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Kingsmore DB, Edgar B, Rostron M, Delles C, Brady AJB. A novel index for measuring the impact of devices on hypertension. Sci Rep 2023; 13:13651. [PMID: 37607949 PMCID: PMC10444873 DOI: 10.1038/s41598-023-39943-4] [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: 11/30/2022] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
A key limitation in assessing the therapeutic impact of non-pharmacological approaches to treating hypertension is the method of reporting outcomes. Reducing the medications required to achieve the same blood pressure may be reported separately to a reduction in the blood pressure without change in medication, and thus lessen the reported beneficial impact of treatment. This study aims to derive a novel scoring system to gauge the therapeutic impact of non-drug treatment of hypertension by utilising a combination of excessive blood pressure and the number of anti-hypertensives into a combined score-the hypertensive index (HTi). The hypertensive index was empirically derived based on the systolic blood pressure and number of antihypertensive drugs, and applied retrospectively to a cohort undergoing intervention for renovascular hypertension. Subgroup and receiver operating characteristic analyses were used to compare the HTi to traditional methods of reporting outcomes. Following intervention (99 patients), 46% had improvement in both medication load and blood pressure, 29% had benefit in blood pressure without reduction in medication load, 15% had reduction in medication load without significant change in blood pressure and 9% showed no benefit in either parameter. The HTi was superior in detecting benefit from intervention compared with measuring blood pressure or medication load alone (AUC 0.94 vs 0.85;0.84). The hypertensive index may be a more sensitive marker of treatment effect than assessing blood pressure measurements alone. The use of such scoring systems in future trial design may allow more accurate reporting of the effects of interventions for hypertension.
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Affiliation(s)
- D B Kingsmore
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Vascular Surgery, Elizabeth University Hospital, Glasgow, Queen, UK
| | - B Edgar
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK.
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK.
| | - M Rostron
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK
| | - C Delles
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - A J B Brady
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
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2
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Degenaar A, Jacobs A, Kruger R, Delles C, Mischak H, Mels C. Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study. BMC Nephrol 2023; 24:96. [PMID: 37055746 PMCID: PMC10103421 DOI: 10.1186/s12882-023-03100-w] [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: 09/07/2022] [Accepted: 03/02/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Low- and middle-income countries experience an increasing burden of chronic kidney disease. Cardiovascular risk factors, including advancing age, may contribute to this phenomenon. We (i) profiled cardiovascular risk factors and different biomarkers of subclinical kidney function and (ii) investigated the relationship between these variables. METHODS We cross-sectionally analysed 956 apparently healthy adults between 20 and 30 years of age. Cardiovascular risk factors such as high adiposity, blood pressure, glucose levels, adverse lipid profiles and lifestyle factors were measured. Various biomarkers were used to assess subclinical kidney function, including estimated glomerular filtration rate (eGFR), urinary albumin, uromodulin and the CKD273 urinary proteomics classifier. These biomarkers were used to divide the total population into quartiles to compare extremes (25th percentiles) on the normal kidney function continuum. The lower 25th percentiles of eGFR and uromodulin and the upper 25th percentiles of urinary albumin and the CKD273 classifier represented the more unfavourable kidney function groups. RESULTS In the lower 25th percentiles of eGFR and uromodulin and the upper 25th percentile of the CKD273 classifier, more adverse cardiovascular profiles were observed. In multi-variable adjusted regression analyses performed in the total group, eGFR associated negatively with HDL-C (β= -0.44; p < 0.001) and GGT (β= -0.24; p < 0.001), while the CKD273 classifier associated positively with age and these same risk factors (age: β = 0.10; p = 0.021, HDL-C: β = 0.23; p < 0.001, GGT: β = 0.14; p = 0.002). CONCLUSION Age, lifestyle and health measures impact kidney health even in the third decade.
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Affiliation(s)
- A Degenaar
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - A Jacobs
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - H Mischak
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Mosaiques Diagnostics GmbH, Hannover, Germany
| | - Cmc Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
- MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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3
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Sykes R, Morrow AJ, McConnachie A, Kamdar A, Bagot C, Bayes H, Blyth KG, Briscoe M, Bulluck H, Carrick D, Church C, Corcoran D, Delles C, Findlay I, Gibson VB, Gillespie L, Grieve D, Barrientos PH, Ho A, Lang NN, Lowe DJ, Lennie V, MacFarlane P, Mayne KJ, Mark P, McIntosh A, McGeoch R, McGinley C, Mckee C, Nordin S, Payne A, Rankin A, Robertson KE, Ryan N, Roditi GH, Sattar N, Stobo DB, Allwood-Spiers S, Touyz R, Veldtman G, Weeden S, Watkins S, Welsh P, Wereski R, Mangion K, Berry C. Adjudicated myocarditis and multisystem illness trajectory in healthcare workers post-COVID-19. Open Heart 2023; 10:openhrt-2022-002192. [PMID: 36822817 PMCID: PMC9950584 DOI: 10.1136/openhrt-2022-002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND We investigated the associations of healthcare worker status with multisystem illness trajectory in hospitalised post-COVID-19 individuals. METHODS AND RESULTS One hundred and sixty-eight patients were evaluated 28-60 days after the last episode of hospital care. Thirty-six (21%) were healthcare workers. Compared with non-healthcare workers, healthcare workers were of similar age (51.3 (8.7) years vs 55.0 (12.4) years; p=0.09) more often women (26 (72%) vs 48 (38%); p<0.01) and had lower 10-year cardiovascular risk (%) (8.1 (7.9) vs 15.0 (11.5); p<0.01) and Coronavirus Clinical Characterisation Consortium in-hospital mortality risk (7.3 (10.2) vs 12.7 (9.8); p<0.01). Healthcare worker status associated with less acute inflammation (peak C reactive protein 48 mg/L (IQR: 14-165) vs 112 mg/L (52-181)), milder illness reflected by WHO clinical severity score distribution (p=0.04) and shorter duration of admission (4 days (IQR: 2-6) vs 6 days (3-12)).In adjusted multivariate logistic regression analysis, healthcare worker status associated with a binary classification (probable/very likely vs not present/unlikely) of adjudicated myocarditis (OR: 2.99; 95% CI (1.01 to 8.89) by 28-60 days postdischarge).After a mean (SD, range) duration of follow-up after hospital discharge of 450 (88) days (range 290, 627 days), fewer healthcare workers died or were rehospitalised (1 (3%) vs 22 (17%); p=0.038) and secondary care referrals for post-COVID-19 syndrome were common (42%) and similar to non-healthcare workers (38%; p=0.934). CONCLUSION Healthcare worker status was independently associated with the likelihood of adjudicated myocarditis, despite better antecedent health. Two in five healthcare workers had a secondary care referral for post-COVID-19 syndrome. TRIAL REGISTRATION NUMBER NCT04403607.
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Affiliation(s)
- Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - C Bagot
- Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | - Hannah Bayes
- Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Kevin G Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, UK.,Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Michael Briscoe
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Heeraj Bulluck
- Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - David Carrick
- Cardiology, University Hospital Hairmyres, East Kilbride, South Lanarkshire, UK
| | - Colin Church
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Scottish Pulmonary Vascular Unit, Golden Jubilee Hospital, Clydebank, UK
| | - David Corcoran
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - C Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Iain Findlay
- Cardiology, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| | | | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Glasgow, UK
| | - Douglas Grieve
- Respiratory Medicine, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - N N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Vera Lennie
- Cardiology, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, UK
| | - Peter MacFarlane
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kaithlin J Mayne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Patrick Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Cardiology, University Hospital Hairmyres, East Kilbride, South Lanarkshire, UK
| | | | - Connor Mckee
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sabrina Nordin
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Cardiology, University Hospital Crosshouse, Kilmarnock, East Ayrshire, UK
| | - Alastair Rankin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith E Robertson
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Nicola Ryan
- Cardiology, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, UK
| | - Giles H Roditi
- Radiology, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David B Stobo
- Radiology, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UK
| | | | - Rhian Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Stuart Watkins
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK .,Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
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Abstract
Abstract
Background
The principle of initial value (Wilder's law of initial value) proposes that the “direction of response of body function to any agent depends to a large degree on the initial value of that function”. Indeed, in several trials on renal denervation (RDN), pre-treatment blood pressure (BP) has been consistently and repeatedly found to predict the decrease in BP after RDN. Efforts to discover further statistically significant and clinically meaningful predictors of BP response to RDN failed.
Objective
By use of a new methodological approach, we aimed to determine predictors of BP response after RDN in patients with resistant hypertension.
Methods
The study population comprised 266 patients with resistant hypertension (mean age 62 years, 34% females, mean BMI 30.5 kg/m2, 27% had coronary heart disease, 42% had diabetes mellitus and 61% had hypercholesterolaemia) who underwent radiofrequency RDN with the Symplicity catheter at the Universities of Homburg and Erlangen. Clinical data including 24h ambulatory BP (ABP) were obtained prior to, and 3, 6 and 12 months after RDN. The primary parameter of response was defined as change in 24-hour systolic ABP after 6 months from pre-treatment values. As expected, change in 24h systolic ABP correlated with pre-treatment 24h systolic ABP (r2 linear = 0.225, p<0.001), with change in 24h systolic ABP = 73.82 + 0.55 x pre-treatment 24h systolic ABP. To overcome the predominant role of the pre-treatment BP that may mask other factors, we calculated for each individual patient the “expected systolic ABP decrease” by applying this regression equation and the “excessive systolic ABP decrease” by subtracting the measured from expected change in 24h systolic ABP. We divided the study population into 2 groups (above [responders] and below [non-responders] of the median change in excessive 24h systolic ABP.
Results
Neither pre-treatment 24h systolic or diastolic ABP, nor office systolic or diastolic BP differed between the two groups (all p>0.20). Following RDN, 24h systolic ABP decreased in the responders by −23.3±16 vs non-responders +1.4±11 mmHg at 6 month, and 24h systolic ABP values were also significantly lower in responders at 3 and 12 months (all p<0.001), without difference in number of antihypertensive drugs between the groups. Of all clinical variables at baseline, office heart rate (65.6 vs 68.7±12 bpm, p=0.024) and HbA1c (6.07±0.88 vs. 6.37±1.23%, p=0.035) were lower in responders compared with non-responders. Finally, a multiple regression analysis confirmed that pre-treatment 24h systolic ABP (beta +0.565, p<0001), HbA1c (beta −0.167, p=0.004) and office HR (beta +0.106, p=0.057) were independent predictors of decrease in 24h systolic ABP.
