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Kashani F, Weiss BG, Bartenstein P, Canis M, Haubner F. Lymphatic drainage of sinonasal malignancies and the role of sentinel node biopsies. Orphanet J Rare Dis 2024; 19:120. [PMID: 38481240 PMCID: PMC10938691 DOI: 10.1186/s13023-024-03127-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Locoregional recurrence is a critical factor in the prognosis of sinonasal malignancies. Due to the rarity of these tumours, as well as the heterogeneity of histologies and anatomical subsites, there is little evidence regarding the rate and location of regional metastases in sinonasal malignancies. Elective regional lymph node dissection in the therapy of sinonasal malignancies has become controversial. On the one hand, elective regional lymph node dissection is considered to be an overtreatment in the cN0 cases. On the other hand, undetected occult lymphatic metastases are associated with a poor prognosis. In this study, we discuss the role of sentinel lymph node biopsy as a minimally invasive procedure in the treatment of sinonasal malignancies based on our two years of practical experience and the currently available data. RESULTS This is a descriptive, monocentric, retrospective study, including 20 cases of cN0 malignant sinonasal neoplasm, that underwent a surgical therapy between 2020 and 2022. The following aspects were investigated: tumour entity, localisation of the primary tumour, tumoral stage, localisation of the sentinel lymph nodes, and postoperative complications. Squamous cell carcinoma was the most frequently diagnosed tumour entity (50%), followed by adenocarcinoma (20%) and malignant melanoma (15%), adenoid cystic carcinoma and mucoepidermoid carcinoma. Sentinel lymph nodes were most frequently found in the ipsilateral neck region I (45%), followed by the ipsilateral neck region II (40%). In all cases, the removed lymph nodes were free of malignancy. There were no postoperative complications due to lymph node biopsy. There were no recurrences during the study period. CONCLUSION Sentinel node biopsy could add more safety to the management of cN0 sinonasal malignancies due to its low morbidity. Whether SNB could provide an alternative to elective neck dissection in the management of SNM should be investigated in further studies.
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Affiliation(s)
- Fatemeh Kashani
- Department of Otorhinolarnygology, Head and Neck Surgery, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.
| | - B G Weiss
- Department of Otorhinolarnygology, Head and Neck Surgery, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians University, Munich, Germany
| | - M Canis
- Department of Otorhinolarnygology, Head and Neck Surgery, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany
| | - F Haubner
- Department of Otorhinolarnygology, Head and Neck Surgery, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany
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Haubner F, Schneider A, Schinke H, Bertlich M, Weiss BG, Canis M, Kashani F. Classification of endonasal HHT lesions using digital microscopy. Orphanet J Rare Dis 2021; 16:182. [PMID: 33865423 PMCID: PMC8053266 DOI: 10.1186/s13023-021-01801-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recurrent spontaneous epistaxis is the most common clinical manifestation and the most debilitating symptom in hereditary haemorrhagic telangiectasia (HHT) patients. To this date, there exist only a classification of HHT patients by different genetic mutations. There is no standard classification for the mucocutaneous endonasal manifestations of HHT. The aim of the present study was to document the variety of endonasal HHT lesions using digital microscopy and to propose a clinical classification. METHODS We recorded the endonasal HHT lesions of 28 patients using a digital microscope. We reconstructed the 3D images und videos recorded by digital microscope afterwards and classified the endonasal lesions of HHT in two classes: Grade A, presence of only flat telangiectasias in the mucosa level and Grade B, (additional) presence of raised berry or wart-like telangiectasia spots. We investigated also Haemoglobin level by routine laboratory procedures, plasma VEGF level by ELISA, Severity of epistaxis by epistaxis severity score (ESS) and quality of life by a linear visual analogue scale (VAS). RESULTS We found a higher quality of life and a lower severity of epistaxis in Grade A patients in comparison to Grade B patients. No difference in plasma VEGF level and in Haemoglobin between Grad A patients and Grade B patients could be detected. Plasma VEGF levels showed no gender specific differences. It could also not be correlated to the extranasal manifestation. CONCLUSION The classification for endonasal manifestation of HHT proposed in this study indicates severity of epistaxis und quality of life. Digital microscopy with the ability of 3D reconstruction of images presents a useful tool for such classifications. The classification of endonasal HHT lesions using digital microscopy allows to evaluate the dynamic of HHT lesions in the course of time independent of examiner. This allows also to evaluate the efficacy of the different treatment modalities by dynamic of HHT lesions. Moreover digital microscopy is very beneficial in academic teaching of rare diseases.
