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Zhang D, Xu C, Zhang J, Zeng R, Qi Q, Xu J, Pan Y, Liu X, Shi S, Zhang J, Dong L. Plasma TNFRSF11B as a New Predictive Inflammatory Marker of Sepsis-ARDS with Endothelial Dysfunction. J Proteome Res 2023; 22:3640-3651. [PMID: 37851947 PMCID: PMC10629264 DOI: 10.1021/acs.jproteome.3c00576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Indexed: 10/20/2023]
Abstract
Inflammation plays an important role in the development of sepsis-acute respiratory distress syndrome (ARDS). Olink inflammation-related biomarker panels were used to analyze the levels of 92 inflammation-related proteins in plasma with sepsis-ARDS (n = 25) and healthy subjects (n = 25). There were significant differences in 64 inflammatory factors, including TNFRSF11B in sepsis-ARDS, which was significantly higher than that in controls. Functional analysis showed that TNFRSF11B was closely focused on signal transduction, immune response, and inflammatory response. The TNFRSF11B level in sepsis-ARDS plasma, LPS-induced mice, and LPS-stimulated HUVECs significantly increased. The highest plasma concentration of TNFRSF11B in patients with sepsis-ARDS was 10-20 ng/mL, and 10 ng/mL was selected to stimulate HUVECs. Western blot results demonstrated that the levels of syndecan-1, claudin-5, VE-cadherin, occludin, aquaporin-1, and caveolin-1 in TNFRSF11B-stimulated HUVECs decreased, whereas that of connexin-43 increased in TNFRSF11B-stimulated HUVECs. To the best of the authors' knowledge, this study was the first to reveal elevated TNFRSF11B in sepsis-ARDS associated with vascular endothelial dysfunction. In summary, TNFRSF11B may be a new potential predictive and diagnostic biomarker for vascular endothelium damage in sepsis-ARDS.
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Affiliation(s)
- Dong Zhang
- Department
of Respiratory and Intensive Care Unit, Shandong Provincial Qianfoshan
Hospital, Shandong University, Jinan 250021, Shandong China
| | - Changjuan Xu
- Department
of Respiratory and Intensive Care Unit, The First Affiliated
Hospital of Shandong First Medical University and Shandong Provincial
Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong
Characteristic Laboratory of Clinical Transformation of Respiratory
Biological Immunity and Regenerative Medicine, Jinan 250021, Shandong China
| | - Jintao Zhang
- Department
of Respiratory and Intensive Care Unit, The First Affiliated
Hospital of Shandong First Medical University and Shandong Provincial
Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong
Characteristic Laboratory of Clinical Transformation of Respiratory
Biological Immunity and Regenerative Medicine, Jinan 250021, Shandong China
| | - Rong Zeng
- Department
of Respiratory and Intensive Care Unit, Shandong Provincial Qianfoshan
Hospital, Shandong University, Jinan 250021, Shandong China
| | - Qian Qi
- Department
of Respiratory and Intensive Care Unit, The First Affiliated
Hospital of Shandong First Medical University and Shandong Provincial
Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong
Characteristic Laboratory of Clinical Transformation of Respiratory
Biological Immunity and Regenerative Medicine, Jinan 250021, Shandong China
| | - Jiawei Xu
- Department
of Respiratory and Intensive Care Unit, The First Affiliated
Hospital of Shandong First Medical University and Shandong Provincial
Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong
Characteristic Laboratory of Clinical Transformation of Respiratory
Biological Immunity and Regenerative Medicine, Jinan 250021, Shandong China
| | - Yun Pan
- Department
of Respiratory and Intensive Care Unit, Shandong Provincial Qianfoshan
Hospital, Shandong University, Jinan 250021, Shandong China
| | - Xiaofei Liu
- Department
of Respiratory and Intensive Care Unit, The First Affiliated
Hospital of Shandong First Medical University and Shandong Provincial
Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong
Characteristic Laboratory of Clinical Transformation of Respiratory
Biological Immunity and Regenerative Medicine, Jinan 250021, Shandong China
| | - Shuochuan Shi
- Department
of Respiratory and Intensive Care Unit, The First Affiliated
Hospital of Shandong First Medical University and Shandong Provincial
Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong
Characteristic Laboratory of Clinical Transformation of Respiratory
Biological Immunity and Regenerative Medicine, Jinan 250021, Shandong China
| | - Jianning Zhang
- Department
of Respiratory and Intensive Care Unit, The First Affiliated
Hospital of Shandong First Medical University and Shandong Provincial
Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong
Characteristic Laboratory of Clinical Transformation of Respiratory
Biological Immunity and Regenerative Medicine, Jinan 250021, Shandong China
| | - Liang Dong
- Department
of Respiratory and Intensive Care Unit, Shandong Provincial Qianfoshan
Hospital, Shandong University, Jinan 250021, Shandong China
- Department
of Respiratory and Intensive Care Unit, The First Affiliated
Hospital of Shandong First Medical University and Shandong Provincial
Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong
Characteristic Laboratory of Clinical Transformation of Respiratory
Biological Immunity and Regenerative Medicine, Jinan 250021, Shandong China
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Wang JL, Cao QY, Xin ZJ, Liu SS, Xu M, Wang TG, Lu JL, Chen YH, Wang SY, Zhao ZY, Xu Y, Ning G, Wang WQ, Bi YF, Li M. Association between the Neutrophil-to-lymphocyte Ratio and New-onset Subclinical Macrovascular and Microvascular Diseases in the Chinese Population. Biomed Environ Sci 2022; 35:4-12. [PMID: 35078557 DOI: 10.3967/bes2022.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The association between neutrophil-to-lymphocyte ratio (NLR) with subclinical macrovascular and microvascular diseases has been less investigated. We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population. METHODS From a community cohort, we included 6,430 adults aged ≥ 40 years without subclinical macrovascular and microvascular diseases at baseline. We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and albuminuria. RESULTS During a mean follow-up of 4.3 years, 110 participants developed incident abnormal ABI, 746 participants developed incident elevated baPWV, and 503 participants developed incident albuminuria. Poisson regression analysis indicated that NLR was significantly associated with an increased risk of new-onset abnormal ABI, elevated baPWV, and albuminuria. Compared to overweight/obese participants, we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight. Furthermore, we found an interaction between the NLR and body mass index (BMI) on the risk of new-onset abnormal ABI ( P for interaction: 0.01). CONCLUSION NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population. Furthermore, in participants with normal weight, the association between NLR and subclinical vascular abnormalities was much stronger.
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Affiliation(s)
- Jia Lu Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qiu Yu Cao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhuo Jun Xin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Shan Shan Liu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Tian Ge Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jie Li Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yu Hong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Shuang Yuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhi Yun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei Qing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yu Fang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Kumar V, Jain N, Raizada N, Aslam M, Mehrotra G, Gambhir JK, Singh G, Madhu SV. Postprandial endothelial dysfunction and CIMT after oral fat challenge in patients with type 2 diabetes mellitus with and without macrovascular disease - A preliminary study. Diabetes Metab Syndr 2021; 15:102317. [PMID: 34695772 DOI: 10.1016/j.dsx.2021.102317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Very few studies have reported on association of postprandial lipids and endothelial dysfunction among patients with diabetes. Whether endothelial dysfunction particularly postprandial FMD is worse in patients with T2DM with macrovascular disease compared to those without and whether this difference is related to postprandial hypertriglyceridemia (PPHTg) is unclear. Therefore, present study was aimed to assess the relationship between PPHTg and endothelial function in patients with T2DM with and without macrovascular disease. METHOD Endothelial dysfunction by FMD and CIMT were compared in patients with T2DM with and without macrovascular disease (n = 13 each group) and 13 age, sex and BMI matched healthy individuals after an oral fat challenge. RESULTS There was significant postprandial deterioration of FMD 4-hr after fat challenge in patients with diabetes (P < 0.001) as well as healthy individuals (P = 0.004). Patients with diabetes with macrovascular disease had significantly lower fasting (5.7 ± 6.1% vs. 22.7 ± 10.0% and vs. 24.7 ± 5.3%) as well as postprandial (4-hr) (3.1 ± 5.0% vs. 15.3 ± 8.1% and vs. 15.4 ± 5.7%) FMD compared to other two groups. Fasting, postprandial as well as change in FMD and CIMT in patients with diabetes correlated significantly with fasting as well as postprandial triglycerides with stronger correlation in those with macrovascular disease. CONCLUSION Study found significant endothelial dysfunction by FMD that shows substantial further deterioration postprandially following high fat meal in patients with diabetes with macrovascular disease compared to patients with diabetes without macrovascular disease and healthy individuals. Study also indicates that PPHTg is a contributor to endothelial dysfunction. However, more studies are required to corroborate these findings.
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Affiliation(s)
- V Kumar
- Department of Medicine, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi-110095, India
| | - N Jain
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi-110095, India
| | - N Raizada
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi-110095, India
| | - M Aslam
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi-110095, India
| | - G Mehrotra
- Department of Radiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi-110095, India
| | - J K Gambhir
- Department of Biochemistry, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi-110095, India
| | - G Singh
- Department of Medicine, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi-110095, India
| | - S V Madhu
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi-110095, India.
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Hsu BG, Wang CH, Lai YH, Tsai JP. Serum Galectin-3 Level Is Positively Associated with Endothelial Dysfunction in Patients with Chronic Kidney Disease Stage 3 to 5. Toxins (Basel) 2021; 13:toxins13080532. [PMID: 34437403 PMCID: PMC8402460 DOI: 10.3390/toxins13080532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022] Open
Abstract
Galectin-3, which is a novel biomarker of cardiovascular stress and related to inflammation, could predict adverse cardiovascular events. However, its relationship with endothelial function in patients with chronic kidney disease (CKD) remains inconclusive. This study aimed to investigate the association between serum galectin-3 levels and endothelial function in patients with stages 3–5 CKD. Fasting blood samples were obtained from 130 patients. Serum galectin-3 levels were determined using the enzyme-linked immunosorbent assay. The endothelial function, demonstrated as a vascular reactivity index (VRI), was measured noninvasively through digital thermal monitoring test. Then, we sorted the patients into poor, intermediate, and good vascular reactivity (VRI < 1.0, 1.0 ≤ VRI < 2.0, and VRI ≥ 2.0), accounting for 24 (18.5%), 44 (33.8%), and 62 (47.7%) patients, respectively. As the VRI decreased, the serum galectin-3 and C-reactive protein (CRP) levels significantly increased. The galectin-3 value positively correlated with the CRP value but negatively correlated with estimated glomerular filtration rate. In multivariable stepwise linear regression analysis, serum log-transformed galectin-3 level and log-transformed CRP were significantly negatively associated with VRI values. Therefore, galectin-3 together with CRP is associated with VRI values and is a potential endothelial function modulator and a valuable biomarker of endothelial dysfunction in patients with CKD.
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Affiliation(s)
- Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (B.-G.H.); (C.-H.W.); (Y.-H.L.)
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Chih-Hsien Wang
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (B.-G.H.); (C.-H.W.); (Y.-H.L.)
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Yu-Hsien Lai
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (B.-G.H.); (C.-H.W.); (Y.-H.L.)
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Jen-Pi Tsai
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (B.-G.H.); (C.-H.W.); (Y.-H.L.)
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
- Correspondence:
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Papadopoulou C, Hong Y, Krol P, Al Obaidi M, Pilkington C, Wedderburn LR, Brogan PA, Eleftheriou D. The Vasculopathy of Juvenile Dermatomyositis: Endothelial Injury, Hypercoagulability, and Increased Arterial Stiffness. Arthritis Rheumatol 2021; 73:1253-1266. [PMID: 33393715 DOI: 10.1002/art.41639] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Vasculopathy is considered central to the pathogenesis of juvenile dermatomyositis (DM) and is associated with severe extramuscular manifestations. We undertook this study to investigate the hypothesis that the vasculopathy of juvenile DM can be noninvasively tracked by examining biomarkers of endothelial injury, subclinical inflammation, hypercoagulability, and vascular arterial stiffness. METHODS The study population was a UK cohort of children with juvenile DM. Circulating endothelial cells (CECs) and microparticles (MPs) were identified using immunomagnetic bead extraction and flow cytometry, respectively. Plasma thrombin generation was determined using a fluorogenic assay. Cytokine and chemokine levels were measured by electrochemiluminescence. Arterial stiffness was assessed using pulse wave velocity (PWV). Results were expressed as the median and interquartile range (IQR), and statistical significance was assessed using nonparametric analyses. RESULTS Ninety patients with juvenile DM and 79 healthy control subjects were included. The median age of the patients was 10.21 years (IQR 6.68-13.40), and the median disease duration was 1.63 years (IQR 0.28-4.66). CEC counts were higher in all patients with juvenile DM compared to controls (median 96 cells/ml [IQR (40-192] and 12 cells/ml [IQR 8-24], respectively; P < 0.0001). Circulating MP numbers were also significantly higher in patients with active juvenile DM compared to controls (median 204.7 × 103 /ml [IQR 87.9-412.6] and 44.3 × 103 /ml [IQR 15.0-249.1], respectively; P < 0.0001). MPs were predominantly of platelet and endothelial origin. Enhanced plasma thrombin generation was demonstrated in patients with active juvenile DM compared to those with inactive disease (P = 0.0003) and controls (P < 0.0001). Carotid-radial PWV adjusted for age was increased in patients with juvenile DM compared to controls (P = 0.003). CONCLUSION We observed increased endothelial injury and increased levels of proinflammatory cytokines in patients with active juvenile DM. MP profiles reflected distinct disease activity status in juvenile DM and are markers of vascular pathology, platelet activation, and thrombotic propensity. Ongoing long-term vascular injury may result in increased arterial stiffness in patients with juvenile DM.
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Affiliation(s)
- Charalampia Papadopoulou
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ying Hong
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Petra Krol
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK, and Skåne University Hospital, Lund, Sweden
| | - Muthana Al Obaidi
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Clarissa Pilkington
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, NIHR Great Ormond Street Hospital Biomedical Research Centre, and Centre for Adolescent Rheumatology Versus Arthritis, London, UK
| | - Paul A Brogan
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, and Centre for Adolescent Rheumatology Versus Arthritis, London, UK
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Scheitz JF, Lim J, Broersen LHA, Ganeshan R, Huo S, Sperber PS, Piper SK, Heuschmann PU, Audebert HJ, Nolte CH, Siegerink B, Endres M, Liman TG. High-Sensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke. J Am Heart Assoc 2021; 10:e018326. [PMID: 33982599 PMCID: PMC8200699 DOI: 10.1161/jaha.120.018326] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/22/2021] [Indexed: 12/16/2022]
Abstract
Background Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high-sensitivity cardiac troponin T (hs-cTnT) are associated with recurrent vascular events and death in patients with first-ever, mild to moderate ischemic stroke. Methods and Results We used data from the PROSCIS-B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs-cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all-cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hs-cTnT above upper reference limit, 39.2%). During a mean follow-up of 3 years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of all-cause death. The primary outcome occurred more often in patients with hs-cTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3-3.3), with a dose-response relationship when the highest and lowest hs-cTnT quartiles were compared (15.2 versus 1.8 events per 100 person-years; adjusted hazard ratio, 4.8; 95% CI, 1.9-11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex. Conclusions Hs-cTnT is dose-dependently associated with an increased risk of recurrent vascular events and death within 3 years after first-ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs-cTnT for individualized risk stratification after stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01363856.
