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Kovacs B, Burri H, Reek S, Sticherling C, Linka A, Ammann P, Mueller A, Kobza R, Haegeli L, Mayer K, Eriksson U, Reichlin T, Steffel J, Saguner A, Duru F. High incidence of inappropriate alarms in patients with wearable cardioverter-defibrillators: findings from the swiss WCD registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The wearable cardioverter defibrillator (WCD) uses surface electrodes built into the vest to detect underlying arrhythmia before initiating a treatment sequence. However, it is also prone to inappropriate detection due to artefacts.
Purpose
The aim of this study was to assess the alarm burden in patients and its possible impact on clinical outcomes.
Methods
The Swiss WCD Registry is a nationwide, retrospective, observational registry. Patients were included from December 2011 until February 2018. Clinical characteristics and data from the WCDs, including alarm burden were analysed. Recordings ≥30 seconds of length were analysed and categorized as VT/VF, atrial fibrillation (AF), supraventricular tachycardia or artefact.
Results
A total of 10'653 device alarms were documented in 324 of 456 patients (71.1%) over a mean WCD wear-time of 2.0±1.6 months. Among these, the episode duration was 30 seconds or more in 2996 (28.2%). One hundred and eleven (3.7%) were VT/VF episodes. The remaining recordings were inappropriate arrhythmia detections (2736 (91%) due to artefacts; 117 (3.7%) AF; 48 (1.6%) supraventricular tachycardia). Two-hundred and seven patients (45.0%) had 3 or more alarms per month, whereas 49 patients (10.7%) had 1 or more alarms per day. Body mass index (BMI) was significantly higher in patients with 3 or more alarms per month (p=0.002, 25.6 vs. 27.3 kg/m2) High alarm burden was not associated with a lower average daily wear time (20.8 hours vs 20.7 hours, p=0.785) or a decreased implantable cardioverter defibrillator implantation rate after stopping WCD use (48% vs 47.3%, p=0.156).
Conclusions
In patients using WCDs, alarms emitted by the device and impending inappropriate shocks were frequent and most commonly caused by artefacts. A high alarm burden did not lead to a decreased adherence, as determined by average daily wear-times. Obesity was significantly associated with a higher alarm burden.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - H Burri
- University Hospital of Geneva, Cardiology, Geneva, Switzerland
| | - S Reek
- Hirslanden Medical Center, Cardiology, Aarau, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A Linka
- Cantonal Hospital Winterthur, Cardiology, Winterthur, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, Cardiology, St. Gallen, Switzerland
| | - A.S Mueller
- Triemli Hospital, Cardiology, Zurich, Switzerland
| | - R Kobza
- Lucerne Cantonal Hospital, Cardiology, Lucerne, Switzerland
| | - L Haegeli
- Cantonal Hospital Aarau, Cardiology, Aarau, Switzerland
| | - K Mayer
- Cantonal Hospital Grison, Cardiology, Chur, Switzerland
| | - U Eriksson
- GZO Zurich Regional Health Center, Cardiology, Wetzikon, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - J Steffel
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Cardiology, Zurich, Switzerland
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2
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Vdovenko D, Wijnen W, Zarak Crnkovic M, Blyszczuk P, Bachmann M, Costantino S, Paneni F, Camici G, Luescher T, Eriksson U. IL-23 promotes T-cell mediated cardiac inflammation but protects the heart from fibrosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiac inflammation varies widely and, in some cases, triggers autoimmune myocarditis and further inflammatory dilated cardiomyopathy (iDCM) and heart failure. In children, myocarditis leads to cardiomyopathy in almost half of affected individuals and up to 20% of sudden death cases in young adults have been reported to be due to myocarditis. IL-12 and IL-23 belong to the same family of cytokines known to mediate inflammatory conditions. Both regulate the differentiation of T cells: IL-12 promotes towards IFN-gamma-producing Th-1 cells, while IL-23 induces IL-17-producing Th-17 cells. Heart-reactive CD4+Th17 cells play a leading role in the development of myocarditis, however, literature reports excessiveness of IL-23 in Th17-derived IL-17 production. Therapeutic strategies blocking IL-23 were suggested as a promising approach, though the specific role of IL-23 in pathogenesis is unclear and the long-term perspectives stay elusive.
Purpose
We aim to explore the role IL-23 compared to IL-12 in the manifestation of cardiac autoimmune myocarditis.
Methodology
We use dendritic cell (DC) model of experimental autoimmune myocarditis in IL-12 and IL-23-deficient mice. Mice were injected with bone marrow-derived in vitro activated and loaded with cardiac-specific peptide DCs. This model mimics natural processes taking place during heart inflammation and provides a unique method to address the role of DCs-derived cytokines. Cardiac inflammation, as well as remodeling and heart function, were analysed at the acute and chronic stages of the disease.
Results
Surprisingly, all mice developed acute myocarditis, though wt receiving IL-23−/−bmDCs showed a twofold decrease in heart-infiltrating T cells and lower numbers of Th17 population. Further decrease of heart-infiltrating T cells appeared upon total systemic IL-23 deficiency. In comparison to IL-12, directly inducing differentiation of IFN-gamma–producing Th1, IL-23 cannot induce Th17 differentiation. None of the two cytokines affect proliferation, though, IL-23 activates T cell migratory potential and increases T cell migration by twofold. At the same time, deficiency of IL-23-production by bmDCs leads to lower migration of T cells. We also show an involvement of RhoA, and the other Rho GTPases, in the mechanism of migration as blocking revoke the IL-23 effect on T cells. Moreover, we further observed more fibrosis and worse heart functioning in IL-23−/−, but not IL-12−/− mice at the chronic stage what underlines the importance of IL-23-dependent T cell trafficking in the resolution of the acute stage of autoimmune myocarditis.
Conclusion
Our observations underline IL-23 as an important cytokine responsible for T cell trafficking and resolution of the inflammation in autoimmune myocarditis. Therapeutic approaches involving inflammatory cytokine targeting are a promising clinical perspective though IL-23 deficiency might lead to increased cardiac remodeling and iDCM progression.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Swiss National Science Foundation
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Affiliation(s)
- D Vdovenko
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - W.J Wijnen
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - M Zarak Crnkovic
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - P Blyszczuk
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - M Bachmann
- GZO Zurich Regional Health Center, Department of Medicine, Wetzikon, Switzerland
| | - S Costantino
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - F Paneni
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - G.G Camici
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - T.F Luescher
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - U Eriksson
- GZO Zurich Regional Health Center, Department of Medicine, Wetzikon, Switzerland
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Hunziker L, Radovanovic D, Jeger R, Pedrazzini G, Cuculi F, Urban P, Erne P, Rickli H, Pilgrim T, Hess F, Simon R, Hangartner P, Hufschmid U, Hornig B, Altwegg L, Trummler S, Windecker S, Rueff T, Loretan P, Roethlisberger C, Evéquoz D, Mang G, Ryser D, Müller P, Jecker R, Kistler W, Hongler T, Stäuble S, Freiwald G, Schmid H, Stauffer J, Cook S, Bietenhard K, Roffi M, Wojtyna W, Schönenberger R, Simonin C, Waldburger R, Schmidli M, Federspiel B, Weiss E, Marty H, Weber K, Zender H, Poepping I, Hugi A, Koltai E, Iglesias J, Erne P, Heimes T, Jordan B, Pagnamenta A, Feraud P, Beretta E, Stettler C, Repond F, Widmer F, Heimgartner C, Polikar R, Bassetti S, Iselin H, Giger M, Egger P, Kaeslin T, Fischer A, Herren T, Eichhorn P, Neumeier C, Flury G, Girod G, Vogel R, Niggli B, Yoon S, Nossen J, Stoller U, Veragut U, Bächli E, Weber A, Schmidt D, Hellermann J, Eriksson U, Fischer T, Peter M, Gasser S, Fatio R, Vogt M, Ramsay D, Wyss C, Bertel O, Maggiorini M, Eberli F, Christen S. Twenty-Year Trends in the Incidence and Outcome of Cardiogenic Shock in AMIS Plus Registry. Circ Cardiovasc Interv 2019; 12:e007293. [DOI: 10.1161/circinterventions.118.007293] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lukas Hunziker
- Department of Cardiology, Bern University Hospital, Switzerland (L.H., T.P.)
