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Noborn F, Thomsen C, Vorontsov E, Bobbio E, Sihlbom C, Nilsson J, Polte CL, Bollano E, Vukusic K, Sandstedt J, Dellgren G, Karason K, Oldfors A, Larson G. Subtyping of cardiac amyloidosis by mass spectrometry-based proteomics of endomyocardial biopsies. Amyloid 2023; 30:96-108. [PMID: 36209425 DOI: 10.1080/13506129.2022.2127088] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cardiac amyloidosis is a severe condition leading to restrictive cardiomyopathy and heart failure. Mass spectrometry-based methods for cardiac amyloid subtyping have become important diagnostic tools but are currently used only in a few reference laboratories. Such methods include laser-capture microdissection to ensure the specific analysis of amyloid deposits. Here we introduce a direct proteomics-based method for subtyping of cardiac amyloidosis. METHODS Endomyocardial biopsies were retrospectively analysed from fresh frozen material of 78 patients with cardiac amyloidosis and from 12 biopsies of unused donor heart explants. Cryostat sections were digested with trypsin and analysed with liquid chromatography - mass spectrometry, and data were evaluated by proteomic software. RESULTS With a diagnostic threshold set to 70% for each of the four most common amyloid proteins affecting the heart (LC κ, LC λ, TTR and SAA), 65 of the cases (87%) could be diagnosed, and of these, 61 cases (94%) were in concordance with the original diagnoses. The specimens were also analysed for the summed intensities of the amyloid signature proteins (ApoE, ApoA-IV and SAP). The intensities were significantly higher (p < 0.001) for all assigned cases compared with controls. CONCLUSION Cardiac amyloidosis can be successfully subtyped without the prior enrichment of amyloid deposits with laser microdissection.
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Affiliation(s)
- Fredrik Noborn
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christer Thomsen
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Egor Vorontsov
- Proteomics Core Facility, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carina Sihlbom
- Proteomics Core Facility, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jonas Nilsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Proteomics Core Facility, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christian L Polte
- Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Vukusic
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joakim Sandstedt
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Dellgren
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Oldfors
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Larson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
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De Gregori S, De Silvestri A, Cattadori B, Rapagnani A, Albertini R, Novello E, Concardi M, Arbustini E, Pellegrini C. Therapeutic Drug Monitoring of Tacrolimus-Personalized Therapy in Heart Transplantation: New Strategies and Preliminary Results in Endomyocardial Biopsies. Pharmaceutics 2022; 14:pharmaceutics14061247. [PMID: 35745819 PMCID: PMC9229567 DOI: 10.3390/pharmaceutics14061247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/24/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Tacrolimus (TAC) is an immunosuppressant drug approved both in the US and in the EU, widely used for the prophylaxis of organ rejection after transplantation. This is a critical dose drug: low levels in whole blood can lead to low exposure and a high risk of acute rejection, whereas overexposure puts patients at risk for toxicity and infection. Both situations can occur at whole-blood concentrations considered to be within the narrow TAC therapeutic range. We assumed a poor correlation between TAC trough concentrations in whole blood and the incidence of acute rejection; therefore, we propose to study TAC concentrations in endomyocardial biopsies (EMBs). We analyzed 70 EMBs from 18 transplant recipients at five scheduled follow-up visits during the first year post-transplant when closer TAC monitoring is mandatory. We observed five episodes of acute rejection (grade 2R) in three patients (2 episodes at 0.5 months, 2 at 3 months, and 1 at 12 months), when TAC concentrations in EMBs were low (63; 62; 59; 31; 44 pg/mg, respectively), whereas concentrations in whole blood were correct. Our results are preliminary and further studies are needed to confirm the importance of this new strategy to prevent acute rejection episodes.
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Affiliation(s)
- Simona De Gregori
- U.O.C Laboratorio Analisi Chimico Cliniche, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (R.A.); (E.N.)
- Correspondence: ; Tel.: +39-0382-503647
| | - Annalisa De Silvestri
- U.O.S Epidemiologia Clinica e Biostatistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Barbara Cattadori
- U.O.C. di Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Andrea Rapagnani
- Unità di Chirurgia Cardiaca, Dipartimento di Scienze Clinico Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, 27100 Pavia, Italy;
| | - Riccardo Albertini
- U.O.C Laboratorio Analisi Chimico Cliniche, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (R.A.); (E.N.)
| | - Elisa Novello
- U.O.C Laboratorio Analisi Chimico Cliniche, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (R.A.); (E.N.)
| | - Monica Concardi
- Centro Malattie Genetiche Cardiovascolari, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.C.); (E.A.)
| | - Eloisa Arbustini
- Centro Malattie Genetiche Cardiovascolari, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.C.); (E.A.)