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Affiliation(s)
- Jan F. Scheitz
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
- German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen), partner site BerlinGermany
| | - Jess Lim
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
| | - Leonie H. A. Broersen
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
| | - Ramanan Ganeshan
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
| | - Shufan Huo
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
| | - Pia S. Sperber
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz‐Kreislaufforschung, DHZK), partner site BerlinGermany
| | - Sophie K. Piper
- Berlin Institute of Health (BIH)Germany
- Institute of Biometry and Clinical EpidemiologyCharité–Universitätsmedizin BerlinBerlinGermany
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and BiometryUniversity of WürzburgGermany
- Clinical Trial CenterUniversity Hospital WürzburgGermany
| | - Heinrich J. Audebert
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
| | - Christian H. Nolte
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz‐Kreislaufforschung, DHZK), partner site BerlinGermany
- German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen), partner site BerlinGermany
- Berlin Institute of Health (BIH)Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
| | - Matthias Endres
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz‐Kreislaufforschung, DHZK), partner site BerlinGermany
- German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen), partner site BerlinGermany
- ExcellenceCluster NeuroCureBerlinGermany
- Berlin Institute of Health (BIH)Germany
| | - Thomas G. Liman
- Center for Stroke Research Berlin (CSB)Charité Universitätsmedizin BerlinBerlinGermany
- Klinik für Neurologie mit Experimenteller NeurologieCharité–Universitätsmedizin BerlinBerlinGermany
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7
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Snow SJ, Henriquez AR, Thompson LC, Fisher C, Schladweiler MC, Wood CE, Kodavanti UP. Pulmonary and vascular effects of acute ozone exposure in diabetic rats fed an atherogenic diet. Toxicol Appl Pharmacol 2021; 415:115430. [PMID: 33524446 PMCID: PMC8086743 DOI: 10.1016/j.taap.2021.115430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 01/06/2023]
Abstract
Air pollutants may increase risk for cardiopulmonary disease, particularly in susceptible populations with metabolic stressors such as diabetes and unhealthy diet. We investigated effects of inhaled ozone exposure and high-cholesterol diet (HCD) in healthy Wistar and Wistar-derived Goto-Kakizaki (GK) rats, a non-obese model of type 2 diabetes. Male rats (4-week old) were fed normal diet (ND) or HCD for 12 weeks and then exposed to filtered air or 1.0 ppm ozone (6 h/day) for 1 or 2 days. We examined pulmonary, vascular, hematology, and inflammatory responses after each exposure plus an 18-h recovery period. In both strains, ozone induced acute bronchiolar epithelial necrosis and inflammation on histopathology and pulmonary protein leakage and neutrophilia; the protein leakage was more rapid and persistent in GK compared to Wistar rats. Ozone also decreased lymphocytes after day 1 in both strains consuming ND (~50%), while HCD increased circulating leukocytes. Ozone increased plasma thrombin/antithrombin complexes and platelet disaggregation in Wistar rats on HCD and exacerbated diet effects on serum IFN-γ, IL-6, KC-GRO, IL-13, and TNF-α, which were higher with HCD (Wistar>GK). Ex vivo aortic contractility to phenylephrine was lower in GK versus Wistar rats at baseline(~30%); ozone enhanced this effect in Wistar rats on ND. GK rats on HCD had higher aortic e-NOS and tPA expression compared to Wistar rats. Ozone increased e-NOS in GK rats on ND (~3-fold) and Wistar rats on HCD (~2-fold). These findings demonstrate ways in which underlying diabetes and HCD may exacerbate pulmonary, systemic, and vascular effects of inhaled pollutants.
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MESH Headings
- Air Pollutants/toxicity
- Animals
- Aorta, Thoracic/drug effects
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/physiopathology
- Biomarkers/blood
- Blood Platelets/drug effects
- Blood Platelets/metabolism
- Cholesterol, Dietary/metabolism
- Cholesterol, Dietary/toxicity
- Cytokines/blood
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diet, Atherogenic/adverse effects
- Disease Models, Animal
- Inflammation Mediators/blood
- Inhalation Exposure
- Lung/drug effects
- Lung/metabolism
- Lung/pathology
- Lung Injury/blood
- Lung Injury/chemically induced
- Lung Injury/pathology
- Male
- Necrosis
- Ozone/toxicity
- Pulmonary Edema/blood
- Pulmonary Edema/chemically induced
- Pulmonary Edema/pathology
- Rats, Wistar
- Vascular Diseases/blood
- Vascular Diseases/chemically induced
- Vascular Diseases/physiopathology
- Vasoconstriction/drug effects
- Rats
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Affiliation(s)
- Samantha J Snow
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States
| | - Andres R Henriquez
- Oak Ridge Institute for Science and Education Research Participation Program, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States
| | - Leslie C Thompson
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States
| | - Cynthia Fisher
- School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Mette C Schladweiler
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States
| | - Charles E Wood
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States
| | - Urmila P Kodavanti
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States.
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8
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Gu SX, Tyagi T, Jain K, Gu VW, Lee SH, Hwa JM, Kwan JM, Krause DS, Lee AI, Halene S, Martin KA, Chun HJ, Hwa J. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation. Nat Rev Cardiol 2021; 18:194-209. [PMID: 33214651 PMCID: PMC7675396 DOI: 10.1038/s41569-020-00469-1] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
The core pathology of coronavirus disease 2019 (COVID-19) is infection of airway cells by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that results in excessive inflammation and respiratory disease, with cytokine storm and acute respiratory distress syndrome implicated in the most severe cases. Thrombotic complications are a major cause of morbidity and mortality in patients with COVID-19. Patients with pre-existing cardiovascular disease and/or traditional cardiovascular risk factors, including obesity, diabetes mellitus, hypertension and advanced age, are at the highest risk of death from COVID-19. In this Review, we summarize new lines of evidence that point to both platelet and endothelial dysfunction as essential components of COVID-19 pathology and describe the mechanisms that might account for the contribution of cardiovascular risk factors to the most severe outcomes in COVID-19. We highlight the distinct contributions of coagulopathy, thrombocytopathy and endotheliopathy to the pathogenesis of COVID-19 and discuss potential therapeutic strategies in the management of patients with COVD-19. Harnessing the expertise of the biomedical and clinical communities is imperative to expand the available therapeutics beyond anticoagulants and to target both thrombocytopathy and endotheliopathy. Only with such collaborative efforts can we better prepare for further waves and for future coronavirus-related pandemics.
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Affiliation(s)
- Sean X Gu
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tarun Tyagi
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kanika Jain
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Vivian W Gu
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Seung Hee Lee
- Division of Cardiovascular Diseases, Center for Biomedical Sciences, National Institute of Health, Cheongju, Chungbuk, Korea
| | - Jonathan M Hwa
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer M Kwan
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Diane S Krause
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alfred I Lee
- Section of Hematology, Department of Internal Medicine and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Stephanie Halene
- Section of Hematology, Department of Internal Medicine and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen A Martin
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Hyung J Chun
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - John Hwa
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
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9
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Abstract
Platelets rapidly undergo responsive transitions in form and function to repair vascular endothelium and mediate hemostasis. In contrast, heterogeneous platelet subpopulations with a range of primed or refractory phenotypes gradually arise in chronic inflammatory and other conditions in a manner that may indicate or support disease. Qualitatively distinguishable platelet phenotypes are increasingly associated with a variety of physiological and pathological circumstances; however, the origins and significance of platelet phenotypic variation remain unclear and conceptually vague. As changes in platelet function in disease exhibit many similarities to platelets following the activation of platelet agonist receptors, the intracellular responses of platelets common to hemostasis and inflammation may provide insights to the molecular basis of platelet phenotype. Here, we review concepts around how protein-level relations-from platelet receptors through intracellular signaling events-may help to define platelet phenotypes in inflammation, immune responses, aging, and other conditions. We further discuss how representing systems-wide platelet proteomics data profiles as circuit-like networks of causally related intracellular events, or, pathway maps, may inform molecular definitions of platelet phenotype. In addition to offering insights into platelets as druggable targets, maps of causally arranged intracellular relations underlying platelet function can also advance precision and interceptive medicine efforts by leveraging platelets as accessible, dynamic, endogenous, circulating biomarkers of vascular wellness and disease. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Joseph E. Aslan
- Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Chemical Physiology and Biochemistry and School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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10
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Gasparini G, Canepa P, Verdiani S, Carmisciano L, Cozzani E, De Grazia D, Andrea O, Icardi G, Parodi A. A retrospective study on the prevalence of anti-phospholipid antibodies, thrombotic events and cutaneous signs of vasculopathy in 173 hospitalized COVID-19 patients. Int J Immunopathol Pharmacol 2021; 35:20587384211042115. [PMID: 34541915 PMCID: PMC8460963 DOI: 10.1177/20587384211042115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypercoagulability is a risk factor of thromboembolic events in COVID-19. Anti-phospholipid (aPL) antibodies have been hypothesized to be involved. Typical COVID-19 dermatological manifestations of livedo reticularis and digital ischemia may resemble cutaneous manifestations of anti-phospholipid syndrome (APS). OBJECTIVES To investigate the association between aPL antibodies and thromboembolic events, COVID-19 severity, mortality, and cutaneous manifestations in patients with COVID-19. METHODS aPL antibodies [anti-beta2-glycoprotein-1 (B2GP1) and anti-cardiolipin (aCL) antibodies] were titered in frozen serum samples from hospitalized COVID-19 patients and the patients' clinical records were retrospectively analyzed. RESULTS 173 patients were enrolled. aPL antibodies were detected in 34.7% of patients, anti-B2GP1 antibodies in 30.1%, and aCL antibodies in 10.4%. Double positivity was observed in 5.2% of patients. Thromboembolic events occurred in 9.8% of patients, including 11 pulmonary embolisms, 1 case of celiac tripod thrombosis, and six arterial ischemic events affecting the cerebral, celiac, splenic, or femoral-popliteal arteries or the aorta. aPL antibodies were found in 52.9% of patients with vascular events, but thromboembolic events were not correlated to aPL antibodies (adjusted OR = 1.69, p = 0.502). Ten patients (5.8%) had cutaneous signs of vasculopathy: nine livedo reticularis and one acrocyanosis. No significant association was observed between the presence of cutaneous vasculopathy and aPL antibodies (p = 0.692). CONCLUSIONS Anti-phospholipid antibodies cannot be considered responsible for hypercoagulability and thrombotic events in COVID-19 patients. In COVID-19 patients, livedo reticularis and acrocyanosis do not appear to be cutaneous manifestations of APS.
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Affiliation(s)
- Giulia Gasparini
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Paola Canepa
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Simonetta Verdiani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Section of Statistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
| | - Denise De Grazia
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Orsi Andrea
- Hygiene and Preventive medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene and Preventive medicine Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
| | - Giancarlo Icardi
- Hygiene and Preventive medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene and Preventive medicine Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
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11
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Aid M, Busman-Sahay K, Vidal SJ, Maliga Z, Bondoc S, Starke C, Terry M, Jacobson CA, Wrijil L, Ducat S, Brook OR, Miller AD, Porto M, Pellegrini KL, Pino M, Hoang TN, Chandrashekar A, Patel S, Stephenson K, Bosinger SE, Andersen H, Lewis MG, Hecht JL, Sorger PK, Martinot AJ, Estes JD, Barouch DH. Vascular Disease and Thrombosis in SARS-CoV-2-Infected Rhesus Macaques. Cell 2020; 183:1354-1366.e13. [PMID: 33065030 PMCID: PMC7546181 DOI: 10.1016/j.cell.2020.10.005] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has led to extensive morbidity and mortality throughout the world. Clinical features that drive SARS-CoV-2 pathogenesis in humans include inflammation and thrombosis, but the mechanistic details underlying these processes remain to be determined. In this study, we demonstrate endothelial disruption and vascular thrombosis in histopathologic sections of lungs from both humans and rhesus macaques infected with SARS-CoV-2. To define key molecular pathways associated with SARS-CoV-2 pathogenesis in macaques, we performed transcriptomic analyses of bronchoalveolar lavage and peripheral blood and proteomic analyses of serum. We observed macrophage infiltrates in lung and upregulation of macrophage, complement, platelet activation, thrombosis, and proinflammatory markers, including C-reactive protein, MX1, IL-6, IL-1, IL-8, TNFα, and NF-κB. These results suggest a model in which critical interactions between inflammatory and thrombosis pathways lead to SARS-CoV-2-induced vascular disease. Our findings suggest potential therapeutic targets for COVID-19.
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Affiliation(s)
- Malika Aid
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | | | - Samuel J Vidal
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Zoltan Maliga
- Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Stephen Bondoc
- Oregon Health & Sciences University, Beaverton, OR 97006, USA
| | - Carly Starke
- Oregon Health & Sciences University, Beaverton, OR 97006, USA
| | - Margaret Terry
- Oregon Health & Sciences University, Beaverton, OR 97006, USA
| | - Connor A Jacobson
- Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Linda Wrijil
- Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | - Sarah Ducat
- Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Andrew D Miller
- Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, NY 14853, USA
| | | | - Kathryn L Pellegrini
- Yerkes Genomics Core Laboratory, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Maria Pino
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Timothy N Hoang
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Abishek Chandrashekar
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Shivani Patel
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Kathryn Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Steven E Bosinger
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Yerkes Genomics Core Laboratory, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Department of Pathology & Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, GA 30329, USA
| | | | | | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Peter K Sorger
- Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Amanda J Martinot
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | - Jacob D Estes
- Oregon Health & Sciences University, Beaverton, OR 97006, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA.
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12
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Leleu D, Levionnois E, Laurent P, Lazaro E, Richez C, Duffau P, Blanco P, Sisirak V, Contin-Bordes C, Truchetet ME. Elevated Circulatory Levels of Microparticles Are Associated to Lung Fibrosis and Vasculopathy During Systemic Sclerosis. Front Immunol 2020; 11:532177. [PMID: 33193304 PMCID: PMC7645042 DOI: 10.3389/fimmu.2020.532177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022] Open
Abstract
Background Microparticles (MPs) are vesicular structures that derive from multiple cellular sources. MPs play important roles in intercellular communication, regulation of cell signaling or initiation of enzymatic processes. While MPs were characterized in Systemic Sclerosis (SSc) patients, their contribution to SSc pathogenesis remains unknown. Our aim was to investigate the potential role of MPs in SSc pathophysiology and their impact on tissue fibrosis. Methods Ninety-six SSc patients and 37 sex-matched healthy donors (HD) were enrolled in this study in order to quantify and phenotype their plasmatic MPs by flow cytometry. The ability of MPs purified from SSc patients and HD controls to modulate fibroblast's extra-cellular matrix genes expression was evaluated in vitro by reverse transcriptase quantitative polymerase chain reaction. Results SSc patients exhibited a higher concentration of circulatory MPs compared to HD. This difference was exacerbated when we only considered patients that were not treated with methotrexate or targeted disease-modifying antirheumatic drugs. Total circulatory MPs were associated to interstitial lung disease, lung fibrosis and diminished lung functional capacity, but also to vascular involvement such as active digital ulcers. Finally, contrary to HD MPs, MPs from SSc patients stimulated the production of extracellular matrix by fibroblast, demonstrating their profibrotic potential. Conclusions In this study, we provide evidence for a direct profibrotic role of MPs from SSc patients, underpinned by strong clinical associations in a large cohort of patients.