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (D.R.)
| | - Raban Jeger
- Division of Cardiology, University Hospital Basel, Switzerland (R.J.)
| | | | - Florim Cuculi
- Heart Centre Lucerne, Luzerner Kantonsspital, Switzerland (F.C.)
| | - Philip Urban
- Cardiology Department, La Tour Hospital, Geneva, Switzerland (P.U.)
| | - Paul Erne
- Department of Biomedicine, University of Basel, Switzerland (P.E.)
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, Switzerland (H.R.)
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Switzerland (L.H., T.P.)
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Chia P, Russell P, Asadi K, Murone C, Walkiewicz M, Eriksson U, Scott A, John T. MA12.11 Analysis of Angiogenic and Stromal Biomarkers in a Large Malignant Mesothelioma Cohort. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Weckbach L, Grabmaier U, Uhl A, Zehrer A, Pick R, Klingel K, Eriksson U, Massberg S, Brunner S, Walzog B. P498Myocarditis-induced heart failure is caused by the cytokine midkine mediating neutrophil recruitment and NET formation. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.355] [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: 11/13/2022] Open
Affiliation(s)
- L Weckbach
- University Hospital of Munich, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - U Grabmaier
- Ludwig-Maximilians University, Walter Brendel Center of Experimental Medicine, Munich, Germany
| | - A Uhl
- University Hospital of Munich, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - A Zehrer
- Ludwig-Maximilians University, Walter Brendel Center of Experimental Medicine, Munich, Germany
| | - R Pick
- Ludwig-Maximilians University, Walter Brendel Center of Experimental Medicine, Munich, Germany
| | - K Klingel
- Eberhard-Karls-Universitätsklinikum Tübingen, Kardiopathologie, Institut für Pathologie und Neuropathologie, Tübingen, Germany
| | - U Eriksson
- University of Zurich, Cardioimmunology, Center of Molecular Cardiology, Zurich, Switzerland
| | - S Massberg
- University Hospital of Munich, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - S Brunner
- University Hospital of Munich, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - B Walzog
- Ludwig-Maximilians University, Walter Brendel Center of Experimental Medicine, Munich, Germany
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Antonsson T, Bylund R, Eriksson U, Gyzander E, Nilsson I, Elg M, Mattsson C, Deinum J, Pehrsson S, Karlsson O, Nilsson A, Sörensen H, Gustafsson D. Effects of Melagatran, a New Low-molecular-weight Thrombin Inhibitor, on Thrombin and Fibrinolytic Enzymes. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614245] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryMelagatran, a new, competitive and rapid inhibitor of thrombin with a molecular mass of 429 Da is described. Melagatran is well tolerated when administered in very high doses, and the oral bioavailability in the dog is relatively high. The aim of the study was to determine, in the preclinical setting, the degree of selectivity against the fibrinolytic system required for entering the clinical development phase. Melagatran was compared with two structurally similar thrombin inhibitors, inogatran and H 317/86. The potent inhibition of thrombin by melagatran was demonstrated by a low inhibition constant (Ki) for thrombin (0.002 μmol/l) and prolongation of clotting time to twice the control value in coagulation assays at low concentrations (0.010, 0.59 and 2.2 μmol/l for thrombin time, activated partial thromboplastin time and prothrombin time, respectively). Furthermore, thrombin-induced platelet aggregation was inhibited at the same concentration (IC50-value 0.002 μmol/l) as the Ki-value for thrombin. In two assays of global fibrinolysis, inhibition was observed at a concentration of 1.1 μmol/l in a euglobulin plasma fraction model, while no inhibition was observed at a concentration of ≤10 μmol/l in a plasma model. In an in vivo model of endogenous fibrinolysis in the rat, inhibition of fibrinolysis was observed at ≥1.0 μmol/l. In all assays, except the Ki-ratio determinations, the compounds could be graded with regard to selectivity against the fibrinolytic system: inogatran > melagatran > H 317/86. For melagatran, inhibition of fibrinolysis was not observed at concentrations below the upper limit of the proposed therapeutic plasma concentration interval (<0.5 μmol/l). Thus, melagatran seems to have a sufficient selectivity against the fibrinolytic system, while H 317/86 was considered to be insufficient for clinical development.
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Czepiel M, Kania G, Diviani D, Diestler O, Eriksson U, Siedlar M, Blyszczuk P. P6295Role of angiotensin II receptor type 1 in TGF-beta-mediated fibrogenesis in mouse model of experimental autoimmune myocarditis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Wahlgren N, Thorén M, Höjeberg B, Käll TB, Laska AC, Sjöstrand C, Höijer J, Almqvist H, Holmin S, Lilja A, Fredriksson L, Lawrence D, Eriksson U, Ahmed N. Randomized assessment of imatinib in patients with acute ischaemic stroke treated with intravenous thrombolysis. J Intern Med 2017; 281:273-283. [PMID: 27862464 PMCID: PMC5573589 DOI: 10.1111/joim.12576] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Imatinib, a tyrosine kinase inhibitor, has been shown to restore blood-brain barrier integrity and reduce infarct size, haemorrhagic transformation and cerebral oedema in stroke models treated with tissue plasminogen activator. We evaluated the safety of imatinib, based on clinical and neuroradiological data, and its potential influence on neurological and functional outcomes. METHODS A phase II randomized trial was performed in patients with acute ischaemic stroke treated with intravenous thrombolysis. A total of 60 patients were randomly assigned to four groups [3 (active): 1 (control)]; the active treatment groups received oral imatinib for 6 days at three dose levels (400, 600 and 800 mg). Primary outcome was any adverse event; secondary outcomes were haemorrhagic transformation, cerebral oedema, neurological severity on the National Institutes of Health Stroke Scale (NIHSS) at 7 days and at 3 months and functional outcomes on the modified Rankin scale (mRS). RESULTS Four serious adverse events were reported, which resulted in three deaths (one in the control group and two in the 400-mg dose group; one patient in the latter group did not receive active treatment and the other received two doses). Nonserious adverse events were mostly mild, resulting in full recovery. Imatinib ameliorated neurological outcomes with an improvement of 0.6 NIHSS points per 100 mg imatinib (P = 0.02). For the 800-mg group, the mean unadjusted and adjusted NIHSS improvements were 4 (P = 0.037) and 5 points (P = 0.012), respectively, versus controls. Functional independence (mRS 0-2) increased by 18% versus controls (61 vs. 79; P = 0.296). CONCLUSION This phase II study showed that imatinib is safe and tolerable and may reduce neurological disability in patients treated with intravenous thrombolysis after ischaemic stroke. A confirmatory randomized trial is currently underway.
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Affiliation(s)
- N Wahlgren
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Thorén
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - B Höjeberg
- Department of Neurology, Capio St Göran Hospital, Stockholm, Sweden
| | - T-B Käll
- Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - A-C Laska
- Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden
| | - C Sjöstrand
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - J Höijer
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - H Almqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - S Holmin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - A Lilja
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - L Fredriksson
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - D Lawrence
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - U Eriksson
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - N Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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9
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Grabmaier U, Kania G, Kreiner J, Grabmeier J, Uhl A, Huber BC, Lackermair K, Herbach N, Todica A, Eriksson U, Weckbach LT, Brunner S. Soluble Vascular Cell Adhesion Molecule-1 (VCAM-1) as a Biomarker in the Mouse Model of Experimental Autoimmune Myocarditis (EAM). PLoS One 2016; 11:e0158299. [PMID: 27501319 PMCID: PMC4976901 DOI: 10.1371/journal.pone.0158299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/13/2016] [Indexed: 01/02/2023] Open
Abstract
Vascular cell adhesion molecule-1 (VCAM-1) is strongly upregulated in hearts of mice with coxsackie virus-induced as well as in patients with viral infection-triggered dilated cardiomyopathy. Nevertheless, the role of its soluble form as a biomarker in inflammatory heart diseases remains unclear. Therefore, we investigated whether plasma levels of soluble VCAM-1 (sVCAM-1) directly correlated with disease activity and progression of cardiac dysfunction in the mouse model of experimental autoimmune myocarditis (EAM). EAM was induced by immunization of BALB/c mice with heart-specific myosin-alpha heavy chain peptide together with complete Freund`s adjuvant. ELISA revealed strong expression of cardiac VCAM-1 (cVCAM-1) throughout the course of EAM in immunized mice compared to control animals. Furthermore, sVCAM-1 was elevated in the plasma of immunized compared to control mice at acute and chronic stages of the disease. sVCAM-1 did not correlate with the degree of acute cardiac inflammation analyzed by histology or cardiac cytokine expression investigated by ELISA. Nevertheless, heart to body weight ratio correlated significantly with sVCAM-1 at chronic stages of EAM. Cardiac systolic dysfunction studied with positron emission tomography indicated a weak relationship with sVCAM-1 at the chronic stage of the disease. Our data provide evidence that plasma levels of sVCAM-1 are elevated throughout all stages of the disease but showed no strong correlation with the severity of EAM.
