1
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Durrer I, Ackermann D, Klossner R, Grössl M, Vögel C, Du Toit T, Vogt B, Jamin H, Mohaupt MG, Gennari-Moser C. No extra-adrenal aldosterone production in various human cell lines. J Mol Endocrinol 2024; 72:e230100. [PMID: 38175924 PMCID: PMC10895282 DOI: 10.1530/jme-23-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/04/2024] [Indexed: 01/06/2024]
Abstract
Extra-adrenal de novo aldosterone (Aldo) production has been described inconsistently. Systematic data based upon state-of-the-art technology including validated controls are sparse. We hypothesized that aldosterone synthase (CYP11B2) expression and de novo Aldo production are absent in nonadrenal human cell lines, either immortalized cell lines or commercially available primary cell lines, including peripheral blood mononuclear cells (PBMCs) of individuals without and with primary hyperaldosteronism (PA). CYP11B2-transfected COS-7 and endogenous CYP11B2 expressing adrenal H295R cells served as positive controls. Various well-characterized, purchased, immortalized (BeWo, HEK293, HTR-8/SVneo, JEG-3) and primary (HAEC, HLEC, HRGEC, HRMC, HUAEC, HUVEC, PBMC) cell lines as well as self-isolated PBMCs from PA patients (n = 5) were incubated with the steroid hormone substrates progesterone, deoxycorticosterone, corticosterone or 18-OH-corticosterone with and without Ang II for 24 h to assess CYP11B2 enzymatic activity. CYP11B2 expression was analyzed by real-time PCR and liquid chromatography-mass spectrometry was used to quantify Aldo production. Pronounced CYP11B2 mRNA expression and Aldo production were observed in both positive controls, which followed an incremental time course. Neither substrates alone nor coincubation with Ang II significantly stimulated CYP11B2 expression or Aldo production in various immortalized and primary cell lines and PBMCs of PA patients. These results strongly support the absence of relevant de novo extra-adrenal Aldo production in nonadrenal cells, including blood mononuclear cells, irrespective of the absence or presence of autonomous adrenal Aldo production.
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Affiliation(s)
- Isabelle Durrer
- Department of Nephrology and Hypertension University of Bern, Berne, Switzerland
| | - Daniel Ackermann
- Department of Nephrology and Hypertension University of Bern, Berne, Switzerland
| | - Rahel Klossner
- Department of Nephrology and Hypertension University of Bern, Berne, Switzerland
- Department of Internal Medicine, Sonnenhof, Lindenhofgruppe, Berne, Switzerland
| | - Michael Grössl
- Department of Nephrology and Hypertension University of Bern, Berne, Switzerland
| | - Clarissa Vögel
- Department of Nephrology and Hypertension University of Bern, Berne, Switzerland
| | - Therina Du Toit
- Department for BioMedical Research University of Bern, Berne, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension University of Bern, Berne, Switzerland
| | - Heidi Jamin
- Department of Nephrology and Hypertension University of Bern, Berne, Switzerland
- Department for BioMedical Research University of Bern, Berne, Switzerland
| | - Markus G Mohaupt
- Department of Internal Medicine, Sonnenhof, Lindenhofgruppe, Berne, Switzerland
- Department for BioMedical Research University of Bern, Berne, Switzerland
| | - Carine Gennari-Moser
- Department of Nephrology and Hypertension University of Bern, Berne, Switzerland
- Department for BioMedical Research University of Bern, Berne, Switzerland
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2
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Gasser B, Escher G, Calin AE, Deppeler M, Marchon M, Mistry HD, Kurz J, Mohaupt MG. Prior to versus after Metformin Treatment-Effects on Steroid Enzymatic Activities. Life (Basel) 2023; 13:life13051094. [PMID: 37240739 DOI: 10.3390/life13051094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Background: We recently reported that metformin administration has substantial effects on steroid hormone concentrations. In this study, we specifically explored which enzymatic activities were affected before a first treatment versus after a time of metformin treatment. Material and Methods: Twelve male subjects (54.2 ± 9.1 years, 177.3 ± 4.1 cm, 80 ± 10.4 kg) and seven female subjects (57.2 ± 18.9 years, 162.7 ± 4.1 cm, 76.1 ± 10.4 kg) were recruited based on an indication of metformin. Prior to the first intake of metformin and after 24 h, urine collections were performed. Urine steroid analysis was completed using gas chromatography-mass spectrometry. Results: The average reduction in steroid hormone concentrations after the metformin treatment was substantial and relatively equally distributed in all metabolites and the sum of all metabolites with 35.4%. An exception was dehydroepiandrosterone, with a decrease of almost three hundred percent of average concentration. In addition, the sum of all cortisol metabolites and 18-OH cortisol (indicative of oxidative stress) were lower after the metformin treatment. Furthermore, significant inhibition of 3ß-HSD activity was detectable. Discussion: Effects prior to and after the metformin treatment on inhibiting 3ß-HSD activity were detected in line with findings from others. Furthermore, the pattern of a reduction, for example, in the sum of all glucocorticoids following the metformin treatment supported an effect on oxidative stress, which was further supported by the reduction in 18-OH cortisol. Nevertheless, we do not understand all steps in the complex pattern of the enzymes that affect steroid hormone metabolism and, consequently, further studies are necessary to improve our understanding.
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Affiliation(s)
- Benedikt Gasser
- Department of Sport, Exercise and Health, Division Sport and Exercise Medicine, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Genevieve Escher
- Department of Biomedical Research, University Bern, 3006 Bern, Switzerland
| | - Anca-Elena Calin
- Lindenhofgruppe, Teaching Hospital of Internal Medicine, 3006 Berne, Switzerland
| | - Michael Deppeler
- Lindenhofgruppe, Teaching Hospital of Internal Medicine, 3006 Berne, Switzerland
| | - Miriam Marchon
- Lindenhofgruppe, Teaching Hospital of Internal Medicine, 3006 Berne, Switzerland
| | - Hiten D Mistry
- Department of Women and Children's Health, School of Life Course and Population Science, Kings College, London SE1 1UL, UK
| | - Johann Kurz
- Lindenhofgruppe, Teaching Hospital of Internal Medicine, 3006 Berne, Switzerland
- Interscience Research Collaboration, 8430 Leibnitz, Austria
| | - Markus G Mohaupt
- Department of Biomedical Research, University Bern, 3006 Bern, Switzerland
- Lindenhofgruppe, Teaching Hospital of Internal Medicine, 3006 Berne, Switzerland
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3
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Ackermann D, Vogt B, Bochud M, Burnier M, Martin PY, Paccaud F, Ehret G, Guessous I, Ponte B, Pruijm M, Pechère-Bertschi A, Jamin H, Klossner R, Dick B, Mohaupt MG, Gennari-Moser C. Increased glucocorticoid metabolism in diabetic kidney disease. PLoS One 2022; 17:e0269920. [PMID: 35749380 PMCID: PMC9231809 DOI: 10.1371/journal.pone.0269920] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Aims
Glomerular damage indicated by proteinuria is a main symptom in diabetic nephropathy. Mineralocorticoid receptor (MR) antagonists (MRAs) are beneficial irrespective of aldosterone availability. Thus, we hypothesized an alternatively activated MR to promote glomerular damage in proteinuric diabetic nephropathy. Specifically, we aimed first to demonstrate the presence of steroid hormones serving as alternative MR targets in type II diabetic patients with proteinuric kidney disease, second whether MR selectivity was modified, third to characterize MR and glucocorticoid receptor (GR) expression and activity in glomerular cell types exposed to eu- and hyperglycemic conditions, fourth to characterize the pro-fibrotic potential of primary human renal mesangial cells (HRMC) upon stimulation with aldosterone and cortisol, and fifth to specify the involvement of the MR and/or GR in pro-fibrotic signaling.
Materials and methods
Urinary steroid hormone profiles of patients with diabetic kidney disease were analyzed by gas chromatography–mass spectrometry and compared to an age and gender matched healthy control group taken out of a population study. In both cohorts, the activity of the MR pre-receptor enzyme 11β-hydroxysteroid dehydrogenase type 2 (HSD11B2), which inactivates cortisol to prevent it from binding to the MR, was assessed to define a change in MR selectivity. Expression of HSD11B2, MR and GR was quantified in HRMC and primary human renal glomerular endothelial cells (HRGEC). Activity of MR and GR was explored in HRMC by measuring the MR/GR down-stream signal SGK1 and the pro-fibrotic genes TGFB1, FN1 and COL1A1 in normal and high glucose conditions with the MR/GR agonists aldosterone/cortisol and the MR/GR antagonists spironolactone/RU486.
Results
Patients with diabetic kidney disease excreted more tetrahydroaldosterone than the control group reaching significance in men. The excretion of MR-agonistic steroid hormones was only increased for 18-hydroxytetrahydrocorticosterone in diabetic women. The excretion of most glucocorticoids was higher in the diabetic cohort. Higher apparent systemic HSD11B2 activity suggested less activation of the MR by cortisol in diabetic patients. Both cell types, HRMC and HRGEC, lacked expression of HSD11B2. Hyperglycemic conditions did not change MR and GR expression and activity. Stimulation with both aldosterone and cortisol promoted upregulation of pro-fibrotic genes in HRMC. This effect of MR and/or GR activation was more pronounced in high glucose conditions and partially inhibited by MRAs and GR antagonists.
Conclusions
In patients with diabetic kidney disease alternative MR activation is conceivable as cortisol and cortisone metabolites are increased. Systemic availability of active metabolites is counteracted via an increased HSD11B2 activity. As this cortisol deactivation is absent in HRMC and HRGEC, cortisol binding to the MR is enabled. Both, cortisol and aldosterone stimulation led to an increased expression of pro-fibrotic genes in HRMC. This mechanism was related to the MR as well as the GR and more marked in high glucose conditions linking the benefit of MRAs in diabetic kidney disease to these findings.