Conclusion
In patients with resistant hypertension, lower HbA1c and office HR were identified as predictors of BP response in addition to pre-treatment BP. This finding may help to identify hypertensive patients who benefit most from RDN.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Extramural grant provided vy Medtronic INc
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Affiliation(s)
- R Schmieder
- University Hospital Erlangen, Department of Nephrology and Hypertension, Erlangen, Germany
| | - C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - L Lauder
- Saarland University Hospital, Department of Internal Medicine and Angiology, Intensive Care Medicine, homburg, Germany
| | - C Ott
- University Hospital Erlangen, Department of Nephrology and Hypertension, Erlangen, Germany
| | - M Boehm
- Saarland University Hospital, Department of Internal Medicine and Angiology, Intensive Care Medicine, homburg, Germany
| | - F Mahfoud
- Saarland University Hospital, Department of Internal Medicine and Angiology, Intensive Care Medicine, homburg, Germany
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5
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Van Vliet N, Bos M, Thesing C, Chaker L, Pietzner M, Houtman E, Neville M, Li-Gao R, Trompet S, Mustafa R, Ahmadizar F, Beekman M, Bot M, Budde K, Christodoulides C, Dehghan A, Delles C, Elliott P, Evangelou M, Gao H, Ghanbari M, Van Herwaarden A, Ikram M, Jaeger M, Jukema J, Karaman I, Karpe F, Kloppenburg M, Meessen J, Meulenbelt I, Milaneschi Y, Mooijaart S, Mook-Kanamori D, Netea M, Netea-Maier R, Peeters R, Penninx B, Sattar N, Slagboom P, Suchiman H, Völzke H, Van Dijk KW, Noordam R. Higher thyroid stimulating hormone leads to cardiovascular disease and an unfavorable lipid profile: EVidence from multi-cohort Mendelian randomization and metabolomic profiling. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Delles C, Dayan CM, Dominiczak AF, Donnelly SC, Irvine AD. Announcing the first AoP webinar: 'Can evidence-based medicine survive in a pandemic?'. QJM 2021; 114:11-12. [PMID: 33070190 DOI: 10.1093/qjmed/hcaa287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - C M Dayan
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - A F Dominiczak
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - S C Donnelly
- Department of Medicine, Tallaght University Hospital & Trinity College Dublin, Ireland
| | - A D Irvine
- Clinical Medicine, Trinity College Dublin, Ireland
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7
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Rossitto G, Mary S, McAllister C, Neves K, Haddow L, Rocchiccioli P, Lang N, Murphy C, Touyz R, Petrie M, Delles C. Abnormalities of the lymphatic system and impaired fluid clearance in patients with heart failure with preserved ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary and skeletal muscle microvascular dysfunction have been proposed as main factors in the pathogenesis of Heart Failure with Preserved Ejection Fraction (HFpEF). However, assessment of systemic arterial function has only been indirect thus far; most importantly, no direct link between systemic microvasculature and congestion, one of the core characteristics of the syndrome, has yet been investigated.
Purpose
To provide direct functional and anatomical characterisation of the systemic microvasculature and to explore in vivo parameters of capillary fluid extravasation and lymphatic clearance in HFpEF.
Methods
In 16 patients with HFpEF and 16 age- and sex-matched healthy controls (72±6 and 68±5 years, respectively) we determined peripheral microvascular filtration coefficient (proportional to vascular permeability and area) and isovolumetric pressure (above which lymphatic drainage cannot compensate for fluid extravasation) by venous occlusion plethysmography and collected a skin biopsy for vascular immunohistochemistry and gene expression analysis (TaqMan). Additionally, we measured brachial flow-mediated dilatation (FMD) and assessed by wire myography the vascular function of resistance arteries isolated from gluteal subcutaneous fat biopsies.
Results
Skin biopsies in patients with HFpEF showed rarefaction of small blood vessels (82±31 vs 112±21 vessels/mm2; p=0.003) and in ex-vivo analysis (n=6/group) we found defective relaxation of peripheral resistance arteries (p<0.001). Accordingly, post-ischaemic hyperaemic response (fold-change vs baseline, 4.6±1.6 vs 6.7±1.7; p=0.002) and FMD (3.9±2.1 vs 5.6±1.5%; p=0.014) were found to be reduced in patients with HFpEF compared to controls.
In the skin of patients with HFpEF we also observed a reduced number (85±27 vs 130±60 vessels/mm2; p=0.012) but larger average diameter of lymphatic vessels (42±19 vs 26±9 μm2; p=0.007) compared to control subjects. These changes were paralleled by reduced expression of LYVE1 (p<0.05) and PROX1 (p<0.001), key determinants of lymphatic differentiation and function.
Whilst patients with HFpEF had reduced peripheral capillary fluid extravasation compared to controls (microvascular filtration coefficient, leg 33.1±13.3 vs 48.4±15.2, p<0.01; trend for arm 49.9±20.5 vs 66.3±30.1, p=0.09), they had lower lymphatic clearance (isovolumetric pressure: leg 22±4 vs 16±4 mmHg, p<0.005; arm 25±5 vs 17±4 mmHg, p<0.001).
Conclusions
We provide direct evidence of systemic dysfunction and rarefaction of small blood vessels in patients with HFpEF. Despite a reduced microvascular filtration coefficient, which is in keeping with microvascular rarefaction, the clearance of extravasated fluid in HFpEF is limited by an anatomically and functionally defective lymphatic system.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation Centre of Research Excellence Award
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Affiliation(s)
- G Rossitto
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Centre for Research Excellence, Glasgow, United Kingdom
| | - S Mary
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Centre for Research Excellence, Glasgow, United Kingdom
| | - C McAllister
- Queen Elizabeth University Hospital, Clinical Research Facility, Glasgow, United Kingdom
| | - K.B Neves
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Centre for Research Excellence, Glasgow, United Kingdom
| | - L Haddow
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Centre for Research Excellence, Glasgow, United Kingdom
| | - P Rocchiccioli
- Golden Jubilee National Hospital, Cardiology, Clydebank, United Kingdom
| | - N Lang
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Centre for Research Excellence, Glasgow, United Kingdom
| | - C Murphy
- Royal Alexandra Hospital, Cardiology, Paisley, United Kingdom
| | - R.M Touyz
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Centre for Research Excellence, Glasgow, United Kingdom
| | - M.C Petrie
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Centre for Research Excellence, Glasgow, United Kingdom
| | - C Delles
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Centre for Research Excellence, Glasgow, United Kingdom
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8
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Moreton FC, Cullen B, Dickie DA, Lopez Gonzalez R, Santosh C, Delles C, Muir KW. Brain imaging factors associated with progression of subcortical hyperintensities in CADASIL over 2-year follow-up. Eur J Neurol 2020; 28:220-228. [PMID: 32931073 DOI: 10.1111/ene.14534] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/03/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Mutations in the NOTCH3 gene cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a cerebral small vessel disease manifesting with stroke, migraine and dementia in adults. The disease displays significant phenotypic variability that is incompletely explained. Early abnormalities in vascular function have been shown in animal models. We postulated that studying changes in vascular function may offer insights into disease progression. METHODS Twenty-two subjects with CADASIL [50% female, 50 (±11) years] from 19 pedigrees were included in a longitudinal multimodality study using brain magnetic resonance imaging (MRI), clinical measures, neuropsychology and measures of peripheral vascular function. MRI studies included measurement of structural brain changes, cerebral blood flow (CBF) and cerebrovascular reactivity by arterial spin labelling and a CO2 respiratory challenge. RESULTS Over 2 years, new stroke or transient ischaemic attack (TIA) occurred in five (23%) subjects and new significant disability in one (5%). There were significant increases in number of lacunes, subcortical hyperintensity volume and microbleeds, and a decrease in brain volume. CBF declined by 3.2 (±4.5) ml/100 g/min over 2 years. CBF and carotid-femoral pulse wave velocity at baseline predicted change in subcortical hyperintensity volume at follow-up. Carotid intima-media thickness and age predicted brain atrophy. Baseline CBF was lower in subjects who showed a decline in attention and working memory. CONCLUSIONS Cerebral blood flow predicts radiological progression of hyperintensities and thus is a potential biomarker of disease progression in CADASIL. Over 2 years, there were changes in several relevant imaging biomarkers (CBF, brain volume, lacunes, microbleeds and hyperintensity volume). Future studies in CADASIL should consider assessment of CBF as prognostic factor.
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Affiliation(s)
- F C Moreton
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK
| | - B Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D A Dickie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - R Lopez Gonzalez
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK.,Department of Clinical Physics and Bioengineering, Glasgow Royal Infirmary, Glasgow, UK
| | - C Santosh
- Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - K W Muir
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK
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9
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Korevaar TIM, Derakhshan A, Taylor PN, Meima M, Chen L, Bliddal S, Carty DM, Meems M, Vaidya B, Shields B, Ghafoor F, Popova PV, Mosso L, Oken E, Suvanto E, Hisada A, Yoshinaga J, Brown SJ, Bassols J, Auvinen J, Bramer WM, López-Bermejo A, Dayan C, Boucai L, Vafeiadi M, Grineva EN, Tkachuck AS, Pop VJM, Vrijkotte TG, Guxens M, Chatzi L, Sunyer J, Jiménez-Zabala A, Riaño I, Murcia M, Lu X, Mukhtar S, Delles C, Feldt-Rasmussen U, Nelson SM, Alexander EK, Chaker L, Männistö T, Walsh JP, Pearce EN, Steegers EAP, Peeters RP. Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth: A Systematic Review and Meta-analysis. JAMA 2019; 322:632-641. [PMID: 31429897 PMCID: PMC6704759 DOI: 10.1001/jama.2019.10931] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [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: 01/24/2019] [Accepted: 07/08/2019] [Indexed: 01/27/2023]
Abstract
Importance Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. Objective To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Data Sources and Study Selection Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. Data Extraction and Synthesis The primary authors provided individual participant data that were analyzed using mixed-effects models. Main Outcomes and Measures The primary outcome was preterm birth (<37 weeks' gestational age). Results From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Conclusions and Relevance Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.