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Affiliation(s)
- U. Grabmaier
- Medical Department I, Ludwig-Maximilians-University, Munich, Germany
- * E-mail:
| | - G. Kania
- Research of Systemic Autoimmune Diseases, Division of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - J. Kreiner
- Medical Department I, Ludwig-Maximilians-University, Munich, Germany
| | - J. Grabmeier
- Medical Department I, Ludwig-Maximilians-University, Munich, Germany
| | - A. Uhl
- Medical Department I, Ludwig-Maximilians-University, Munich, Germany
| | - B. C. Huber
- Medical Department I, Ludwig-Maximilians-University, Munich, Germany
| | - K. Lackermair
- Medical Department I, Ludwig-Maximilians-University, Munich, Germany
| | - N. Herbach
- Institute of Veterinary Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - A. Todica
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - U. Eriksson
- Cardioimmunology, Center of Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - L. T. Weckbach
- Medical Department I, Ludwig-Maximilians-University, Munich, Germany
- Walter Brendel Centre of Experimental Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - S. Brunner
- Medical Department I, Ludwig-Maximilians-University, Munich, Germany
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10
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Abrahamsson K, Andersson P, Bergman J, Bredberg U, Brånalt J, Egnell AC, Eriksson U, Gustafsson D, Hoffman KJ, Nielsen S, Nilsson I, Pehrsson S, Polla MO, Skjaeret T, Strimfors M, Wern C, Ölwegård-Halvarsson M, Örtengren Y. Discovery of AZD8165 – a clinical candidate from a novel series of neutral thrombin inhibitors. Med Chem Commun 2016. [DOI: 10.1039/c5md00479a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A novel series of neutral thrombin inhibitors has been developed using a selection process based on docking experiments and property calculations and predictions.
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11
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Volgina G, Gadzhikulieva M, Uyshuk N, Kawamura E, Hisano S, Nakashima H, Saito T, Boor P, Babi kova J, Martin IV, Bucher EB, Eriksson U, Van Roeyen CRC, Eitner F, Floege J, Peutz-Kootstra CJ, Ostendorf T, Leh S, Leh F, Bjanes TK, Ohldieck C, Svarstad E, Han BG, Kim JS, Yang JW, Choi SO, Lollinga W, Rahbar A, De Wit RH, Riezebos-Brilman A, Soderberg-Naucler C, Van Son WJ, Sanders JS, Smit MJ, Van Den Born J, Koike K, Tsuboi N, Ikezumi Y, Go K, Ogura M, Saitoh A, Yokoo T, Yamaguchi T, Nokiba H, Hara M, Morito T, Kakihana K, Ohashi K, Ando M, Kimura T, Yagisawa T, Nanmoku K, Kurosawa A, Sakuma Y, Miki A, Nukui A, Alfieri CM, Regalia A, Simonini P, Ikehata M, Chatziantoniou C, Moroni G, Rastaldi MP, Messa P, Bockmeyer C, Sauberlich K, Zell S, Zeuschner P, Agustian PA, Wittig J, Becker JU, Peters B, Andersson Y, Hadimeri H, Stegmayr B, Molne J, Li T, He Y, Chen H, Chen J, Kobayashi A, Mitome J, Yamamoto I, Mafune A, Yamakawa T, Nakada Y, Tanno Y, Ohkido I, Tsuboi N, Yamamoto H, Yokoyama K, Yokoo T, Dervishi E, Buti E, Nozzoli C, Caldini LA, Giannakakis C, Minetti EE, Cirami L, Bergesio F, Ryuge A, Nomura A, Shimizu H, Fujita Y, Nishi S, Goto S, Nakai K, Ito J, Fujii H, Hara S, Mori G, Ligabue G, Cappelli G, Pinho A, Moreno F, Dias R, Vizcaino R, Ossareh S, Asgari M, Abdi E, Ataipour Y, Malakoutian T, Saddadi F, Rayatnia M. RENAL HISTOPATHOLOGY. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Inagi R, Motonishi S, Nangaku M, Buhl EM, Djudjaj S, Klinkhammer BM, Eriksson U, Floege J, Boor P, Kramann R, Fleig S, Fabian S, Dirocco D, Humphreys BD, Jasiek M, Karras A, Terrier B, Mesbah R, Faguer S, Jourde N, Remy P, Ronco P, Mariette X, Seror R, Thervet E, Le Guern V, Francois H, Grgic I, Krautzberger M, Hofmeister A, Lalli M, Dirocco D, Fleig S, Liu J, Duffield JS, McMahon AP, Aronow B, Humphreys BD. PATHOLOGY. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yasuda G, Kinguchi S, Katsumata M, Hirawa N, Shibata K, Van Roeyen CRC, Drescher A, Hess K, Boor P, Martin IV, Zok S, Braun G, Kuppe C, Liehn E, Weiskirchen R, Eriksson U, Gross O, Floege J, Eitner F, Ostendorf T, Mose FH, Jensen JM, Therwani S, Mortensen J, Hansen AB, Bech JN, Pedersen EB, Vink EE, De Boer A, Hoogduin JM, Leiner T, Bots ML, Blankestijn PJ, Silva Sousa H, Branco P, Dores H, Carvalho MS, Goncalves P, Almeida MS, Andrade MJ, Pereira M, Gaspar MA, Mendes M, Barata JD. HYPERTENSION: EXPERIMENTAL. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu137] [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: 11/13/2022] Open
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14
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Li H, Eriksson U. Functional Characterization of Latent PDGFS Versus Activated PDGFS Induced by Proteolytic Processing. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt459.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Kivela A, Heinonen SE, Leppanen P, Dijkstra MH, Gurzeler E, Huusko J, Olkkonen VM, Eriksson U, Jauhiainen M, Yla-Herttuala S. The effects of VEGF-A on atherosclerosis, lipoprotein profile and lipoprotein lipase in hyperlipidemic mouse models. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Kania G, Blyszczuk P, Mueller-Edenborn B, Behnke S, Luescher TF, Eriksson U. Novel link between angiotensin II and Wnt signalling in myocardial fibrogenesis in inflammatory cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Seikrit C, Henkel C, van Roeyen CRC, Bokemeyer D, Eitner F, Martin IV, Boor P, Knuchel R, Meyer HE, Muller-Newen G, Eriksson U, Floege J, Ostendorf T. Biological responses to PDGF-AA versus PDGF-CC in renal fibroblasts. Nephrol Dial Transplant 2012; 28:889-900. [DOI: 10.1093/ndt/gfs509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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18
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Li H, Kristiansen G, Holger M, Eriksson U. PDGF-CC: A Therapeutic Target in Breast Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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19
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Carlsund A, Eriksson U, Lofstedt P, Sellstrom E. Risk behaviour in Swedish adolescents: is shared physical custody after divorce a risk or a protective factor? Eur J Public Health 2012; 23:3-8. [DOI: 10.1093/eurpub/cks011] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Abstract
The use of tissue plasminogen activator (tPA) as a thrombolytic treatment in ischemic stroke is limited largely due to concerns for hemorrhagic complications. The underlying mechanisms are still unknown, but evidence is beginning to emerge that tPA interacts with key regulators of the neurovascular unit (NVU), and that these interactions may contribute to the undesirable side effects associated with the use of tPA in ischemic stroke. Understanding these connections and tPA's normal function within the NVU may offer new insights into future therapeutic approaches.
