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Scheuermann BC, Parr SK, Schulze KM, Kunkel ON, Turpin VG, Liang J, Ade CJ. Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2023; 12:e032616. [PMID: 37930079 PMCID: PMC10727345 DOI: 10.1161/jaha.123.032616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Cerebral small vessel disease (cSVD) is a major contributing factor to ischemic stroke and dementia. However, the vascular pathologies of cSVD remain inconclusive. The aim of this systematic review and meta-analysis was to characterize the associations between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS). METHODS AND RESULTS MEDLINE, Web of Science, and Embase were searched from inception to September 2023 for studies reporting CVR, cerebral autoregulation, or AS in relation to radiological markers of cSVD. Data were extracted in predefined tables, reviewed, and meta-analyses performed using inverse-variance random effects models to determine pooled odds ratios (ORs). A total of 1611 studies were identified; 142 were included in the systematic review, of which 60 had data available for meta-analyses. Systematic review revealed that CVR, cerebral autoregulation, and AS were consistently associated with cSVD (80.4%, 78.6%, and 85.4% of studies, respectively). Meta-analysis in 7 studies (536 participants, 32.9% women) revealed a borderline association between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99-5.14]; P=0.05). In 37 studies (27 952 participants, 53.0% women) increased AS, per SD, was associated with cSVD (OR, 1.24 [95% CI, 1.15-1.33]; P<0.01). Meta-regression adjusted for comorbidities accounted for one-third of the AS model variance (R2=29.4%, Pmoderators=0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18-1.70]; P<0.01). CONCLUSIONS The collective findings of the present systematic review and meta-analyses suggest an association between cSVD and impaired CVR and elevated AS. However, longitudinal investigations into vascular stiffness and regulatory function as possible risk factors for cSVD remain warranted.
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Affiliation(s)
| | - Shannon K. Parr
- Department of KinesiologyKansas State UniversityManhattanKSUSA
| | | | | | | | - Jia Liang
- Department of Biostatistics, St. Jude Children’s Research HospitalMemphisTNUSA
| | - Carl J. Ade
- Department of KinesiologyKansas State UniversityManhattanKSUSA
- Department of Physician’s Assistant Studies, Kansas State UniversityManhattanKSUSA
- Johnson Cancer Research CenterKansas State UniversityManhattanKSUSA
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Hammond ST, Baumfalk DR, Parr SK, Butenas AL, Scheuermann BC, Turpin VRG, Behnke BJ, Hashmi MH, Ade CJ. Impaired microvascular reactivity in patients treated with 5-fluorouracil chemotherapy regimens: Potential role of endothelial dysfunction. Int J Cardiol Heart Vasc 2023; 49:101300. [PMID: 38173789 PMCID: PMC10761309 DOI: 10.1016/j.ijcha.2023.101300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
Background 5-fluorouracil (5-FU) is the second most common cancer chemotherapy associated with short- and long-term cardiotoxicity. Although the mechanisms mediating these toxicities are not well understood, patients often present with symptoms suggestive of microvascular dysfunction. We tested the hypotheses that patients undergoing cancer treatment with 5-FU based chemotherapy regimens would present with impaired microvascular reactivity and that these findings would be substantiated by decrements in endothelial nitric oxide synthase (eNOS) gene expression in 5-FU treated human coronary artery endothelial cells (HCAEC). Methods We first performed a cross-sectional analysis of 30 patients undergoing 5-FU based chemotherapy treatment for cancer (5-FU) and 32 controls (CON) matched for age, sex, body mass index, and prior health history (excluding cancer). Cutaneous microvascular reactivity was evaluated by laser Doppler flowmetry in response to endothelium-dependent (local skin heating; acetylcholine iontophoresis, ACh) and -independent (sodium nitroprusside iontophoresis, SNP) stimuli. In vitro experiments in HCAEC were completed to assess the effects of 5-FU on eNOS gene expression. Results 5-FU presented with diminished microvascular reactivity following eNOS-dependent local heating compared to CON (P = 0.001). Iontophoresis of the eNOS inhibitor L-NAME failed to alter the heating response in 5-FU (P = 0.95), despite significant reductions in CON (P = 0.03). These findings were corroborated by lower eNOS gene expression in 5-FU treated HCAEC (P < 0.01) compared to control. Peak vasodilation to ACh (P = 0.58) nor SNP (P = 0.39) were different between groups. Conclusions The present findings suggest diminished microvascular function along the eNOS-NO vasodilatory pathway in patients with cancer undergoing treatment with 5-FU-based chemotherapy regimens and thus, may provide insight into the underlying mechanisms of 5-FU cardiotoxicity.