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Affiliation(s)
- Daniel Ackermann
- Department of Nephrology and Hypertension, University of Bern, Berne, Switzerland
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension, University of Bern, Berne, Switzerland
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Murielle Bochud
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Michel Burnier
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Pierre-Yves Martin
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Fred Paccaud
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Georg Ehret
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Idris Guessous
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Belen Ponte
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | - Menno Pruijm
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
| | | | - Heidi Jamin
- Department of Nephrology and Hypertension, University of Bern, Berne, Switzerland
- Department for BioMedical Research, University of Bern, Berne, Switzerland
| | - Rahel Klossner
- Department of Nephrology and Hypertension, University of Bern, Berne, Switzerland
- Department of Internal Medicine, Sonnenhof, Lindenhofgruppe, Berne, Switzerland
| | - Bernhard Dick
- Department of Nephrology and Hypertension, University of Bern, Berne, Switzerland
- Department for BioMedical Research, University of Bern, Berne, Switzerland
| | - Markus G. Mohaupt
- Swiss Kidney Project on Genes in Hypertension (SKIPOGH) Team, Lausanne, Switzerland
- Department of Internal Medicine, Sonnenhof, Lindenhofgruppe, Berne, Switzerland
- School of Medicine, University of Nottingham, Division of Child Health, Obstetrics & Gynaecology, Nottingham, United Kingdom
| | - Carine Gennari-Moser
- Department of Nephrology and Hypertension, University of Bern, Berne, Switzerland
- Department for BioMedical Research, University of Bern, Berne, Switzerland
- * E-mail:
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Mistry HD, Klossner R, Kallol S, Lüthi MP, Moser R, Schneider H, Ontsouka EC, Kurlak LO, Mohaupt MG, Albrecht C. Effects of aldosterone on the human placenta: Insights from placental perfusion studies. Placenta 2022; 123:32-40. [DOI: 10.1016/j.placenta.2022.03.129] [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] [Received: 07/15/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
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5
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Dong Y, Koch JBH, Löwe AL, Christen M, Wang WP, Jung EM, Mohaupt MG, Dietrich CF. VueBox® for quantitative analysis of contrast-enhanced ultrasound in liver tumors. Clin Hemorheol Microcirc 2021; 80:473-486. [PMID: 34897079 DOI: 10.3233/ch-211261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) enables quantification of tumor perfusion. VueBox is a platform independent external software using DICOM cine loops which objectively provides various DCE-US parameters of tumor vascularity. This review summaries its use for diagnosis and treatment monitoring of liver tumors. The existing literature provides evidence on the successful application of Vuebox based DCE-US for characterization and differential diagnosis of focal liver lesions, as well as on its use for monitoring of local ablative therapies and of modern systemic treatment in oncology.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jonas B H Koch
- Department General Internal Medicine, Hirslanden Clinics Beau-Site, Salem and Permancence, Bern, Switzerland
| | - Axel L Löwe
- Department General Internal Medicine, Hirslanden Clinics Beau-Site, Salem and Permancence, Bern, Switzerland
| | - Michael Christen
- Department General Internal Medicine, Hirslanden Clinics Beau-Site, Salem and Permancence, Bern, Switzerland
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Markus G Mohaupt
- Department of Medicine, Teaching Hospital General Medicine Lindenhofgruppe, Berne, Switzerland
| | - Christoph F Dietrich
- Department General Internal Medicine, Hirslanden Clinics Beau-Site, Salem and Permancence, Bern, Switzerland
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6
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Klossner R, Groessl M, Schumacher N, Fux M, Escher G, Verouti S, Jamin H, Vogt B, Mohaupt MG, Gennari-Moser C. Steroid hormone bioavailability is controlled by the lymphatic system. Sci Rep 2021; 11:9666. [PMID: 33958648 PMCID: PMC8102502 DOI: 10.1038/s41598-021-88508-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/13/2021] [Indexed: 11/09/2022] Open
Abstract
The steroid hormone progesterone accounts for immune tolerance in pregnancy. Enhanced progesterone metabolism to 6α-OH-pregnanolone occurs in complicated pregnancies such as in preeclampsia with preterm delivery or intrauterine growth restriction, and in cancer. As lymphatic endothelial cells (LECs) promote tumor immunity, we hypothesized that human LECs modify progesterone bioavailability. Primary human LECs and mice lymph nodes were incubated with progesterone and progesterone metabolism was analyzed by thin layer chromatography and liquid chromatography-mass spectrometry. Expression of steroidogenic enzymes, down-stream signal and steroid hormone receptors was assessed by Real-time PCR. The placental cell line HTR-8/SV neo was used as reference. The impact of the progesterone metabolites of interest was investigated on the immune system by fluorescence-activated cell sorting analysis. LECs metabolize progesterone to 6α-OH-pregnanolone and reactivate progesterone from a precursor. LECs highly express 17β-hydroxysteroid dehydrogenase 2 and are therefore antiandrogenic and antiestrogenic. LECs express several steroid hormone receptors and PIBF1. Progesterone and its metabolites reduced TNF-α and IFN-γ production in CD4+ and CD8+ T cells. LECs modify progesterone bioavailability and are a target of steroid hormones. Given the global area represented by LECs, they might have a critical immunomodulatory control in pregnancy and cancer.
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Affiliation(s)
- Rahel Klossner
- Department of Nephrology and Hypertension, University of Bern, 3010, Bern, Switzerland.,Department of Medicine, Lindenhofgruppe, 3006, Bern, Switzerland.,Department for BioMedical Research, University of Bern, 3010, Bern, Switzerland
| | - Michael Groessl
- Department of Nephrology and Hypertension, University of Bern, 3010, Bern, Switzerland.,Department for BioMedical Research, University of Bern, 3010, Bern, Switzerland
| | - Nadine Schumacher
- Department of Nephrology and Hypertension, University of Bern, 3010, Bern, Switzerland
| | - Michaela Fux
- Department for Clinical Chemistry, Inselspital, 3010, Bern, Switzerland
| | - Geneviève Escher
- Department of Nephrology and Hypertension, University of Bern, 3010, Bern, Switzerland.,Department for BioMedical Research, University of Bern, 3010, Bern, Switzerland
| | - Sophia Verouti
- Department of Nephrology and Hypertension, University of Bern, 3010, Bern, Switzerland.,Department for BioMedical Research, University of Bern, 3010, Bern, Switzerland
| | - Heidi Jamin
- Department of Nephrology and Hypertension, University of Bern, 3010, Bern, Switzerland.,Department for BioMedical Research, University of Bern, 3010, Bern, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension, University of Bern, 3010, Bern, Switzerland.,Department for BioMedical Research, University of Bern, 3010, Bern, Switzerland
| | - Markus G Mohaupt
- Department of Medicine, Lindenhofgruppe, 3006, Bern, Switzerland.,Campus SLB, Sitem, 3010, Bern, Switzerland.,Division of Child Health, Obstetrics and Gynecology, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Carine Gennari-Moser
- Department of Nephrology and Hypertension, University of Bern, 3010, Bern, Switzerland. .,Department for BioMedical Research, University of Bern, 3010, Bern, Switzerland.
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7
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Christakoudi S, Runglall M, Mobillo P, Rebollo-Mesa I, Tsui TL, Nova-Lamperti E, Taube C, Norris S, Kamra Y, Hilton R, Augustine T, Bhandari S, Baker R, Berglund D, Carr S, Game D, Griffin S, Kalra PA, Lewis R, Mark PB, Marks SD, MacPhee I, McKane W, Mohaupt MG, Paz-Artal E, Kon SP, Serón D, Sinha MD, Tucker B, Viklický O, Stahl D, Lechler RI, Lord GM, Hernandez-Fuentes MP. Development and validation of the first consensus gene-expression signature of operational tolerance in kidney transplantation, incorporating adjustment for immunosuppressive drug therapy. EBioMedicine 2020; 58:102899. [PMID: 32707447 PMCID: PMC7374249 DOI: 10.1016/j.ebiom.2020.102899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background Kidney transplant recipients (KTRs) with “operational tolerance” (OT) maintain a functioning graft without immunosuppressive (IS) drugs, thus avoiding treatment complications. Nevertheless, IS drugs can influence gene-expression signatures aiming to identify OT among treated KTRs. Methods We compared five published signatures of OT in peripheral blood samples from 18 tolerant, 183 stable, and 34 chronic rejector KTRs, using gene-expression levels with and without adjustment for IS drugs and regularised logistic regression. Findings IS drugs explained up to 50% of the variability in gene-expression and 20–30% of the variability in the probability of OT predicted by signatures without drug adjustment. We present a parsimonious consensus gene-set to identify OT, derived from joint analysis of IS-drug-adjusted expression of five published signature gene-sets. This signature, including CD40, CTLA4, HSD11B1, IGKV4–1, MZB1, NR3C2, and RAB40C genes, showed an area under the curve 0⋅92 (95% confidence interval 0⋅88–0⋅94) in cross-validation and 0⋅97 (0⋅93–1⋅00) in six months follow-up samples. Interpretation We advocate including adjustment for IS drug therapy in the development stage of gene-expression signatures of OT to reduce the risk of capturing features of treatment, which could be lost following IS drug minimisation or withdrawal. Our signature, however, would require further validation in an independent dataset and a biomarker-led trial. Funding FP7-HEALTH-2012-INNOVATION-1 [305147:BIO-DrIM] (SC,IR-M,PM,DSt); MRC [G0801537/ID:88245] (MPH-F); MRC [MR/J006742/1] (IR-M); Guy's&StThomas’ Charity [R080530]&[R090782]; CONICYT-Bicentennial-Becas-Chile (EN-L); EU:FP7/2007–2013 [HEALTH-F5–2010–260687: The ONE Study] (MPH-F); Czech Ministry of Health [NV19–06–00031] (OV); NIHR-BRC Guy's&StThomas' NHS Foundation Trust and KCL (SC); UK Clinical Research Networks [portfolio:7521].
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Affiliation(s)
- Sofia Christakoudi
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK.
| | - Manohursingh Runglall
- NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Paula Mobillo
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Irene Rebollo-Mesa
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Tjir-Li Tsui
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | | | - Catharine Taube
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Sonia Norris
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Yogesh Kamra
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Rachel Hilton
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Titus Augustine
- Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK
| | - Sunil Bhandari
- Hull University Teaching Hospitals NHS Trust, Anlaby Rd, Hull HU3 2JZ, UK
| | - Richard Baker
- St James's University Hospital, Beckett St, Leeds LS9 7TF, UK
| | - David Berglund
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbecklaboratoriet, 751 85 Uppsala, Sweden
| | - Sue Carr
- Leicester General Hospital, Gwendolen Rd, Leicester LE5 4PW, UK
| | - David Game
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Sian Griffin
- Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Philip A Kalra
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
| | - Robert Lewis
- Queen Alexandra Hospital, Southwick Hill Rd, Cosham, Portsmouth PO6 3LY, UK
| | - Patrick B Mark
- University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, UK
| | - Iain MacPhee
- St George's Hospital, Blackshaw Rd, London SW17 0QT, UK & Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London SW17 0RE
| | - William McKane
- Northern General Hospital, Herries Rd, Sheffield S5 7AU, UK
| | - Markus G Mohaupt
- Internal Medicine, Lindenhofgruppe Berne, Switzerland; University of Bern, Berne, Switzerland; School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Estela Paz-Artal
- Department of Immunology and imas12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
| | - Sui Phin Kon
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Daniel Serón
- Hospital Universitario Vall d'Hebrón, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Manish D Sinha
- Evelina London Children's Hospital, Westminster Bridge Rd, Lambeth, London SE1 7EH, UK; Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK; King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Beatriz Tucker
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Ondrej Viklický
- Transplantační laboratoř, Institut klinické a experimentální medicíny (IKEM), Vídeňská 1958/9, 140 21 Praha 4, Czech Republic
| | - Daniel Stahl
- Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Robert I Lechler
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Graham M Lord
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Great Maze Pond, London SE1 9RT, UK; Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Maria P Hernandez-Fuentes
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; King's Health Partners, Guy's Hospital, London SE1 9RT, UK
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8
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Kurlak LO, Broughton Pipkin F, Mohaupt MG, Mistry HD. Responses of the renin-angiotensin-aldosterone system in pregnant chronic kidney disease patients with and without superimposed pre-eclampsia. Clin Kidney J 2019; 12:847-854. [PMID: 31807298 PMCID: PMC6885683 DOI: 10.1093/ckj/sfz025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/05/2018] [Indexed: 11/12/2022] Open
Abstract
Background Women with chronic kidney disease (CKD) are at increased risk of superimposed pre-eclampsia (SPE). Accurate identification of SPE is challenging. We hypothesized that specific components of the renin-angiotensin-aldosterone system (RAAS) would discriminate between CKD and SPE. The aim of the study was to establish differences in circulating and intrarenal RAAS in women with CKD with and without SPE and compare these to normotensive controls (NCs) and women with pre-eclampsia (PE). Methods White European NC women (n = 20), women with PE (n = 9), normotensive CKD without SPE (n = 8) and with SPE (n = 11) were recruited in the third trimester. Plasma renin, plasma and urine total angiotensinogen (AGT) concentrations were quantified by enzyme-linked immunosorbent assay, urinary tetrahydroaldosterone (TH-aldo) concentration by gas chromatography-mass spectrometry and placental growth factor (PlGF) by immunoassay. Results Urinary TH-aldo:creatinine ratios were lower in women with PE or SPE compared with NC or women with CKD (P < 0.05 for all). The same group differences were observed for plasma active renin and PlGF concentrations (P < 0.05 for all). Urine total AGT was higher in women with PE compared with NC (P < 0.05) and urine TH-aldo:urine AGT was lower (P < 0.05). However, women with SPE had lower urinary AGT concentrations compared with women with PE (P < 0.05). No differences in plasma total AGT were observed between groups. Conclusions Women with SPE have a lower urinary TH-aldo:creatinine ratio, lower plasma active renin and lower PlGF concentrations than women with CKD, comparable to women with PE without pre-existing disease, suggestive of similar pathophysiology. These data suggest disruption of the RAAS pathway in SPE similar to PE. Exploration of the predictive value of RAAS components for adverse pregnancy events in women with CKD is required.