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Affiliation(s)
- F Haubner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | | | - H Schinke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - M Bertlich
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - B G Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - M Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - F Kashani
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Kashani F, Haubner F. [Nasal foreign body - innocuous or pernicious?]. MMW Fortschr Med 2020; 162:44-45. [PMID: 32895833 DOI: 10.1007/s15006-020-1212-2] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Fatemeh Kashani
- Klinik u. Poliklinik f. Hals-Nasen-Ohrenheilkunde, Marchioninistraße 15, 81377, München, Germany.
| | - Frank Haubner
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Marchioninistr. 15, 81377, München, Germany
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Bertlich M, Kashani F, Weiss BG, Wiebringhaus R, Ihler F, Freytag S, Gires O, Kühnel T, Haubner F. Safety and Efficacy of Blue Light Laser Treatment in Hereditary Hemorrhagic Telangiectasia. Lasers Surg Med 2020; 53:309-315. [PMID: 32573010 DOI: 10.1002/lsm.23289] [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: 04/15/2020] [Revised: 06/09/2020] [Accepted: 06/14/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Hereditary hemorrhagic telangiectasia (HHT) is a hereditary condition that is associated with arteriovenous malformations. A common site for these malformations is the nasal mucosa, which is associated with severe epistaxis and debilitation for affected patients. We evaluated the efficacy and safety of blue light laser technology in treating these endonasal manifestations in a retrospective chart analysis. Additionally, we compared blue light laser technology to bipolar coagulation in an animal model. STUDY DESIGN/MATERIALS AND METHODS We performed a retrospective chart analysis of all patients that were diagnosed with HHT and received endonasal blue light laser treatment between 10/2017 and 04/2019. In addition, we performed bipolar or blue light laser coagulation of all macroscopically visible vessels on thyroid gland lobes (n = 4) from Dunkin-Hartley Guinea Pigs. Hematoxylin-eosin (HE) staining was then used to visualize depth and area of coagulation surrounding these vessels. RESULTS One hundred and fifty-one treatments in 23 patients were analyzed. Under regular blue light laser treatment, quality of life (QOL), indicated on a visual analog scale from 1 to 10, gradually increased significantly from 5.6 ± 0.5 (before the first treatment) to 7.5 ± 0.9 (after the second treatment). Following this, QOL remained steady throughout additional treatments. Adverse effects were not recorded. HE staining showed that coagulation depth (162 ± 56 vs. 586 ± 192 µm) and area (74 ± 35 vs. 1015 ± 449 µm2 ) were significantly lower after laser treatment. CONCLUSION Blue light laser therapy is safe and efficient in treating HHT. Damage to the surrounding tissue is significantly lower compared with bipolar coagulation. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.
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Affiliation(s)
- Mattis Bertlich
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Marchioninistr. 15, Munich, 81377, Germany
| | - Fatemeh Kashani
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Marchioninistr. 15, Munich, 81377, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Marchioninistr. 15, Munich, 81377, Germany
| | - Robert Wiebringhaus
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Marchioninistr. 15, Munich, 81377, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Marchioninistr. 15, Munich, 81377, Germany
| | - Saskia Freytag
- Epigenetics and Genomics, The Harry Perkins Institute of Medical Research, 6 Verdun St, Nedlands, Western Australia, 6009, Australia
| | - Olivier Gires
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Marchioninistr. 15, Munich, 81377, Germany.,Clinical Cooperation Group "Personalized Radiotherapy in Head and Neck Cancer", Helmholtz Zentrum, Marchioninistr. 25, Munich, 81377, Germany
| | - Thomas Kühnel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, 93047, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Marchioninistr. 15, Munich, 81377, Germany
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Affiliation(s)
- Fatemeh Kashani
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Univ. München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland.