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Affiliation(s)
- Stephen T. Hammond
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Shannon K. Parr
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Alec L.E. Butenas
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | | | | | - Bradley J. Behnke
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
- Johnson Cancer Research Center, Kansas State University, Manhattan, KS, USA
| | | | - Carl J. Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
- Johnson Cancer Research Center, Kansas State University, Manhattan, KS, USA
- Physicians Associates Studies, Kansas State University, Manhattan, KS, USA
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Turpin VRG, Parr SK, Hammond ST, White ZJ, Tickner PJ, Chisam CE, Goerl KV, Drezner JA, Ade CJ. Cardiac changes in collegiate athletes following SARS-CoV-2 infection and quarantine: a prospective Case-Control study. Ann Med 2023; 55:2269586. [PMID: 37883807 PMCID: PMC10836285 DOI: 10.1080/07853890.2023.2269586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE Athletes are susceptible to acute respiratory tract infections, including SARS-CoV-2, which can affect cardiovascular function. We aimed to evaluate the impact of COVID-19 infection and quarantine on cardiac function in male and female collegiate athletes. METHODS We conducted a single-center, prospective, case-control study and performed transthoracic echocardiography in a diverse group of convalescent SARS-CoV-2-positive athletes following a 10-14-day quarantine, matched to non-SARS-CoV-2 athletes. Data collection occurred from August 1, 2020, to May 31, 2021. RESULTS We evaluated 61 SARS-CoV-2-positive athletes (20 ± 1 years, 39% female) and 61 controls (age 20 ± 2 years, 39% female). Echocardiography in SARS-CoV-2-positive athletes was performed on average 40 ± 38 days after infection diagnosis. All SARS-CoV-2-positive athletes had clinically normal systolic left ventricular function (LVEF > 50%). However, SARS-CoV-2-positive athletes exhibited mildly lower LVEF compared to controls (65 ± 6% vs. 72 ± 8%, respectively, p < 0.001), which remained significant when evaluated separately for female and male athletes. Sub-analysis revealed these differences occurred only when imaging occurred within a mean average of 27 days of infection, with a longer recovery period (≥27 days) resulting in no differences. SARS-CoV-2-positive male athletes exhibited higher left ventricular end-diastolic volume and mitral filling velocities compared to male controls. CONCLUSION Our study reveals unique sex-specific cardiac changes in collegiate athletes following SARS-CoV-2 infection and quarantine compared to controls. Despite a mild reduction in LVEF, which was only observed in the first weeks following infection, no clinically significant cardiac abnormalities were observed. Further research is required to understand if the changes in LVEF are directly attributed to the infection or indirectly through exercise restrictions resulting from quarantine.
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Affiliation(s)
- Vanessa-Rose G Turpin
- Department of Kinesiology, College of Health and Human Sciences, KS State University, Manhattan, KS, USA
| | - Shannon K Parr
- Department of Kinesiology, College of Health and Human Sciences, KS State University, Manhattan, KS, USA
| | - Stephen T Hammond
- Department of Kinesiology, College of Health and Human Sciences, KS State University, Manhattan, KS, USA
| | - Zachary J White
- Department of Kinesiology, College of Health and Human Sciences, KS State University, Manhattan, KS, USA
| | - Preston J Tickner
- Department of Kinesiology, College of Health and Human Sciences, KS State University, Manhattan, KS, USA
| | - Chloe E Chisam
- Department of Kinesiology, College of Health and Human Sciences, KS State University, Manhattan, KS, USA
| | - Kyle V Goerl
- Lafene Health Center, Kansas State University, Manhattan, KS, USA
| | - Jonathan A Drezner
- Department of Family Medicine, Center for Sports Cardiology, University of WA, Seattle, WA, USA
| | - Carl J Ade
- Department of Kinesiology, College of Health and Human Sciences, KS State University, Manhattan, KS, USA
- Physician Associate Studies, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
- Johnson Cancer Center, Kansas State University, Manhattan, KS, USA
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Turpin VRG, Lovoy GM, Parr SK, Hammond ST, Post HK, Caldwell JT, Banister HR, Scheuermann BC, Colburn TD, Ade CJ. Inorganic nitrate supplementation may improve diastolic function and the O 2 cost of exercise in cancer survivors: a pilot study. Support Care Cancer 2022; 31:63. [PMID: 36534177 DOI: 10.1007/s00520-022-07520-6] [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: 10/22/2021] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
In non-cancer populations, inorganic dietary nitrate (NO3-) supplementation is associated with enhanced cardiorespiratory function but remains untested in patients with a history of cancer. Therefore, this pilot study sought to determine if oral NO3- supplementation, as a supportive care strategy, increases left ventricular (LV) function and exercise performance in survivors of cancer treated with anticancer therapy while simultaneously evaluating the feasibility of the methods and procedures required for future large-scale randomized trials. Two cohorts of patients with a history of cancer treated with anticancer chemotherapy were recruited. Patients in cohort 1 (n = 7) completed a randomized, double-blind, crossover study with 7 days of NO3- or placebo (PL) supplementation, with echocardiography. Similarly, patients in cohort 2 (n = 6) received a single, acute dose of NO3- supplementation or PL. Pulmonary oxygen uptake (VO2), arterial blood pressure, and stroke volume were assessed during exercise. In cohort 1, NO3- improved LV strain rate in early filling (mean difference (MD) [95% CI]: - 0.3 1/s [- 0.6 to 0.06]; P = 0.04) and early mitral septal wall annular velocity (MD [95% CI]: 0.1 m/s [- 0.01 to - 0.001]; P = 0.02) compared to placebo. In cohort 2, NO3- decreased the O2 cost of low-intensity steady-state exercise (MD [95% CI]: - 0.5 ml/kg/min [- 0.9 to - 0.09]; P = 0.01). Resting and steady-state arterial blood pressure and stroke volume were not different between conditions. No differences between conditions for peak VO2 (MD [95% CI]: - 0.7 ml/kg/min [- 3.0 to 1.6]; P = 0.23) were observed. The findings from this pilot study warrant further investigation in larger clinical trials targeting the use of long-term inorganic dietary NO3- supplementation as a possible integrative supportive care strategy in patients following anticancer therapy.
