, adjusted HR 1.30, 95% CI 1.02–1.64) in those with hs-cTnT increases >99th percentile, but not in those without hs-cTnT increases. Among patients with an echocardiogram during index presentation or within 30-days (n=452), the diagnostic accuracy of AI-ECG for LVEF ≤35% was 81.4% (95% CI 77.5, 84.9) with a negative predictive value of 96.5% (95% CI 94.0, 98.2). A normal LVEF (>50%) was observed in 87% of those with a negative AI ECG, whereas in those with a positive AI-ECG LVEF was reduced (<50%) in 60%.
Conclusions
Among ED patients evaluated with hs-cTnT, a positive AI-ECG screen for LVSD identifies patients at high risk of MACE. These findings are largely because of more deaths and HF hospitalizations in those with hs-cTnT increases >sex-specific 99th percentiles.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Knott
- Mayo Clinic , Rochester , United States of America
| | - Z Attia
- Mayo Clinic , Rochester , United States of America
| | - O Ola
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - A Akula
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Mehta
- Mayo Clinic , Rochester , United States of America
| | - M Dworak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Lobo
- Mayo Clinic , Rochester , United States of America
| | - D Hodge
- Mayo Clinic , Jacksonville , United States of America
| | - T Tak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - C Cagin
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - P Friedman
- Mayo Clinic , Rochester , United States of America
| | - R Gulati
- Mayo Clinic , Rochester , United States of America
| | - A Jaffe
- Mayo Clinic , Rochester , United States of America
| | - Y Sandoval
- Mayo Clinic , Rochester , United States of America
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Tak T, Jaekel C, Gharacholou M, Dworak M, Marshall S, Novotany J. PO023 Cardiovascular Magnetic Resonance Imaging Compared To Echocardiography For Detecting Doxorubicin-Induced Cardiotoxicity. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.061] [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: 11/29/2022] Open
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Wachter R, Balas B, Klebs S, Kap E, Engelhard J, Fonseca AF, Schlienger R, Dworak M, Bruce Wirta S. P907Titration patterns and clinical characteristics of patients prescribed sacubitril/valsartan in the primary care and cardiology settings in Germany. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Wachter
- Universitätsklinikum Leipzig, Leipzig, Germany
| | - B Balas
- Novartis Pharma AG, Basel, Switzerland
| | - S Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
| | - E Kap
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
| | - J Engelhard
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
| | | | | | - M Dworak
- Novartis Pharma GmbH, Nuremberg, Germany
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Klebs S, Balas B, Grunow S, Schindler M, Engelhard J, Proenca C, Calado F, Schlienger R, Dworak M, Bruce Wirta S. P4395Characteristics of patients with heart failure prescribed sacubitril/valsartan in the primary care setting in Germany. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bruce Wirta S, Klebs S, Grunow S, Schindler M, Engelhard J, Proenca C, Calado F, Schlienger R, Dworak M, Balas B. P608Characteristics of patients with heart failure prescribed sacubitril/valsartan in the primary care and cardiology settings in Germany. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zeiser R, Robson SC, Vaikunthanathan T, Dworak M, Burnstock G. Unlocking the Potential of Purinergic Signaling in Transplantation. Am J Transplant 2016; 16:2781-2794. [PMID: 27005321 PMCID: PMC5472988 DOI: 10.1111/ajt.13801] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 01/21/2016] [Revised: 03/11/2016] [Accepted: 03/19/2016] [Indexed: 01/25/2023]
Abstract
Purinergic signaling has been recognized as playing an important role in inflammation, angiogenesis, malignancy, diabetes and neural transmission. Activation of signaling pathways downstream from purinergic receptors may also be implicated in transplantation and related vascular injury. Following transplantation, the proinflammatory "danger signal" adenosine triphosphate (ATP) is released from damaged cells and promotes proliferation and activation of a variety of immune cells. Targeting purinergic signaling pathways may promote immunosuppression and ameliorate inflammation. Under pathophysiological conditions, nucleotide-scavenging ectonucleotidases CD39 and CD73 hydrolyze ATP, ultimately, to the anti-inflammatory mediator adenosine. Adenosine suppresses proinflammatory cytokine production and is associated with improved graft survival and decreased severity of graft-versus-host disease. Furthermore, purinergic signaling is involved both directly and indirectly in the mechanism of action of several existing immunosuppressive drugs, such as calcineurin inhibitors and mammalian target of rapamycin inhibitors. Targeting of purinergic receptor pathways, particularly in the setting of combination therapies, could become a valuable immunosuppressive strategy in transplantation. This review focuses on the role of the purinergic signaling pathway in transplantation and immunosuppression and explores possible future applications in clinical practice.
