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Didembourg M, Reda S, Oldenburg J, Rühl H, Douxfils J, Morimont L. Hemostatic imbalance induced by tamoxifen in estrogen receptor-positive breast cancer patients: An observational study. Int J Lab Hematol 2024; 46:546-554. [PMID: 38296772 DOI: 10.1111/ijlh.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Estrogen receptor (ER)-positive (ER+) breast cancer accounts for approximately 75% of all breast cancers. Tamoxifen, a selective estrogen receptor modulator, is the standard adjuvant treatment. Although better tolerated than aromatase inhibitors, tamoxifen increases the risk of venous thromboembolism (VTE) 1.4-fold. AIM To assess the hemostatic imbalance induced by tamoxifen in adjuvant treatment of ER+ breast cancer. METHOD Twenty-five patients in remission from ER+ breast cancer under tamoxifen were included. One hundred and thirty one age- and BMI-matched healthy controls were included to establish reference ranges of thrombin generation assay (TGA) parameters. TGA was performed in the absence and presence of exogenous activated protein C (APC) to calculate the normalized APC sensitivity ratio (nAPCsr), a marker of APC resistance. RESULTS All TG parameters except the endogenous thrombin potential (ETP) (-APC) were significantly impacted by tamoxifen (p < 0.001). In absence of APC, regardless of TGA parameters, at least 50% of results were outside the reference ranges except for ETP, which was above the upper reference limit in only two individuals. The most impacted parameter was the Peak Height with 52% (-APC) and 80% (+APC) of results above the upper reference range limit, respectively. The nAPCsr was significantly higher in tamoxifen users (mean ± standard deviation = 3.18 ± 0.91) compared to the control group (2.19 ± 0.92, p < 0.0001). CONCLUSION This observational study showed that patients in remission from ER+ breast cancer taking tamoxifen had altered thrombin generation, as well as an acquired APC resistance. Moreover, this is the first study using the validated ETP-based APC resistance assay in tamoxifen-treated patients.
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Affiliation(s)
- Marie Didembourg
- Department of Pharmacy, Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
| | - Sara Reda
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Jonathan Douxfils
- Department of Pharmacy, Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
- Research and Development Department, QUALI blood s.a., Namur, Belgium
| | - Laure Morimont
- Department of Pharmacy, Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
- Research and Development Department, QUALI blood s.a., Namur, Belgium
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Reda S, Schwarz N, Müller J, McRae HL, Oldenburg J, Pötzsch B, Rühl H. Fibrinolysis biomarker, thrombin, and activated protein C level alterations after coagulation activation depend on type of thrombophilia and clinical phenotype. Res Pract Thromb Haemost 2024; 8:102351. [PMID: 38487678 PMCID: PMC10937968 DOI: 10.1016/j.rpth.2024.102351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/14/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Background Recently, we have shown alterations in the anticoagulant response to recombinant activated factor VII (rFVIIa)-induced coagulation activation in patients with thrombophilia. Objectives This study aimed to extend this in vivo model to fibrinolysis biomarkers. Methods This interventional in vivo study included 56 patients with thrombophilia and previous venous thromboembolism (VTE+), 38 without VTE (VTE-), and 35 healthy controls. Plasma levels of D-dimer, plasmin-α2-antiplasmin (PAP) complex, and plasminogen activator inhibitor-1 (PAI-1) were monitored for over 8 hours after rFVIIa infusion (15 μg/kg) along with thrombin markers and activated protein C (APC). Results Throughout cohorts, median PAP increased by 40% to 52% (P < 3.9 × 10-10) and PAI-1 decreased by 59% to 79% (P < 3.5 × 10-8). In contrast to thrombin-antithrombin (TAT) complex, which also increased temporarily (44% to 115%, P < 3.6 × 10-6), changes in PAP and PAI-1 did not reverse during the observation period. The area under the measurement-time curves (AUCs) of PAP and TAT, which are measures of plasmin and thrombin formation, respectively, were each greater in the VTE+ cohort than in healthy controls (median PAP-AUC = 0.48 vs 0.27 ng·h/L [P = .003], TAT-AUC = 0.12 vs 0.03 nmol·h/L [P = 2.5 × 10-4]) and were correlated with one another (r = 0.554). As evidenced by the respective AUCs, asymptomatic factor (F)V Leiden carriers showed less PAP formation (0.22 vs 0.41 ng·h/L, P = 9 × 10-4), more pronounced PAI-1 decline (0.10 vs 0.18 ng·h/L, P = .01), and increased APC formation (28.7 vs 15.4 pmol·h/L, P = .02) than those within the VTE+ group (n = 19 each). Conclusion rFVIIa-induced thrombin formation is associated with fibrinolysis parameter changes outlasting the concomitant anticoagulant response. Both correlate with thrombosis history in FV Leiden and might help explain its variable clinical expressivity.
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Affiliation(s)
- Sara Reda
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Nadine Schwarz
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Jens Müller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Hannah L. McRae
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Bernd Pötzsch
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
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Ivaškevičius V, Biswas A, Singh S, Stulpinaitė U, Reda S, Rühl H, Pezeshkpoor B, Pavlova A, Oldenburg J. Fibrinogen Bonn (p. Arg510Cys) in the Aα-Chain Is Associated with High Risk of Venous Thrombosis. Hamostaseologie 2023; 43:440-446. [PMID: 37442158 DOI: 10.1055/a-2094-7191] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Inherited dysfibrinogenemia is a qualitative defect of fibrinogen caused by various mutations among three fibrinogen genes. Dysfibrinogenemia can be associated with an increased risk of thrombosis, bleeding, or both. Here, we report a 36-year-old female with dysfibrinogenemia who experienced two successful pregnancies under thromboprophylaxis after cerebral venous sinus thrombosis (CVST). PATIENTS AND METHODS In addition to plasmatic coagulation tests, fibrinogen genes FGA, FGB, and FGG were screened using direct genomic DNA sequencing. The structural-functional implications of the detected mutation were analyzed in silico. RESULTS Inherited dysfibrinogenemia was diagnosed in an index patient after CVST in a risk situation. Anticoagulation with warfarin was stopped after 12 months when the first pregnancy was planned. Pregnancy and spontaneous delivery (2020) was uncomplicated. A second pregnancy was interrupted because of acute cytomegalovirus infection and the third pregnancy was successful in 2022. Pregnancies were accompanied by thromboprophylaxis with enoxaparin 40 mg once daily until 6 weeks postpartum. Substitution of fibrinogen has not become necessary in the index patient so far. Genetic analysis revealed a novel missense mutation (p. Arg510Cys) in the FGA gene ("fibrinogen Bonn") in the index patient, as well as an asymptomatic sister, and their father who experienced recurrent pulmonary embolism. Surface exposure of wild-type Arg510 suggested the mutated Cys510 to form nonnative disulfide bonds with surface-exposed reactive cysteines from other plasma proteins like albumin leading to formation of aggregates and impaired fibrinolysis. CONCLUSIONS Fibrinogen Bonn might be associated with an increased risk of thrombosis, possibly due to impaired polymerization.
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Affiliation(s)
- V Ivaškevičius
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - A Biswas
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - S Singh
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - U Stulpinaitė
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Reda
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - H Rühl
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - B Pezeshkpoor
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - A Pavlova
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - J Oldenburg
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
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Soriano-Martín D, García-Consuegra L, Junquera L, Reda S, Junquera S. Juvenile Recurrent Parotitis: Video-Documented Sialendoscopy. J Clin Med 2023; 12:6842. [PMID: 37959307 PMCID: PMC10649241 DOI: 10.3390/jcm12216842] [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: 08/14/2023] [Revised: 10/01/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Juvenile recurrent parotitis (JRP) is characterised by recurrent episodes of painful parotid swelling in children. JRP is the second most common cause of parotitis in childhood, behind only paramyxovirus. The prevention of recurrent attacks represents the most dramatic and serious aspect of this pathology. Since 2004, different authors have evaluated sialendoscopy for the diagnostic and therapeutic management of JRP. In this paper, we share our clinical experience of the use of sialendoscopy for the treatment of JRP. We document with video sialendoscopy the glandular pathology in four children with a mean age of 11.5 years, who had suffered from 3-6 episodes/year of inflammation prior to treatment. The use of sialendoscopy in our patients was effective in preventing recurrences. For the first time, the videosialendoscopy of a series of children diagnosed with JRP is documented in the literature.