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Affiliation(s)
- Vanessa-Rose G Turpin
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Garrett M Lovoy
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Shannon K Parr
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Stephen T Hammond
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Hunter K Post
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Jacob T Caldwell
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Heather R Banister
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Britton C Scheuermann
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Trenton D Colburn
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Carl J Ade
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA. .,Physician Assistant Studies, College of Health and Human Sciences, Kansas State University, Manhattan, USA. .,Johnson Cancer Research Center, Kansas State University, Manhattan, USA. .,Clinical Integrative Physiology Laboratory, Kansas State University, Manhattan, KS, 66506, USA.
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Butenas ALE, Rollins KS, Williams AC, Parr SK, Hammond ST, Ade CJ, Hageman KS, Musch TI, Copp SW. Mechanisms Of Mechanoreflex Activation In Rats With Heart Failure: Possible Mechanosensory Role Of ASIC1a. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876356.21458.7e] [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: 11/21/2022]
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Hammond ST, Baumfalk DR, Horn AG, Kunkel ON, Parr SK, Colburn TD, Schadler KL, Ade CJ, Behnke BJ. Acute exercise in 5‐Fluorouracil cardiotoxicity: Effects on cardiac function and reverse phase protein analysis. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r5999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Carl J. Ade
- KinesiologyKansas State UniversityManhattanKS
- Kansas State UniversityManhattanKS
| | - Bradley J. Behnke
- KinesiologyKansas State UniversityManhattanKS
- Kansas State UniversityManhattanKS
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Butenas ALE, Parr SK, Hammond ST, Ade CJ, Hageman KS, Musch TI, Copp SW. Protein Kinase C Epsilon Contributes to the Exaggerated Mechanoreflex in Rats with Heart Failure. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Carl J. Ade
- KinesiologyKansas State UniversityManhattanKS
| | - K. S. Hageman
- Anatomy and PhysiologyKansas State UniversityManhattanKS
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Butenas ALE, Rollins KS, Parr SK, Hammond ST, Ade CJ, Hageman KS, Musch TI, Copp SW. Novel mechanosensory role for acid sensing ion channel subtype 1a in evoking the exercise pressor reflex in rats with heart failure. J Physiol 2022; 600:2105-2125. [PMID: 35343594 PMCID: PMC9893514 DOI: 10.1113/jp282923] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/18/2022] [Indexed: 02/05/2023] Open
Abstract
Mechanical and metabolic signals associated with skeletal muscle contraction stimulate the sensory endings of thin fibre muscle afferents, which, in turn, generates reflex increases in sympathetic nerve activity (SNA) and blood pressure (the exercise pressor reflex; EPR). EPR activation in patients and animals with heart failure with reduced ejection fraction (HF-rEF) results in exaggerated increases in SNA and promotes exercise intolerance. In the healthy decerebrate rat, a subtype of acid sensing ion channel (ASIC) on the sensory endings of thin fibre muscle afferents, namely ASIC1a, has been shown to contribute to the metabolically sensitive portion of the EPR (i.e. metaboreflex), but not the mechanically sensitive portion of the EPR (i.e. the mechanoreflex). However, the role played by ASIC1a in evoking the EPR in HF-rEF is unknown. We hypothesized that, in decerebrate, unanaesthetized HF-rEF rats, injection of the ASIC1a antagonist psalmotoxin-1 (PcTx-1; 100 ng) into the hindlimb arterial supply would reduce the reflex increase in renal SNA (RSNA) evoked via 30 s of electrically induced static hindlimb muscle contraction, but not static hindlimb muscle stretch (model of mechanoreflex activation isolated from contraction-induced metabolite-production). We found that PcTx-1 reduced the reflex increase in RSNA evoked in response to muscle