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Affiliation(s)
- R. Zeiser
- Department of Hematology and Oncology, Freiburg University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
| | - S. C. Robson
- Department of Medicine, Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Corresponding authors: Markus Dworak and Simon C. Robson, and
| | - T. Vaikunthanathan
- Division of Transplantation Immunology & Mucosal Biology, MRC Centre for Transplantation, King’s College London, Great Maze Pond, London, UK
| | - M. Dworak
- Novartis Pharma, Nuernberg, Germany,Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany,Corresponding authors: Markus Dworak and Simon C. Robson, and
| | - G. Burnstock
- Autonomic Neuroscience Centre, University College Medical School, London, UK,Department of Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Australia
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Göke R, Gruenberger JB, Bader G, Dworak M. Real-life efficacy and safety of vildagliptin compared with sulfonylureas as add-on to metformin in patients with type 2 diabetes mellitus in Germany. Curr Med Res Opin 2014; 30:785-9. [PMID: 24328429 DOI: 10.1185/03007995.2013.875464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Metformin is an established first-line treatment for type 2 diabetes mellitus (T2DM) patients, but intensification of oral anti-diabetes therapy is usually required over time. A large observational study of 45,868 T2DM patients in 27 countries (EDGE) was conducted to compare the effectiveness and safety of vildagliptin as add-on therapy to another oral anti-diabetes drug (OAD) vs other dual OAD combinations. This report presents results from a post-hoc analysis of patients in Germany who received vildagliptin or a sulfonylurea (SU) in combination with metformin. RESEARCH DESIGN AND METHODS Patients inadequately controlled with monotherapy became eligible only after the add-on treatment was finalized. Patients included were assigned to receive either vildagliptin or another OAD (SUs, thiazolidinediones, glinides, α-glucosidase inhibitors, or metformin; DPP-4 inhibitors or glucagon-like peptide-1 [GLP-1] mimetics/analogs were excluded). The primary end-point was the proportion of patients achieving a reduction in HbA1c >0.3% without peripheral edema, hypoglycemia, discontinuation due to gastrointestinal event, or weight gain ≥5%. RESULTS Of 8887 patients enrolled in Germany, 6439 received vildagliptin and 971 received SUs as add-on to metformin. The primary end-point was reached in 34.9% and 29.6% of patients in the vildagliptin and SU groups, respectively, with an unadjusted odds ratio of 1.27 (95% CI = 1.09, 1.47; p = 0.001). HbA1c decreased in both cohorts from baseline (-0.7% with vildagliptin vs -0.5% with SUs), with a mean between-group difference of -0.2% (95% CI = -0.22, -0.09). The number of hypoglycemic events was 4-fold higher in the SU group than in the vildagliptin group (vildagliptin = 0.11%; SU = 0.41%). CONCLUSIONS In a real-life setting, vildagliptin was associated with a numerically greater reduction in HbA1c, less hypoglycemia, and more patients reaching target HbA1c without hypoglycemia or weight gain compared with SUs. Open-label design and under reporting of adverse events are limitations of this post hoc analysis.
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Affiliation(s)
- R Göke
- University of Marburg , Marburg , Germany
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Forst T, Dworak M, Berndt-Zipfel C, Löffler A, Klamp I, Mitry M, Pfützner A. Effect of vildagliptin compared to glimepiride on postprandial proinsulin processing in the β cell of patients with type 2 diabetes mellitus. Diabetes Obes Metab 2013; 15:576-9. [PMID: 23384119 DOI: 10.1111/dom.12063] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/21/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Abstract
This study compared the effect of Glimepiride versus Vildagliptin on β-cell function and the release of intact proinsulin (PI) in patients with type 2 diabetes mellitus. Patients on metformin monotherapy were randomized to add on treatment with Vildagliptin or Glimepiride. A standardized test meal was given at baseline, after 12 and 24 weeks of treatment. Insulin, PI and blood glucose values were measured in the fasting state and postprandial for 300 min. Fasting PI levels significantly decreased in the Vildagliptin group. The area under the curve for the postprandial release of PI decreased during Vildagliptin and increased during Glimepiride treatment. The proinsulin to insulin ratio declined in the Vildagliptin group, whereas it did not change significantly in the Glimepiride group. Addition of Vildagliptin to ongoing Metformin treatment reconstitutes the disproportionality of the proinsulin to insulin secretion from the β cell.