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Affiliation(s)
- David Soriano-Martín
- Department of Oral and Maxillofacial Surgery, Central University Hospital of Asturias, 33011 Oviedo, Spain
| | - Luis García-Consuegra
- Department of Oral and Maxillofacial Surgery, Central University Hospital of Asturias, 33011 Oviedo, Spain
| | - Luis Junquera
- Department of Oral and Maxillofacial Surgery, Central University Hospital of Asturias, 33011 Oviedo, Spain
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine and Health Sciences, University of Oviedo, C/. Catedrático Serrano s/n., 33006 Oviedo, Spain
| | - Sara Reda
- Department of Otolaringology, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Sonsoles Junquera
- Department of Radiology, San Agustín University Hospital, 33401 Avilés, Spain
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Reda S, Fawzy O, Sayed D, Mohamed G, Khidr EG. Inactive Matrix Gla Protein in Relation to Renal and Cardiac Functions and Cardiac Valvular Calcification Among Type 2 Diabetes Patients. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231203862. [PMID: 37846365 PMCID: PMC10576928 DOI: 10.1177/11795514231203862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/04/2023] [Indexed: 10/18/2023] Open
Abstract
Background Matrix Gla protein (MGP) is a robust innate suppressor of the detrimental process of vascular calcification in the human body. Objectives The interrelationship between circulating MGP levels and renal and cardiac dysfunction, besides echocardiographic calcification score (ECS) was investigated in a sample of type 2 diabetes (T2D) patients. Methods The study included 130 subjects. They were 95 patients with T2D and 35 age- and sex-matched healthy controls. Patients were further subdivided into 52 T2D patients without DKD (eGFR ⩾ 60 ml/minute/1.73 m²) and 43 T2D persons with DKD (eGFR > 60 ml/minute/1.73 m²). Serum MGP levels, determined by ELISA, renal function tests, lipid profile, and echocardiography were studied in all participants. Results Significantly elevated circulating inactive MGP level was noted in individuals having T2D compared to controls. It correlated negatively with eGFR and left ventricular (LV) diastolic and systolic functions and positively with indices of LV hypertrophy. ECS was significantly increased in both T2D groups compared to controls and in DKD group compared to the diabetic group without DKD. A significant positive correlation was observed between inactive MGP and ECS. Conclusion Serum inactive MGP may contribute to the development of DKD and to the associated process of cardiac valvular calcification. It may be a beneficial diagnostic marker for early prediction of cardiac calcification and preclinical LV systolic and diastolic dysfunction in T2D patients, especially in those complicated with DKD.
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Affiliation(s)
- Sara Reda
- Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Olfat Fawzy
- Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Doaa Sayed
- Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ghada Mohamed
- Department of Cardiology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Emad Gamil Khidr
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy for Boys, Al-Azhar University, Cairo, Egypt
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Schwarz N, Müller J, Yadegari H, McRae HL, Reda S, Hamedani NS, Oldenburg J, Pötzsch B, Rühl H. Ex Vivo Modeling of the PC (Protein C) Pathway Using Endothelial Cells and Plasma: A Personalized Approach. Arterioscler Thromb Vasc Biol 2023; 43:109-119. [PMID: 36353988 DOI: 10.1161/atvbaha.122.318433] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND The endothelial cell-dependent PC (protein C) pathway is critically involved in the regulation of coagulation, anti-inflammatory, and cytoprotective signaling. Its reactivity shows high interindividual variability, and it contributes to prothrombotic disorders, such as the FVL (factor V Leiden) mutation. METHODS Endothelial colony-forming cells (ECFCs) were isolated from heparinized peripheral blood from healthy individuals and FVL carriers. Confluent monolayers of ECFCs were overlaid with plasma, and thrombin formation was initiated by addition of tissue factor (1 pmol/L). Subsequently, thrombin and APC (activated PC) formation rates were measured over time using oligonucleotide-based enzyme capture assays. To induce downregulation of TM (thrombomodulin) expression, ECFCs were stimulated with IL-1β (interleukin 1β). In vivo APC response rates were monitored in study participants after infusion of low-dose rFVIIa (recombinant activated factor VII). RESULTS The median peak APC concentration was 1.12 nmol/L in experiments with IL-1β stimulated ECFCs and 3.66 nmol/L without IL-1β. Although thrombin formation rates were comparable, APC formation rates were significantly higher in FVL carriers (n=6) compared to noncarriers (n=5) as evidenced by a higher ratio between the area under the curve of APC generation to the area under the curve of thrombin generation (median 0.090 versus 0.031, P=0.017). These ex vivo results were correlated with an increased APC response to rFVIIa-induced thrombin formation in FVL carriers in vivo. CONCLUSIONS Patient-specific ex vivo modeling of the PC pathway was achieved using blood-derived ECFCs. The correlation between in and ex vivo APC response rates confirms that the autologous PC model accurately depicts the in vivo situation.
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Affiliation(s)
- Nadine Schwarz
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Jens Müller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Hamideh Yadegari
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Hannah L McRae
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Sara Reda
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Nasim Shahidi Hamedani
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Bernd Pötzsch
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
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Reda S, Rudde E, Müller J, Hamedani NS, Oldenburg J, Pötzsch B, Rühl H. Variation in Plasma Levels of Apixaban and Rivaroxaban in Clinical Routine Treatment of Venous Thromboembolism. Life (Basel) 2022; 12:life12050705. [PMID: 35629372 PMCID: PMC9143219 DOI: 10.3390/life12050705] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
Direct oral anticoagulants (DOACs) apixaban and rivaroxaban are broadly used in the management of venous thromboembolism (VTE). Although not routinely required, measurement of their plasma concentration is advised for an increasing number of indications. Due to the lack of therapeutic ranges, current guidelines recommend reporting DOAC plasma levels together with expected levels from previous pivotal studies. The aim of this study was to assess DOAC level variation in a large VTE patient population. Drug concentrations determined by measurement of the anti-Xa-activity using drug-specific calibrators in citrated plasma samples from patients on rivaroxaban (n = 1471) or apixaban (n = 725) were analyzed. Observed 5th–95th percentile ranges of apixaban peak/trough levels (63–299/13–114 ng/mL for 5 mg, 37–161/7–68 ng/mL for 2.5 mg twice daily) were similar to previously reported mass-spectrometry-based reference data, and 10th–90th percentile ranges of rivaroxaban peak/trough levels (98–367/8–55 ng/mL for 20 mg, 51–211/5–27 ng/mL for 10 mg once daily) were even narrower. Age and drug levels correlated weakly (r ≤ 0.330). Drug levels measured repeatedly in subgroups of patients showed a strong correlation (r ≥ 0.773). In conclusion, anti-Xa-activity-based measurement of apixaban and rivaroxaban yields reliable results. However, the paucity of levels off-range underlines the need for evidence-based thresholds to better assist clinical decision making.
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Affiliation(s)
| | | | | | | | | | | | - Heiko Rühl
- Correspondence: ; Tel.: +49-228-28716753
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Reda S, Thiele Serra E, Müller J, Hamedani NS, Oldenburg J, Pötzsch B, Rühl H. Increased Prevalence of Elevated D-Dimer Levels in Patients on Direct Oral Anticoagulants: Results of a Large Retrospective Study. Front Cardiovasc Med 2022; 9:830010. [PMID: 35433891 PMCID: PMC9008253 DOI: 10.3389/fcvm.2022.830010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Elevated D-dimer levels during anticoagulant therapy with vitamin K antagonists (VKA) are associated with an increased risk of thrombosis. It has been hypothesized that elevated D-dimer levels in patients receiving direct oral anticoagulants (DOACs) also indicate an increased risk of thrombosis recurrence, but data on the distribution of D-dimer levels in patients with VTE on DOACs are sparse. In the present study we retrospectively analyzed D-dimer levels in patients taking DOACs after first or recurrent venous thrombosis (n = 1,716, 1,126 thereof rivaroxaban, 481 apixaban, 62 edoxaban, and 47 dabigatran). Patients on VKA (n = 402) served as control group. Thrombotic events in the study population were categorized into distal deep venous thrombosis (DVT, n = 552 patients), distal DVT with pulmonary embolism (PE, n = 166), proximal DVT (n = 685), proximal DVT with PE (n = 462), PE without DVT (n = 522), DVT of the upper extremity (n = 78), cerebral venous sinus thrombosis (CVST, n = 48), and other venous thrombosis (n = 74). In VKA users a median D-dimer level of 0.20 mg/l was observed. In patients on DOACs D-dimer levels were significantly higher, with 0.26 mg/l for rivaroxaban, 0.31 mg/l for apixaban (P < 10−16 each), 0.24 mg/l for edoxaban (P = 2 × 10−5), and 0.25 mg/l for dabigatran (P = 4 × 10−4). These differences in comparison to patients on VKA treatment could not be explained by the patients' age, sex, body mass index, and type of thrombosis as these characteristics did not differ significantly between cohorts. Moreover, the prevalence of D-dimer levels above age-adjusted cut-offs [≥0.50 mg/l in ≤50-year-old patients, ≥(age × 0.01) mg/l in >50-year-old patients] was higher in patients on rivaroxaban (13.9%, RR 1.74, 95% CI 1.21–2.50), apixaban (17.0%, RR 2.14, 95% CI 1.45–3.15) and dabigatran (23.4%, RR 2.94, 95% CI 1.59–5.44) than in patients on VKA (8.0%). In patients on edoxaban D-dimer levels above the reference range were observed in 14.5%, but no statistical significance was reached in comparison to the VKA cohort. In conclusion, the obtained data suggest, that the type of oral anticoagulant should be considered in the clinical assessment of D-dimer levels in thrombosis patients. Further studies are warranted to evaluate a potential association between elevated D-dimer levels and thrombosis risk in patients on DOACs.
