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Dolmaci OB, Hilhorst TL, Malekzadeh A, Mertens BJA, Klautz RJM, Poelmann RE, Grewal N. The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature. Aorta (Stamford) 2024. [PMID: 38698623 DOI: 10.1055/s-0044-1785190] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) patients is a debatable topic. Several studies have indicated that BAV patients have a lower prevalence of CAD compared with patients with a tricuspid aortic valve (TAV), but the effects of age and gender have not always been considered. This systematic review provides an overview of articles which report on CAD in BAV and TAV patients. Searches were executed in April 2021 and January 2022 according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines in three online databases: Medline, Embase, and Scopus. Screening and data extraction was done by two investigators separately. Primary and secondary outcomes were compared between BAV and TAV patients; a fixed effects model was used for correcting on confounders. Literature search yielded 1,529 articles with 44 being eligible for inclusion. BAV patients were younger (56.4 ± 8.3 years) than TAV patients (64 ± 10.3 years, p < 0.001). All CAD risk factors and CAD were more prevalent in TAV patients. No significant difference remained after correcting for age and gender as confounders. BAV patients have a lower prevalence of CAD and CAD risk factors compared with TAV patients. However, when the age differences between both groups are considered in the analyses, a similar prevalence of both CAD and CAD risk factors is found.
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Affiliation(s)
- Onur B Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Tijmen L Hilhorst
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arjan Malekzadeh
- Medical Library, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Bart J A Mertens
- Department of Statistics, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert E Poelmann
- Institute of Biology, Leiden University, Sylvius Laboratory, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Grewal N, Dolmaci OB, Klautz RJ, Poelmann RE. Sex differences in the histopathology of acute type A aortic dissections. Thorac Cardiovasc Surg 2024. [PMID: 38181821 DOI: 10.1055/a-2239-1741] [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: 01/07/2024]
Abstract
BACKGROUND While sex-related differences in cardiovascular surgery outcomes have increasingly garnered attention in the past decades, knowledge about sex disparities in the pathophysiology of acute type A aortic dissections (ATAADs) remains sparce. In this study, we evaluate the histopathologic and atherosclerotic lesions in female and male ATAAD patients. METHODS A total of 68 patients were studied: 51 ATAAD patients (mean age 62.5 ± 10.8 years, 49% women) and 17 control patients (mean age 63 ± 5.5 years, 53% women). Cardiovascular risk factors were assessed clinically. Intimal and medial histopathological features were systematically evaluated in all. RESULTS Compared to the control group, all ATAAD patients showed significantly more elastic fibre pathology, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration (p<0.0001). The intimal layer was significantly thinner in the ATAAD vs the control group (p<0.023), with the control group exhibiting significantly more progressive atherosclerotic lesions compared to the ATAAD patients. No difference in medial vessel wall pathology was seen between the sexes. As compared to male ATAAD patients, atherosclerotic lesions were more severe in female ATAAD patients, independent of age and the cardiovascular risk factor hypertension. CONCLUSIONS All ATAAD patients had a significantly thinner intimal layer and significantly diseased middle media compared to the control patients. Our results suggest that the severity of medial aortic pathology is not sex-specific in ATAAD patients. Intimal differences between sexes could however be considered as a potential risk factor for the development of an aortic dissection.
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Affiliation(s)
- Nimrat Grewal
- Cardiothoracic surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Onur Baris Dolmaci
- Cardiothoracic surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
- Cardiothoracic surgery, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Robert Jm Klautz
- Cardiothoracic surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
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Grewal N, Dolmaci O, Klautz A, Legue J, Driessen A, Klautz R, Poelmann R. The role of transforming growth factor beta in bicuspid aortic valve aortopathy. Indian J Thorac Cardiovasc Surg 2023; 39:270-279. [PMID: 38093932 PMCID: PMC10713891 DOI: 10.1007/s12055-023-01513-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 12/17/2023] Open
Abstract
A bicuspid aortic valve (BAV) is the most prevalent congenital cardiac deformity, which is associated with an increased risk to develop a thoracic aortic aneurysm and/or an aortic dissection as compared to persons with a tricuspid aortic valve. Due to the high prevalence of a BAV in the general population and the associated life-long increased risk for adverse vascular events, BAV disease places a considerable burden on the public health. The aim of the present review is to discuss the role of transforming growth factor beta (TGF-β) signaling in the development of the vascular wall and on how this complex signaling pathway may be involved in thoracic aortic aneurysm formation in tricuspid and BAV patients.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Onur Dolmaci
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Juno Legue
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Antoine Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Waldron C, Zafar MA, Ziganshin BA, Weininger G, Grewal N, Elefteriades JA. Evidence Accumulates: Patients with Ascending Aneurysms Are Strongly Protected from Atherosclerotic Disease. Int J Mol Sci 2023; 24:15640. [PMID: 37958625 PMCID: PMC10650782 DOI: 10.3390/ijms242115640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Ascending thoracic aortic aneurysms may be fatal upon rupture or dissection and remain a leading cause of death in the developed world. Understanding the pathophysiology of the development of ascending thoracic aortic aneurysms may help reduce the morbidity and mortality of this disease. In this review, we will discuss our current understanding of the protective relationship between ascending thoracic aortic aneurysms and the development of atherosclerosis, including decreased carotid intima-media thickness, low-density lipoprotein levels, coronary and aortic calcification, and incidence of myocardial infarction. We also propose several possible mechanisms driving this relationship, including matrix metalloproteinase proteins and transforming growth factor-β.
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Affiliation(s)
- Christina Waldron
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Mohammad A. Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Bulat A. Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
- Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, 420012 Kazan, Russia
| | - Gabe Weininger
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - John A. Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
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Grewal N, Klautz RJM, Poelmann RE. Intrinsic histological and morphological abnormalities of the pediatric thoracic aorta in bicuspid aortic valve patients are predictive for future aortopathy. Pathol Res Pract 2023; 248:154620. [PMID: 37392550 DOI: 10.1016/j.prp.2023.154620] [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: 05/18/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Patients with a bicuspid aortic valve (BAV) have an increased risk to develop aortic complications. Many studies are pointing towards a possible embryonic explanation for the development of both a bicuspid aortic valve as well as a defective ascending aortic wall in these patients. The fetal and newborn ascending aortic wall has however scarcely been studied in bicuspid aortic valve patients. We hypothesize that early histopathological defects might already be visible in the fetal and pediatric ascending aortic wall of bicuspid aortic valve patients, indicating at an early embryonic defect. METHODS Non-dilated BAV ascending aortic wall samples were collected (n = 40), categorized in five age groups: premature (age range 17.5 weeks + days GA till 37.6 weeks + days GA) 2. neonate (age range 1 - 21 days) 3. infant (age range 1 month - 4 years) 4. adolescent (age range 12 years - 15 years) and 5. adult (age range 41 - 72 years). Specimen were studied for intimal and medial histopathological features. RESULTS The premature ascending aortic wall has a significantly thicker intimal and significantly thinner medial layer as compared to all other age categories (p < 0.05). After birth the intimal thickness decreases significantly. The medial layer increases in thickness before adulthood (p < 0.05) with an increasing number of elastic lamellae (p < 0.01) and interlamellar mucoid extracellular matrix accumulation (p < 0.0001). Intimal atherosclerosis was scarce and medial histopathological features such as overall medial degeneration, smooth muscle cell nuclei loss and elastic fiber fragmentation were not appreciated in the BAV ascending aortic wall of any age. CONCLUSIONS The main characteristics of a bicuspid ascending aortic wall are already present before adulthood, albeit not before birth. Considering the early manifestations of ascending aortic wall pathology in bicuspid aortic valve patients, the pediatric population should be considered while searching for markers predictive for future aortopathy.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, The Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Dolmaci OB, Klautz RJM, Poelmann RE, Lindeman JHN, Sprengers R, Kroft L, Grewal N. Thoracic aortic atherosclerosis in patients with a bicuspid aortic valve; a case-control study. BMC Cardiovasc Disord 2023; 23:363. [PMID: 37468858 DOI: 10.1186/s12872-023-03396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Bicuspid aortic valve (BAV) patients have an increased risk to develop thoracic aortic complications. Little is known about the prevalence and severity of atherosclerosis in the BAV ascending aortic wall. This study evaluates and compares the prevalence of thoracic aortic atherosclerosis in BAV and tricuspid aortic valve (TAV) patients. METHODS Atherosclerosis was objectified using three diagnostic modalities in two separate BAV patient cohorts (with and without an aortic dilatation). Within the first group, atherosclerosis was graded histopathologically according to the modified AHA classification scheme proposed by Virmani et al. In the second group, the calcific load of the ascending aorta and coronary arteries, coronary angiographies and cardiovascular risk factors were studied. Patients were selected from a surgical database (treated between 2006-2020), resulting in a total of 128 inclusions. RESULTS Histopathology showed atherosclerotic lesions to be more prevalent and severe in all TAV as compared to all BAV patients (OR 1.49 (95%CI 1.14 - 1.94); p = 0.003). Computed tomography showed no significant differences in ascending aortic wall calcification between all BAV and all TAV patients, although a tendency of lower calcific load in favor of BAV was seen. Coronary calcification was higher in all TAV as compared to all BAV (OR 1.30 (95%CI 1.06 - 1.61); p = 0.014). CONCLUSION Ascending aortic atherosclerotic plaques were histologically more pronounced in TAV as compared to the BAV patients, while CT scans revealed equal amounts of calcific depositions within the ascending aortic wall. This study confirms less atherosclerosis in the ascending aortic wall and coronary arteries of BAV patients as compared to TAV patients. These results were not affected by the presence of a thoracic aortic aneurysm.