contraction (n = 8; mean (SD) ∫ΔRSNA pre: 1343 (588) a.u.; post: 816 (573) a.u.; P = 0.026) and muscle stretch (n = 6; ∫ΔRSNA pre: 688 (583) a.u.; post: 304 (370) a.u.; P = 0.025). Our data suggest that, in HF-rEF rats, ASIC1a contributes to activation of the exercise pressor reflex and that contribution includes a novel role for ASIC1a in mechanosensation that is not present in healthy rats. KEY POINTS: Skeletal muscle contraction results in exaggerated reflex increases in sympathetic nerve activity in heart failure patients compared to healthy counterparts, which likely contributes to increased cardiovascular risk and impaired tolerance for even mild exercise (i.e. activities of daily living) for patients suffering with this condition. Activation of acid sensing ion channel subtype 1a (ASIC1a) on the sensory endings of thin fibre muscle afferents during skeletal muscle contraction contributes to reflex increases in sympathetic nerve activity and blood pressure, at least in healthy subjects. In this study, we demonstrate that ASIC1a on the sensory endings of thin fibre muscle afferents plays a role in both the mechanical and metabolic components of the exercise pressor reflex in male rats with heart failure. The present data identify a novel role for ASIC1a in evoking the exercise pressor reflex in heart failure and may have important clinical implications for heart failure patients.
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Affiliation(s)
| | | | - Shannon K. Parr
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | | | - Carl J. Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - K. Sue Hageman
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Timothy I. Musch
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA,Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Steven W. Copp
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
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Ade CJ, Turpin VRG, Parr SK, Hammond ST, White Z, Weber RE, Schulze KM, Colburn TD, Poole DC. Does wearing a facemask decrease arterial blood oxygenation and impair exercise tolerance? Respir Physiol Neurobiol 2021; 294:103765. [PMID: 34352384 PMCID: PMC9715989 DOI: 10.1016/j.resp.2021.103765] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/12/2021] [Accepted: 07/25/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Concerns have been raised that COVID-19 face coverings compromise lung function and pulmonary gas exchange to the extent that they produce arterial hypoxemia and hypercapnia during high intensity exercise resulting in exercise intolerance in recreational exercisers. This study therefore aimed to investigate the effects of a surgical, flannel or vertical-fold N95 masks on cardiorespiratory responses to incremental exercise. METHODS This investigation studied 11 adult males and females at rest and while performing progressive cycle exercise to exhaustion. We tested the hypotheses that wearing a surgical (S), flannel (F) or horizontal-fold N95 mask compared to no mask (control) would not promote arterial deoxygenation or exercise intolerance nor alter primary cardiovascular variables during submaximal or maximal exercise. RESULTS Despite the masks significantly increasing end-expired peri-oral %CO2 and reducing %O2, each ∼0.8-2% during exercise (P < 0.05), our results supported the hypotheses. Specifically, none of these masks reduced sub-maximal or maximal exercise arterial O2 saturation (P = 0.744), but ratings of dyspnea were significantly increased (P = 0.007). Moreover, maximal exercise capacity was not compromised nor were there any significant alterations of primary cardiovascular responses (mean arterial pressure, stroke volume, cardiac output) found during sub-maximal exercise. CONCLUSION Whereas these results are for young healthy recreational male and female exercisers and cannot be applied directly to elite athletes, older or patient populations, they do support that arterial hypoxemia and exercise intolerance are not the obligatory consequences of COVID-19-indicated mask-wearing at least for cycling exercise.
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Affiliation(s)
- Carl J Ade
- Departments of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA.