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Affiliation(s)
- Lesia O Kurlak
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK
| | - Fiona Broughton Pipkin
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK
| | - Markus G Mohaupt
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK.,Internal Medicine, Teaching Hospital Lindenhofgruppe, Bern, Switzerland
| | - Hiten D Mistry
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK
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Klossner R, Mistry HD, Scaife PJ, Kurlak LO, Lüthi M, Kallol S, Albrecht C, Mohaupt MG. 107. Tonicity responses by TonEBP and SMIT in human primary term cytotrophoblasts. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.08.225] [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: 11/27/2022]
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10
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Christakoudi S, Runglall M, Mobillo P, Rebollo-Mesa I, Tsui TL, Nova-Lamperti E, Norris S, Kamra Y, Hilton R, Bhandari S, Baker R, Berglund D, Carr S, Game D, Griffin S, Kalra PA, Lewis R, Mark PB, Marks SD, Macphee I, McKane W, Mohaupt MG, Pararajasingam R, Kon SP, Serón D, Sinha M, Tucker B, Viklický O, Lechler RI, Lord GM, Stahl D, Hernandez-Fuentes MP. Steroid regulation: An overlooked aspect of tolerance and chronic rejection in kidney transplantation. Mol Cell Endocrinol 2018; 473:205-216. [PMID: 29427591 DOI: 10.1016/j.mce.2018.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 01/21/2018] [Accepted: 01/29/2018] [Indexed: 01/08/2023]
Abstract
Steroid conversion (HSD11B1, HSD11B2, H6PD) and receptor genes (NR3C1, NR3C2) were examined in kidney-transplant recipients with "operational tolerance" and chronic rejection (CR), independently and within the context of 88 tolerance-associated genes. Associations with cellular types were explored. Peripheral whole-blood gene-expression levels (RT-qPCR-based) and cell counts were adjusted for immunosuppressant drug intake. Tolerant (n = 17), stable (n = 190) and CR patients (n = 37) were compared. Healthy controls (n = 14) were used as reference. The anti-inflammatory glucocorticoid receptor (NR3C1) and the cortisol-activating HSD11B1 and H6PD genes were up-regulated in CR and were lowest in tolerant patients. The pro-inflammatory mineralocorticoid gene (NR3C2) was downregulated in stable and CR patients. NR3C1 was associated with neutrophils and NR3C2 with T-cells. Steroid conversion and receptor genes, alone, enabled classification of tolerant patients and were major contributors to gene-expression signatures of both, tolerance and CR, alongside known tolerance-associated genes, revealing a key role of steroid regulation and response in kidney transplantation.
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Affiliation(s)
- Sofia Christakoudi
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK.
| | - Manohursingh Runglall
- NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Paula Mobillo
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Irene Rebollo-Mesa
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Tjir-Li Tsui
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | | | - Sonia Norris
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Yogesh Kamra
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Rachel Hilton
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Sunil Bhandari
- Hull and East Yorkshire Hospitals NHS Trust, Anlaby Rd, Hull HU3 2JZ, UK
| | - Richard Baker
- St James's University Hospital, Beckett St, Leeds LS9 7TF, UK
| | - David Berglund
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbecklaboratoriet, 751 85 Uppsala, Sweden
| | - Sue Carr
- Leicester General Hospital, Gwendolen Rd, Leicester LE5 4PW, UK
| | - David Game
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Sian Griffin
- Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Philip A Kalra
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
| | - Robert Lewis
- Queen Alexandra Hospital, Southwick Hill Rd, Cosham, Portsmouth PO6 3LY, UK
| | - Patrick B Mark
- University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
| | - Iain Macphee
- St George's Hospital, Blackshaw Rd, London SW17 0QT, UK
| | - William McKane
- Northern General Hospital, Herries Rd, Sheffield S5 7AU, UK
| | - Markus G Mohaupt
- INSELSPITAL, Universitätsspital Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital, Freiburgstrasse 8, 3010 Bern, Switzerland
| | | | - Sui Phin Kon
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Daniel Serón
- Hospital Universitario Vall d'Hebrón, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Manish Sinha
- Evelina London Children's Hospital, Westminster Bridge Rd, Lambeth, London SE1 7EH, UK
| | - Beatriz Tucker
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Ondrej Viklický
- Transplantační laboratoř, Institut klinické a experimentální medicíny (IKEM), Vídeňská 1958/9, 140 21 Praha 4, Czech Republic
| | - Robert I Lechler
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Graham M Lord
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Great Maze Pond, London SE1 9RT, UK; Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Daniel Stahl
- Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Maria P Hernandez-Fuentes
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; King's Health Partners, Guy's Hospital, London SE1 9RT, UK
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Eisele N, Klossner R, Escher G, Rudloff S, Larionov A, Theilig F, Mohaupt MG, Mistry HD, Gennari‐Moser C. Physiological and Molecular Responses to Altered Sodium Intake in Rat Pregnancy. J Am Heart Assoc 2018; 7:e008363. [PMID: 30371243 PMCID: PMC6201473 DOI: 10.1161/jaha.117.008363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/07/2018] [Indexed: 11/21/2022]
Abstract
Background In pregnancy, a high plasma volume maintains uteroplacental perfusion and prevents placental ischemia, a condition linked to elevated maternal blood pressure ( BP ). Reducing BP by increasing Na+ intake via plasma volume expansion appears contra-intuitive. We hypothesize that an appropriate Na+ intake in pregnancy reduces maternal BP and adapts the renin-angiotensin system in a pregnancy-specific manner. Methods and Results BP was measured by implanted telemetry in Sprague-Dawley rats before and throughout pregnancy. Pregnant and nonpregnant animals received either a normal-salt (0.4%; NS ), high-salt (8%; HS ), or low-salt (0.01%; LS ) diet, or HS (days 1-14) followed by LS (days 14-20) diet ( HS / LS ). Before delivery (day 20), animals were euthanized and organs collected. Food, water, and Na+ intake were monitored in metabolic cages, and urinary creatinine and Na+ were analyzed. Na+ intake and retention increased in pregnancy ( NS , LS ), leading to a positive Na+ balance ( NS , LS ). BP was stable during LS , but reduced in HS conditions in pregnancy. The renin-angiotensin system was adapted as expected. Activating cleavage of α- and γ-subunits of the renal epithelial Na+ channel and expression of-full length medullary β-subunits, accentuated further in all LS conditions, were upregulated in pregnancy. Conclusions Pregnancy led to Na+ retention adapted to dietary changes. HS exposure paradoxically reduced BP . Na+ uptake while only modestly linked to the renin-angiotensin system is enhanced in the presence of posttranslational renal epithelial Na+ channel modifications. This suggests (1) storage of Na+ in pregnancy upon HS exposure, bridging periods of LS availability; and (2) that potentially non-renin-angiotensin-related mechanisms participate in EN aC activation and consecutive Na+ retention.
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Affiliation(s)
- Nicole Eisele
- Department of Nephrology and HypertensionUniversity of BernSwitzerland
- Department of BioMedical ResearchUniversity of BernSwitzerland
| | - Rahel Klossner
- Department of BioMedical ResearchUniversity of BernSwitzerland
- Teaching Hospital Internal Medicine LindenhofgruppeBerneSwitzerland
| | - Geneviève Escher
- Department of Nephrology and HypertensionUniversity of BernSwitzerland
- Department of BioMedical ResearchUniversity of BernSwitzerland
| | - Stefan Rudloff
- Department of Nephrology and HypertensionUniversity of BernSwitzerland
- Department of BioMedical ResearchUniversity of BernSwitzerland
| | - Alexey Larionov
- Division of Internal MedicineUniversity of FribourgSwitzerland
| | | | - Markus G. Mohaupt
- Department of BioMedical ResearchUniversity of BernSwitzerland
- Teaching Hospital Internal Medicine LindenhofgruppeBerneSwitzerland
| | - Hiten D. Mistry
- Department of BioMedical ResearchUniversity of BernSwitzerland
- Division of Child Health, Obstetrics and GynaecologySchool of MedicineCity Hospital NottinghamNottinghamUnited Kingdom
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12
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van der Stouwe JG, Carmeli C, Aeschbacher S, Schoen T, Krisai P, Wenger G, Ehret G, Ponte B, Pruijm M, Ackermann D, Guessous I, Paccaud F, Pechère-Bertschi A, Vogt B, Mohaupt MG, Martin PY, Burnier M, Risch M, Risch L, Bochud M, Conen D. Association of 24-Hour Blood Pressure With Urinary Sodium Excretion in Healthy Adults. Am J Hypertens 2018; 31:784-791. [PMID: 29481641 DOI: 10.1093/ajh/hpy031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/21/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While the positive relationship between urinary sodium excretion and blood pressure (BP) is well established for middle-aged to elderly individuals using office BP, data are limited for younger individuals and ambulatory BP measurements. METHODS Our analysis included 2,899 individuals aged 18 to 90 years from 2 population-based studies (GAPP, Swiss Kidney Project on Genes in Hypertension [SKIPOGH]). Participants with prevalent cardiovascular disease, diabetes, or on BP-lowering treatment were excluded. In SKIPOGH, 24-hour urinary sodium excretion was used as a measure of sodium intake, while in GAPP it was calculated from fasting morning urinary samples using the Kawasaki formula. Multivariable linear regression models were used to assess the relationships of 24-hour urinary salt excretion with office and ambulatory BP measurements. RESULTS Mean age, ambulatory BP, sodium excretion, and estimated glomerular filtration rate in GAPP and SKIPOGH were 35 and 44 years, 123/78 and 118/77 mm Hg, 4.2 and 3.3 g/d, and 110 and 99 ml/min/1.73 m2, respectively. A weak linear association was observed between 24-hour ambulatory systolic BP and urinary sodium excretion (β (95% confidence interval [CI]) per 1 g increase in sodium excretion (0.33 % (0.09; 0.57); P = 0.008). No significant relationships were observed for 24-hour ambulatory diastolic BP (β (95% CI) (0.13 % (-0.15; 0.40) P = 0.37). When repeating the analyses in different age groups, all BP indices appeared to have stronger relationships in the older age groups (>40 years). CONCLUSIONS In these large cohorts of healthy adults, urinary sodium excretion was only weakly associated with systolic 24-hour ambulatory BP.
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Affiliation(s)
- Jan Gerrit van der Stouwe
- Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Cristian Carmeli
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefanie Aeschbacher
- Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Schoen
- Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Giuditta Wenger
- Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Georg Ehret
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Belen Ponte
- Department of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | - Menno Pruijm
- Service of Nephrology and Hypertension, University Hospital Lausanne, Lausanne, Switzerland
| | - Daniel Ackermann
- University Clinic for Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Idris Guessous
- Geneva University Hospitals, Unit of population epidemiology, Geneva, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne and Department of Epidemiology, Lausanne, Switzerland
- Emory University, Atlanta, Georgia, USA
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Bruno Vogt
- University Clinic for Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Pierre-Yves Martin
- Department of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital Lausanne, Lausanne, Switzerland
| | - Martin Risch
- Labormedizinisches Zentrum Dr. Risch, Principality of Liechtenstein, Schaan, FL
- Division of Laboratory Medicine, Kantonspital Graubünden, Chur, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Principality of Liechtenstein, Schaan, FL
- Division of Clinical Biochemistry, Medical University Innsbruck, Innsbruck, Austria
- Private University, Triesen, FL
| | - Murielle Bochud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - David Conen
- Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Population Health Research Institute, McMaster University, Hamilton, Canada
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13
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Pecks U, Rath W, Bauerschlag DO, Maass N, Orlikowsky T, Mohaupt MG, Escher G. Serum cholesterol acceptor capacity in intrauterine growth restricted fetuses. J Perinat Med 2017; 45:829-835. [PMID: 28195552 DOI: 10.1515/jpm-2016-0270] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/10/2017] [Indexed: 01/30/2023]
Abstract
AIM Intrauterine growth restriction (IUGR) is an independent risk factor for the development of cardiovascular diseases later in life. The mechanisms whereby slowed intrauterine growth confers vascular risk are not clearly established. In general, a disturbed cholesterol efflux has been linked to atherosclerosis. The capacity of serum to accept cholesterol has been repeatedly evaluated in clinical studies by the use of macrophage-based cholesterol efflux assays and, if disturbed, precedes atherosclerotic diseases years before the clinical diagnosis. We now hypothesized that circulating cholesterol acceptors in IUGR sera specifically interfere with cholesterol transport mechanisms leading to diminished cholesterol efflux. METHODS RAW264.7 cells were used to determine efflux of [3H]-cholesterol in response to [umbilical cord serum (IUGR), n=20; controls (CTRL), n=20]. RESULTS Cholesterol efflux was lower in IUGR as compared to controls [controls: mean 7.7% fractional [3H]-cholesterol efflux, standard deviation (SD)=0.98; IUGR: mean 6.3%, SD=0.79; P<0.0001]. Values strongly correlated to HDL (ρ=0.655, P<0.0001) and apoE (ρ=0.510, P=0.0008), and mildly to apoA1 (ρ=0.3926, P=0.0122) concentrations. CONCLUSIONS Reduced cholesterol efflux in IUGR could account for the enhanced risk of developing cardiovascular diseases later in life.