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Affiliation(s)
- Onur B Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, The Netherlands
| | - Jan H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Ralf Sprengers
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lucia Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.
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Staal AHJ, Cortenbach KRG, Gorris MAJ, van der Woude LL, Srinivas M, Heijmen RH, Geuzebroek GSC, Grewal N, Hebeda KM, de Vries IJM, DeRuiter MC, van Kimmenade RRJ. Adventitial adaptive immune cells are associated with ascending aortic dilatation in patients with a bicuspid aortic valve. Front Cardiovasc Med 2023; 10:1127685. [PMID: 37057097 PMCID: PMC10086356 DOI: 10.3389/fcvm.2023.1127685] [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] [Received: 12/19/2022] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundBicuspid aortic valve (BAV) is associated with ascending aorta aneurysms and dissections. Presently, genetic factors and pathological flow patterns are considered responsible for aneurysm formation in BAV while the exact role of inflammatory processes remains unknown.MethodsIn order to objectify inflammation, we employ a highly sensitive, quantitative immunohistochemistry approach. Whole slides of dissected, dilated and non-dilated ascending aortas from BAV patients were quantitatively analyzed.ResultsDilated aortas show a 4-fold increase of lymphocytes and a 25-fold increase in B lymphocytes in the adventitia compared to non-dilated aortas. Tertiary lymphoid structures with B cell follicles and helper T cell expansion were identified in dilated and dissected aortas. Dilated aortas were associated with an increase in M1-like macrophages in the aorta media, in contrast the number of M2-like macrophages did not change significantly.ConclusionThis study finds unexpected large numbers of immune cells in dilating aortas of BAV patients. These findings raise the question whether immune cells in BAV aortopathy are innocent bystanders or contribute to the deterioration of the aortic wall.
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Affiliation(s)
- Alexander H. J. Staal
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kimberley R. G. Cortenbach
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mark A. J. Gorris
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Division of Immunotherapy, Oncode Institute, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lieke L. van der Woude
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Division of Immunotherapy, Oncode Institute, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mangala Srinivas
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Cell Biology and Immunology, Wageningen University and Research, Wageningen, Netherlands
| | - Robin H. Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Konnie M. Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - I. Jolanda M. de Vries
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marco C. DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Roland R. J. van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Roland R. J. van Kimmenade,
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Grewal N, Klautz R, Poelmann RE. Can transforming growth factor beta and downstream signalers distinguish bicuspid aortic valve patients susceptible for future aortic complications? Cardiovasc Pathol 2023; 63:107498. [PMID: 36403918 DOI: 10.1016/j.carpath.2022.107498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with a bicuspid aortic valve have an extreme high risk to develop a thoracic aortic aneurysm and dissection (TAAD). TAADs form a leading cause of death worldwide, with the majority of deaths being preventable if individuals at risk are identified and properly managed. Risk stratification for TAADs in bicuspidy is so far solely based on the aortic diameter. Exclusive use of aortic wall dimension, as in the current guidelines, is however not sufficient in selecting patients vulnerable for future aortic wall complications. Moreover, there are no effective medical treatments for TAADs to retain progressive aortic dilatation and thus prevent or delay aortic complications. Only surgical replacement of the aorta increases life expectancy in patients with a risk for a TAAD. Therefore, the next major challenge in the management of TAADs is the development of a personalized patient-tailored risk stratification for early detection of patients with an increased risk for TAADs, who will benefit from surgical resection of the aorta. Several signaling pathways have been studied in recent times to develop a patient specific risk stratification model. In this paper we discuss TGF-β signaling and downstream signalers as potential markers for future aortic complications in bicuspid aortic valve patients.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Grewal N, Eberl S. Letter to the editor: The motivators and barriers to a career in cardiothoracic surgery: a cross-sectional study among surgical residents in India. Indian J Thorac Cardiovasc Surg 2023; 39:209-210. [PMID: 36785607 PMCID: PMC9918650 DOI: 10.1007/s12055-022-01444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Susanne Eberl
- Department of Cardiac Anesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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10
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Grewal N, Dolmaci O, Jansen E, Klautz R, Driessen A, Poelmann RE. Thoracic aortopathy in Marfan syndrome overlaps with mechanisms seen in bicuspid aortic valve disease. Front Cardiovasc Med 2023; 10:1018167. [PMID: 36844720 PMCID: PMC9949376 DOI: 10.3389/fcvm.2023.1018167] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Background Thoracic aortopathy is a serious complication which is more often seen in patients with Marfan syndrome (MFS) and patients with a bicuspid aortic valve (BAV) than in individuals with a tricuspid aortic valve (TAV). The identification of common pathological mechanisms leading to aortic complications in non-syndromic and syndromic diseases would significantly improve the field of personalized medicine. Objective This study sought to compare thoracic aortopathy between MFS, BAV, and TAV individuals. Materials and methods Bicuspid aortic valve (BAV; n = 36), TAV (n = 23), and MFS (n = 8) patients were included. Ascending aortic wall specimen were studied for general histologic features, apoptosis, markers of cardiovascular ageing, expression of synthetic and contractile vascular smooth muscle cells (VSMC), and fibrillin-1 expression. Results The MFS group showed many similarities with the dilated BAV. Both patient groups showed a thinner intima (p < 0.0005), a lower expression of contractile VSMCs (p < 0.05), more elastic fiber thinning (p < 0.001), lack of inflammation (p < 0.001), and a decreased progerin expression (p < 0.05) as compared to the TAV. Other features of cardiovascular ageing differed between the BAV and MFS. Dilated BAV patients demonstrated less medial degeneration (p < 0.0001), VSMC nuclei loss (p < 0.0001), apoptosis of the vessel wall (p < 0.03), and elastic fiber fragmentation and disorganization (p < 0.001), as compared to the MFS and dilated TAV. Conclusion This study showed important similarities in the pathogenesis of thoracic aortic aneurysms in BAV and MFS. These common mechanisms can be further investigated to personalize treatment strategies in non-syndromic and syndromic conditions.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: Nimrat Grewal,
| | - Onur Dolmaci
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Evert Jansen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Antoine Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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11
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Grewal N, Klautz R, Poelmann RE. Commentary: Transforming growth factor serum concentrations in patients with proven non-syndromic aortopathy. Front Cardiovasc Med 2023; 10:1097201. [PMID: 36818342 PMCID: PMC9931743 DOI: 10.3389/fcvm.2023.1097201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: Nimrat Grewal,
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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12
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Dolmaci OB, Ayyildiz T, Poelmann RE, Driessen AHG, Koolbergen DR, Klautz RJM, Lindeman JHN, Grewal N. Risk for acquired coronary artery disease in genetic vs. congenital thoracic aortopathy. Front Cardiovasc Med 2023; 9:1036522. [PMID: 36712236 PMCID: PMC9877288 DOI: 10.3389/fcvm.2022.1036522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Objective Patients with Marfan syndrome (MFS) and patients with a bicuspid aortic valve (BAV) have a significantly increased risk to develop thoracic aortopathy. Both conditions share many pathophysiological mechanisms leading to aortic complications. Bicuspidy is known to have a low risk for acquired coronary artery sclerosis. The aim of this study is to determine the risk of coronary sclerosis in MFS patients. Methods Marfan syndrome patients with an aortic root dilatation, which were surgically treated between 1999 and 2017, were included and matched with BAV and tricuspid aortic valves (TAV) patients based on sex and age. Cardiovascular risk profiles were determined in all three groups. Coronary sclerosis was graded in all patients on coronary imaging (coronary angiography or computed tomography) using a coronary artery scoring method, which divides the coronaries in 28 segments and scores non-obstructive (20-49% sclerosis) and obstructive coronary sclerosis (>49% sclerosis) in each segment. Results A total of 90 matched patients (30 within each group) were included. MFS patients showed less cardiovascular risk factors compared to BAV and TAV patients. TAV patients had higher amounts of obstructive coronary sclerosis as compared to BAV patients (p = 0.039) and MFS patients (p = 0.032). No difference in non- and obstructive coronary artery disease (CAD) was found between the MFS and BAV population. Conclusion Marfan syndrome and bicuspid aortic valve patients have a significantly lower risk for, and prevalence of CAD as compared to TAV individuals.