| | | | - Shannon K Parr
- Departments of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Stephen T Hammond
- Departments of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Zachary White
- Departments of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Ramona E Weber
- Departments of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA; Anatomy and Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Kiana M Schulze
- Departments of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA; Anatomy and Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Trenton D Colburn
- Departments of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA; Anatomy and Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - David C Poole
- Departments of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA; Anatomy and Physiology, Kansas State University, Manhattan, KS, 66506, USA
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Butenas ALE, Rollins KS, Williams AC, Parr SK, Hammond ST, Ade CJ, Hageman KS, Musch TI, Copp SW. Thromboxane A 2 receptors contribute to the exaggerated exercise pressor reflex in male rats with heart failure. Physiol Rep 2021; 9:e15052. [PMID: 34558221 PMCID: PMC8461035 DOI: 10.14814/phy2.15052] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 01/31/2023] Open
Abstract
Mechanical and metabolic signals associated with skeletal muscle contraction stimulate the sensory endings of thin fiber muscle afferents and produce reflex increases in sympathetic nerve activity and blood pressure during exercise (i.e., the exercise pressor reflex; EPR). The EPR is exaggerated in patients and animals with heart failure with reduced ejection fraction (HF-rEF) and its activation contributes to reduced exercise capacity within this patient population. Accumulating evidence suggests that the exaggerated EPR in HF-rEF is partially attributable to a sensitization of mechanically activated channels produced by thromboxane A2 receptors (TxA2 -Rs) on those sensory endings; however, this has not been investigated. Accordingly, the purpose of this investigation was to determine the role played by TxA2 -Rs on the sensory endings of thin fiber muscle afferents in the exaggerated EPR in rats with HF-rEF induced by coronary artery ligation. In decerebrate, unanesthetized rats, we found that injection of the TxA2 -R antagonist daltroban (80 μg) into the arterial supply of the hindlimb reduced the pressor response to 30 s of electrically induced 1 Hz dynamic hindlimb muscle contraction in HF-rEF (n = 8, peak ∆MAP pre: 22 ± 3; post: 14 ± 2 mmHg; p = 0.01) but not sham (n = 10, peak ∆MAP pre: 13 ± 3; post: 11 ± 2 mmHg; p = 0.68) rats. In a separate group of HF-rEF rats (n = 4), we found that the systemic (intravenous) injection of daltroban had no effect on the EPR (peak ΔMAP pre: 26 ± 7; post: 25 ± 7 mmHg; p = 0.50). Our data suggest that TxA2 -Rs on thin fiber muscle afferents contribute to the exaggerated EPR evoked in response to dynamic muscle contraction in HF-rEF.
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Affiliation(s)
| | | | - Auni C. Williams
- Department of KinesiologyKansas State UniversityManhattanKansasUSA
| | - Shannon K. Parr
- Department of KinesiologyKansas State UniversityManhattanKansasUSA
| | | | - Carl J. Ade
- Department of KinesiologyKansas State UniversityManhattanKansasUSA
| | - K. Sue Hageman
- Department of Anatomy and PhysiologyKansas State UniversityManhattanKansasUSA
| | - Timothy I. Musch
- Department of KinesiologyKansas State UniversityManhattanKansasUSA
- Department of Anatomy and PhysiologyKansas State UniversityManhattanKansasUSA
| | - Steven W. Copp
- Department of KinesiologyKansas State UniversityManhattanKansasUSA
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Parr SK, Steele CC, Hammond ST, Turpin VRG, Ade CJ. Arterial stiffness is associated with cardiovascular and cancer mortality in cancer patients: Insight from NHANESIII. Int J Cardiol Hypertens 2021; 9:100085. [PMID: 34095811 PMCID: PMC8167280 DOI: 10.1016/j.ijchy.2021.100085] [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: 01/29/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cancer survivors are at greater risk for cardiovascular disease (CVD) than second malignancy, resulting in a decreased quality of life and increased cost of care. Additional knowledge of CVD prevention by identifying possible risk factors has clinical relevance. Our main objective was to determine the relevance of a clinical index of arterial stiffness, pulse pressure, in predicting CVD mortality in cancer patients, with a second objective to examine its relationship with cancer mortality. METHODS We retrospectively analyzed 781 cancer patients from Third National Health and Nutrition Examination Survey and Linked Mortality File, including demographic, anthropometric, blood pressure, and cause of death. Kaplan-Meier survival curve and Cox hazard regression analyses were performed to assess the relationship between pulse pressure and cardiovascular, cancer, and all-cause mortality. RESULTS During a mean follow-up time of 8.1 years, 603 deaths, 257 cancer and 151 CVD, occurred. In unadjusted models, the risk of CVD, cancer, and all-cause mortality were 3.8-fold, 5.3-fold, and 1.6-fold higher, respectively, for pulse pressure ≥70 mmHg compared to <50 mmHg. Adjusted analyses revealed a higher CVD mortality in cancer patients <65 years with a pulse pressure 60-70 mmHg (adjusted hazard ratio, 5.26; 95%CI, 1.12-24.78) when compared to pulse pressure of <50 mmHg. Pulse pressure was not associated with risk of all-cause, CVD, or cancer in those ≥65 years. CONCLUSION Pulse pressure, an index of arterial stiffness, is predictive of CVD mortality in cancer patients. Our findings support non-invasive office-setting measurements of arterial stiffness to identify high risk patients.