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Mohaupt MG. KL 1 Modern management of hypertension in pregnancy – More than just antihypertensive therapy and delivery. Pregnancy Hypertens 2017. [DOI: 10.1016/j.preghy.2017.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Mistry HD, Kurlak LO, Mansour YT, Zurkinden L, Mohaupt MG, Escher G. Increased maternal and fetal cholesterol efflux capacity and placental CYP27A1 expression in preeclampsia. J Lipid Res 2017; 58:1186-1195. [PMID: 28396342 DOI: 10.1194/jlr.m071985] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 09/09/2016] [Revised: 04/07/2017] [Indexed: 01/17/2023] Open
Abstract
Preeclampsia is a pregnancy-specific condition that leads to increased cardiovascular risk in later life. A decrease in cholesterol efflux capacity is linked to CVD. We hypothesized that in preeclampsia there would be a disruption of maternal/fetal plasma to efflux cholesterol, as well as differences in the concentrations of both placental sterol 27-hydroxylase (CYP27A1) and apoA1 binding protein (AIBP). Total, HDL-, and ABCA1-mediated cholesterol effluxes were performed with maternal and fetal plasma from women with preeclampsia and normotensive controls (both n = 17). apoA1 and apoE were quantified by chemiluminescence, and 27-hydroxycholesterol (27-OHC) by GC-MS. Immunohistochemistry was used to determine placental expression/localization of CYP27A1, AIBP, apoA1, apoE, and SRB1. Maternal and fetal total and HDL-mediated cholesterol efflux capacities were increased in preeclampsia (by 10-20%), but ABCA1-mediated efflux was decreased (by 20-35%; P < 0.05). Maternal and fetal apoE concentrations were higher in preeclampsia. Fetal plasma 27-OHC levels were decreased in preeclamptic samples (P < 0.05). Placental protein expression of both CYP27A1 and AIBP were localized around fetal vessels and significantly increased in preeclampsia (P = 0.04). Placental 27-OHC concentrations were also raised in preeclampsia (P < 0.05). Increased HDL-mediated cholesterol efflux capacity and placental CYP27A1/27-OHC could be a rescue mechanism in preeclampsia, to remove cholesterol from cells to limit lipid peroxidation and increase placental angiogenesis.
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Affiliation(s)
- Hiten D Mistry
- Department of Nephrology, Hypertension, Clinical Pharmacology, and Clinical Research, University of Bern, Bern, Switzerland .,Division of Child Health, Obstetrics, and Gynecology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Lesia O Kurlak
- Division of Child Health, Obstetrics, and Gynecology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Yosef T Mansour
- Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom
| | - Line Zurkinden
- Department of Nephrology, Hypertension, Clinical Pharmacology, and Clinical Research, University of Bern, Bern, Switzerland
| | - Markus G Mohaupt
- Department of Nephrology, Hypertension, Clinical Pharmacology, and Clinical Research, University of Bern, Bern, Switzerland
| | - Geneviève Escher
- Department of Nephrology, Hypertension, Clinical Pharmacology, and Clinical Research, University of Bern, Bern, Switzerland
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16
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Vasku M, Kleine-Eggebrecht N, Rath W, Mohaupt MG, Escher G, Pecks U. Maternal serum glucocorticoid levels and maternal cortisol/cortisone ratio in healthy pregnancy, preeclampsia and intrauterine growth restriction. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1600078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- M Vasku
- Florence-Nightingale-Krankenhaus, Klinik für Gynäkologie und Geburtsthilfe, Düsseldorf, Deutschland
| | - N Kleine-Eggebrecht
- Universitätsklinik Aachen, Klinik für Gynäkologie und Geburtsthilfe, Aachen, Deutschland
| | - W Rath
- Universitätsklinik Schleswig-Holstein, Kiel, Klinik für Gynäkologie und Geburtsthilfe, Kiel, Deutschland
| | - MG Mohaupt
- Inselspital, Universität Bern, Klinik für Nephrologie, Hypertonie Bern, Schweiz
| | - G Escher
- Inselspital, Universität Bern, Klinische Forschung, Bern, Schweiz
| | - U Pecks
- Universitätsklinik Aachen, Klinik für Gynäkologie und Geburtsthilfe, Aachen, Deutschland
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Abstract
Zusammenfassung. Kardiovaskuläre Erkrankungen sind eine Hauptursache für Morbidität und Mortalität. Es ist vordringlich, diese Bedrohung zu minimieren. Hypertensive Schwangerschaften treten einerseits bevorzugt bei Frauen auf, die zu kardiovaskulären Erkrankungen tendieren, andererseits prädisponieren hypertensive Schwangerschaftserkrankungen, z.B. eine Präeklampsie, für spätere kardiovaskuläre Komplikationen. So sollten präventive Massnahmen schon früh nach der akuten Erkrankungen dieses Risiko reduzieren. Dazu gehört die Information bezüglich eines gesunden Lebensstil und zukünftige hausärztliche Kontrolluntersuchungen der kardiovaskulären Risikoindikatoren. In ähnlicher Weise sind Kinder mit einem erniedrigten Geburtsgewicht bzw. Mangelgeburtlichkeit für ein gegebenes Gestationsalter betroffen. Da diese Geburtskomplikationen häufiger bei hypertensiven Schwangerschaftserkrankungen auftreten, sollten den Müttern vergleichbare langfristige präventive Massnahmen getroffen werden. Zusammenfassend benötigen Mutter und häufig auch die Kinder aus hypertensiven Schwangerschaften geeignete kardiovaskuläre langfristige Präventionsmassnahmen. Frauen mit einem bislang nicht erkannten metabolischen bzw. Herz-Kreislauferkrankungsrisiko können damit einem sorgfältigen Follow-up zugeführt werden. Somit kann die hypertensive Schwangerschaft als Risikoindikator die Basis für eine frühzeitige Risikoprävention und ein gesundes Leben legen.
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Affiliation(s)
- Markus G Mohaupt
- 1 Universitätsklinik für Nephrologie, Hypertonie und Klinische Pharmakologie, Inselspital Bern.,2 Departement für Klinische Forschung, Universität Bern
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18
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Cathomas R, Crabb SJ, Mark M, Winterhalder R, Rothermundt C, Elliott T, von Burg P, Kenner H, Hayoz S, Vilei SB, Rauch D, Roggero E, Mohaupt MG, Bernhard J, Manetsch G, Gillessen S. Orteronel Switch Maintenance Therapy in Metastatic Castration Resistant Prostate Cancer After First-Line Docetaxel: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial (SAKK 08/11). Prostate 2016; 76:1519-1527. [PMID: 27457964 DOI: 10.1002/pros.23236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/12/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND We tested whether a switch maintenance treatment with orteronel, an oral inhibitor of androgen biosynthesis, prolongs disease control in men with metastatic castration-resistant prostate cancer (mCRPC) after documented disease stabilization with docetaxel. METHODS Men with mCRPC and non-progressive disease after a cumulative dose of ≥300 mg/m2 docetaxel for first line treatment were randomized 1:1 to receive orteronel 300 mg twice daily or placebo. The primary endpoint was event-free survival (EFS) defined as the time from randomization to death or the combination of at least two of radiographic, clinical, or PSA progression. Ninety-six patients per arm were planned to demonstrate an improvement of median EFS from 4 months on placebo to 6.7 months on orteronel (hazard ratio (HR) 0.6; type I error 5% and power 90%). RESULTS Forty-seven patients (23 orteronel, 24 placebo) were randomized before premature closure of the trial because of discontinuation of clinical development of orteronel. Median EFS was 8.5 months with orteronel and 2.9 months with placebo (P = 0.001; HR 0.32; 95%CI 0.15-0.65). Median radiographic progression-free survival (rPFS) was 8.5 and 2.8 months (P = 0.02; HR 0.42; 95%CI 0.20-0.91) in the orteronel and placebo arm, respectively. PSA decline ≥50% was seen in 57% on orteronel and 4% on placebo. Toxicity was mainly mild, one patient on orteronel developed transient grade 3 adrenal insufficiency and one grade 4 pneumonitis. CONCLUSIONS Orteronel significantly prolongs EFS in men with mCRPC who achieve disease stabilization with docetaxel. The concept of switch maintenance therapy in mCRPC warrants further research. Prostate 76:1519-1527, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Richard Cathomas
- Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland.
| | - Simon J Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
| | - Michael Mark
- Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | | | - Christian Rothermundt
- Department of Oncology/Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Tony Elliott
- Department of Oncology, The Christie Clinic, Manchester, United Kingdom
| | | | | | | | | | | | - Enrico Roggero
- Department of Oncology, Bellinzona IOSI, Bellinzona, Switzerland
| | - Markus G Mohaupt
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, Bern, Switzerland
| | - Jürg Bernhard
- International Breast Cancer Study Group Coordinating Center Bern and University Hospital, Inselspital Bern, Switzerland
| | | | - Silke Gillessen
- Department of Oncology/Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Mohaupt MG, Arampatzis S, Atkinson N, Yi D, Cui XW, Ignee A, Dietrich CF. Comments and extensions to EFSUMB guidelines on renal interventional ultrasound (INVUS). Med Ultrason 2016; 18:351-361. [PMID: 27622413 DOI: 10.11152/mu.2013.2066.183.moh] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The substantial evidence base for interventional ultrasound approaches to renal diagnostic sampling and therapeutic access exists. This review comments on the evidence-based recommendations on ultrasound-guided renal access which have been published recently within the framework of Guidelines on Interventional Ultrasound (InVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) from a clinical practice point of view. Specific aspects of tissue handling and workup, procedural approach and patient interaction are discussed. Indications, contraindications, risk factors and methods to reduce these risks are considered.
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Affiliation(s)
- Markus G Mohaupt
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, Switzerland
| | - Spyridon Arampatzis
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, Berne, Switzerland
| | - Nathan Atkinson
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
| | - Dong Yi
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Andre Ignee
- Department of Internal Medicine, Caritas Hospital, Bad Mergentheim, Germany
| | - Christoph F Dietrich
- Department of Internal Medicine, Caritas Hospital, Bad Mergentheim, Germany;Sino-German Research Center of Ultrasound in Medicine, The first affiliated Hospital of Zhengzhou University, China.