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Affiliation(s)
- T I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, England
| | - Marcel Meima
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Liangmiao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sofie Bliddal
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David M Carty
- Department of Diabetes, Endocrinology, and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, Scotland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Margreet Meems
- Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, England
| | - Beverley Shields
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, England
| | - Farkhanda Ghafoor
- National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Polina V Popova
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Lorena Mosso
- Department of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Aya Hisada
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Juha Auvinen
- Medical Research Center Oulu, Oulu University Hospital, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Colin Dayan
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, England
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York
| | - Marina Vafeiadi
- Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Elena N Grineva
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Alexandra S Tkachuck
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Victor J M Pop
- Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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Tofte N, Lindhardt M, Adamova K, Beige J, Beulens JWJ, Birkenfeld AL, Currie G, Delles C, Dimos I, Francová L, Frimodt-Møller M, Girman P, Göke R, Havrdova T, Kooy A, Mischak H, Navis G, Nijpels G, Noutsou M, Ortiz A, Parvanova A, Persson F, Ruggenenti PL, Rutters F, Rychlík I, Spasovski G, Speeckaert M, Trillini M, von der Leyen H, Rossing P. Characteristics of high- and low-risk individuals in the PRIORITY study: urinary proteomics and mineralocorticoid receptor antagonism for prevention of diabetic nephropathy in Type 2 diabetes. Diabet Med 2018; 35:1375-1382. [PMID: 29781558 DOI: 10.1111/dme.13669] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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] [Accepted: 05/10/2018] [Indexed: 12/13/2022]
Abstract
AIM To compare clinical baseline data in individuals with Type 2 diabetes and normoalbuminuria, who are at high or low risk of diabetic kidney disease based on the urinary proteomics classifier CKD273. METHODS We conducted a prospective, randomized, double-blind, placebo-controlled international multicentre clinical trial and observational study in participants with Type 2 diabetes and normoalbuminuria, stratified into high- or low-risk groups based on CKD273 score. Clinical baseline data for the whole cohort and stratified by risk groups are reported. The associations between CKD273 and traditional risk factors for diabetic kidney disease were evaluated using univariate and logistic regression analysis. RESULTS A total of 1777 participants from 15 centres were included, with 12.3% of these having a high-risk proteomic pattern. Participants in the high-risk group (n=218), were more likely to be men, were older, had longer diabetes duration, a lower estimated GFR and a higher urinary albumin:creatinine ratio than those in the low-risk group (n=1559, P<0.02). Numerical differences were small and univariate regression analyses showed weak associations (R2 < 0.04) of CKD273 with each baseline variable. In a logistic regression model including clinical variables known to be associated with diabetic kidney disease, estimated GFR, gender, log urinary albumin:creatinine ratio and use of renin-angiotensin system-blocking agents remained significant determinants of the CKD273 high-risk group: area under the curve 0.72 (95% CI 0.68-0.75; P<0.01). CONCLUSIONS In this population of individuals with Type 2 diabetes and normoalbuminuria, traditional diabetic kidney disease risk factors differed slightly between participants at high risk and those at low risk of diabetic kidney disease, based on CKD273. These data suggest that CKD273 may provide additional prognostic information over and above the variables routinely available in the clinic. Testing the added value will be subject to our ongoing study. (European Union Clinical Trials Register: EudraCT 2012-000452-34 and Clinicaltrials.gov: NCT02040441).
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Affiliation(s)
- N Tofte
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - M Lindhardt
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - K Adamova
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Skopje, Macedonia
| | - J Beige
- Klinikum St. Georg, Nephrology and KfH Renal Unit, Leipzig, Martin-Luther University Halle, Wittenberg, Germany
| | - J W J Beulens
- Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A L Birkenfeld
- Clinical Study Centre Metabolic Vascular Medicine, GWT TU-Dresden GmbH, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Centre Munich at University Hospital, and Faculty of Medicine, TU Dresden, Dresden, Germany
- German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - G Currie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - I Dimos
- Diabetespraxis, Leipzig, Germany
| | - L Francová
- 1st Department, Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | | | - P Girman
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - R Göke
- Diabetologische Schwerpunktpraxis, Diabetologen Hessen, Marburg, Germany
| | - T Havrdova
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - A Kooy
- Bethesda Diabetes Research Centre, Hoogeveen and University Medical Centre Groningen, Netherlands
| | - H Mischak
- Mosaiques Diagnostics, Hannover, Germany
| | - G Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - G Nijpels
- Department General Practice and Elderly Care, Amsterdam Public Health VU University Medical Centre, Amsterdam, The Netherlands
| | - M Noutsou
- Diabetes Centre and 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokratio General Hospital, Athens, Greece
| | - A Ortiz
- Instituto de Investigacion Sanitaria de la Fundacion Jiménez Díaz UAM, Madrid, Spain
| | - A Parvanova
- Istituto di Richerche Farmacologiche Mario Negri, Bergamo, Italy
| | - F Persson
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - P L Ruggenenti
- Istituto di Richerche Farmacologiche Mario Negri, Bergamo, Italy
| | - F Rutters
- Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - I Rychlík
- 1st Department, Charles University, Third Faculty of Medicine, Prague, Czech Republic
- Faculty Hospital Královské Vinohrady, Prague, Czech Republic
| | - G Spasovski
- Department of Nephrology, Cyril and Methodius University in Skopje, Skopje, Macedonia
| | - M Speeckaert
- Ghent University Hospital, Department of Nephrology, Ghent, Belgium
| | - M Trillini
- Istituto di Richerche Farmacologiche Mario Negri, Bergamo, Italy
| | | | - P Rossing
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
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Rutherford C, Speirs C, Williams JJL, Ewart MA, Mancini SJ, Hawley SA, Delles C, Viollet B, Costa-Pereira AP, Baillie GS, Salt IP, Palmer TM. Phosphorylation of Janus kinase 1 (JAK1) by AMP-activated protein kinase (AMPK) links energy sensing to anti-inflammatory signaling. Sci Signal 2016; 9:ra109. [DOI: 10.1126/scisignal.aaf8566] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
The last decade has seen a surge in publications describing novel biomarkers for early detection of diabetic nephropathy (DN), but as yet none have outperformed albuminuria in well-designed prospective studies. This is partially attributable to our incomplete understanding of the many complex interrelated mechanisms underlying DN development, a heterogeneous process unlikely to be captured by a single biomarker. Proteomics offers the advantage of simultaneously analysing the entire protein content of a biological sample, and the technique has gained attention as a potential tool for a more accurate diagnosis of disease at an earlier stage as well as a means by which to unravel the pathogenesis of complex diseases such as DN using an untargeted approach. This review will discuss the potential of proteomics as both a clinical and research tool, evaluating exploratory work in animal models as well as diagnostic potential in human subjects.
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Affiliation(s)
- G Currie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
| | - C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
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Shiohira S, Yoshida T, Sugiura H, Nishida M, Nitta K, Tsuchiya K, Grampp S, Goppelt-Strube M, Eckardt KU, Schodel J, Kang SW, Kim Y, Seo SK, Kim T, Ong S, Yang WS, Han NJ, Lee JM, Baek CH, Park SK, Kemter E, Aigner B, Wanke R, Troyano Suarez N, Olmos Centenero G, Mora I, Griera M, Cano JL, Martin P, Zamora J, Ruiz-Torres MP, Falke LL, Leask A, Lyons K, Nguyen TQ, Goldschmeding R, Park SK, Kim D, Lee AS, Jung YJ, Yang KH, Lee S, Kim W, Kim W, Kang KP, Garcia-Jerez A, Luengo-Rodriguez A, Ramirez-Chamond R, Carracedo J, Medrano-Andres D, Rodriguez-Puyol D, Calleros L, Kim HW, Park SK, Yang WS, Lee SK, Chang JW, Seo JW, Lee CT, Chou CA, Lee YT, Ng HY, Sanchez-Nino MD, Fernandez-Fernandez B, Perez-Gomez MV, Poveda J, Sanz AB, Cannata-Ortiz P, Egido J, Selgas R, Ortiz A, Ma SK, Kim IJ, Kim CS, Bae EH, Kim SW, Kokeny G, Boo'Si M, Fazekas K, Rosivall L, Mozes MM, Mijuskovic M, Ulrich C, Berger H, Trojanowicz B, Kohler F, Wolf A, Seibert E, Fiedler R, Markau S, Glomb M, Girndt M, Lajdova I, Spustova V, Oksa A, Chorvat D, Marcek Chorvatova A, Choi SO, Kim JS, Han BG, Yang JW, Liu S, Lv J, Chang R, Su F, Liang W, Zawada AM, Rogacev KS, Hundsdorfer J, Sester U, Fliser D, Heine GH, Chen JS, Cheng CW, Chang LC, Wu CZ, Novaes AS, Borges FT, Boim MA, Tramonti G, Romiti N, Chieli E, Hamahata S, Nagasawa Y, Kawabe M, Kida A, Yahiro M, Nanami M, Hasuike Y, Kuragano T, Nakasho K, Ohyama H, Nakanishi T, Tanaka S, Yano S, Sugimoto T, Bae E, Stevens KK, Hillyard DZ, Delles C, Jardine AG, Burke M, Morais C, Soyer P, Sinnya S, Winterford C, Oliver K, Lambie D, Staatz C, Carroll R, Campbell S, Isbel N, Felaco P, Pesce M, Patruno A, Sirolli V, Speranza L, Amoroso L, Franceschelli S, Bonomini M, Thilo F, Zakrzewicz A, Tepel M, Thilo F, Zakrzewicz A, Tepel M, Liu S, Li Y, Liang W, Su F, Wang B. CELL SIGNALLING AND APOPTOSIS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stevens KK, Patel RK, Smith GL, Clancy MJ, Delles C, Jardine AG, Verkaart S, Buchel J, Steppan S, Lavrijsen M, de Baaij J, Hoenderop JG, Bindels R. Phosphate: a novel risk factor for cardiovascular disease and CKD progression. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kutlay S, Kurultak I, Nergizoglu G, Erturk S, Karatan O, Azevedo P, Pinto CT, Pereira CM, Marinho A, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Rei S, Aleksandrova I, Kiselev V, Ilynskiy M, Berdnikov G, Marchenkova L, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Daher EF, Vieira APF, Souza JB, Falcao FS, Costa CR, Fernandes AACS, Mota RMS, Lima RSA, Silva Junior GB, Ulusal Okyay G, Erten Y, Er R, Aybar M, Inal S, Tekbudak M, Aygencel G, Onec K, Bali M, Sindel S, Soto K, Fidalgo P, Papoila AL, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Lentini P, Zanoli L, Granata A, Contestabile A, Basso A, Berlingo G, de Cal M, Pellanda V, Dell'Aquila R, Fortrie G, Stads S, van Bommel J, Zietse R, Betjes MG, Berrada A, Arias C, Riera M, Orfila MA, Rodriguez E, Barrios C, Peruzzi L, Chiale F, Camilla R, Martano C, Cresi F, Bertino E, Coppo R, Klimenko A, Villevalde S, Efremovtseva M, Kobalava Z, Pipili C, Ioannidou S, Kokkoris S, Poulaki S, Tripodaki ES, Parisi M, Papastylianou A, Nanas S, Wang YN, Cheng H, Chen YP, Wen Z, Li X, Shen P, Zou Y, Lu Y, Ma X, Chen Y, Ren H, Chen X, Chen N, Yue T, Cheng H, Chen YP, Elmamoun S, Wodeyar H, Goldsmith C, Abraham A, Wootton A, Ahmed S, Hill C, Curtis S, Miller A, Hine T, Stevens KK, Patel RK, Mark PB, Delles C, Jardine AG, Wilflingseder J, Heinzel A, Mayer P, Perco P, Kainz A, Mayer B, Oberbauer R, Huang TM, Wu VC, Park DJ, Bae EJ, Kang YJ, Cho HS, Chang SH, Lentini P, Zanoli L, Granata A, Contestabile A, Berlingo G, Basso A, Pellanda V, de Cal M, Stramana R, Cognolato D, Baiocchi M, Dell'Aquila R, Chiella BM, Pilla C, Balbinotto A, Antunes VH, Heglert A, Collares FM, Thome FS, Gjyzari A, Thereska N, Xhango O, Xue J, Chen MC, Wang L, Chen YJ, Sun XZ, An WS, Kim ES, Son YK, Kim SE, Kim KH, Oh YJ, Tsai HB, Ko WJ, Chao CT, Fortrie G, Stads S, Aarnoudse AJL, Zietse R, Betjes MG, Peride I, Radulescu D, Niculae A, Ciocalteu A, Checherita AI, Kao CC, Wang CY, Lai CF, Huang TM, Chen HH, Wu VC, Ko WJ, Wu KD, Klaus F, Goldani JC, Cantisani G, Zanotelli ML, Carvalho L, Klaus D, Garcia VD, Keitel E, Hussaini SM, Rao PN, Kul A, Ye N, Zhang Y, Cheng H, Chen YP, Baines R, Westacott R, Trew J, Kirtley J, Selby N, Carr S, Xu G, Steffgen J, Blaschke S, Brun-Schulte-Wissing N, Pagel P, Huber F, Mapes J, Jaehnige A, Pestel S, Deray G, Rouviere O, Bacigalupo L, Maes B, Hannedouche T, Vrtovsnik F, Rigothier C, Billiouw JM, Campioni P, Marti-Bonmati L, Gao YM, Li D, Cheng H, Chen YP, Woo S, Lee J, Noh H, Kwon SH, Han DC, Hetherington L, Valluri A, McQuarrie E, Fleming S, Geddes C, Bell S, MacKinnon B, Bell S, Patton A, Sneddon J, Donnan P, Vadiveloo T, Marwick C, Bennie M, Davey P, Yasuda H, Tsuji N, Tsuji T, Iwakura T, Ohashi N, Kato A, Fujigaki Y, Sasaki S, Kawarazaki H, Shibagaki Y, Kimura K, Lingaraju U, Rajanna S, Radhakrishnan H, Parekh A, Sreedhar CG, Sarvi R, Rainone F, Merlino L, Ritchie JP, Kalra PA, Daher EF, Vieira APF, Jacinto CN, Abreu KLS, Silva Junior GB, Neves M, Baptista JP, Rodrigues L, Pinho J, Teixeira L, Pimentel J, Gonzalez Sanchidrian S, Rangel Hidalgo G, Cebrian Andrada C, Deira Lorenzo J, Marin Alvarez J, Garcia-Bernalt Funes V, Gallego Dominguez S, Labrador Gomez P, Castellano Cervino I, Novillo Santana R, Gomez-Martino Arroyo J, Kim Y, Choi BS, Kim YO, Yoon SA, Lin MC, Wu VC, Ko WJ, Wu KD, Wang WJ, Melo MJ, Lopes JA, Raimundo M, Fragoso A, Antunes F, Martin-Moreno PL, Varo N, Restituto P, Sayon-Orea C, Garcia-Fernandez N, Leite Filho NCV, Souza LEO, Cavalcante RM, Silva Junior GB, Morais BM, Leite TT, Silva SL, Kubrusly M, Daher EF, Jung YS, Kim YN, Shin HS, Rim H, Bentall A, Al-Baaj F, Williamson S, Cheshire S, Jelakovic M, Ivkovic V, Laganovic M, Karanovic S, Pecin I, Premuzic V, Vukovic Lela I, Vrdoljak A, Fucek M, Cvitkovic A, Juric D, Bozina N, Bitunjac M, Leko N, Abramovic Baric M, Matijevic V, Jelakovic B, Ullah A, Exarchou K, Archer T, Anijeet H, Brown R, Ahmed S, Zhang Y, Ye N, Cheng H, Cheng YP, Rocha JCG, Gushiken da Silva T, de Castro PF, Kioroglo PS, Branco Martins JP, Tzanno-Martins C, Biesenbach P, Luf F, Fleischmann E, Grunberger T, Druml W, Gaipov A, Turkmen K, Toker A, Solak Y, Cicekler H, Ucar R, Kilicaslan A, Gormus N, Tonbul HZ, Yeksan M, Turk S, Monteburini T, Cenerelli S, Santarelli S, Boggi R, Tazza L, Bossola M, Ferraresi M, Merlo I, Giovinazzo G, Quercia AD, Gai M, Leonardi G, Anania P, Guarena C, Cantaluppi V, Pacitti A, Biancone L, Hissa PNG, Daher EDF, Liborio AB, Thereza BMF, Mendes CCP, Sousa ARO. AKI - human studies. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stevens K, Beattie E, Delles C, Jardine A, Neumann K, Fang L, Ritz E, Gross-Weissmann ML, Kokeny G, Nakano C, Hamano T, Fujii N, Matsui I, Mikami S, Obi Y, Shimomura A, Rakugi H, Tsubakihara Y, Isaka Y, Torremade N, Arcidiacono MV, Valcheva P, Bozic M, Fernandez E, Valdivielso JM, Rotondi S, Pasquali M, Conte C, Leonangeli C, Muci ML, Pirro G, Tartaglione L, Mazzaferro S, Janssen U, Naderi S, Hennies M, Kruger T, Brandenburg V. CKD-MBD - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To study gene expression profiles in human endothelial cells incubated with plasma from women who developed pre-eclampsia and women with normotensive pregnancies. DESIGN A case-control study. SETTING A longitudinal nested case-control study within three maternity units. POPULATION A mixed obstetric population attending maternity hospitals in Glasgow. METHODS Plasma was obtained at both 16 and 28 weeks of gestation from 12 women: six women subsequently developed pre-eclampsia (cases) and six women, matched for age, body mass index (BMI) and parity, remained normotensive (controls). Human umbilical vein endothelial cells (HUVECs) were incubated with plasma for 24 hour before RNA isolation. MAIN OUTCOME MEASURES Gene expression profiles were compared between the two gestational time points using Illumina(®) HumanHT-12 v4 Expression BeadChips. Differential mRNA expression observed in microarray experiments were validated using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR), and gene networks were analysed using Ingenuity(®) pathway analysis. RESULTS There was a significant difference in the expression of 25 genes following incubation with plasma from controls, and an increase in the expression of 11 genes following incubation with plasma from cases, with no overlap between the two groups (false discovery rate, FDR < 0.05). There was a 3.74-fold (FDR < 0.001) increase in the expression of the c-Fos gene (FOS) when HUVECs were incubated with control plasma from 16 and 28 weeks of gestation, with no significant difference between the two time points with plasma from cases. Similar findings for FOS were obtained by qRT-PCR. CONCLUSIONS Plasma from women who subsequently develop pre-eclampsia appears to contain factors that lead to the dysregulation of FOS in endothelial cells during pregnancy. Reduced expression of c-Fos may lead to impaired vasculogenesis, and thereby contribute to the development of pre-eclampsia.
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Affiliation(s)
- R M Mackenzie
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
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Bryce G, Payne C, Gibson S, Kingsmore D, Byrne D, Delles C. Risk Stratification Scores in Elective Open Abdominal Aortic Aneurysm Repair: Are They Suitable for Preoperative Decision Making? Eur J Vasc Endovasc Surg 2012; 44:55-61. [DOI: 10.1016/j.ejvs.2012.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Bryce G, Payne C, Gibson S, Kingsmore D, Byrne D, Delles C. Risk Stratification Scores in Elective Open Abdominal Aortic Aneurysm Repair: Are They Suitable for Preoperative Decision Making? J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.05.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Walter* S, Dong J, Alexander S, Hunter T, Yin K, Maclean D, Tomlinson J, Karim F, Johnson R, Stevens K, Patel R, Clancy M, Graham D, Delles C, Jardine A, Behets G, Viaene L, Meijers B, D'haese P, Evenepoel P, Seiler S, Herath E, Flugge F, Weihrauch A, Fliser D, Heine GH, Brandenburg V, Kruger T, Wagstaff R, Floege J, Specht P, Ketteler M, Angelini ML, Angelini ML, Cianciolo G, La Manna G, Cappuccilli ML, Della Bella E, Rum I, Conte D, Cuna V, Dormi A, Todeschini P, Donati G, Costa R, Bagnara GP, Stefoni S. Bone and mineral diseases - 1. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mullen W, Gonzalez J, Siwy J, Franke J, Sattar N, Mullan A, Roberts S, Delles C, Mischak H, Albalat A. A pilot study on the effect of short-term consumption of a polyphenol rich drink on biomarkers of coronary artery disease defined by urinary proteomics. J Agric Food Chem 2011; 59:12850-12857. [PMID: 22070129 DOI: 10.1021/jf203369r] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Polyphenol rich diets have been associated with a reduced risk of cardiovascular disease. We examined the effect of a polyphenol rich (P-R) drink on biomarkers assessed by urinary proteomics. Thirty nine middle aged and overweight subjects were randomized to P-R drink (n = 20) or placebo (n = 19) in addition to their normal diet. After two weeks urine samples were obtained for assessment of the urinary proteome using capillary electrophoresis coupled to a mass spectrometer. A total of 93 polypeptides were found to be candidates for differential distribution with a nominal p-value <0.05, though these differences did not reach significance when multiple testing was accounted for. Sequences were determined in 19 of these demonstrating that they originate from alpha-1 antitrypsin, collagens, fibrinogen alpha and IgG kappa. Levels of 27 polypeptides were greater than 4-fold different between the two groups. Of these, 7 were previously found to be part of a coronary artery disease (CAD) specific urinary biomarker pattern. Their direction of expression was closer to the healthy state in the P-R drink group and closer to CAD state in the placebo group. Our data suggest that the P-R drink may have beneficial effects on urinary biomarkers of CAD. The data encourage the planning of future prospective studies, aimed at investigating significant effects of polyphenol rich dietary products.
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Affiliation(s)
- W Mullen
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
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Goto S, Fujii H, Kono K, Nakai K, Hamada Y, Yamato H, Shinohara M, Kitazawa R, Kitazawa S, Nishi S, Fukagawa M, Stevens K, Beattie E, Sands W, Delles C, Jardine A, Masai H, Joki N, Kunimasa T, Furuhashi T, Fukuda H, Sugi K, Moroi M, Sinha MD, Turner C, Dalton RN, Rasmussen P, Waller S, Booth CJ, Goldsmith DJ, Van Zuilen A, Blankestijn P, Van Buren M, Ten Dam M, Kaasjager H, Ligtenberg G, Sijpkens Y, Sluiter H, Van de Ven P, Vervoort G, Vleming L, Bots M, Wetzels J. CKD / Mineral bone disease. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stevens KK, Morgan IR, Patel RK, Geddes CC, Mark PB, Jardine AG, Delles C. Serum phosphate and outcome at one year after deceased donor renal transplantation. Clin Transplant 2011; 25:E199-204. [PMID: 21303413 DOI: 10.1111/j.1399-0012.2011.01400.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traditional risk factors do not adequately explain the increased prevalence of cardiovascular disease in renal patients. This study considered a "non-traditional" risk factor, serum phosphate and outcome in renal transplant recipients. Data from 377 patients who received a first deceased donor renal transplant between January 1, 1999, and December 31, 2008, were recorded; 10% (n=38) had diabetes, 16.7% (n=63) were smokers, and 18.8% (n=71) had a history of vascular disease. Three hundred and thirty-three patients were alive at the time of the analysis. Survivors were significantly younger, less likely to be smokers or diabetic, and had a higher estimated glomerular filtration rate at one yr post-transplantation. Serum phosphate was significantly lower in these patients (0.95 ± 0.23 vs. 1.04 ± 0.26, p = 0.031). Analysis of recipient survival, stratified by serum phosphate at one yr post-transplant, revealed that serum phosphate > 1.11 mMol/L was a significant predictor of all-cause mortality (p=0.006). Serum phosphate between 0.9 and 1.11 mMol/L afforded the best outcome. In multivariate analysis, serum phosphate remained a significant predictor of mortality (p=0.016). Serum phosphate at one yr after transplant seems to have a J-shaped relationship with mortality, and this effect is independent of traditional cardiovascular risk factors.
