1
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Sarajlic P, Vigor C, Avignon A, Zhou B, Oger C, Galano JM, Durand T, Sultan A, Bäck M. Omega-3 to omega-6 fatty acid oxidation ratio as a novel inflammation resolution marker for metabolic complications in obesity. Nutr Metab Cardiovasc Dis 2023; 33:1206-1213. [PMID: 37032252 DOI: 10.1016/j.numecd.2023.03.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND AND AIMS The oxidative metabolism of polyunsaturated fatty acids (PUFAs) leads to bioactive isoprostanoids. The aim was to establish the associations of a complete urinary isoprostanoid profiling in a cohort study of carefully phenotyped obese subjects to determine possible potential differential implications for omega-6 PUFA- and omega-3 PUFA-derived isoprostanoids for obesity, metabolic indicators, and inflammation. METHODS AND RESULTS PUFA peroxidation compounds were determined in urine samples from obese human subjects (n = 46) by liquid chromatography coupled to tandem mass spectrometry. Increased omega-6 arachidonic acid (AA) oxidation, mainly represented by 5-F2c isoprostane (5-F2c-IsoP) and metabolites of 15-F2t-IsoP, was associated with body mass index, glycated hemoglobin (HbA1c) and mean arterial blood pressure. In addition, we identified the omega-3 PUFA-derived urinary metabolites 14-F4t-NeuroP from docosahexaenoic acid (DHA) and 5-F3t-IsoP from eicosapentaenoic acid (EPA), which declined with age. The omega-3 to omega-6 oxidation ratio was a significant predictor of inflammation in obesity. CONCLUSION The findings point to full urinary isoprostanoid profiling as a more sensitive measure of PUFA oxidative stress in obesity-induced metabolic complications compared with individual isoprostanoid measures. Furthermore, the results suggest the balance between the omega-3 and omega-6 PUFA oxidation as determinative for the consequences of oxidative stress on inflammation in obesity.
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Affiliation(s)
- Philip Sarajlic
- Translational Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Claire Vigor
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293 Cedex 5 Montpellier, France
| | - Antoine Avignon
- Endocrinology Diabetes Department, CHU Montpellier, Université Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, IDESP UMR UA11 INSERM, Université Montpellier, Montpellier, France
| | - Bingqing Zhou
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293 Cedex 5 Montpellier, France
| | - Camille Oger
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293 Cedex 5 Montpellier, France
| | - Jean-Marie Galano
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293 Cedex 5 Montpellier, France
| | - Thierry Durand
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293 Cedex 5 Montpellier, France
| | - Ariane Sultan
- Endocrinology Diabetes Department, CHU Montpellier, Université Montpellier, Montpellier, France; Phymedexp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France
| | - Magnus Bäck
- Translational Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Université de Lorraine, INERM U1116, CHRU Nancy, Vandoeuvre-lès-Nancy, France.
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2
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Pawelzik SC, Arnardottir H, Sarajlic P, Mahdi A, Vigor C, Zurita J, Zhou B, Kolmert J, Galano JM, Religa D, Durand T, Wheelock CE, Bäck M. Decreased oxidative stress and altered urinary oxylipidome by intravenous omega-3 fatty acid emulsion in a randomized controlled trial of older subjects hospitalized for COVID-19. Free Radic Biol Med 2023; 194:308-315. [PMID: 36509313 PMCID: PMC9733960 DOI: 10.1016/j.freeradbiomed.2022.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Proinflammatory bioactive lipid mediators and oxidative stress are increased in coronavirus disease 2019 (COVID-19). The randomized controlled single-blind trial COVID-Omega-F showed that intravenous omega-3 polyunsaturated fatty acids (n-3 PUFA) shifted the plasma lipid signature of COVID-19 towards increased proresolving precursor levels and decreased leukotoxin diols, associated with a beneficial immunodulatory response. The present study aimed to determine the effects of n-3 PUFA on the urinary oxylipidome and oxidative stress in COVID-19. From the COVID-Omega-F trial, 20 patients hospitalized for COVID-19 had available serial urinary samples collected at baseline, after 24-48 h, and after completing 5 days treatment with one daily intravenous infusion (2 mL/kg) of either placebo (NaCl; n = 10) or a lipid emulsion containing 10 g of n-3 PUFA per 100 mL (n = 10). Urinary eicosanoids and isoprostanes were analyzed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Erythrocytes obtained at the different time-points from n = 10 patients (n = 5 placebo and n = 5 n-3 PUFA) were used for determination of reactive oxygen species. Intravenous n-3 PUFA emulsion administration altered eicosanoid metabolites towards decreased levels for mediators of inflammation and thrombosis, and increased levels of the endothelial function mediator prostacyclin. Furthermore, non-enzymatic metabolism was skewed towards n-3 PUFA-derived metabolites with potential anti-inflammatory and pro-resolving effects. The oxidative stress marker 15-F2t-isoprostane was significantly lower in patients receiving n-3 PUFA treatment, who also exhibited significantly decreased erythrocyte oxidative stress compared with placebo-treated patients. These findings point to additional beneficial effects of intravenous n-3 PUFA emulsion treatment through a beneficial oxylipin profile and decreased oxidative stress in COVID-19.