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Affiliation(s)
- E J Su
- Department of Internal Medicine, University of Michigan Medical School, MI 48109, USA
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21
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Karvinen H, Rutanen J, Leppänen O, Lach R, Levonen AL, Eriksson U, Ylä-Herttuala S. PDGF-C and -D and their receptors PDGFR-alpha and PDGFR-beta in atherosclerotic human arteries. Eur J Clin Invest 2009; 39:320-7. [PMID: 19292888 DOI: 10.1111/j.1365-2362.2009.02095.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Platelet derived growth factors (PDGFs) are mitogens for fibroblasts and smooth muscle cells. This growth factor family contains four members PDGF-A, PDGF-B, PDGF-C and PDGF-D. Biology of recently discovered PDGF-C and PDGF-D is not well-established. Here we studied the expression of PDGF-C and PDGF-D and their receptors PDGFR-alpha and PDGFR-beta in normal and atherosclerotic human arteries. MATERIALS AND METHODS Human arterial samples from amputations and autopsies were classified according to the atherosclerotic stage and the expression of PDGF-C and PDGF-D proteins and their receptors was studied by immunohistochemistry. In situ hybridization and reverse transcriptase-PCR were used to study mRNA expression. RESULTS Both growth factors were expressed in medial smooth muscle cells (SMCs) in normal arteries and atherosclerotic lesions. However, clear differences were found in the expression profiles in endothelium: PDGF-C was strongly expressed in endothelial cells in both normal arteries and lesions whereas PDGF-D was only weakly expressed in endothelium. PDGF-C expression was very prominent in lesion macrophages. PDGF-D was expressed throughout the artery wall in lesions. PDGFR-alpha expression was strong in endothelium and in lesion macrophage-rich areas, whereas PDGFR-beta was mostly expressed in SMCs. CONCLUSIONS Our results suggest that PDGF-C may play an important role in endothelium in normal and atherosclerotic arteries and in macrophages in lesions. PDGF-D was expressed in all types of lesions with the same intensity and thus differs from the expression of PDGF-C.
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Affiliation(s)
- H Karvinen
- Department of Biotechnology and Molecular Medicine, University of Kuopio, Kuopio, Finland
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22
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Vinjevoll OP, Øfsti R, Eriksson U, Uleberg O, Rødevand E. Is the observation unit a proper place to observe a trauma patient with minor injuries? Scand J Trauma Resusc Emerg Med 2009. [PMCID: PMC3313135 DOI: 10.1186/1757-7241-17-s3-o22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Eriksson U, Alm A. Macular thickness decreases with age in normal eyes: a study on the macular thickness map protocol in the Stratus OCT. Br J Ophthalmol 2008; 93:1448-52. [DOI: 10.1136/bjo.2007.131094] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Leppanen P, Heinonen S, Olkkonen V, Muilu M, Metso J, Eriksson U, Jauhianen M, Yla-Herttuala S. THE EFFECT OF VEGF-A GENE TRANSFER ON ATHEROSCLEROSIS, LIPOPROTEIN PROFILES AND LPL ACTIVITY. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Burri E, Decker M, Eriksson U, Buser P, Hunziker L. 28-jähriger Patient mit erfolgreich behandelter dilatativer Kardiomyopathie. Internist (Berl) 2008; 49:349-52. [DOI: 10.1007/s00108-007-2007-6] [Citation(s) in RCA: 2] [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: 11/29/2022]
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26
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Abstract
BACKGROUND Different criteria are employed to activate trauma teams. Because of a growing concern about overtriage, the objective of this study was to investigate the performance of our trauma team's activation protocol. METHODS Injured patients with trauma team activation (TTA), admission to an intensive care unit or surgical intermediate care unit with a trauma diagnosis, or trauma-related death in the emergency department were investigated retrospectively from 1 January 2004 to 31 December 2005. Different TTA criteria were analysed with respect to sensitivity, positive predictive value (PPV) and overtriage (1 - PPV). RESULTS Eight hundred and nine patients were included, 185 (23%) of whom had an Injury Severity Score (ISS) of more than 15. The performance of our protocol showed a sensitivity of 87%, PPV of 22% and overtriage of 78%. The mechanism of injury as a TTA criterion had a sensitivity of 14%, PPV of 7% and overtriage of 93%. Physiological/anatomical criteria and interfacility transfer showed higher PPV and less overtriage. Undertriage (no TTA despite ISS > 15) was identified in 23 patients (13%), 18 of whom were hospital transfers. CONCLUSION A TTA protocol based on physiological, anatomical and interfacility transfer criteria seems to yield a higher precision than, in particular, that based on mechanism of injury criteria. Because of substantial overtriage in our hospital, the TTA protocol needs to be re-evaluated.
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Affiliation(s)
- O Uleberg
- Department of Anaesthesia and Intensive Care, St. Olav's University Hospital and Norwegian University of Science and Technology, Trondheim, Norway.
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Leppanen P, Koota S, Kholova I, Koponen J, Fieber C, Eriksson U, Alitalo K, Ylä-Herttuala S. PO6-160 GENE TRANSFERS OF VEGF-GENE FAMILY HAVE NO EFFECT ON ATHEROSCLEROSIS IN LDLR/APOB48-DEFICIENT MICE. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Shafqat N, Shafqat J, Eissner G, Marschall HU, Tryggvason K, Eriksson U, Gabrielli F, Lardy H, Jörnvall H, Oppermann U. Hep27, a member of the short-chain dehydrogenase/reductase family, is an NADPH-dependent dicarbonyl reductase expressed in vascular endothelial tissue. Cell Mol Life Sci 2006; 63:1205-13. [PMID: 16685466 DOI: 10.1007/s00018-006-6013-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Human Hep27 was originally isolated from growth-arrested HepG2 cells and identified as a member of the superfamily of short-chain dehydrogenases/reductases (SDR). Its substrate specificity has not been determined, but a cross-species comparison suggests that it occurs in widely divergent species, such as human, Cenorhabditis elegans, Drosophila and Arabidopsis thaliana. In this study, Hep27 was expressed as a His(6) fusion protein, and subjected to a substrate screen, using a compound library of SDR substrates, comprising steroids, retinoids, sugars and carbonyl compounds. Whereas no steroid dehydrogenase or retinoid activity was detected, it was found that Hep27 catalyzed the NADPH-dependent reduction of dicarbonyl compounds, like 3,4-hexanedione and 1-phenyl-1,2-propanedione with similar turnover numbers as DCXR (a mitochondrial dicarbonyl reductase/xylulose reductase). In contrast, Hep27 does not convert sugar substrates like xylulose or threose. Based on its substrate specificity and expression in endothelial tissues, it is suggested that Hep27 functions as a dicarbonyl reductase in enzymatic inactivation of reactive carbonyls, involved in covalent modification of cellular components.
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Affiliation(s)
- N Shafqat
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77, Stockholm, Sweden.
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29
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Schuetz P, Eriksson U, Christ-Crain M, Zulewski H, Miller B. [Amiodarone-induced thyrotoxicosis: a diagnostic and therapeutic challenge]. Praxis (Bern 1994) 2005; 94:1397-401. [PMID: 16190373 DOI: 10.1024/0369-8394.94.36.1397] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Amiodaron is a widely used antiarrhytmic drug in a number of cardiac conditions. The most common side effects affect the thyroid gland (14-18% of treated patients) resulting in hypothyroidism or hyperthyroidism. We describe a complex case of amiodaron-induced thyrotoxicosis (AIT) and discuss the pathogenesis of the different subtypes (AIT I, II and mixed forms) and the diagnostic and therapeutic challenges in such patients.
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Affiliation(s)
- Ph Schuetz
- Abteilung Innere Medizin, Abteilung Endokrinologie, Universitätsspital Basel.
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30
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Abstract
HISTORY AND CLINICAL FINDINGS A 20-year-old patient was hospitalized with persistent high fever after tonsillitis and swelling of the talocalcanean joint. INVESTIGATIONS The ECG showed a partial right bundle branch block pattern and pathological T inversions on the left precordial leads. Cardiac Troponin I levels were slightly elevated and echocardiography revealed a dyscinetic area at the right ventricular apex. The anti-streptolysin titer was elevated. DIAGNOSIS Post-streptococcal rheumatic myocarditis. THERAPY AND FOLLOW-UP: Antibiotic therapy for 2 weeks. The patient showed subjective full recovery after 6 weeks. The anti-streptolysin titer further increases. Nuclear spin tomography of the heart reveal postinflammatory alterations at the apex of the right ventricle. CONCLUSION Rheumatoid fever is a rare diagnosis in developed countries. This case, however, illustrates that the true prevalence of rheumatoid carditis might be underestimated in the presence of only minimal heart-and joint-specific symptoms.