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Affiliation(s)
- K K Stevens
- BHF, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Delles C, Jardine AG. Renal function and cardiovascular events: relevance of eGFR and albuminuria in patients with diabetes. Diabetologia 2011; 54:4-6. [PMID: 20938633 DOI: 10.1007/s00125-010-1942-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 09/01/2010] [Indexed: 10/19/2022]
Abstract
Impaired renal function has been recognised as an independent cardiovascular risk factor in the general population and in patients with established cardiovascular disease. In this issue of Diabetologia, Drury et al. examined the association of two markers of renal function with cardiovascular outcome in patients with type 2 diabetes. They found that both estimated glomerular filtration rate (eGFR) and albuminuria were independent predictors, but that their incremental contribution to cardiovascular risk was modest compared with that of other risk factors. Both eGFR and albuminuria appear to integrate information from other risk factors and may be more suitable than population-based risk scores for risk prediction in individuals, but further research is required to examine whether reduced eGFR and albuminuria mainly represent generalised vascular damage or if impaired renal function directly affects vascular structure and function in patients with type 2 diabetes.
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Affiliation(s)
- C Delles
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK.
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McQuarrie EP, Patel RK, Mark PB, Delles C, Connell J, Dargie HJ, Steedman T, Jardine AG. Association between proteinuria and left ventricular mass index: a cardiac MRI study in patients with chronic kidney disease. Nephrol Dial Transplant 2010; 26:933-8. [DOI: 10.1093/ndt/gfq418] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mackenzie RM, Hamilton CA, Miller WH, Salt IP, Murphy MP, Delles C, Dominiczak AF. 022 MitoQ10 decreases AMPK activation in endothelial cells from patients with coronary artery disease and diabetes. Heart 2010. [DOI: 10.1136/hrt.2010.195941.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dominiczak AF, Herget-Rosenthal S, Delles C, Fliser D, Fournier I, Graber A, Girolami M, Holmes E, Lang F, Molina F, Nicholson J, Remuzzi G, Rossing P, Rudolph KL, Wolkenhauer O, Xenarios I, Zubarev R, Zubov D, Vlahou A, Schanstra JP. Systems biology to battle vascular disease. Nephrol Dial Transplant 2010; 25:1019-22. [DOI: 10.1093/ndt/gfq025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Delles C, Raff U, Mimran A, Fauvel JP, Ruilope LM, Schmieder RE. Effects of telmisartan and ramipril on adiponectin and blood pressure in patients with type 2 diabetes. Am J Hypertens 2008; 21:1330-6. [PMID: 18989258 DOI: 10.1038/ajh.2008.297] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Adiponectin is secreted by adipose tissue and may play a role in cardiovascular disease. We examined adiponectin levels in patients with type 2 diabetes who participated in the Telmisartan vs. Ramipril in Renal Endothelial Dysfunction (TRENDY) study. METHODS A total of 87 patients were assessed at baseline and following 9 weeks treatment with the angiotensin-receptor blocker telmisartan (final dose, 80 mg; n = 45) or the angiotensin-converting enzyme inhibitor ramipril (final dose, 10 mg; n = 42). Adiponectin levels were measured in plasma by radioimmunoassay. RESULTS Adiponectin levels were inversely correlated with systolic (SBP; r = -0.240, P < 0.05) and diastolic (DBP; r = -0.227, P < 0.05) blood pressure at baseline and following treatment with telmisartan or ramipril (SBP: r = -0.228, P < 0.05; DBP: r = -0.286, P < 0.05). Changes in adiponectin levels were related to changes in SBP (r = -0.357, P < 0.01) and DBP (r = -0.286, P < 0.01). There was a significant increase in adiponectin levels in the telmisartan (0.68 (95% confidence interval (CI), 0.27 to 1.10) microg/ml, P < 0.01) but not in the ramipril group (0.17 (95% CI, -0.56 to 0.90) microg/ml, P = 0.67). Blood pressure reduction in the telmisartan group (DeltaSBP: -13.5 (95% CI, -17.0 to -10.0) mm Hg; DeltaDBP: -7.6 (95% CI, -9.8 to -5.3) mm Hg, each P < 0.001) was significantly (P < or = 0.01 for SBP and P < 0.01 for DBP) greater than in the ramipril group (DeltaSBP: -6.1 (95% CI, -6.2 to -2.0) mm Hg; DeltaDBP: -2.7 (95% CI, -5.0 to -0.5) mm Hg; P < 0.01 and P < 0.05, respectively). CONCLUSION Adiponectin is correlated with blood pressure in patients with type 2 diabetes. Whether increased adiponectin contributes to the blood pressure-lowering effect of telmisartan needs further study.
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Zimmerli LU, Mark PB, Steedman T, Foster JE, Berg GA, Dargie HJ, Jardine AG, Delles C, Dominiczak AF. Vascular function in patients with end-stage renal disease and/or coronary artery disease: A cardiac magnetic resonance imaging study. Kidney Int 2007; 71:68-73. [PMID: 17136027 DOI: 10.1038/sj.ki.5002024] [Citation(s) in RCA: 23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Decreased arterial compliance in end-stage renal disease (ESRD) is associated with increased cardiovascular risk. Our aim was to examine aortic compliance in patients with ESRD using cardiac magnetic resonance imaging (MRI) and to compare these with patients with advanced atherosclerotic disease who are known to be at high cardiovascular risk. We examined a total of 83 subjects matched for age: 24 had ESRD and were on dialysis therapy for 3+/-6 years, 24 had severe coronary artery disease (CAD), 11 had both ESRD and CAD (4+/-5 years on dialysis therapy), and 24 healthy subjects with no evidence of CAD. Vascular and cardiac function was assessed using cardiac MRI. Aortic compliance was significantly reduced in patients with CAD compared to control subjects (11.3+/-6.3 ml x 10(-3)/mm Hg vs 15.6+/-6.0 ml x 10(-3)/mm Hg, P=0.009). Patients with ESRD also exhibited significantly reduced aortic compliance compared to healthy controls (12.4+/-5.8 ml x 10(-3)/mm Hg vs 15.6+/-6.0 ml 10(-3)/mm Hg, P=0.012), whereas there was no significant difference in aortic compliance between patients with CAD and ESRD. Even in the absence of symptomatic CAD, patients with ESRD have significantly reduced aortic compliance compared to normal subjects. Patients with ESRD have equivalent aortic compliance to patients with advanced CAD. These findings suggest that a significantly reduced aortic compliance is one of many mechanisms promoting premature cardiovascular events in patients with ESRD compared to age-matched controls from the general population.
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Affiliation(s)
- L U Zimmerli
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Schäufele TG, Schlaich MP, Delles C, Klingbeil AU, Fleischmann EH, Schmieder RE. Impaired basal NO activity in patients with glomerular disease and the influence of oxidative stress. Kidney Int 2006; 70:1177-81. [PMID: 16883318 DOI: 10.1038/sj.ki.5001745] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Endothelial dysfunction has been found to be linked to and predictive of cardiovascular events. Whether endothelial function of the renal vasculature is impaired in patients with chronic glomerular disease and whether oxidative stress is of importance in this setting has not yet been determined. In this study, endothelial function of the renal vasculature was investigated in 25 patients with chronic glomerular disease and 50 control subjects matched for age and blood pressure. Renal plasma flow (RPF) and glomerular filtration rate were measured by constant infusion input clearance technique at baseline and following infusions of the nitric oxide synthase (NOS) inhibitor N(G)-monomethyl-L-arginine (L-NMMA, 4.25 mg/kg), the substrate of NOS L-arginine (100 mg/kg) and the antioxidant vitamin C (3 g co-infused with L-arginine 100 mg/kg). At baseline, RPF was similar in the two groups. The reduction in RPF in response to L-NMMA was less pronounced in patients with chronic glomerular disease compared to control subjects (-4.6+/-12 vs -9.8+/-9%; P=0.040), indicating reduced basal nitric oxide (NO) activity in chronic glomerular disease. Co-infusion of the antioxidant vitamin C on top of L-arginine induced a more pronounced increase in RPF in patients with chronic glomerular disease than in control subjects (21.7+/-17 vs 10.9+/-22%; P=0.036). Our findings suggest that basal NO activity of the renal vasculature is reduced in patients with chronic glomerular disease compared to age- and blood pressure-matched control subjects. This might be in part related to increased oxidative stress.
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Affiliation(s)
- T G Schäufele
- Department of Medicine 4/Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
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Fleischmann EH, John S, Delles C, Schneider MP, Schmidt BMW, Schmieder RE. The effect of statins on angiotensin II-induced hemodynamic changes in young, mildly hypercholesterolemic men. Am J Hypertens 2004; 17:1120-6. [PMID: 15607618 DOI: 10.1016/j.amjhyper.2004.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2004] [Revised: 07/07/2004] [Accepted: 07/21/2004] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Angiotensin II type 1 (AT(1)) receptors are well known to mediate angiotensin II (Ang II)-induced pro-atherosclerotic effects. It has been found that hypercholesterolemia influences the expression of AT(1) receptors on vascular smooth muscle cells and that increased density of AT(1) receptors exaggerates the hemodynamic response to Ang II. We analyzed to what extent statins and AT(1) receptor antagonists diminish the vasoconstrictive response to Ang II infusion in hypercholesterolemic patients. METHODS A total of 24 male patients with LDL cholesterol levels >130 mg/dL were enrolled in a randomized, cross-over study. After baseline evaluation, 12 patients received first cerivastatin (0.3 mg/day) and the other 12 patients initially received candesartan (8 mg/day) for 3 weeks, with subsequent cross-over of the medication for the second 3-week drug period. The vascular response was analyzed by the increase in mean arterial pressure (MAP) and total peripheral resistance (TPR) during infusion of increasing doses of Ang II at baseline and the end of each treatment period. Hemodynamic changes were also compared with those in 24 normocholesterolemic subjects without any therapy. RESULTS At baseline, Ang II provoked a similar increase of MAP and TPR in patients and control subjects. Treatment with cerivastatin did not affect the response to Ang II compared with baseline. By contrast, treatment with candesartan attenuated significantly the response to Ang II compared with baseline and cerivastatin. CONCLUSIONS Our hemodynamic data indicate the hypothesis that statins do not reduce the responsiveness to Ang II in resistance arteries of young, mildly hypercholesterolemic patients.