| | - Frank Haubner
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Univ. München, München, Deutschland
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Kashani F, Schrötzlmair F, Canis M, Haubner F. Ungewöhnlicher Befund in der Tumornachsorge. Laryngorhinootologie 2019; 98:568-570. [DOI: 10.1055/a-0889-8447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Steven S, Dib M, Hausding M, Kashani F, Oelze M, Kröller-Schön S, Hanf A, Daub S, Roohani S, Gramlich Y, Lutgens E, Schulz E, Becker C, Lackner KJ, Kleinert H, Knosalla C, Niesler B, Wild PS, Münzel T, Daiber A. CD40L controls obesity-associated vascular inflammation, oxidative stress, and endothelial dysfunction in high fat diet-treated and db/db mice. Cardiovasc Res 2019; 114:312-323. [PMID: 29036612 DOI: 10.1093/cvr/cvx197] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/25/2017] [Indexed: 01/29/2023] Open
Abstract
Aims CD40 ligand (CD40L) signaling controls vascular oxidative stress and related dysfunction in angiotensin-II-induced arterial hypertension by regulating vascular immune cell recruitment and platelet activation. Here we investigated the role of CD40L in experimental hyperlipidemia. Methods and results Male wild type and CD40L-/- mice (C57BL/6 background) were subjected to high fat diet for sixteen weeks. Weight, cholesterol, HDL, and LDL levels, endothelial function (isometric tension recording), oxidative stress (NADPH oxidase expression, dihydroethidium fluorescence) and inflammatory parameters (inducible nitric oxide synthase, interleukin-6 expression) were assessed. CD40L expression, weight, leptin and lipids were increased, and endothelial dysfunction, oxidative stress and inflammation were more pronounced in wild type mice on a high fat diet, all of which was almost normalized by CD40L deficiency. Similar results were obtained in diabetic db/db mice with CD40/TRAF6 inhibitor (6877002) therapy. In a small human study higher serum sCD40L levels and an inflammatory phenotype were detected in the blood and Aorta ascendens of obese patients (body mass index > 35) that underwent by-pass surgery. Conclusion CD40L controls obesity-associated vascular inflammation, oxidative stress and endothelial dysfunction in mice and potentially humans. Thus, CD40L represents a therapeutic target in lipid metabolic disorders which is a leading cause in cardiovascular disease.
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Affiliation(s)
- Sebastian Steven
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Mobin Dib
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Michael Hausding
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Fatemeh Kashani
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Matthias Oelze
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Swenja Kröller-Schön
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Alina Hanf
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Steffen Daub
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Siyer Roohani
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Yves Gramlich
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Esther Lutgens
- Department of Medical Biochemistry, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Institute for Cardiovascular Prevention (IPEK), Ludwig Maximilian's University (LMU), Munich, Germany
| | - Eberhard Schulz
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Christian Becker
- Department of Dermatology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Hartmut Kleinert
- Department of Pharmacology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Beate Niesler
- nCounter Core Facility, Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg, Heidelberg, Germany
| | - Philipp S Wild
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Andreas Daiber
- Center for Cardiology 1, Molecular Cardiology; Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
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Steven S, Dib M, Roohani S, Kashani F, Münzel T, Daiber A. Time Response of Oxidative/Nitrosative Stress and Inflammation in LPS-Induced Endotoxaemia-A Comparative Study of Mice and Rats. Int J Mol Sci 2017; 18:ijms18102176. [PMID: 29057830 PMCID: PMC5666857 DOI: 10.3390/ijms18102176] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/01/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022] Open
Abstract
Sepsis is a severe and multifactorial disease with a high mortality rate. It represents a strong inflammatory response to an infection and is associated with vascular inflammation and oxidative/nitrosative stress. Here, we studied the underlying time responses in the widely used lipopolysaccharide (LPS)-induced endotoxaemia model in mice and rats. LPS (10 mg/kg; from Salmonella Typhosa) was intraperitoneally injected into mice and rats. Animals of every species were divided into five groups and sacrificed at specific points in time (0, 3, 6, 9, 12 h). White blood cells (WBC) decreased significantly in both species after 3 h and partially recovered with time, whereas platelet decrease did not recover. Oxidative burst and iNOS-derived nitrosyl-iron hemoglobin (HbNO) increased with time (maxima at 9 or 12 h). Immune cell infiltration (CD68 and F4/80 content) showed an increase with time, which was supported by increased vascular mRNA expression of VCAM-1, P-selectin, IL-6 and TNF-α. We characterized the time responses of vascular inflammation and oxidative/nitrosative stress in LPS-induced endotoxaemic mice and rats. The results of this study will help to interpret and compare data from different animal species in LPS-induced endotoxaemia models for the identification of new drug targets.