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Pecks U, Rath W, Kleine-Eggebrecht N, Maass N, Voigt F, Goecke TW, Mohaupt MG, Escher G. Maternal Serum Lipid, Estradiol, and Progesterone Levels in Pregnancy, and the Impact of Placental and Hepatic Pathologies. Geburtshilfe Frauenheilkd 2016; 76:799-808. [PMID: 27582578 DOI: 10.1055/s-0042-107078] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Lipids and steroid hormones are closely linked. While cholesterol is the substrate for (placental) steroid hormone synthesis, steroid hormones regulate hepatic lipid production. The aim of this study was to quantify circulating steroid hormones and lipid metabolites, and to characterize their interactions in normal and pathological pregnancies with a focus on hepatic and placental pathologies. METHODS A total of 216 serum samples were analyzed. Group A consisted of 32 patients with uncomplicated pregnancies who were analyzed at three different time-points in pregnancy (from the first through the third trimester) and once post partum. Group B consisted of 36 patients (24th to 42nd week of gestation) with pregnancy pathologies (IUGR n = 10, preeclampsia n = 13, HELLP n = 6, intrahepatic cholestasis n = 7) and 31 controls with uncomplicated pregnancies. Steroid profiles including estradiol, progesterone, and dehydroepiandrosterone were measured by GC-MS and compared with lipid concentrations. RESULTS In Group A, cholesterol and triglycerides correlated positively with estradiol (cholesterol ρ = 0.50, triglycerides ρ = 0.57) and progesterone (ρ = 0.49, ρ = 0.53) and negatively with dehydroepiandrosterone (ρ = - 0.47, ρ = - 0.38). Smoking during pregnancy affected estradiol concentrations, leading to lower levels in the third trimester compared to non-smoking patients (p < 0.05). In Group B, cholesterol levels were found to be lower in IUGR pregnancies and in patients with HELLP syndrome compared to controls (p < 0.05). Steroid hormone concentrations of estradiol (p < 0.05) and progesterone (p < 0.01) were lower in pregnancies with IUGR. DISCUSSION Lipid and steroid levels were affected most in IUGR pregnancies, while only minor changes in concentrations were observed for other pregnancy-related disorders. Each of the analyzed entities displayed specific changes. However, since the changes were most obvious in pregnancies complicated by IUGR and only minor changes were observed in pregnancies where patients had impaired liver function, our data suggests that placental rather than maternal hepatic function strongly determines lipid and steroid levels in pregnancy.
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Affiliation(s)
- U Pecks
- Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - W Rath
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - N Kleine-Eggebrecht
- Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
| | - N Maass
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Voigt
- Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
| | - T W Goecke
- Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
| | - M G Mohaupt
- Department of Nephrology, Hypertension and Clinical Pharmacology and Department of Clinical Research, Inselspital University Hospital Bern, Bern, Switzerland
| | - G Escher
- Department of Nephrology, Hypertension and Clinical Pharmacology and Department of Clinical Research, Inselspital University Hospital Bern, Bern, Switzerland
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Mistry HD, Eisele N, Escher G, Rudloff S, Gennari-Moser C, Mohaupt MG. 51 Differences in sodium intake determine the blood pressure phenotype in pregnant rats. Pregnancy Hypertens 2016. [DOI: 10.1016/j.preghy.2016.08.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Mistry HD, Kurlak LO, Dick B, Escher G, Broughton Pipkin F, Mohaupt MG. SP095REDUCED POSTPARTUM URINARY STEROID HORMONE SYNTHESIS IN WOMEN WHO HAVE EXPERIENCED GESTATIONAL HYPERTENSION OR PRE-ECLAMPSIA DURING PREGNANCY. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw159.04] [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: 11/12/2022] Open
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23
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Eisele N, Mistry HD, Escher G, Rudloff S, Mohaupt MG, Gennari-Moser C. SP075DIFFERENCES IN SODIUM INTAKE DETERMINE THE BLOOD PRESSURE PHENOTYPE OF PREGNANT RATS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw158.03] [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: 11/14/2022] Open
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Eisele N, Albrecht C, Mistry HD, Dick B, Baumann M, Surbek D, Currie G, Delles C, Mohaupt MG, Escher G, Gennari-Moser C. Placental expression of the angiogenic placental growth factor is stimulated by both aldosterone and simulated starvation. Placenta 2016; 40:18-24. [PMID: 27016778 DOI: 10.1016/j.placenta.2016.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 12/28/2022]
Abstract
Aldosterone is an important factor supporting placental growth and fetal development. Recently, expression of placental growth factor (PlGF) has been observed in response to aldosterone exposure in different models of atherosclerosis. Thus, we hypothesized that aldosterone up-regulates growth-adaptive angiogenesis in pregnancy, via increased placental PlGF expression. We followed normotensive pregnant women (n = 24) throughout pregnancy and confirmed these results in a second independent first trimester cohort (n = 36). Urinary tetrahydroaldosterone was measured by gas chromatography-mass spectrometry and corrected for creatinine. Circulating PlGF concentrations were determined by ELISA. Additionally, cultured cell lines, adrenocortical H295R and choriocarcinoma BeWo cells, as well as primary human third trimester trophoblasts were tested in vitro. PlGF serum concentrations positively correlated with urinary tetrahydroaldosterone corrected for creatinine in these two independent cohorts. This observation was not due to PlGF, which did not induce aldosterone production in cultured H295R cells. On the other hand, PlGF expression was specifically enhanced by aldosterone in the presence of forskolin (p < 0.01) in trophoblasts. A pronounced stimulation of PlGF expression was observed with reduced glucose concentrations simulating starvation (p < 0.001). In conclusion, aldosterone stimulates placental PlGF production, enhancing its availability during human pregnancy, a response amplified by reduced glucose supply. Given the crucial role of PlGF in maintaining a healthy pregnancy, these data support a key role of aldosterone for a healthy pregnancy outcome.
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Affiliation(s)
- Nicole Eisele
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
| | - Christiane Albrecht
- Institute for Biochemistry and Molecular Medicine, University of Bern, 3010 Berne, Switzerland; Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, 3010 Berne, Switzerland
| | - Hiten D Mistry
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
| | - Bernhard Dick
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
| | - Marc Baumann
- Department of Obstetrics and Gynecology, University Hospital Bern, University of Bern, 3010 Berne, Switzerland; Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, 3010 Berne, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University Hospital Bern, University of Bern, 3010 Berne, Switzerland; Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, 3010 Berne, Switzerland
| | - Gemma Currie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Markus G Mohaupt
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland.
| | - Geneviève Escher
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
| | - Carine Gennari-Moser
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
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Pruijm M, Ponte B, Ackermann D, Paccaud F, Guessous I, Ehret G, Pechère-Bertschi A, Vogt B, Mohaupt MG, Martin PY, Youhanna SC, Nägele N, Vollenweider P, Waeber G, Burnier M, Devuyst O, Bochud M. Associations of Urinary Uromodulin with Clinical Characteristics and Markers of Tubular Function in the General Population. Clin J Am Soc Nephrol 2015; 11:70-80. [PMID: 26683888 DOI: 10.2215/cjn.04230415] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [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: 04/20/2015] [Accepted: 09/15/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Allelic variants in UMOD, the gene coding for uromodulin, are associated with rare tubulointerstitial kidney disorders and risk of CKD and hypertension in the general population. The factors associated with uromodulin excretion in the normal population remain largely unknown, and were therefore explored in this study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Urinary uromodulin excretion was measured using a validated ELISA in two population-based cohorts that included more than 6500 individuals. The Swiss Kidney Project on Genes in Hypertension study (SKIPOGH) included 817 adults (mean age±SD, 45±17 years) who underwent renal ultrasonography and performed a 24-hour urine collection. The Cohorte Lausannoise study included 5706 adults (mean age, 53±11 years) with fresh spot morning urine samples. We calculated eGFRs using the CKD-Epidemiology Collaboration formula and by 24-hour creatinine clearance. RESULTS In both studies, positive associations were found between uromodulin and urinary sodium, chloride, and potassium excretion and osmolality. In SKIPOGH, 24-hour uromodulin excretion (median, 41 [interquartile range, 29-57] mg/24 h) was positively associated with kidney length and volume and with creatinine excretion and urine volume. It was negatively associated with age and diabetes. Both spot uromodulin concentration and 24-hour uromodulin excretion were linearly and positively associated (multivariate analyses) with eGFR<90 ml/min per 1.73 m(2). CONCLUSION Age, creatinine excretion, diabetes, and urinary volume are independent clinical correlates of urinary uromodulin excretion. The associations of uromodulin excretion with markers of tubular functions and kidney dimensions suggest that it may reflect tubule activity in the general population.
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Affiliation(s)
- Menno Pruijm
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Belen Ponte
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Daniel Ackermann
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Fred Paccaud
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Idris Guessous
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Georg Ehret
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | | | - Bruno Vogt
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Markus G Mohaupt
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Pierre-Yves Martin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sonia C Youhanna
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Nadine Nägele
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Peter Vollenweider
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Gérard Waeber
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michel Burnier
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Olivier Devuyst
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Murielle Bochud
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
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Broughton Pipkin F, Mistry HD, Roy C, Dick B, Waugh J, Chikhi R, Kurlak LO, Mohaupt MG. Born from pre-eclamptic pregnancies predisposes infants to altered cortisol metabolism in the first postnatal year. Endocr Connect 2015; 4:233-41. [PMID: 26378058 PMCID: PMC4621850 DOI: 10.1530/ec-15-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/16/2015] [Indexed: 11/15/2022]
Abstract
Pre-eclampsia leads to disturbed fetal organ development, including metabolic syndrome, attributed to altered pituitary-adrenal feedback loop. We measured cortisol metabolites in infants born from pre-eclamptic and normotensive women and hypothesised that glucocorticoid exposure would be exaggerated in the former. Twenty-four hour urine was collected from infants at months 3 and 12. Cortisol metabolites and apparent enzyme activities were analysed by gas chromatography-mass spectrometry. From 3 to 12 months, excretion of THS, THF and pregnandiol had risen in both groups; THF also rose in the pre-eclamptic group. No difference was observed with respect to timing of the visit or to hypertensive status for THE or total F metabolites (P>0.05). All apparent enzymes activities, except 17α-hydroxylase, were lower in infants at 12 compared to 3 months in the normotensive group. In the pre-eclamptic group, only 11β-HSD activities were lower at 12 months.17α-hydroxylase and 11β-HSD activities of tetrahydro metabolites were higher in the pre-eclamptic group at 3 months (P<0.05). 11β-hydroxylase activity increased in the pre-eclamptic group at 12 months. Cortisol excretion, determined by increased 11β-hydroxylase, compensates for high 11β-HSD-dependent cortisol degradation at 3 months and at 12 months counterbalances the reduced cortisol substrate availability in infants born from pre-eclamptic mothers.