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Affiliation(s)
- Sven-Christian Pawelzik
- Department of Medicine, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Hildur Arnardottir
- Department of Medicine, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Philip Sarajlic
- Department of Medicine, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Ali Mahdi
- Department of Medicine, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Claire Vigor
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293, Cedex 5, Montpellier, France
| | - Javier Zurita
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bingqing Zhou
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293, Cedex 5, Montpellier, France
| | - Johan Kolmert
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jean-Marie Galano
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293, Cedex 5, Montpellier, France
| | - Dorota Religa
- Department of Neurobiology, Karolinska Institutet and Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Thierry Durand
- Institut des Biomolécules Max Mousseron, IBMM, UMR 5247, Université de Montpellier, CNRS, ENSCM, Pôle Recherche Chimie Balard, 34293, Cedex 5, Montpellier, France
| | - Craig E Wheelock
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden.
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3
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Arnardottir H, Pawelzik SC, Sarajlic P, Quaranta A, Kolmert J, Religa D, Wheelock CE, Bäck M. Immunomodulation by intravenous omega-3 fatty acid treatment in older subjects hospitalized for COVID-19: A single-blind randomized controlled trial. Clin Transl Med 2022; 12:e895. [PMID: 36121173 PMCID: PMC9484265 DOI: 10.1002/ctm2.895] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/30/2022] [Accepted: 05/09/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hildur Arnardottir
- Department of Medicine Solna, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Sven-Christian Pawelzik
- Department of Medicine Solna, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Philip Sarajlic
- Department of Medicine Solna, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Alessandro Quaranta
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Johan Kolmert
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden.,The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dorota Religa
- Department of Neurobiology, Karolinska Institutet and Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Craig E Wheelock
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden.,The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine Solna, Karolinska Institutet, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
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4
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Hupin D, Sarajlic P, Venkateshvaran A, Fridén C, Nordgren B, Opava CH, Lundberg IE, Bäck M. Cardiovascular Autonomic Function Changes and Predictors During a 2-Year Physical Activity Program in Rheumatoid Arthritis: A PARA 2010 Substudy. Front Med (Lausanne) 2021; 8:788243. [PMID: 34977091 PMCID: PMC8717774 DOI: 10.3389/fmed.2021.788243] [Citation(s) in RCA: 3] [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: 10/01/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Chronic inflammation leads to autonomic dysfunction, which may contribute to the increased risk of cardiovascular diseases (CVD) in patients with rheumatoid arthritis (RA). Exercise is known to restore autonomic nervous system (ANS) activity and particularly its parasympathetic component. A practical clinical tool to assess autonomic function, and in particular parasympathetic tone, is heart rate recovery (HRR). The aim of this substudy from the prospective PARA 2010 study was to determine changes in HRR post-maximal exercise electrocardiogram (ECG) after a 2-year physical activity program and to determine the main predictive factors associated with effects on HRR in RA. Methods: Twenty-five participants performed physiotherapist-guided aerobic and muscle-strengthening exercises for 1 year and were instructed to continue the unsupervised physical activity program autonomously in the next year. All participants were examined at baseline and at years 1 and 2 with a maximal exercise ECG on a cycle ergometer. HRR was measured at 1, 2, 3, 4, and 5 min following peak heart rate during exercise. Machine-learning algorithms with the elastic net linear regression models were performed to predict changes in HRR1 and HRR2 at 1 year and 2 years of the PARA program. Results: Mean age was 60 years, range of 41-73 years (88% women). Both HRR1 and HRR2 increased significantly from baseline to year 1 with guided physical activity and decreased significantly from year 1 to year 2 with unsupervised physical activity. Blood pressure response to exercise, low BMI, and muscular strength were the best predictors of HRR1/HRR2 increase during the first year and HRR1/HRR2 decrease during the second year of the PARA program. Conclusion: ANS activity in RA assessed by HRR was improved by guided physical activity, and machine learning allowed to identify predictors of the HRR response at the different time points. HRR could be a relevant marker of the effectiveness of physical activity recommended in patients with RA at high risk of CVD. Very inactive and/or high CVD risk RA patients may get substantial benefits from a physical activity program.