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Reda S, Schwarz N, Muller J, Oldenburg J, Potzsch B, Ruhl H. Impaired in vivo activated protein C response rates indicate a thrombophilic phenotype in inherited thrombophilia. Haematologica 2022; 107:1197-1200. [PMID: 35142157 PMCID: PMC9052898 DOI: 10.3324/haematol.2021.280573] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sara Reda
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn
| | - Nadine Schwarz
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn
| | - Jens Muller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn
| | - Bernd Potzsch
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn
| | - Heiko Ruhl
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn.
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Yagan J, Mahmoud T, Geith O, El Serwey N, Mustafa M, Reda S, Nair P, AlOtaibi T. POS-822 SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS (SGLT2i); SHORT-TERM OUTCOME IN DIABETIC KIDNEY TRANSPLANT RECIPIENTS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.858] [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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Oezkur M, Reda S, Rühl H, Theuerkauf N, Kreyer S, Duerr GD, Charitos E, Silaschi M, Medina M, Zimmer S, Putensen C, Treede H. Role of acquired von Willebrand syndrome in the development of bleeding complications in patients treated with Impella RP devices. Sci Rep 2021; 11:23722. [PMID: 34887445 PMCID: PMC8660831 DOI: 10.1038/s41598-021-02833-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/16/2021] [Indexed: 11/09/2022] Open
Abstract
Axial flow pumps are standard treatment in cases of cardiogenic shock and high-risk interventions in cardiology and cardiac surgery, although the optimal anticoagulation strategy remains unclear. We evaluated whether laboratory findings could predict bleeding complications and acquired von Willebrand syndrome (avWS) among patients who were treated using axial flow pumps. We retrospectively evaluated 60 consecutive patients who received Impella devices (Impella RP: n = 20, Impella CP/5.0: n = 40; Abiomed Inc., Danvers, USA) between January 2019 and December 2020. Thirty-two patients (53.3%) experienced major or fatal bleeding complications (Bleeding Academic Research Consortium score of > 3) despite intravenous heparin being used to maintain normal activated partial thromboplastin times (40–50 s). Extensive testing was performed for 28 patients with bleeding complications (87.5%). Relative to patients with left ventricular support, patients with right ventricular support were less likely to develop avWS (87.5% vs. 58.8%, p = 0.035). Bleeding was significantly associated with avWS (odds ratio [OR]: 20.8, 95% confidence interval [CI]: 3.3–128.5; p = 0.001) and treatment duration (OR: 1.3, 95% CI 1.09–1.55; p = 0.003). Patients with avWS had longer Impella treatment than patients without avWS (2 days [1–4.7 days] vs. 7.3 days [3.2–13.0 days]). Bleeding complications during Impella support were associated with avWS in our cohort, while aPTT monitoring was not sufficient to prevent bleeding complications. A more targeted anticoagulation monitoring might be needed for patients who receive Impella devices.
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Affiliation(s)
- Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany. .,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Sara Reda
- Department of Haematology, University Hospital of Bonn, Bonn, Germany
| | - Heiko Rühl
- Department of Haematology, University Hospital of Bonn, Bonn, Germany
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Stefan Kreyer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany.,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Efstratios Charitos
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Marta Medina
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany.,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
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12
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Reda S, Rühl H, Witkowski J, Müller J, Pavlova A, Oldenburg J, Pötzsch B. PC Deficiency Testing: Thrombin-Thrombomodulin as PC Activator and Aptamer-Based Enzyme Capturing Increase Diagnostic Accuracy. Front Cardiovasc Med 2021; 8:755281. [PMID: 34708097 PMCID: PMC8542722 DOI: 10.3389/fcvm.2021.755281] [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: 08/08/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022] Open
Abstract
Protein C (PC) activity tests are routinely performed in a thrombophilia workup to screen for PC deficiency. Currently used tests combine conversion of PC to activated PC (APC) by the snake venom Protac with subsequent APC detection through hydrolysis of a chromogenic peptide substrate or prolongation of a clotting time. In this prospective cohort study, we analyzed how different modes of PC activation and subsequent APC determination influence the diagnostic accuracy of PC activity testing in a cohort of 31 patients with genetically confirmed PC deficiency. In addition to chromogenic and clot-based measurement, an oligonucleotide-based enzyme capture assay utilizing a basic exosite-targeting aptamer was used for APC detection. To study the influence of the PC activation step on diagnostic sensitivity, PC activation through Protac and through the thrombin-thrombomodulin (TM) complex were compared. Twenty-six (84%) and 24 (77%) PC deficient patients were identified as true-positive using the chromogenic and the clot-based PC activity assay, respectively. True-positive results increased to 27 (87%) when the basic exosite-targeting aptamer approach was used for APC measurement. Additional replacement of the PC activator Protac by thrombin-TM gave true-positive results in all patients. These data indicate that the mode of PC activation is crucial in determining the accuracy of PC activity testing and that diagnostic sensitivity can be significantly improved by replacing the PC activator Protac with thrombin-TM. APC detection using a basic exosite-targeting aptamer achieves high sensitivity toward mutations outside the active center while being less subject to interfering factors than clot-based PC activity assays.
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Affiliation(s)
- Sara Reda
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Jana Witkowski
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Jens Müller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Anna Pavlova
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Bernd Pötzsch
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
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13
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García-Marín R, Reda S, Riobello C, Cabal VN, Suárez-Fernández L, Vivanco B, Álvarez-Marcos C, López F, Llorente JL, Hermsen MA. Prognostic and Therapeutic Implications of Immune Classification by CD8 + Tumor-Infiltrating Lymphocytes and PD-L1 Expression in Sinonasal Squamous Cell Carcinoma. Int J Mol Sci 2021; 22:ijms22136926. [PMID: 34203211 PMCID: PMC8268278 DOI: 10.3390/ijms22136926] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/18/2022] Open
Abstract
Sinonasal squamous cell carcinoma (SNSCC) is an aggressive tumor predominantly arising in the maxillary sinus and nasal cavities. Advances in imaging, surgical and radiotherapeutic techniques have reduced complications and morbidity; however, the prognosis generally remains poor, with an overall 5-year survival rate of 30-50%. As immunotherapy may be a new therapeutic option, we analyzed CD8+ tumor-infiltrating lymphocytes (TILs) and the tumor microenvironment immune type (TMIT, combining CD8+ TILs and PD-L1) in a series of 57 SNSCCs. Using immunohistochemistry, tissue samples of 57 SNSCCs were analyzed for expression of CD8 on TILs and of PD-L1 on tumor cells. The results were correlated to the clinical and survival data. In total, 88% (50/57) of the tumors had intratumoral CD8+ TILs; 19% (11/57)-CD8high (>10%); and 39/57 (68%)-CD8low (1-10%). PD-L1 positivity (>5%) was observed in 46% (26/57) of the SNSCCs and significantly co-occurred with CD8+ TILs (p = 0.000). Using univariate analysis, high intratumoral CD8+ TILs and TMIT I (CD8high/PD-L1pos) correlated with a worse survival rate. These results indicate that SNSCCs are immunogenic tumors, similar to head and neck squamous cell carcinomas. Nineteen percent of the cases were both CD8high and PD-L1pos and this subgroup may benefit from therapy with immune checkpoint inhibitors.
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Affiliation(s)
- Rocío García-Marín
- Department Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (R.G.-M.); (C.R.); (V.N.C.); (L.S.-F.)
| | - Sara Reda
- Department Otolaryngology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (S.R.); (C.Á.-M.); (F.L.); (J.L.L.)
| | - Cristina Riobello
- Department Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (R.G.-M.); (C.R.); (V.N.C.); (L.S.-F.)
| | - Virginia N. Cabal
- Department Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (R.G.-M.); (C.R.); (V.N.C.); (L.S.-F.)
| | - Laura Suárez-Fernández
- Department Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (R.G.-M.); (C.R.); (V.N.C.); (L.S.-F.)
| | - Blanca Vivanco
- Department Pathology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - César Álvarez-Marcos
- Department Otolaryngology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (S.R.); (C.Á.-M.); (F.L.); (J.L.L.)
| | - Fernando López
- Department Otolaryngology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (S.R.); (C.Á.-M.); (F.L.); (J.L.L.)
| | - José L. Llorente
- Department Otolaryngology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (S.R.); (C.Á.-M.); (F.L.); (J.L.L.)
| | - Mario A. Hermsen
- Department Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (R.G.-M.); (C.R.); (V.N.C.); (L.S.-F.)