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Affiliation(s)
- Damien Leleu
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- Immunology and Immunogenetic Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Paoline Laurent
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
| | - Estibaliz Lazaro
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- Internal Medicine Department, Bordeaux University Hospital, Bordeaux, France
- Centre national de reference des maladies auto-immunes systémiques rares de l’Est et du Sud-Ouest (RESO), Bordeaux, France
| | - Christophe Richez
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- Centre national de reference des maladies auto-immunes systémiques rares de l’Est et du Sud-Ouest (RESO), Bordeaux, France
- Rheumatology Department, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Duffau
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- Internal Medicine Department, Bordeaux University Hospital, Bordeaux, France
| | - Patrick Blanco
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- Immunology and Immunogenetic Department, Bordeaux University Hospital, Bordeaux, France
| | - Vanja Sisirak
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
| | - Cecile Contin-Bordes
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- Immunology and Immunogenetic Department, Bordeaux University Hospital, Bordeaux, France
| | - Marie-Elise Truchetet
- University of Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- Centre national de reference des maladies auto-immunes systémiques rares de l’Est et du Sud-Ouest (RESO), Bordeaux, France
- Rheumatology Department, Bordeaux University Hospital, Bordeaux, France
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13
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Al-Sofiani M, MacLeod S, Ghanim H, Stecker N, Hall J, Lippes H. Type 1 diabetes and hearing loss: Audiometric assessment and measurement of circulating levels of soluble receptor for advanced glycation end products. Diabetes Metab Res Rev 2020; 36:e3312. [PMID: 32191386 DOI: 10.1002/dmrr.3312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/25/2019] [Accepted: 03/08/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND We examined the hearing function in adults with and without type 1 diabetes (T1D) to investigate whether an association exists between hearing loss and duration of diabetes, haemoglobin A1C level, diabetes complications and levels of select serum and urinary biomarkers. METHODS We measured pure tone audiometry (PTA) thresholds; serum levels of C-reactive protein (CRP), vascular endothelial growth factor (VEGF), soluble receptors for advanced glycation end-product (sRAGE); and urinary isoprostane in 30 adults with T1D (age 43.8 ± 11.4 years). We also measured PTA thresholds in 11 adults without diabetes (age 53 ± 5.5 years). RESULTS 63.3% of adults with T1D had high-frequency hearing loss. Among adults with T1D, those with hearing loss were older (48.2 vs 36.2 years old, P < .01), had a longer duration of diabetes (30.7 vs 21.2 years, P = .02), a greater prevalence of peripheral neuropathy (57.9 vs 9.1%, P = .02) and significantly lower median levels of sRAGE (1054.27 vs 1306.83 pg/mL, P = .03) compared to those with normal hearing. Adults with T1D between the ages of 40 and 60 years old, who had diabetes for ≥35 years, had significantly higher PTA thresholds at both 500and 8000 Hz than age-matched adults without diabetes. CONCLUSIONS A significant proportion of adults with T1D have high-frequency hearing loss before age of 60 that is positively associated with age, duration of diabetes and presence of peripheral neuropathy. Our results are in support of previous studies suggesting a potential protective role of sRAGE against AGE toxicity and diabetes complications.
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Affiliation(s)
- Mohammed Al-Sofiani
- Endocrinology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, Maryland, USA
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sara MacLeod
- Internal Medicine, State University of New York at Buffalo, Catholic Health System, Buffalo, New York, USA
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Kaleida Health, Buffalo, New York, USA
| | - Nancy Stecker
- Department of Communicative Disorders and Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - John Hall
- Internal Medicine, State University of New York at Buffalo, Catholic Health System, Buffalo, New York, USA
| | - Howard Lippes
- Internal Medicine, State University of New York at Buffalo, Catholic Health System, Buffalo, New York, USA
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14
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Baeck M, Herman A, Peeters C, Marot L, Hermans C. Are chilblains a skin expression of COVID-19 microangiopathy? J Thromb Haemost 2020; 18:2414-2415. [PMID: 32657464 PMCID: PMC7405401 DOI: 10.1111/jth.15008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/10/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Marie Baeck
- Division of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Anne Herman
- Division of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Caroline Peeters
- Division of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Liliane Marot
- Division of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Division of Anatomopathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Cedric Hermans
- Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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Matsumoto M, Suganuma H, Shimizu S, Hayashi H, Sawada K, Tokuda I, Ihara K, Nakaji S. Skin Carotenoid Level as an Alternative Marker of Serum Total Carotenoid Concentration and Vegetable Intake Correlates with Biomarkers of Circulatory Diseases and Metabolic Syndrome. Nutrients 2020; 12:E1825. [PMID: 32575348 PMCID: PMC7353351 DOI: 10.3390/nu12061825] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
To confirm the usefulness of noninvasive measurements of skin carotenoids to indicate vegetable intake and to elucidate relationships between skin carotenoid levels and biomarkers of circulatory diseases and metabolic syndrome, we conducted a cross-sectional study on a resident-based health checkup (n = 811; 58% women; 49.5 ± 15.1 years). Skin and serum carotenoid levels were measured via reflectance spectroscopy and high-performance liquid chromatography, respectively. Vegetable intake was estimated using a dietary questionnaire. Levels of 9 biomarkers (body mass index [BMI], brachial-ankle pulse wave velocity [baPWV], systolic and diastolic blood pressure [SBP and DBP], homeostasis model assessment as an index of insulin resistance [HOMA-IR], blood insulin, fasting blood glucose [FBG], triglycerides [TGs], and high-density lipoprotein cholesterol [HDL-C]) were determined. Skin carotenoid levels were significantly positively correlated with serum total carotenoids and vegetable intake (r = 0.678 and 0.210, respectively). In women, higher skin carotenoid levels were significantly associated with lower BMI, SBP, DBP, HOMA-IR, blood insulin, and TGs levels and higher HDL-C levels. In men, it was also significantly correlated with BMI and blood insulin levels. In conclusion, dermal carotenoid level may indicate vegetable intake, and the higher level of dermal carotenoids are associated with a lower risk of circulatory diseases and metabolic syndrome.
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Affiliation(s)
- Mai Matsumoto
- Innovation Division, KAGOME CO., LTD. 17 Nishitomiyama, Nasushiobara 329-2762, Japan; (M.M.); (S.S.); (H.H.)
| | - Hiroyuki Suganuma
- Innovation Division, KAGOME CO., LTD. 17 Nishitomiyama, Nasushiobara 329-2762, Japan; (M.M.); (S.S.); (H.H.)
| | - Sunao Shimizu
- Innovation Division, KAGOME CO., LTD. 17 Nishitomiyama, Nasushiobara 329-2762, Japan; (M.M.); (S.S.); (H.H.)
- Department of Vegetable Life Science, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
- Center for Advanced Medical Science, Department of Stress Response Science, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Hiroki Hayashi
- Innovation Division, KAGOME CO., LTD. 17 Nishitomiyama, Nasushiobara 329-2762, Japan; (M.M.); (S.S.); (H.H.)
| | - Kahori Sawada
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan; (K.S.); (I.T.); (K.I.); (S.N.)
| | - Itoyo Tokuda
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan; (K.S.); (I.T.); (K.I.); (S.N.)
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan; (K.S.); (I.T.); (K.I.); (S.N.)
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan; (K.S.); (I.T.); (K.I.); (S.N.)
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Six I, Flissi N, Lenglet G, Louvet L, Kamel S, Gallet M, Massy ZA, Liabeuf S. Uremic Toxins and Vascular Dysfunction. Toxins (Basel) 2020; 12:toxins12060404. [PMID: 32570781 PMCID: PMC7354618 DOI: 10.3390/toxins12060404] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023] Open
Abstract
Vascular dysfunction is an essential element found in many cardiovascular pathologies and in pathologies that have a cardiovascular impact such as chronic kidney disease (CKD). Alteration of vasomotricity is due to an imbalance between the production of relaxing and contracting factors. In addition to becoming a determining factor in pathophysiological alterations, vascular dysfunction constitutes the first step in the development of atherosclerosis plaques or vascular calcifications. In patients with CKD, alteration of vasomotricity tends to emerge as being a new, less conventional, risk factor. CKD is characterized by the accumulation of uremic toxins (UTs) such as phosphate, para-cresyl sulfate, indoxyl sulfate, and FGF23 and, consequently, the deleterious role of UTs on vascular dysfunction has been explored. This accumulation of UTs is associated with systemic alterations including inflammation, oxidative stress, and the decrease of nitric oxide production. The present review proposes to summarize our current knowledge of the mechanisms by which UTs induce vascular dysfunction.
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Affiliation(s)
- Isabelle Six
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), Picardie Jules Verne University, 80025 Amiens, France; (N.F.); (G.L.); (L.L.); (S.K.); (M.G.); (S.L.)
- Correspondence: ; Tel./Fax: +03-22-82-54-25
| | - Nadia Flissi
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), Picardie Jules Verne University, 80025 Amiens, France; (N.F.); (G.L.); (L.L.); (S.K.); (M.G.); (S.L.)
| | - Gaëlle Lenglet
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), Picardie Jules Verne University, 80025 Amiens, France; (N.F.); (G.L.); (L.L.); (S.K.); (M.G.); (S.L.)
| | - Loïc Louvet
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), Picardie Jules Verne University, 80025 Amiens, France; (N.F.); (G.L.); (L.L.); (S.K.); (M.G.); (S.L.)
| | - Said Kamel
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), Picardie Jules Verne University, 80025 Amiens, France; (N.F.); (G.L.); (L.L.); (S.K.); (M.G.); (S.L.)
- Amiens-Picardie University Hospital, Human Biology Center, 80054 Amiens, France
| | - Marlène Gallet
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), Picardie Jules Verne University, 80025 Amiens, France; (N.F.); (G.L.); (L.L.); (S.K.); (M.G.); (S.L.)
| | - Ziad A. Massy
- Service de Néphrologie et Dialyse, Assistance Publique—Hôpitaux de Paris (APHP), Hôpital Universitaire Ambroise Paré, 92100 Boulogne Billancourt, France;
- INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), Université Paris Saclay et Université Versailles Saint Quentin en Yvelines, 94800 Villejuif, France
| | - Sophie Liabeuf
- UR 7517 UPJV, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), Picardie Jules Verne University, 80025 Amiens, France; (N.F.); (G.L.); (L.L.); (S.K.); (M.G.); (S.L.)
- Pharmacology Department, Amiens University Hospital, 80025 Amiens, France
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Gordon JL, Rubinow DR, Watkins L, Hinderliter AL, Caughey MC, Girdler SS. The Effect of Perimenopausal Transdermal Estradiol and Micronized Progesterone on Markers of Risk for Arterial Disease. J Clin Endocrinol Metab 2020; 105:dgz262. [PMID: 31838497 PMCID: PMC7096310 DOI: 10.1210/clinem/dgz262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/13/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The arterial effects of hormone therapy remain controversial. This study tested the effects of transdermal estradiol plus intermittent micronized progesterone (TE + IMP) in healthy perimenopausal and early postmenopausal women on several mechanisms involved in the pathophysiology of arterial disease. METHODS Healthy perimenopausal and early postmenopausal women, ages 45 to 60 years, were enrolled in this randomized, double-blind, placebo-controlled trial. Women were randomized to receive TE (0.1 mg/day) + IMP (200 mg/day for 12 days) or identical placebo patches and pills for 12 months. Outcomes included: change in stress reactivity composite z-score (combining inflammatory, cortisol, and hemodynamic responses to a standardized psychological laboratory stressor); flow-mediated dilation (FMD) of the brachial artery (an index of vascular endothelial function); baroreflex sensitivity; and metabolic risk (presence of the metabolic syndrome or insulin resistance), all assessed at baseline and at months 6 and 12. RESULTS Of 172 women enrolled, those assigned to TE + IMP tended to have higher resting baroreflex sensitivity than those assigned to placebo across the 6- and 12-month visits. Although treatment groups did not differ in terms of the other prespecified outcomes, a significant treatment-by-age interaction was found for FMD and stress reactivity such that an age-related decrease in FMD and increase in stress reactivity were seen among women assigned to placebo but not those assigned to TE + IMP. Women on TE + IMP also had lower resting diastolic blood pressure, lower levels of low-density lipoprotein cholesterol, and higher baroreflex sensitivity during stress testing. CONCLUSIONS TE + IMP tended to improve cardiac autonomic control and prevented age-related changes in stress reactivity and endothelial function among healthy perimenopausal and early postmenopausal women.
