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Ameri P, Mercurio V, Pollesello P, Anker MS, Backs J, Bayes-Genis A, Borlaug BA, Burkhoff D, Caravita S, Chan SY, de Man F, Giannakoulas G, González A, Guazzi M, Hassoun PM, Hemnes AR, Maack C, Madden B, Melenovsky V, Müller OJ, Papp Z, Pullamsetti SS, Rainer PP, Redfield MM, Rich S, Schiattarella GG, Skaara H, Stellos K, Tedford RJ, Thum T, Vachiery JL, van der Meer P, Van Linthout S, Pruszczyk P, Seferovic P, Coats AJS, Metra M, Rosano G, Rosenkranz S, Tocchetti CG. A roadmap for therapeutic discovery in pulmonary hypertension associated with left heart failure. A scientific statement of the Heart Failure Association (HFA) of the ESC and the ESC Working Group on Pulmonary Circulation & Right Ventricular Function. Eur J Heart Fail 2024. [PMID: 38639017 DOI: 10.1002/ejhf.3236] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/23/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
Pulmonary hypertension (PH) associated with left heart failure (LHF) (PH-LHF) is one of the most common causes of PH. It directly contributes to symptoms and reduced functional capacity and negatively affects right heart function, ultimately leading to a poor prognosis. There are no specific treatments for PH-LHF, despite the high number of drugs tested so far. This scientific document addresses the main knowledge gaps in PH-LHF with emphasis on pathophysiology and clinical trials. Key identified issues include better understanding of the role of pulmonary venous versus arteriolar remodelling, multidimensional phenotyping to recognize patient subgroups positioned to respond to different therapies, and conduct of rigorous pre-clinical studies combining small and large animal models. Advancements in these areas are expected to better inform the design of clinical trials and extend treatment options beyond those effective in pulmonary arterial hypertension. Enrichment strategies, endpoint assessments, and thorough haemodynamic studies, both at rest and during exercise, are proposed to play primary roles to optimize early-stage development of candidate therapies for PH-LHF.
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Affiliation(s)
- Pietro Ameri
- Department of Internal Medicine, University of Genova, Genoa, Italy
- Cardiac, Thoracic, and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Interdepartmental Center for Clinical and Translational Research (CIRCET), and Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Piero Pollesello
- Content and Communication, Branded Products, Orion Pharma, Espoo, Finland
| | - Markus S Anker
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin (Campus CBF), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, University Hospital Heidelberg, University of Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Sergio Caravita
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
- Department of Cardiology, Istituto Auxologico Italiano IRCCS Ospedale San Luca, Milan, Italy
| | - Stephen Y Chan
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Frances de Man
- PHEniX laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aránzazu González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain
- CIBERCV, Madrid, Spain
| | - Marco Guazzi
- University of Milan, Milan, Italy
- Cardiology Division, San Paolo University Hospital, Milan, Italy
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cristoph Maack
- Comprehensive Heart Failure Center (CHFC) and Medical Clinic I, University Clinic Würzburg, Würzburg, Germany
| | | | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Oliver J Müller
- Department of Internal Medicine V, University Hospital Schleswig-Holstein, and German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Zoltan Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Soni Savai Pullamsetti
- Department of Internal Medicine and Excellence Cluster Cardio-Pulmonary Institute (CPI), Justus-Liebig University, Giessen, Germany
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- Department of Medicine, St. Johann in Tirol General Hospital, St. Johann in Tirol, Austria
| | | | - Stuart Rich
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gabriele G Schiattarella
- Max-Rubner Center (CMR), Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Hall Skaara
- Pulmonary Hypertension Association Europe, Vienna, Austria
| | - Kostantinos Stellos
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site, Heidelberg and Mannheim, Germany
- Department of Cardiology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Jean Luc Vachiery
- Department of Cardiology, Hopital Universitaire de Bruxelles Erasme, Brussels, Belgium
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sophie Van Linthout
- Berlin Institute of Health (BIH) at Charité, BIH Center for Regenerative Therapies, University of Medicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK, partner site Berlin), Berlin, Germany
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Petar Seferovic
- University of Belgrade Faculty of Medicine, Belgrade University Medical Center, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Stephan Rosenkranz
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Interdepartmental Center for Clinical and Translational Research (CIRCET), and Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy
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2
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Schwegel N, Zach D, Peikert A, Santner V, Höller V, Gollmer J, Späth J, Riepl H, Rainer PP, Wallner M, Pilz S, Zirlik A, von Lewinski D, Ablasser K, Verheyen N, Kolesnik E. The Prognostic Value of Right Ventricular Function in Patients with Chronic Heart Failure-A Prospective Study. J Clin Med 2024; 13:1930. [PMID: 38610695 PMCID: PMC11012981 DOI: 10.3390/jcm13071930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: In patients with stable chronic heart failure with a reduced ejection fraction (HFrEF), left ventricular ejection fraction (LVEF) provides limited prognostic value, especially in patients with moderately to severely reduced LVEF. Echocardiographic parameters of right ventricular function may be associated with adverse clinical events in these patients. Therefore, we analyzed 164 patients with HFrEF in a prospective single-center cohort study to evaluate whether the parameters of right ventricular function are associated with worsening heart failure (WHF) hospitalizations, cardiovascular and all-cause deaths and combined endpoints. Methods: Echocardiographic cine loops were analyzed using vendor-independent post-processing software. Multivariate Cox regression analyses were performed, which were then adjusted for clinical characteristics and left ventricular functional parameters. Results: In these models, higher tricuspid annular plane systolic excursion (TAPSE) was significantly associated with lower rates of WHF hospitalizations (HR 0.880, 95%CI 0.800-0.968, p = 0.008), a composite endpoint of WHF hospitalizations and cardiovascular death (HR 0.878, 95%CI 0.800-0.964, p = 0.006), and a composite endpoint of WHF hospitalization and all-cause death (HR 0.918, 95%CI 0.853-0.988, p = 0.023). These associations were more pronounced in patients with LVEF ≤ 35%. Conclusions: In conclusion, in patients with HFrEF, TAPSE is an independent prognosticator for adverse clinical outcomes, warranting further studies to elucidate whether incorporating TAPSE into established risk scores improves their diagnostic accuracy.
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Affiliation(s)
- Nora Schwegel
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - David Zach
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Alexander Peikert
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Viktoria Santner
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Viktoria Höller
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Johannes Gollmer
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Johannes Späth
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Hermann Riepl
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Peter P. Rainer
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
- Department of Medicine, St. Johann in Tirol General Hospital, 6380 St. Johann in Tirol, Austria
- BioTechMed Graz, 8010 Graz, Austria
| | - Markus Wallner
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Andreas Zirlik
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Klemens Ablasser
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Nicolas Verheyen
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
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3
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Zach DK, Schwegel N, Santner V, Winkelbauer L, Hoeller V, Kolesnik E, Gollmer J, Seggewiss H, Batzner A, Perl S, Wallner M, Reiter U, Rainer PP, Zirlik A, Ablasser K, Verheyen N. Low-grade systemic inflammation and left ventricular dysfunction in hypertensive compared to non-hypertensive hypertrophic cardiomyopathy. Int J Cardiol 2024; 399:131661. [PMID: 38158132 DOI: 10.1016/j.ijcard.2023.131661] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Arterial hypertension (HTN) is associated with excess mortality in hypertrophic cardiomyopathy (HCM), but underlying mechanisms are largely elusive. The objective of this study was to investigate the association between HTN and markers of left ventricular (LV) dysfunction and low-grade systemic inflammation in a HCM cohort. METHODS This was a single-center cross-sectional case-control study comparing echocardiographic and plasma-derived indices of LV dysfunction and low-grade systemic inflammation between 30 adult patients with HCM and HTN (HTN+) and 30 sex- and age-matched HCM patients without HTN (HTN-). Echocardiographic measures were assessed using post-processing analyses by blinded investigators. RESULTS Mean age of the study population was 55.1 ± 10.4 years, 30% were women. Echocardiographic measures of systolic and diastolic dysfunction, including speckle-tracking derived parameters, did not differ between HTN+ and HTN-. Moreover, levels of N-terminal pro B-type natriuretic peptide were balanced between cases and controls. Compared with HTN-, HTN+ patients exhibited a higher white blood cell count [8.1 ± 1.8 109/l vs. 6.4 ± 1.6 109/l; p < 0.001] as well as higher plasma levels of interleukin-6 [2.8 pg/ml (2.0, 5.4) vs. 2.1 pg/ml (1.5, 3.4); p = 0.008] and high-sensitivity C-reactive protein [2.6 mg/l (1.4, 6.5) vs. 1.1 mg/l (0.9, 2.4); p = 0.004]. CONCLUSION This study demonstrates that HTN is associated with indices of low-grade systemic inflammation among HCM patients. Moreover, this analysis indicates that the adverse impact of HTN in HCM patients is a consequence of systemic effects rather than alterations of cardiac function, as measures of LV systolic and diastolic dysfunction did not differ between HTN+ and HTN-.