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Affiliation(s)
- Shannon K. Parr
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, USA
| | - Catherine C. Steele
- Department of Psychology and Communication, College of Arts and Sciences, Texas A&M International University, USA
| | - Stephen T. Hammond
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, USA
| | - Vanessa Rose G. Turpin
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, USA
| | - Carl J. Ade
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, USA
- Physician Assistant Studies, College of Health and Human Sciences, Kansas State University, USA
- Johnson Cancer Center, Kansas State University, USA
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Banister HR, Hammond ST, Parr SK, Sutterfield SL, Turpin VRG, Treinen S, Bell MJ, Ade CJ. Lower endothelium-dependent microvascular function in adult breast cancer patients receiving radiation therapy. Cardiooncology 2021; 7:18. [PMID: 33985593 PMCID: PMC8117502 DOI: 10.1186/s40959-021-00104-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/22/2021] [Indexed: 12/03/2022]
Abstract
Purpose Cancer patients with a history of radiotherapy are at an increased risk of ischemic heart disease. Preclinical animal studies demonstrate markedly impaired acetylcholine (ACh)-mediated endothelium-dependent vasorelaxation within days to weeks post-irradiation, however, whether microvascular function is affected in the intact human circulation during cancer radiation therapy has yet to be determined. Materials and methods Using laser-Doppler flowmetry, microvascular endothelium-dependent and independent responses were evaluated through iontophoresis of acetylcholine (ACh) (part 1, n = 7) and sodium nitroprusside (SNP) (part 2, n = 8), respectively, in women currently receiving unilateral chest adjuvant radiation therapy for breast cancer. Measurements were performed at the site of radiation treatment and at a contralateral control, non-radiated site. Cutaneous vascular conductance (CVC) was calculated by normalizing for mean arterial pressure. Results and Conculsions In part 1, patients received an average radiation dose of 2104 ± 236 cGy. A significantly lower peak ACh-mediated endothelium-dependent vasodilation was observed within the radiated microvasculature when compared to non-radiated (radiated: 532 ± 167%, non-radiated 1029 ± 263%; P = 0.02). In part 2, the average radiation dose received was 2251 ± 196 cGy. Iontophoresis of SNP elicited a similar peak endothelium-independent vasodilator response in radiated and non-radiated tissue (radiated: 179 ± 58%, non-radiated: 310 ± 158; P = 0.2). The time to 50% of the peak response for ACh and SNP was similar between radiated and non-radiated microvasculature (P < 0.05). These data provide evidence of early endothelium-dependent microvascular dysfunction in cancer patients currently receiving chest radiation and provide the scientific premise for future work evaluating coronary endothelial function and vasomotor reactivity using more detailed and invasive procedures.
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Affiliation(s)
- Heather R Banister
- Clinical Integrative Physiology Laboratory, Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Stephen T Hammond
- Clinical Integrative Physiology Laboratory, Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Shannon K Parr
- Clinical Integrative Physiology Laboratory, Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Shelbi L Sutterfield
- Clinical Integrative Physiology Laboratory, Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Vanessa-Rose G Turpin
- Clinical Integrative Physiology Laboratory, Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | | | | | - Carl J Ade
- Clinical Integrative Physiology Laboratory, Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, KS, 66506, USA. .,Johnson Cancer Research Center, Kansas State University, Manhattan, KS, 66506, USA.
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Butenas ALE, Rollins KS, Williams AC, Parr SK, Hammond ST, Ade CJ, Hageman KS, Musch TI, Copp SW. Exaggerated sympathetic and cardiovascular responses to dynamic mechanoreflex activation in rats with heart failure: Role of endoperoxide 4 and thromboxane A 2 receptors. Auton Neurosci 2021; 232:102784. [PMID: 33610008 DOI: 10.1016/j.autneu.2021.102784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/18/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022]
Abstract
The primary purpose of this investigation was to determine the role played by endoperoxide 4 receptors (EP4-R) and thromboxane A2 receptors (TxA2-R) during isolated dynamic muscle mechanoreflex activation in rats with heart failure with reduced ejection fraction (HF-rEF) and sham-operated healthy controls. We found that injection of the EP4-R antagonist L-161,982 (1 μg) into the arterial supply of the hindlimb had no effect on the peak pressor response to dynamic hindlimb muscle stretch in HF-rEF (n = 6, peak ∆MAP pre: 27 ± 7; post: 27 ± 4 mm Hg; P = 0.99) or sham (n = 6, peak ∆MAP pre: 15 ± 3; post: 13 ± 3 mm Hg; P = 0.67) rats. In contrast, injection of the TxA2-R antagonist daltroban (80 μg) into the arterial supply of the hindlimb reduced the pressor response to dynamic hindlimb muscle stretch in HF-rEF (n = 11, peak ∆MAP pre: 28 ± 4; post: 16 ± 2 mm Hg; P = 0.02) but not sham (n = 8, peak ∆MAP pre: 17 ± 3; post: 16 ± 3; P = 0.84) rats. Our data suggest that TxA2-Rs on thin fibre muscle afferents contribute to the exaggerated mechanoreflex in HF-rEF.