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Affiliation(s)
- C Ramazzina
- Departement für Innere Medizin, Universitätsspital Basel.
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31
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Gasser S, Eriksson U. [Septic shock: diagnosis and management]. Praxis (Bern 1994) 2005; 94:765-9. [PMID: 15940907 DOI: 10.1024/0369-8394.94.19.765] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Sepsis is the most important reason for death among intensive care patients. This review will cover the actual definition of septic shock, and the difficulties regarding the diagnosis of sepsis. The principles of management of sepsis, the recently established principles as early goal directed therapy, low dose steroid substitution, insulin therapy, and the activated protein C are discussed.
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Affiliation(s)
- S Gasser
- Medizinische Klinik A, Universitätsspital Basel.
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Abstract
Angiotensin-converting enzyme 2 (ACE2) is a recently discovered homologue of the key enzyme of the renin-angiotensin system, the angiotensin-converting enzyme. The ACE2 enzyme is mainly expressed in cardiac blood vessels and tubular epithelia of the kidneys. Together with ACE2's unique metallocarboxypeptidase activity, the restricted tissue distribution suggests a distinctive physiological function in blood pressure, blood flow and fluid regulation. The ace2 gene was mapped to quantitative trait loci affecting susceptibility to hypertension in rats. Furthermore, ACE2 appears to be a negative regulator of ACE in the heart. ACE2 messenger RNA and protein levels are substantially regulated in the kidney of diabetic and pregnant rats. The mechanism of ACE2 function and its physiologic significance are not yet fully understood; however, as ACE2 differs in its specificity and physiological role from ACE, this opens a new potential venue for drug discovery aimed at cardiovascular disease, hypertension and diabetic complications.
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Affiliation(s)
- U Danilczyk
- Department of Medical Biophysics, University of Toronto, 620 University Avenue, Toronto M5G 2C1, Ontario, Canada
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33
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Arranto CA, Mueller C, Hunziker PR, Marsch SC, Eriksson U. Adverse cardiac events in ICU patients with presumptive antidepressant overdose. Swiss Med Wkly 2003; 133:479-83. [PMID: 14652803 DOI: 2003/35/smw-10211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Antidepressants account for most poison-related admissions to intensive care units. In selected patients with confirmed cyclic antidepressant intoxication a QRS interval <0.1 s in the ECG limb leads during the first six hours excludes adverse cardiac events. However, the incidence of cardiac events and the value of ECG criteria have never been assessed prospectively on patients with presumed antidepressant overdose. AIM To assess ingested drugs, adverse cardiac events, and ECG findings in ICU patients with a presumptive diagnosis of antidepressant overdose. METHODS 103 consecutive patients with a presumptive diagnosis of antidepressant overdose were enrolled and prospectively followed. Outcome criteria were arrhythmias, mortality, and duration of the ICU stay. RESULTS Mixed intoxication was identified in 66 (64%) patients. Tricyclic antidepressants were found in 88 (85%), and serotonin-reuptake inhibitors in 25 (24%) patients. Mean APACHE II score was 9.5 (SD +/- 6.0). Arrhythmias affected 15 (15%) and cardiopulmonary resuscitation was performed on 4 (4%) patients. Three patients (3%) died in the ICU. Median duration of the ICU stay was 1 day (12 hours to 6 days). Adverse cardiac events affected patients with normal and prolonged QRS interval at study entry. CONCLUSIONS Mixed intoxication is present in most ICU patients with suspected antidepressant overdose. There is a considerable risk for adverse cardiac events, even in the presence of normal ECG recordings within the first six hours after hospital admission.
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Affiliation(s)
- C A Arranto
- Division of Intensive Care, Basel University Hospital, Switzerland.
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34
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Arranto CA, Mueller C, Hunziker PR, Marsch SC, Eriksson U. Adverse cardiac events in ICU patients with presumptive antidepressant overdose. Swiss Med Wkly 2003; 133:479-83. [PMID: 14652803 DOI: 10.4414/smw.2003.10211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Antidepressants account for most poison-related admissions to intensive care units. In selected patients with confirmed cyclic antidepressant intoxication a QRS interval <0.1 s in the ECG limb leads during the first six hours excludes adverse cardiac events. However, the incidence of cardiac events and the value of ECG criteria have never been assessed prospectively on patients with presumed antidepressant overdose. AIM To assess ingested drugs, adverse cardiac events, and ECG findings in ICU patients with a presumptive diagnosis of antidepressant overdose. METHODS 103 consecutive patients with a presumptive diagnosis of antidepressant overdose were enrolled and prospectively followed. Outcome criteria were arrhythmias, mortality, and duration of the ICU stay. RESULTS Mixed intoxication was identified in 66 (64%) patients. Tricyclic antidepressants were found in 88 (85%), and serotonin-reuptake inhibitors in 25 (24%) patients. Mean APACHE II score was 9.5 (SD +/- 6.0). Arrhythmias affected 15 (15%) and cardiopulmonary resuscitation was performed on 4 (4%) patients. Three patients (3%) died in the ICU. Median duration of the ICU stay was 1 day (12 hours to 6 days). Adverse cardiac events affected patients with normal and prolonged QRS interval at study entry. CONCLUSIONS Mixed intoxication is present in most ICU patients with suspected antidepressant overdose. There is a considerable risk for adverse cardiac events, even in the presence of normal ECG recordings within the first six hours after hospital admission.
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Affiliation(s)
- C A Arranto
- Division of Intensive Care, Basel University Hospital, Switzerland.
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Abstract
HISTORY AND CLINICAL FINDINGS An 80-year old female patient, hospitalised with pneumonia and myocardial infarction, suddenly developed fever, dyspnoea, malaise, arthralgia and crampy abdominal pain. On the following day, she developed a petechial rash and on the 6 (th) day, macroscopic haematuria. On physical examination, the patient presented with a temperature of 40 degrees C, tachypnoea, tachycardia, and on auscultation coarse crepitations at the left lower base. The abdomen was tender upon deep palpation but bowel sounds were normal. Initially the petechial rash was located at the trunk, later progressing towards the extremities. INVESTIGATIONS Chest X-ray and laboratory tests were consistent with left lower lobe pneumonia. The clinical picture was not consistent with any haematological causes, coagulopathy or any medication the patient was taking. Rheumatological blood tests (involving ANA, ANCA, rheumatoid factors) were basically negative. A skin biopsy revealed microvessel necrosis and IgA deposits, verifying Henoch-Schoenlein Purpura. An immune electrophoresis revealed a selective IgG-deficiency, which may explain the cause for the patient's recurrent pneumonias. COURSE The patient recovered well under antibiotic treatment and skin lesions healed without sequelae. CONCLUSION We present an unusual case of Henoch Schoenlein purpura associated with strictly petechial rash in an 80 year old female.
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Affiliation(s)
- J J Rüdiger
- Medizin Klinik A und Dermatologie, Kantonsspital Universität Basel.
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Lidén M, Romert A, Tryggvason K, Persson B, Eriksson U. Biochemical defects in 11-cis-retinol dehydrogenase mutants associated with fundus albipunctatus. J Biol Chem 2001; 276:49251-7. [PMID: 11675386 DOI: 10.1074/jbc.m107337200] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mutations in the gene encoding 11-cis-retinol dehydrogenase (RDH5; EC ) are associated with fundus albipunctatus, an autosomal recessive eye disease characterized by stationary night blindness and accumulation of white spots in the retina. In addition, some mutated alleles are associated with development of cone dystrophy, especially in elderly patients. The numbers of identified RDH5 mutations linked to fundus albipunctatus have increased considerably during recent years. In this work, we have characterized the biochemical and cell biological properties of 11 mutants of RDH5 to understand the molecular pathology of the disease. All RDH5 mutants showed decreased protein stability and subcellular mislocalization and, in most cases, loss of enzymatic activity in vitro and in vivo. Surprisingly, mutant A294P displays significant enzymatic activity. Cross-linking studies and molecular modeling showed that RDH5 is dimeric, and co-expression analyses of wild-type and mutated alleles showed that the mutated enzymes, in a trans-dominant-negative manner, influenced the in vivo enzymatic properties of functional variants of the enzyme, particularly the A294P mutant. Thus, under certain conditions, nonfunctional alleles act in a dominant-negative way on functional but relatively unstable mutated alleles. However, in heterozygous individuals carrying one wild-type allele, the disease is recessive, probably due to the stability of the wild-type enzyme.
