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Holmsten K, Eknert J, Öfverholm E, Papantoniou D, Jawdat F, Verbiéné I, Laurell A, Jänes E, Sandzén J, Wojtyna-Dziedzic E, Lagstam I, Söderkvist K, Costa Svedman F, Liedberg F, Bruzelius M, Fransson AS, Kjellström S, Omland LH, Pappot H, Ullén A. Treatment Patterns and Efficacy of Chemotherapy After Pembrolizumab in Advanced Urothelial Cancer-a Real-World Study in the pre-Antibody-Drug Conjugate Era. Clin Genitourin Cancer 2023; 21:e438-e448. [PMID: 37308329 DOI: 10.1016/j.clgc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have been established as a routine treatment in patients with metastatic urothelial cancer (mUC). However, there has been no standard of care after progression on ICIs. We investigated real-world treatment patterns and efficacy of chemotherapy (CHT) after pembrolizumab, in the era before introduction of maintenance avelumab and antibody-drug conjugates (ADC). PATIENTS AND METHODS An observational, retrospective study was conducted at twelve Nordic centers. Patients with mUC were treated according to investigator´s choice of CHT after pembrolizumab. Primary endpoint was overall response (ORR) and disease control rate (DCR); secondary endpoints were progression-free (PFS) and overall survival (OS). RESULTS In total, 102 patients were included whereof 23 patients received CHT after pembrolizumab as second line treatment (subcohort A) and 79 patients in third line (subcohort B). Platinum-gemcitabine combinations were the most common regimens in subcohort A, and vinflunine in subcohort B. The ORR and DCR were 36% and 47%, respectively. Presence of liver metastases was independently associated with lower ORR and DCR. The PFS and OS were 3.3 months and 7.7 months, respectively. Eastern Cooperative Oncology Group Performance Status (ECOG PS) and number of previous cycles of pembrolizumab were found to be independent prognostic factors associated with OS. CONCLUSION In a real-world setting, CHT showed clinically meaningful response rates and survival in mUC patients after progression with pembrolizumab. Clinical benefit may primarily be achieved in patients with favorable ECOG PS, in patients treated with > 6 cycles pembrolizumab as well as in patients without presence of liver metastases.
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Affiliation(s)
- Karin Holmsten
- Department of Oncology, S:t Görans Hospital, and Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.
| | - Johanna Eknert
- Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Theme Cancer, Karolinska University Hospital, and Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.
| | | | | | - Faith Jawdat
- Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Theme Cancer, Karolinska University Hospital, and Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Ingrida Verbiéné
- Department of Oncology, Akademiska University Hospital, Uppsala, Sweden
| | - Anna Laurell
- Department of Oncology, Akademiska University Hospital, Uppsala, Sweden
| | - Elin Jänes
- Department of Oncology, Sundsvall Härnösand County Hospital, Sundsvall, Sweden
| | - Johan Sandzén
- Department of Oncology, Karlstad County Hospital, Karlstad, Sweden
| | | | - Ida Lagstam
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Söderkvist
- Department of Oncology, Norrland University Hospital, Umeå, Sweden
| | - Fernanda Costa Svedman
- Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Theme Cancer, Karolinska University Hospital, and Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Martin Bruzelius
- Department of Oncology, Västmanland County Hospital, Västerås, Sweden
| | | | - Sofia Kjellström
- Department of Oncology, Skåne University Hospital, Malmö, Sweden
| | | | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Anders Ullén
- Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Theme Cancer, Karolinska University Hospital, and Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
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Yuan S, Mason AM, Bruzelius M, Akesson A, Burgess S, Larsson SC. Selenium concentration and cardiovascular disease risk: Mendelian randomization study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Selenium has been associated with cardiovascular disease (CVD) risk in observational studies; however, the causality of the association remains unestablished.
Purpose
To examine the associations of selenium concentrations with 15 CVDs using Mendelian randomization analysis.
Methods
Genetic variants significantly associated with concentrations of toenail and blood (TAB) and blood selenium in mild linkage disequilibrium (r2 <0.3) were used as instrumental variables. Summary-level data for 15 CVDs were obtained from the UK Biobank study (n=367,561), FinnGen study (n=218,792), and six international consortia. The inverse variance weighted method accounting for linkage disequilibrium was used to estimate the associations. Results for one outcome from different sources were combined using the fixed effect meta-analysis method. Bonferroni correction was used to account for multiple testing, and associations with P value ≤0.003 (0.05 / 15 outcomes) were described as significant. Associations with P value between ≤0.05 and >0.003 were regarded as suggestive associations.