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Affiliation(s)
- Alec L E Butenas
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States of America
| | - Korynne S Rollins
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States of America
| | - Auni C Williams
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States of America
| | - Shannon K Parr
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States of America
| | - Stephen T Hammond
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States of America
| | - Carl J Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States of America
| | - K Sue Hageman
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, United States of America
| | - Timothy I Musch
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States of America; Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, United States of America
| | - Steven W Copp
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States of America.
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Butenas ALE, Rollins KS, Matney JE, Williams AC, Kleweno TE, Parr SK, Hammond ST, Ade CJ, Hageman KS, Musch TI, Copp SW. No effect of endoperoxide 4 or thromboxane A 2 receptor blockade on static mechanoreflex activation in rats with heart failure. Exp Physiol 2020; 105:1840-1854. [PMID: 32954541 DOI: 10.1113/ep088835] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/18/2020] [Indexed: 12/30/2022]
Abstract
NEW FINDINGS What is the central question of this study? Do endoperoxide 4 and thromboxane A2 receptors, which are receptors for cyclooxygenase products of arachidonic metabolism, on thin fibre muscle afferents play a role in the chronic mechanoreflex sensitization present in rats with heart failure with reduced ejection fraction (HF-rEF)? What is the main finding and its importance? The data do not support a role for endoperoxide 4 receptors or thromboxane A2 receptors in the chronic mechanoreflex sensitization in HF-rEF rats. ABSTRACT We investigated the role of cyclooxygenase metabolite-associated endoperoxide 4 receptors (EP4-R) and thromboxane A2 receptors (TxA2 -R) on thin fibre muscle afferents in the chronic mechanoreflex sensitization in rats with myocardial infarction-induced heart failure with reduced ejection fraction (HF-rEF). We hypothesized that injection of either the EP4-R antagonist L-161,982 (1 µg) or the TxA2 -R antagonist daltroban (80 µg) into the arterial supply of the hindlimb would reduce the increase in blood pressure and renal sympathetic nerve activity (RSNA) evoked in response to 30 s of static hindlimb skeletal muscle stretch (a model of isolated mechanoreflex activation) in decerebrate, unanaesthetized HF-rEF rats but not sham-operated control rats (SHAM). Ejection fraction was significantly reduced in HF-rEF (45 ± 11%) compared to SHAM (83 ± 6%; P < 0.01) rats. In SHAM and HF-rEF rats, we found that the EP4-R antagonist had no effect on the peak increase in mean arterial pressure (peak ΔMAP SHAM n = 6, pre: 15 ± 7, post: 15 ± 9, P = 0.99; HF-rEF n = 9, pre: 30 ± 11, post: 32 ± 15 mmHg, P = 0.84) or peak increase in RSNA (peak ΔRSNA SHAM pre: 33 ± 14, post: 47 ± 31%, P = 0.94; HF-rEF, pre: 109 ± 47, post: 139 ± 150%, P = 0.76) response to stretch. Similarly, in SHAM and HF-rEF rats, we found that the TxA2 -R antagonist had no effect on the peak ΔMAP (SHAM n = 7, pre: 13 ± 7, post: 19 ± 14, P = 0.15; HF-rEF n = 14, pre: 24 ± 13, post: 21 ± 13 mmHg, P = 0.47) or peak ΔRSNA (SHAM pre: 52 ± 43, post: 57 ± 67%, P = 0.94; HF-rEF, pre: 108 ± 93, post: 88 ± 72%, P = 0.30) response to stretch. The data do not support a role for EP4-Rs or TxA2 -Rs in the chronic mechanoreflex sensitization in HF-rEF.