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Affiliation(s)
- M Lidén
- Ludwig Institute for Cancer Research, Stockholm Branch, Box 240, Karolinska Institutet, S-171 77 Stockholm, Sweden
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Tegnell A, Hellers M, Wollin R, Eriksson U, Forsman M, Engstrand L, Elgh F. [Anthrax--the Swedish perspective]. Lakartidningen 2001; 98:5742-5. [PMID: 11789095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The recent occurrence in the USA of deliberate release of virulent Bacillus anthracis in letters sent to three media corporations and to the American senate has led to a great anxiety in Sweden and elsewhere in Europe. Numerous letters have been suspected to contain B. anthracis spores and several have contained powder of different types. In none of the tested letters collected by the Swedish police have we been able to detect anthrax bacilli. Powder containing letters have been tested with either bacterial isolation and/or B. anthracis specific PCR. Anthrax is a disease found naturally in herbivores and is occasionally spread to humans. It is caused by the gram-positive rod B. anthracis that was discovered by Robert Koch in 1876. Beginning in the 1930s many states have developed B. anthracis for use as a weapon. A few releases of the bacteria have been reported before October 2001. B. anthracis causes three forms of disease, cutaneous, pulmonary and gastro-intestinal. The pulmonary form is the most dangerous and may lead to death merely one to two days after onset of severe symptoms. This is due to the rapid growth and release of several potent toxins that engage the immune system and promote tissue destruction. B. anthracis infection can be treated with several antibiotics, among which quinolones and tetracyclins have been recommended. Diagnosis can readily be achieved by microscopy, bacterial isolation and PCR at the Swedish Institute for Infectious Disease Control and the Swedish Defence Research Agency. Antibiotics relevant for treatment of B. anthracis infections are already stockpilled in our country. Further actions to strengthen our capability to deal with bioterrorism are ongoing.
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Affiliation(s)
- A Tegnell
- Bakteriologiska avdelningen, Smittskyddsinstitutet, Solna
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Abstract
Several signalling pathways have been defined by studies of genes originally characterised in Drosophila. However, some mammalian signalling systems have so far escaped discovery in the fly. Here, we describe the identification and characterisation of fly homologs for the mammalian vascular endothelial growth factor/platelet derived growth factor (VEGF/PDGF) and the VEGF receptor. The Drosophila factor (DmVEGF-1) gene has two splice variants and is expressed during all stages, the signal distribution during embryogenesis being ubiquitous. The receptor (DmVEGFR) gene has several splice variants; the variations affecting only the extracellular domain. The most prominent form is expressed in cells of the embryonic haematopoietic cell lineage, starting in the mesodermal area of the head around stage 10 of embryogenesis. Expression persists in hemocytes as embryonic development proceeds and the cells migrate posteriorly. In a fly strain carrying a deletion uncovering the DmVEGFR gene, hemocytes are still present, but their migration is hampered and the hemocytes remain mainly in the anterior end close to their origin. These data suggest that the VEGF/PDGF signalling system may regulate the migration of the Drosophila embryonic haemocyte precursor cells.
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Affiliation(s)
- T I Heino
- Institute of Biotechnology, Viikki Biocenter, PB 56 (Viikinkaari 9), FIN-00014, University of Helsinki, Helsinki, Finland
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Eriksson U, Kurrer MO, Sebald W, Brombacher F, Kopf M. Dual role of the IL-12/IFN-gamma axis in the development of autoimmune myocarditis: induction by IL-12 and protection by IFN-gamma. J Immunol 2001; 167:5464-9. [PMID: 11673566 DOI: 10.4049/jimmunol.167.9.5464] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
IL-12 and IFN-gamma positively regulate each other and type 1 inflammatory responses, which are believed to cause tissue damage in autoimmune diseases. We investigated the role of the IL-12/IFN-gamma (Th1) axis in the development of autoimmune myocarditis. IL-12p40-deficient mice on a susceptible background resisted myocarditis. In the absence of IL-12, autospecific CD4(+) T cells proliferated poorly and showed increased Th2 cytokine responses. However, IFN-gamma-deficient mice developed fatal autoimmune disease, and blockade of IL-4R signaling did not confer susceptibility to myocarditis in IL-12p40-deficient mice, demonstrating that IL-12 triggers autoimmunity by a mechanism independent of the effector cytokines IFN-gamma and IL-4. In conclusion, our results suggest that the IL-12/IFN-gamma axis is a double-edged sword for the development of autoimmune myocarditis. Although IL-12 mediates disease by induction/expansion of Th1-type cells, IFN-gamma production from these cells limits disease progression.
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Affiliation(s)
- U Eriksson
- Medicine A, University Hospital, and Basel Institute for Immunology, Basel, Switzerland.
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40
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Gidlöf AC, Romert A, Olsson A, Törmä H, Eriksson U, Sirsjö A. Increased retinoid signaling in vascular smooth muscle cells by proinflammatory cytokines. Biochem Biophys Res Commun 2001; 286:336-42. [PMID: 11500042 DOI: 10.1006/bbrc.2001.5395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Retinoids have been shown to modulate inflammation and the immune response in many cell types including macrophages, endothelial cells, and vascular smooth muscle cells. However, present knowledge of whether inflammatory mediators modulate vitamin A status in these cells is limited. To identify the role of inflammation on retinoid metabolism in vascular smooth muscle cells, the cells were exposed to a combination of proinflammatory cytokines: interleukin-1beta, interferon-gamma, and lipopolysaccharides. Without stimulation with proinflammatory cytokines, vascular smooth muscle cells expressed retinol dehydrogenases-2 and 5 mRNA detected by RT-PCR. Stimulation with the combination of cytokines induced a substantial increase of retinol dehydrogenase-5 mRNA. This was associated with increased production of ligands for retinoic acid receptors, when assayed in a retinoic acid receptor-dependent luciferase reporter system. Our results demonstrate that inflammatory mediators activate the retinoid metabolic pathway in vascular smooth muscle cells, which potentially may modulate the inflammatory response in the vascular wall.
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Affiliation(s)
- A C Gidlöf
- Center for Molecular Medicine, Karolinska Institute, Stockholm, S-171 76, Sweden
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41
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Aase K, von Euler G, Li X, Pontén A, Thorén P, Cao R, Cao Y, Olofsson B, Gebre-Medhin S, Pekny M, Alitalo K, Betsholtz C, Eriksson U. Vascular endothelial growth factor-B-deficient mice display an atrial conduction defect. Circulation 2001; 104:358-64. [PMID: 11457758 DOI: 10.1161/01.cir.104.3.358] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.2] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vascular endothelial growth factors (VEGFs) and their receptors are essential regulators of vasculogenesis and angiogenesis in both embryos and adults. One of the factors with a still unknown physiological function is VEGF-B, which is expressed in many tissues, including the heart. METHODS AND RESULTS Mice carrying a targeted deletion in the VEGF-B gene were developed. In VEGF-B(-/-) animals, no gross abnormalities were observed in organs that normally show high expression of VEGF-B, such as the heart, muscle, and kidney. Analysis of heart function by ECG showed that adult VEGF-B(-/-) mice have an atrial conduction abnormality characterized by a prolonged PQ interval. VEGF- or basic fibroblast growth factor-induced corneal angiogenesis was similar in normal and VEGF-B(-/-) mice. CONCLUSIONS VEGF-B seems to be required for normal heart function in adult animals but is not required for proper development of the cardiovascular system either during development or for angiogenesis in adults.