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Affiliation(s)
- Onur B. Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Tugay Ayyildiz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Antoine H. G. Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Dave R. Koolbergen
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jan H. N. Lindeman
- Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
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Grewal N, Dolmaci O, Jansen E, Klautz R, Driessen A, Lindeman J, Poelmann RE. Are acute type A aortic dissections atherosclerotic? Front Cardiovasc Med 2023; 9:1032755. [PMID: 36698948 PMCID: PMC9868270 DOI: 10.3389/fcvm.2022.1032755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background Type A aortic dissections (TAAD) are devastating aortic complications. Patients with Marfan syndrome, a bicuspid aortic valve or a thoracic aortic aneurysm have an increased risk to develop a TAAD. These predisposing conditions are characterized by a histologically thin intimal layer and hardly any atherosclerosis. Little is known about the susceptibility for atherosclerosis in patients with a type A aortic dissection. Objective We aim to systematically describe atherosclerotic lesions in TAAD patients. Materials and methods A total of 51 patients with a TAAD (mean age 62.5 ± 10.8 years, 49% females) and 17 control patients (mean age 63 ± 5.5 years, 53% females) were included in this study. Cardiovascular risk factors were assessed clinically. All sections were stained with Movat pentachrome and hematoxylin eosin. Plaque morphology was classified according to the modified AHA classification scheme proposed by Virmani et al. Results In the TAAD group thirty-seven percent were overweight (BMI > 25). Diabetes and peripheral arterial disease were not present in any of the patients. Fifty-nine percent of the patients had a history of hypertension. The intima in TAAD patients was significantly thinner as compared to the control group (mean thickness 143 ± 126.5 μm versus 193 ± 132 μm, p < 0.023). Seven TAAD patients had a normal intima without any form of adaptive or pathological thickening. Twenty-three TAAD patients demonstrated adaptive intimal thickening. Fourteen had an intimal xanthoma, also known as fatty streaks. A minority of 7 TAAD patients had progressive atherosclerotic lesions, 4 of which demonstrated pathological intimal thickening, 3 patients showed early fibroatheroma, late fibroatheroma and thin cap fibroatheroma. In the control group the majority of the patients exhibited progressive atherosclerotic lesions: three pathologic intimal thickening, two early fibroatheroma, six late fibroatheroma, one healed rupture and two fibrotic calcified plaque. Discussion This study shows that TAAD patients hardly exhibit any form of progressive atherosclerosis. The majority of TAAD patients showcase non-progressive intimal lesions, whereas the control group mostly demonstrated progressive intimal atherosclerotic lesions. Findings are independent of age, sex, or the presence of (a history of) hypertension.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: Nimrat Grewal,
| | - Onur Dolmaci
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Evert Jansen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Antoine Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jan Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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14
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Grewal N, Girdauskas E, Idhrees M, Velayudhan B, Klautz R, Driessen A, Poelmann RE. Structural abnormalities in the non-dilated ascending aortic wall of bicuspid aortic valve patients. Cardiovasc Pathol 2023; 62:107478. [PMID: 36155835 DOI: 10.1016/j.carpath.2022.107478] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/10/2022] [Revised: 08/31/2022] [Accepted: 09/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. The development of the aortic valve is closely related to the development of the ascending aorta, associated with structural differences in the bicuspid aorta. Here we describe the non-dilated ascending aortic wall in bicuspid aortic valve patients. METHODS BAV (n=41) and tricuspid aortic valve (TAV) (n=18) non-dilated ascending aortic wall samples were studied. We investigated the following features of the aortic wall: vessel wall thickness, endothelial cell morphology, atherosclerosis, and elastic lamellae organization. Medial pathologic features encompassing elastic fiber thinning, fragmentation and degeneration, overall medial degeneration, mucoid extracellular matrix accumulation, and smooth muscle cell nuclei loss were studied. Furthermore, we included apoptosis, periaortic inflammation, and the level of expression of differentiated vascular smooth muscle cells. RESULTS The non-dilated BAV ascending aortic wall is characterized by a significantly thinner intimal layer, without features of atherosclerosis (P<.001). The medial layer is significantly thicker (P<.001) with more mucoid extracellular matrix accumulation (P<.001). All other medial pathologic features were more prominent in the TAV (P<.001). The media has significantly less differentiated vascular smooth muscle cells (P<.001) between the neatly regulated elastic lamellae which are thinner in the BAV as compared to the TAV (P<.0001). CONCLUSIONS The BAV ascending aorta without dilatation is characterized by a differentiation defect of vascular smooth muscle cells in the media and a significantly thinner intimal layer without overt pathologic features.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Evaldas Girdauskas
- Department of Cardiothoracic Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - Bashi Velayudhan
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Antoine Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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15
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Dolmaci OB, El Mathari S, Driessen AHG, Klautz RJM, Poelmann RE, Lindeman JHN, Grewal N. Are Thoracic Aortic Aneurysm Patients at Increased Risk for Cardiovascular Diseases? J Clin Med 2022; 12:jcm12010272. [PMID: 36615072 PMCID: PMC9821759 DOI: 10.3390/jcm12010272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives: Abdominal aortic aneurysms are associated with a sharply increased cardiovascular risk. Cardiovascular risk management is therefore recommended in prevailing guidelines for abdominal aneurysm patients. It has been hypothesized that associated risk relates to loss of aortic compliance. If this hypothesis is correct, observations for abdominal aneurysms would also apply to thoracic aortic aneurysms. The objective of this study is to test whether thoracic aneurysms are also associated with an increased cardiovascular risk burden. Methods: Patients who underwent aortic valve or root surgery were included in the study (n = 239). Cardiovascular risk factors were studied and atherosclerosis was scored based on the preoperative coronary angiographies. Multivariate analyses were performed, controlling for cardiovascular risk factors and aortic valve morphology. Comparisons were made with the age- and gender-matched general population and non-aneurysm patients as control groups. A thoracic aortic aneurysm was defined as an aortic aneurysm of ≥45 mm. Results: Thoracic aortic aneurysm was not associated with an increased coronary atherosclerotic burden (p = 0.548). Comparison with the general population revealed a significantly higher prevalence of hypertension (61.4% vs. 32.2%, p < 0.001) and a lower prevalence of diabetes (1.4% vs. 13.1%, p = 0.001) in the thoracic aneurysm group. Conclusions: The extreme cardiovascular risk associated with abdominal aortic aneurysms is location-specific and not explained by loss of aortic compliance. Thoracic aortic aneurysm, in contrast to abdominal, is not part of the atherosclerotic disease spectrum and, therefore, cardiovascular risk management does not need to be implemented in treatment guidelines of isolated thoracic aneurysms. Hypertension should be treated.