| | - Carlo Pellegrini
- Unità di Chirurgia Cardiaca, Dipartimento di Scienze Clinico Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia—U.O.C. di Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
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Casella M, Bergonti M, Dello Russo A, Maragna R, Gasperetti A, Compagnucci P, Catto V, Trombara F, Frappampina A, Conte E, Fogante M, Sommariva E, Rizzo S, De Gaspari M, Giovagnoni A, Andreini D, Pompilio G, Di Biase L, Natale A, Basso C, Tondo C. Endomyocardial Biopsy: The Forgotten Piece in the Arrhythmogenic Cardiomyopathy Puzzle. J Am Heart Assoc 2021; 10:e021370. [PMID: 34569251 PMCID: PMC8649151 DOI: 10.1161/jaha.121.021370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Endomyocardial biopsy (EMB) is part of 2010 Task Force Criteria (TFC) for arrhythmogenic right ventricular cardiomyopathy (ARVC). However, its usage has been curtailed because of its low presumed diagnostic yield, and it is now a poorly used tool. This study aims to analyze the contribution of EMB to the final diagnosis of ARVC. Methods and Results We included 104 consecutive patients evaluated for a suspicion of ARVC, who were referred for EMB. Patients with suspected left dominant pattern were excluded from the primary analysis. Subjects were initially stratified according to TFC without considering EMB. After EMB, patients were reclassified accordingly, and the reclassification rate was calculated. EMB yielded a diagnostic finding in 92 patients (85.5%). After including EMB evaluation, 20 (43%) more patients "at risk" received a definite diagnosis of ARVC. Overall, 59 patients received a definite diagnosis of ARVC, 34% only after EMB. EMB appeared to be the better-performing exam with respect to the final diagnosis (β, 2.2; area uder the curve, 0.73; P<0.05). The reclassification improvement after EMB measured 28%. TFC score increased from 3.5±1.3 to 4.3±1.4 (P<0.001). Notably, active inflammation was present in 6 (10%) patients. Minor complications were reported in only 2% of the cohort. In patients with suspected left-dominant disease, conventional TFC performed poorly. Conclusions Electroanatomic voltage mapping-guided EMB was safe and yielded an optimal diagnostic yield. It allowed upgrading of the diagnosis of nearly one-third of the patients considered "at risk." Classical TFC without EMB performed poorly in patients with the left dominant form of ARVC.
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Affiliation(s)
- Michela Casella
- Cardiology and Arrhythmology Clinic University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Clinical, Special and Dental Sciences University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy
| | - Marco Bergonti
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Biomedical Sciences and Public Health University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy
| | - Riccardo Maragna
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Alessio Gasperetti
- Department of Biomedical Sciences and Public Health University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Biomedical Sciences and Public Health University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy
| | - Valentina Catto
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Filippo Trombara
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Antonio Frappampina
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Edoardo Conte
- Cardiovascular Computed Tomography and Radiology Unit Monzino Cardiology CenterIRCCS Milano Italy
| | - Marco Fogante
- Department of Clinical, Special and Dental Sciences University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Radiology University Hospital "Umberto I -Lancisi - Salesi" Ancona Italy
| | - Elena Sommariva
- Unit of Vascular Biology and Regenerative Medicine Monzino Cardiology CenterIRCCS Milano Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health Azienda Ospedaliera-University of Padua Padova Italy
| | - Monica De Gaspari
- Cardiovascular Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health Azienda Ospedaliera-University of Padua Padova Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Radiology University Hospital "Umberto I -Lancisi - Salesi" Ancona Italy
| | - Daniele Andreini
- Cardiovascular Computed Tomography and Radiology Unit Monzino Cardiology CenterIRCCS Milano Italy.,Department of Clinical Sciences and Community Health University of Milan Milano Italy
| | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine Monzino Cardiology CenterIRCCS Milano Italy
| | - Luigi Di Biase
- Montefiore Medical Center Albert-Einstein College of Medicine Bronx NY
| | - Andrea Natale
- Texas Cardiac Arrhyhtmia Institute (TCAI)St. David's Hospital Austin TX
| | - Cristina Basso
- Cardiovascular Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health Azienda Ospedaliera-University of Padua Padova Italy
| | - Claudio Tondo
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy.,Department of Biochemical Surgical and Dentist Sciences University of Milan Milano Italy
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Tarazón E, Ortega A, Gil-Cayuela C, Sánchez-Lacuesta E, Marín P, Lago F, González-Juanatey JR, Martínez-Dolz L, Portolés M, Rivera M, Roselló-Lletí E. SERCA2a: A potential non-invasive biomarker of cardiac allograft rejection. J Heart Lung Transplant 2017; 36:1322-8. [PMID: 28750934 DOI: 10.1016/j.healun.2017.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/15/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The detection of heart transplant rejection by non-invasive methods remains a major challenge. Despite the well-known importance of the study of sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) in the heart, its role as a rejection marker has never been analyzed. Our objective in this study was to determine whether circulating SERCA2a could be a good marker of cardiac rejection. METHODS We collected 127 consecutive endomyocardial biopsies (EMBs) and serum samples from adult heart transplant recipients (49 without allograft rejection and 78 with the diagnosis of biopsy allograft rejection, including 48 Grade 1R, 21 Grade 2R and 9 Grade 3R). Serum concentrations of SERCA2a were determined using a specific sandwich enzyme-linked immunosorbent assay. We also analyzed SERCA2a expression changes on EMBs using immunofluorescence. RESULTS SERCA2a cardiac tissue and serum levels were decreased in patients with cardiac rejection (p < 0.0001). A receiver-operating characteristic analysis showed that SERCA2a strongly discriminated between patients with and without allograft rejection: normal grafts vs all rejecting grafts (AUC = 0.804); normal grafts vs Grade 1R (AUC = 0.751); normal grafts vs Grade 2R (AUC = 0.875); normal grafts vs Grade 3R (AUC = 0.922); normal grafts vs Grade 2R and 3R (AUC = 0.889), with p < 0.0001 for all comparisons. CONCLUSIONS We demonstrated that changes in SERCA2a cardiac tissue and serum levels occur in cardiac allograft rejection. Our findings suggest that SERCA2a concentration assessment may be a relatively simple, non-invasive test for heart transplant rejection, showing a strong capability for detection that improves progressively as rejection grades increase.
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