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Affiliation(s)
- Fiona Broughton Pipkin
- Department of Obstetrics and GynaecologySchool of Medicine, University of Nottingham, Nottingham, NG5 1PB, UKDepartment of NephrologyHypertension and Clinical Pharmacology, Clinical Research, University of Bern, 3010 Berne, SwitzerlandLeicester Royal InfirmaryLeicester, LE1 5WW, UK
| | - Hiten D Mistry
- Department of Obstetrics and GynaecologySchool of Medicine, University of Nottingham, Nottingham, NG5 1PB, UKDepartment of NephrologyHypertension and Clinical Pharmacology, Clinical Research, University of Bern, 3010 Berne, SwitzerlandLeicester Royal InfirmaryLeicester, LE1 5WW, UK
| | - Chandrima Roy
- Department of Obstetrics and GynaecologySchool of Medicine, University of Nottingham, Nottingham, NG5 1PB, UKDepartment of NephrologyHypertension and Clinical Pharmacology, Clinical Research, University of Bern, 3010 Berne, SwitzerlandLeicester Royal InfirmaryLeicester, LE1 5WW, UK
| | - Bernhard Dick
- Department of Obstetrics and GynaecologySchool of Medicine, University of Nottingham, Nottingham, NG5 1PB, UKDepartment of NephrologyHypertension and Clinical Pharmacology, Clinical Research, University of Bern, 3010 Berne, SwitzerlandLeicester Royal InfirmaryLeicester, LE1 5WW, UK
| | - Jason Waugh
- Department of Obstetrics and GynaecologySchool of Medicine, University of Nottingham, Nottingham, NG5 1PB, UKDepartment of NephrologyHypertension and Clinical Pharmacology, Clinical Research, University of Bern, 3010 Berne, SwitzerlandLeicester Royal InfirmaryLeicester, LE1 5WW, UK
| | - Rebecca Chikhi
- Department of Obstetrics and GynaecologySchool of Medicine, University of Nottingham, Nottingham, NG5 1PB, UKDepartment of NephrologyHypertension and Clinical Pharmacology, Clinical Research, University of Bern, 3010 Berne, SwitzerlandLeicester Royal InfirmaryLeicester, LE1 5WW, UK
| | - Lesia O Kurlak
- Department of Obstetrics and GynaecologySchool of Medicine, University of Nottingham, Nottingham, NG5 1PB, UKDepartment of NephrologyHypertension and Clinical Pharmacology, Clinical Research, University of Bern, 3010 Berne, SwitzerlandLeicester Royal InfirmaryLeicester, LE1 5WW, UK
| | - Markus G Mohaupt
- Department of Obstetrics and GynaecologySchool of Medicine, University of Nottingham, Nottingham, NG5 1PB, UKDepartment of NephrologyHypertension and Clinical Pharmacology, Clinical Research, University of Bern, 3010 Berne, SwitzerlandLeicester Royal InfirmaryLeicester, LE1 5WW, UK
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Pecks U, Rath W, Mohaupt MG, Kleine-Eggebrecht N, Escher G, Maass N. Mütterliche Lipid- und Steroid-Hormon-Konzentrationen im Schwangerschaftsverlauf und bei Schwangerschaftspathologie. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566722] [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: 10/22/2022]
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Mistry HD, Eisele N, Escher G, Dick B, Surbek D, Delles C, Currie G, Schlembach D, Mohaupt MG, Gennari-Moser C. Gestation-specific reference intervals for comprehensive spot urinary steroid hormone metabolite analysis in normal singleton pregnancy and 6 weeks postpartum. Reprod Biol Endocrinol 2015; 13:101. [PMID: 26337185 PMCID: PMC4559160 DOI: 10.1186/s12958-015-0100-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/27/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Normal pregnancy depends on pronounced adaptations in steroid hormone concentrations. Although in recent years, the understanding of these hormones in pregnancy has improved, the interpretation is hampered by insufficient reference values. Our aim was to establish gestation-specific reference intervals for spot urinary steroid hormone levels in normal singleton pregnancies and 6 weeks postpartum. METHODS Cross-sectional multicentre observational study. Women recruited between 2008 and 2013 at 3 University Hospitals in Switzerland (Bern), Scotland (Glasgow) and Austria (Graz). Spot urine was collected from healthy women undergoing a normal pregnancy (age, 16-45 years; mean, 31 years) attending routine antenatal clinics at gestation weeks 11, 20, and 28 and approximately 6 weeks postpartum. Urine steroid hormone levels were analysed using gas-chromatography mass spectrometry. Creatinine was also measured by routine analysis and used for normalisation. RESULTS From the results, a reference interval was calculated for each hormone metabolite at each trimester and 6 weeks postpartum. Changes in these concentrations between trimesters and postpartum were also observed for several steroid hormones and followed changes proposed for index steroid hormones. CONCLUSIONS Normal gestation-specific reference values for spot urinary steroid hormones throughout pregnancy and early postpartum are now available to facilitate clinical management and research approaches to steroid hormone metabolism in pregnancy and the early postpartum period.
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Affiliation(s)
- Hiten D Mistry
- Department of Nephrology, Hypertension, Clinical Pharmacology and Clinical Research, University of Bern, 3010, Berne, Switzerland
| | - Nicole Eisele
- Department of Nephrology, Hypertension, Clinical Pharmacology and Clinical Research, University of Bern, 3010, Berne, Switzerland
| | - Geneviève Escher
- Department of Nephrology, Hypertension, Clinical Pharmacology and Clinical Research, University of Bern, 3010, Berne, Switzerland
| | - Bernhard Dick
- Department of Nephrology, Hypertension, Clinical Pharmacology and Clinical Research, University of Bern, 3010, Berne, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University Hospital Bern, 3010, Berne, Switzerland
| | - Christian Delles
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Gemma Currie
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Dietmar Schlembach
- Vivantes Clinic Berlin-Neukölln, Department of Obstetrics, Berlin, Germany
| | - Markus G Mohaupt
- Department of Nephrology, Hypertension, Clinical Pharmacology and Clinical Research, University of Bern, 3010, Berne, Switzerland.
- Division of Hypertension, Department of Nephrology, Hypertension, Clinical Pharmacology and Clinical Research, University of Bern, CH-3010, Berne, Switzerland.
| | - Carine Gennari-Moser
- Department of Nephrology, Hypertension, Clinical Pharmacology and Clinical Research, University of Bern, 3010, Berne, Switzerland
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Mistry HD, Bramham K, Eisele N, Dick B, Gill CA, Poston L, Chappell LC, Mohaupt MG. SP110REDUCED URINARY ALDOSTERONE IN PRE-ECLAMPSIA, SUPERIMPOSED PRE-ECLAMPSIA COMPARED TO STANDARD- AND HIGH-RISK PREGNANT WOMEN. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv188.73] [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: 11/14/2022] Open
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30
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Mistry HD, Bramham K, Eisele N, Dick B, Poston L, Chappell LC, Mohaupt MG. Reduced urinary aldosterone in preeclampsia, superimposed pre-eclampsia compared to standard- and high-risk pregnant women. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1548693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Affiliation(s)
- Markus G Mohaupt
- From the Departments of Nephrology, Hypertension, Clinical Pharmacology, and Clinical Research, University of Bern, Berne, Switzerland.
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Lindner G, Funk GC, Leichtle AB, Fiedler GM, Schwarz C, Eleftheriadis T, Pasch A, Mohaupt MG, Exadaktylos AK, Arampatzis S. Impact of proton pump inhibitor use on magnesium homoeostasis: a cross-sectional study in a tertiary emergency department. Int J Clin Pract 2014; 68:1352-7. [PMID: 24898571 DOI: 10.1111/ijcp.12469] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 12/22/2013] [Accepted: 05/01/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To date, the use of proton pump inhibitors (PPIs) has been associated with a low risk of hypomagnesaemia and associated adverse outcomes. We hypothesised that a better risk estimate could be derived from a large cohort of outpatients admitted to a tertiary emergency department (ED). METHODS A cross-sectional study was performed in 5118 patients who had measurements of serum magnesium taken on admission to a large tertiary care ED between January 2009 and December 2010. Hypomagnesaemia was defined as a serum magnesium concentration < 0.75 mmol/l. Demographical data, serum electrolyte values, data on medication, comorbidities and outcome with regard to length of hospital stay and mortality were analysed. RESULTS Serum magnesium was normally distributed where upon 1246 patients (24%) were hypomagnesaemic. These patients had a higher prevalence of out-of-hospital PPI use and diuretic use when compared with patients with magnesium levels > 0.75 mmol/l (both p < 0.0001). In multivariable regression analyses adjusted for PPIs, diuretics, renal function and the Charlson comorbidity index score, the association between use of PPIs and risk for hypomagnesaemia remained significant (OR = 2.1; 95% CI: 1.54-2.85). While mortality was not directly related to low magnesium levels (p = 0.67), the length of hospitalisation was prolonged in these patients even after adjustment for underlying comorbid conditions (p < 0.0001). CONCLUSION Use of PPIs predisposes patients to hypomagnesaemia and such to prolonged hospitalisation irrespective of the underlying morbidity, posing a critical concern.
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Affiliation(s)
- G Lindner
- Department of Emergency Medicine, Inselspital University of Bern, Bern, Switzerland
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Pecks U, Kleine-Eggebrecht N, Goecke TW, Maass N, Mohaupt MG, Escher G, Rath W. Materiale Lipid- und Steroidhormon-Konzentrationen in der normalen und pathologischen Schwangerschaft. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pecks U, Rath W, Mohaupt MG, Hirshman S, Hütten M, Goecke TW, Schlembach D, Escher G, Maass N. Interaktionswege des fetalen Serums und der zellulären Cholesterin-Abgabe bei IUGR. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Gennari-Moser C, Escher G, Kramer S, Dick B, Eisele N, Baumann M, Raio L, Frey FJ, Surbek D, Mohaupt MG. Normotensive Blood Pressure in Pregnancy. Hypertension 2014; 63:362-8. [DOI: 10.1161/hypertensionaha.113.02320] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carine Gennari-Moser
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Geneviève Escher
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Simea Kramer
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Bernhard Dick
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Nicole Eisele
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Marc Baumann
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Luigi Raio
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Felix J. Frey
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Daniel Surbek
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Markus G. Mohaupt
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
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Ponte B, Pruijm M, Ackermann D, Vuistiner P, Eisenberger U, Guessous I, Rousson V, Mohaupt MG, Alwan H, Ehret G, Pechere-Bertschi A, Paccaud F, Staessen JA, Vogt B, Burnier M, Martin PY, Bochud M. Reference Values and Factors Associated With Renal Resistive Index in a Family-Based Population Study. Hypertension 2014; 63:136-42. [DOI: 10.1161/hypertensionaha.113.02321] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Increased renal resistive index (RRI) has been recently associated with target organ damage and cardiovascular or renal outcomes in patients with hypertension and diabetes mellitus. However, reference values in the general population and information on familial aggregation are largely lacking. We determined the distribution of RRI, associated factors, and heritability in a population-based study. Families of European ancestry were randomly selected in 3 Swiss cities. Anthropometric parameters and cardiovascular risk factors were assessed. A renal Doppler ultrasound was performed, and RRI was measured in 3 segmental arteries of both kidneys. We used multilevel linear regression analysis to explore the factors associated with RRI, adjusting for center and family relationships. Sex-specific reference values for RRI were generated according to age. Heritability was estimated by variance components using the ASSOC program (SAGE software). Four hundred women (mean age±SD, 44.9±16.7 years) and 326 men (42.1±16.8 years) with normal renal ultrasound had mean RRI of 0.64±0.05 and 0.62±0.05, respectively (
P
<0.001). In multivariable analyses, RRI was positively associated with female sex, age, systolic blood pressure, and body mass index. We observed an inverse correlation with diastolic blood pressure and heart rate. Age had a nonlinear association with RRI. We found no independent association of RRI with diabetes mellitus, hypertension treatment, smoking, cholesterol levels, or estimated glomerular filtration rate. The adjusted heritability estimate was 42±8% (
P
<0.001). In a population-based sample with normal renal ultrasound, RRI normal values depend on sex, age, blood pressure, heart rate, and body mass index. The significant heritability of RRI suggests that genes influence this phenotype.
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Affiliation(s)
- Belén Ponte
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Menno Pruijm
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Daniel Ackermann
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Philippe Vuistiner
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Ute Eisenberger
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Idris Guessous
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Valentin Rousson
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Markus G. Mohaupt
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Heba Alwan
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Georg Ehret
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Antoinette Pechere-Bertschi
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Fred Paccaud
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Jan A. Staessen
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Bruno Vogt
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Michel Burnier
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Pierre-Yves Martin
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Murielle Bochud
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
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Gennari-Moser C, Khankin EV, Escher G, Burkhard F, Frey BM, Karumanchi SA, Frey FJ, Mohaupt MG. Response to "Are aldosterone levels inappropriately low in preeclampsia"? Hypertension 2013; 62:e40. [PMID: 24288784 DOI: 10.1161/hypertensionaha.113.02063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gennari-Moser C, Khankin EV, Escher G, Burkhard F, Frey BM, Karumanchi SA, Frey FJ, Mohaupt MG. Vascular Endothelial Growth Factor-A and Aldosterone. Hypertension 2013; 61:1111-7. [DOI: 10.1161/hypertensionaha.111.00575] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aldosterone levels are markedly elevated during normal pregnancy but fall even though volume contracts when preeclampsia occurs. The level of aldosterone in either condition cannot be explained solely by the activity of the renin–angiotensin II system. In normal gestation, vascular endothelial growth factor (VEGF) is thought to maintain vascular health, but its role in adrenal hormone production is unknown. We hypothesized that the role of VEGF in the adrenal gland is to maintain vascular health and regulate aldosterone production. Here, we demonstrate that supernatant of endothelial cells grown in the presence of VEGF enhanced aldosterone synthase activity in human adrenocortical cells. VEGF either alone or combined with angiotensin II increased aldosterone production in adrenal cells. These data suggest that endothelial cell–dependent and independent activation of aldosterone is regulated by VEGF. In contrast to angiotensin II, VEGF did not upregulate the steroidogenic acute regulatory protein. Consistent with this observation, angiotensin II stimulated both aldosterone and cortisol synthesis from progesterone, whereas VEGF stimulated selectively aldosterone production. In rats, overexpression of soluble fms-like tyrosine kinase-1, an endogenous VEGF inhibitor, led to adrenocortical capillary rarefaction and fall in aldosterone concentrations that correlated inversely with soluble fms-like tyrosine kinase-1 levels. These findings may explain why aldosterone increases so markedly during normal gestation and why preeclampsia, a condition characterized by high soluble fms-like tyrosine kinase-1, is associated with inappropriately low aldosterone levels in spite of relatively lower plasma volumes.