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Affiliation(s)
- Onur B. Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Sulayman El Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Antoine H. G. Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, 2333 ZA Leiden, The Netherlands
| | - Jan H. N. Lindeman
- Department of Vascular Surgery, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
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16
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Grewal N, Driessen A, Klautz RJM, Poelmann RE. Can general histopathology distinguish bicuspid aortopathy? J Card Surg 2022; 37:4207-4208. [PMID: 36335626 DOI: 10.1111/jocs.17103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoine Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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17
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Grewal N, Gittenberger-de Groot AC, Lindeman JH, Klautz A, Driessen A, Klautz RJM, Poelmann RE. Normal and abnormal development of the aortic valve and ascending aortic wall: a comprehensive overview of the embryology and pathology of the bicuspid aortic valve. Ann Cardiothorac Surg 2022; 11:380-388. [PMID: 35958528 PMCID: PMC9357963 DOI: 10.21037/acs-2021-bav-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/26/2021] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
Abstract
A bicuspid aortic valve (BAV) is the most prevalent congenital cardiac anomaly, in which the valve has only two leaflets, instead of the normal three. Patients with a BAV have an increased risk of aneurysm formation and the development of an aortic dissection. Vascular smooth muscle cells in both the non- and dilated aortic wall are characterized by a maturation defect in all BAV patients, as compared to patients with a tricuspid aortic valve, which can contribute to inherent developmental susceptibility. Besides structural abnormalities of the vascular wall, a turbulent blood flow, caused by bicuspid valve geometry, could expedite the pathological process in the aortic wall, leading to aortopathy. Although the risk for aortopathy is significant, not all BAV patients experience (acute) aortic complications in their lifespan, highlighting the complexity of the pathogenetic process. Recent studies have focused on the embryonic development of semilunar valves and the ascending aortic wall. Their findings highlight that a defect in the embryogenesis could not only explain the development of a malformed aortic valve but also the increased risk for ascending aorta and arch pathology. This review presents an overview of the normal and abnormal development of the aortic valve and the aortic wall: a common defect in early embryogenesis causes the development of a BAV and associated aortopathy.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jan H. Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoine Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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18
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Grewal N, Yousef D, Palmen M, Klautz R, Eikenboom J, Wink J. Accuracy of point-of-care coagulation testing during cardiopulmonary bypass in a patient post COVID-19 infection. J Cardiothorac Surg 2022; 17:108. [PMID: 35526037 PMCID: PMC9077632 DOI: 10.1186/s13019-022-01862-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/28/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Extracorporeal circulation (ECC) in cardiac surgery is performed under systemic heparinization. Adequacy of heparin therapy and anticoagulation during ECC is assessed by activated clotting time (ACT), although there are concerns regarding the reliability of this measure. The ACT can be affected by factors other than heparin anticoagulation. A novel factor that should be considered is the influence of a COVID-19 infection. More than half of the hospitalized COVID-19 patients develop coagulation abnormalities with dysregulated coagulation test results. Patients recently recovered from COVID-19 may still demonstrate some forms of coagulation disorder affecting the ACT. This case describes an inaccurate point-of-care ACT testing in a patient with previous COVID-19 infection undergoing cardiac surgery with ECC and the alternative coagulation testing performed. CASE PRESENTATION A 77-years-old Caucasian male presented with symptomatic severe mitral valve regurgitation for which he underwent surgery. Medical history revealed a COVID-19 infection one month before surgery. Pre-operative hematological lab results were normal and baseline ACT during surgery was 100 s. To achieve an adequate ACT of > 400 s, multiple doses of heparin were needed and after administration of a triple dose (75,000 IE heparin in total) this adequate ACT was achieved. In the meanwhile we measured anti-Xa level and APTT, which were at adequate levels when ACT was still < 400 s. DISCUSSION This case emphasizes the need of alternative methods for monitoring heparin therapy in case ACT does not respond adequately. Another point to highlight in this case is the poorly correlated relation between ACT and APTT and anti-Xa in light of the recent COVID-19 infection. Although studies have shown that COVID-19 infection can cause coagulopathy and altered hemostatic parameters, ACT has never been investigated in COVID-19 patient. Understanding the correlation between ACT, APTT and anti-Xa in COVID-19 patients is mandatory.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - David Yousef
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jeroen Eikenboom
- Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Jeroen Wink
- Department of Anesthesiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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19
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Shetty V, Shetty D, Grewal N. Acute aortic syndromes in India: The need for a nationwide program to increase awareness. Indian Heart J 2021; 74:76-78. [PMID: 34864018 PMCID: PMC8890998 DOI: 10.1016/j.ihj.2021.11.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/20/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 01/16/2023] Open
Abstract
Acute aortic dissection is a rare, but potentially life-threatening and time-critical condition that is frequently misdiagnosed. Therefore, its prompt and proper diagnosis is vital to increase a patient's chance of survival and to prevent grievous complications. Raising awareness and educating the general population and healthcare professionals about an aortic dissection is mandatory, for early diagnosis and improving the chances of survival.
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Affiliation(s)
- Varun Shetty
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Deviprasad Shetty
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands.
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20
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Poelmann RE, Gittenberger-de Groot AC, Goerdajal C, Grewal N, De Bakker MAG, Richardson MK. Ventricular Septation and Outflow Tract Development in Crocodilians Result in Two Aortas with Bicuspid Semilunar Valves. J Cardiovasc Dev Dis 2021; 8:jcdd8100132. [PMID: 34677201 PMCID: PMC8537894 DOI: 10.3390/jcdd8100132] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023] Open
Abstract
Background: The outflow tract of crocodilians resembles that of birds and mammals as ventricular septation is complete. The arterial anatomy, however, presents with a pulmonary trunk originating from the right ventricular cavum, and two aortas originating from either the right or left ventricular cavity. Mixing of blood in crocodilians cannot occur at the ventricular level as in other reptiles but instead takes place at the aortic root level by a shunt, the foramen of Panizza, the opening of which is guarded by two facing semilunar leaflets of both bicuspid aortic valves. Methods: Developmental stages of Alligator mississipiensis, Crocodilus niloticus and Caiman latirostris were studied histologically. Results and Conclusions: The outflow tract septation complex can be divided into two components. The aorto-pulmonary septum divides the pulmonary trunk from both aortas, whereas the interaortic septum divides the systemic from the visceral aorta. Neural crest cells are most likely involved in the formation of both components. Remodeling of the endocardial cushions and both septa results in the formation of bicuspid valves in all three arterial trunks. The foramen of Panizza originates intracardially as a channel in the septal endocardial cushion.
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Affiliation(s)
- Robert E. Poelmann
- Sylvius Laboratory, Department of Animal Sciences and Health, Institute of Biology, University of Leiden, Sylvi-usweg 72, 2333BE Leiden, The Netherlands; (C.G.); (M.A.G.D.B.); (M.K.R.)
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300RC Leiden, The Netherlands;
- Correspondence: ; Tel.: +31-652695875
| | | | - Charissa Goerdajal
- Sylvius Laboratory, Department of Animal Sciences and Health, Institute of Biology, University of Leiden, Sylvi-usweg 72, 2333BE Leiden, The Netherlands; (C.G.); (M.A.G.D.B.); (M.K.R.)
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300RC Leiden, The Netherlands;
| | - Merijn A. G. De Bakker
- Sylvius Laboratory, Department of Animal Sciences and Health, Institute of Biology, University of Leiden, Sylvi-usweg 72, 2333BE Leiden, The Netherlands; (C.G.); (M.A.G.D.B.); (M.K.R.)
| | - Michael K. Richardson
- Sylvius Laboratory, Department of Animal Sciences and Health, Institute of Biology, University of Leiden, Sylvi-usweg 72, 2333BE Leiden, The Netherlands; (C.G.); (M.A.G.D.B.); (M.K.R.)
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21
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Dolmaci OB, Driessen AHG, Klautz RJM, Poelmann R, Lindeman JHN, Grewal N. Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective. Open Heart 2021; 8:openhrt-2021-001772. [PMID: 34497063 PMCID: PMC8438949 DOI: 10.1136/openhrt-2021-001772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/20/2021] [Accepted: 08/30/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Bicuspid aortic valve (BAV) has been associated with less atherosclerosis as compared with tricuspid aortic valve (TAV) patients. It, however, remains unclear whether this reflects the older age of TAV patients and/or accumulation of atherosclerotic risk factors or that the BAV phenotype is atheroprotective. Therefore, we compared the atherosclerotic disease burden of BAV and TAV patients, with that of the general (age-matched) population. METHODS The prevalence of coronary artery disease (CAD) and CAD risk factors in BAV and TAV patients who underwent aortic valve surgery were compared with the Dutch general practitioners registry data. BAV (n=454) and TAV (n=1101) patients were divided into four groups: BAV with aortic valve stenosis (BAV-AoS), BAV with aortic valve regurgitation (BAV-AR), TAV with AoS (TAV-AoS) and TAV with AR (TAV-AR). The atherosclerotic disease burden of each group was compared with that of the corresponding age cohort for the general population. RESULTS CAD risk factors hypertension and hypercholesterolaemia were more prevalent in the surgery groups than the age-matched general population (all p<0.001). All BAVs (BAV-AoS and BAV-AR) and TAV-AR had a similar incidence of CAD history as compared to the age-matched general populations (p=0.689, p=0.325 and p=0.617 respectively), whereas TAV-AoS had a higher incidence (21.6% versus 14.9% in the age-matched general population, p<0.001). CONCLUSIONS Stenotic TAV disease is part of the atherosclerotic disease spectrum, while regurgitant TAV and all BAVs are not. Although the prevalence of cardiovascular risk factors is higher in all BAV patients, the prevalence of CAD is similar to the general population.