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Affiliation(s)
- E H Fleischmann
- Department of Medicine 4/IV, University Erlangen-Nuremberg, 90475 Nuremberg, Germany
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Delles C. Reply. Nephrol Dial Transplant 2004. [DOI: 10.1093/ndt/gfh457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Delles C, Schlüter C, Wittmann M, Renders L, Riess R, Rösch W, Schott GE, Rupprecht HD, Kunzendorf U. “Very delayed” graft function in a patient after living related kidney transplantation: a case report. Transplant Proc 2004; 36:1377-9. [PMID: 15251336 DOI: 10.1016/j.transproceed.2004.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report the case of a patient who experienced anuric renal transplant failure for 44 days after living related kidney transplantation. Immunosuppressive and other therapies were carefully adapted to the findings of frequent renal transplant biopsies, which ultimately led to excellent graft function.
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Affiliation(s)
- C Delles
- Department of Medicine IV, University of Erlangen-Nürnberg, Erlangen, Germany.
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Affiliation(s)
- C Delles
- Medizinische Klinik IV der Universität Erlangen-Nürnberg, Nürnberg
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Abstract
Non-modulation has been suggested as a possible intermediate phenotype defining a subgroup of genetic hypertension. The trait is characterized by an attenuated response of renal blood flow and/or aldosterone to angiotensin (Ang) II. We tested the hypothesis that functional polymorphisms of the core promoter of the angiotensinogen gene are associated with non-modulation. Fifty-six young, white, male, untreated hypertensive patients and 65 age-matched normotensive volunteers were genotyped for 3 known functional variants of the angiotensinogen core promoter. All subjects were infused with 2 doses (0.5 and 3 ng/kg per minute) of Ang II while they were on a high sodium diet (250 mmol/d). The blood pressure, renal plasma flow, and aldosterone responses to Ang II were not affected by the -6 G/A polymorphism. The -20 A/C variant had no significant effects on the blood pressure or renal hemodynamic response to Ang II. However, the aldosterone response to both doses of Ang II was significantly decreased in -20 C allele carriers compared with -20 AA homozygotes in a multivariate analysis. The -18 T allele was not detected in our population, and there was a linkage dysequilibrium between -20 C and -6 A: -20 C almost exclusively occurred on the -6 A allele. Haplotype analysis indicated that the -20 C/-6 A haplotype but not the -20 A/-6 A haplotype was associated with a decreased aldosterone response to Ang II. We conclude that the -20 C variant or the -20 C/-6 A haplotype of the angiotensinogen core promoter is associated with a blunted aldosterone response to Ang II and may thus contribute to the non-modulating phenotype.
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Affiliation(s)
- K F Hilgers
- Department of Medicine/Nephrology, University of Erlangen-Nürnberg, Nürnberg, Germany
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Veelken R, Delles C, Hilgers KF, Schmieder RE. Outcome survey in unselected hypertensive patients with type 2 diabetes mellitus: effects of ACE inhibition. Am J Hypertens 2001; 14:672-8. [PMID: 11465652 DOI: 10.1016/s0895-7061(01)01300-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although the benefit of angiotensin converting enzyme (ACE) inhibitors in diabetic nephropathy is well documented in double-blind randomized, controlled clinical trials, it is uncertain whether the benefit extends to unselected patients with diabetes mellitus and arterial hypertension in general practice. In 2504 unselected patients with type 2 diabetes mellitus (mean age 63+/-10 years) blood pressure, cardiovascular, renal, and metabolic parameters were assessed at baseline and during a treatment period of 1 year with the ACE inhibitor cilazapril by primary care physicians. The average dose of cilazapril was 2.5 mg/day. Outcome measures were blood pressure, serum creatinine, proteinuria (dip stick), HbA1c levels, evaluation of edema, and exertional dyspnea. In the study cohort, systolic blood pressure decreased by 24+/-17 mm Hg and diastolic blood pressure by 12+/-11 mm Hg. An increase in serum creatinine (> 0.2 mg/dL) occurred more frequently in patients with than in those without renal involvement (19% v 7%; P < .05). Serum creatinine decreased more frequently in patients with renal involvement than in those without (26%+/-4% v 12%+/-3.8%; P < .05). Overall renal function in patients with diabetic nephropathy (n = 318) improved (2.1+/-1.6 mg/dL v 1.7+/-1.4 mg/dL; P < .05). The frequency of proteinuria was lower after 1 year than at baseline (62%+/-9% v 82%+/-8%; P < .05). Metabolic control of diabetes mellitus improved in parallel (median HbA1c 8.0% v 7.0%; P < .01). Scores for edema formation and exertional dyspnea improved as well (P < .01). In this outcome survey of unselected patients with type 2 diabetes mellitus and arterial hypertension, the ACE inhibitor cilazapril effectively lowered blood pressure, which was associated with an improvement in glucose metabolism, cardiac function, and renal function.
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Affiliation(s)
- R Veelken
- Department of Internal Medicine, University of Erlangen-Nürnberg, Germany
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Abstract
In this paper we review the effect of medical treatment on renal function in patients with congestive heart failure. We have examined data from the large-scale heart failure studies with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-receptor blockers, an aldosterone antagonist, and a vasopeptidase inhibitor. Renal outcome was reported in almost all of the studies with angiotensin-converting enzyme inhibitors. Despite concern about renal adverse events with drugs in this class, they seem to be safe in patients with congestive heart failure. In contrast, we did not find any report about renal function in patients treated with beta-receptor blockers for congestive heart failure.
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Affiliation(s)
- C Delles
- Department of Medicine IV/Nephrology, University of Erlangen-Nürnberg, Germany
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John S, Delles C, Jacobi J, Schlaich MP, Schneider M, Schmitz G, Schmieder RE. Rapid improvement of nitric oxide bioavailability after lipid-lowering therapy with cerivastatin within two weeks. J Am Coll Cardiol 2001; 37:1351-8. [PMID: 11300446 DOI: 10.1016/s0735-1097(01)01128-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [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: 11/24/2022]
Abstract
OBJECTIVES We investigated whether improvement of endothelial dysfunction in hypercholesterolemia can be achieved with short-term lipid-lowering therapy. BACKGROUND Impaired endothelium-dependent vasodilation plays a pivotal role in the pathogenesis of atherosclerosis and acute coronary syndromes. METHODS In a randomized, double-blind, placebo-controlled trial, we studied 37 patients (52 +/- 11 yrs) with low density lipoprotein cholesterol > or = 160 mg/dl (196 +/- 44 mg/dl) randomly assigned to either cerivastatin (0.4 mg/d) or placebo. Endothelium-dependent vasodilation of the forearm vasculature was measured by plethysmography and intra-arterial infusion of acetylcholine (ACh 12, 48 microg/min) and endothelium-independent vasodilation by intra-arterial infusion of nitroprusside (3.2, 12.8 microg/min). RESULTS Low density lipoprotein cholesterol decreased after two weeks of treatment (cerivastatin -33 +/- 4% vs. placebo + 2 +/- 4%, x +/- SEM, p < 0.001). Endothelium-dependent vasodilation improved after two weeks of therapy with cerivastatin compared with baseline (ACh 12 microg/min: + 22.3 +/- 5.2 vs. + 11.2 +/- 1.9 ml/min/100 ml, p < 0.01; ACh 48 microg/min: +31.2 +/- 6.3 vs. +19.1 +/- 3.1 ml/min/100 ml, p < 0.05). In contrast, changes in forearm blood flow to ACh were similar before and after therapy in the placebo group (ACh 12 microg/min: + 12.9 +/- 3.6 vs. + 9.0 +/- 1.9 ml/min/100 ml, NS; ACh 48 microg/min: +20.7 +/- 3.7 vs. 19.4 +/- 2.9 ml/min/100 ml, NS). Endothelium-dependent vasodilation improved in comparison with placebo (ACh 48 microg/min: +203 +/- 85% [cerivastatin] vs. -26 +/- 71% [placebo], p < 0.05). This improvement in endothelium-dependent vasodilation was no longer observed when the nitric oxide-synthase inhibitor N(G)-monomethyl-L-arginine was coinfused (ACh 48 microg/min + N(G)-monomethyl-L-arginine 4 micromol/min -48 +/- 85% [cerivastatin]). CONCLUSIONS Short-term lipid-lowering therapy with cerivastatin can improve endothelial function and NO bioavailability after two weeks in patients with hypercholesterolemia.
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Affiliation(s)
- S John
- Department of Medicine IV, University of Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Nürnberg, Germany
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Zeltner R, Delles C, Schneider M, Siffert W, Schmieder RE. G-protein beta(3) subunit gene (GNB3) 825T allele is associated with enhanced renal perfusion in early hypertension. Hypertension 2001; 37:882-6. [PMID: 11244012 DOI: 10.1161/01.hyp.37.3.882] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The C825T polymorphism of the gene encoding the G-protein beta(3) subunit (GNB3) is associated with increased intracellular signal transduction and arterial hypertension. The aim of the study was to investigate the impact of this polymorphism on early adaptive processes of the left ventricle and renal hemodynamic changes in young normotensive to mildly hypertensive subjects. Ninety-five white male students with normal or mildly elevated blood pressure were genotyped for the GNB3 C825T polymorphism. In each participant, 24-hour ambulatory blood pressure, left ventricular structure and function (2D-guided M-mode echocardiography), renal plasma flow (para-aminohippurate clearance), glomerular filtration rate (inulin clearance), and 24-hour urinary sodium excretion were determined. The GNB3 825T allele was not associated with casual or ambulatory blood pressure, parameters of left ventricular structure or function, glomerular filtration, or 24-hour urinary sodium excretion. However, in T:-allele carriers (CT+TT), renal plasma flow was higher than in CC subjects (CT/TT: 659+/-96 versus CC: 614+/-91 mL/min, P:=0.019). ANOVA disclosed that renal plasma flow was independently influenced by both genotype and blood pressure, with hypertensives having a higher renal plasma flow than normotensive subjects. This was the fact irrespective of the criteria used for the definition of hypertension (World Health Organization or 24-hour ambulatory blood pressure criteria). The GNB3 825T variant is associated with increased renal perfusion in this study. Because early renal hemodynamic changes play a pivotal role in the pathogenesis of essential hypertension, our data suggest a relevance of increased G-protein activation in the pathogenesis of hypertension.