- Correspondence:
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14
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Rühl H, Friemann AM, Reda S, Schwarz N, Winterhagen FI, Berens C, Müller J, Oldenburg J, Pötzsch B. Activated Factor XI is Increased in Plasma in Response to Surgical Trauma but not to Recombinant Activated FVII-Induced Thrombin Formation. J Atheroscler Thromb 2020; 29:82-98. [PMID: 33298665 PMCID: PMC8737067 DOI: 10.5551/jat.59873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/11/2022] Open
Abstract
Aim:
Feedback activation of factor XI (FXI) by thrombin is believed to play a critical role in the amplification phase of thrombin generation and to contribute to thrombosis development and hemostasis. However, the activation of FXI by thrombin has been shown
in vitro
to require a cofactor. In this study, the role of thrombin in activated FXI (FXIa) formation
in vivo
is investigated.
Methods:
The study population comprised probands in whom coagulation activation was triggered by low-dose (15 µg/kg) recombinant activated factor VII (rFVIIa,
n
=89), of whom 34 with (VTE+) and 45 without a history of venous thromboembolism (VTE−), and patients undergoing major orthopedic surgeries (
n
=45). FXIa was quantified via an enzyme capture assay using a monoclonal FXI-specific antibody. Thrombin formation was monitored using an oligonucleotide-based enzyme capture assay and the thrombin activation markers prothrombin fragment 1+2 (F1+2) and thrombin–antithrombin complex (TAT).
Results:
In the rFVIIa cohort, FXIa and thrombin remained below their lower limit of quantification of 3.48 and 1.06 pmol/L, respectively. By contrast, during the surgeries, median FXIa levels increased from 3.69 pmol/L pre-operatively to 9.41 pmol/L mid-operatively (
P
=4·10
−4
) and remained significantly elevated 24 h thereafter, with 9.38 pmol/L (
P
=0.001). Peak levels of F1+2 were comparable in the VTE+, VTE−, and surgery cohort (235, 268, and 253 pmol/L), whereas peak TAT levels were higher in the surgery cohort (53.1, 33.9, and 147.6 pmol/L).
Conclusions:
Under
in vivo
conditions, the activation of FXI requires specific local features that are present at the wounded site including potential cofactors of thrombin.
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Affiliation(s)
- Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
| | - Anne M Friemann
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
| | - Sara Reda
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
| | - Nadine Schwarz
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
| | | | - Christina Berens
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
| | - Jens Müller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
| | - Bernd Pötzsch
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
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15
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Reda S, Morimont L, Douxfils J, Rühl H. Can We Measure the Individual Prothrombotic or Prohemorrhagic Tendency by Global Coagulation Tests? Hamostaseologie 2020; 40:364-378. [DOI: 10.1055/a-1153-5824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractHemostasis is a complex process in which abnormalities can cause shifts toward prothrombotic or prohemorrhagic states resulting in thrombosis or bleeding, respectively. Several coagulation tests may be required to characterize these defects but may yet not always reflect a patient's true hemostatic capacity. Thus, global coagulation tests aiming to simulate the coagulation process in vitro instead of measuring single components thereof are certainly of interest to assess prothrombotic or prohemorrhagic tendencies. This review describes the development and application of global coagulation tests, concentrating on the more widely used methods of viscoelastometry and thrombin generation. A focus is placed on conditions characterized by simultaneous changes of various components of hemostasis, such as anticoagulant therapy or hormone-induced coagulopathy, in which global coagulation tests are especially promising. If the key challenges of standardization and automation of these tests are solved, as is the case with automated thrombogram or clot waveform analysis, global coagulation assays will play an important role in the future of laboratory diagnostics of hemostasis and thrombosis.
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Affiliation(s)
- Sara Reda
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Laure Morimont
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center, University of Namur, Namur, Belgium
- Qualiblood s.a., Namur, Belgium
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center, University of Namur, Namur, Belgium
- Qualiblood s.a., Namur, Belgium
| | - Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Bonn, Germany
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16
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Rühl H, Berens C, Winterhagen FI, Reda S, Müller J, Oldenburg J, Pötzsch B. Increased Activated Protein C Response Rates Reduce the Thrombotic Risk of Factor V Leiden Carriers But Not of Prothrombin 20210G>A Carriers. Circ Res 2019; 125:523-534. [PMID: 31314700 DOI: 10.1161/circresaha.119.315037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/08/2023]
Abstract
RATIONALE Carriers of the most common prothrombotic mutations FVL (factor V Leiden) and FII (prothrombin) 20210G>A show a highly variable clinical phenotype. Using standardized in vivo coagulation activation followed by activity pattern analysis we have recently shown, that the FVL mutation accelerates thrombin and APC (activated protein C) formation in carriers without a history of venous thromboembolism (VTE). OBJECTIVE The aim of this prospective cohort study was to investigate, if the FII 20210G>A mutation induces a similar reaction pattern, and if the response rates differ in FVL and FII 20210G>A mutation carriers with prior VTE (VTE+). METHODS AND RESULTS We comparatively analyzed 30 FVL carriers, 28 FII 20210G>A carriers (thereof 13 VTE+ each) and 15 healthy controls. Changes in plasma levels of thrombin, prothrombin activation fragment 1+2 (F1+2), TAT (thrombin-antithrombin complex), APC, and D-dimer were monitored over 8 hours after infusion of recombinant factor VIIa (15 µg/kg). An increase of F1+2 and TAT levels was observed, that did neither differ between FVL and FII 20210G>A carriers nor between asymptomatic and VTE+ carriers of these mutations. Median plasma levels of APC increased more (P=0.008) in FVL carriers (from 1.39 to 7.79 pmol/L) than in FII 20210G>A carriers (from 1.03 to 5.79 pmol/L), and more in FII 20210G>A carriers (P=2×10-4) than in healthy controls (from 0.86 to 3.00 pmol/L). Most importantly, however, the APC response was greater (P=0.015) in asymptomatic (n=13) than in VTE+ (n=12) heterozygous FVL carriers, with an increase of APC levels from 1.44 to 8.11 pmol/L versus 1.27 to 5.62 pmol/L. CONCLUSIONS These in vivo data demonstrate that the FII 20210G>A and FVL mutations share an intermediate phenotype that is characterized by increased thrombin formation after coagulation activation. Furthermore, our data support the conclusion that the APC activating capacity of FVL carriers modifies the thrombotic risk of this common prothrombotic mutation.
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Affiliation(s)
- Heiko Rühl
- From the Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Christina Berens
- From the Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Franziska I Winterhagen
- From the Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Sara Reda
- From the Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Jens Müller
- From the Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Johannes Oldenburg
- From the Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
| | - Bernd Pötzsch
- From the Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Germany
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17
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López F, García-Marín R, Suárez-Fernández L, Naves-Cabal V, Riobello C, Reda S, Hermsen M, Llórente J. PO-180 InfiltratingCD8 + T-cells and PD-L1 expression as indicators for immunotherapy in sinonasal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30346-9] [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: 11/17/2022]
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18
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Kolbitsch T, Larbig R, Reda S, Blasius A, Paar V, Wernly B, Ohnewein B, Dinges C, Lichtenauer M, Brandt M, Hoppe UC, Motloch LJ. P5136Coronary tortuosity is an indicator of poor controlled arterial hypertension and correlates with the severity of dyspnea in the absence of coronary artery disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Kolbitsch
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - R Larbig
- Clinics Maria Hilf, Cardiology, Mönchengladbach, Germany
| | - S Reda
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - A Blasius
- Clinics Maria Hilf, Cardiology, Mönchengladbach, Germany
| | - V Paar
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - B Wernly
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - B Ohnewein
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - C Dinges
- University Clinics Salzburg, Cardiac Surgery, Salzburg, Austria
| | - M Lichtenauer
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - M Brandt
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - U C Hoppe
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - L J Motloch
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
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19
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Rühl H, Reda S, Müller J, Oldenburg J, Pötzsch B. Activated Factor X-Based versus Thrombin-Based Antithrombin Testing in Thrombophilia Workup in the DOAC Era. Thromb Haemost 2018; 118:381-387. [PMID: 29378360 DOI: 10.1160/th17-08-0568] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antithrombin (AT) activity tests are used for diagnosing hereditary AT deficiency, a main genetic determinant of thrombophilia. They are either based on inhibition of thrombin (FIIa) or activated factor X (FXa). FXa-based assays have been suggested to be preferable to FIIa-based assays due to their higher sensitivity for certain AT deficiency causing mutations. To assess the performance of these two methods in a real-world scenario, 745 consecutively collected samples from patients referred to our institute during a 3-month period for thrombophilia testing were analysed. In samples from patients not receiving direct-acting oral anticoagulants or heparins (n = 485), both methods showed good agreement (r = 0.874, Bland-Altman limits of agreement 6.57%, -15.76%). While similar results were obtained in patients receiving low-molecular-weight heparin (LMWH, n = 76, r = 0.891, 4.09%, -14.35%), the agreement was lower in patients receiving rivaroxaban (n = 86, r = 0.570, 5.97%, -49.43%) and apixaban (n = 72, r = 0.735, 3.77%, -42.45%). Direct FXa inhibitors but not LMWH increased FXa-based assay results in a dose-dependent manner, while the FIIa-based test was unaffected. Both assay types were equally successful in detecting hereditary AT deficiency in our study population, as samples from 9 out of 10 patients with AT deficiency causing mutations were detected by each method. These data suggest that FXa-based AT testing can be preferred over FIIa-based methods only in the absence of direct FXa inhibitors. In patients receiving direct FXa inhibitors, AT activity testing should be performed using FIIa-based assays.