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Affiliation(s)
- T Forst
- Medical Department, Institute for Clinical Research and Development, Mainz, Germany.
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Forst T, Michelson G, Dworak M, Berndt-Zipfel C, Löffler A, Mitry M, Pfützner A. Effekt von Vildagliptin im Vergleich zu Glimeprid auf die Erythtrozytenverformbarkeit und die Mikroperfusion der Retina bei Patienten mit einem Diabetes mellitus Typ 2. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341907] [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: 10/26/2022]
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10
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Rathmann W, Kostev K, Gruenberger JB, Dworak M, Bader G, Giani G. Treatment persistence, hypoglycaemia and clinical outcomes in type 2 diabetes patients with dipeptidyl peptidase-4 inhibitors and sulphonylureas: a primary care database analysis. Diabetes Obes Metab 2013; 15:55-61. [PMID: 22862879 DOI: 10.1111/j.1463-1326.2012.01674.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/10/2012] [Accepted: 07/31/2012] [Indexed: 11/30/2022]
Abstract
AIMS To investigate therapy persistence, frequency of hypoglycaemia and macrovascular outcomes among type 2 diabetes patients with dipeptidyl peptidase-4 (DPP-4) inhibitors (DPP-4) and sulphonylureas (SU). METHODS Data from 19,184 DPP-4 (mean age: 64 years; 56% males) and 31,110 SU users (69 years; 51%) with new prescriptions (index date), without additional antidiabetics except metformin, in 1201 general practises in Germany were analysed. Therapy discontinuation (prescription gap >90 days), hypoglycaemia [International Classification of Diseases (ICD-10)] and macrovascular outcomes (ICD-10) (2-year follow-up) were compared adjusting for age, sex, diabetes duration, metformin, previous hypoglycaemia, health insurance, hypertension, hyperlipidaemia, antihypertensives, lipid-lowering and antithrombotic drugs, microvascular complications and Charlson co-morbidity score using logistic or Cox regression models. RESULTS Two years after index date, DDP-4 (non-persistence: 39%) were associated with a lower risk of discontinuation compared to SU (49%) [adjusted hazard ratio (HR): 0.74; 95% confidence interval (CI): 0.71-0.76]. Hypoglycaemias (≥1) were documented in 0.18% patients with DPP-4 and in 1.00% with SU [odds ratio (OR): 0.21; 95%CI: 0.08-0.57]. Hypoglycaemias were significantly associated with incident macrovascular complications (HR: 1.6; 95% CI: 1.1-2.2). Risk of macrovascular events was 26% lower in DPP-4 than in SU users. CONCLUSIONS Lack of persistence with antidiabetic therapy is frequently found in primary care patients. DPP-4 was associated with lower therapy discontinuation and a fivefold reduced frequency of patients with hypoglycaemia compared to SU. The low absolute numbers of hypoglycaemias are most likely due to the fact that only severe events were documented. DPP-4 treatment was associated with reduced incidence of macrovascular events relative to SU in type 2 diabetes patients in primary care practises.
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Affiliation(s)
- W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Dusseldorf, Germany.