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Affiliation(s)
- Onur Baris Dolmaci
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Robert J M Klautz
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Robert Poelmann
- Animal Sciences and Health, Leiden University Institute of Biology, Leiden, The Netherlands
| | - Jan H N Lindeman
- Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands .,Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Dolmaci OB, Legué J, Lindeman JHN, Driessen AHG, Klautz RJM, Van Brakel TJ, Siebelink HMJ, Mertens BJA, Poelmann RE, Gittenberger-de Groot AC, Grewal N. Extent of Coronary Artery Disease in Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valves. J Am Heart Assoc 2021; 10:e020080. [PMID: 34075785 PMCID: PMC8477872 DOI: 10.1161/jaha.120.020080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Indexed: 11/16/2022]
Abstract
Background Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, which is often complicated by aortic valve stenosis (AoS). In tricuspid aortic valve (TAV), AoS strongly associates with coronary artery disease (CAD) with common pathophysiological factors. Yet, it remains unclear whether AoS in patients with BAV is also associated with CAD. This study investigated the association between the aortic valve morphological features and the extent of CAD. Methods and Results A single-center study was performed, including all patients who underwent an aortic valve replacement attributable to AoS between 2006 and 2019. Coronary sclerosis was graded on preoperative coronary angiographies using the coronary artery greater even than scoring method, which divides the coronaries in 28 segments and scores nonobstructive (20%-49% sclerosis) and obstructive coronary sclerosis (>49% sclerosis) in each segment. Multivariate analyses were performed, controlling for age, sex, and CAD risk factors. A total of 1296 patients (931 TAV and 365 BAV) were included, resulting in 548 matched patients. Patients with TAV exhibited more CAD risk factors (odds ratio [OR], 2.66; 95% CI, 1.79-3.96; P<0.001). Patients with BAV had lower coronary artery greater even than 20 (1.61±2.35 versus 3.60±2.79) and coronary artery greater even than 50 (1.24±2.43 versus 3.37±3.49) scores (P<0.001), even after correcting for CAD risk factors (P<0.001). Patients with TAV more often needed concomitant coronary revascularization (OR, 3.50; 95% CI, 2.42-5.06; P<0.001). Conclusions Patients with BAV who are undergoing surgery for AoS carry a lower cardiovascular risk profile, correlating with less coronary sclerosis and a lower incidence of concomitant coronary revascularization compared with patients with TAV.
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Affiliation(s)
- Onur B Dolmaci
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands.,Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Juno Legué
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
| | - Jan H N Lindeman
- Department of Vascular Surgery Leiden University Medical Center the Netherlands
| | - Antoine H G Driessen
- Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands.,Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Thomas J Van Brakel
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
| | | | - Bart J A Mertens
- Biomedical Data Science Biostatistics Section Leiden University Medical Center the Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health Leiden University the Netherlands
| | | | - Nimrat Grewal
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
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Mathew G, Sinha A, Grewal N, Ahmad A, Hari P, Bagga A. POS-457 EFFICACY AND SAFETY OF RITUXIMAB VERSUS TACROLIMUS IN FREQUENTLY RELAPSING NEPHROTIC SYNDROME: AN OPEN LABEL RANDOMIZED CONTROLLED TRIAL. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.483] [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: 10/21/2022] Open
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24
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Basham CA, Grewal N, Orr PH, McMullin K, Wobeser W. What will it take to achieve meaningful action on tuberculosis among Indigenous Peoples? Int J Tuberc Lung Dis 2020; 24:661-664. [PMID: 32718397 DOI: 10.5588/ijtld.20.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C A Basham
- School of Population and Public Health, University of British Columbia, Vancouver, BC, British Columbia Centre for Disease Control, Vancouver, BC
| | - N Grewal
- Departments of Biomedical and Molecular Sciences, and Public Health Sciences, Queen's University, Kingston, ON
| | - P H Orr
- Departments of Community Health Sciences, Internal Medicine and Medical Microbiology, University of Manitoba, Winnipeg, MB
| | - K McMullin
- Cree member of Lac La Ronge Indian Band, Saskatchewan, SK, Department of Health Sciences, College of Medicine, University of Saskatchewan, Saskatoon, SK
| | - W Wobeser
- Departments of Biomedical and Molecular Sciences, and Public Health Sciences, Queen's University, Kingston, ON, Global Indigenous Stop TB Initiative Working Group, The International Union Against Tuberculosis and Lung Disease, Paris, France, ,
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25
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Grewal N, Gittenberger-de Groot AC. Wall Shear Stress Directional Abnormalities in BAV Aortas: Toward a New Hemodynamic Predictor of Aortopathy? Front Physiol 2019; 10:225. [PMID: 30941050 PMCID: PMC6433698 DOI: 10.3389/fphys.2019.00225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/21/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
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26
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Davis C, McCain J, Israel H, Choi D, Behrman D, Grewal N. Arthroscopy of Temporomandibular Joint Prosthesis, Preliminary Experience and Results. J Oral Maxillofac Surg 2018. [DOI: 10.1016/j.joms.2018.06.084] [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: 11/30/2022]
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27
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Mohamed SA, Grewal N, Gittenberger-de Groot AC. The senescence of vascular smooth muscle cells in BAV-associated aortopathy. Atherosclerosis 2018; 278:317-318. [PMID: 30166206 DOI: 10.1016/j.atherosclerosis.2018.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/18/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Salah A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, Luebeck University Hospital, Luebeck, Germany.
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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28
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Campbell IG, Li N, Rowley S, Goode D, Devereux L, McInerny S, Grewal N, Lee A, Trainer A, Wong-Brown M, Scott R, Gorringe K, James P. Abstract PD1-04: The contribution of rare variants, polygenic risk, and novel candidate genes to the hereditary risk of breast cancer in a large cohort of breast cancer families. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd1-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Identifying the missing hereditary factors underlying the familial risk of breast cancer could have a major and immediate impact on managing the breast cancer risk for these families.
Methods: We identified candidate breast cancer predisposition genes through whole exome sequencing of BRCAx families and subsequently sequenced up to 1325 genes, along with 76 common low penetrance variants associated with breast cancer, in index cases from 6,000 BRCAx families and 6,000 cancer free women (ethnically matched on principal component analysis).
Results: The role of recently described (PALB2) or suspected (MRE11A) moderately penetrant genes was confirmed. Conversely, the size of the cohort means that the absence of enrichment for loss of function (LoF mutations) provides strong evidence against other reported breast cancer genes (BRIP1, RINT1, RECQL). For further moderate risk variants (in CHEK2, ATM, BRCA2) we observed significant risk modification based on the polygenic risk score (PRS - calculated from the common variant data), with the risk restricted to the co-occurrence of the rare variant and high PRS. Novel candidate genes were identified based on LoF mutations, including NTHL1 (38 cases versus 15 controls, OR 2.5 p=0.002): a member of the base excision repair (BER) pathway. DNA sequencing of the breast carcinomas from 17 heterozygous NTHL1 mutation carriers revealed a strong bias towards a C:G>T:A (C>T) transitions, consistent with a BER defect, which confirmed the recent findings in colorectal carcinomas from bi-allelic NTHL1 mutation carriers. This data extends the cancer predisposition phenotype of NTHL1 to heterozygous carriers. In addition to NTHL1, there are a large number of candidate genes where the ratio of LoF mutations in cases versus controls indicates that they may convey an actionable level of risk; 46 genes (519 families) meet the basic criteria of multiple LoF variants and an OR >2 for cases versus controls – including previously proposed breast cancer genes MRE11A, BLM, MLH1, MYH, FANCD2 and functionally plausible candidates such as MLH3, PARP2 and ATR. Collectively the OR of breast cancer for LoF mutations in this group of genes is 3.3 (95% CI 2.7-3.9, P=3.5x10-41).
Conclusion: Our data shows that the effect of rare variation in established and novel breast cancer genes, along with consideration of the background polygenic risk, together explains a substantial component of the heritable risk of breast cancer in our cohort.
Citation Format: Campbell IG, Li N, Rowley S, Goode D, Devereux L, McInerny S, Grewal N, Lee A, Trainer A, Wong-Brown M, Scott R, Gorringe K, James P. The contribution of rare variants, polygenic risk, and novel candidate genes to the hereditary risk of breast cancer in a large cohort of breast cancer families [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD1-04.
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Affiliation(s)
- IG Campbell
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - N Li
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - S Rowley
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - D Goode
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - L Devereux
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - S McInerny
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - N Grewal
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - A Lee
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - A Trainer
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - M Wong-Brown
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - R Scott
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - K Gorringe
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
| | - P James
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Lifepool, PterMacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr., Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Hunter Area Pathology Service, Newcastle, New South Wales, Australia
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29
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Campbell IG, Rowley S, Devereux L, McInerny S, Grewal N, Young MA, Lee A, Trainer A, James P. Abstract PD1-07: Population genetic testing for breast cancer susceptibility. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd1-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Germline mutations in certain genes account for a large proportion of inherited risk for breast and ovarian cancer. The identification of asymptomatic mutation carriers could significantly reduce the incidence of these diseases as active risk management can dramatically reduce the risk of developing cancer.
In most countries, identifying high-risk individuals is based on their family history. In general, a family is first identified because one family member develops cancer and, because of high-risk indicators is referred to a familial cancer centre (FCC). However, current data suggests that many BRCA1 or BRCA2 mutation carriers do not have a remarkable history of cancer in a close relative. Population-based genetic testing would be a far more effective strategy for identification of at-risk individuals. To test the feasibility of such a strategy we are conducting a population genetic testing trial for actionable mutations in 11 breast/ovarian cancer predisposition genes (BRCA1, BRCA2, PALB2, ATM, CDH1, PTEN, STK11, TP53, BRIP1, RAD51C, RAD51D) among 15,000 healthy women from the Australian population.