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Affiliation(s)
- K Aase
- Ludwig Institute for Cancer Research, Stockholm Branch, Sweden
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42
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Tryggvason K, Romert A, Eriksson U. Biosynthesis of 9-cis-retinoic acid in vivo. The roles of different retinol dehydrogenases and a structure-activity analysis of microsomal retinol dehydrogenases. J Biol Chem 2001; 276:19253-8. [PMID: 11279029 DOI: 10.1074/jbc.m100215200] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 11/06/2022] Open
Abstract
Retinoic acid is generated by a two-step mechanism. First, retinol is converted into retinal by a retinol dehydrogenase, and, subsequently, retinoic acid is formed by a retinal dehydrogenase. In vitro, several enzymes are suggested to act in this metabolic pathway. However, little is known regarding their capacity to contribute to retinoic acid biosynthesis in vivo. We have developed a versatile cell reporter system to analyze the role of several of these enzymes in 9-cis-retinoic acid biosynthesis in vivo. Using a Gal4-retinoid X receptor fusion protein-based luciferase reporter assay, the formation of 9-cis-retinoic acid from 9-cis-retinol was measured in cells transfected with expression plasmids encoding different combinations of retinol and retinal dehydrogenases. The results suggested that efficient formation of 9-cis-retinoic acid required co-expression of retinol and retinal dehydrogenases. Interestingly, the cytosolic alcohol dehydrogenase 4 failed to efficiently catalyze 9-cis-retinol oxidation. A structure-activity analysis showed that mutants of two retinol dehydrogenases, devoid of the carboxyl-terminal cytoplasmic tails, displayed greatly reduced enzymatic activities in vivo, but were active in vitro. The cytoplasmic tails mediate efficient endoplasmic reticulum localization of the enzymes, suggesting that the unique milieu in the endoplasmic reticulum compartment is necessary for in vivo activity of microsomal retinol dehydrogenases.
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Affiliation(s)
- K Tryggvason
- Ludwig Institute for Cancer Research, Stockholm Branch, Box 240, S-171 77 Stockholm, Sweden
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43
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Uutela M, Laurén J, Bergsten E, Li X, Horelli-Kuitunen N, Eriksson U, Alitalo K. Chromosomal location, exon structure, and vascular expression patterns of the human PDGFC and PDGFD genes. Circulation 2001; 103:2242-7. [PMID: 11342471 DOI: 10.1161/01.cir.103.18.2242] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Platelet-derived growth factor (PDGF), which is a major mitogen for vascular smooth muscle cells and has been implicated in the pathogenesis of arteriosclerosis, is composed of dimers of PDGF-A and PDGF-B polypeptide chains, encoded by different genes. Here, we have analyzed the chromosomal localization, structure, and expression of 2 newly identified human genes of the PDGF family, called PDGFC and PDGFD. METHODS AND RESULTS We used fluorescence in situ hybridization to locate PDGFC and PDGFD in chromosomes 4q32 and 11q22.3 to 23.2, respectively. Exon structures of PDGFC and PDGFD were determined by sequencing from genomic DNA clones. The coding region of PDGFC consists of 6 and PDGFD of 7 exons, of which the last 2 encode the C-terminal PDGF cystine knot growth factor homology domain. An N-terminal CUB domain is encoded by exons 2 and 3 of both genes, and a region of proteolytic cleavage involved in releasing and activating the growth factor domain is located in exon 4 in PDGFC and exon 5 in PDGFD. PDGF-C was expressed predominantly in smooth muscle cells and PDGF-D in fibroblastic adventitial cells, and both genes were active in cultured endothelial cells and in a variety of tumor cell lines. Both PDGF-C and PDGF-D also stimulated human coronary artery smooth muscle cells. CONCLUSIONS PDGFC and PDGFD have similar genomic structures, which resemble those of the PDGFA and PDGFB genes. Their expression in the arterial wall and cultured vascular cells suggests that they can transduce proliferation/migration signals to pericytes and smooth muscle cells.
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MESH Headings
- Amino Acid Motifs
- Cell Division/drug effects
- Cells, Cultured
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 4/genetics
- Conserved Sequence
- Endothelium, Vascular/cytology
- Endothelium, Vascular/metabolism
- Exons/genetics
- Fibroblasts/metabolism
- Humans
- In Situ Hybridization, Fluorescence
- Introns/genetics
- Kidney/blood supply
- Kidney/cytology
- Kidney/metabolism
- Lymphokines
- Molecular Sequence Data
- Multigene Family/genetics
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/metabolism
- Neoplasms/metabolism
- Physical Chromosome Mapping
- Platelet-Derived Growth Factor/biosynthesis
- Platelet-Derived Growth Factor/genetics
- Platelet-Derived Growth Factor/pharmacology
- Proto-Oncogene Proteins c-sis/genetics
- RNA, Messenger/biosynthesis
- Renal Artery/metabolism
- Sequence Homology, Amino Acid
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Affiliation(s)
- M Uutela
- Molecular/Cancer Biology Laboratory and Ludwig Institute for Cancer Research, Haartman Institute and Biomedicum Helsinki, Finland
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44
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Bergsten E, Uutela M, Li X, Pietras K, Ostman A, Heldin CH, Alitalo K, Eriksson U. PDGF-D is a specific, protease-activated ligand for the PDGF beta-receptor. Nat Cell Biol 2001; 3:512-6. [PMID: 11331881 DOI: 10.1038/35074588] [Citation(s) in RCA: 394] [Impact Index Per Article: 17.1] [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: 11/09/2022]
Abstract
The term 'platelet-derived growth factor' (PDGF) refers to a family of disulphide-bonded dimeric isoforms that are important for growth, survival and function in several types of connective tissue cell. So far, three different PDGF chains have been identified - the classical PDGF-A and PDGF-B and the recently identified PDGF-C. PDGF isoforms (PDGF-AA, AB, BB and CC) exert their cellular effects by differential binding to two receptor tyrosine kinases. The PDGF alpha-receptor (PDGFR-alpha) binds to all three PDGF chains, whereas the beta-receptor (PDGFR-beta) binds only to PDGF-B. Gene-targeting studies using mice have shown that the genes for PDGF-A and PDGF-B, as well as the two PDGFR genes, are essential for normal development. Furthermore, overexpression of PDGFs is linked to different pathological conditions, including malignancies, atherosclerosis and fibroproliferative diseases. Here we have identify and characterize a fourth member of the PDGF family, PDGF-D. PDGF-D has a two-domain structure similar to PDGF-C and is secreted as a disulphide-linked homodimer, PDGF-DD. Upon limited proteolysis, PDGF-DD is activated and becomes a specific agonistic ligand for PDGFR-beta. PDGF-DD is the first known PDGFR-beta-specific ligand, and its unique receptor specificity indicates that it may be important for development and pathophysiology in several organs.