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Affiliation(s)
- David K Zach
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Nora Schwegel
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Santner
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Larissa Winkelbauer
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Hoeller
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ewald Kolesnik
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Gollmer
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hubert Seggewiss
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Angelika Batzner
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Sabine Perl
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria
| | - Andreas Zirlik
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Klemens Ablasser
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nicolas Verheyen
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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4
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Kneihsl M, Gattringer T, Hofer E, Rainer PP, Ranner G, Fandler-Höfler S, Haidegger M, Perl S, Enzinger C, Schmidt R. Cerebral white matter hyperintensities indicate severity and progression of coronary artery calcification. Sci Rep 2024; 14:4664. [PMID: 38409473 PMCID: PMC10897190 DOI: 10.1038/s41598-024-55305-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/22/2024] [Indexed: 02/28/2024] Open
Abstract
Cerebral white matter hyperintensities (WMH) have been associated with subclinical atherosclerosis including coronary artery calcification (CAC). However, previous studies on this association are limited by only cross-sectional analysis. We aimed to explore the relationship between WMH and CAC in elderly individuals both cross-sectionally and longitudinally. The study population consisted of elderly stroke- and dementia-free participants from the community-based Austrian Stroke Prevention Family Study (ASPFS). WMH volume and CAC levels (via Agatston score) were analyzed at baseline and after a 6-year follow-up period. Of 324 study participants (median age: 68 years), 115 underwent follow-up. Baseline WMH volume (median: 4.1 cm3) positively correlated with baseline CAC levels in multivariable analysis correcting for common vascular risk factors (p = 0.010). While baseline CAC levels were not predictive for WMH progression (p = 0.447), baseline WMH volume was associated CAC progression (median Agatston score progression: 27) in multivariable analysis (ß = 66.3 ± 22.3 [per cm3], p = 0.004). Ten of 11 participants (91%) with severe WMH (Fazekas Scale: 3) at baseline showed significant CAC progression > 100 during follow-up. In this community-based cohort of elderly individuals, WMH were associated with CAC and predictive of its progression over a 6-year follow-up. Screening for coronary artery disease might be considered in people with more severe WMH.
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Affiliation(s)
- Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
| | - Edith Hofer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | | | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Sabine Perl
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
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Kolland M, Amenitsch J, Schreiber N, Ginthör N, Schuller M, Riedl R, Rainer PP, Schneditz D, Niedrist T, Eller K, Krietemeyer B, Rosenkranz AR, Kirsch AH. Changes in cardiac troponins during hemodialysis depend on hemodialysis membrane and modality: a randomized crossover trial. Clin Kidney J 2024; 17:sfad297. [PMID: 38213495 PMCID: PMC10783248 DOI: 10.1093/ckj/sfad297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Michael Kolland
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Jascha Amenitsch
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Nikolaus Schreiber
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Noemi Ginthör
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Max Schuller
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, BioTechMed Graz, Graz, Austria
| | - Daniel Schneditz
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Benedikt Krietemeyer
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Alexander H Kirsch
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
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6
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Hardy SA, Liesinger L, Patrick R, Poettler M, Rech L, Gindlhuber J, Mabotuwana NS, Ashour D, Stangl V, Bigland M, Murtha LA, Starkey MR, Scherr D, Hansbro PM, Hoefler G, Campos Ramos G, Cochain C, Harvey RP, Birner-Gruenberger R, Boyle AJ, Rainer PP. Extracellular Matrix Protein-1 as a Mediator of Inflammation-Induced Fibrosis After Myocardial Infarction. JACC Basic Transl Sci 2023; 8:1539-1554. [PMID: 38205347 PMCID: PMC10774582 DOI: 10.1016/j.jacbts.2023.05.010] [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: 07/25/2022] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 01/12/2024]
Abstract
Irreversible fibrosis is a hallmark of myocardial infarction (MI) and heart failure. Extracellular matrix protein-1 (ECM-1) is up-regulated in these hearts, localized to fibrotic, inflammatory, and perivascular areas. ECM-1 originates predominantly from fibroblasts, macrophages, and pericytes/vascular cells in uninjured human and mouse hearts, and from M1 and M2 macrophages and myofibroblasts after MI. ECM-1 stimulates fibroblast-to-myofibroblast transition, up-regulates key fibrotic and inflammatory pathways, and inhibits cardiac fibroblast migration. ECM-1 binds HuCFb cell surface receptor LRP1, and LRP1 inhibition blocks ECM-1 from stimulating fibroblast-to-myofibroblast transition, confirming a novel ECM-1-LRP1 fibrotic signaling axis. ECM-1 may represent a novel mechanism facilitating inflammation-fibrosis crosstalk.