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Affiliation(s)
- Alec L E Butenas
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Korynne S Rollins
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Jacob E Matney
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Auni C Williams
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Talyn E Kleweno
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Shannon K Parr
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Stephen T Hammond
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Carl J Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Karen S Hageman
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Timothy I Musch
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA.,Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Steven W Copp
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
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Abstract
Background Cardio‐oncology is a clinical discipline focused primarily on the early detection of anticancer therapy–related cardiomyopathy. However, there is growing evidence that the direct adverse consequences extend beyond the myocardium to affect the vasculature, but this evidence remains limited. In addition, there remains a paucity of clinically based strategies for monitoring vascular toxicity in these patients. Importantly, arterial stiffness is increasingly recognized as a surrogate end point for cardiovascular disease and may be an important vascular outcome to consider. Therefore, the aim of this systematic review and meta‐analysis was to summarize evidence of increased arterial stiffening with anticancer therapy and evaluate the effect of treatment modifiers. Methods and Results A total of 19 longitudinal and cross‐sectional studies that evaluated arterial stiffness both during and following anticancer therapy were identified using multiple databases. Two separate analyses were performed: baseline to follow‐up (12 studies) and control versus patient groups (10 studies). Subgroup analysis evaluated whether stiffness differed as a function of treatment type and follow‐up time. Standard mean differences and mean differences were calculated using random effect models. Significant increases in arterial stiffness were identified from baseline to follow‐up (standard mean difference, 0.890; 95% CI, 0.448–1.332; P<0.0001; mean difference, 1.505; 95% CI, 0.789–2.221; P≤0.0001) and in patient versus control groups (standard mean difference, 0.860; 95% CI, 0.402–1.318; P=0.0002; mean difference, 1.437; 95% CI, 0.426–2.448; P=0.0052). Subgroup analysis indicated differences in arterial stiffness between anthracycline‐based and non‐anthracycline‐based therapies (standard mean difference, 0.20; 95% CI, 0.001–0.41; P=0.048), but not follow‐up time. Conclusions Significant arterial stiffening occurs following anticancer therapy. Our findings support the use of arterial stiffness as part of a targeted vascular imaging strategy for the identification of early cardiovascular injury during treatment and for the detection of long‐term cardiovascular injury into survivorship.
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Affiliation(s)
- Shannon K Parr
- Department of Kinesiology College of Health and Human Sciences Kansas State University Manhattan KS
| | - Jia Liang
- Department of Statistics Kansas State University Manhattan KS
| | - Keri L Schadler
- Division of Pediatrics Department of Pediatrics The University of Texas MD Anderson Cancer Center Houston TX
| | - Susan C Gilchrist
- Department of Clinical Cancer Prevention and Department of Cardiology The University of Texas MD Anderson Cancer Center Houston TX
| | - Catherine C Steele
- Department of Food, Nutrition, Dietetics, Health Kansas State University Manhattan KS
| | - Carl J Ade
- Department of Kinesiology College of Health and Human Sciences Kansas State University Manhattan KS
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Turpin VRG, Parr SK, Hammond ST, Colburn TD, Ade CJ. Therapeutic Role of Dietary Nitrates on Cardiorespiratory Function in Cancer Survivors. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.03000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hammond ST, Parr SK, Hilgenfeld EG, Turpin VRG, Ade CJ. Microvascular Responses Following 5‐Fluoruracil Chemotherapy Administration. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.06985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Parr SK, Hammond ST, Baumfalk DR, Kunkel ON, Steele CC, Behnke BJ, Ade CJ. Protein Kinase C Activity is Increased in Human Coronary Smooth Muscle Cells following Exposure to 5‐FU Chemotherapy. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.07144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hopfenspirger MT, Parr SK, Hopp RJ, Townley RG, Agrawal DK. Mycobacterial antigens attenuate late phase response, airway hyperresponsiveness, and bronchoalveolar lavage eosinophilia in a mouse model of bronchial asthma. Int Immunopharmacol 2001; 1:1743-51. [PMID: 11562066 DOI: 10.1016/s1567-5769(01)00084-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Allergens, in combination with genetic predisposition, drive undifferentiated T cells towards the type 2 T cells. Some childhood infections may activate the production of a type 1 T cell profile. It is reasonable to speculate that a decrease in childhood infections may increase the incidence of allergy by allowing the immune balance to shift towards the type 2 T cells. We hypothesized that pre-exposure of mycobacterial antigens in sensitized mice would prevent the development of asthma-like conditions. Specifically, we examined the effect of mycobacterial antigens, Bacillus Calmette-Guerin (BCG) vaccine and Mycobacterium vaccae, on antigen-induced bronchoconstriction, airway hyperresponsiveness to methacholine, bronchoalveolar lavage eosinophilia, and plasma IL-4 and IL-12 levels in ovalbumin (OVA)-sensitized and challenged Balb/c mice. Challenge with OVA produced a 2-3-fold increase in bronchoconstriction within 3-5 min, followed by a delayed response after 60 min, the latter of which was significantly attenuated by both BCG and M. vaccae. Airway hyperresponsiveness to methacholine 24 h after OVA challenge was prevented by BCG and M. vaccae. Airway eosinophilia was also prevented by BCG and M. vaccae. The plasma IL-12 levels were significantly increased and plasma IL-4 levels were significantly decreased following BCG or M. vaccae administration in OVA-sensitized and challenged mice. Interestingly, a significant increase in plasma IL-12 was observed with BCG as compared to M. vaccae administration, suggesting a stronger type 1 response to BCG. These data support our hypothesis and suggest that BCG and M. vaccae may prevent the underlying pathophysiological changes in asthma.
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Affiliation(s)
- M T Hopfenspirger
- Center for Allergy, Asthma and Immunology, Creighton University School of Medicine, Omaha, NE 68178, USA
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