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Kostev K, Schröder-Bernhardi D, Grünberger JB, Bader G, Dworak M, Rathmann W, Giani G. Inzidenz kardiovaskulärer Ereignisse bei Typ-2-Diabetespatienten mit DDP-4-Inhibitoren und Sulfonylharnstoffen in primärärztlichen Praxen in Deutschland und UK: Retrospektive Datenbankanalyse. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314552] [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: 10/28/2022]
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Blüher M, Kurz I, Müller A, Dworak M. Tablettenlast bei Typ 2 Diabetikern - Ergebnisse der prospektiven nicht-interventionellen Studie PROVIL. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314611] [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: 10/28/2022]
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13
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Kostev K, Schröder-Bernhardi D, Grünberger JB, Bader G, Dworak M, Rathmann W, Giani G. Inzidenz von Hypoglykämien bei Typ-2-Diabetespatienten mit DDP-4-Inhibitoren und Sulfonylharnstoffen in primärärztlichen Praxen in Deutschland: Retrospektive Datenbankanalyse. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314502] [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: 10/28/2022]
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14
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Kostev K, Rex J, Schröder-Bernardi D, Grünberger JB, Bader G, Dworak M, Rathmann W, Giani G. Persistenz bei DDP-4-Inhibitoren und Sulfonylharnstoffen in primärärztlichen Praxen in Deutschland und Frankreich: Retrospektive Datenbankanalyse. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314561] [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: 10/28/2022]
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Dworak M, McCarley RW, Kim T, Basheer R. Delta oscillations induced by ketamine increase energy levels in sleep-wake related brain regions. Neuroscience 2011; 197:72-9. [PMID: 21958867 DOI: 10.1016/j.neuroscience.2011.09.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 08/24/2011] [Accepted: 09/13/2011] [Indexed: 11/26/2022]
Abstract
Neuronal signaling consumes much of the brain energy, mainly through the restoration of the membrane potential (MP) by ATP-consuming ionic pumps. We have reported that, compared with waking, ATP levels increase during the initial hours of natural slow-wave sleep, a time with prominent electroencephalogram (EEG) delta oscillations (0.5-4.5 Hz). We have hypothesized that there is a delta oscillation-ATP increase coupling, since, during delta waves, neurons exhibit a prolonged hyperpolarizing phase followed by a very brief phase of action potentials. However, direct proof of this hypothesis is lacking, and rapid changes in EEG/neuronal activity preclude measurement in the naturally sleeping brain. Thus, to induce a uniform state with pure delta oscillations and one previously shown to be accompanied by a similar pattern of neuronal activity during delta waves as natural sleep, we used ketamine-xylazine treatment in rats. We here report that, with this treatment, the high-energy molecules ATP and ADP increased in frontal and cingulate cortices, basal forebrain, and hippocampus compared with spontaneous waking. Moreover, the degree of ATP increase positively and significantly correlated with the degree of EEG delta activity. Supporting the hypothesis of decreased ATP consumption during delta activity, the ATP-consuming Na+-K+-ATPase mRNA levels were significantly decreased, whereas the mRNAs for the ATP-producing cytochrome c oxidase (COX) subunits COX III and COX IVa were unchanged. Taken together, these data support the hypothesis of a cortical delta oscillation-dependent reduction in ATP consumption, thus providing the brain with increased ATP availability, and likely occurring because of reduced Na+-K+-ATPase-related energy consumption.
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Affiliation(s)
- M Dworak
- Laboratory of Neuroscience, Department of Psychiatry, VA Boston Healthcare System and Harvard Medical School, West Roxbury, MA, USA
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Blüher M, Lenhardt P, Müller A, Pirkl F, Dworak M. Wirksamkeit und Sicherheit von Vildagliptin in Kombination mit Metformin im Vergleich mit anderen oral verabreichten Antidiabetika bei Typ 2 Diabetikern – eine prospektive nicht-interventionelle Studie. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1280954] [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: 10/17/2022]
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Dworak M, Kim T, McCarley RW, Basheer R. Sleep, brain energy levels, and food intake: Relationship between hypothalamic ATP concentrations, food intake, and body weight during sleep-wake and sleep deprivation in rats. Somnologie (Berl) 2011; 15:111-117. [PMID: 23585726 DOI: 10.1007/s11818-011-0524-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The feeling of hunger and feeding, a wake-state-dependent behavior, is regulated by specific centers within the hypothalamus. While paraventricular nucleus (PVN), arcuate nucleus (ARC), and dorso- and ventromedial hypothalamus (DMH/VMH) regulate feeding, the lateral hypothalamus (LH) is associated both with feeding and wake/REM sleep regulation. In order to examine the effects of sleep and wakefulness on food intake and body weight, we also measured hypothalamic ATP concentrations, which are known to be involved in feeding behavior and sleep-wake regulation. METHODS In rats, food intake and body weight was measured during a 24-h light-dark cycle and during 6 h of sleep deprivation (SD) performed by gentle handling. Tissue samples from the PVN, ARC/DMH/VMH, and LH were collected after 6 h of SD and from time-matched diurnal controls. ATP was measured by luciferin-luciferase bioluminescence assay. RESULTS Across the 24-h light-dark period, rats consumed approximately 28.13±4.48 g of food and gained 5.22±1.65 g with a positive correlation between food intake and body weight. During SD, while food intake increased significantly +147.31±6.13%, they lost weight significantly (-93.29±13.64%) when compared to undisturbed controls. SD resulted in a significant decrease in ATP levels only in LH (-44.60±21.13%) with no change in PVN, ARC/DMH/VMH region when compared with undisturbed controls. CONCLUSION The results indicate a strong overall correlation between ATP concentrations in the LH and individual food intake and suggest a sleep-wake dependent neuronal control of food intake and body weight.