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Affiliation(s)
- David Hupin
- Translational Cardiology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- INSERM, U1059, SAINBIOSE, Université de Lyon, Université Jean-Monnet, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Philip Sarajlic
- Translational Cardiology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ashwin Venkateshvaran
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Nordgren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Christina H. Opava
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Rheumatology, Inflammation and Ageing Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid E. Lundberg
- Rheumatology, Inflammation and Ageing Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Bäck
- Translational Cardiology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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5
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Plunde O, Sarajlic P, Franco-Cereceda A, Back M. Atherosclerosis associated pathways are upregulated in stenotic aortic valves from patients with severe concomitant coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aortic valve stenosis (AVS) share pathobiology and risk factors with atherosclerosis. However, medical treatment effective against atherosclerosis lack ability to halt the progression of AVS. The aims of this study were to (i) determine the prevalence of coronary artery disease (CAD) in surgical AVS patients and (ii) to establish predictors of CAD in AVS patients and (iii) to identify differential aortic valve transcriptomic profiles depending on concomitant CAD.
The study cohort consisted of 256 consecutive AVS patients with surgically verified tricuspid aortic valves, of which 74 aortic valves were collected. CAD defined as coronary artery stenosis requiring concomitant bypass surgery or previous acute coronary syndrome or percutaneous coronary intervention Transcriptomic data were obtained from microarray analysis of tissues from three different stages of AVS process (healthy, intermediate, and calcified tissue). All comparisons were sex and tissue adjusted. Non-coding probes were removed and a variance filter was applied prior to analysis which yielded 5121 genes.
The prevalence of CAD in AVS was 49%. A logistic regression model revealed male sex, claudication, diabetes and current smoking as significant predictors of CAD when age, sex, peak transaortic velocity, hsCRP, eGFR and BMI were held constant.
28 genes were significantly (q<0.05) differentially expressed when aortic valves from patients with (n=43) and without (n=31) CAD were compared. A comparison of patients with concomitant multi vessel disease (2–3 affected vessel territories, n=20) and patients without CAD or single vessel disease (n=54) revealed 189 significantly expressed genes and an optimal visual separation on heatmap (Figure 2). Active-subnetwork-oriented-enrichment analysis identified upregulated aortic valve atherosclerosis associated pathways in multi vessel disease patients related to reactive oxygen species and cytokine signaling.