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Affiliation(s)
- Sean A. Hardy
- Department of Internal Medicine and University Heart Center, Division of Cardiology, Medical University of Graz, Graz, Austria
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Laura Liesinger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
- Institute of Chemical Technologies and Analytical Chemistry, Technische Universität Wien, Vienna, Austria
| | - Ralph Patrick
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Maria Poettler
- Department of Internal Medicine and University Heart Center, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Lavinia Rech
- Department of Internal Medicine and University Heart Center, Division of Cardiology, Medical University of Graz, Graz, Austria
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nishani S. Mabotuwana
- Department of Internal Medicine and University Heart Center, Division of Cardiology, Medical University of Graz, Graz, Austria
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - DiyaaEldin Ashour
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Mark Bigland
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lucy A. Murtha
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Malcolm R. Starkey
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Daniel Scherr
- Department of Internal Medicine and University Heart Center, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Philip M. Hansbro
- Centre for Inflammation, Centenary Institute, and University of Technology Sydney, Faculty of Science, School of Life Sciences, Sydney, New South Wales, Australia
| | - Gerald Hoefler
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Gustavo Campos Ramos
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine 1, University Hospital of Würzburg, Würzburg, Germany
| | - Clement Cochain
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Richard P. Harvey
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- School of Biotechnology and Biomolecular Sciences, Faculty of Science, UNSW Sydney, Sydney, Australia
| | - Ruth Birner-Gruenberger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
- Institute of Chemical Technologies and Analytical Chemistry, Technische Universität Wien, Vienna, Austria
- BioTechMed Graz, Graz, Austria
| | - Andrew J. Boyle
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Department of Cardiovascular Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Peter P. Rainer
- Department of Internal Medicine and University Heart Center, Division of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- Department of Medicine, St. Johann in Tirol General Hospital, St. Johann in Tirol, Austria
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7
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Santner V, Riepl HS, Posch F, Wallner M, Rainer PP, Ablasser K, Kolesnik E, Hoeller V, Zach D, Schwegel N, Kreuzer P, Lueger A, Petutschnigg J, Pieske B, Zirlik A, Edelmann F, Verheyen N. Non-eligibility for pivotal HFpEF/HFmrEF outcome trials and mortality in a contemporary heart failure cohort. Eur J Intern Med 2023; 118:73-81. [PMID: 37517939 DOI: 10.1016/j.ejim.2023.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
Pivotal outcome trials targeting heart failure with preserved (HFpEF) and mildly-reduced ejection fraction (HFmrEF) may have excluded patients at highest risk of poor outcomes. We aimed to assess eligibility for HFpEF/HFmrEF outcome trials in an unselected heart failure cohort and its association with all-cause mortality. Among 32.028 patients presenting to a tertiary care center emergency unit for any reason between August 2018 and July 2019, we identified 407 admissions with evident HFpEF and HFmrEF. Eligibility criteria for pivotal trials CHARM-Preserved, I-PRESERVE, TOPCAT, PARAGON-HF, EMPEROR-Preserved and DELIVER were assessed by chart review. The proportions of admissions fulfilling HFpEF/HFmrEF trial eligibility criteria were 88% for CHARM-Preserved, 40% for I-PRESERVE, 35% for TOPCAT, 28% for PARAGON-HF, 51% for EMPEROR-Preserved, and 49% for DELIVER. During a median follow-up of 1.9 years, death-from-any-cause occurred in 121 cases (30%). Twenty-four-month overall survival estimates for non-eligible and eligible admissions were 53% vs. 76% for CHARM-Preserved (HR=2.32, 95% CI: 1.47-3.67, p<0.001), 62% vs. 87% for I-PRESERVE (HR=2.97, 1.85-4.77, p<0.001), 67% vs. 84% for TOPCAT (HR=2.04, 1.29-3.24, p = 0.002), 68% vs. 85% for PARAGONHF (HR=2.28, 1.33-3.90, p = 0.003), 64% vs. 81% for EMPEROR-Preserved (HR=1.90, 1.27-2.84, p = 0.002), and 65% vs. 80% for DELIVER (HR=1.71, 1.14-2.57, p = 0.010). Exclusion criteria independently predicting death were eGFR <20 ml/min/1.73 m2, COPD with home oxygen therapy, and severe valvular heart disease. Conclusively, in a contemporary HFpEF/HFmrEF cohort, non-eligibility for outcome trials predicted for strongly increased mortality. HFpEF/HFmrEF patients at highest mortality risk were likely underrepresented in previous outcome trials and their treatment remains an unmet medical need.
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Affiliation(s)
- Viktoria Santner
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hermann S Riepl
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Medicine, St. Johann in Tirol General Hospital, St. Johann in Tirol, Austria; BioTechMed Graz, Graz, Austria
| | - Klemens Ablasser
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Hoeller
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - David Zach
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nora Schwegel
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Kreuzer
- Emergency Medicine Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Lueger
- Emergency Medicine Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Petutschnigg
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; German Center for Cardiovascular Research, Partner Site Berlin, Germany
| | | | - Andreas Zirlik
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; German Center for Cardiovascular Research, Partner Site Berlin, Germany
| | - Nicolas Verheyen
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, Graz, Austria.
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8
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Ciccarelli M, Pires IF, Bauersachs J, Bertrand L, Beauloye C, Dawson D, Hamdani N, Hilfiker-Kleiner D, van Laake LW, Lezoualc'h F, Linke WA, Lunde IG, Rainer PP, Rispoli A, Visco V, Carrizzo A, Ferro MD, Stolfo D, van der Velden J, Zacchigna S, Heymans S, Thum T, Tocchetti CG. Acute heart failure: mechanisms and pre-clinical models-a Scientific Statement of the ESC Working Group on Myocardial Function. Cardiovasc Res 2023; 119:2390-2404. [PMID: 37967390 DOI: 10.1093/cvr/cvad088] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/16/2023] [Accepted: 03/06/2023] [Indexed: 11/17/2023] Open
Abstract
While chronic heart failure (CHF) treatment has considerably improved patient prognosis and survival, the therapeutic management of acute heart failure (AHF) has remained virtually unchanged in the last decades. This is partly due to the scarcity of pre-clinical models for the pathophysiological assessment and, consequently, the limited knowledge of molecular mechanisms involved in the different AHF phenotypes. This scientific statement outlines the different trajectories from acute to CHF originating from the interaction between aetiology, genetic and environmental factors, and comorbidities. Furthermore, we discuss the potential molecular targets capable of unveiling new therapeutic perspectives to improve the outcome of the acute phase and counteracting the evolution towards CHF.
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Affiliation(s)
- Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
| | - Inês Falcão Pires
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Luc Bertrand
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Christophe Beauloye
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St.Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Linda W van Laake
- Division Heart and Lungs, Department of Cardiology and Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Frank Lezoualc'h
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1297-I2MC, Toulouse, France
| | - Wolfgang A Linke
- Institute of Physiology II, University Hospital Münster, Robert-Koch-Str. 27B, Münster 48149, Germany
| | - Ida G Lunde
- Division of Diagnostics and Technology (DDT), Akershus University Hospital, and KG Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
- BioTechMed Graz - University of Graz, 8036 Graz, Austria
| | - Antonella Rispoli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
| | - Valeria Visco
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
| | - Albino Carrizzo
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
- Laboratory of Vascular Physiopathology-I.R.C.C.S. Neuromed, 86077 Pozzilli, Italy
| | - Matteo Dal Ferro
- Cardiothoracovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
- Laboratory of Cardiovascular Biology, The International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Serena Zacchigna
- Laboratory of Cardiovascular Biology, The International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental medicine, Hannover, Germany
| | - Carlo Gabriele Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Via Pansini 5, 80131 Naples, Italy
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9
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Abstract
Normal circulatory function is a key determinant of disease-free life expectancy (healthspan). Indeed, pathologies affecting the cardiovascular system, which are growing in prevalence, are the leading cause of global morbidity, disability and mortality, whereas the maintenance of cardiovascular health is necessary to promote both organismal healthspan and lifespan. Therefore, cardiovascular ageing might precede or even underlie body-wide, age-related health deterioration. In this Review, we posit that eight molecular hallmarks are common denominators in cardiovascular ageing, namely disabled macroautophagy, loss of proteostasis, genomic instability (in particular, clonal haematopoiesis of indeterminate potential), epigenetic alterations, mitochondrial dysfunction, cell senescence, dysregulated neurohormonal signalling and inflammation. We also propose a hierarchical order that distinguishes primary (upstream) from antagonistic and integrative (downstream) hallmarks of cardiovascular ageing. Finally, we discuss how targeting each of the eight hallmarks might be therapeutically exploited to attenuate residual cardiovascular risk in older individuals.
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Affiliation(s)
- Mahmoud Abdellatif
- Department of Cardiology, Medical University of Graz, Graz, Austria.
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France.
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France.
- BioTechMed Graz, Graz, Austria.
| | - Peter P Rainer
- Department of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | - Simon Sedej
- Department of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France.
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France.