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Affiliation(s)
- Sebastian Steven
- Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, D-55131 Mainz, Germany.
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, D-55131 Mainz, Germany.
| | - Mobin Dib
- Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, D-55131 Mainz, Germany.
| | - Siyer Roohani
- Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, D-55131 Mainz, Germany.
| | - Fatemeh Kashani
- Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, D-55131 Mainz, Germany.
| | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, D-55131 Mainz, Germany.
| | - Andreas Daiber
- Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, D-55131 Mainz, Germany.
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, D-55131 Mainz, Germany.
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Steven S, Oelze M, Roohani S, Kashani F, Hausding M, Kroeller-Schoen S, Schulz E, Munzel T, Daiber A. P3470Suppression of endothelin-1 signaling by macitentan improves isosorbide-5-mononitrate (ISMN) and isosorbide dinitrate (ISDN) induced endothelial dysfunction, oxidative stress and vascular inflammation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Steven S, Oelze M, Hanf A, Kröller-Schön S, Kashani F, Roohani S, Welschof P, Kopp M, Gödtel-Armbrust U, Xia N, Li H, Schulz E, Lackner KJ, Wojnowski L, Bottari SP, Wenzel P, Mayoux E, Münzel T, Daiber A. The SGLT2 inhibitor empagliflozin improves the primary diabetic complications in ZDF rats. Redox Biol 2017; 13:370-385. [PMID: 28667906 PMCID: PMC5491464 DOI: 10.1016/j.redox.2017.06.009] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/20/2022] Open
Abstract
Hyperglycemia associated with inflammation and oxidative stress is a major cause of vascular dysfunction and cardiovascular disease in diabetes. Recent data reports that a selective sodium-glucose co-transporter 2 inhibitor (SGLT2i), empagliflozin (Jardiance®), ameliorates glucotoxicity via excretion of excess glucose in urine (glucosuria) and significantly improves cardiovascular mortality in type 2 diabetes mellitus (T2DM). The overarching hypothesis is that hyperglycemia and glucotoxicity are upstream of all other complications seen in diabetes. The aim of this study was to investigate effects of empagliflozin on glucotoxicity, β-cell function, inflammation, oxidative stress and endothelial dysfunction in Zucker diabetic fatty (ZDF) rats. Male ZDF rats were used as a model of T2DM (35 diabetic ZDF‐Leprfa/fa and 16 ZDF-Lepr+/+ controls). Empagliflozin (10 and 30 mg/kg/d) was administered via drinking water for 6 weeks. Treatment with empagliflozin restored glycemic control. Empagliflozin improved endothelial function (thoracic aorta) and reduced oxidative stress in the aorta and in blood of diabetic rats. Inflammation and glucotoxicity (AGE/RAGE signaling) were epigenetically prevented by SGLT2i treatment (ChIP). Linear regression analysis revealed a significant inverse correlation of endothelial function with HbA1c, whereas leukocyte-dependent oxidative burst and C-reactive protein (CRP) were positively correlated with HbA1c. Viability of hyperglycemic endothelial cells was pleiotropically improved by SGLT2i. Empagliflozin reduces glucotoxicity and thereby prevents the development of endothelial dysfunction, reduces oxidative stress and exhibits anti-inflammatory effects in ZDF rats, despite persisting hyperlipidemia and hyperinsulinemia. Our preclinical observations provide insights into the mechanisms by which empagliflozin reduces cardiovascular mortality in humans (EMPA-REG trial). Hyperglycemia induces vascular complications and cardiovascular disease. Empagliflozin reduces hyperglycemia and cardiovascular mortality (EMPA-REG trial). Here, empagliflozin normalized vascular function and oxidative stress in ZDF rats. Here, empagliflozin reduced AGE/RAGE signaling, inflammation and oxidative stress. Here, empagliflozin conferred glycemic control, epigenetic and pleiotropic effects.