Methods. All subjects are female participants in the LifePool cohort (www.lifepool.org) who had no personal history of breast or ovarian cancer at the time of DNA collection. Participants found to carry an actionable germline mutation were notified by letter with an invitation to contact the PeterMac telephone genetic counselling service for further information and/or also invited for counselling at an FCC. Only participants with an actionable mutation were notified of their genetic testing result.
Results. Of the 5,557 women tested to date, 40 (0.72%) were carriers of mutations that are currently actionable in the Australian context (BRCA1 n=7, BRCA2 n=15, PALB2 n=15, ATM n=3). All 40 women accepted the invitation to attend a familial cancer centre for formal predictive testing. Less than 20% of the women would have met the minimum threshold for clinical genetic testing under current guidelines. A further 16 participants (0.29%) carried mutations in BRIP1, RAD51C and RAD51D but were not notified of the result as these genes are not currently actionable in Australia. No mutations were identified in CDH1, PTEN, STK11 or TP53.
Conclusions. A relatively large proportion of cancer free-women from Australia carry high-risk mutations in BRCA genes and subsequent uptake of clinical genetic testing was very high. Population-based genetic testing is well accepted and can identify a much larger proportion of the at risk-population than contemporary family history based approaches.
Citation Format: Campbell IG, Rowley S, Devereux L, McInerny S, Grewal N, Young M-A, Lee A, Trainer A, James P. Population genetic testing for breast cancer susceptibility [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD1-07.
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Affiliation(s)
- IG Campbell
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
| | - S Rowley
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
| | - L Devereux
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
| | - S McInerny
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
| | - N Grewal
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
| | - M-A Young
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
| | - A Lee
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
| | - A Trainer
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
| | - P James
- Research Division, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Parkville Familial Cancer Ctr, Peter MacCallum Cancer Ctr., Melbourne, Victoria, Australia; Garvan Institute, Sydney, New South Wales, Australia
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30
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Grewal N, Gittenberger-de Groot AC. Pathogenesis of aortic wall complications in Marfan syndrome. Cardiovasc Pathol 2018; 33:62-69. [PMID: 29433109 DOI: 10.1016/j.carpath.2018.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 11/30/2017] [Revised: 01/01/2018] [Accepted: 01/09/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with Marfan (MFS) syndrome and patients with a bicuspid aortic valve (BAV) are more prone to develop aortic dilation and dissection compared to persons with a tricuspid aortic valve (TAV). To elucidate potential common as well as distinct pathways of clinical relevance, we compared the histopathological substrates of aortic pathology. PATIENT AND METHODS Ascending aortic wall specimen were divided in five groups: BAV (n=36) and TAV (n=23) without and with dilation and non-dilated MFS (n=8). We performed routine histology to study aortic wall features based on the aortic consensus statement. Immunohistological markers for vascular smooth muscle cell (VSMC) maturation, and expression of fibrillin-1 were additionally investigated for the underlying pathogenesis. RESULTS On basis of the routine histology the aorta in MFS was similar to the aorta in dilated TAVs (overall medial degeneration, elastic fiber fragmentation, loss and disorganization, , and VSMC nuclei loss). The other markers aided in clustering the MFS and BAV patients with a significantly lower fibrillin-1 expression as compared to the TAVs (p<0.05), a lower level of differentiated VSMC markers (p<0.05) and elastic fiber thinning. CONCLUSIONS Pathogenesis of aortopathy in MFS overlaps with mechanisms seen in BAV and TAV, leading to a so called double hit hypothesis for aortic complications in MFS. The ascending aortic wall in MFS is immature with undifferentiated VSMCs and low levels of fibrillin-1. The immature media becomes even more vulnerable for aortopathy due to other degenerative features which develop probably as a direct consequence of the fibrillin-1 mutation.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Adriana C Gittenberger-de Groot
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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31
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Terragni L, Grewal N, Wandel M. Challenges in child feeding practices among immigrant mothers living in Norway. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.024] [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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32
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Koenraadt WMC, Grewal N, Gaidoukevitch OY, DeRuiter MC, Gittenberger-de Groot AC, Bartelings MM, Holman ER, Klautz RJM, Schalij MJ, Jongbloed MRM. The extent of the raphe in bicuspid aortic valves is associated with aortic regurgitation and aortic root dilatation. Neth Heart J 2016; 24:127-33. [PMID: 26758507 PMCID: PMC4722007 DOI: 10.1007/s12471-015-0784-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Indexed: 11/21/2022] Open
Abstract
Background The clinical course of bicuspid aortic valves (BAVs) is variable. Data on predictors of aortopathy and valvular dysfunction mainly focus on valve morphology. Aim To determine whether the presence and extent of the raphe (fusion site of valve leaflets) is associated with the degree of aortopathy and valvular dysfunction in patients with isolated BAV and associated aortic coarctation (CoA). Methods Valve morphology and aortic dimensions of 255 BAV patients were evaluated retrospectively by echocardiography. Results BAVs with a complete raphe had a significantly higher prevalence of valve dysfunction (especially aortic regurgitation) than BAVs with incomplete raphes (82.9 vs. 66.7 %, p = 0.01). Type 1A BAVs (fusion of right and left coronary leaflets) and complete raphe had larger aortic sinus diameters compared with the rest of the population (37.74 vs. 36.01, p = 0.031). Patients with CoA and type 1A BAV had significantly less valve regurgitation (13.6 vs. 55.8 %, p < 0.001) and smaller diameters of the ascending aorta (33.7 vs. 37.8 mm, p < 0.001) and aortic arch (25.8 vs. 30.2 mm, p < 0.001) than patients with isolated BAV. Conclusions Type 1A BAV with complete raphe is associated with more aortic regurgitation and root dilatation. The majority of CoA patients have incomplete raphes, associated with smaller aortic root diameters and less valve regurgitation.
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Affiliation(s)
- W M C Koenraadt
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - N Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy & Embryology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - O Y Gaidoukevitch
- Department of Anatomy & Embryology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - M C DeRuiter
- Department of Anatomy & Embryology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - A C Gittenberger-de Groot
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Anatomy & Embryology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - M M Bartelings
- Department of Anatomy & Embryology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - E R Holman
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - R J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - M R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Department of Anatomy & Embryology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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33
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Grewal N, Franken R, Mulder BJM, Goumans MJ, Lindeman JHN, Jongbloed MRM, DeRuiter MC, Klautz RJM, Bogers AJJC, Poelmann RE, Groot ACGD. Histopathology of aortic complications in bicuspid aortic valve versus Marfan syndrome: relevance for therapy? Heart Vessels 2015; 31:795-806. [PMID: 26129868 PMCID: PMC4850207 DOI: 10.1007/s00380-015-0703-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 12/09/2014] [Accepted: 06/12/2015] [Indexed: 11/11/2022]
Abstract
Patients with bicuspid aortic valve (BAV) and patients with Marfan syndrome (MFS) are more prone to develop aortic dilation and dissection compared to persons with a tricuspid aortic valve (TAV). To elucidate potential common and distinct pathways of clinical relevance, we compared the histopathological substrates of aortopathy. Ascending aortic wall biopsies were divided in five groups: BAV (n = 36) and TAV (n = 23) without and with dilation and non-dilated MFS (n = 8). General histologic features, apoptosis, the expression of markers for vascular smooth muscle cell (VSMC) maturation, markers predictive for ascending aortic dilation in BAV, and expression of fibrillin-1 were investigated. Both MFS and BAV showed an altered distribution and decreased fibrillin-1 expression in the aorta and a significantly lower level of differentiated VSMC markers. Interestingly, markers predictive for aortic dilation in BAV were not expressed in the MFS aorta. The aorta in MFS was similar to the aorta in dilated TAV with regard to the presence of medial degeneration and apoptosis, while other markers for degeneration and aging like inflammation and progerin expression were low in MFS, comparable to BAV. Both MFS and BAV aortas have immature VSMCs, while MFS and TAV patients have a similar increased rate of medial degeneration. However, the mechanism leading to apoptosis is expected to be different, being fibrillin-1 mutation induced increased angiotensin-receptor-pathway signaling in MFS and cardiovascular aging and increased progerin in TAV. Our findings could explain why angiotensin inhibition is successful in MFS and less effective in TAV and BAV patients.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Romy Franken
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Postal zone S-5-24, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery and Heart Valve Bank, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert E Poelmann
- Department of Cardiology, Leiden University Medical Center, Postal zone S-5-24, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Biology, Integrative Zoology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriana C Gittenberger-de Groot
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Cardiology, Leiden University Medical Center, Postal zone S-5-24, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Grewal N, Gittenberger-de Groot AC, DeRuiter MC. Reply to the editor. J Thorac Cardiovasc Surg 2014; 148:2440-2. [PMID: 25444210 DOI: 10.1016/j.jtcvs.2014.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriana C Gittenberger-de Groot