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Affiliation(s)
- Carine Gennari-Moser
- From the Department of Nephrology, Hypertension and Clinical Pharmacology (C.G.-M., G.E., B.M.F., F.J.F., M.G.M.), and Division of Urology (F.B.), University Hospital Bern, Berne, Switzerland; and Department of Medicine, Division of Vascular and Molecular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K., S.A.K.)
| | - Eliyahu V. Khankin
- From the Department of Nephrology, Hypertension and Clinical Pharmacology (C.G.-M., G.E., B.M.F., F.J.F., M.G.M.), and Division of Urology (F.B.), University Hospital Bern, Berne, Switzerland; and Department of Medicine, Division of Vascular and Molecular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K., S.A.K.)
| | - Geneviève Escher
- From the Department of Nephrology, Hypertension and Clinical Pharmacology (C.G.-M., G.E., B.M.F., F.J.F., M.G.M.), and Division of Urology (F.B.), University Hospital Bern, Berne, Switzerland; and Department of Medicine, Division of Vascular and Molecular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K., S.A.K.)
| | - Fiona Burkhard
- From the Department of Nephrology, Hypertension and Clinical Pharmacology (C.G.-M., G.E., B.M.F., F.J.F., M.G.M.), and Division of Urology (F.B.), University Hospital Bern, Berne, Switzerland; and Department of Medicine, Division of Vascular and Molecular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K., S.A.K.)
| | - Brigitte M. Frey
- From the Department of Nephrology, Hypertension and Clinical Pharmacology (C.G.-M., G.E., B.M.F., F.J.F., M.G.M.), and Division of Urology (F.B.), University Hospital Bern, Berne, Switzerland; and Department of Medicine, Division of Vascular and Molecular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K., S.A.K.)
| | - S. Ananth Karumanchi
- From the Department of Nephrology, Hypertension and Clinical Pharmacology (C.G.-M., G.E., B.M.F., F.J.F., M.G.M.), and Division of Urology (F.B.), University Hospital Bern, Berne, Switzerland; and Department of Medicine, Division of Vascular and Molecular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K., S.A.K.)
| | - Felix J. Frey
- From the Department of Nephrology, Hypertension and Clinical Pharmacology (C.G.-M., G.E., B.M.F., F.J.F., M.G.M.), and Division of Urology (F.B.), University Hospital Bern, Berne, Switzerland; and Department of Medicine, Division of Vascular and Molecular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K., S.A.K.)
| | - Markus G. Mohaupt
- From the Department of Nephrology, Hypertension and Clinical Pharmacology (C.G.-M., G.E., B.M.F., F.J.F., M.G.M.), and Division of Urology (F.B.), University Hospital Bern, Berne, Switzerland; and Department of Medicine, Division of Vascular and Molecular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K., S.A.K.)
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Eisele N, Gennari-Moser C, Albrecht C, Baumann M, Surbek D, Mohaupt MG. PP010. Does aldosterone participate in placental angiogenesis via PLGF? Pregnancy Hypertens 2012; 2:245. [PMID: 26105333 DOI: 10.1016/j.preghy.2012.04.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Angiogenic signals are a vital signal of placental integrity. Aldosterone has recently been shown to enhance placental growth factor (PlGF) expression in the peripheral vasculature [1] and to promote trophoblast growth [2]. The plgf gene possesses a functional mineralocorticoid receptor responsive element in the promoter region. OBJECTIVES Thus, we hypothesized that aldosterone adapts placental angiogenesis to trophoblast growth by secreting PlGF. METHODS The human choriocarcinoma cell line BeWo and first and third trimester human primary trophoblasts cells were subjected to several syncytialization signals. Upon visual confirmation, the cultured cells were subjected to either control conditions, the known stimulator forskolin, and increasing amounts of aldosterone (10(-9) to 10(-6)M) with and without the competitive aldosterone receptor blocker spironolactone. After 6 and 24h of incubation, RNA and protein were extracted. PlGF transcripts were quantified by Taqman PCR normalized to several housekeeping genes. Protein expression was quantified by ELISA. RESULTS PlGF mRNA expression increased 3-fold with forskolin in BeWo cells. In this cell line, aldosterone could slightly stimulate PlGF production. In non-syncytialized primary human first trimester trophoblasts, aldosterone did not exert a specific effect. In contrast, the term primary human trophoblasts did respond with a 2.5-fold increase after incubation with aldosterone (10(-7)M) in the presence of forskolin to allow forming a syncytial layer. PlGF protein was already slightly upregulated following 6h of incubation with aldosterone. CONCLUSION We concluded that aldosterone does regulate PlGF expression in specified conditions during pregnancy. Inappropriately low aldosterone levels such as in preeclampsia might such not only compromise plasma volume and trophoblast growth but also placental vascularization and systemic PlGF availability. These observations merit further investigation.
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Affiliation(s)
- N Eisele
- Klinik für Nephrologie/Hypertonie, Universität Bern, Switzerland
| | - C Gennari-Moser
- Klinik für Nephrologie/Hypertonie, Universität Bern, Switzerland
| | - C Albrecht
- Institute of Biochemistry and Molecular Medicine, Switzerland
| | - M Baumann
- Division of Obstetrics, University Women's Hospital Bern, Switzerland
| | - D Surbek
- Division of Obstetrics, University Women's Hospital Bern, Switzerland
| | - M G Mohaupt
- Klinik für Nephrologie/Hypertonie, Inselspital, Universität Bern, Bern, Switzerland
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Gennari-Moser C, Khankin EV, Escher G, Burkhard F, Frey BM, Karumanchi AS, Frey FJ, Mohaupt MG. OS067. VEGF, a novel stimulator of aldosterone production. Pregnancy Hypertens 2012; 2:213. [PMID: 26105281 DOI: 10.1016/j.preghy.2012.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Adrenal aldosterone production depends upon capillary integrity. Inadequately explained by increased renin secretion, aldosterone is high in pregnancy, a proangiogenic state. In preeclampsia, low aldosterone levels coincide with disturbed endothelial integrity due to disrupted VEGF signaling. OBJECTIVES We hypothesized that the stimulation of adrenal aldosterone production is VEGF-sensitive. METHODS We cultured endothelial cells (EC) in the presence and absence of VEGF. The supernatent was transferred to cultured adrenal cells, either the cell line H295R or isolated primary human adrenal cells from zona glomerulosa. aldosterone synthase mRNA and protein expression, aldosterone synthesis was assessed by adding radioactive labeled precursors or measuring aldosterone in the supernatent by Elisa. Cells were cultured either with angiotensin II (Ang II), VEGF or a combination hereof. Adenovirus-based overexpression of the soluble VEGF receptor type 1 (sFlt-1) was used to simulated conditions of preeclampsia in rats and its effect on the adrenocortical vasculature and circulating aldosterone levels. RESULTS EC conditioning in the presence of VEGF enhanced aldosterone synthase activity in human adrenocortical cells. VEGF either alone or combined with Ang II increased aldosterone synthase transcription, enzyme availability and aldosterone production in adrenal cells. Neuropilin-1 and VEGF receptor expression differed only for Flt-1 which was present in ECs but not in adrenocortical cells. In contrast to Ang II, VEGF did not upregulate the steroidogenic acute regulatory protein. In line with this observation, Ang II stimulated both aldosterone and cortisol synthesis from progesterone whereas VEGF preferably the former. In rats, overexpression of sFlt-1 which traps VEGF led to adrenocortical capillary rarefaction. Serum aldosterone concentrations inversely correlated with sFlt-1 levels. CONCLUSION In conclusion, VEGF stimulates aldosterone production indirectly via ECs and directlyin adrenocortical cells a finding explaining the increased aldosterone/renin ratio in normal pregnancy. It is reasonable to assume that the inappropriately low aldosterone availability in preeclampsia is a consequence of the known disturbed VEGF signaling.
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Affiliation(s)
- C Gennari-Moser
- Nephrology/Hypertension, University of Bern, Bern, Switzerland
| | - E V Khankin
- Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
| | - G Escher
- Urology, University of Bern, Bern, Switzerland
| | | | - B M Frey
- Nephrology/Hypertension, University of Bern, Bern, Switzerland
| | - A S Karumanchi
- Nephrology/Hypertension, University of Bern, Bern, Switzerland
| | - F J Frey
- University of Bern, Bern, Switzerland
| | - M G Mohaupt
- Nephrology/Hypertension, University of Bern, Bern, Switzerland
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Schmidli J, Mohaupt MG. [Drug-independent blood pressure control through the autonomous nervous system]. Ther Umsch 2012; 69:325-9. [PMID: 22547365 DOI: 10.1024/0040-5930/a000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Arterial hypertension is a chronic disease with a therapeutical challenge for the patient and the physician involved. Patient-independent techniques with good efficacy and tolerability are wanted. The autonomous nervous system insufficiently therapeutically exploited to date, is now approachable by two types of intervention: renal nerve ablation, an endovascular approach without remaining foreign body, and BAT, baroreflex activating therapy using an implantable device stimulating the carotid sinus. The blood pressure lowering potency of BAT appears more than with renal nerve ablation and also clinical study data are more prevalent. With both treatment options the patients having the most profit are insufficiently defined. Given this knowledge, any form of secondary hypertension needs to be excluded beforehand.
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Affiliation(s)
- Jürg Schmidli
- Klinik für Vaskuläre Chirurgie, Universitätsspital Bern
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Gennari-Moser C, Khankin EV, Schüller S, Escher G, Frey BM, Portmann CB, Baumann MU, Lehmann AD, Surbek D, Karumanchi SA, Frey FJ, Mohaupt MG. Regulation of placental growth by aldosterone and cortisol. Endocrinology 2011; 152:263-71. [PMID: 21068161 DOI: 10.1210/en.2010-0525] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [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] [Indexed: 11/19/2022]
Abstract
During pregnancy, trophoblasts grow to adapt the feto-maternal unit to fetal requirements. Aldosterone and cortisol levels increase, the latter being inactivated by a healthy placenta. By contrast, preeclamptic placental growth is reduced while aldosterone levels are low and placental cortisol tissue levels are high due to improper deactivation. Aldosterone acts as a growth factor in many tissues, whereas cortisol inhibits growth. We hypothesized that in preeclampsia low aldosterone and enhanced cortisol availability might mutually affect placental growth and function. Proliferation of cultured human trophoblasts was time- and dose-dependently increased with aldosterone (P < 0.04 to P < 0.0001) and inhibited by spironolactone and glucocorticoids (P < 0.01). Mineralo- and glucocorticoid receptor expression and activation upon agonist stimulation was verified by visualization of nuclear translocation of the receptors. Functional aldosterone deficiency simulated in pregnant mice by spironolactone treatment (15 μg/g body weight/day) led to a reduced fetal umbilical blood flow (P < 0.05). In rat (P < 0.05; R(2) = 0.2055) and human (X(2) = 3.85; P = 0.0249) pregnancy, placental size was positively related to plasma aldosterone. Autocrine production of these steroid hormones was excluded functionally and via the absence of specific enzymatic transcripts for CYP11B2 and CYP11B1. In conclusion, activation of mineralocorticoid receptors by maternal aldosterone appears to be required for trophoblast growth and a normal feto-placental function. Thus, low aldosterone levels and enhanced cortisol availability may be one explanation for the reduced placental size in preeclampsia and related disorders.