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Affiliation(s)
- Heiko Rühl
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Sara Reda
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Jens Müller
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Bernd Pötzsch
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
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20
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Riobello C, Vivanco B, Reda S, López-Hernández A, García-Inclán C, Potes-Ares S, Cabal VN, López F, Llorente JL, Hermsen MA. Programmed death ligand-1 expression as immunotherapeutic target in sinonasal cancer. Head Neck 2018; 40:818-827. [PMID: 29356178 DOI: 10.1002/hed.25067] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 02/23/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sinonasal cancer carries a poor prognosis, especially in recurrent stages, and it is a disease with very limited treatment options. METHODS The expression of programmed death ligand-1 (PD-L1) as a marker for immunotherapy was evaluated in 53 sinonasal squamous cell carcinoma (SCC) and 126 intestinal-type adenocarcinoma (ITAC) samples. Results were correlated to clinicopathological characteristics and follow-up data. RESULTS Membranous PD-L1 staining of tumor cells was observed in 34% (18/53) of the sinonasal SCC samples and in 17% (22/126) of the ITAC samples. The PD-L1 positivity on infiltrating immune cells occurred in 45% (24/53) of the sinonasal SCC samples and in 33% (41/126) of the ITAC samples. Expression of PD-L1 showed no correlation to clinicopathological parameters and was not an independent risk factor for survival. CONCLUSION The PD-L1 positivity does not seem to have prognostic value. However, a proportion of patients with sinonasal SCC and ITAC may benefit from therapy with immune checkpoint inhibitors that recently have been approved for clinical application in head and neck cancer.
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Affiliation(s)
- Cristina Riobello
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Blanca Vivanco
- Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sara Reda
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alejandro López-Hernández
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Cristina García-Inclán
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sira Potes-Ares
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Virginia N Cabal
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Fernando López
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José Luis Llorente
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Mario A Hermsen
- Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Hospital Universitario Central de Asturias, Oviedo, Spain
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21
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Motloch LJ, Larbig R, Darabi T, Reda S, Motloch KA, Wernly B, Lichtenauer M, Gebing T, Schwaiger A, Zagidullin N, Wolny M, Hoppe UC. Long-QT syndrome-associated caveolin-3 mutations differentially regulate the hyperpolarization-activated cyclic nucleotide gated channel 4. Physiol Int 2017. [DOI: 10.1556/2060.104.2017.2.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background
Caveolin-3 (cav-3) mutations are linked to the long-QT syndrome (LQTS) causing distinct clinical symptoms. Hyperpolarization-activated cyclic nucleotide channel 4 (HCN4) underlies the pacemaker current If. It associates with cav-3 and both form a macromolecular complex.
Methods
To examine the effects of human LQTS-associated cav-3 mutations on HCN4-channel function, HEK293-cells were cotransfected with HCN4 and wild-type (WT) cav-3 or a LQTS-associated cav-3 mutant (T78M, A85T, S141R, or F97C). HCN4 currents were recorded using the whole-cell patch-clamp technique.
Results
WT cav-3 significantly decreased HCN4 current density and shifted midpoint of activation into negative direction. HCN4 current properties were differentially modulated by LQTS-associated cav-3 mutations. When compared with WT cav-3, A85T, F97C, and T78M did not alter the specific effect of cav-3, but S141R significantly increased HCN4 current density. Compared with WT cav-3, no significant modifications of voltage dependence of steady-state activation curves were observed. However, while WT cav-3 alone had no significant effect on HCN4 current activation, all LQTS-associated cav-3 mutations significantly accelerated HCN4 activation kinetics.
Conclusions
Our results indicate that HCN4 channel function is modulated by cav-3. LQTS-associated mutations of cav-3 differentially influence pacemaker current properties indicating a pathophysiological role in clinical manifestations.
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Affiliation(s)
- LJ Motloch
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - R Larbig
- 2Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - T Darabi
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - S Reda
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - KA Motloch
- 3Research Program for Ophthalmology and Glaucoma Research, University Clinic of Ophthalmology and Optometry, Paracelsus Medical University/SALK, Salzburg, Austria
| | - B Wernly
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - M Lichtenauer
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - T Gebing
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - A Schwaiger
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - N Zagidullin
- 4Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - M Wolny
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - UC Hoppe
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
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Larbig R, Reda S, Paar V, Trost A, Leitner J, Weichselbaumer S, Motloch KA, Wernly B, Arrer A, Strauss B, Lichtenauer M, Reitsamer HA, Eckardt L, Seebohm G, Hoppe UC, Motloch LJ. Through modulation of cardiac Ca2+handling, UCP2 affects cardiac electrophysiology and influences the susceptibility for Ca2+-mediated arrhythmias. Exp Physiol 2017; 102:650-662. [DOI: 10.1113/ep086209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/28/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Robert Larbig
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
- Division of Electrophysiology, Department of Cardiovascular Medicine; University Hospital Münster; Münster Germany
| | - Sara Reda
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
| | - Vera Paar
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
| | - Andrea Trost
- Research Program for Ophthalmology and Glaucoma Research, University Clinic of Ophthalmology and Optometry; Paracelsus Medical University/SALK; Salzburg Austria
| | - Johannes Leitner
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
| | | | - Karolina A. Motloch
- Research Program for Ophthalmology and Glaucoma Research, University Clinic of Ophthalmology and Optometry; Paracelsus Medical University/SALK; Salzburg Austria
| | - Bernhard Wernly
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
| | - Andreas Arrer
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
| | - Benjamin Strauss
- Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Michael Lichtenauer
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
| | - Herbert A. Reitsamer
- Research Program for Ophthalmology and Glaucoma Research, University Clinic of Ophthalmology and Optometry; Paracelsus Medical University/SALK; Salzburg Austria
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine; University Hospital Münster; Münster Germany
| | - Guiscard Seebohm
- Institute for Genetics of Heart Diseases (IFGH), Department of Cardiovascular Medicine; University Hospital Münster; Münster Germany
| | - Uta C. Hoppe
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
| | - Lukas J. Motloch
- Department of Internal Medicine II; Paracelsus Medical University/SALK; Salzburg Austria
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Motloch LJ, Reda S, Larbig R, Wolff A, Motloch KA, Wernly B, Granitz C, Lichtenauer M, Wolny M, Hoppe UC. Characteristics of coronary artery disease among patients with atrial fibrillation compared to patients with sinus rhythm. Hellenic J Cardiol 2017; 58:204-212. [PMID: 28300667 DOI: 10.1016/j.hjc.2017.03.001] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/24/2017] [Accepted: 03/03/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND With a high prevalence of coronary artery disease (CAD) among patients with atrial fibrillation (AF), CAD is one of the main risk factors for AF. However, little is known about the characteristics of CAD in AF patients, especially whether a specific anatomical distribution of coronary artery stenoses might predispose an individual to AF via atrial ischemia remains speculative. To address this issue, we evaluated the potential associations between angiographic characteristics of CAD and AF. METHODS In this single-center retrospective analysis, 796 consecutive patients with confirmed CAD and AF (CAD-AF) and 785 patients with CAD and sinus rhythm (CAD-SR) were enrolled. Clinical characteristics and angiographic findings were compared between groups in stable CAD and during acute myocardial infarction (MI). RESULTS Mitral valve disease and chronic heart failure were significantly more common in CAD-AF than in CAD-SR. Clinical condition in CAD-AF was significantly more severe as indicated by New York Heart Association/World Health Organization functional class. Left ventricular ejection fraction was reduced in CAD-AF, reflecting the marked fraction of patients with ischemic cardiomyopathy. No association between anatomical characteristics of CAD and AF was found. However, CAD-AF seemed to be associated with a higher CAD severity (p = 0.06). Additionally, CAD-AF with MI showed a significantly higher number of diseased coronary vessels. CONCLUSION The anatomical distribution of coronary artery stenoses does not contribute to AF in CAD patients. However, AF is linked to a higher CAD severity, which might predispose individuals to AF by driving ischemic heart disease and changes in left ventricular function.