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Grewal N, Gittenberger-de Groot AC, DeRuiter MC, Klautz RJM, Poelmann RE, Duim S, Lindeman JHN, Koenraadt WMC, Jongbloed MRM, Mohamed SA, Sievers HH, Bogers AJJC, Goumans MJ. Bicuspid aortic valve: phosphorylation of c-Kit and downstream targets are prognostic for future aortopathy. Eur J Cardiothorac Surg 2014; 46:831-9. [PMID: 25161185 DOI: 10.1093/ejcts/ezu319] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The clinical course of many patients with a bicuspid aortic valve (BAV) is complicated by ascending aortic dilatation. Currently, the indication for aortic surgery is solely based on the aortic diameter and subsequently only a small proportion of BAV patients undergoing valve surgery require concomitant ascending aortic replacement based on these recommendations. Unfortunately, a substantial number of BAV patients still develop aortic dilatation in the future and would potentially benefit from a more aggressive approach towards ascending aortic replacement. We, therefore, designed this study to identify molecular biological markers in the aortic wall predictive of aortopathy in BAV. METHODS Ascending aortic wall specimen of BAV (n = 36) and tricuspid aortic valve (TAV) (n = 23), both without and with (>44 mm) dilatation were investigated histologically and immunohistochemically for the expression of markers for vascular remodelling [transforming growth factor (TGF)-β, phosphorylated Smad2, matrix metalloproteinase 9 (MMP9)], cellular differentiation [c-Kit, phosphorylated-c-Kit, hypoxia-inducable factor-1 alpha (HIF1α)] and haemodynamic influences on the aortic wall [endothelial nitric oxide (eNOS)]. RESULTS All BAV patients showed significantly less inflammation (P < 0.001) and an altered intima/media ratio when compared with TAV patients. The expression of markers of a signalling pathway characteristic for cellular dedifferentiation, as exemplified by the marked expression of c-Kit, phosphorylated c-Kit and HIF1α; in the dilated BAV group was however completely comparable with only a subgroup of the non-dilated BAV (BAb), whereas the remainder of the non-dilated BAV group (BAa) was significantly distinct. This difference between the dilated BAV and BAa was further confirmed in the expression of TGF-β, phosphorylated Smad2, MMP9 and eNOS. Besides the expression pattern, similarity in the dilated BAV and BAb was also noted clinically in the most common variant of commissure position and conjoined raphe of the BAV. Based on these observations, we consider the BAb group a likely candidate for future dilatation as opposed to the BAa group. CONCLUSIONS Using a panel of molecular tissue markers, the non-dilated BAV patients can be divided into groups susceptible and non-susceptible to aortopathy.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robert E Poelmann
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Sjoerd Duim
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Johannes H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Wilke M C Koenraadt
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Salah A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery and Heart Valve Bank, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
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Grewal N, Gittenberger-de Groot AC, Poelmann RE, Klautz RJM, Lindeman JHN, Goumans MJ, Palmen M, Mohamed SA, Sievers HH, Bogers AJJC, DeRuiter MC. Ascending aorta dilation in association with bicuspid aortic valve: a maturation defect of the aortic wall. J Thorac Cardiovasc Surg 2014; 148:1583-90. [PMID: 24560417 DOI: 10.1016/j.jtcvs.2014.01.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [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] [Received: 09/06/2013] [Revised: 01/06/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Patients with a bicuspid aortic valve have increased susceptibility to the development of ascending aortic dilation and dissection compared with persons with a tricuspid valve. To unravel a possible different mechanism underlying dilation in bicuspidy and tricuspidy, a comparison of the structure of the aortic wall was made. METHODS Ascending aortic wall biopsies were divided into 4 groups: bicuspid (n=36) and tricuspid (n=23) without and with dilation. The expression of vascular smooth muscle cell maturation markers including lamin A/C, which plays a pivotal role in smooth muscle cell differentiation, and its splicing variant progerin indicative of aging, were studied immunohistochemically. Attention was also paid to the inflammatory status. RESULTS There is a significant difference in the structure and maturation of the aortic wall in bicuspidy, persisting in the dilated aortic wall, presenting with a thinner intima, lower expression of α smooth muscle actin, smooth muscle 22α, calponin, and almost absent expression of smoothelin. We show for the first time significantly lowered lamin A/C expression in bicuspidy. Progerin was found to be significantly increased in the media of the dilated wall in tricuspidy, also showing increased periaortic inflammation. CONCLUSIONS The structure of the nondilated and dilated aortic wall in bicuspidy and tricuspidy are intrinsically different, with the latter having more aspects of aging. In bicuspidy there is a defective smooth muscle cell differentiation possibly linked to lowered lamin A/C expression. Based on this vessel wall immaturity and increased susceptibility to dilation, different diagnostic and therapeutic approaches are warranted.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriana C Gittenberger-de Groot
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert E Poelmann
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Salah A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery and Heart Valve Bank, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.
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Grewal N, Gittenberger-De Groot AC, Klautz RJM, Palmen M, Lindeman JHN, Goumans MJ, Poelmann RE, Deruiter MC. Bicuspid aortic valve and aneurysm formation: immaturity of the aortic wall. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5680] [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: 11/14/2022] Open
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Grewal N, Seth R. Comparative in vivo evaluation of restoring severely mutilated primary anterior teeth with biological post and crown preparation and reinforced composite restoration. J Indian Soc Pedod Prev Dent 2008; 26:141-8. [PMID: 19008621 DOI: 10.4103/0970-4388.44028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This study was designed to compare the success rate of biological and composite restorations when used to replace structural loss of primary anterior teeth using intracanal post for radicular support of the restoration. MATERIALS AND METHODS Forty-two patients aged between 3-5 years presenting with early childhood caries (ECC) received at least one or more composite and biological restorations for comparative evaluation. A total of 150 restorations were done (75 biological restorations and 75 composite restorations). The restorations were evaluated single-blind according to a modified USPHS system. Assessment of the patient's response in accepting a biological restoration, psychological impact of the restorations, view of the parents, and peer group reviews, etc. were recorded in a response sheet in presence of the child and the parents. OBSERVATIONS AND RESULTS In vivo clinical performance of biological post and crown restorations and intracanal reinforced composite restorations was comparable with respect to shade match, marginal discoloration, marginal integrity, surface finish, gingival health, retention, and recurrent carious lesions. The cost effectiveness of biological restorations was certainly a positive attribute. CONCLUSION The biological restoration presented as a cost effective, clinician friendly, less-technique sensitive, and esthetic alternative to commercially available restorative materials used for restoring deciduous teeth affected by ECC.
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Affiliation(s)
- N Grewal
- Department of Pedodontia and Preventive Dentistry, GDC, Amritsar, India.
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Bradley J, Grewal N, Katchikian H, Jarrahy R. O.074 Primary cleft repair with alveolar molding, gingivoperiosteoplasty and rhBMP-2. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71198-3] [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: 11/25/2022] Open
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Grewal N, Chopra R. The effect of fissure morphology and eruption time on penetration and adaptation of pit and fissure sealants: An SEM study. J Indian Soc Pedod Prev Dent 2008; 26:59-63. [PMID: 18603729 DOI: 10.4103/0970-4388.41617] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED This study was designed to examine the effect of fissure morphology on penetration and adaptation of fissure sealants and their relationship with the eruption time of tooth. MATERIALS AND METHODS One hundred and fifty extracted molars and premolars were divided into two groups on the basis of their eruption time. The two groups were further divided into five subgroups on the basis of fissure morphology. An scanning electron microscopic analysis of penetration and adaptation of sealant was done. OBSERVATIONS AND RESULTS V- and U-shaped fissures were found to have the maximum penetration. Penetration was very poor for I- and IK-types of fissures. No significant difference in penetration was found in relation to eruption time. Adaptation of sealant was not affected by any of the factors. CONCLUSION Even the well-applied sealant does not necessarily provide complete obturation of pits and fissures, thus necessitating periodical clinical observation to determine the success or potential failure of the sealant treatment.
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Affiliation(s)
- N Grewal
- Department of Pedodontia, Government Dental College, Amritsar, India.
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Abstract
Root canal morphology of deciduous mandibular first molar was studied using roentgenographic and decalcification and clearing methods. Two groups of 15 teeth were formed. In the roentgenographic group, roots of the teeth were separated from the crown at the level of CEJ. Cut roots of the teeth were radiographed from both mesiodistal and buccolingual directions using separate IOPA films. In the decalcification and clearing group, teeth were decalcified and made transparent. Dye was injected later. The roots of the teeth were examined under 10 times for number, curvature, types and additional features of root canals. Deciduous mandibular first molar showed variability in root canal morphology. Four to five root canals were recorded. Majority of the teeth had 1-1 type of root canal anatomy, but 1-2 type anatomy was also reported. Straight, curved and S-shaped canal curvatures were recorded. Horizontal anastomosis, lateral canals and buccolingually broad root canals were also recorded.