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Affiliation(s)
- Sebastian Steven
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany; Center for Thrombosis and Hemostasis, Medical Center of the Johannes Gutenberg University, Mainz, Germany, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Matthias Oelze
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alina Hanf
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Swenja Kröller-Schön
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Fatemeh Kashani
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Siyer Roohani
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp Welschof
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Maximilian Kopp
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ute Gödtel-Armbrust
- Department of Pharmacology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ning Xia
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Huige Li
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Eberhard Schulz
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Karl J Lackner
- Institute for Advanced Biosciences, INSERM U1209 - CNRS UMR 5309, Grenoble-Alps University and Institute for Biology and Pathology, CHU, Grenoble, France
| | - Leszek Wojnowski
- Department of Pharmacology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Serge P Bottari
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Philip Wenzel
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany; Center for Thrombosis and Hemostasis, Medical Center of the Johannes Gutenberg University, Mainz, Germany, Medical Center of the Johannes Gutenberg University, Mainz, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Eric Mayoux
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Andreas Daiber
- Center for Cardiology, Cardiology I - Laboratory of Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany.
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Steven S, Jurk K, Kopp M, Kröller-Schön S, Mikhed Y, Schwierczek K, Roohani S, Kashani F, Oelze M, Klein T, Tokalov S, Danckwardt S, Strand S, Wenzel P, Münzel T, Daiber A. Glucagon-like peptide-1 receptor signalling reduces microvascular thrombosis, nitro-oxidative stress and platelet activation in endotoxaemic mice. Br J Pharmacol 2016; 174:1620-1632. [PMID: 27435156 DOI: 10.1111/bph.13549] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/01/2016] [Accepted: 07/08/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Excessive inflammation in sepsis causes microvascular thrombosis and thrombocytopenia associated with organ dysfunction and high mortality. The present studies aimed to investigate whether inhibition of dipeptidyl peptidase-4 (DPP-4) and supplementation with glucagon-like peptide-1 (GLP-1) receptor agonists improved endotoxaemia-associated microvascular thrombosis via immunomodulatory effects. EXPERIMENTAL APPROACH Endotoxaemia was induced in C57BL/6J mice by a single injection of LPS (17.5 mg kg-1 for survival and 10 mg kg-1 for all other studies). For survival studies, treatment was started 6 h after LPS injection. For all other studies, drugs were injected 48 h before LPS treatment. KEY RESULTS Mice treated with LPS alone showed severe thrombocytopenia, microvascular thrombosis in the pulmonary circulation (fluorescence imaging), increased LDH activity, endothelial dysfunction and increased markers of inflammation in aorta and whole blood (leukocyte-dependent oxidative burst, nitrosyl-iron haemoglobin, a marker of nitrosative stress, and expression of inducible NOS). Treatment with the DPP-4 inhibitor linagliptin or the GLP-1 receptor agonist liraglutide, as well as genetic deletion of DPP-4 (DPP4-/- mice) improved all these parameters. In GLP-1 receptor-deficient mice, both linagliptin and liraglutide lost their beneficial effects and improvement of prognosis. Incubation of platelets and cultured monocytes (containing GLP-1 receptor protein) with GLP-1 receptor agonists inhibited the monocytic oxidative burst and platelet activation, with a GLP-1 receptor-dependent elevation of cAMP levels and PKA activation. CONCLUSIONS AND IMPLICATIONS GLP-1 receptor activation in platelets by linagliptin and liraglutide strongly attenuated endotoxaemia-induced microvascular thrombosis and mortality by a cAMP/PKA-dependent mechanism, preventing systemic inflammation, vascular dysfunction and end organ damage. LINKED ARTICLES This article is part of a themed section on Redox Biology and Oxidative Stress in Health and Disease. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.12/issuetoc.
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Affiliation(s)
- Sebastian Steven
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Kerstin Jurk
- Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Maximilian Kopp
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Swenja Kröller-Schön
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Yuliya Mikhed
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Kathrin Schwierczek
- Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Siyer Roohani
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Fatemeh Kashani
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Matthias Oelze
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas Klein
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Sergey Tokalov
- Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Sven Danckwardt
- Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Susanne Strand
- I. Department of Internal Medicine, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Philip Wenzel
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas Münzel
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Daiber
- Centre for Cardiology, Cardiology I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Mikhed Y, Fahrer J, Oelze M, Kröller-Schön S, Steven S, Welschof P, Zinßius E, Stamm P, Kashani F, Roohani S, Kress JM, Ullmann E, Tran LP, Schulz E, Epe B, Kaina B, Münzel T, Daiber A. Nitroglycerin induces DNA damage and vascular cell death in the setting of nitrate tolerance. Basic Res Cardiol 2016; 111:52. [DOI: 10.1007/s00395-016-0571-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 12/13/2022]
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