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Affiliation(s)
- M Dworak
- Department of Psychiatry, Laboratory of Neuroscience, VA Boston Healthcare System & Harvard Medical School, West Roxbury
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Dworak M, Diel P, Voss S, Hollmann W, Strüder HK. Intense exercise increases adenosine concentrations in rat brain: implications for a homeostatic sleep drive. Neuroscience 2007; 150:789-95. [PMID: 18031936 DOI: 10.1016/j.neuroscience.2007.09.062] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2007] [Revised: 09/25/2007] [Accepted: 10/04/2007] [Indexed: 11/19/2022]
Abstract
Intense exercise and sleep deprivation affect the amount of homeostatically regulated slow wave sleep in the subsequent sleep period. Since brain energy metabolism plays a decisive role in the regulation of behavioral states, we determined the concentrations of nucleotides and nucleosides: phosphocreatine, creatine, ATP, ADP, AMP, adenosine, and inosine after moderate and exhaustive treadmill exercise as well as 3 and 5 h of sleep deprivation and sleep in the rat brain using the freeze-clamp technique. High intensity exercise resulted in a significant increase of the sleep-promoting substance adenosine. In contrast, following sleep, inosine and adenosine levels declined considerably, with an accompanied increase of ADP after 3 h and ATP after 5 h. Following 3 h and 5 h sleep deprivation, ADP and ATP did not differ significantly, whereas inosine increased during the 3 and 5-h period. The concentrations of AMP, creatine and phosphocreatine remained unchanged between experimental conditions. The present results are in agreement with findings from other authors and suggest that depletion of cerebral energy stores and accumulation of the sleep promoting substance adenosine after high intensity exercise may play a key role in homeostatic sleep regulation, and that sleep may play an essential role in replenishment of high-energy compounds.
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Affiliation(s)
- M Dworak
- Institute of Motor Control and Movement Technique, German Sport University Cologne, Carl-Diem-Weg 6, 50933 Cologne, Germany.
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Hufnagel B, Dworak M, Soufi M, Mester Z, Zhu Y, Schaefer JR, Klumpp S, Krieglstein J. Unsaturated fatty acids isolated from human lipoproteins activate protein phosphatase type 2Cβ and induce apoptosis in endothelial cells. Atherosclerosis 2005; 180:245-54. [PMID: 15910849 DOI: 10.1016/j.atherosclerosis.2004.12.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 11/23/2004] [Accepted: 12/03/2004] [Indexed: 10/25/2022]
Abstract
Activity of serine/threonine protein phosphatase type 2C is known to be stimulated by certain unsaturated fatty acids and this enzyme dephosphorylates Bad, thus acting on apoptosis. This prompted us to investigate endothelial cell death. Here, we present evidence for the presence of protein phosphatase type 2Cbeta (PP2Cbeta) in human umbilical vein endothelial cells (HUVECs) and report on colocalization of PP2Cbeta and Bad in the cytosol of endothelial cells. Lipophilic compounds that stimulated PP2Cbeta activity in vitro were found to induce cell death of HUVECs. Lipoproteins did neither influence PP2Cbeta activity nor affect cell behaviour. Lipoproteins treated with the lipoprotein lipase, however, stimulated the activity of PP2Cbeta at least 10-fold concomitantly triggering cell death. Analytical methods revealed that both effects - stimulation of PP2Cbeta and apoptosis - were caused by free fatty acids liberated from VLDL, LDL and HDL with oleic acid and linoleic acid as major constituents. The results provide novel insights in endothelial apoptosis and suggest that PP2Cbeta participates in the development and progress of atherosclerosis.
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Affiliation(s)
- B Hufnagel
- Department for Pharmacology and Toxicology, Philipps-University Marburg, Ketzerbach 63, D-35032 Marburg, Germany
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