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Affiliation(s)
- Lukas J Motloch
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Sara Reda
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Robert Larbig
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Ariane Wolff
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Karolina A Motloch
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria; Department of Ophthalmology, SALK/University Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christina Granitz
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Martin Wolny
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
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Motloch LJ, Gebing T, Reda S, Schwaiger A, Wolny M, Hoppe UC. UCP3 Regulates Single-Channel Activity of the Cardiac mCa1. J Membr Biol 2016; 249:577-84. [PMID: 27371160 PMCID: PMC4942494 DOI: 10.1007/s00232-016-9913-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/15/2016] [Indexed: 12/14/2022]
Abstract
Mitochondrial Ca(2+) uptake (mCa(2+) uptake) is thought to be mediated by the mitochondrial Ca(2+) uniporter (MCU). UCP2 and UCP3 belong to a superfamily of mitochondrial ion transporters. Both proteins are expressed in the inner mitochondrial membrane of the heart. Recently, UCP2 was reported to modulate the function of the cardiac MCU related channel mCa1. However, the possible role of UCP3 in modulating cardiac mCa(2+) uptake via the MCU remains inconclusive. To understand the role of UCP3, we analyzed cardiac mCa1 single-channel activity in mitoplast-attached single-channel recordings from isolated murine cardiac mitoplasts, from adult wild-type controls (WT), and from UCP3 knockout mice (UCP3(-/-)). Single-channel registrations in UCP3(-/-) confirmed a murine voltage-gated Ca(2+) channel, i.e., mCa1, which was inhibited by Ru360. Compared to WT, mCa1 in UCP3(-/-) revealed similar single-channel characteristics. However, in UCP3(-/-) the channel exhibited decreased single-channel activity, which was insensitive to adenosine triphosphate (ATP) inhibition. Our results suggest that beyond UCP2, UCP3 also exhibits regulatory effects on cardiac mCa1/MCU function. Furthermore, we speculate that UCP3 might modulate previously described inhibitory effects of ATP on mCa1/MCU activity as well.
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Affiliation(s)
- Lukas J Motloch
- Department of Internal Medicine II, Paracelsus Medical University, Muellner Hauptstr. 48, A-5020, Salzburg, Austria.
| | - Tina Gebing
- Department of Internal Medicine II, Paracelsus Medical University, Muellner Hauptstr. 48, A-5020, Salzburg, Austria
| | - Sara Reda
- Department of Internal Medicine II, Paracelsus Medical University, Muellner Hauptstr. 48, A-5020, Salzburg, Austria
| | - Astrid Schwaiger
- Department of Internal Medicine II, Paracelsus Medical University, Muellner Hauptstr. 48, A-5020, Salzburg, Austria
| | - Martin Wolny
- Department of Internal Medicine II, Paracelsus Medical University, Muellner Hauptstr. 48, A-5020, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University, Muellner Hauptstr. 48, A-5020, Salzburg, Austria
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Motloch LJ, Larbig R, Gebing T, Reda S, Schwaiger A, Leitner J, Wolny M, Eckardt L, Hoppe UC. By Regulating Mitochondrial Ca2+-Uptake UCP2 Modulates Intracellular Ca2+. PLoS One 2016; 11:e0148359. [PMID: 26849136 PMCID: PMC4746117 DOI: 10.1371/journal.pone.0148359] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/19/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction The possible role of UCP2 in modulating mitochondrial Ca2+-uptake (mCa2+-uptake) via the mitochondrial calcium uniporter (MCU) is highly controversial. Methods Thus, we analyzed mCa2+-uptake in isolated cardiac mitochondria, MCU single-channel activity in cardiac mitoplasts, dual Ca2+-transients from mitochondrial ((Ca2+)m) and intracellular compartment ((Ca2+)c) in the whole-cell configuration in cardiomyocytes of wild-type (WT) and UCP2-/- mice. Results Isolated mitochondria showed a Ru360 sensitive mCa2+-uptake, which was significantly decreased in UCP2-/- (229.4±30.8 FU vs. 146.3±23.4 FU, P<0.05). Single-channel registrations confirmed a Ru360 sensitive voltage-gated Ca2+-channel in mitoplasts, i.e. mCa1, showing a reduced single-channel activity in UCP2-/- (Po,total: 0.34±0.05% vs. 0.07±0.01%, P<0.05). In UCP2-/- cardiomyocytes (Ca2+)m was decreased (0.050±0.009 FU vs. 0.021±0.005 FU, P<0.05) while (Ca2+)c was unchanged (0.032±0.002 FU vs. 0.028±0.004 FU, P>0.05) and transsarcolemmal Ca2+-influx was inhibited suggesting a possible compensatory mechanism. Additionally, we observed an inhibitory effect of ATP on mCa2+-uptake in WT mitoplasts and (Ca2+)m of cardiomyocytes leading to an increase of (Ca2+)c while no ATP dependent effect was observed in UCP2-/-. Conclusion Our results indicate regulatory effects of UCP2 on mCa2+-uptake. Furthermore, we propose, that previously described inhibitory effects on MCU by ATP may be mediated via UCP2 resulting in changes of excitation contraction coupling.
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Affiliation(s)
- Lukas Jaroslaw Motloch
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
- * E-mail:
| | - Robert Larbig
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Tina Gebing
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Sara Reda
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Astrid Schwaiger
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Johannes Leitner
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Martin Wolny
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Uta C. Hoppe
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
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Motloch LJ, Reda S, Wolny M, Hoppe UC. UCP2 Modulates Cardioprotective Effects of Ru360 in Isolated Cardiomyocytes during Ischemia. Pharmaceuticals (Basel) 2015; 8:474-82. [PMID: 26248074 PMCID: PMC4588178 DOI: 10.3390/ph8030474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Ruthenium 360 (Ru360) has been shown to induce cardioprotective mechanisms in perfused hearts. The agent is a specific blocker of the main cardiac mitochondrial uptake mechanism, the mitochondrial calcium uniporter (MCU). UCP2, a mitochondrial membrane protein, which influences cardiac ROS formation was reported to interact with the MCU. METHODS To prove whether Ru360 affects ischemic cell injury on the singular cell level, cell viability (CV) in isolated cardiomyocytes from wild type mice (WT) was measured in a model of pelleting hypoxia (PH). To explore a possible influence of UCP2 on cellular survival, as well as on Ru360 function, cardiomyocytes from UCP2-/- mice were investigated. RESULTS During PH, Ru360 significantly improved CV in WT cardiomyocytes (Control 26.32% ± 1.58% vs. PH 13.60% ± 1.20% vs. PH+Ru360 19.98% ± 0.98%, n = 6; p < 0.05). No differences in the rate of apoptosis were observed in UCP2-/- vs. WT. In UCP2-/- cardiomyocytes, Ru360 reduced the rate of cell death. However, the effect was less pronounced compared to WT cardiomyocytes. CONCLUSION Ru360 significantly reduces hypoxic cell injury by preventing single cell apoptosis in WT cardiomyoctes. UCP2 does not affect cell survival in hypoxic cardiomyocytes, but it might modulate cardioprotective effects of Ru360 during ischemia.
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Affiliation(s)
- Lukas J Motloch
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg 5020, Austria.
| | - Sara Reda
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg 5020, Austria.
| | - Martin Wolny
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg 5020, Austria.
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg 5020, Austria.