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Affiliation(s)
- R Zeltner
- Department of Medicine/Nephrology, University of Erlangen-Nürnberg (Germany)
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Delles C, Erdmann J, Jacobi J, Hilgers KF, Fleck E, Regitz-Zagrosek V, Schmieder RE. Aldosterone synthase (CYP11B2) -344 C/T polymorphism is associated with left ventricular structure in human arterial hypertension. J Am Coll Cardiol 2001; 37:878-84. [PMID: 11693765 DOI: 10.1016/s0735-1097(00)01174-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [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: 10/18/2022]
Abstract
OBJECTIVES This study examined the association between the -344 C/T polymorphism of the human aldosterone synthase promoter and left ventricular structure in arterial hypertension. BACKGROUND Because of conflicting results from different studies, the mechanism of such an association, if any, has not been determined. METHODS We examined the aldosterone synthase promoter genotype in 120 young (age: 26 +/- 3 years) male, white subjects with normal or mildly elevated blood pressure. Left ventricular structural parameters and urinary sodium excretion over 24 h before and after additional oral sodium load (6 g/day over 1 week) were determined. RESULTS Hypertensive subjects with the CC genotype had a greater left ventricular end-diastolic diameter but smaller relative wall thickness than those with the TT genotype (54 +/- 2 vs. 50 +/- 4 mm, and 0.37 +/- 0.07 vs. 0.44 +/- 0.06 mm, respectively; p < 0.05). Hypertensive subjects with the TT genotype (n = 15) had a greater increase in urinary sodium excretion after oral sodium load than those with the CC genotype (n = 11) (135 +/- 95 vs. 24 +/- 133 mmol/liter/day; p < 0.05). Serum aldosterone levels were found to be decreased after oral sodium load in hypertensive subjects with the TT and CT genotypes only (-37 +/- 45 and -38 +/- 51 pg/ml, respectively; all p < 0.01) but not in those with the CC genotype (-12 +/- 30 pg/ml, n.s.). Such differences were not found in normotensive subjects. CONCLUSIONS Hypertensive subjects with the -344 CC genotype of the aldosterone synthase promoter are characterized by a pattern of early eccentric left ventricular hypertrophy. Differences in renal sodium handling across the genotypes might contribute to this finding.
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Affiliation(s)
- C Delles
- Department of Medicine/Nephrology, University of Erlangen, Nürnberg, Germany
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Schmieder RE, Erdmann J, Delles C, Jacobi J, Fleck E, Hilgers K, Regitz-Zagrosek V. Effect of the angiotensin II type 2-receptor gene (+1675 G/A) on left ventricular structure in humans. J Am Coll Cardiol 2001; 37:175-82. [PMID: 11153734 DOI: 10.1016/s0735-1097(00)01063-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [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: 11/30/2022]
Abstract
OBJECTIVES Our study goal was to analyze whether gene variants of angiotensin II type 2-receptor (AT2-R) modulate the effects of angiotensin II on the left ventricle (LV). BACKGROUND Experimental data suggest that angiotensin II modifies ventricular growth responses via angiotensin II type 1-receptors (AT1-R) and AT2-R. METHODS In 120 white, young male subjects with normal or mildly elevated blood pressure, we assessed plasma angiotensin II and aldosterone concentrations (RIA), 24-h urinary sodium excretion, 24-h ambulatory blood pressure and LV structure (two-dimensional guided M-mode echocardiography). The intronic +1675 G/A polymorphism of the X-chromosomal located AT2-R gene was investigated by single-strand conformational polymorphism analysis and DNA-sequencing. RESULTS Hypertensive subjects with the A-allele had a greater LV posterior (11.0 +/- 1.3 vs. 9.9 +/- 1.3 mm, p < 0.001), septal (11.8 +/- 1.4 vs. 10.1 +/- 1.2 mm, p < 0.001) and relative wall thickness (0.44 +/- 0.06 vs. 0.39 +/- 0.06, p < 0.01) as well as LV mass index (138 +/- 23 vs. 120 +/- 13 g/m2, p < 0.001) than those with the G-allele. Confounding factors (i.e., body mass index and surface area, plasma angiotensin II, sodium excretion, systolic and diastolic ambulatory blood pressure) were similar between the two genotypes. In normotensive subjects, relative wall thickness (0.36 +/- 0.05 vs. 0.35 +/- 0.05) and LV mass index (115 +/- 21 vs. 112 +/- 17 g/m2) were nearly identical across the two genotypes, with similar confounding variables. CONCLUSIONS Our data indicate that the X-chromosomal located +1675 G/A-polymorphism of the AT2-R gene is associated with LV structure in young male humans with early structural changes of the heart due to arterial hypertension.
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Affiliation(s)
- R E Schmieder
- Department of Medicine IV/Nephrology, University of Erlangen-Nürnberg, Germany.
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Schneider MP, Erdmann J, Delles C, Fleck E, Regitz-Zagrosek V, Schmieder RE. Functional gene testing of the Glu298Asp polymorphism of the endothelial NO synthase. J Hypertens 2000; 18:1767-73. [PMID: 11132600 DOI: 10.1097/00004872-200018120-00010] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To test whether the Glu298Asp polymorphism of the endothelial nitric oxide synthase (eNOS) gene is of functional relevance in humans by altering endothelium-dependent vasodilation. BACKGROUND The Asp298 variant of the eNOS gene product has been associated with arterial hypertension, coronary artery disease and myocardial infarction. The pathogenetic mechanism has not yet been elucidated. Since endothelium-dependent vasodilation has been shown to be impaired in these disorders, we hypothesized that the Glu298Asp polymorphism of the eNOS gene influences endothelium-dependent vasodilation. METHODS In 80 patients with normal or elevated cholesterol, endothelium-dependent and -independent vasodilation was assessed. Forearm blood flow was measured by plethysmography in response to intra-arterial (i.a.) infusion of 12 and 48 microg/min acetylcholine and 3.2 and 12.8 microg/min nitroprusside, respectively. NG-monomethyl-L-arginine (L-NMMA) in doses of 4, 8 and 16 micromol/min was infused to test basal nitric oxide (NO) production and release. Genomic DNA was extracted from blood samples to determine the Glu298Asp polymorphism of the eNOS gene at position 1917 G/T after BanII restriction. RESULTS Baseline parameters (age, gender, blood pressure, body mass index, cholesterol level) were similar across the genotypes. Genotype frequencies did not deviate from the Hardy-Weinberg equilibrium. No differences in forearm blood flow to i.a. acetylcholine (average increase: + 554 +/- 371%), nitroprusside or L-NMMA infusion were found across the eNOS genotypes, neither for endothelium-dependent or endothelium-independent vasodilation, nor for basal NO production and release. Our sample size of n = 80 had a power of > 80% (beta = 0.20) with a P value < 0.05 (alpha = 0.05) to detect a 200% difference in forearm blood flow response to 48 microg/min acetylcholine. CONCLUSIONS At a power of 80%, we can exclude a relevant effect on endothelium-dependent vasodilation due to the eNOS Glu298Asp polymorphism. Thus, our functional genetic study does not suggest any biological effect of the eNOS Glu298Asp genotype on the cardiovascular system via an influence on endothelium-dependent vasodilation.
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Affiliation(s)
- M P Schneider
- Department of Medicine/Nephrology, University of Erlangen-Nürnberg, Germany.
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Klingbeil AU, Müller HJ, Delles C, Fleischmann E, Schmieder RE. Regression of left ventricular hypertrophy by AT1 receptor blockade in renal transplant recipients. Am J Hypertens 2000; 13:1295-300. [PMID: 11130774 DOI: 10.1016/s0895-7061(00)01213-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AT1 receptor antagonists control blood pressure (BP) effectively and reduce left ventricular hypertrophy in patients with essential hypertension. Because left ventricular hypertrophy is very common in renal transplant recipients, we examined the cardiovascular effects and the safety profile of the AT1 receptor antagonist losartan in hypertensive renal transplant recipients. In 20 renal transplant recipients with stable renal graft function 50 mg of losartan was added to the preexisting antihypertensive treatment (no angiotensin-converting enzyme inhibitors) at least 6 months after renal transplantation. Twenty-four-hour ambulatory BP, two-dimensional-guided M-mode echocardiography, and duplex sonography, as well as renal function, red blood cell count, cyclosporine A and FK 506 levels, erythropoetin, and angiotensin II concentration were determined at baseline and after 6 months of therapy. With 24-h ambulatory BP measurement, systolic blood pressure (SBP) was reduced by 7.5 +/- 2.4 mm Hg and diastolic blood pressure (DBP) by 4.5 +/- 1.8 mm Hg (P < .01 and P < .05, respectively). Posterior, septal, and relative wall thickness decreased by 0.95 +/- 0.2 mm, 0.91 +/- 0.2 mm and 0.04 +/- 0.01 mm, respectively (all P < .001). Left ventricular mass index decreased by 18.1 +/- 4.7 g/m2 (P < .01). Ejection fraction and midwall fractional fiber shortening as systolic parameters and the relation of passive-to-active diastolic filling of the left ventricle were unaltered. Serum creatinine and cyclosporine A concentration remained stable in all patients. Hemoglobin and hematocrit decreased by 1.0 +/- 0.3 g/dL and 3.6% +/- 0.9%, respectively (P < .002 and P < .001) without a change in serum erythropoetin level. In renal transplant recipients the AT1 receptor antagonist losartan reduces left ventricular hypertrophy without altering systolic or diastolic function. It is safe with regard to renal function and immunosuppression, but slightly decreases hemoglobin level.
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Affiliation(s)
- A U Klingbeil
- Department of Medicine IV and Nephrology, University of Erlangen-Nürnberg, Germany
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Delles C, Erdmann J, Jacobi J, Fleck E, Regitz-Zagrosek V, Schmieder RE. Lack of association between polymorphisms of angiotensin II receptor genes and response to short-term angiotensin II infusion. J Hypertens 2000; 18:1573-8. [PMID: 11081769 DOI: 10.1097/00004872-200018110-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The physiological effects of polymorphisms of the renin-angiotensin-aldosterone system (RAAS) are poorly understood. Long-term effects of genetic variants can be studied in cross-sectional linkage studies. In this study, we examined the short-term effects of genetic polymorphisms of the angiotensin II AT1 - and AT2-receptor subtypes in humans by means of angiotensin II infusion. METHODS In 120 male, white, young (26 +/- 3 years) subjects with normal or mildly elevated blood pressure, changes in mean arterial blood pressure, aldosterone levels, glomerular filtration rate (GFR), and renal plasma flow (RPF) were measured in response to angiotensin II infusion (0.5 ng/kg per min and 3.0 ng/kg per min, each over 30 min). The -2228 G/A polymorphism of the AT1-receptor gene, and the +1675 G/A polymorphism of the AT2-receptor gene were determined by restriction digestion and single strand conformation polymorphism analysis, respectively. RESULTS Infusion of angiotensin II resulted in an increase in mean arterial pressure, serum aldosterone levels and GFR, and in a decrease in RPF (all P< 0.001). However, at similar baseline mean arterial pressure, aldosterone levels, and renal haemodynamics, the response to angiotensin II did not significantly differ across the AT1 - and AT2-receptor genotypes with the sample size of our study being adequate to detect relevant differences across the genotypes with a power of > 90% for all parameters. CONCLUSIONS The response to angiotensin II infusion does not differ across the the AT1- and AT2-receptor genotypes examined in our study. However, long-term effects of variants of angiotensin II receptor genes cannot be ruled out with this approach.