This study provides a novel observation of differential aortic valve gene expression profile depending on concomitant severe CAD. The results revealed that patients with concomitant severe CAD exhibited underlying atherosclerosis-related mechanisms to their aortic valve disease. Therefore, future precision medicine against AVS may be facilitated by assessing concomitant CAD.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Karolinska Institute - Clinical Science Training ProgrammeSwedish Heart Lung Foundation Predictors of concomitant CADDEGs in AVs stratified on severe CAD
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Affiliation(s)
- O Plunde
- Karolinska Institute, Unit of Cardiovascular Medicine, Department of Medicine, Stockholm, Sweden
| | - P Sarajlic
- Karolinska Institute, Unit of Cardiovascular Medicine, Department of Medicine, Stockholm, Sweden
| | - A Franco-Cereceda
- Karolinska University Hospital, Theme Heart and Vessels, Devision of Valvular and Coronary Disease, Stockholm, Sweden
| | - M Back
- Karolinska University Hospital, Theme Heart and Vessels, Devision of Valvular and Coronary Disease, Stockholm, Sweden
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6
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Sarajlic P, Simonsson M, Jernberg T, Bäck M, Hofmann R. Incidence, associated outcomes, and predictors of upper gastrointestinal bleeding following acute myocardial infarction: a SWEDEHEART-based nationwide cohort study. Eur Heart J Cardiovasc Pharmacother 2021; 8:483-491. [PMID: 34423350 PMCID: PMC9366628 DOI: 10.1093/ehjcvp/pvab059] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 08/02/2021] [Indexed: 01/10/2023]
Abstract
Aims Of all spontaneous bleeding complications in patients with acute myocardial infarction (MI), upper gastrointestinal bleeding (UGIB) is common and of specific interest since it could be prevented by several prophylactic measures. We aimed to determine the incidence, associated outcomes, and predictors of UGIB following acute MI. Methods and results All patients with acute MI enrolled in the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry from January 2007 to June 2016 and discharged alive on any antithrombotic therapy (n = 149 477) were followed regarding UGIB for 1 year. Associated outcomes were determined by Cox proportional hazards regression with UGIB as a time-dependent covariate, adjusting for baseline characteristics, invasive treatment, and medical treatment at discharge. Predictors of UGIB were determined by logistic regression and machine learning models. At 1 year, UGIB had occurred in 2230 patients (cumulative incidence 1.5%) and was significantly associated with an increased risk of all-cause death [hazard ratio (HR) 2.86, 95% confidence interval (CI) 2.58–3.16] and stroke (HR 1.80, 95% CI 1.32–2.45) but not with recurrent MI (HR 1.17, 95% CI 0.97–1.42). The most important predictors of UGIB were haemoglobin, age, systolic blood pressure, blood glucose, smoking status, previous upper gastrointestinal bleeding, and antithrombotic and gastroprotective treatment. Conclusion After acute MI, readmission because of UGIB is common and significantly associated with poor prognosis. By using machine learning in addition to traditional logistic regression, new predictors of UGIB, such as blood glucose and smoking status, were identified.
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Affiliation(s)
- Philip Sarajlic
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Moa Simonsson
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine, Karolinska Institute, Stockholm, Sweden.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
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7
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Sarajlic P, Artiach G, Larsson SC, Bäck M. Dose-Dependent Risk Reduction for Myocardial Infarction with Eicosapentaenoic Acid: a Meta-analysis and Meta-regression Including the STRENGTH Trial. Cardiovasc Drugs Ther 2021; 35:1079-1081. [PMID: 34101063 PMCID: PMC8452549 DOI: 10.1007/s10557-021-07212-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Philip Sarajlic
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
- Department of Medicine, Translational Cardiology, Karolinska University Hospital, Hälsovägen 7C, 141 57, Stockholm, Sweden.
| | - Gonzalo Artiach
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Bäck
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology Huddinge, Karolinska University Hospital, Stockholm, Sweden
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8
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Sarajlic P, Plunde O, Franco-Cereceda A, Bäck M. Artificial Intelligence Models Reveal Sex-Specific Gene Expression in Aortic Valve Calcification. JACC Basic Transl Sci 2021; 6:403-412. [PMID: 34095631 PMCID: PMC8165113 DOI: 10.1016/j.jacbts.2021.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Differences in the clinical presentation and physiology of aortic stenosis in men and women complicate the management of the condition. By combining traditional inferential statistics, artificial intelligence predictive modeling, and genetic pathway analysis, one can gain further insight into sex-specific gene expression patterns, potentially driving the valvular phenotype differences between the sexes. Results from this study, implementing a mixed and comprehensive methodological approach, offer a foundation for further exploration of potential drug targets.