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Affiliation(s)
- Carine Gennari-Moser
- Department of Nephrology/Hypertension, University Hospital Bern, 3010 Berne, Switzerland
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Scheffers IJM, Kroon AA, Schmidli J, Jordan J, Tordoir JJM, Mohaupt MG, Luft FC, Haller H, Menne J, Engeli S, Ceral J, Eckert S, Erglis A, Narkiewicz K, Philipp T, de Leeuw PW. Novel baroreflex activation therapy in resistant hypertension: results of a European multi-center feasibility study. J Am Coll Cardiol 2010; 56:1254-8. [PMID: 20883933 DOI: 10.1016/j.jacc.2010.03.089] [Citation(s) in RCA: 238] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 03/08/2010] [Accepted: 03/09/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study assessed the safety and efficacy of a novel implantable device therapy in resistant hypertension patients. BACKGROUND Despite the availability of potent antihypertensive drugs, a substantial proportion of patients remain hypertensive. A new implantable device (Rheos system, CVRx, Inc., Minneapolis, Minnesota) that activates the carotid baroreflex may help these patients. METHODS Forty-five subjects with systolic blood pressure ≥160 mm Hg or diastolic ≥90 mm Hg despite at least 3 antihypertensive drugs were enrolled in a prospective, nonrandomized feasibility study to assess whether Rheos therapy could safely lower blood pressure. Subjects were followed up for as long as 2 years. An external programmer was used to optimize and individualize efficacy. RESULTS Baseline mean blood pressure was 179/105 mm Hg and heart rate was 80 beats/min, with a median of 5 antihypertensive drugs. After 3 months of device therapy, mean blood pressure was reduced by 21/12 mm Hg. This result was sustained in 17 subjects who completed 2 years of follow-up, with a mean reduction of 33/22 mm Hg. The device exhibited a favorable safety profile. CONCLUSIONS The Rheos device sustainably reduces blood pressure in resistant hypertensive subjects with multiple comorbidities receiving numerous medications. This unique therapy offers a safe individualized treatment option for these high-risk subjects. This novel approach holds promise for patients with resistant hypertension and is currently under evaluation in a prospective, placebo-controlled clinical trial.
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Affiliation(s)
- Ingrid J M Scheffers
- University Hospital Maastricht and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
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Arampatzis S, Stefanidis I, Lakiopoulos V, Raio L, Surbek D, Mohaupt MG. Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature. Thromb J 2010; 8:12. [PMID: 20565738 PMCID: PMC2909175 DOI: 10.1186/1477-9560-8-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 06/17/2010] [Indexed: 11/16/2022] Open
Abstract
Normal pregnancy corresponds to a procoagulant state. Acute myocardial infarction during pregnancy is rare, yet considering the low non-pregnant risk score of childbearing women it is still surprisingly frequent. We report a case of postpartum recurrent non-ST elevation myocardial infarction in a 40-year-old caucasian woman with essential thrombocythaemia in the presence of a positive JAK-2 mutation and an elevated anti-cardiolipin IgM antibody titer. In the majority of cases of myocardial infarction in pregnancy or in the peripartal period, atherosclerosis, a thrombus or coronary artery dissection is observed. The combination of essential thrombocythaemia and elevated anti-cardiolipin IgM antibody titer in the presence of several cardiovascular risk factors seems to be causative in our case. In conclusion, with the continuing trend of childbearing at older ages, rare or unlikely conditions leading to severe events such as myocardial infarction must be considered in pregnant women.
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Affiliation(s)
- Spyridon Arampatzis
- Department of Nephrology/Hypertension, University of Bern, Berne, Switzerland.
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Draeger A, Sanchez-Freire V, Monastyrskaya K, Hoppeler H, Mueller M, Breil F, Mohaupt MG, Babiychuk EB. Statin therapy and the expression of genes that regulate calcium homeostasis and membrane repair in skeletal muscle. Am J Pathol 2010; 177:291-9. [PMID: 20489141 DOI: 10.2353/ajpath.2010.091140] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In skeletal muscle of patients with clinically diagnosed statin-associated myopathy, discrete signs of structural damage predominantly localize to the T-tubular region and are suggestive of a calcium leak. The impact of statins on skeletal muscle of non-myopathic patients is not known. We analyzed the expression of selected genes implicated in the molecular regulation of calcium and membrane repair, in lipid homeostasis, myocyte remodeling and mitochondrial function. Microscopic and gene expression analyses were performed using validated TaqMan custom arrays on skeletal muscle biopsies of 72 age-matched subjects who were receiving statin therapy (n = 38), who had discontinued therapy due to statin-associated myopathy (n = 14), and who had never undergone statin treatment (n = 20). In skeletal muscle, obtained from statin-treated, non-myopathic patients, statins caused extensive changes in the expression of genes of the calcium regulatory and the membrane repair machinery, whereas the expression of genes responsible for mitochondrial function or myocyte remodeling was unaffected. Discontinuation of treatment due to myopathic symptoms led to a normalization of gene expression levels, the genes encoding the ryanodine receptor 3, calpain 3, and dystrophin being the most notable exceptions. Hence, even in clinically asymptomatic (non-myopathic) patients, statin therapy leads to an upregulation in the expression of genes that are concerned with skeletal muscle regulation and membrane repair.
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Affiliation(s)
- Annette Draeger
- Institute of Anatomy, University of Bern, Baltzerstr. 2, 3012 Bern, Switzerland.
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Mohaupt MG, Karas RH, Babiychuk EB, Sanchez-Freire V, Monastyrskaya K, Iyer L, Hoppeler H, Breil F, Draeger A. Association between statin-associated myopathy and skeletal muscle damage. CMAJ 2009; 181:E11-8. [PMID: 19581603 DOI: 10.1503/cmaj.081785] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Many patients taking statins often complain of muscle pain and weakness. The extent to which muscle pain reflects muscle injury is unknown. METHODS We obtained biopsy samples from the vastus lateralis muscle of 83 patients. Of the 44 patients with clinically diagnosed statin-associated myopathy, 29 were currently taking a statin, and 15 had discontinued statin therapy before the biopsy (minimal duration of discontinuation 3 weeks). We also included 19 patients who were taking statins and had no myopathy, and 20 patients who had never taken statins and had no myopathy. We classified the muscles as injured if 2% or more of the muscle fibres in a biopsy sample showed damage. Using reverse transcriptase polymerase chain reaction, we evaluated the expression levels of candidate genes potentially related to myocyte injury. RESULTS Muscle injury was observed in 25 (of 44) patients with myopathy and in 1 patient without myopathy. Only 1 patient with structural injury had a circulating level of creatine phosphokinase that was elevated more than 1950 U/L (10x the upper limit of normal). Expression of ryanodine receptor 3 was significantly upregulated in patients with biopsy evidence of structural damage (1.7, standard error of the mean 0.3). INTERPRETATION Persistent myopathy in patients taking statins reflects structural muscle damage. A lack of elevated levels of circulating creatine phosphokinase does not rule out structural muscle injury. Upregulation of the expression of ryanodine receptor 3 is suggestive of an intracellular calcium leak.
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Affiliation(s)
- Markus G Mohaupt
- Department of Nephrology and Hypertension, Inselspital, University of Bern, Bern, Switzerland
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Vincenti M, von Vigier RO, Wühl E, Mohaupt MG, Simonetti GD. The ambulatory arterial stiffness index is not affected by night-time blood pressure characteristics. J Hum Hypertens 2009; 23:680-2. [DOI: 10.1038/jhh.2009.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Aufdenblatten M, Baumann M, Raio L, Dick B, Frey BM, Schneider H, Surbek D, Hocher B, Mohaupt MG. Prematurity is related to high placental cortisol in preeclampsia. Pediatr Res 2009; 65:198-202. [PMID: 19047954 DOI: 10.1203/pdr.0b013e31818d6c24] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [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: 11/06/2022]
Abstract
Fetal growth is compromised in animal models with high cortisol availability. In healthy pregnancies, the fetus is protected from high circulating cortisol levels by the placental 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2), which is reduced in preeclampsia. We hypothesized increased placental cortisol availability in preeclampsia as missing link to fetal growth restriction and prematurity. Placental tissue was obtained from 39 pregnant women dichotomized normotensive (n = 16) or preeclamptic (n = 23). Placental steroid hormone metabolites were analyzed by gas chromatography-mass spectrometry. Apparent 11beta-HSD2 enzyme activity was calculated as substrate to product ratio. Estradiol and pregnandiol positively correlated with gestational age. Cortisol was virtually absent in 93.8% of controls, yet detectable in 79.3% of preeclamptic samples resulting in an odds ratio (OR) of 0.019 (95% CI 0.002-0.185) for the presence of placental cortisol. Apparent 11beta-HSD2 activity directly correlated with birth weight (R2 = 0.16; p < 0.02) and gestational age (R2 = 0.11; p < 0.04) ensuing a reduced risk of premature delivery (OR 0.12; 95% CI 0.02-0.58). We conclude that normotensive pregnancies are characterized by an almost completely inactivated placental cortisol. In line with our hypothesis, reduced 11beta-HSD2 activity in preeclampsia is unable to abolish placental cortisol, a finding clearly associated with prematurity and low birth weight.
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Affiliation(s)
- Myriam Aufdenblatten
- Department of Nephrology and Hypertension, University of Bern, 3010 Berne, Switzerland
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Escher G, Cristiano M, Causevic M, Baumann M, Frey FJ, Surbek D, Mohaupt MG. High aldosterone-to-renin variants of CYP11B2 and pregnancy outcome. Nephrol Dial Transplant 2009; 24:1870-5. [PMID: 19151144 DOI: 10.1093/ndt/gfn763] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increased aldosterone concentrations and volume expansion of normal pregnancies are hallmarks of normal pregnancies and blunted in pre-eclampsia. Accordingly, we hypothesized an active mineralocorticoid system to protect from pre-eclampsia. METHODS In pregnant women (normotensive n = 44; pre-eclamptic n = 48), blood pressure, urinary tetrahydro-aldosterone excretion and activating polymorphisms (SF-1 site and intron 2) of the aldosterone synthase gene (CYP11B2) were determined; 185 non-pregnant normotensive individuals served as control. Amino acid-changing polymorphisms of the DNA- and agonist-binding regions of the mineralocorticoid receptor were evaluated by RT-PCR, SSCP and sequencing. RESULTS Urinary tetrahydro-aldosterone excretion was reduced in pre-eclampsia as compared to normal pregnancy (P < 0.05). It inversely correlated with blood pressure (r = 0.99, P < 0.04). Homozygosity for activating CYP11B2 polymorphisms was preferably present in normotensive as compared to pre-eclamptic pregnancies, identified (intron 2, P = 0.005; SF-1 site, P = 0.016). Two mutant haplotypes decreased the risk of developing pre-eclampsia (RR 0.16; CI 0.05-0.54; P < 0.001). In contrast, intron 2 wild type predisposed to pre-eclampsia (P < 0.0015). No functional mineralocorticoid receptor mutant has been observed. CONCLUSIONS High aldosterone availability is associated with lower maternal blood pressure. In line with this observation, gain-of-function variants of the CYP11B2 reduce the risk of developing pre-eclampsia. Mutants of the mineralocorticoid receptor cannot explain the frequent syndrome of pre-eclampsia.
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Affiliation(s)
- Geneviève Escher
- Department of Nephrology/Hypertension, University of Bern, Berne, Switzerland
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Abstract
Arterial hypertension in adults is often associated with an increased arterial stiffness, which correlates with the ambulatory arterial stiffness index (AASI) as derived from ambulatory blood pressure (BP) measurements. The purpose of this study was to demonstrate whether children with diagnosed hypertension have an increased AASI as in hypertensive adults. AASI was calculated from 185 ambulatory BP measurements of 114 hypertensive and 71 normotensive, healthy children. Hypertensive children had higher AASI values compared with their normotensive healthy counterparts (0.370 +/- 0.120 versus 0.204 +/- 0.199, p < 0.0001). Children with longer duration of hypertension or a history of primary or secondary aortic coarctation displayed even more elevated AASI values. A receiver operator curve derived cut-off of AASI set at 0.301 distinguished (p < 0.0001) hypertensive from normotensive children with an odds ratio of 8.2, a sensitivity of 81%, and a specificity of 65%. Moreover, AASI correlated with pulse and systolic BP. In conclusion, AASI is elevated in hypertensive children and correlates with the duration and the origin of hypertension in childhood.
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Affiliation(s)
- Giacomo D Simonetti
- Division of Paediatric Nephrology, University of Bern, 3010 Berne, Switzerland
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