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El-Moghazy E, Abd-Elmageed AE, Reda S. Measurements of UV-A radiation and hazard limits from some types of outdoor lamps. Int J Metrol Qual Eng 2014; 5:407. [DOI: 10.1051/ijmqe/2014021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Larbig RK, Motloch LJ, Gebing T, Reda S, Deininger E, Schwaiger A, Wolny M, Hoppe UC. Ucp2 Modulates Cellular Excitation Contraction Coupling via Mitochondrial Calcium Uptake. Biophys J 2014. [DOI: 10.1016/j.bpj.2013.11.3283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Motloch LJ, Larbig R, Gebing T, Reda S, Weichselbaumer S, Kokoschinegg D, Schwaiger A, Wolny M, Hoppe UC. Ucp2 Modulates Mitochondrial Calcium Uniporter. Biophys J 2014. [DOI: 10.1016/j.bpj.2013.11.3282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Chronic heart failure has an age-dependent prevalence of 2% and is therefore one of the most frequent diseases in western societies. A reduced hemoglobin concentration according to the definition of the World Health Organization is a common comorbidity affecting more than half of all heart failure patients. Elderly patients, patients suffering from renal impairment and women are more likely to develop anemia but a definitive etiology of anemia is only identified in the minority of cases. Anemia is associated with a poor clinical status and a greater risk of hospitalization and is a predictive factor for increased mortality. The incidence of anemia appears to increase with a poorer functional class. Intravenous iron therapy improves the exercise capacity in patients with systolic heart failure and iron deficiency and is currently being recommended for patients with persistent symptoms despite optimal medical and device therapy. However, erythropoietin-stimulating agents as a treatment for anemia in chronic heart failure have failed to improve clinical outcome in a large randomized trial. In patients with heart failure but with maintained ejection fraction, anemia is also associated with a poor prognosis. Specific therapeutic recommendations for these patients are still not available.
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Affiliation(s)
- S Reda
- Klinik II für Innere Medizin, Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, A-5020, Salzburg, Österreich,
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Brandt MC, Reda S, Mahfoud F, Lenski M, Böhm M, Hoppe UC. Effects of renal sympathetic denervation on arterial stiffness and central hemodynamics in patients with resistant hypertension. J Am Coll Cardiol 2012; 60:1956-65. [PMID: 23062529 DOI: 10.1016/j.jacc.2012.08.959] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 07/09/2012] [Accepted: 08/08/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study investigated the effect of catheter-based renal sympathetic denervation (RD) on central hemodynamics in patients with resistant hypertension. BACKGROUND High central blood pressure (BP) increases cardiovascular events and mortality independently of peripheral BP. The effect of RD on central BP is unclear. METHODS A total of 110 patients underwent bilateral RD. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressure and hemodynamic indices at baseline and 1, 3, and 6 months after ablation. Ten patients with resistant hypertension not undergoing RD served as controls. RESULTS RD significantly reduced mean central aortic BP from 167/92 mm Hg to 149/88 mm Hg, 147/85 mm Hg, and 141/85 mm Hg at 1, 3, and 6 months (p < 0.001), respectively. Aortic pulse pressure decreased from 76.2 ± 23.3 mm Hg to 61.5 ± 17.5 mm Hg, 62.7 ± 18.1 mm Hg, and 54.5 ± 15.7 mm Hg 1, 3, and 6 months after RD (p < 0.001), respectively. Six months after RD aortic augmentation and augmentation index were significantly reduced by -11 mm Hg (p < 0.001) and -5.3% (p < 0.001), respectively. Carotid to femoral pulse wave velocity showed a significant reduction from 11.6 ± 3.2 m/s to 9.6 ± 3.1 m/s at 6 months (p < 0.001). Consistently, ejection duration and aortic systolic pressure load were significantly diminished, indicating improvement of cardiac work load by RD. No significant changes were obtained in control patients. CONCLUSIONS Besides the known effect of RD on brachial blood pressure, the study showed for the first time that this novel approach significantly improves arterial stiffness and central hemodynamics, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.
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Affiliation(s)
- Mathias C Brandt
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48,Salzburg, Austria
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Rottlaender D, Motloch L, Reda S, Larbig R, Hoppe U. Cardiac arrest due to long QT syndrome associated with excessive consumption of energy drinks. Int J Cardiol 2012; 158:e51-2. [DOI: 10.1016/j.ijcard.2011.10.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
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Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Böhm M, Hoppe UC. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 2012; 59:901-9. [PMID: 22381425 DOI: 10.1016/j.jacc.2011.11.034] [Citation(s) in RCA: 372] [Impact Index Per Article: 31.0] [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] [Received: 07/19/2011] [Revised: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This study investigated the effect of catheter-based renal sympathetic denervation (RD) on left ventricular hypertrophy (LVH) and systolic and diastolic function in patients with resistant hypertension. BACKGROUND LVH and diastolic dysfunction are associated with elevated sympathetic activity and increased morbidity and mortality. The effect of RD on LVH and LV function is unclear. METHODS Forty-six patients underwent bilateral RD, and 18 patients served as controls. Transthoracic echocardiography was performed at baseline, and after 1 month and 6 months. RESULTS Besides reduction of systolic and diastolic blood pressure (-22.5/-7.2 mm Hg at 1 month and -27.8/-8.8 mm Hg at 6 months, p < 0.001 at each time point), RD significantly reduced mean interventricular septum thickness from 14.1 ± 1.9 mm to 13.4 ± 2.1 mm and 12.5 ± 1.4 mm (p = 0.007), and LV mass index from 53.9 ± 15.6 g/m(2.7) (112.4 ± 33.9 g/m(2)) to 47.0 ± 14.2 g/m(2.7) (103.6 ± 30.5 g/m(2)) and 44.7 ± 14.9 g/m(2.7) (94.9 ± 29.8 g/m(2)) (p < 0.001) at 1 month and 6 months, respectively. The mitral valve lateral E/E' decreased after RD from 9.9 ± 4.0 to 7.9 ± 2.2 at 1 month and 7.4 ± 2.7 at 6 months (p < 0.001), indicating reduction of LV filling pressures. Isovolumic relaxation time shortened (baseline 109.1 ± 21.7 ms vs. 85.6 ± 24.4 ms at 6 months, p = 0.006), whereas ejection fraction significantly increased after RD (baseline: 63.1 ± 8.1% vs. 70.1 ± 11.5% at 6 months, p < 0.001). No significant changes were obtained in control patients. CONCLUSIONS Besides the known effect on blood pressure, our study showed for the first time that RD significantly reduces LV mass and improves diastolic function, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.
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Affiliation(s)
- Mathias C Brandt
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
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Rottlaender D, Motloch LJ, Schmidt D, Reda S, Larbig R, Wolny M, Dumitrescu D, Rosenkranz S, Erdmann E, Hoppe UC. Clinical impact of atrial fibrillation in patients with pulmonary hypertension. PLoS One 2012; 7:e33902. [PMID: 22439013 PMCID: PMC3306317 DOI: 10.1371/journal.pone.0033902] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 02/19/2012] [Indexed: 11/30/2022] Open
Abstract
Background Pulmonary hypertension (PH) is associated with progressive impairment of right ventricular function, reduced exercise capacity and a poor prognosis. Little is known about the prevalence, clinical manifestation and impact of atrial fibrillation (AF) on cardiac function in PH. Methods In a four year single-centre retrospective analysis 225 patients with confirmed PH of various origins were enrolled to investigate the prevalence of AF, and to assess the clinical manifestation, 6-minute walk distance, NT-proBNP levels, echocardiographic parameters and hemodynamics obtained by right heart catheterization in PH with AF. Results AF was prevalent in 31.1%. In patients with PH and AF, parameters of clinical deterioration (NYHA/WHO functional class, 6-minute walk distance, NT-proBNP levels) and renal function were significantly compromised compared to patients with PH and sinus rhythm (SR). In the total PH cohort and in PH not related to left heart disease occurrence of AF was associated with an increase of right atrial pressure (RAP) and right atrial dilatation. While no direct association was found between pulmonary artery pressure (PAP) and AF in these patients, right ventricular function was reduced in AF, indicating more advanced disease. In PH due to left heart failure the prevalence of AF was particularly high (57.7% vs. 23.1% in other forms of PH). In this subgroup, left atrial dilatation, increase of pulmonary capillary wedge pressure, PAP and RAP were more pronounced in AF than in SR, suggesting that more marked backward failure led to AF in this setting. Conclusion PH is associated with increased prevalence of AF. Occurrence of AF in PH indicates clinical deterioration and more advanced disease.
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Affiliation(s)
- Dennis Rottlaender
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria.