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Affiliation(s)
- Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lana Watkins
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, North Carolina
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Melissa C Caughey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan S Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Zhang X, Shah BN, Zhang W, Saraf SL, Nouraie M, Nekhai S, Machado RF, Gladwin MT, Gordeuk VR. S100B has pleiotropic effects on vaso-occlusive manifestations in sickle cell disease. Am J Hematol 2020; 95:E62-E65. [PMID: 31805207 PMCID: PMC7326008 DOI: 10.1002/ajh.25691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/29/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Xu Zhang
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Binal N Shah
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Santosh L. Saraf
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - Sergei Nekhai
- Center for Sickle Cell Disease, Howard University, Washington, DC
| | - Roberto F. Machado
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, Indiana University, Indianapolis, IN
| | - Mark T. Gladwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - Victor R. Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
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Xu N, Xu H, Zhao M, Xu Y, Huang L. Associations of systemic, serum lipid and lipoprotein metabolic pathway gene variations with polypoidal choroidal vasculopathy in China. PLoS One 2019; 14:e0226763. [PMID: 31877157 PMCID: PMC6932770 DOI: 10.1371/journal.pone.0226763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/01/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To investigate the association of systemic, serum lipids and genetic variants in the high-density lipoprotein (HDL) metabolic pathway with polypoidal choroidal vasculopathy (PCV) in China. METHODS The case-control study was included 150 controls and 66 cases with PCV. Serum levels of total cholesterol (TC), low-density lipoprotein (LDL), HDL, triglycerides (TG), apolipoprotein A1 (APOA1), apolipoprotein B (APOB) together with systemic risk factors including gender, hyperlipidemia, diabetes mellitus (DM), hypertension, coronary artery disease (CAD) and asthma were identified. All subjects were genotyped for four single nucleotide polymorphisms (SNPs) from three genes in the HDL metabolic pathway: rs10468017 of hepatic lipase (LIPC), rs12678919 of lipoprotein lipase (LPL), rs3764261 and rs173539 of cholesterol ester transfer protein (CETP) with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Student's t-tests, chi-square tests, anova and logistic regression were used to evaluate associations. RESULTS Hyperlipidemia was a risk factor (odds ratio (OR) = 1.19, P = 0.001) for PCV. HDL, LDL and APOB levels were associated with PCV (OR = 0.001, P = 0.004; OR = 0.099, P = 0.010; OR = 0.839, P = 0.018). Higher level of TC was potently associated with increased risk of PCV (OR = 109.8, P = 0.000). LIPC rs10468017 was a risk factor for PCV (OR = 11.68, P = 0.000). CETP rs3764261 conferred a decreased risk for PCV (OR = 0.08, P = 0.000). No associations of LPL rs12678919 or CETP rs173539 with PCV were found. Mean level of HDL increased with T allele of the CETP gene (p = 0.026): 1.24 mmol/L (±0.31) for the GG genotype and 1.66 mmol/L (±0.54) for the TT genotype. Additionally, T allele was associated with the following increase in APOA1: 136.78 mg/dl (±20.53) for the CC genotype and 149.57 mg/dl (±22.67) for the TT genotype of LIPC and 137.91 mg/dl (±20.36) for the GG genotype and 162.67 mg/dl (±22.50) for the TT genotype of CETP gene. CONCLUSION Our study suggested that the significant association was found between hyperlipidemia, the serum levels of TC, HDL, LDL and APOB and PCV. The result of present study also showed that the association of LIPC rs10468017 and CETP rs3764261 with PCV.
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Affiliation(s)
- Ningda Xu
- Department of Ophthalmology, Peking University People’s Hospital Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center; Beijing,China
| | - Hui Xu
- Department of Ophthalmology, Peking University People’s Hospital Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center; Beijing,China
| | - Mingwei Zhao
- Department of Ophthalmology, Peking University People’s Hospital Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center; Beijing,China
| | - Yongsheng Xu
- Department of Ophthalmology, Peking University People’s Hospital Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center; Beijing,China
| | - Lvzhen Huang
- Department of Ophthalmology, Peking University People’s Hospital Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center; Beijing,China
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20
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Barbagallo C, Mostile G, Baglieri G, Giunta F, Luca A, Raciti L, Zappia M, Purrello M, Ragusa M, Nicoletti A. Specific Signatures of Serum miRNAs as Potential Biomarkers to Discriminate Clinically Similar Neurodegenerative and Vascular-Related Diseases. Cell Mol Neurobiol 2019; 40:531-546. [PMID: 31691877 DOI: 10.1007/s10571-019-00751-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/25/2019] [Indexed: 01/31/2023]
Abstract
Neurodegenerative diseases (NDs) are age-dependent; among them, Alzheimer's disease (AD) and Parkinson's disease (PD) are the most frequent. Similarly, cerebrovascular damage can induce the development of vascular-related disorders that share common features with AD and PD, respectively, named vascular dementia (VD) and vascular parkinsonism (VP). To date, ND diagnosis is mainly clinical; therefore, since these disorders show similar symptoms, their correct discrimination may be difficult. We detected 23 ND-associated microRNAs (miRNAs) by literature mining and investigated their serum expression in a cohort of 139 patients including AD, PD, VD, and VP patients and healthy controls. TaqMan RT-PCR data showed that miR-23a upregulation was associated with an ongoing neurodegenerative process, similar to miR-22* and miR-29a, while let-7d, miR-15b, miR-24, miR-142-3p, miR-181c, and miR-222 showed an altered expression in Parkinson-like phenotypes, as well as miR-34b, miR-125b, and miR-130b in Alzheimer-like disorders. By computing logistic regression models and ROC curves, we identified signatures of neuro-miRNAs specific for each disease, showing good diagnostic performance. Interestingly, we found that miR-23a, miR-29a, miR-34b, and miR-125b exhibited a different distribution between exosomes and vesicle-free serum, suggesting a heterogeneity of secretion for these miRNAs. Our results suggest that miRNA signatures could discriminate in a non-invasive manner neurodegenerative disorders, thus improving clinical diagnoses.
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Affiliation(s)
- Cristina Barbagallo
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics G. Sichel, University of Catania, via Santa Sofia 87, 95123, Catania, Italy
| | - Giovanni Mostile
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123, Catania, Italy
| | - Gloriangela Baglieri
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics G. Sichel, University of Catania, via Santa Sofia 87, 95123, Catania, Italy
| | - Flavia Giunta
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics G. Sichel, University of Catania, via Santa Sofia 87, 95123, Catania, Italy
| | - Antonina Luca
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123, Catania, Italy
| | - Loredana Raciti
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123, Catania, Italy
| | - Mario Zappia
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123, Catania, Italy
| | - Michele Purrello
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics G. Sichel, University of Catania, via Santa Sofia 87, 95123, Catania, Italy
| | - Marco Ragusa
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics G. Sichel, University of Catania, via Santa Sofia 87, 95123, Catania, Italy.
- Oasi Research Institute - IRCCS, 94018, Troina, Italy.
| | - Alessandra Nicoletti
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123, Catania, Italy
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Geng S, Kuang Z, Peissig PL, Page D, Maursetter L, Hansen KE. Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease. Osteoporos Int 2019; 30:2019-2025. [PMID: 31190122 DOI: 10.1007/s00198-019-05033-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/22/2019] [Indexed: 12/18/2022]
Abstract
UNLABELLED Doctors do not know whether treatment of high parathyroid hormone levels is linked to better outcomes in their patients with kidney disease. In this study, lower parathyroid hormone levels at baseline were linked to lower risk of fracture, vascular events, and death in people with kidney disease. PURPOSE Chronic kidney disease (CKD) affects ~ 20% of older adults, and secondary hyperparathyroidism (HPT) is a common condition in these patients. To what degree HPT predicts fractures, vascular events, and mortality in pre-dialysis CKD patients is debated. In stage 3 and 4 CKD patients, we assessed relationships between baseline serum PTH levels and subsequent 10-year probabilities of clinical fractures, vascular events, and death. METHODS We used Marshfield Clinic Health System electronic health records to analyze data from adult CKD patients receiving care between 1985 and 2013, and whose PTH was measured using a second-generation assay. Covariates included PTH, age, gender, tobacco use, vascular disease, diabetes, hypertension, hyperlipidemia, obesity, GFR, and use of osteoporosis medications. RESULTS Five thousand one hundred eight subjects had a mean age of 68 ± 17 years, 48% were men, and mean follow-up was 23 ± 10 years. Fractures, vascular events, and death occurred in 18%, 71%, and 56% of the cohort, respectively. In univariate and multivariate models, PTH was an independent predictor of fracture, vascular events, and death. The hazards of fracture, vascular events and death were minimized at a baseline PTH of 0, 69, and 58 pg/mL, respectively. CONCLUSIONS We found that among individuals with stage 3 and 4 CKD, PTH was an independent predictor of fractures, vascular events, and death. Additional epidemiologic studies are needed to confirm these findings. If a target PTH range can be confirmed, then randomized placebo-controlled trials will be needed to confirm that treating HPT reduces the risk of fracture, vascular events, and death.
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Affiliation(s)
- S Geng
- Department of Computer Science, Princeton University, Princeton, NJ, USA
| | - Z Kuang
- Computer Science Department, Stanford University, Stanford, CA, USA
| | - P L Peissig
- Center for Computational and Biomedical Informatics, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - D Page
- Department of Biostatistics and Medical Informatics, Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - L Maursetter
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Mailbox 4124, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - K E Hansen
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Mailbox 4124, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705-2281, USA.
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Affiliation(s)
- Megan A. Slack
- Saha Cardiovascular Research Center and Department of Physiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Scott M. Gordon
- Saha Cardiovascular Research Center and Department of Physiology, University of Kentucky College of Medicine, Lexington, KY, USA
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Feldo M, Wójciak-Kosior M, Sowa I, Kocki J, Bogucki J, Zubilewicz T, Kęsik J, Bogucka-Kocka A. Effect of Diosmin Administration in Patients with Chronic Venous Disorders on Selected Factors Affecting Angiogenesis. Molecules 2019; 24:molecules24183316. [PMID: 31547271 PMCID: PMC6767141 DOI: 10.3390/molecules24183316] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 01/09/2023] Open
Abstract
Diosmin is a natural compound with a wide range of biological activity, e.g., it improves lymphatic drainage, supports microcirculation, and increases venous tone, and venous elasticity, hence, it is applied in the pharmacotherapy of chronic venous disorders (CVD). The aim of this study was to assess the correlation between diosmin administration (2 × 600 mg daily) in patients suffering from CVD and the levels of selected factors influencing angiogenesis, which are involved in CVD pathophysiology. Thirty-five CVD patients were examined. Levels of plasma tumor necrosis factor alpha (TNF alpha), vascular endothelial growth factor (VEGF-A and VEGF-C); angiostatin, interleukin 6 (IL-6), fibroblast growth factor 2 (FGF2); and plasminogen (PLG) were measured with an Elisa assay before and after three months of diosmin administration. The clinical symptoms of CVD were monitored using ultrasound images, echo Doppler assay, visual analogue scale (VAS), and measurement of the leg circumference. The average content of TNF alpha, VEGF-C, VEGF-A IL-6, and FGF2 decreased after the therapy with diosmin in a significant manner; with p < 0.001, p < 0.05, p < 0.05, p < 0.01, and p < 0.01, respectively, and a significant (p < 0.05) increase in the plasma angiostatin level after the three-month treatment was found. A significant (p < 0.05) decrease in edema and the average leg circumference of the patients was observed after the therapy. Diosmin influences the angiogenic and inflammatory mechanisms involved in the pathophysiology of edema presented in patients with a different class of CVD.
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Affiliation(s)
- Marcin Feldo
- Department of Vascular Surgery and Angiology, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland.
| | - Magdalena Wójciak-Kosior
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland.
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland.
| | - Janusz Kocki
- Department of Clinical Genetics, Medical University of Lublin, Lublin, Poland, Radziwiłłowska 11, 20-080 Lublin, Poland.
| | - Jacek Bogucki
- Department of Clinical Genetics, Medical University of Lublin, Lublin, Poland, Radziwiłłowska 11, 20-080 Lublin, Poland.
| | - Tomasz Zubilewicz
- Department of Vascular Surgery and Angiology, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland.
| | - Jan Kęsik
- Department of Vascular Surgery and Angiology, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland.
| | - Anna Bogucka-Kocka
- Chair and Department of Biology and Genetics, Medical University of Lublin, W. Chodźki 4A, 20-093 Lublin, Poland.
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Aminuddin A, Salamt N, Ahmad Fuad AF, Chin KY, Ugusman A, Soelaiman IN, Wan Ngah WZ. Vascular Dysfunction among Malaysian Men with Increased BMI: An Indication of Synergistic Effect of Free Testosterone and Inflammation. Medicina (Kaunas) 2019; 55:E575. [PMID: 31500378 PMCID: PMC6780688 DOI: 10.3390/medicina55090575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/31/2022]
Abstract
Background and objectives: Obesity is associated with poor vascular function and may lead to future cardiovascular disease (CVD). Obesity is also related to increased inflammation and a low testosterone level. This study was conducted to determine the relationship between inflammation, testosterone level, and vascular function among subjects with an increased body mass index (BMI) and to determine whether both low testosterone and high inflammation have synergistic effects towards vascular dysfunction. Materials and Methods: A total of 303 men aged 40-80 years were recruited from Klang Valley, Malaysia. Their height, weight, blood pressure (BP), lipid, blood glucose level, total testosterone (TT), free testosterone (FT), and C-reactive protein (CRP) were measured. The carotid femoral pulse wave velocity (PWVCF) and augmentation index (AI) were also recorded as markers of vascular function. Results: The mean age of all the subjects was 54.46 ± 9.77 years. Subjects were divided into a low/normal body mass index (BMI) group (BMI < 25 kg/m2; NG, n = 154) and high BMI group (BMI ≥ 25 kg/m2; OG, n = 149). The mean BMI for NG was 22.20 ± 1.94 kg/m2 while for OG was 28.87 ± 3.24 kg/m2 (p < 0.01). The level of TT (OG = 21.13 ± 6.44 versus NG = 16.18 ± 6.16 nmol/L, p < 0.01) and FT (OG = 0.34 ± 0.12 versus NG = 0.39 ± 0.11 nmol/L, p < 0.01) were reduced while the level of CRP [OG = 1.05 (2.80) versus NG = 0.50 (1.50) mmol/L, p = 0.01] was increased in OG compared to NG. PWVCF (OG = 8.55 ± 1.34 versus NG = 8.52 ± 1.42 m/s, p = 0.02) and AI (OG = 16.91% ± 6.00% versus 15.88% ± 5.58%, p < 0.01) were significantly increased in OG after adjustment for other CVD risk factors. The subjects that had both a low FT and an increased CRP had higher AI when compared to those with a high CRP and high FT (p < 0.01). Conclusions: The increased BMI was associated with vascular dysfunction, mediated by a low testosterone level and increased inflammation. Furthermore, having both conditions concurrently lead to higher vascular dysfunction. Weight loss, testosterone supplementation, and the anti-inflammatory agent may be beneficial for men to prevent vascular dysfunction.
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Affiliation(s)
- Amilia Aminuddin
- Department of Physiology, Universiti Kebangsaan Malaysia Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Norizam Salamt
- Department of Physiology, Universiti Kebangsaan Malaysia Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Ahmad Faiz Ahmad Fuad
- Department of Physiology, Universiti Kebangsaan Malaysia Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Kok-Yong Chin
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Azizah Ugusman
- Department of Physiology, Universiti Kebangsaan Malaysia Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Ima Nirwana Soelaiman
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Wan Zurinah Wan Ngah
- Department of Biochemistry, Universiti Kebangsaan Malaysia Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
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von Meijenfeldt GCI, Chary S, van der Laan MJ, Zeebregts CJAM, Christopher KB. Eosinopenia and post-hospital outcomes in critically ill non-cardiac vascular surgery patients. Nutr Metab Cardiovasc Dis 2019; 29:847-855. [PMID: 31248714 DOI: 10.1016/j.numecd.2019.05.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/28/2019] [Accepted: 05/13/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Eosinopenia is a marker for acute inflammation. We hypothesized that eosinopenia at Intensive Care Unit (ICU) admission in vascular surgery patients who receive critical care, would be associated with increased mortality following hospital discharge. METHODS AND RESULTS We performed a two-center observational cohort study of critically ill, non-cardiac adult vascular surgery patients who received treatment in Boston between 1997 and 2012 and survived hospital admission. The consecutive sample included 5083 patients (male 57%, white 82%, mean age [SD] 61.6 [17.4] years). The exposure was Absolute eosinophil count measured within 24 h of admission to the ICU and categorized as ≤10 cells/μL, 11-50 cells/μL, 51-100 cells/μL, 101-350 cells/μL (normal range), and >350 cells/μL. The primary outcome was all-cause mortality within 90 days of hospital discharge. The secondary outcome was discharge to home following hospitalization. 90-day post-discharge mortality was 6.7%, and 12.9% of patients were readmitted within 30 days. After multivariable adjustment, patients with eosinopenia (≤10 cells/μL) have a 90-day post-discharge mortality OR of 1.97 (95%CI 1.42, 2.73; P < 0.001) relative to patients with an absolute eosinophil count of 101-350 cells/μL. Further, after multivariable adjustment, patients with eosinopenia (≤10 cells/μL) have a 25% lower odds of discharge to home compared to patients with an absolute eosinophil count of 101-350 cells/μL [OR = 0.71 (CI 95% 0.59-0.85); P < 0.001]. CONCLUSION Eosinopenia at ICU admission is a robust predictor of increased mortality and lower likelihood of discharge to home in vascular surgery patients treated with critical care who survive hospitalization.