Male and female aortic stenosis patients have distinct valvular phenotypes, increasing the complexities in the evaluation of valvular pathophysiology. In this study, we present cutting-edge artificial intelligence analyses of transcriptome-wide array data from stenotic aortic valves to highlight differences in gene expression patterns between the sexes, using both sex-differentiated transcripts and unbiased gene selections. This approach enabled the development of efficient models with high predictive ability and determining the most significant sex-dependent contributors to calcification. In addition, analyses of function-related gene groups revealed enriched fibrotic pathways among female patients. Ultimately, we demonstrate that artificial intelligence models can be used to accurately predict aortic valve calcification by carefully analyzing sex-specific gene transcripts.
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Affiliation(s)
- Philip Sarajlic
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Oscar Plunde
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
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9
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Artiach G, Sarajlic P, Bäck M. Inflammation and its resolution in coronary artery disease: a tightrope walk between omega-6 and omega-3 polyunsaturated fatty acids. Kardiol Pol 2020; 78:93-95. [PMID: 32108752 DOI: 10.33963/kp.15202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Gonzalo Artiach
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Philip Sarajlic
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
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10
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Eliasson SA, Sarajlic P, Wandell P, Wallen H, Back M, Braunschweig F. P4426Prolonged troponin t elevation in male and female master athletes after long-distance running. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Troponin levels may be elevated after long-distance running, probably due to increased membrane permeability of cardiomyocytes. It is believed that elevated troponin post exercise, in contrast to acute coronary syndromes, normalize within 24 (−48) hours. This phenomenon has been mainly studied in young and elite athletes. However, participation in endurance exercise is increasingly popular among elderly and recreational sportsmen.
Purpose
To assess troponin levels in master athletes before and up to 7 days after long-distance running.
Method
We studied 97 participants (56 males and 41 females, matched for age) in the world's largest cross-country race (30 km, Lidingöloppet). They were ≥45 years (53±5 years). Baseline evaluation included a physical exam, blood pressure, BMI, NT-proBNP and an ECG. Blood tests were taken at baseline, immediately after as well as 1d, 4d and 7d after the race, including high sensitive troponin T (TnT), creatinine and high sensitive CRP. Elevated TnT was defined as ≥15 ng/l.
Results
After the race TnT had increased from 5±3 ng/l at baseline to 46±32 ng/l (range 11–180; p<0.0001). TnT was still significantly elevated at day 1 (16±16ng/l, range 4–106; p<0.0001) and day 4 (8±8 ng/l, range 4–63; p<0.01) with a borderline increase at day 7 (6±3; range 4–22; p=0.062). Both men and women showed a significant TnT increases at day 1 and day 4. Elevated TnT above the diagnostic threshold for myocardial infarction was observed in 96% (post race), 34% (day 1), 9% (day 4) and 3% (day 7). Males had generally higher TnT levels. At day 1, elevated TnT levels were present in 39% of males and 17% of females while all subjects with elevated TnT at day 4 and day 7 were male.
Conclusion
TnT is elevated in the vast majority of male and female master athletes after participation in a 30 km cross country race. To our knowledge, this is the first report showing that TnT levels can be still significantly elevated four days after endurance running. Prolonged TnT values above the diagnostic threshold for myocardial infarction were predominantly seen in males. Our findings are relevant to the clinical management of patients with increased troponin values after endurance exercise.
Acknowledgement/Funding
Hjärt och lungfonden (Swedish heart- and lung fund). Governmental grants.