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
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10
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Murtha LA, Hardy SA, Mabotuwana NS, Bigland MJ, Bailey T, Raguram K, Liu S, Ngo DT, Sverdlov AL, Tomin T, Birner-Gruenberger R, Hume RD, Iismaa SE, Humphreys DT, Patrick R, Chong JJH, Lee RJ, Harvey RP, Graham RM, Rainer PP, Boyle AJ. Fibulin-3 is necessary to prevent cardiac rupture following myocardial infarction. Sci Rep 2023; 13:14995. [PMID: 37696945 PMCID: PMC10495317 DOI: 10.1038/s41598-023-41894-9] [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: 06/13/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
Despite the high prevalence of heart failure in the western world, there are few effective treatments. Fibulin-3 is a protein involved in extracellular matrix (ECM) structural integrity, however its role in the heart is unknown. We have demonstrated, using single cell RNA-seq, that fibulin-3 was highly expressed in quiescent murine cardiac fibroblasts, with expression highest prior to injury and late post-infarct (from ~ day-28 to week-8). In humans, fibulin-3 was upregulated in left ventricular tissue and plasma of heart failure patients. Fibulin-3 knockout (Efemp1-/-) and wildtype mice were subjected to experimental myocardial infarction. Fibulin-3 deletion resulted in significantly higher rate of cardiac rupture days 3-6 post-infarct, indicating a weak and poorly formed scar, with severe ventricular remodelling in surviving mice at day-28 post-infarct. Fibulin-3 knockout mice demonstrated less collagen deposition at day-3 post-infarct, with abnormal collagen fibre-alignment. RNA-seq on day-3 infarct tissue revealed upregulation of ECM degradation and inflammatory genes, but downregulation of ECM assembly/structure/organisation genes in fibulin-3 knockout mice. GSEA pathway analysis showed enrichment of inflammatory pathways and a depletion of ECM organisation pathways. Fibulin-3 originates from cardiac fibroblasts, is upregulated in human heart failure, and is necessary for correct ECM organisation/structural integrity of fibrotic tissue to prevent cardiac rupture post-infarct.
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Affiliation(s)
- Lucy A Murtha
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Sean A Hardy
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Nishani S Mabotuwana
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Mark J Bigland
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Taleah Bailey
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Kalyan Raguram
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Saifei Liu
- Department of Cardiology and Clinical Pharmacology, Basil Hetzel Institute, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Doan T Ngo
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
- Department of Cardiology and Clinical Pharmacology, Basil Hetzel Institute, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Aaron L Sverdlov
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
- Department of Cardiology and Clinical Pharmacology, Basil Hetzel Institute, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Tamara Tomin
- Institute of Chemical Technologies and Analytics, Faculty of Technical Chemistry, Technische Universität Wien, Vienna, Austria
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Ruth Birner-Gruenberger
- Institute of Chemical Technologies and Analytics, Faculty of Technical Chemistry, Technische Universität Wien, Vienna, Austria
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Robert D Hume
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Siiri E Iismaa
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- St Vincent's Clinical School, UNSW, Sydney, Kensington, NSW, Australia
| | - David T Humphreys
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- St Vincent's Clinical School, UNSW, Sydney, Kensington, NSW, Australia
| | - Ralph Patrick
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- St Vincent's Clinical School, UNSW, Sydney, Kensington, NSW, Australia
| | - James J H Chong
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Randall J Lee
- Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
- Edyth and Eli Broad Center for Regenerative Medicine and Stem Cell Research, University of California San Francisco, San Francisco, CA, USA
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Richard P Harvey
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- St Vincent's Clinical School, UNSW, Sydney, Kensington, NSW, Australia
- School of Biotechnology and Molecular Bioscience, UNSW, Sydney, Kensington, NSW, Australia
| | - Robert M Graham
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- St Vincent's Clinical School, UNSW, Sydney, Kensington, NSW, Australia
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | - Andrew J Boyle
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia.
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia.
- Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
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11
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Sattler S, Campos Ramos G, Ludewig B, Rainer PP. Cardioimmunology: the new frontier! Eur Heart J 2023; 44:2355-2357. [PMID: 37165516 DOI: 10.1093/eurheartj/ehad230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Affiliation(s)
- Susanne Sattler
- Division of Cardiology, University Heart Centre Graz, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, W12 0NN London, UK
| | - Gustavo Campos Ramos
- Department of Internal Medicine I / Comprehensive Heart Failure Centre, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Burkhard Ludewig
- Kantonsspital St. Gallen, Rorschacherstrasse 959007, St. Gallen, Switzerland
- University Heart Center, University Hospital Zurich and University of Zurich, Rämistrasse 1008091, Zurich, Switzerland
| | - Peter P Rainer
- Division of Cardiology, University Heart Centre Graz, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
- BioTechMed Graz, Mozartgasse 12/II, A-8010 Graz, Austria
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12
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Polat Erdeniz S, Kramer D, Schrempf M, Rainer PP, Felfernig A, Tran TNT, Burgstaller T, Lubos S. Machine Learning Based Risk Prediction for Major Adverse Cardiovascular Events for ELGA-Authorized Clinics1. Stud Health Technol Inform 2023; 301:20-25. [PMID: 37172147 DOI: 10.3233/shti230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Artificial Intelligence (AI) has had an important impact on many industries as well as the field of medical diagnostics. In healthcare, AI techniques such as case-based reasoning and data driven machine learning (ML) algorithms have been used to support decision-making processes for complex tasks. This is used to assist medical professionals in making clinical decisions. A way of supporting clinicians is providing predicted prognoses of various ML models. OBJECTIVES Training an ML model based on the data of a hospital and using it on another hospital have some challenges. METHODS In this research, we applied data analysis to discover required data filters on a hospital's EHR data for training a model for another hospital. RESULTS We applied experiments on real-world data of ELGA (Austrian health record system) and KAGes (a public healthcare provider of 20+ hospitals in Austria). In this scenario, we train the prediction model for ELGA- authorized health service providers using the KAGes data since we do not have access to the complete ELGA data. CONCLUSION Finally, we observed that filtering the data with both feature and value selection increases the classification performance of the prediction model, which is trained for another system.