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Affiliation(s)
- D Gupta
- Department of Pedodontia and Preventive Dentistry, Punjab Government Dental College and Hospital, Amritsar, Punjab, India
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Grewal N. Implementation of behaviour management techniques--how well accepted they are today. J Indian Soc Pedod Prev Dent 2003; 21:70-4. [PMID: 14700338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Dynamic changes in society with working parents and smaller nuclear families have brought about a sea of changes in parental attitudes and anxieties towards their children. This has affected the perception and implementation of behaviour modification techniques by the dentist. Today, the significance of Tell Show Do technique and its efficiency in behaviour modification is questionable. Insistence of parents on conscious sedation is seen to be on the rise. This study aimed to assess the change in the utilization pattern of behaviour management techniques by pediatric dentists of Punjab in the past five years along with identification of change in parental attitude towards these techniques.
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Affiliation(s)
- N Grewal
- Department of Pedodontia and Preventive Dentistry, Govt. Dental College, Amritsar, Punjab
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Gupta S, Khinda VIS, Grewal N. A comparative study of microleakage below cemento-enamel junction using light cure and chemically cured glass ionomer cement liners. J Indian Soc Pedod Prev Dent 2002; 20:158-64. [PMID: 12587752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Posterior composite resins have gained considerable importance over last few years. However, improper placement techniques continue to be a prime cause of failure of these restorations. This study was done to compare the microleakage at the tooth restoration interface extending below cementoenamel junction when posterior composite restorations were placed directly in the cavity or when placed over a glass ionomer cement liner, both chemically cured and light cured. The results have shown that light cured glass ionomer when used as a liner under a composite restoration used below gingival cementum/dentin margin has the best sealing capability.
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Affiliation(s)
- S Gupta
- Dept of Pediatric Dentistry, SGRD Institute of Dental Sciences, Amritsar
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Khinda VIS, Grewal N. Retentive [correction of Preventive] efficacy of glass ionomer, zinc phosphate and zinc polycarboxylate luting cements in preformed stainless steel crowns: a comparative clinical study. J Indian Soc Pedod Prev Dent 2002; 20:41-6. [PMID: 12435014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
This study was undertaken to assess the efficacy of three luting cements, namely, glass ionomer, zinc phosphate and zinc polycarboxylate in retainng the preformed stainless steel crowns in-vivo. Twenty subjects, with an indication for restoration of three primary molars with stainless steel crowns, were selected. Sixty teeth were taken up for the study, and twenty crowns were cemented with each of the three luting cements. After an eight month follow up the crowns were assessed for their presence/ absence or "rocking". Statistical analysis was done using Chi-square test. The results have shown no significant difference in retentivity of stainless steel crowns with the use of either of the three luting agents.
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McClelland M, Sanderson KE, Spieth J, Clifton SW, Latreille P, Courtney L, Porwollik S, Ali J, Dante M, Du F, Hou S, Layman D, Leonard S, Nguyen C, Scott K, Holmes A, Grewal N, Mulvaney E, Ryan E, Sun H, Florea L, Miller W, Stoneking T, Nhan M, Waterston R, Wilson RK. Complete genome sequence of Salmonella enterica serovar Typhimurium LT2. Nature 2001; 413:852-6. [PMID: 11677609 DOI: 10.1038/35101614] [Citation(s) in RCA: 1400] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Salmonella enterica subspecies I, serovar Typhimurium (S. typhimurium), is a leading cause of human gastroenteritis, and is used as a mouse model of human typhoid fever. The incidence of non-typhoid salmonellosis is increasing worldwide, causing millions of infections and many deaths in the human population each year. Here we sequenced the 4,857-kilobase (kb) chromosome and 94-kb virulence plasmid of S. typhimurium strain LT2. The distribution of close homologues of S. typhimurium LT2 genes in eight related enterobacteria was determined using previously completed genomes of three related bacteria, sample sequencing of both S. enterica serovar Paratyphi A (S. paratyphi A) and Klebsiella pneumoniae, and hybridization of three unsequenced genomes to a microarray of S. typhimurium LT2 genes. Lateral transfer of genes is frequent, with 11% of the S. typhimurium LT2 genes missing from S. enterica serovar Typhi (S. typhi), and 29% missing from Escherichia coli K12. The 352 gene homologues of S. typhimurium LT2 confined to subspecies I of S. enterica-containing most mammalian and bird pathogens-are useful for studies of epidemiology, host specificity and pathogenesis. Most of these homologues were previously unknown, and 50 may be exported to the periplasm or outer membrane, rendering them accessible as therapeutic or vaccine targets.
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Affiliation(s)
- M McClelland
- Sidney Kimmel Cancer Center, 10835 Altman Row, San Diego, California 92121, USA.
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Parveen Z, Large A, Grewal N, Lata N, Cancio I, Cajaraville MP, Perry CJ, Connock MJ. D-Aspartate oxidase and D-amino acid oxidase are localised in the peroxisomes of terrestrial gastropods. Eur J Cell Biol 2001; 80:651-60. [PMID: 11713869 DOI: 10.1078/0171-9335-00197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
D-Aspartate oxidase and D-amino acid oxidase were found in high activity in the tissues of representative species of terrestrial gastropods. Analytical subcellular fractionation demonstrated that both of these oxidases co-localised with the peroxisome markers, acyl-CoA oxidase and catalase, in the digestive gland homogenate. Electron microscopy of peak peroxisome fractions showed particles of uniform size with generally well preserved variably electron-dense matrices bounded by an apparently single limiting membrane. Many of the particles exhibited a core region of enhanced electron density. Catalase cytochemistry of peak fractions confirmed the peroxisome identity of the organelles. Peroxisome-enriched subcellular fractions were used to investigate the properties of gastropod D-aspartate oxidase and D-amino acid oxidase activities. The substrate and inhibitor specificities of the two activities demonstrated that two distinct enzymes were present analogous to, but not identical to, the equivalent mammalian peroxisomal enzymes.
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Affiliation(s)
- Z Parveen
- School of Applied Sciences, University of Wolverhampton, United Kingdom
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Grewal N, Parveen Z, Large A, Perry C, Connock M. Gastropod mollusc aliphatic alcohol oxidase: subcellular localisation and properties. Comp Biochem Physiol B Biochem Mol Biol 2000; 125:543-54. [PMID: 10904867 DOI: 10.1016/s0305-0491(00)00164-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 10/16/2022]
Abstract
The digestive gland and other tissues of several species of terrestrial gastropod mollusc contain an aliphatic alcohol oxidase activity (EC1.1.3.13). The enzyme is FAD dependent, consumes oxygen and generates hydrogen peroxide and the corresponding aldehyde. Saturated primary alcohols are favoured as substrates with octanol preferred with an apparent Km of 3-4 microM. The activity is clearly distinguishable from previously reported molluscan aromatic alcohol oxidase (EC1.1.3.7) on the basis of FAD dependence, sensitivity to heat treatment and high salt concentration and with regard to substrate preferences. The aliphatic alcohol oxidase is membrane associated and most likely localised to the endoplasmic reticulum. Extraction of membranes with 1% Igipal solubilises the enzyme in active form. This enzyme is a further example of an oxidase apparently restricted to molluscs.
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Affiliation(s)
- N Grewal
- School of Applied Sciences, University of Wolverhampton, UK
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Khinda V, Grewal N. Relationship of tongue-thrust swallowing and anterior open bite with articulation disorders: a clinical study. J Indian Soc Pedod Prev Dent 1999; 17:33-9. [PMID: 10863488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
A Paediatric dentist may be the first person consulted for professional advice concerning children with speech problems. A positive significant relationship has been hypothesized by some authors between tongue-thrust swallowing and articulation disorders in children. This study was undertaken to find out whether any articulation disorders are associated with the habit of tongue-thrust swallowing, or is it the type of anterior bite that plays an important role in the normal or abnormal speech production in tongue-thrust swallowers. Forty subjects with tongue-thrust swallowing in the age group of 7-16 years were examined. Of these 20 had normal anterior bite while rest had anterior open bite. A word articulation test was used and word level articulation testing was done for initial, medial and final positions. The sounds tested were: Linguoalveolars, Labiodentals, Linguodentals, Linguopalatals, Bilabials and Linguovelars. The results of the study have indicated that the presence of articulation disorders is strongly associated with the anterior open bite present in tongue-thrust swallowers but a simple, direct relationship between the presence of defective consonant sounds and tongue-thrust swallowing has not been found.
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Affiliation(s)
- V Khinda
- Department of Pedodontia and Preventive Dentistry, Punjab Govt. Dental College & Hospital, Amritsar
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