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Affiliation(s)
- Gerdine C I von Meijenfeldt
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Surgery, Deventer Ziekenhuis, Deventer, the Netherlands
| | | | - M J van der Laan
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - C J A M Zeebregts
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kenneth B Christopher
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital, Boston, USA.
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26
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Volpi S, Insalaco A, Caorsi R, Santori E, Messia V, Sacco O, Terheggen-Lagro S, Cardinale F, Scarselli A, Pastorino C, Moneta G, Cangemi G, Passarelli C, Ricci M, Girosi D, Derchi M, Bocca P, Diociaiuti A, El Hachem M, Cancrini C, Tomà P, Granata C, Ravelli A, Candotti F, Picco P, DeBenedetti F, Gattorno M. Efficacy and Adverse Events During Janus Kinase Inhibitor Treatment of SAVI Syndrome. J Clin Immunol 2019; 39:476-485. [PMID: 31144250 PMCID: PMC7086512 DOI: 10.1007/s10875-019-00645-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/10/2019] [Indexed: 02/07/2023]
Abstract
Objectives Mutations affecting the TMEM173 gene cause STING-associated vasculopathy with onset in infancy (SAVI). No standard immunosuppressive treatment approach is able to control disease progression in patients with SAVI. We studied the efficacy and safety of targeting type I IFN signaling with the Janus kinase inhibitor, ruxolitinib. Methods We used DNA sequencing to identify mutations in TMEM173 in patients with peripheral blood type I IFN signature. The JAK1/2 inhibitor ruxolitinib was administered on an off-label basis. Results We identified three patients with SAVI presenting with skin involvement and progressive severe interstitial lung disease. Indirect echocardiographic signs of pulmonary hypertension were present in one case. Following treatment with ruxolitinib, we observed improvements of respiratory function including increased forced vital capacity in two patients, with discontinuation of oxygen therapy and resolution of echocardiographic abnormalities in one case. Efficacy was persistent in one patient and only transitory in the other two patients. Clinical control of skin complications was obtained, and one patient discontinued steroid treatment. One patient, who presented with kidney involvement, showed resolution of hematuria. One patient experienced increased recurrence of severe viral respiratory infections. Monitoring of peripheral blood type I interferon signature during ruxolitinib treatment did not show a stable decrease. Conclusions We conclude that targeting type I IFN receptor signaling may represent a promising therapeutic option for a subset of patients with SAVI syndrome and severe lung involvement. However, the occurrence of viral respiratory infection might represent an important cautionary note for the application of such form of treatment. Electronic supplementary material The online version of this article (10.1007/s10875-019-00645-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Volpi
- U.O.C. Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
- Centro per le Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
- Universita' Degli Studi di Genova, Genoa, Italy.
- UOSD Centro per le Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Roberta Caorsi
- U.O.C. Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Centro per le Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elettra Santori
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Virginia Messia
- U.O. Reumatologia IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Oliviero Sacco
- Department of Pediatrics, Pediatric Pulmonology and Allergy Unit and Cystic Fibrosis Center, Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Alessia Scarselli
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Bambino Gesù Children's Hospital IRCCS, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Pastorino
- Centro per le Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianmarco Moneta
- U.O. Reumatologia IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Giuliana Cangemi
- Central Laboratory of Analyses, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Passarelli
- UOC Laboratory of Medical Genetics, IRCCS Children Hospital Bambino Gesù, Rome, Italy
| | - Margherita Ricci
- U.O.C. Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Donata Girosi
- Department of Pediatrics, Pediatric Pulmonology and Allergy Unit and Cystic Fibrosis Center, Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Derchi
- Pediatric Cardiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Bocca
- Centro per le Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - May El Hachem
- Dermatology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Caterina Cancrini
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Bambino Gesù Children's Hospital IRCCS, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Claudio Granata
- Department of Pediatric Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angelo Ravelli
- U.O.C. Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Universita' Degli Studi di Genova, Genoa, Italy
| | - Fabio Candotti
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Paolo Picco
- U.O.C. Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Marco Gattorno
- U.O.C. Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Centro per le Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Silaghi CN, Fodor D, Gheorghe SR, Crăciun AM. Serum total matrix Gla protein: Reference interval in healthy adults and variations in patients with vascular and osteoarticular diseases. Clin Chim Acta 2019; 490:128-134. [PMID: 30597137 DOI: 10.1016/j.cca.2018.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Matrix Gla protein (MGP) species are inhibitors of ectopic calcification in vascular diseases (VD) and osteoarticular diseases (OD). Among the MGP assays, we aimed to establish the reference interval for serum total MGP (tMGP) in healthy adults, the variation in patients with VD and OD and the associations with common cardiovascular risk factors. METHODS We enrolled n = 124 healthy subjects and n = 95 patients with VD and OD in a small cross-sectional study. Serum high sensitivity C-reactive protein (hs-CRP), tMGP, glucose and lipid profile was measured. RESULTS We established the reference interval for tMGP as 6-108 μg/L in healthy adults, the population under 40 having higher tMGP levels than those over 40 (61 ± 28, 51 ± 22 μg/L, p < 0.05). In healthy participants, tMGP was associated with smoking (β = 0.303, p = 0.001), age under 40 (β = -0.201, p = 0.032) and marginally with hs-CRP (β = -0.165, p = 0.08). In multivariate regression models, the association between smoking and tMGP was preserved even after adjusting for age under 40 and hs-CRP (β = 0.267, p = 0.005). The healthy population over 40 had lower tMGP levels than patients with OD and VD (51 ± 22, 90 ± 26, 106 ± 30 μg/L, p < 0.001). CONCLUSIONS Higher tMGP levels could identify patients with VD and OD, being also associated with smoking in healthy adults.
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Affiliation(s)
- Ciprian N Silaghi
- Department of Medical Biochemistry, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Daniela Fodor
- Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona R Gheorghe
- Department of Medical Biochemistry, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandra M Crăciun
- Department of Medical Biochemistry, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Yousif OO, Hassan MK, Al-Naama LM. Red Blood Cell and Serum Magnesium Levels Among Children and Adolescents With Sickle Cell Anemia. Biol Trace Elem Res 2018; 186:295-304. [PMID: 29637408 DOI: 10.1007/s12011-018-1307-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/13/2018] [Indexed: 01/12/2023]
Abstract
Patients with sickle cell anemia (SCA) can acquire many biochemical abnormalities, including altered magnesium levels. However, the roles of magnesium in the pathogenesis and management of SCA need to be determined. The aim of this work was to evaluate magnesium levels among pediatric patients with SCA in Basra, Iraq. The study employed a case-control design and examined 87 patients with SCA (3-15 years old) who had attended the Basra Center for Hereditary Blood Diseases while in a steady state and 90 apparently healthy control subjects. Complete blood count, red blood cell (RBC), and serum magnesium, calcium, potassium, sodium, zinc, and copper levels were measured in all subjects. The results revealed significantly lower RBC and serum magnesium levels among the patients with SCA (3.62 ± 0.42 and 1.35 ± 0.19 mg/dL, respectively) than those among the control subjects (4.47 ± 0.55 and 1.87 ± 0.27 mg/dL, respectively). In addition, compared to the control subjects, the patients with SCA had significantly lower serum levels of potassium, sodium, and zinc; significantly higher serum levels of copper; and significantly higher Ca/Mg and Na/Mg ratios. Among the SCA patients, the RBC magnesium level was significantly negatively associated with the frequencies of vaso-occlusive crises (r = - 0.423, P < 0.001) and disease-related hospitalization (r = - 0.225, P < 0.05). To conclude, the RBC magnesium level, but not the serum magnesium level, is significantly associated with vaso-occlusive crises and hospitalization. Therefore, screening and management of low RBC magnesium levels in SCA patients are required.
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Affiliation(s)
- Osama Omar Yousif
- Basra Pediatric Specialty Hospital, Basra Health Directorate, Basra, Iraq
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Maranhão PA, de Souza MDGC, Panazzolo DG, Nogueira Neto JF, Bouskela E, Kraemer-Aguiar LG. Metabolic Changes Induced by High-Fat Meal Evoke Different Microvascular Responses in Accordance with Adiposity Status. Biomed Res Int 2018; 2018:5046508. [PMID: 30515403 PMCID: PMC6236900 DOI: 10.1155/2018/5046508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Frequently, ingestion of lipids exceeds our daily requirements and constantly exposes humans to circulating lipid overload which may lead to endothelial dysfunction (ED), the earliest marker of atherosclerosis. Nailfold videocapillaroscopy (NVC) technique can detect ED on microcirculation. Using NVC, we aimed to demonstrate if metabolic alterations evoked by high-fat meals can act differently on microvascular endothelial reactivity in lean and women with obesity. METHODS Women, aged between 19 and 40 years, were allocated to control group (CG) and with obesity group (OBG) and were subjected to blood analysis for determination of glucose, total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) and NVC evaluation at fasting and 30, 60, 120, and 180-min after high-fat meal ingestion. NVC technique evaluated microvascular reactivity through the following variables: red blood cell velocity (RBCV) at rest and after 1-min ischemia (maximal red blood cell velocity, RBCVmax) and time taken to reach it (TRBCVmax). A P value ≤0.05 was considered significant. RESULTS High-fat meal promoted a two-phase response in both groups: one until 60-min, associated with glucose and insulin levels, and the other after 120-min, associated with TG levels. Significant differences between groups were observed concerning insulin and HDL-c concentrations only at fasting and TC, TG, and LDL-c levels in all-time points. Regarding microvascular reactivity, RBCV, RBCVmax, and TRBCVmax were significantly different in OBG at 30-min compared to baseline. RBCVmax and TRBCVmax were significantly different in CG at 30-min and 60-min comparing to fasting. In all-time points, OBG presented RBCV, RBCVmax , and TRBCVmax significantly different in comparison to CG. CONCLUSION High-fat meal worsened ED on microcirculation in women with obesity and induced impairment of endothelial function in lean ones, reinforcing the association between high-fat meal and atherosclerosis.
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Affiliation(s)
- Priscila Alves Maranhão
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, RJ 20550-013, Brazil
| | - Maria das Graças Coelho de Souza
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, RJ 20550-013, Brazil
| | - Diogo Guarnieri Panazzolo
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, RJ 20550-013, Brazil
| | - José Firmino Nogueira Neto
- Lipids Laboratory (Lablip), Policlínica Piquet Carneiro, State University of Rio de Janeiro, Rio de Janeiro, RJ 20550-003, Brazil
| | - Eliete Bouskela
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, RJ 20550-013, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, RJ 20550-013, Brazil
- Obesity Unit, Policlínica Piquet Carneiro, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ 20550-030, Brazil
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Kofink D, Muller SA, Patel RS, Dorresteijn JAN, Berkelmans GFN, de Groot MCH, van Solinge WW, Haitjema S, Leiner T, Visseren FLJ, Hoefer IE, Asselbergs FW. Routinely measured hematological parameters and prediction of recurrent vascular events in patients with clinically manifest vascular disease. PLoS One 2018; 13:e0202682. [PMID: 30192769 PMCID: PMC6128486 DOI: 10.1371/journal.pone.0202682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 03/19/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022] Open
Abstract
Background and aims The predictive value of traditional risk factors for vascular events in patients with manifest vascular disease is limited, underscoring the need for novel biomarkers to improve risk stratification. Since hematological parameters are routinely assessed in clinical practice, they are readily available candidates. Methods We used data from 3,922 vascular patients, who participated in the Second Manifestations of ARTerial Disease (SMART) study. We first investigated associations between recurrent vascular events and 22 hematological parameters, obtained from the Utrecht Patient Oriented Database (UPOD), and then assessed whether parameters associated with outcome improved risk prediction. Results After adjustment for all SMART risk score (SRS) variables, lymphocyte %, neutrophil count, neutrophil % and red cell distribution width (RDW) were significantly associated with vascular events. When individually added to the SRS, lymphocyte % improved prediction of recurrent vascular events with a continuous net reclassification improvement (cNRI) of 17.4% [95% CI: 2.1, 32.1%] and an increase in c-statistic of 0.011 [0.000, 0.022]. The combination of lymphocyte % and neutrophil count resulted in a cNRI of 22.2% [3.2, 33.4%] and improved c-statistic by 0.011 [95% CI: 0.000, 0.022]. Lymphocyte % and RDW yielded a cNRI of 18.7% [3.3, 31.9%] and improved c-statistic by 0.016 [0.004, 0.028]. However, the addition of hematological parameters only modestly increased risk estimates for patients with an event during follow-up. Conclusions Several hematological parameters were independently associated with recurrent vascular events. Lymphocyte % alone and in combination with other parameters enhanced discrimination and reclassification. However, the incremental value for patients with a recurrent event was limited.
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Affiliation(s)
- Daniel Kofink
- Department of Cardiology, University Medical Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Steven A. Muller
- Department of Cardiology, University Medical Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Riyaz S. Patel
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
- The Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Jannick A. N. Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Gijs F. N. Berkelmans
- Department of Vascular Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Mark C. H. de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Wouter W. van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Saskia Haitjema
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Frank L. J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Imo E. Hoefer
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Folkert W. Asselbergs
- Department of Cardiology, University Medical Utrecht, University of Utrecht, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
- * E-mail:
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van Steen SC, Woodward M, Chalmers J, Li Q, Marre M, Cooper ME, Hamet P, Mancia G, Colagiuri S, Williams B, Grobbee DE, DeVries JH. Haemoglobin glycation index and risk for diabetes-related complications in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Diabetologia 2018; 61:780-789. [PMID: 29308539 PMCID: PMC6448976 DOI: 10.1007/s00125-017-4539-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/21/2017] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Previous studies have suggested that the haemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications in individuals with type 1 and type 2 diabetes. We investigated whether HGI was a predictor of adverse outcomes of intensive glucose lowering and of diabetes-related complications in general, using data from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. METHODS We studied participants in the ADVANCE trial with data available for baseline HbA1c and fasting plasma glucose (FPG) (n = 11,083). HGI is the difference between observed HbA1c and HbA1c predicted from a simple linear regression of HbA1c on FPG. Using Cox regression, we investigated the association between HGI, both categorised and continuous, and adverse outcomes, considering treatment allocation (intensive or standard glucose control) and compared prediction of HGI and HbA1c. RESULTS Intensive glucose control lowered mortality risk in individuals with high HGI only (HR 0.74 [95% CI 0.61, 0.91]; p = 0.003), while there was no difference in the effect of intensive treatment on mortality in those with high HbA1c. Irrespective of treatment allocation, every SD increase in HGI was associated with a significant risk increase of 14-17% for macrovascular and microvascular disease and mortality. However, when adjusted for identical covariates, HbA1c was a stronger predictor of these outcomes than HGI. CONCLUSIONS/INTERPRETATION HGI predicts risk for complications in ADVANCE participants, irrespective of treatment allocation, but no better than HbA1c. Individuals with high HGI have a lower risk for mortality when on intensive treatment. Given the discordant results and uncertain relevance beyond HbA1c, clinical use of HGI in type 2 diabetes cannot currently be recommended.