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Affiliation(s)
- Seda Polat Erdeniz
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
- Medical University of Graz, Graz, Austria
- Graz University of Technology, Graz, Austria
| | - Diether Kramer
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
| | - Michael Schrempf
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
- Medical University of Graz, Graz, Austria
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13
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Patel H, Sintou A, Chowdhury RA, Rothery S, Iacob AO, Prasad S, Rainer PP, Martinón-Torres F, Sancho-Shimizu V, Shimizu C, Dummer K, Tremoulet AH, Burns JC, Sattler S, Levin M. Evaluation of Autoantibody Binding to Cardiac Tissue in Multisystem Inflammatory Syndrome in Children and COVID-19 Vaccination-Induced Myocarditis. JAMA Netw Open 2023; 6:e2314291. [PMID: 37200028 PMCID: PMC10196878 DOI: 10.1001/jamanetworkopen.2023.14291] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/15/2022] [Accepted: 04/05/2023] [Indexed: 05/19/2023] Open
Abstract
Importance Cardiac dysfunction and myocarditis have emerged as serious complications of multisystem inflammatory syndrome in children (MIS-C) and vaccines against SARS-CoV-2. Understanding the role of autoantibodies in these conditions is essential for guiding MIS-C management and vaccination strategies in children. Objective To investigate the presence of anticardiac autoantibodies in MIS-C or COVID-19 vaccine-induced myocarditis. Design, Setting, and Participants This diagnostic study included children with acute MIS-C or acute vaccine myocarditis, adults with myocarditis or inflammatory cardiomyopathy, healthy children prior to the COVID-19 pandemic, and healthy COVID-19 vaccinated adults. Participants were recruited into research studies in the US, United Kingdom, and Austria starting January 2021. Immunoglobulin G (IgG), IgM, and IgA anticardiac autoantibodies were identified with immunofluorescence staining of left ventricular myocardial tissue from 2 human donors treated with sera from patients and controls. Secondary antibodies were fluorescein isothiocyanate-conjugated antihuman IgG, IgM, and IgA. Images were taken for detection of specific IgG, IgM, and IgA deposits and measurement of fluorescein isothiocyanate fluorescence intensity. Data were analyzed through March 10, 2023. Main Outcomes and Measures IgG, IgM and IgA antibody binding to cardiac tissue. Results By cohort, there were a total of 10 children with MIS-C (median [IQR] age, 10 [13-14] years; 6 male), 10 with vaccine myocarditis (median age, 15 [14-16] years; 10 male), 8 adults with myocarditis or inflammatory cardiomyopathy (median age, 55 [46-63] years; 6 male), 10 healthy pediatric controls (median age, 8 [13-14] years; 5 male), and 10 healthy vaccinated adults (all older than 21 years, 5 male). No antibody binding above background was observed in human cardiac tissue treated with sera from pediatric patients with MIS-C or vaccine myocarditis. One of the 8 adult patients with myocarditis or cardiomyopathy had positive IgG staining with raised fluorescence intensity (median [IQR] intensity, 11 060 [10 223-11 858] AU). There were no significant differences in median fluorescence intensity in all other patient cohorts compared with controls for IgG (MIS-C, 6033 [5834-6756] AU; vaccine myocarditis, 6392 [5710-6836] AU; adult myocarditis or inflammatory cardiomyopathy, 5688 [5277-5990] AU; healthy pediatric controls, 6235 [5924-6708] AU; healthy vaccinated adults, 7000 [6423-7739] AU), IgM (MIS-C, 3354 [3110-4043] AU; vaccine myocarditis, 3843 [3288-4748] AU; healthy pediatric controls, 3436 [3313-4237] AU; healthy vaccinated adults, 3543 [2997-4607] AU) and IgA (MIS-C, 3559 [2788-4466] AU; vaccine myocarditis, 4389 [2393-4780] AU; healthy pediatric controls, 3436 [2425-4077] AU; healthy vaccinated adults, 4561 [3164-6309] AU). Conclusions and Relevance This etiological diagnostic study found no evidence of antibodies from MIS-C and COVID-19 vaccine myocarditis serum binding cardiac tissue, suggesting that the cardiac pathology in both conditions is unlikely to be driven by direct anticardiac antibody-mediated mechanisms.
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Affiliation(s)
- Harsita Patel
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Imperial College London, United Kingdom
| | - Amalia Sintou
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom
| | - Rasheda A. Chowdhury
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom
| | - Stephen Rothery
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom
| | - Alma Octavia Iacob
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom
- Royal Brompton & Harefield hospitals, Guy’s and St Thomas’ National Health Service Foundation Trust, United Kingdom
| | - Sanjay Prasad
- Royal Brompton & Harefield hospitals, Guy’s and St Thomas’ National Health Service Foundation Trust, United Kingdom
| | - Peter P. Rainer
- Department of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | - Federico Martinón-Torres
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanessa Sancho-Shimizu
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Imperial College London, United Kingdom
- Department of Infectious Disease, Section of Virology, Imperial College London, London, United Kingdom
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Chisato Shimizu
- Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego
- Rady Children’s Hospital, San Diego, California
| | - Kirsten Dummer
- Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego
- Rady Children’s Hospital, San Diego, California
| | - Adriana H. Tremoulet
- Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego
- Rady Children’s Hospital, San Diego, California
| | - Jane C. Burns
- Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego
- Rady Children’s Hospital, San Diego, California
| | - Susanne Sattler
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Imperial College London, United Kingdom
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14
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Hatab I, Kneihsl M, Bisping E, Rainer PP, Fandler-Höfler S, Eppinger S, Haidegger M, Berger N, Mangge H, Schmidt R, Enzinger C, Gattringer T. The value of clinical routine blood biomarkers in predicting long-term mortality after stroke. Eur Stroke J 2023; 8:532-540. [DOI: 10.1177/23969873231162125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Background: Several blood biomarkers have been identified as predictors for poor outcome after ischemic stroke. However, recent studies mainly focused on single or experimental biomarkers and considered rather short follow-up intervals limiting their value for daily clinical practice. We, therefore, aimed to compare various clinical routine blood biomarkers for their predictive value on post-stroke mortality over a 5-year follow-up period. Patients and methods: This data analysis of a prospective single-center study included all consecutive ischemic stroke patients admitted to the stroke unit of our university hospital over a 1-year period. Various blood biomarkers of inflammation, heart failure, metabolic disorders, and coagulation were analyzed from standardized routine blood samples collected within 24 h of hospital admission. All patients underwent a thorough diagnostic workup and were followed for 5 years post-stroke. Results: Of 405 patients (mean age: 70.3 years), 72 deceased (17.8%) during the follow-up period. While various routine blood biomarkers were associated with post-stroke mortality in univariable analyses, only NT-proBNP remained an independent predictor (adjusted odds ratio 5.1; 95% CI 2.0–13.1; p < 0.001) for death after stroke. NT-proBNP levels ⩾794 pg/mL ( n = 169, 42%) had a sensitivity of 90% for post-stroke mortality with a negative predictive value of 97% and was additionally associated with cardioembolic stroke and heart failure (each p ⩽ 0.05). Conclusion: NT-proBNP represents the most relevant routine blood-based biomarker for the prediction of long-term mortality after ischemic stroke. Increased NT-proBNP levels indicate a vulnerable subgroup of stroke patients in which early and thorough cardiovascular assessment and consistent follow-ups could improve outcome after stroke.
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Affiliation(s)
- Isra Hatab
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Egbert Bisping
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | | | - Sebastian Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | | | - Natalie Berger
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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15
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Delgobo M, Weiß E, Ashour D, Richter L, Popiolkowski L, Arampatzi P, Stangl V, Arias-Loza P, Mariotti-Ferrandiz E, Rainer PP, Saliba AE, Ludewig B, Hofmann U, Frantz S, Campos Ramos G. Myocardial Milieu Favors Local Differentiation of Regulatory T Cells. Circ Res 2023; 132:565-582. [PMID: 36744467 DOI: 10.1161/circresaha.122.322183] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the past years, several studies investigated how distinct immune cell subsets affects post-myocardial infarction repair. However, whether and how the tissue environment controls these local immune responses has remained poorly understood. We sought to investigate how antigen-specific T-helper cells differentiate under myocardial milieu's influence. METHODS We used a transgenic T cell receptor (TCR-M) model and major histocompatibility complex-II tetramers, both myosin-specific, combined with single-cell transcriptomics (single-cell RNA sequencing [scRNA-seq]) and functional phenotyping to elucidate how the antigen-specific CD4+ T cells differentiate in the murine infarcted myocardium and influence tissue repair. Additionally, we transferred proinflammatory versus regulatory predifferentiated TCR-M-cells to dissect how they specially contribute to post-myocardial infarction inflammation. RESULTS Flow cytometry and scRNA-/TCR-seq analyses revealed that transferred TCR-M cells acquired an induced regulatory phenotype (induced regulatory T cell) in the infarcted myocardium and blunted local inflammation. Myocardial TCR-M cells differentiated into 2 main lineages enriched with either cell activation and profibrotic transcripts (eg, Tgfb1) or suppressor immune checkpoints (eg, Pdcd1), which we also found in human myocardial tissue. These cells produced high levels of LAP (latency-associated peptide) and inhibited IL-17 (interleukin-17) responses. Endogenous myosin-specific T-helper cells, identified using genetically barcoded tetramers, also accumulated in infarcted hearts and exhibited a regulatory phenotype. Notably, TCR-M cells that were predifferentiated toward a regulatory phenotype in vitro maintained stable in vivo FOXP3 (Forkhead box P3) expression and anti-inflammatory activity whereas TH17 partially converted toward a regulatory phenotype in the injured myocardium. Overall, the myosin-specific Tregs dampened post-myocardial infarction inflammation, suppressed neighboring T cells, and were associated with improved cardiac function. CONCLUSIONS These findings provide novel evidence that the heart and its draining lymph nodes actively shape local immune responses by promoting the differentiation of antigen-specific Tregs poised with suppressive function.