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Affiliation(s)
- C Delles
- Department of Medicine and Nephrology, University of Erlangen-Nürnberg, Germany
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Schlaich MP, Jacobi J, John S, Delles C, Fleischmann I, Schmieder RE. Is l-arginine infusion an adequate tool to assess endothelium-dependent vasodilation of the human renal vasculature? Clin Sci (Lond) 2000; 99:293-302. [PMID: 10995594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Systemic administration of L-arginine alters renal haemodynamics in humans. We examined whether L-arginine-induced vasodilation of the renal vasculature is related to an increased production and release of NO by comparing the effects of L- and D-arginine on renal endothelium-dependent vasodilation. In a double-blind randomized cross-over study including 20 young, healthy male white subjects (age 26+/-2 years), we determined the effects of intravenous administration of L-arginine or its enantiomer D-arginine, at doses of 100 mg/kg body weight for 30 min or 500 mg/kg for 30 min, on renal haemodynamics. Renal plasma flow (RPF) and glomerular filtration rate (GFR) were assessed by a constant-infusion input-clearance technique (using p-aminohippuric acid and inulin respectively). In addition, changes in blood pressure, heart rate, urinary sodium excretion (U(Na)) and urinary cGMP were measured. HPLC was used to determine L- and D-arginine concentrations. Intravenous infusion of L-arginine at 100 mg/kg for 30 min increased RPF from 641+/-87 to 677+/-98 ml/min (P=0.019), whereas infusion of D-arginine did not (from 642+/-74 to 657+/-86 ml/min; not significant). The change in RPF was more marked during the infusion of L-arginine than during the infusion of D-arginine (+36+/-61 versus +16+/-57 ml/min; P=0.037). Infusion of both L- and D-arginine at doses of 500 mg/kg for 30 min increased RPF from baseline [from 641+/-87 to 762+/-133 ml/min (P<0.001) and from 642+/-74 to 713+/-120 ml/min (P=0.004) respectively], but the change in RPF again was greater in response to L-arginine infusion than to infusion with D-arginine (+121+/-97 versus +71+/-94 ml/min; P=0.018). In accordance, changes in renal vascular resistance (RVR) were higher in response to L-arginine compared with D-arginine for both doses (P<0.05 and P<0.001 respectively). U(Na) increased only with L-arginine (change in U(Na), +0.33+/-0.26 mmol/min; P<0.01) but not with D-arginine (change in U(Na), +0.11+/-0.17 mmol/min; not significant). The change in U(Na) was more pronounced during infusion of L-arginine compared with infusion of D-arginine (P=0.023). In parallel, urinary excretion of cGMP only increased in response to L-arginine (+676+/-272 pmol/l; P=0.038) and not during D-arginine infusion (+185+/-153 pmol/l; not significant). L-Arginine-induced changes in RPF, RVR, U(Na) and cGMP excretion differed significantly from those induced by D-arginine. Thus although no direct measurements of NO synthesis were performed, putative markers of NO synthesis suggest that the renal vasodilatory response to L-arginine, at least in part, was due to increased production and release of NO. The dose of L-arginine at 100 mg/kg for 30 min emerged as the most suitable, because of the absence of systemic haemodynamic changes. The effects of infusion of L-arginine at 500 mg/kg for 30 min on renal endothelium-dependent vasodilation need to be corrected for the effects of D-arginine before conclusions can be drawn.
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Affiliation(s)
- M P Schlaich
- Department of Medicine IV/Nephrology, University of Erlangen-Nürnberg, Breslauer Str. 201, D-90471 Nürnberg, Germany
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Schmieder RE, Delles C, Messerli FH. Diuretic therapy and the risk for renal cell carcinoma. J Nephrol 2000; 13:343-6. [PMID: 11063137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Diuretics are important drugs in the treatment of arterial hypertension, congestive heart failure, the nephrotic syndrome, and other clinical conditions. With diuretic treatment, reduction of both morbidity and mortality has been clearly shown in those conditions. However, a recent meta-analysis showed an increased risk for renal cell carcinoma in patients treated with diuretics. We summarize and critically review data from studies examining the association between diuretic use and renal cell carcinoma. In general, in many clinical conditions, the reduction of mortality with diuretic therapy outweighs a potential risk of renal cell carcinoma. However, in certain conditions, alternative medical treatment should be considered.
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Affiliation(s)
- R E Schmieder
- Department of Medicine/Nephrology, University of Erlangen-Nürnberg, Germany.
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Abstract
OBJECTIVE Premenopausal women are protected against atherosclerosis by high plasma estrogen levels, which have been suggested to augment endothelial nitric oxide synthesis and to improve endothelial function. In contrast, premenopausal use of oral contraceptives is associated with an increased cardiovascular risk. We investigated the influence of oral contraception on endothelial function. STUDY DESIGN Sixteen healthy premenopausal women with a mean age (+/-SD) of 27 +/- 3 years, 8 of whom used oral contraceptives and 8 of whom did not, were examined in a case-control study. Forearm plethysmography was used to measure changes of forearm blood flow in response to intra-arterial infusion of increasing doses of acetylcholine, sodium nitroprusside, and N (G)-monomethyl-L -arginine. RESULTS Endothelium-dependent vasodilatation (change from baseline after acetylcholine 48 microg/min) was similar between women with (828% +/- 137%) and without oral contraception (701% +/- 114%; P not significant), as was endothelium-independent vasodilatation (change from baseline after sodium nitroprusside 3200 ng/min, 271% +/- 38% vs 289% +/- 23%; P not significant). In contrast, inhibition of nitric oxide synthase with N (G)-monomethyl-L -arginine induced a significantly more marked decrease in blood flow among women with oral contraception than among those without at all dosages (change from baseline after 4-micromol/min N (G)-monomethyl-L -arginine, -26% +/- 3% vs -14% +/- 5%; P =.009 by analysis of variance). CONCLUSION Stimulated nitric oxide bioavailability remained unaffected in a group of premenopausal women receiving oral contraceptives. In contrast, basal nitric oxide production and release appeared to be enhanced by oral contraceptive use.
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Affiliation(s)
- S John
- Department of Medicine IV, University of Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Germany
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John S, Jacobi J, Delles C, Schlaich MP, Alter O, Schmieder RE. Plasma soluble adhesion molecules and endothelium-dependent vasodilation in early human atherosclerosis. Clin Sci (Lond) 2000; 98:521-9. [PMID: 10781382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Levels of soluble cellular adhesion molecules are increased in patients with atherosclerosis, and have been found to predict coronary heart disease. Therefore these molecules have been suggested to represent laboratory markers for inflammation and activation of endothelial cells. Impaired endothelium-dependent vasodilation has been demonstrated to be an early marker of atherosclerosis. We hypothesized that soluble adhesion molecules are related to impaired endothelium-dependent vasodilation and may serve as an early marker of atherosclerosis. Patients (n=52) with moderate and uncomplicated hypercholesterolaemia [low-density lipoprotein (LDL)-cholesterol 4.89+/-1.26 mmol/l] were compared with healthy controls (n=43; LDL-cholesterol 2.44+/-0.79 mmol/l). Endothelium-dependent vasodilation of the forearm vasculature was assessed by intra-arterial infusion of acetylcholine (12 and 48 microg/min). Forearm blood flow was measured by venous occlusion plethysmography. Plasma concentrations of the soluble forms of ICAM-1 (intercellular cell adhesion molecule-1), VCAM-1 (vascular cell adhesion molecule-1) and E-selectin were measured by ELISA. Hypercholesterolaemic patients had impaired endothelium-dependent vasodilation in comparison with healthy controls (forearm blood flow after 48 microg/min acetylcholine: 21.3+/-10.6 and 30.4+/-16.3 ml. min(-1).100 ml(-1) respectively; P=0.002). Plasma concentrations of soluble adhesion molecules were not different between hypercholesterolaemic patients and controls (ICAM-1, 196+/-56 and 180+/-38 ng/ml respectively; VCAM-1, 431+/-137 and 405+/-65 ng/ml respectively; E-selectin, 39+/-17 and 37+/-12 ng/ml respectively). Moreover, levels of soluble adhesion molecules were not correlated with endothelium-dependent vasodilation. Thus, in hypercholesterolaemic patients without clinical atherosclerosis, levels of soluble adhesion molecules were not elevated in comparison with healthy controls. In addition, these markers of endothelial inflammation were not related to impaired endothelium-dependent vasodilation. Our data indicate that measurement of levels of soluble adhesion molecules cannot replace assessment of endothelium-dependent vasodilation in detection of early hypercholesterolaemic atherosclerosis.
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Affiliation(s)
- S John
- Department of Medicine IV, University of Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Breslauerstr. 201, 90471 Nürnberg, Germany
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John S, Delles C, Klingbeil AU, Jacobi J, Schlaich MP, Schmieder RE. Low-density lipoprotein-cholesterol determines vascular responsiveness to angiotensin II in normocholesterolaemic humans. J Hypertens 1999; 17:1933-9. [PMID: 10703892 DOI: 10.1097/00004872-199917121-00024] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Both LDL-cholesterol and angiotensin II have been shown to increase the risk for and severity of cardiovascular disease. In hypercholesterolaemia, experimental studies have demonstrated an increased angiotensin type 1 (AT1) receptor expression on vascular smooth muscle cells and an increased vascular responsiveness to vasopressors has been documented in humans. We investigated in a normocholesterolaemic young population whether vascular responsiveness to angiotensin II (Ang II) infusion depends on LDL-cholesterol serum levels in the systemic and renal circulation. DESIGN AND METHODS Changes in systolic and diastolic blood pressure (deltaBP) to Ang II infusion (0.5 and 3.0 ng/kg per min) were investigated in 103 normocholesterolaemic (LDL-cholesterol < 160 mg/dl) young white men (26+/-3 years; 24 h BP: 128+/-10/75+/-7 mmHg) without cardiovascular disease. According to their LDL-cholesterol levels, participants were classified into tertiles (lower tertile < 85 mg/dl, middle tertile 85-111 mg/dl, upper tertile > 111 mg/dl). RESULTS Blood pressure (BP) responses to Ang II infusion 3.0 ng/kg per min were enhanced in the group with the highest LDL-cholesterol levels (delta systolic BP: +12.8+/-6.7, +13.2+/-8.6, +17.9+/-9.6, P < 0.02; delta diastolic BP: +11.1+/-5.8, +11.5+/-6.5, +16.5+/-8.3, P < 0.01, for the lower, middle and upper tertiles, respectively). This holds true when baseline BP was taken into account as a confounding covariable (P < 0.015). BP responses to Ang II infusion were related to LDL-cholesterol serum levels (delta systolic BP: r = 0.26, P = 0.01; delta diastolic BP: r = 0.32, P = 0.001). In multiple stepwise regression analysis, LDL-cholesterol emerged as the strongest determinant of vascular responsiveness to Ang II (delta systolic BP: P < 0.01; delta diastolic BP: P < 0.001). CONCLUSION In young male subjects, responsiveness to Ang II is determined by the LDL-cholesterol serum level even in the normal range of LDL-cholesterol, thereby potentially contributing to the cardiovascular risk of LDL-cholesterol even within the so-called normal range.
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Affiliation(s)
- S John
- Department of Medicine IV, University of Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Germany
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