Results
Genetically predicted concentrations of TAB selenium were not significantly associated with the risk of the 15 CVDs. However, there were suggestive associations of genetically predicted higher concentrations of TAB selenium with increased risk of atrial fibrillation and peripheral artery disease. The odds ratio per one-unit increase in log-transformed concentrations of TAB selenium was 1.07 (95% confidence interval, 1.01–1.12; P=0.019) for atrial fibrillation and 1.20 (95% confidence interval, 1.05–1.38; P=0.008) for peripheral artery disease. We observed no associations between genetically predicted blood selenium concentrations and risk of the 15 CVDs.
Conclusions
Genetically predicted higher concentrations of TAB or blood selenium were not associated with a lower risk of CVD, which suggests that high selenium status may not prevent CVD development. The suggestive positive associations of TAB selenium with atrial fibrillation and peripheral artery disease warrants verification.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Yuan
- Karolinska Institute, Institute of Environmental Medicine , Stockholm , Sweden
| | - A M Mason
- University of Cambridge, Department of Public Health and Primary Care , Cambridge , United Kingdom
| | - M Bruzelius
- Karolinska University Hospital, Department of Hematology , Stockholm , Sweden
| | - A Akesson
- Karolinska Institute, Institute of Environmental Medicine , Stockholm , Sweden
| | - S Burgess
- University of Cambridge, MRC Biostatistics Unit , Cambridge , United Kingdom
| | - S C Larsson
- Karolinska Institute, Institute of Environmental Medicine , Stockholm , Sweden
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Karandyszowska N, Oesman J, Alagündüz H, Magnusson M, Svenungsson E, Bruzelius M, Antovic A. AB0318 RISK FOR CONCOMITANT AUTOIMMUNITY IN PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME; A SWEDISH COHORT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In patients with the antiphospholipid syndrome (APS), concomitant systemic autoimmune rheumatic diseases (SARD) are common and often associated with more disease associated damage.Less is known about the prevalence of non-rheumatic autoimmune diseases (NRAID) in patients with APS.Objectives:To evaluate the incidence and prevalence of concomitant autoimmune diseases (AID) in a cohort of APS patients. The risk of AID was also evaluated with respect to the antiphospholipid antibodies (aPL) profiles.Methods:This retrospective cohort study comprises consecutive patients identified with APS through review of electronic medical records at Karolinska University Hospital, Sweden between 2014 and 2020. Exclusion criteria were misdiagnosis and age <18. Descriptive statistics was used for baseline data and multivariable Cox proportional hazard regression analysis to investigate the risk factors to develop new onset AID. Ethical approval was obtained from the Swedish Ethical Review Authority (2020-02333).Results:Of 271 included patients, 66% were women and the median age at diagnosis of APS was 43 years (IQR 31–55). At inclusion, 130 (48%) patients presented with other AID; 101 (37%) of them had a concomitant SARD while 54 (19%) had a NRAID. Systemic lupus erythematosus (SLE) was the most frequent in 30% of patients, followed by autoimmune thyroid disease (ATD) in 10% of patients.In addition, 35 (13%) APS-patients developed AID during the study period, corresponding to an incidence rate of 28.4 (95% CI; 19.3-40.3) per 1.000 person-years with mean time at risk of 4 (±2) years. Twenty-one (8%) patients developed a SARD and further 14 (5%) were diagnosed with a NRAID.The cumulative incidence for AID was significantly higher in patients with high titers of IgG aPL. Patients that developed SARD had significantly higher median titers of a-β2GPI IgG isotype, p=0.05. In the NRAID group, median a-β2GPI and aCL IgG isotypes were significantly increased, p=0.02 and p=0.04, respectively. The hazard ratio to develop diagnosis of AID was significantly increased in patients with high titers of the IgG isotype aPL (HR 2.4 95% CI; 1.1-5.3). Obstetric APS manifestations were associated with a significantly increased hazard ratio of 2.8 (95% CI; 1.1-7.7) to develop SARD, and also trendwise for AID, as a compound variable.During the study period, 52 patients had at least one new APS manifestation, as defined by the Sydney criteria (1). In comparison to patients without new manifestations, these patients had significantly higher median titers of aPL of the IgG isotype, and concomitant AID at first visit (p=0.01, p=0.02, respectively).Conclusion:APS patients are at high risk to develop other AID, and APS patients with concomitant AID had an increased risk to develop new clinical APS manifestations. These findings might be helpful when considering risk stratification and alternate treatment options in this patient group.References:[1]Miyakis S, Lockshin MD, Atsumi T et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295–306.Acknowledgements:I have no acknowledgements to declare.Disclosure of Interests:None declared
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Schmidt DE, Majeed A, Bruzelius M, Odeberg J, Holmström M, Ågren A. A prospective diagnostic accuracy study evaluating rotational thromboelastometry and thromboelastography in 100 patients with von Willebrand disease. Haemophilia 2016; 23:309-318. [DOI: 10.1111/hae.13121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2016] [Indexed: 01/15/2023]
Affiliation(s)
- D. E. Schmidt
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
- University Medical Center Utrecht; Utrecht The Netherlands
| | - A. Majeed
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - M. Bruzelius
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - J. Odeberg