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MESH Headings
- Amino Acid Sequence
- Animals
- Baculoviridae/metabolism
- Blotting, Northern
- Cloning, Molecular
- Cysteine/chemistry
- DNA, Complementary/metabolism
- Dimerization
- Dose-Response Relationship, Drug
- Humans
- Immunohistochemistry
- Insecta
- Ligands
- Lymphokines
- Mice
- Mice, Transgenic
- Molecular Sequence Data
- Phylogeny
- Platelet-Derived Growth Factor/chemistry
- Protein Binding
- Protein Structure, Tertiary
- RNA, Messenger/metabolism
- Receptor, Platelet-Derived Growth Factor beta/chemistry
- Receptor, Platelet-Derived Growth Factor beta/metabolism
- Recombinant Proteins/chemistry
- Recombinant Proteins/metabolism
- Sequence Homology, Amino Acid
- Tissue Distribution
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Affiliation(s)
- E Bergsten
- Ludwig Institute for Cancer Research, Stockholm Branch, PO Box 240, S-171 77 Stockholm, Sweden
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45
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Wuttge DM, Romert A, Eriksson U, Törmä H, Hansson GK, Sirsjö A. Induction of CD36 by all-trans retinoic acid: retinoic acid receptor signaling in the pathogenesis of atherosclerosis. FASEB J 2001; 15:1221-3. [PMID: 11344094 DOI: 10.1096/fj.00-0488fje] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D M Wuttge
- Center for Molecular Medicine and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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46
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Carmeliet P, Moons L, Luttun A, Vincenti V, Compernolle V, De Mol M, Wu Y, Bono F, Devy L, Beck H, Scholz D, Acker T, DiPalma T, Dewerchin M, Noel A, Stalmans I, Barra A, Blacher S, VandenDriessche T, Ponten A, Eriksson U, Plate KH, Foidart JM, Schaper W, Charnock-Jones DS, Hicklin DJ, Herbert JM, Collen D, Persico MG. Synergism between vascular endothelial growth factor and placental growth factor contributes to angiogenesis and plasma extravasation in pathological conditions. Nat Med 2001; 7:575-83. [PMID: 11329059 DOI: 10.1038/87904] [Citation(s) in RCA: 1169] [Impact Index Per Article: 50.8] [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: 02/07/2023]
Abstract
Vascular endothelial growth factor (VEGF) stimulates angiogenesis by activating VEGF receptor-2 (VEGFR-2). The role of its homolog, placental growth factor (PlGF), remains unknown. Both VEGF and PlGF bind to VEGF receptor-1 (VEGFR-1), but it is unknown whether VEGFR-1, which exists as a soluble or a membrane-bound type, is an inert decoy or a signaling receptor for PlGF during angiogenesis. Here, we report that embryonic angiogenesis in mice was not affected by deficiency of PlGF (Pgf-/-). VEGF-B, another ligand of VEGFR-1, did not rescue development in Pgf-/- mice. However, loss of PlGF impaired angiogenesis, plasma extravasation and collateral growth during ischemia, inflammation, wound healing and cancer. Transplantation of wild-type bone marrow rescued the impaired angiogenesis and collateral growth in Pgf-/- mice, indicating that PlGF might have contributed to vessel growth in the adult by mobilizing bone-marrow-derived cells. The synergism between PlGF and VEGF was specific, as PlGF deficiency impaired the response to VEGF, but not to bFGF or histamine. VEGFR-1 was activated by PlGF, given that anti-VEGFR-1 antibodies and a Src-kinase inhibitor blocked the endothelial response to PlGF or VEGF/PlGF. By upregulating PlGF and the signaling subtype of VEGFR-1, endothelial cells amplify their responsiveness to VEGF during the 'angiogenic switch' in many pathological disorders.
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Affiliation(s)
- P Carmeliet
- The Center for Transgene Technology and Gene Therapy, Flanders Interuniversity Institute for Biotechnology, KU Leuven, Leuven, Belgium.
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Abstract
Vascular endothelial growth factors (VEGFs) constitute a group of structurally and functionally related growth factors that modulate many important physiological functions of endothelial cells. Currently, five different mammalian VEGFs have been identified and they all show unique temporal and spatial expression patterns, receptor specificity and function. The VEGFs may play pivotal roles in formation of the vascular systems during embryonic development, in regulation of capillary growth in normal and pathological conditions in adults, and in the maintenance of the normal vasculature. In the future, the VEGFs and their receptors may become important therapeutic tools in treatment of conditions characterized by aberrant or defective formation of blood vessels and lymphatic vessels.
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Affiliation(s)
- X Li
- Ludwig Institute for Cancer Research, Stockholm Branch, Box 240, S-171 77, Stockholm, Sweden
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48
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Eriksson U, Seifert B, Schaffner A. Comparison of effects of amphotericin B deoxycholate infused over 4 or 24 hours: randomised controlled trial. BMJ 2001; 322:579-82. [PMID: 11238151 PMCID: PMC26549 DOI: 10.1136/bmj.322.7286.579] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To test the hypothesis that amphotericin B deoxycholate is less toxic when given by continuous infusion than by conventional rapid infusion. DESIGN Randomised, controlled, non-blinded, single centre study. SETTING University hospital providing tertiary clinical care. PATIENTS 80 mostly neutropenic patients with refractory fever and suspected or proved invasive fungal infections. INTERVENTION Patients were randomised to receive 0.97 mg/kg amphotericin B by continuous infusion over 24 hours or 0.95 mg/kg by rapid infusion over four hours. MAIN OUTCOME MEASURES Patients were evaluated for side effects related to infusion, nephrotoxicity, and mortality up to three months after treatment. Analysis was on an intention to treat basis. RESULTS Patients in the continuous infusion group had fewer side effects and significantly reduced nephrotoxicity than those in the rapid infusion group. Overall mortality was higher during treatment and after three months' follow up in the rapid infusion than in the continuous infusion group. CONCLUSION Continuous infusions of amphotericin B reduce nephrotoxicity and side effects related to infusion without increasing mortality.
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Affiliation(s)
- U Eriksson
- Medicine B, University Hospital, University of Zurich, CH-8091 Zurich, Switzerland.
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49
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Gustafsson D, Nyström J, Carlsson S, Bredberg U, Eriksson U, Gyzander E, Elg M, Antonsson T, Hoffmann K, Ungell A, Sörensen H, Någård S, Abrahamsson A, Bylund R. The direct thrombin inhibitor melagatran and its oral prodrug H 376/95: intestinal absorption properties, biochemical and pharmacodynamic effects. Thromb Res 2001; 101:171-81. [PMID: 11228340 DOI: 10.1016/s0049-3848(00)00399-6] [Citation(s) in RCA: 241] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Suboptimal gastrointestinal absorption is a problem for many direct thrombin inhibitors. The studies presented herein describe the new oral direct thrombin inhibitor H 376/95, a prodrug with two protecting residues added to the direct thrombin inhibitor melagatran. Absorption properties in vitro: H 376/95 is uncharged at intestinal pH while melagatran is charged. H 376/95 is 170 times more lipophilic (octanol water partition coefficient) than melagatran. As a result, the permeability coefficient across cultured epithelial Caco-2 cells is 80 times higher for H 376/95 than for melagtran. Pharmacokinetic studies in healthy volunteers: H 376/95 is converted to melagatran in man. Oral bioavailability, measured as melagatran in plasma, is about 20% after oral administration of H 376/95, which is 2.7-5.5 times higher than after oral administration of melagatran. The variability in the area under the drug plasma concentration vs. time curve (AUC) is much smaller with oral H 376/95 (coefficient of variation 20%) than with oral melagatran (coefficient of variation 38%). Pharmacodynamic properties: H 376/95 is inactive towards human alpha-thrombin compared with melagatran [inhibition constant (K(i)) ratio, 185 times], a potential advantage for patients with silent gastrointestinal bleeding. In an experimental thrombosis model in the rat, oral H 376/95 was more effective than the subcutaneous low molecular weight heparin dalteparin in preventing thrombosis. CONCLUSION By the use of the prodrug principle, H 376/95 endows the direct thrombin inhibitor melagatran with pharmacokinetic properties required for oral administration without compromising the promising pharmacodynamic properties of melagatran.
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Affiliation(s)
- D Gustafsson
- Department of Cardiovascular Pharmacology, AstraZeneca R&D Mölndal, S-431 83, Mölndal, Sweden.
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50
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Eriksson U, Kurrer MO, Bingisser R, Eugster HP, Saremaslani P, Follath F, Marsch S, Widmer U. Lethal autoimmune myocarditis in interferon-gamma receptor-deficient mice: enhanced disease severity by impaired inducible nitric oxide synthase induction. Circulation 2001; 103:18-21. [PMID: 11136679 DOI: 10.1161/01.cir.103.1.18] [Citation(s) in RCA: 77] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interferon-gamma (IFN-gamma) is an essential cytokine in the regulation of inflammatory responses in autoimmune diseases. Little is known about its role in inflammatory heart disease. METHODS AND RESULTS We showed that IFN-gamma receptor-deficient mice (IFN-gammaR(-/-)) on a BALB/c background immunized with a peptide derived from cardiac alpha-myosin heavy chain develop severe myocarditis with high mortality. Although myocarditis subsided in wild-type mice after 3 weeks, IFN-gammaR(-/-) mice showed persistent disease. The persistent inflammation was accompanied by vigorous in vitro CD4 T-cell responses and impaired inducible nitric oxide synthase expression, together with evidence of impaired nitric oxide production in IFN-gammaR(-/-) hearts. Treatment of wild-type mice with the nitric oxide synthetase inhibitor N:-nitro-l-arginine-methyl-ester enhanced in vitro CD4 T-cell proliferation and prevented healing of myocarditis. CONCLUSIONS Our data provide evidence that IFN-gamma protects mice from lethal autoimmune myocarditis by inducing the expression of inducible nitric oxide synthase followed by the downregulation of T-cell responses.
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Affiliation(s)
- U Eriksson
- Medical Intensive Care Unit, University Hospital, Basel, Switzerland.
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