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Affiliation(s)
| | - P Sarajlic
- Karolinska Institutet, Stockholm, Sweden
| | - P Wandell
- Karolinska Institutet, Stockholm, Sweden
| | - H Wallen
- Karolinska Institutet, Stockholm, Sweden
| | - M Back
- Karolinska Institutet, Stockholm, Sweden
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11
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Sarajlic P, Fridén C, Lund LH, Manouras A, Venkateshvaran A, Larsson SC, Nordgren B, Opava CH, Lundberg IE, Bäck M. Enhanced ventricular-arterial coupling during a 2-year physical activity programme in patients with rheumatoid arthritis: a prospective substudy of the physical activity in rheumatoid arthritis 2010 trial. J Intern Med 2018; 284:664-673. [PMID: 29143384 DOI: 10.1111/joim.12715] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/17/2022]
Abstract
OBJECTIVE To establish how guided physical activity in patients with rheumatoid arthritis (RA) without known cardiovascular disease affected vascular and cardiac function, and how these two entities were prospectively interconnected in this patient group. METHODS Prospective substudy of 29 participants in the Physical Activity in RA (PARA) 2010 trial. All subjects were examined at baseline, at year 1 and 2 with measures of pulse wave velocity and arterial augmentation index, as well as echocardiographic evaluation of diastolic parameters and ventricular-arterial coupling. Muscle strength and aerobic exercise capacity were assessed at baseline and yearly. All participants performed physiotherapist-guided aerobic and muscle strength exercise during 2 years and were reminded through SMS to report physical activity progress. RESULTS This cohort of patients with RA exhibited increased vascular stiffness despite normal blood pressure. At baseline, lower muscle strength was associated with increased vascular stiffness (β = 0.68; P = 0.004), whereas lower aerobic working capacity was associated with left ventricular diastolic dysfunction (β = 0.85; P = 0.03). There was a significant positive correlation between vascular stiffness and diastolic dysfunction at baseline (R2 = 0.64) and for the changes in those parameters observed during 2 years of guided physical activity. Finally, a significant improvement in ventricular-arterial coupling was observed after exercise (P < 0.001). CONCLUSION These results indicate that although differentially associated with physical capacity parameters, improved vascular stiffness and improved diastolic dysfunction are interrelated, and that an optimization of the ventricular-arterial coupling may contribute to the beneficial effects of physical activity in patients with RA.
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Affiliation(s)
- P Sarajlic
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C Fridén
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - L H Lund
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Heart and Vascular Theme Division of Heart Failure, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Manouras
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Heart and Vascular Theme Division of Heart Failure, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Venkateshvaran
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Heart and Vascular Theme Division of Heart Failure, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S C Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - B Nordgren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C H Opava
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - I E Lundberg
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Rheumatology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Bäck
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Heart and Vascular Theme Division of Valvular and Coronary Disease, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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12
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Abstract
BACKGROUND Physical activity is associated with lower risk of coronary and cerebrovascular disease but its potential role in prevention of aortic valve stenosis (AVS) is unclear. Methods and Results: We investigated whether physical activity influences AVS risk in a cohort of 69,288 adults. During a mean follow-up of 15.3 years, 1,238 AVS cases were diagnosed. No associations were observed between AVS and walking/bicycling (≥1 h/day vs. almost never: hazard ratio 0.92, 95% CI 0.74-1.15) or exercise (≥4 hs/week vs. <1 h/week: hazard ratio 1.18, 95% CI 0.97-1.43). CONCLUSIONS Physical activity did not reduce the incidence of AVS.
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Affiliation(s)
- Philip Sarajlic
- Center for Molecular Medicine, Department of Medicine, Karolinska Institutet
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet.,Department of Surgical Sciences, Uppsala University
| | - Magnus Bäck
- Center for Molecular Medicine, Department of Medicine, Karolinska Institutet.,Heart and Vascular Theme - Division of Valvular and Coronary Disease, Karolinska University Hospital
| | - Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
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13
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Venkateshvaran A, Sarajlic P, Lund LH, Fridén C, Nordgren B, Opava CH, Lundberg IE, Larsson SC, Manouras A, Bäck M. Impaired left atrial dynamics and its improvement by guided physical activity reveal left atrial strain as a novel early indicator of reversible cardiac dysfunction in rheumatoid arthritis. Eur J Prev Cardiol 2018; 25:1106-1108. [PMID: 29799295 DOI: 10.1177/2047487318777775] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashwin Venkateshvaran
- 1 Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,2 Heart and Vascular Theme - Division of Heart Failure, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Philip Sarajlic
- 1 Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Lars H Lund
- 1 Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,2 Heart and Vascular Theme - Division of Heart Failure, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Fridén
- 3 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Birgitta Nordgren
- 3 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Christina H Opava
- 3 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,4 Rheumatology Clinic, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid E Lundberg
- 1 Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,4 Rheumatology Clinic, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Susanna C Larsson
- 5 Institute of Environmental Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Aristomenis Manouras
- 1 Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,2 Heart and Vascular Theme - Division of Heart Failure, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Bäck
- 1 Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,6 Heart and Vascular Theme - Division of Valvular and Coronary Disease, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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