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Affiliation(s)
- Murilo Delgobo
- Department of Internal Medicine I (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany
| | - Emil Weiß
- Department of Internal Medicine I (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany
| | - DiyaaElDin Ashour
- Department of Internal Medicine I (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany
| | - Leon Richter
- Department of Internal Medicine I (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany
| | - Lisa Popiolkowski
- Department of Internal Medicine I (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany
| | | | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Austria (V.S.)
| | - Paula Arias-Loza
- Department of Nuclear Medicine (P.A.-L.), University Hospital Würzburg, Germany
| | - Encarnita Mariotti-Ferrandiz
- Sorbonne Université, INSERM, UMRS959, Immunology-Immunopathology-Immunotherapy (i3) lab, Paris France (E.M.-F.).,Institut Universitaire de France (IUF) (E.M.-F.)
| | - Peter P Rainer
- Division of Cardiology at the Medical University of Graz, Austria (P.P.R.).,BioTechMed Graz, Austria (P.P.R.)
| | - Antoine-Emmanuel Saliba
- Helmholtz Institute for RNA-based Infection Research, Helmholtz Centre for Infection Research, Würzburg, Germany (A.-E.S.)
| | - Burkhard Ludewig
- Institute of Immunobiology, Kantonsspital St. Gallen, Switzerland (B.L.)
| | - Ulrich Hofmann
- Department of Internal Medicine I (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany
| | - Gustavo Campos Ramos
- Department of Internal Medicine I (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center (M.D., E.W., D.E.A., L.R., L.P., U.H., S.F., G.C.R.), University Hospital Würzburg, Germany
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16
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Kolesnik E, Stangl V, Haring B, Scherr D, Rainer PP. Cardiac relapse of extranodal NK/T-cell lymphoma manifesting as incessant ventricular tachycardia: a case report. Eur Heart J Case Rep 2022; 6:ytac363. [PMID: 36111075 PMCID: PMC9470109 DOI: 10.1093/ehjcr/ytac363] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/05/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022]
Abstract
Background Cardiac tumours are rare but affected patients may present with symptoms mimicking other cardiac diseases. The most frequent symptoms include heart failure, arrhythmias, or embolic phenomena. Case summary A 39-year-old man with a history of extranodal NK/T-cell lymphoma of the nasal type (ENKTL-NT) in clinical remission presented at our department with incessant ventricular tachycardia. The arrhythmia could only be controlled with a combination of intravenously administered beta-blockers, ajmaline, and amiodarone. Diagnostic workup excluded ischaemia, but imaging revealed a tumour located in the apex of the left ventricle. Endomyocardial biopsy confirmed the diagnosis of cardiac relapse of ENKTL-NT. Upon chemotherapy no further arrhythmias developed. Discussion Many malignancies can metastasize into the heart. Multimodal imaging including echocardiography, cardiac magnetic resonance imaging, and a positron-emission tomography computed tomography paved the way to the diagnosis that was finally established by endomyocardial biopsy. In the present case, a cardiac metastasis from an ENKTL-NT presented with incessant ventricular tachycardia.
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Affiliation(s)
- Ewald Kolesnik
- Division of Cardiology, University Heart Center, Medical University of Graz , Auenbruggerplatz 15, Graz 8036 , Austria
| | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz , Graz , Austria
| | - Bernhard Haring
- Division of Cardiology, University Heart Center, Medical University of Graz , Auenbruggerplatz 15, Graz 8036 , Austria
| | - Daniel Scherr
- Division of Cardiology, University Heart Center, Medical University of Graz , Auenbruggerplatz 15, Graz 8036 , Austria
| | - Peter P Rainer
- Division of Cardiology, University Heart Center, Medical University of Graz , Auenbruggerplatz 15, Graz 8036 , Austria
- BioTechMed Graz , Graz , Austria
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17
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Wakabayashi I, Sotoda Y, Groschner K, Rainer PP, Sourij H. Differences in circulating obesity-related microRNAs in Austrian and Japanese men: A two-country cohort analysis. Metabol Open 2022; 15:100206. [PMID: 36065413 PMCID: PMC9440426 DOI: 10.1016/j.metop.2022.100206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background The prevalence of obesity is higher in Western countries than in East Asian countries. It remains unknown whether microRNAs (miRNAs) are involved in the pathogenesis of the ethnic difference in obesity. The purpose of this study was to determine whether expression levels of circulating obesity-associated miRNAs are different in Europeans and Asians. Methods The subjects were middle-aged healthy male Austrians (n = 20, mean age of 49.9 years) and Japanese (n = 20, mean age of 48.7 years). Total miRNAs in serum from each subject were analyzed using the 3D-Gene miRNA Oligo chip. miRNAs that showed significant differences between the Austrian and Japanese groups were uploaded into Ingenuity Pathway Analysis (IPA). Results Among 16 miRNAs that were revealed to be associated with obesity in previous studies and showed expression levels that were high enough for a reasonable comparison, serum levels of 3 miRNAs displayed significant differences between the Austrian and Japanese groups: miR-125b-1-3p was significantly lower with a fold change of −2.94 and miR-20a-5p and miR-486–5p were significantly higher with fold changes of 1.73 and 2.38, respectively, in Austrians than in Japanese. In IPA including all 392 miRNAs that showed significant differences between Austrians and Japanese, three canonical pathways including leptin signaling in obesity, adipogenesis pathway and white adipose tissue browning pathway were identified as enriched pathways. Conclusions miRNAs are thought to be involved in the ethnic difference in the prevalence of obesity, which may in part be caused by different expression levels of miR-125b-1-3p, miR-20a-5p and miR-486–5p. Ethnic difference in circulating obesity-related microRNAs (miRs) were investigated. Levels of 2565 miRs in blood were compared between Austrians and Japanese. miR-125b-1-3p, −20a-5p and -486–5p levels were significantly different between them. Significant ethnic differences were found in blood levels of 392 miRs. These miRs target the molecules comprising obesity-related three canonical pathways.