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Affiliation(s)
- Sigrid C van Steen
- Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Mark Woodward
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Michel Marre
- Department of Endocrinology, Hôpital Bichat-Claude Bernard, Université Paris, Paris, France
| | - Mark E Cooper
- Diabetes Domain, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Pavel Hamet
- Centre de Rechercher, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Istituto Auxologico Italiano, Milan, Italy
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW, Australia
| | - Bryan Williams
- National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK
| | - Diederick E Grobbee
- Julius Clinical, Zeist, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
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Lalanne-Mistrih ML, Connes P, Lamarre Y, Lemonne N, Hardy-Dessources MD, Tarer V, Etienne-Julan M, Mougenel D, Tressières B, Romana M. Lipid profiles in French West Indies sickle cell disease cohorts, and their general population. Lipids Health Dis 2018; 17:38. [PMID: 29506549 PMCID: PMC5836466 DOI: 10.1186/s12944-018-0689-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/27/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The pathophysiology of sickle cell disease (SCD) and the variability of its clinical expression remain not fully understood, whether within or between different SCD genotypes. Recent studies have reported associations between lipid levels and several SCD complications. If lipid levels have been previously described as low in sickle cell anemia (SCA), few data have been provided for sickle cell SC disease (SCC). We designed our epidemiological study to isolate lipid levels and profiles by genotype in Guadeloupian cohorts of SCA and SCC adult patients, at steady state. We compared SCD lipid levels with those of the Guadeloupian general population (GGP), and analyzed potential associations between lipid levels and SCD complications (vaso-occlusive crises, acute chest syndrome and osteonecrosis). METHODS Lipids, apolipoproteins, biological variables and anthropometric evaluation, were collected at steady state from medical files for 62 SCC and 97 SCA adult patients. Clinical SCD complications were collected from the clinical files. Analysis was conducted by genotype for all variables. RESULTS Different SCC and SCA lipid profiles, both distinct from their GGP's, were identified. Compared to SCC and GGP, higher triglyceride (TG) levels were observed in SCA patients, independent of hydroxyurea, hemolysis, gender, age, body mass index (BMI), abdominal obesity and clinical nutritional status. Our survey highlights also subsequent anthropometrical phenotypes, with an over-representation of abdominal obesity with normal BMI in SCA patients, and affecting almost exclusively females in both genotypes. Moreover, more frequent positive history of acute chest syndrome (ACS) was observed in SCA patients with TG level higher than 1.50 g/l, and of osteonecrosis in SCC patients having non high-density lipoprotein-cholesterol level (Non HDL-C) higher than 1.30 g/l. CONCLUSIONS This study reveals that SCA and SCC patients exhibit distinct lipid profiles and suggests that high TG and Non HDL-C levels are associated with past histories of ACS and osteonecrosis in SCA and SCC patients, respectively.
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Affiliation(s)
- Marie-Laure Lalanne-Mistrih
- Université des Antilles, CHU de Pointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, laboratoire d'Excellence GR-Ex, Paris, France
- Centre d'investigation Clinique Antilles Guyane, Inserm/DGOS CIC 14-24, enceinte de l'Institut Pasteur, Pointe-À-Pitre, Guadeloupe, France
| | - Philippe Connes
- Université des Antilles, CHU de Pointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, laboratoire d'Excellence GR-Ex, Paris, France
- Institut Universitaire de France, Paris, France
- Laboratoire LIBM EA7424, Equipe « Biologie Vasculaire et du Globule Rouge », Laboratoire d'Excellence GR-Ex, Université de Lyon, Lyon, France
| | - Yann Lamarre
- Université des Antilles, CHU de Pointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, laboratoire d'Excellence GR-Ex, Paris, France
| | - Nathalie Lemonne
- Unité Transversale de la Drépanocytose, CHU de Pointe à Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Marie-Dominique Hardy-Dessources
- Université des Antilles, CHU de Pointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, laboratoire d'Excellence GR-Ex, Paris, France
| | - Vanessa Tarer
- Unité Transversale de la Drépanocytose, CHU de Pointe à Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Maryse Etienne-Julan
- Unité Transversale de la Drépanocytose, CHU de Pointe à Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Dominique Mougenel
- Unité Transversale de la Drépanocytose, CHU de Pointe à Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Benoît Tressières
- Centre d'investigation Clinique Antilles Guyane, Inserm/DGOS CIC 14-24, enceinte de l'Institut Pasteur, Pointe-À-Pitre, Guadeloupe, France
| | - Marc Romana
- Université des Antilles, CHU de Pointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, laboratoire d'Excellence GR-Ex, Paris, France.
- UMR Inserm 1134, Hôpital Ricou, CHU de Pointe-à-Pitre, 97 157, Pointe-à-Pitre, Guadeloupe, France.
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Dekkers IA, de Mutsert R, de Vries APJ, Rosendaal FR, Cannegieter SC, Jukema JW, le Cessie S, Rabelink TJ, Lamb HJ, Lijfering WM. Determinants of impaired renal and vascular function are associated with elevated levels of procoagulant factors in the general population. J Thromb Haemost 2018; 16:519-528. [PMID: 29285859 DOI: 10.1111/jth.13935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 12/11/2022]
Abstract
Essentials Why venous thrombosis is more prevalent in chronic kidney disease is unclear. We investigated whether renal and vascular function are associated with hypercoagulability. Coagulation factors showed a procoagulant shift with impaired renal and vascular function. This suggests that renal and vascular function play a role in the etiology of thrombosis. SUMMARY Background Impaired renal and vascular function have been associated with venous thrombosis, but the mechanism is unclear. Objectives We investigated whether estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (UACR), and pulse wave velocity (PWV) are associated with a procoagulant state. Methods In this cross-sectional analysis of the NEO Study, eGFR, UACR, fibrinogen, and coagulation factors (F)VIII, FIX and FXI were determined in all participants (n = 6536), and PWV was assessed in a random subset (n = 2433). eGFR, UACR and PWV were analyzed continuously and per percentile: per six categories for eGFR (> 50th [reference] to < 1st) and UACR (< 50th [reference] to > 99th), and per four categories (< 50th [reference] to > 95th percentile) for PWV. Linear regression was used and adjusted for age, sex, total body fat, smoking, education, ethnicity, total cholesterol, C-reactive protein (CRP) and vitamin K antagonists use (FIX). Results Mean age was 55.6 years, mean eGFR 86.0 (12SD) mL 1.73 m- ² and median UACR 0.4 mg mmol-1 (25th, 75th percentile; 0.3, 0.7). All coagulation factors showed a procoagulant shift with lower renal function and albuminuria. For example, FVIII was 22 IU dL-1 (95% CI, 13-32) higher in the eGFR < 1st percentile compared with the > 50th percentile, and FVIII was 12 IU dL-1 (95% CI, 3-22) higher in the UACR > 99th percentile compared with the < 50th percentile. PWV was positively associated with coagulation factors FIX and FXI in continuous analysis; per m/s difference in PWV, FIX was 2.0 IU dL-1 (95% CI, 0.70-3.2) higher. Conclusions Impaired renal and vascular function was associated with higher levels of coagulation factors, underlining the role of renal function and vascular function in the development of venous thrombosis.
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Affiliation(s)
- I A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - A P J de Vries
- Department of Clinical Medicine, Division of Nephrology and Transplant Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Medicine, Division of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - J W Jukema
- Department of Clinical Medicine, Division of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - T J Rabelink
- Department of Clinical Medicine, Division of Nephrology and Transplant Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - H J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - W M Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Abstract
One hundred and four patients with peripheral vascular disease requiring operation were reviewed retrospectively with respect to age, sex, preoperative haemoglobin, smoking habits and diabetic status. The preoperative haemoglobin levels and smoking status in 63 non-diabetic male patients with peripheral vascular disease were compared with a matched group of individuals treated for inguinal hernia. For all patients there was a significant correlation between smoking habits, preoperative haemoglobin level and the presence of peripheral vascular disease. The mechanisms by which smoking may damage the vascular tree are reviewed.
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Wagner BD, Babinec AE, Carpenter C, Gonzalez S, O'Brien G, Rollock K, Williamson K, Mourani PM, Abman SH. Proteomic Profiles Associated with Early Echocardiogram Evidence of Pulmonary Vascular Disease in Preterm Infants. Am J Respir Crit Care Med 2018; 197:394-397. [PMID: 28650220 PMCID: PMC5811950 DOI: 10.1164/rccm.201703-0654le] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
| | | | | | | | - Grace O'Brien
- 5 State University of New York at Geneseo Geneseo, New York and
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Gupta AS, Huang G, Lestini BJ, Sagnella S, Kottke-Marchant K, Marchant RE. RGD-modified liposomes targeted to activated platelets as a potential vascular drug delivery system. Thromb Haemost 2017; 93:106-14. [PMID: 15630499 DOI: 10.1160/th04-06-0340] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryLocal drug delivery has become an important treatment modality for the prevention of thrombotic events following coronary angioplasty. In this study, we investigate the ability of liposomes bearing surface conjugated linear Arg-Gly-Asp (RGD) peptide (GSSSGRGD SPA) moieties to target and bind activated platelets, and the effect of such RGD-modified liposomes on platelet activation and aggregation. The binding of RGD-liposomes to human platelets was assessed by fluorescence microscopy,phase contrast microscopy and flow cytometry. The effect of RGDmodified liposomes on platelet activation and aggregation was investigated in vitro, with and without platelet agonists. RGD-liposomes were found to bind activated platelets at levels significantly greater than the control RGE-liposomes.The RGD-liposomes did not exhibit any statistically significant effect on platelet activation or aggregation.The results demonstrate the ability of the RGD-modified liposomes to target and bind activated platelets without causing significant platelet aggregation and suggests a feasible way for the development of a platelet-targeted anti-thrombogenic drug delivery system. Furthermore, the approach can be extended to the development of liposomes for other vascular targets, for application in drug delivery or gene therapy.
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Affiliation(s)
- Anirban Sen Gupta
- Department of Biomedical Engineering, Wickenden Building, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-7207, USA
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Abstract
Sickle cell disease (SCD) is a hematologic disorder caused by a well-characterized point mutation in the β-globin gene. Abnormal polymerization of hemoglobin tetramers results in the formation of sickle red blood cells that leads to vascular occlusions, hemolytic anemia, vascular inflammation and cumulative, multiple organ damage. Ongoing activation of coagulation is another hallmark of SCD. Recent studies strongly suggested that hypercoagulation in SCD is not just a secondary event but contributes directly to the disease pathophysiology. In this article we summarize mechanisms leading to the activation of coagulation, review data indicating direct contribution of coagulation to the pathology of SCD and, we discuss the anticoagulation as a possible treatment strategy to attenuate the disease progression.
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Affiliation(s)
- E Sparkenbaugh
- University of North Carolina, School of Medicine, Division of Hematology and Oncology, Chapel Hill, NC, USA
| | - R Pawlinski
- University of North Carolina, School of Medicine, Division of Hematology and Oncology, Chapel Hill, NC, USA
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Sins JWR, Schimmel M, Luken BM, Nur E, Zeerleder SS, van Tuijn CFJ, Brandjes DPM, Kopatz WF, Urbanus RT, Meijers JCM, Biemond BJ, Fijnvandraat K. Dynamics of von Willebrand factor reactivity in sickle cell disease during vaso-occlusive crisis and steady state. J Thromb Haemost 2017; 15:1392-1402. [PMID: 28457019 DOI: 10.1111/jth.13728] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Indexed: 02/02/2023]
Abstract
Essentials The role of von Willebrand Factor (VWF) in the pathophysiology of sickle cell disease is unclear. We assessed markers of VWF during admission for vaso-occlusive crisis (VOC) and steady state. VWF reactivity was higher during VOC and was associated with inflammation and neutrophil activation. Hyper-adhesive VWF may promote VOC in sickle cell disease. SUMMARY Background Endothelial activation plays a central role in the pathophysiology of vaso-occlusion in sickle cell disease (SCD), facilitating adhesive interactions with circulating blood cells. Upon activation, various adhesive molecules are expressed, including von Willebrand factor (VWF). Increased VWF levels have been observed in patients with SCD during steady state. However, the role of VWF in the pathogenesis of SCD vaso-occlusion is unclear. Objectives To longitudinally assess the quantity and reactivity of VWF and its regulating protease ADAMTS-13 during vaso-occlusive crisis (VOC). Methods In this observational study, we obtained sequential blood samples in adult SCD patients during VOC. Results VWF reactivity was significantly higher during VOC (active VWF, VWF glycoprotein Ib-binding activity, and high molecular weight multimers), whereas platelet count and levels of ADAMTS-13 antigen and ADAMTS-13 activity were concomitantly lower than during steady state. Levels of VWF antigen, VWF propeptide (VWF:pp) and ADAMTS-13 specific activity did not change during VOC. VWF reactivity correlated strongly with markers of inflammation and neutrophil activation, and was inversely correlated with the platelet count. In patients who developed acute chest syndrome, levels of VWF, VWF:pp and active, hyperadhesive VWF were significantly higher, whereas ADAMTS-13 activity was lower, than in patients without this complication. Conclusions We provide the first evidence that VOC in SCD is associated with increased reactivity of VWF, without a pronounced ADAMTS-13 deficiency. This hyper-reactivity may be explained by resistance of VWF to proteolysis, secondary to processes such as inflammation and oxidative stress. Hyperadhesive VWF, scavenging blood cells in the microcirculation, may thereby amplify and sustain VOC in SCD.