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Jaroslaw Motloch L, Rottlaender D, Gebing T, Wolny M, Reda S, Hoppe UC. Two Voltage-Gated Calcium Channels Regulate Calcium Uptake in Murine Cardiac Mitochondria. Biophys J 2012. [DOI: 10.1016/j.bpj.2011.11.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Motloch LJ, Reda S, Rottlaender D, Khatib R, Müller-Ehmsen J, Seck C, Strauch J, Madershahian N, Erdmann E, Wahlers T, Hoppe UC. Postprocedural Atrial Fibrillation After Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement. Ann Thorac Surg 2012; 93:124-31. [DOI: 10.1016/j.athoracsur.2011.08.078] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 10/15/2022]
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Motloch LJ, Rottlaender D, Reda S, Larbig R, Bruns M, Müller-Ehmsen J, Strauch J, Madershahian N, Erdmann E, Wahlers T, Hoppe UC. Local versus general anesthesia for transfemoral aortic valve implantation. Clin Res Cardiol 2011; 101:45-53. [PMID: 21931964 DOI: 10.1007/s00392-011-0362-8] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 09/07/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) represents a novel option for elderly with severe aortic valve stenosis who are denied surgical aortic valve replacement due to high perioperative risk. While transfemoral TAVI generally is being performed in general anesthesia (GA), TAVI under local anesthesia plus mild sedation (LAPS) might be an effective and safe alternative. METHODS In a single-centre analysis, we assessed clinical data, preoperative risk scores (STS-Score), echocardiography, periprocedural data and labor costs in 74 patients undergoing transfemoral TAVI under GA (n = 33) and LAPS (n = 41). RESULTS Patients who underwent TAVI in LAPS presented significantly more often with pulmonary hypertension and impaired renal function, and tended to have a higher STS score and more severe symptoms (higher NYHA class) versus the GA group. There were no significant differences in procedure-related 30-day mortality or complications between groups. The peak systolic and mean central aortic pressure were significantly higher in the LAPS group, while at the same time these patients required significantly less often periprocedural adrenergic support. Intervention time was shorter in the LAPS group due to avoidance of surgical cut-down of the access site. Moreover, total procedure time was significantly shorter and labor costs were lower in the LAPS group. Patients who underwent TAVI in LAPS could be mobilized significantly earlier. CONCLUSION Our study indicates that TAVI under LAPS is as effective and safe as TAVI under GA. Furthermore, total procedure time, intervention time and labor costs could be reduced by LAPS. Mobilization of patients could be achieved earlier. We therefore consider LAPS to be favorable in patients undergoing transfemoral TAVI.
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Affiliation(s)
- Lukas J Motloch
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020 Salzburg, Austria
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Rottlaender D, Reda S, Motloch LJ, Hoppe UC. [New tyrosine kinase and EGFR inhibitors in cancer therapy. Cardiac and skin toxicity as relevant side effects. Part A: heart]. Internist (Berl) 2011; 52:1245-55. [PMID: 21792599 DOI: 10.1007/s00108-011-2895-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cardiotoxicity is a serious side effect of targeted molecular therapies in cancer treatment. Monoclonal antibodies and tyrosine kinase inhibitors are known to be potent therapies in various neoplastic diseases due to inhibition of specific signal transduction pathways. Although targeted therapies are considered to be less toxic and better tolerated than common chemotherapies certain cardiac side effects have been observed. Cardiac toxicity may range from asymptomatic reduction of left ventricular function to life-threatening events like heart failure and acute coronary syndrome. Further side effects are arterial hypertension, thrombosis and arrhythmias. Cardiovascular side effects are common for anti-HER2 therapy in combination with anthracyclines and for inhibitors of angiogenesis. In these patients careful cardiac monitoring is warranted. Because of missing randomized long-term follow-ups, information about cardiac side effects is limited in newly developed targeted molecular therapies. In case of cardiac side effects or preexisting cardiac disease before therapy initiation, assessments by a cardiologist throughout the course of treatment are important. For patients with severe cardiac side effects, discontinuation of treatment is warranted; in case of asymptomatic cardiac side effects symptom-specific therapy should be performed.
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Affiliation(s)
- D Rottlaender
- Klinik III für Innere Medizin, Universität zu Köln, Kerpener-Straße 62, 50937, Köln, Deutschland
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Abstract
BACKGROUND Prompts to encourage attendance at clinics are often used in day-to-day practice by diligent carers of people with mental health problems. These may take the form of telephone prompting, financial incentives or issuing a copy of the referral letter to the appointee. OBJECTIVES To estimate the effects of simple prompting by professional carers to encourage attendance at clinics for those with serious mental illness. SEARCH STRATEGY Methodical searches of Biological Abstracts (1985-2000), CINAHL (1982-2000), Cochrane Schizophrenia Group's Register (June 2000), Cochrane Library (Issue 2, 2000), EMBASE (1980-2000), MEDLINE (1966-2000) and PsycLIT (1887-2000) were undertaken. These were supplemented by searching of reference lists, personal contact and hand searching of high yield journals. SELECTION CRITERIA All relevant randomised (or quasi-randomised) studies comparing the addition of 'prompts' to standard care for those with serious mental illnesses such as schizophrenia. Prompts had the stated purpose of encouraging attendance or contact with mental health teams and could be text-based, electronic, by telephone call, by personal visit, or could employ financial or other rewards. DATA COLLECTION AND ANALYSIS Studies and data were independently selected and extracted. For homogeneous dichotomous data the random effects relative risk (RR), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data the reviewers calculated weighted mean differences. MAIN RESULTS Only three relevant trials were identified (total n=597). It is not clear whether there is any real difference between attendance of those prompted by telephone one or two days before the appointment, and those given the standard appointment management system (2 trials, n=457, RR missed appointment 0.84 CI 0.7 to 1.1). Text-based prompts, a few days before the appointment day, did increase clinic attendance when compared with no prompt (2 trials, n=200, RR missed appointment 0.6 CI 0.4 to 0.9, NNT 6 CI 2 to 14). Only one small study (n=61) reported data on the combination of telephone and text-based prompts versus no prompt (RR missed appointments 0.7 CI 0.4 to 1.2). When telephone prompts were compared with text-based prompts (1 trial, n=75), the latter, in the form of an 'orientation statement' (a short paragraph, taking about 30 seconds to read, explaining the programme of care, the fee system, and providing gentle encouragement) may be somewhat more effective than the telephone prompt (RR missed appointments 1.9 CI 0.98 to 3.8). One last study (n=120) compared a standard letter prompt with a letter 'orientation statement'. Overall, results tended to favour the orientation statement approach rather than the simple letter prompting attendance but the results did not reach conventional levels of statistical significance (RR missed appointments 1.6 CI 0.9 to 2.9). REVIEWER'S CONCLUSIONS There is evidence that a simple prompt to attend clinic, very close to the time of the appointment may encourage attendance, and a simple orientation-type letter, 24 hours before the clinic appointment, may be more effective than a telephone prompt. This simple intervention could be a more cost effective means of encouraging compliance at first attendance, but supplementing these data with the results of large, well designed, conducted and reported randomised studies would be desirable.
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Affiliation(s)
- S Reda
- European Institute of Health and Mental Science, University of Surrey, Guildford, Surrey, UK, GU2 5XH.
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Abstract
To determine whether casual contact with former psychiatric patients changes public perceptions of and attitudes toward persons with mental illness, 100 residents of urban North London, England, were interviewed before and six months after a residential facility for former patients was opened in their neighborhood. Their responses were compared with those of a control group of residents living elsewhere. The semistructured, door-to-door interviews revealed extremely negative attitudes toward persons with mental illness, largely formed by the media. No differences between the study and control groups were found. The negative attitudes in the study group had not changed at the six-month interview.
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Affiliation(s)
- S Reda
- University of Survey, Guildford, England
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Abstract
The trend in psychiatric care in the National Health Service in Britain is to move patients into the community. However, few attempts have been made to identify public opinions about such moves. This paper describes public beliefs of mental illness and their attitudes towards patients moved from two large institutions into their neighbourhood. Residents local to a community mental health facility were interviewed before and six months after opening the facility. The results shows that public attitudes remain negative. It seems that deinstitutionalisation has little impact on public attitudes. No distinction could be drawn between the study and control groups.
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Affiliation(s)
- S Reda
- European Institute for Health and Medical Sciences, University of Surrey, Guildford, England
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Abstract
The objective of this study was to investigate the staff's experiences involved in the processes of the transition of 20 non-demented long-stay psychiatric patients. Staff members expressed satisfaction from working outside the hospital. They believed that the patients' condition and their quality of life had improved and that they were likely to achieve successful resettlement after a lengthy process of rehabilitation. However, staff members considered that their roles were demanding and involved a lot of domestic activities. They recommended gradual and slow preparation for the patients, and an educational programme for the public as well as appropriate preparation and continuing professional support for staff.
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Thornicroft G, Gooch C, O'Driscoll C, Reda S. The TAPS Project. 9: The reliability of the Patient Attitude Questionnaire. Br J Psychiatry Suppl 1993:25-9. [PMID: 8484927] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The development of the hospital and community versions of the Patient Attitude Questionnaire is described. The instrument rates the attitudes of psychiatric patients towards their treatment settings and staff, and is framed specifically to assess attitudinal change during the transfer of patients from hospital. For the items rated using the kappa coefficient of agreement, the mean test-retest reliability value was 0.51, and the average inter-rater value was 0.82. This study shows that long-term psychiatric patients are able to give clear and consistent views about their living arrangements--views that should be sought and respected by staff.
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