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Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, 663-8501, Japan
- Corresponding author. Department of Environmental and Preventive Medicine, School of Medicine, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Yoko Sotoda
- Department of Cardiovascular Surgery, Yamagata Saisei Hospital, Yamagata, 990-8545, Japan
| | - Klaus Groschner
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, Neue Stiftingtalstrasse 6/D04, 8010, Graz, Austria
| | - Peter P. Rainer
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
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18
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Posch F, Niedrist T, Glantschnig T, Firla S, Moik F, Kolesnik E, Wallner M, Verheyen N, Jost PJ, Zirlik A, Pichler M, Balic M, Rainer PP. Left ventricular ejection fraction and cardiac biomarkers for dynamic prediction of cardiotoxicity in early breast cancer. Front Cardiovasc Med 2022; 9:933428. [PMID: 36051281 PMCID: PMC9424929 DOI: 10.3389/fcvm.2022.933428] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background/Purpose This study aims to quantify the utility of monitoring LVEF, hs-cTnT, and NT-proBNP for dynamic cardiotoxicity risk assessment in women with HER2+ early breast cancer undergoing neoadjuvant/adjuvant trastuzumab-based therapy. Materials and methods We used joint models of longitudinal and time-to-event data to analyze 1,136 echocardiography reports and 326 hs-cTnT and NT-proBNP measurements from 185 women. Cardiotoxicity was defined as a 10% decline in LVEF below 50% and/or clinically overt heart failure. Results Median pre-treatment LVEF was 64%, and 19 patients (10%) experienced cardiotoxicity (asymptomatic n = 12, during treatment n = 19). The pre-treatment LVEF strongly predicted for cardiotoxicity (subdistribution hazard ratio per 5% increase in pre-treatment LVEF = 0.68, 95%CI: 0.48–0.95, p = 0.026). In contrast, pre-treatment hs-cTnT and NT-proBNP were not consistently associated with cardiotoxicity. During treatment, the longitudinal LVEF trajectory dynamically identified women at high risk of developing cardiotoxicity (hazard ratio per 5% LVEF increase at any time of follow-up = 0.36, 95% CI: 0.2–0.65, p = 0.005). Thirty-four patients (18%) developed an LVEF decline ≥ 5% from pre-treatment to first follow-up (“early LVEF decline”). One-year cardiotoxicity risk was 6.8% in those without early LVEF decline and pre-treatment LVEF ≥ 60% (n = 117), 15.9% in those with early LVEF decline or pre-treatment LVEF < 60% (n = 65), and 66.7% in those with early LVEF decline and pre-treatment LVEF < 60% (n = 3), (Gray’s test p < 0.0001). Conclusion Cardiotoxicity risk is low in two thirds of women with HER2+ early breast cancer who have pre-treatment LVEF ≥ 60% and no early LVEF decline > 5% during trastuzumab-based therapy. The longitudinal LVEF trajectory but not hs-cTnT or NT-proBNP allows for a dynamic assessment of cardiotoxicity risk in this setting.
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Affiliation(s)
- Florian Posch
- Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Theresa Glantschnig
- Division of Cardiology, University Heart Center, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Saskia Firla
- Department of Cardiology, Rhythmology, and Intensive Care Medicine, KRH Klinikum Siloah, Klinikum Region Hannover GmbH, Hanover, Germany
| | - Florian Moik
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, University Heart Center, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, University Heart Center, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nicolas Verheyen
- Division of Cardiology, University Heart Center, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp J. Jost
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas Zirlik
- Division of Cardiology, University Heart Center, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Cardiology, University Heart Center, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Experimental Therapeutics, MD Anderson Cancer Center, Houston, TX, United States
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P. Rainer
- Division of Cardiology, University Heart Center, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- *Correspondence: Peter P. Rainer,
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19
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Mabotuwana NS, Rech L, Lim J, Hardy SA, Murtha LA, Rainer PP, Boyle AJ. Paracrine Factors Released by Stem Cells of Mesenchymal Origin and their Effects in Cardiovascular Disease: A Systematic Review of Pre-clinical Studies. Stem Cell Rev Rep 2022; 18:2606-2628. [PMID: 35896860 PMCID: PMC9622561 DOI: 10.1007/s12015-022-10429-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
Mesenchymal stem cell (MSC) therapy has gained significant traction in the context of cardiovascular repair, and have been proposed to exert their regenerative effects via the secretion of paracrine factors. In this systematic review, we examined the literature and consolidated available evidence for the “paracrine hypothesis”. Two Ovid SP databases were searched using a strategy encompassing paracrine mediated MSC therapy in the context of ischemic heart disease. This yielded 86 articles which met the selection criteria for inclusion in this study. We found that the MSCs utilized in these articles were primarily derived from bone marrow, cardiac tissue, and adipose tissue. We identified 234 individual protective factors across these studies, including VEGF, HGF, and FGF2; which are proposed to exert their effects in a paracrine manner. The data collated in this systematic review identifies secreted paracrine factors that could decrease apoptosis, and increase angiogenesis, cell proliferation, and cell viability. These included studies have also demonstrated that the administration of MSCs and indirectly, their secreted factors can reduce infarct size, and improve left ventricular ejection fraction, contractility, compliance, and vessel density. Furthering our understanding of the way these factors mediate repair could lead to the identification of therapeutic targets for cardiac regeneration.
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Affiliation(s)
- Nishani S Mabotuwana
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, Newcastle, NSW, 2305, Australia.,Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Lavinia Rech
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria.,Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Joyce Lim
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, Newcastle, NSW, 2305, Australia.,Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Sean A Hardy
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, Newcastle, NSW, 2305, Australia.,Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Lucy A Murtha
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, Newcastle, NSW, 2305, Australia
| | - Peter P Rainer
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
| | - Andrew J Boyle
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia. .,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, Newcastle, NSW, 2305, Australia. .,Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
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20
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Eaton DM, Martin TG, Kasa M, Djalinac N, Ljubojevic-Holzer S, Von Lewinski D, Pöttler M, Kampaengsri T, Krumphuber A, Scharer K, Maechler H, Zirlik A, McKinsey TA, Kirk JA, Houser SR, Rainer PP, Wallner M. HDAC Inhibition Regulates Cardiac Function by Increasing Myofilament Calcium Sensitivity and Decreasing Diastolic Tension. Pharmaceutics 2022; 14:pharmaceutics14071509. [PMID: 35890404 PMCID: PMC9323146 DOI: 10.3390/pharmaceutics14071509] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 01/09/2023] Open
Abstract
We recently established a large animal model that recapitulates key clinical features of heart failure with preserved ejection fraction (HFpEF) and tested the effects of the pan-HDAC inhibitor suberoylanilide hydroxamic acid (SAHA). SAHA reversed and prevented the development of cardiopulmonary impairment. This study evaluated the effects of SAHA at the level of cardiomyocyte and contractile protein function to understand how it modulates cardiac function. Both isolated adult feline ventricular cardiomyocytes (AFVM) and left ventricle (LV) trabeculae isolated from non-failing donors were treated with SAHA or vehicle before recording functional data. Skinned myocytes were isolated from AFVM and human trabeculae to assess myofilament function. SAHA-treated AFVM had increased contractility and improved relaxation kinetics but no difference in peak calcium transients, with increased calcium sensitivity and decreased passive stiffness of myofilaments. Mass spectrometry analysis revealed increased acetylation of the myosin regulatory light chain with SAHA treatment. SAHA-treated human trabeculae had decreased diastolic tension and increased developed force. Myofilaments isolated from human trabeculae had increased calcium sensitivity and decreased passive stiffness. These findings suggest that SAHA has an important role in the direct control of cardiac function at the level of the cardiomyocyte and myofilament by increasing myofilament calcium sensitivity and reducing diastolic tension.
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Affiliation(s)
- Deborah M. Eaton
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (D.M.E.); (S.R.H.)
- Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Thomas G. Martin
- Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of Medicine, Chicago, IL 60153, USA; (T.G.M.); (T.K.); (J.A.K.)
| | - Michael Kasa
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
| | - Natasa Djalinac
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
| | - Senka Ljubojevic-Holzer
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
| | - Dirk Von Lewinski
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
| | - Maria Pöttler
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
| | - Theerachat Kampaengsri
- Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of Medicine, Chicago, IL 60153, USA; (T.G.M.); (T.K.); (J.A.K.)
| | - Andreas Krumphuber
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
| | - Katharina Scharer
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
| | - Heinrich Maechler
- Department of Cardiothoracic Surgery, Medical University of Graz, 8036 Graz, Austria;
| | - Andreas Zirlik
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
| | - Timothy A. McKinsey
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jonathan A. Kirk
- Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of Medicine, Chicago, IL 60153, USA; (T.G.M.); (T.K.); (J.A.K.)
| | - Steven R. Houser
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (D.M.E.); (S.R.H.)
| | - Peter P. Rainer
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
- BioTechMed Graz, 8010 Graz, Austria
| | - Markus Wallner
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (D.M.E.); (S.R.H.)