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Affiliation(s)
- J W R Sins
- Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M Schimmel
- Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - B M Luken
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - E Nur
- Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S S Zeerleder
- Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - C F J van Tuijn
- Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - D P M Brandjes
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands
| | - W F Kopatz
- Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R T Urbanus
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J C M Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - B J Biemond
- Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
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Minol JP, Reinsch I, Luik M, Leferink A, Barth M, Assmann A, Lichtenberg A, Akhyari P. Focal induction of ROS-release to trigger local vascular degeneration. PLoS One 2017; 12:e0179342. [PMID: 28614411 PMCID: PMC5470706 DOI: 10.1371/journal.pone.0179342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/31/2017] [Accepted: 05/26/2017] [Indexed: 01/04/2023] Open
Abstract
Reactive oxygen species (ROS) play an important role in the process of cardiovascular degeneration. We evaluated the potential of a controlled, local induction of ROS-release by application of rose bengal (RB) and photo energy to induce atherosclerosis-like focal vascular degeneration in vivo. After injection of RB, rats fed with a pro-degenerative diet underwent focal irradiation of the abdominal aorta by a green laser (ROS group), while the controls received irradiation without RB. Aortic tissue was analyzed by histology and immunohistochemistry at 0, 2, 4, 8, 28 and 56 days (n = 5). The intimal surface topography was analyzed by scanning electron microscopy. In the ROS group, an initial thrombus formation had disappeared by day 8. Similarly, ROS-derived products displayed the highest concentrations at day 0. Relative matrix metalloproteinase (MMP) activity achieved a maximum after 8 days (ROS group vs. CONTROL GROUP 1.60 ± 0.11 vs. 0.98 ± 0.01; p < 0.001). After 28 days, no significant differences in any aspect were found between the ROS group and the controls. However, after 56 days, the aortic tissue of ROS animals exhibited relative media-pronounced thickening (ROS vs. CONTROL 2.15 ± 0.19 vs. 0.87 ± 0.10; p < 0.001) with focal calcification and reduced expression of alpha smooth muscle actin (aSMA). The ROS-releasing application of RB and photo energy allowed for the induction of vascular degeneration in a rodent model. This protocol may be used for the focal induction of vascular disease without systemic side effects and can thereby elucidate the role of ROS in the multifactorial processes of vessel degeneration and atherogenesis.
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Affiliation(s)
- Jan-Philipp Minol
- Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
- * E-mail:
| | - Isabella Reinsch
- Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
| | - Maximilian Luik
- Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
| | - Anne Leferink
- Department of Tissue Regeneration, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - Mareike Barth
- Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
| | - Alexander Assmann
- Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
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Gonzalez Rodriguez E, Ostrowski SR, Cardenas JC, Baer LA, Tomasek JS, Henriksen HH, Stensballe J, Cotton BA, Holcomb JB, Johansson PI, Wade CE. Syndecan-1: A Quantitative Marker for the Endotheliopathy of Trauma. J Am Coll Surg 2017; 225:419-427. [PMID: 28579548 DOI: 10.1016/j.jamcollsurg.2017.05.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endothelial glycocalyx breakdown elicits syndecan-1 shedding and endotheliopathy of trauma (EoT). We hypothesized that a cutoff syndecan-1 level can identify patients with endothelial dysfunction who would have poorer outcomes. STUDY DESIGN We conducted a prospective observational study. Trauma patients with the highest level of activation admitted from July 2011 through September 2013 were eligible. We recorded demographics, injury type/severity (Injury Severity Score), physiology and outcomes data, and quantified syndecan-1 and soluble thrombomodulin from plasma with ELISAs. With receiver operating characteristic curve analysis, we defined EoT+ as the syndecan-1 cutoff level that maximized the sum of sensitivity and specificity (Youden index) in predicting 24-hour in-hospital mortality. We stratified by this cutoff and compared both groups. Factors associated with 30-day in-hospital mortality were assessed with multivariable logistic regression (adjusted odds ratios and 95% CIs reported). RESULTS From receiver operating characteristic curve analysis (area under the curve = 0.71; 95% CI 0.58 to 0.84), we defined EoT+ as syndecan-1 level ≥40 ng/mL (sensitivity = 0.62, specificity = 0.73). Of the 410 patients evaluated, 34% (n = 138) were EoT+ patients, who presented with higher Injury Severity Scores (p < 0.001) and blunt trauma frequency (p = 0.016) than EoT- patients. Although EoT+ patients had lower systolic blood pressure (median 119 vs 128 mmHg; p < 0.001), base excess and hemoglobin were similar between groups. The proportion of transfused (EoT+ 71.7% vs EoT- 36.4%; p < 0.001) and deceased EoT+ patients (EoT+ 24.6% vs EoT- 12.1%; p < 0.001) was higher. EoT+ was significantly associated with 30-day in-hospital mortality (adjusted odds ratio = 2.23; 95% CI 1.22 to 4.04). CONCLUSIONS A syndecan-1 level ≥40 ng/mL identified patients with significantly worse outcomes, despite admission physiology similar to those without the condition.
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Affiliation(s)
- Erika Gonzalez Rodriguez
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX.
| | - Sisse R Ostrowski
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jessica C Cardenas
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Lisa A Baer
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Jeffrey S Tomasek
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Hanne H Henriksen
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX; Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Stensballe
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bryan A Cotton
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX
| | - John B Holcomb
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Pär I Johansson
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX; Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Charles E Wade
- Center for Translational Injury Research, Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, TX
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Gong T, Hong ZY, Chen CH, Tsai CY, Liao LD, Kong KV. Optical Interference-Free Surface-Enhanced Raman Scattering CO-Nanotags for Logical Multiplex Detection of Vascular Disease-Related Biomarkers. ACS Nano 2017; 11:3365-3375. [PMID: 28245103 DOI: 10.1021/acsnano.7b00733] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Matrix metalloproteinases (MMPs), specifically MMP-2, MMP-7, and MMP-9, have been discovered to be linked to many forms of vascular diseases such as stroke, and their detection is crucial to facilitate clinical diagnosis. In this work, we prepared a class of optical interference-free SERS nanotags (CO-nanotags) that can be used for the purpose of multiplex sensing of different MMPs. Multiplex detection with the absence of cross-talk was achieved by using CO-nanotags with individual tunable intrinsic Raman shifts of CO in the 1800-2200 cm-1 region determined by the metal core and ligands of the metal carbonyl complex. Boolean logic was used as well to simultaneously probe for two proteolytic inputs. Such nanotags offer the advantages of convenient detection of target nanotags and high sensitivity as validated in the ischemia rat model.
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Affiliation(s)
- Tianxun Gong
- State Key Laboratory of Electronic Thin Films and Integrated Devices, University of Electronic Science and Technology of China , Chengdu, 610054, P. R. China
| | - Zi-Yao Hong
- Department of Chemistry, National Taiwan University , Taipei, 10617, Taiwan
| | - Ching-Hsiang Chen
- Sustainable Energy Development Center, National Taiwan University of Science and Technology , Taipei, 10607, Taiwan
| | - Cheng-Yen Tsai
- Department of Chemistry, National Taiwan University , Taipei, 10617, Taiwan
| | - Lun-De Liao
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes , 35 Keyen Road, Zhunan, Miaoli Country, 35053, Taiwan
| | - Kien Voon Kong
- Department of Chemistry, National Taiwan University , Taipei, 10617, Taiwan
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Abstract
Hemolysis is a fundamental feature of sickle cell anemia that contributes to its pathophysiology and phenotypic variability. Decompartmentalized hemoglobin, arginase 1, asymmetric dimethylarginine, and adenine nucleotides are all products of hemolysis that promote vasomotor dysfunction, proliferative vasculopathy, and a multitude of clinical complications of pulmonary and systemic vasculopathy, including pulmonary hypertension, leg ulcers, priapism, chronic kidney disease, and large-artery ischemic stroke. Nitric oxide (NO) is inactivated by cell-free hemoglobin in a dioxygenation reaction that also oxidizes hemoglobin to methemoglobin, a non-oxygen-binding form of hemoglobin that readily loses heme. Circulating hemoglobin and heme represent erythrocytic danger-associated molecular pattern (eDAMP) molecules, which activate the innate immune system and endothelium to an inflammatory, proadhesive state that promotes sickle vaso-occlusion and acute lung injury in murine models of sickle cell disease. Intravascular hemolysis can impair NO bioavailability and cause oxidative stress, altering redox balance and amplifying physiological processes that govern blood flow, hemostasis, inflammation, and angiogenesis. These pathological responses promote regional vasoconstriction and subsequent blood vessel remodeling. Thus, intravascular hemolysis represents an intrinsic mechanism for human vascular disease that manifests clinical complications in sickle cell disease and other chronic hereditary or acquired hemolytic anemias.
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Wolfson GH, Vargas E, Browne VA, Moore LG, Julian CG. Erythropoietin and Soluble Erythropoietin Receptor: A Role for Maternal Vascular Adaptation to High-Altitude Pregnancy. J Clin Endocrinol Metab 2017; 102:242-250. [PMID: 27809650 PMCID: PMC5413104 DOI: 10.1210/jc.2016-1767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT An imbalance of proangiogenic and antiangiogenic factors is thought to induce the widespread vascular dysfunction characteristic of preeclampsia (PreE). Erythropoietin (Epo), a pleiotropic cytokine, has important angiogenic and vasoactive properties; however, its contribution to maternal vascular dysfunction in PreE is unknown. OBJECTIVES Because high altitude (HA) raises the incidence of PreE, we asked whether HA increased maternal Epo and soluble Epo receptor (sEpoR) levels and whether such effects differed between PreE and normotensive controls at HA. DESIGN, SETTING, AND PARTICIPANTS Longitudinal studies were conducted in pregnant Andean residents at HA (n = 28; 3600 m) or sea level (SL; n = 16; 300 m). Cross-sectional studies included 34 gestational age‒matched Andean PreE cases (n = 17) and controls (n = 17) in La Paz-El Alto, Bolivia (3600 to 4100 m). RESULTS HA augmented the pregnancy-associated rise in Epo relative to SL (P = 0.002), despite similar reductions in hemoglobin (Hb) across pregnancy at each altitude (7% to 9%, P < 0.001 for both). HA PreE cases had circulating Epo levels equivalent to those of controls but greater sEpoR (P < 0.05) and reduced Hb (P = 0.06, trend). CONCLUSION(S) Our findings suggest that an augmented pregnancy-associated rise in Epo may be important for successful vascular adaptation to pregnancy at HA. We further speculate that the elevated sEpoR observed in PreE vs controls at HA impedes the effect of Epo to maintain endothelial function and may, in turn, be of pathological relevance for PreE at HA.
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Affiliation(s)
| | - Enrique Vargas
- Bolivian Institute of High Altitude Biology, La Paz, Bolivia
| | | | - Lorna G. Moore
- Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado 80045; and
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Arpaci D, Karakece E, Tocoglu AG, Ergenc H, Gurol G, Ciftci IH, Tamer A. Endocan, TGF-beta, and ADMA as Risk Factors for Endothelial Dysfunction and Possible Vascular Disease in Patients with Subclinical Hypothyroidism. Ann Clin Lab Sci 2016; 46:601-607. [PMID: 27993872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Although the relationship between atherosclerosis and overt hypothyroidism has been confirmed, it remains controversial in cases of subclinical hypothyroidism. Higher TSH and similar T4 suggest differences in set-points or differences due to diagnostic limitations regarding subclinical hypothyroidism. Endothelial dysfunction (ED) is a marker rather than a precursor of cardiovascular disease. Asymmetric dimethylarginine (ADMA) and endocan are known as novel markers of ED in various diseases. Transforming growth factor-beta (TGF-β) has a protective role against autoimmune diseases such as thyroiditis. This study aimed to determine the relationships between serum ADMA, endocan, TGF-β, and the high-sensitivity C-reactive protein (hs-CRP) levels, a proven indicator of ED, in patients with SH. METHODS Thirty-five patients with SH and 21 age- and sex-matched euthyroid subjects were included in the study. The levels of TSH, FT4, lipid parameters, endocan, ADMA, TGF-β, and hs-CRP were measured. RESULTS No significant differences in age or sex were found between the patient and control groups (p=0.294 and 0.881, respectively). Mean TSH level was higher in the patient group (p=0.005), whereas mean fT4 level was similar in two groups (p=0.455). The average hs-CRP, endocan, TGF-β l level in the patient group was higher than control group (p=0.001; P=0.012; P=0.025; P<0.01 respectively). A positive correlation was found between the endocan and ADMA levels (r=0.760, p=0.000). ADMA levels also were positively correlated with hs-CRP. Both the TSH and low-density lipoprotein cholesterol (LDL-C) levels were positively correlated with the hs-CRP level. CONCLUSIONS Subclinical hypothyroidism is associated with increased levels of serum endocan, ADMA, and TGF-β, which are new markers for ED. In particular, ADMA was correlated with both endocan and hs-CRP levels. These findings are suggestive for increased risk of ED and subsequent development of atherosclerosis in patients with SH.
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Affiliation(s)
- Dilek Arpaci
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Engin Karakece
- Department of Microbiology, Faculty of Medicine, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Aysel Gurkan Tocoglu
- Department of Internal Medicine, Faculty of Medicine, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Hasan Ergenc
- Department of Internal Medicine, Faculty of Medicine, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Gonul Gurol
- Department of Physiology, Faculty of Medicine, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Ihsan Hakki Ciftci
- Department of Microbiology, Faculty of Medicine, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Ali Tamer
- Department of Internal Medicine, Faculty of Medicine, Sakarya University Education and Research Hospital, Sakarya, Turkey
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Schreier M, Schwartze JT, Landgraf K, Scheuermann K, Erbs S, Herberth G, Pospisilik JA, Kratzsch J, Kiess W, Körner A. Osteopontin is BMI-independently Related to Early Endothelial Dysfunction in Children. J Clin Endocrinol Metab 2016; 101:4161-4169. [PMID: 27571184 DOI: 10.1210/jc.2016-2238] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Osteopontin (OPN) has been proposed to predict adverse cardiac events in patients with adult type 2 diabetes. OBJECTIVE We investigated potential associations of circulating OPN and OPN expression in adipose tissue (AT) with obesity and early metabolic and cardiovascular dysfunction in children. Furthermore, we assessed the functional relevance of OPN on primary human endothelial cells. DESIGN Serum OPN was determined in healthy lean (n = 65) and obese (n = 100) children by ELISA. Expression levels were assessed in sc AT samples from healthy lean (n = 33) and overweight and obese (n = 31) children by qRT-PCR. Direct effects of recombinant (rh) OPN on adhesion molecule and ENOS expression were assessed in human coronary arterial endothelial cells. RESULTS OPN serum concentrations decreased with pubertal development in lean children. The degree of obesity was negatively associated with OPN serum levels. Multiple regression analysis revealed that body mass index (BMI) standard deviation score (SDS), next to pubertal status, was the strongest independent predictor for OPN serum concentrations. Metabolically, the homeostasis model assessment index and circulating plasma insulin were negatively correlated with OPN serum levels secondary to obesity. In contrast, independent from BMI, OPN was positively related to VCAM-1 levels, intima media thickening, and negatively associated with endothelial function. Functionally, full-length rhOPN did not affect adhesion molecule and ENOS mRNA expression in primary human coronary arterial endothelial cells. In addition, OPN expression levels in AT positively correlated with BMI SDS, AT inflammation, and markers of metabolic dysfunction but were not related to OPN serum levels. CONCLUSION Our findings suggest that OPN levels are BMI-independently related to markers of early endothelial dysfunction in children.