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - M. Holmström
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - A. Ågren
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
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Bruzelius M, Bottai M, Sabater-Lleal M, Strawbridge RJ, Bergendal A, Silveira A, Sundström A, Kieler H, Hamsten A, Odeberg J. Predicting venous thrombosis in women using a combination of genetic markers and clinical risk factors. J Thromb Haemost 2015; 13:219-27. [PMID: 25472531 DOI: 10.1111/jth.12808] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/28/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family history of venous thromboembolism (VTE) has been suggested to be more useful in risk assessment than thrombophilia testing. OBJECTIVES We investigated established genetic susceptibility variants for association with VTE and evaluated a genetic risk score in isolation and combined with known trigger factors, including family history of VTE. PATIENTS/METHOD A total of 18 single nucleotide polymorphisms (SNPs) selected from the literature were genotyped in 2835 women participating in a Swedish nationwide case-control study (the ThromboEmbolism Hormone Study [TEHS]). Association with VTE was assessed by odds ratios (ORs) with 95% confidence interval (CI) using logistic regression. Clinical and genetic predictors that contributed significantly to the fit of the logistic regression model were included in the prediction models. SNP-SNP interactions were investigated and incorporated into the models if found significant. Risk scores were evaluated by calculating the area under the receiver-operating characteristics curve (AUC). RESULTS Seven SNPs (F5 rs6025, F2 rs1799963, ABO rs514659, FGG rs2066865, F11 rs2289252, PROC rs1799810 and KNG1 rs710446) with four SNP-SNP interactions contributed to the genetic risk score for VTE, with an AUC of 0.66 (95% CI, 0.64-0.68). After adding clinical risk factors, which included family history of VTE, the AUC reached 0.84 (95% CI, 0.82-0.85). The goodness of fit of the genetic and combined scores improved when significant SNP-SNP interaction terms were included. CONCLUSION Prediction of VTE in high-risk individuals was more accurate when a combination of clinical and genetic predictors with SNP-SNP interactions was included in a risk score.
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Affiliation(s)
- M Bruzelius
- Coagulation Unit, Hematology Centre, Karolinska University Hospital Solna, Stockholm, Sweden; Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet (KI), Stockholm, Sweden
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Vikerfors A, Mobarrez F, Bremme K, Holmström M, Ågren A, Eelde A, Bruzelius M, Antovic A, Wallén H, Svenungsson E. Studies of microparticles in patients with the antiphospholipid syndrome (APS). Lupus 2012; 21:802-5. [PMID: 22635239 DOI: 10.1177/0961203312437809] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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
OBJECTIVES To study circulating platelet, monocyte and endothelial microparticles (PMPs, MMPs and EMPs) in patients with antiphospholipid syndrome (APS) in comparison with healthy controls. MATERIAL AND METHOD Fifty-two patients with APS and 52 healthy controls were investigated. MPs were measured on a flow cytometer (Beckman Gallios) and defined as particles sized < 1.0 µm, negative to phalloidin, positive to lactadherin and positive to either CD42a (PMPs), CD144 (EMPs) or CD14 (MMPs). Exposure of CD142 (TF) was measured on CD144 positive MPs. RESULTS Total number of MPs (i.e. lactadherin positive particles) was higher in APS patients versus controls (p < 0.001). An increased number of EMPs (p < 0.001), increased TF-positive EMPs (p < 0.001) and increased MMPs (p < 0.001) were also observed. PMP numbers did not differ between the groups. None of the MP types differed in numbers between obstetric and thrombotic APS patients. CONCLUSION We observed a high number of EMPs expressing TF in APS patients. The numbers of MMPs and total EMPs were also higher as compared with healthy controls but in contrast to previous reports, the number of PMPs did not differ between groups.
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Affiliation(s)
- A Vikerfors
- Karolinska Institutet, Department of Medicine Solna, Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
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Tregouet DA, Sabater-Lleal M, Bruzelius M, Emmerich J, Amouyel P, Dartigues JF, Kieler H, Morange PE. Lack of association of non-synonymous FUT2 and ALPL polymorphisms with venous thrombosis. J Thromb Haemost 2012; 10:1693-5. [PMID: 22672431 DOI: 10.1111/j.1538-7836.2012.04807.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Hans Jacobsson
- Department of Radiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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Bruzelius M, Liedholm LJ, Hellblom M. [Celiac disease can be associated with severe neurological symptoms. Analysis of gliadin antibodies should be considered in suspected cases]. Lakartidningen 2001; 98:3538-42. [PMID: 11571796] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Celiac disease can be associated with a wide spectrum of neurological and psychiatric symptoms (cerebellar ataxia, neuromuscular manifestations, epilepsy, dementia), even in the absence of malabsorption or gastrointestinal symptoms. The case of a 72-year-old man with a rapidly progressive, lethal encephalopathy secondary to celiac disease is reported, together with a review of documented neurological symptoms in celiac disease. The aetiology of these neurological symptoms is unknown, although immunological mechanisms are suspected.