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Affiliation(s)
- Moritz Schreier
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - Julian Tristan Schwartze
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - Kathrin Landgraf
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - Kathrin Scheuermann
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - Sandra Erbs
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - Gunda Herberth
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - J Andrew Pospisilik
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - Jürgen Kratzsch
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - Wieland Kiess
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
| | - Antje Körner
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents (M.S., J.T.S., K.L., K.S., W.K., A.K.), University of Leipzig, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases (K.L., A.K.), University of Leipzig, 04103 Leipzig, Germany; Heart Centre, Department of Cardiology (S.E.), University of Leipzig, 04109 Leipzig, Germany; Department of Environmental Immunology (G.H.), UFZ Helmholtz Centre for Environmental Research Leipzig, 04318 Leipzig, Germany; Max Planck Institute of Immunology and Epigenetics (J.A.P.), 79108 Freiburg, Germany; and Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (J.K.), University of Leipzig, 04109 Leipzig, Germany
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Baltzis D, Dushay JR, Loader J, Wu J, Greenman RL, Roustit M, Veves A. Effect of Linagliptin on Vascular Function: A Randomized, Placebo-controlled Study. J Clin Endocrinol Metab 2016; 101:4205-4213. [PMID: 27583476 PMCID: PMC5095255 DOI: 10.1210/jc.2016-2655] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT The dipeptidyl peptidase-4 inhibitor, linagliptin, possesses pleiotropic vasodilatory, antioxidant, and anti-inflammatory properties in animals, independent of its glucose-lowering properties. Although large, randomized clinical trials are being conducted to better evaluate the efficacy and safety of linagliptin on cardiovascular outcomes, little is known about its effects on vascular function in humans. OBJECTIVE This study sought to evaluate the effect of linagliptin on surrogates of vascular and mitochondrial function. DESIGN AND SETTING This was a randomized, double-blind, placebo-controlled trial at a tertiary care center with a large type 2 diabetes referral base. PATIENTS AND INTERVENTION Forty participants with type 2 diabetes were included in a 12-wk treatment of either linagliptin 5mg/d or placebo. MAIN OUTCOME MEASURES Micro- and macrovascular functions were assessed using laser Doppler coupled with iontophoresis and with brachial flow-mediated dilation, respectively. Mitochondrial function was assessed by phosphorus-31 metabolites changes in the calf muscle measured by magnetic resonance spectroscopy. Circulating endothelial progenitor cells, as well as inflammatory cytokines, growth factors, and biomarkers of endothelial function were also quantified. RESULTS Linagliptin was associated with an increase in axon reflex-dependent vasodilation, a marker of neurovascular function (P = .05). A trend indicating increased endothelium-dependent microvascular reactivity was observed (P = .07). These were associated with decreases in concentrations of IFNγ (P < .05), IL-6 (P = .03), IL-12 (P < .03), and MIP-1 (P < .04) following linagliptin treatment when compared with placebo. CONCLUSIONS This study demonstrates that linagliptin tends to improve endothelial and neurovascular microvascular function and is associated with decreased markers of inflammation in patients with type 2 diabetes. There was no significant effect of linagliptin on mitochondrial function, macrovascular function, or endothelial progenitor cells.
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Affiliation(s)
- Dimitrios Baltzis
- Microcirculatory Laboratory and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115
| | - Jody R Dushay
- Microcirculatory Laboratory and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115
| | - Jordan Loader
- Microcirculatory Laboratory and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115
| | - Jim Wu
- Microcirculatory Laboratory and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115
| | - Robert L Greenman
- Microcirculatory Laboratory and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115
| | - Matthieu Roustit
- Microcirculatory Laboratory and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115
| | - Aristidis Veves
- Microcirculatory Laboratory and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115
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Wagenmakers MAEM, Roerink SHPP, Schreuder THA, Plantinga TS, Holewijn S, Thijssen DHJ, Smit JW, Rongen GA, Pereira AM, Wagenmakers AJM, Netea-Maier RT, Hermus ARMM. Vascular Health in Patients in Remission of Cushing's Syndrome Is Comparable With That in BMI-Matched Controls. J Clin Endocrinol Metab 2016; 101:4142-4150. [PMID: 27552540 DOI: 10.1210/jc.2016-1674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 11/19/2022]
Abstract
CONTEXT In active Cushing's syndrome (CS), patients suffer from endothelial dysfunction and premature atherosclerosis. However, it is uncertain to what extent vascular health recovers after long-term remission. This is highly relevant because this topic relates to future development of cardiovascular disease. OBJECTIVE The objective of the study was to investigate whether micro- and macrovascular health is impaired after long-term remission of CS in patients with no or adequately treated comorbidities. DESIGN AND SETTING This was a cross-sectional case-control study in two tertiary referral centers. PATIENTS AND MAIN OUTCOME MEASURES Sixty-three patients (remission of CS for ≥ 4 y) and 63 healthy, well-matched controls were compared. In group A (58 patients and 58 controls), serum biomarkers associated with endothelial dysfunction, intima media thickness, pulse wave velocity, and pulse wave analysis were studied. In group B (14 patients and 14 controls), endothelium-dependent and -independent vasodilatation was studied in conduit arteries (flow mediated dilation of the brachial artery) and forearm skeletal muscle resistance arteries (vasodilator response to intraarterial acetylcholine, sodium-nitroprusside, and NG-monomethyl-L-arginine using venous occlusion plethysmography). RESULTS There were no significant differences between the outcome measures of vascular health of patients and controls in groups A and B. CONCLUSION The vascular health of patients in long-term remission of CS seems to be comparable with that of healthy gender-, age-, and body mass index-matched controls, provided that the patients have no, or adequately controlled, comorbidities. Therefore, the effects of hypercortisolism per se on the vasculature may be reversible. This accentuates the need for the stringent treatment of metabolic comorbidities in these patients.
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Affiliation(s)
- M A E M Wagenmakers
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - S H P P Roerink
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - T H A Schreuder
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - T S Plantinga
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - S Holewijn
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - D H J Thijssen
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - J W Smit
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - G A Rongen
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - A M Pereira
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - A J M Wagenmakers
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - R T Netea-Maier
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - A R M M Hermus
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
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Bertozzo G, Zoppellaro G, Granziera S, Marigo L, Rossi K, Petruzzellis F, Perissinotto E, Manzato E, Nante G, Pengo V. Reasons for and consequences of vitamin K antagonist discontinuation in very elderly patients with non-valvular atrial fibrillation. J Thromb Haemost 2016; 14:2124-2131. [PMID: 27471198 DOI: 10.1111/jth.13427] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
Essentials Anticoagulation in the elderly is still a challenge and suspension of warfarin is common. This is an observational study reporting reasons and consequences of warfarin suspension. Vascular disease, age, time in therapeutic range, and bleedings are associated with suspension. After suspension for bleeding or frailty, patients remain at high-risk of death or complications. SUMMARY Background Anticoagulation in elderly patients with non-valvular atrial fibrillation (NVAF) is still a challenge, and discontinuation of warfarin is common. The aim of this study was to analyze the aspects related to warfarin discontinuation in a real-world population. Methods This was an observational cohort study on very elderly NVAF patients naive to warfarin therapy (VENPAF). The included subjects were aged at least 80 years, and started using warfarin after a diagnosis of NVAF. Warfarin discontinuation was assessed, and the reason reported for discontinuation, the person who decided to stop treatment, subsequent antithrombotic therapy and mortality, ischemic and bleeding events were collected. Results Over a period of 5 years, warfarin was discontinued in 148 of 798 patients. Despite similar CHA2 DS2 -VASc scores, the frequencies of thromboembolic and major bleeding events were significantly higher (P = 0.01 and P = 0.001, respectively) and the time in therapeutic range (TTR) was significantly lower (P < 0.001) in patients who discontinued warfarin. Independent risk factors for warfarin discontinuation were vascular disease (hazard ratio [HR] 2.5, P < 0.001), age ≥ 85 years (HR 1.4, P = 0.04), TTR < 60% (HR 1.8, P = 0.001), and bleeding events (HR 2.3, P < 0.001). The main reasons for warfarin discontinuation were physician-perceived frailty or low life-expectancy (45.9%), bleeding complications (19.6%), and sinus rhythm restoration (16.9%). Event and death rates were very high, especially in frail patients and in those with bleeding complications. Conclusions Warfarin discontinuation is frequent in very elderly patients, and is associated with increased risks of death and adverse events. Identification of elderly patients who are at high risk of bleeding and the poor quality of anticoagulation during warfarin are still unsolved clinical problems.
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Affiliation(s)
- G Bertozzo
- Department of Medicine (DIMED), Geriatric Clinic, University of Padua, Padua, Italy
| | - G Zoppellaro
- Department of Cardiac, Thoracic and Vascular Sciences, Cardiology Clinic, University of Padua, Padua, Italy
| | - S Granziera
- Department of Medicine (DIMED), Geriatric Clinic, University of Padua, Padua, Italy
- Department of Physical and Rehabilitation Medicine, Ospedale Classificato "Villa Salus", Mestre Venice, Padua, Italy
| | - L Marigo
- Department of Medicine (DIMED), Geriatric Clinic, University of Padua, Padua, Italy
| | - K Rossi
- Department of Medicine (DIMED), Geriatric Clinic, University of Padua, Padua, Italy
| | - F Petruzzellis
- Department of Medicine (DIMED), Geriatric Clinic, University of Padua, Padua, Italy
| | - E Perissinotto
- Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padua, Padua, Italy
| | - E Manzato
- Department of Medicine (DIMED), Geriatric Clinic, University of Padua, Padua, Italy
| | - G Nante
- Department of Medicine (DIMED), Geriatric Clinic, University of Padua, Padua, Italy
| | - V Pengo
- Department of Cardiac, Thoracic and Vascular Sciences, Cardiology Clinic, University of Padua, Padua, Italy
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Souma N, Isakova T, Lipiszko D, Sacco RL, Elkind MSV, DeRosa JT, Silverberg SJ, Mendez AJ, Dong C, Wright CB, Wolf M. Fibroblast Growth Factor 23 and Cause-Specific Mortality in the General Population: The Northern Manhattan Study. J Clin Endocrinol Metab 2016; 101:3779-3786. [PMID: 27501282 PMCID: PMC5052338 DOI: 10.1210/jc.2016-2215] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
CONTEXT An elevated fibroblast growth factor (FGF) 23 is an independent risk factor for cardiovascular disease and mortality in patients with kidney disease. The relationship between FGF23 and cause-specific mortality in the general population is unknown. OBJECTIVE To investigate the association of elevated FGF23 with the risk of cause-specific mortality in a racially and ethnically diverse urban general population. DESIGN, SETTING, PARTICIPANTS The Northern Manhattan Study is a population-based prospective cohort study. Residents who were > 39 years old and had no history of stroke were enrolled between 1993 and 2001. Participants with available blood samples for baseline FGF23 testing were included in the current study (n = 2525). MAIN OUTCOME MEASURES Cause-specific death events. RESULTS A total of 1198 deaths (474 vascular, 612 nonvascular, 112 unknown cause) occurred during a median follow-up of 14 years. Compared to participants in the lowest FGF23 quintile, those in the highest quintile had a 2.07-fold higher risk (95% confidence interval [CI], 1.45, 2.94) of vascular death and a 1.64-fold higher risk (95% CI, 1.22, 2.20) of nonvascular death in fully adjusted models. Higher FGF23 was independently associated with increased risk of mortality due to cancer, but only in Hispanic participants (hazard ratio per 1 unit increase in ln FGF23 of 1.87; 95% CI, 1.40, 2.50; P for interaction = .01). CONCLUSIONS Elevated FGF23 was independently associated with increased risk of vascular and nonvascular mortality in a diverse general population and with increased risk of cancer death specifically in Hispanic individuals.
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Affiliation(s)
- Nao Souma
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - David Lipiszko
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Ralph L Sacco
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Mitchell S V Elkind
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Janet T DeRosa
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Shonni J Silverberg
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Armando J Mendez
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Chuanhui Dong
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Clinton B Wright
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Myles Wolf
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
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Herrington W, Emberson J, Mihaylova B, Blackwell L, Reith C, Solbu M, Mark P, Fellström B, Jardine A, Wanner C, Holdaas H, Fulcher J, Haynes R, Landray M, Keech A, Simes J, Collins R, Baigent C. Impact of renal function on the effects of LDL cholesterol lowering with statin-based regimens: a meta-analysis of individual participant data from 28 randomised trials. Lancet Diabetes Endocrinol 2016; 4:829-39. [PMID: 27477773 DOI: 10.1016/s2213-8587(16)30156-5] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Statin therapy is effective for the prevention of coronary heart disease and stroke in patients with mild-to-moderate chronic kidney disease, but its effects in individuals with more advanced disease, particularly those undergoing dialysis, are uncertain. METHODS We did a meta-analysis of individual participant data from 28 trials (n=183 419), examining effects of statin-based therapy on major vascular events (major coronary event [non-fatal myocardial infarction or coronary death], stroke, or coronary revascularisation) and cause-specific mortality. Participants were subdivided into categories of estimated glomerular filtration rate (eGFR) at baseline. Treatment effects were estimated with rate ratio (RR) per mmol/L reduction in LDL cholesterol. FINDINGS Overall, statin-based therapy reduced the risk of a first major vascular event by 21% (RR 0·79, 95% CI 0·77-0·81; p<0·0001) per mmol/L reduction in LDL cholesterol. Smaller relative effects on major vascular events were observed as eGFR declined (p=0·008 for trend; RR 0·78, 99% CI 0·75-0·82 for eGFR ≥60 mL/min per 1·73 m(2); 0·76, 0·70-0·81 for eGFR 45 to <60 mL/min per 1·73 m(2); 0·85, 0·75-0·96 for eGFR 30 to <45 mL/min per 1·73 m(2); 0·85, 0·71-1·02 for eGFR <30 mL/min per 1·73 m(2) and not on dialysis; and 0·94, 0·79-1·11 for patients on dialysis). Analogous trends by baseline renal function were seen for major coronary events (p=0·01 for trend) and vascular mortality (p=0·03 for trend), but there was no significant trend for coronary revascularisation (p=0·90). Reducing LDL cholesterol with statin-based therapy had no effect on non-vascular mortality, irrespective of eGFR. INTERPRETATION Even after allowing for the smaller reductions in LDL cholesterol achieved by patients with more advanced chronic kidney disease, and for differences in outcome definitions between dialysis trials, the relative reductions in major vascular events observed with statin-based treatment became smaller as eGFR declined, with little evidence of benefit in patients on dialysis. In patients with chronic kidney disease, statin-based regimens should be chosen to maximise the absolute reduction in LDL cholesterol to achieve the largest treatment benefits. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Community Biomed Programme, Australian National Health and Medical Research Council, Australian National Heart Foundation.
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