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Affiliation(s)
- M Bruzelius
- Medicinkliniken, Område medicin, Ostersunds lasarett
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Wuttge D, Bruzelius M, Lundahl A, Bergman T, Stemme S. Cellular immunity in atherosclerosis: T cells specifically recognize oxidatively derived aldehyde adducts. Atherosclerosis 2000. [DOI: 10.1016/s0021-9150(00)80893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Peroxidation of polyunsaturated fatty acids in lipoproteins and cell membrane phospholipids occurs in many situations in the body, both under normal and pathological conditions. Low-density lipoprotein is particularly prone to oxidation and is believed to be a pathogenetic component in atherogenesis. Both antibody responses and T-cell responses to oxidatively modified lipoproteins have been demonstrated in humans as well as in animal models. However, little is known about how these responses arise or how T cells recognize these antigens. In the present study, mice were immunized with homologous albumin covalently modified with a series of defined aldehydes which are known to be generated during lipid peroxidation. T-cell hybridomas from immunized animals demonstrated major histocompatibility complex-restricted and protein sequence-dependent responses to modified albumin, but not to native albumin. In addition to the response to modified epitopes, some aldehyde modifications resulted in strong antibody responses also to the non-modified protein. This T-cell-dependent break of tolerance constitutes a novel pathway for induction of autoimmunity by lipid peroxidation. The findings have implications in many situations where lipid peroxidation products are generated, including atherosclerosis and inflammatory and infectious diseases.
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Affiliation(s)
- D M Wuttge
- Cardiovascular Research Unit, Center for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden
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Hansson GK, Stemme S, Paulsson G, Zhou X, Bruzelius M, Caligiuri G, Nicoletti A, Sirsjö A, Wuttge D, Yan ZQ. 4.W20.2 Autoimmunity in atherosclerosis. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)89496-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Geng YJ, Holm J, Nygren S, Bruzelius M, Stemme S, Hansson GK. Expression of the macrophage scavenger receptor in atheroma. Relationship to immune activation and the T-cell cytokine interferon-gamma. Arterioscler Thromb Vasc Biol 1995; 15:1995-2002. [PMID: 7583581 DOI: 10.1161/01.atv.15.11.1995] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Scavenger receptors mediate internalization of modified lipoproteins and foam cell transformation of monocyte-derived cytokines. We investigated macrophage scavenger receptor (MSR) expression in monocyte-macrophages from human peripheral blood and in atherosclerotic lesions and analyzed its relationship to T lymphocytes and immunoregulatory cytokines by immunohistochemistry and polymerase chain reaction (PCR). Antibodies specific for the two MSR isoforms were generated by immunizing rabbits with isoform-specific synthetic peptides conjugated to keyhole limpet hemocyanin. In human atherosclerotic plaques, these antibodies stained macrophages and foam cells in a pattern that corresponded to the distribution of the macrophage marker CD68. CD3-positive T cells and alpha-actin-positive smooth muscle cells exhibited no reactivity to the anti-MSR antibodies. The frequency of cells stained with antibodies to MSR type I was equal to that of cells stained for type II, suggesting that most macrophages coexpress both isoforms. Reverse transcription (RT)-PCR analysis confirmed that both MSR isoforms were expressed in all plaques examined. There was, however, a tendency toward a lower immunohistochemical staining intensity for MSR type I and a decreased number of lipid-rich foam cells in T cell-rich areas. The mRNAs for interleukin-2 and interferon-gamma, two major products of activated T cells, were detected by RT-PCR in all plaques tested. This indicates that activation of T lymphocytes occurs in atherosclerotic plaques. Since interferon-gamma downregulates MSR expression, these observations suggest a potential mechanism for local regulation of MSR expression in the atherosclerotic plaque.
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Affiliation(s)
- Y J Geng
- Department of Laboratory Medicine, Gothenburg University, Sweden
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Bruzelius M. Inside the agencies:a report on a fact-finding mission to three countries in latin america. Disasters 1980; 4:45-47. [PMID: 20958444 DOI: 10.1111/j.1467-7717.1980.tb00244.x] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- M Bruzelius
- Director of the Swedish Special Units for Disaster Relief A broad Swedish Army Staff UN Department S-100 45 Stockholm Sweden
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