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (M.K.); (N.D.); (S.L.-H.); (D.V.L.); (M.P.); (A.K.); (K.S.); (A.Z.); (P.P.R.)
- Correspondence:
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21
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Matzer I, Voglhuber J, Kiessling M, Djalinac N, Trummer-Herbst V, Mabotuwana N, Rech L, Holzer M, Sossalla S, Rainer PP, Zirlik A, Ljubojevic-Holzer S. β-Adrenergic Receptor Stimulation Maintains NCX-CaMKII Axis and Prevents Overactivation of IL6R-Signaling in Cardiomyocytes upon Increased Workload. Biomedicines 2022; 10:biomedicines10071648. [PMID: 35884952 PMCID: PMC9313457 DOI: 10.3390/biomedicines10071648] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Excessive β-adrenergic stimulation and tachycardia are potent triggers of cardiac remodeling; however, their exact cellular effects remain elusive. Here, we sought to determine the potency of β-adrenergic stimulation and tachycardia to modulate gene expression profiles of cardiomyocytes. Using neonatal rat ventricular cardiomyocytes, we showed that tachycardia caused a significant upregulation of sodium–calcium exchanger (NCX) and the activation of calcium/calmodulin-dependent kinase II (CaMKII) in the nuclear region. Acute isoprenaline treatment ameliorated NCX-upregulation and potentiated CaMKII activity, specifically on the sarcoplasmic reticulum and the nuclear envelope, while preincubation with the β-blocker propranolol abolished both isoprenaline-mediated effects. On a transcriptional level, screening for hypertrophy-related genes revealed tachycardia-induced upregulation of interleukin-6 receptor (IL6R). While isoprenaline prevented this effect, pharmacological intervention with propranolol or NCX inhibitor ORM-10962 demonstrated that simultaneous CaMKII activation on the subcellular Ca2+ stores and prevention of NCX upregulation are needed for keeping IL6R activation low. Finally, using hypertensive Dahl salt-sensitive rats, we showed that blunted β-adrenergic signaling is associated with NCX upregulation and enhanced IL6R signaling. We therefore propose a previously unrecognized protective role of β-adrenergic signaling, which is compromised in cardiac pathologies, in preventing IL6R overactivation under increased workload. A better understanding of these processes may contribute to refinement of therapeutic options for patients receiving β-blockers.
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Affiliation(s)
- Ingrid Matzer
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Julia Voglhuber
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
- BioTechMed-Graz, 8010 Graz, Austria;
- Correspondence: (J.V.); (S.L.-H.)
| | - Mara Kiessling
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Nataša Djalinac
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Viktoria Trummer-Herbst
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Nishani Mabotuwana
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
| | - Lavinia Rech
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Michael Holzer
- BioTechMed-Graz, 8010 Graz, Austria;
- Otto-Loewi Research Centre, Division of Pharmacology, Medical University of Graz, 8036 Graz, Austria
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Centre Regensburg, 93053 Regensburg, Germany;
| | - Peter P. Rainer
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
- BioTechMed-Graz, 8010 Graz, Austria;
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Senka Ljubojevic-Holzer
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
- BioTechMed-Graz, 8010 Graz, Austria;
- Gottfried Schatz Research Center, Division of Molecular Biology and Biochemistry, Medical University of Graz, 8010 Graz, Austria
- Correspondence: (J.V.); (S.L.-H.)
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22
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Djalinac N, Kolesnik E, Maechler H, Scheruebel-Posch S, Pelzmann B, Rainer PP, Foessl I, Wallner M, Scherr D, Heinemann A, Sedej S, Ljubojevic-Holzer S, von Lewinski D, Bisping E. miR-1183 Is a Key Marker of Remodeling upon Stretch and Tachycardia in Human Myocardium. Int J Mol Sci 2022; 23:ijms23136962. [PMID: 35805966 PMCID: PMC9266684 DOI: 10.3390/ijms23136962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Many cardiac insults causing atrial remodeling are linked to either stretch or tachycardia, but a comparative characterization of their effects on early remodeling events in human myocardium is lacking. Here, we applied isometric stretch or sustained tachycardia at 2.5 Hz in human atrial trabeculae for 6 h followed by microarray gene expression profiling. Among largely independent expression patterns, we found a small common fraction with the microRNA miR-1183 as the highest up-regulated transcript (up to 4-fold). Both, acute stretch and tachycardia induced down-regulation of the predicted miR-1183 target genes ADAM20 and PLA2G7. Furthermore, miR-1183 was also significantly up-regulated in chronically remodeled atrial samples from patients with persistent atrial fibrillation (3-fold up-regulation versus sinus rhythm samples), and in ventricular myocardium from dilative cardiomyopathy hearts (2-fold up-regulation) as compared to non-failing controls. In sum, although stretch and tachycardia show distinct transcriptomic signatures in human atrial myocardium, both cardiac insults consistently regulate the expression of miR-1183 and its downstream targets in acute and chronic remodeling. Thus, elevated expression of miR-1183 might serve as a tissue biomarker for atrial remodeling and might be of potential functional significance in cardiac disease.
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Affiliation(s)
- Natasa Djalinac
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
- Unit of Human Molecular Genetics and Functional Genomics, Department of Biology, University of Padua, 35121 Padua, Italy
| | - Ewald Kolesnik
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
| | - Heinrich Maechler
- Department of Cardiothoracic Surgery, Medical University of Graz, 8036 Graz, Austria;
| | - Susanne Scheruebel-Posch
- Gottfried Schatz Research Center, Institute of Biophysics, Medical University of Graz, 8010 Graz, Austria; (S.S.-P.); (B.P.)
| | - Brigitte Pelzmann
- Gottfried Schatz Research Center, Institute of Biophysics, Medical University of Graz, 8010 Graz, Austria; (S.S.-P.); (B.P.)
| | - Peter P. Rainer
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
- BioTechMed Graz, 8036 Graz, Austria
| | - Ines Foessl
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria;
| | - Markus Wallner
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Correspondence: (M.W.); (D.v.L.); Tel.: +43-316-385-31261 (M.W.); +43-316-385-80684 (D.v.L.)
| | - Daniel Scherr
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
| | - Akos Heinemann
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, 8010 Graz, Austria;
| | - Simon Sedej
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
- BioTechMed Graz, 8036 Graz, Austria
- Institute of Physiology, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Senka Ljubojevic-Holzer
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
- BioTechMed Graz, 8036 Graz, Austria
| | - Dirk von Lewinski
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
- Correspondence: (M.W.); (D.v.L.); Tel.: +43-316-385-31261 (M.W.); +43-316-385-80684 (D.v.L.)
| | - Egbert Bisping
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (N.D.); (E.K.); (P.P.R.); (D.S.); (S.S.); (S.L.-H.); (E.B.)
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23
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Abdellatif M, Trummer-Herbst V, Heberle AM, Humnig A, Pendl T, Durand S, Cerrato G, Hofer SJ, Islam M, Voglhuber J, Ramos Pittol JM, Kepp O, Hoefler G, Schmidt A, Rainer PP, Scherr D, von Lewinski D, Bisping E, McMullen JR, Diwan A, Eisenberg T, Madeo F, Thedieck K, Kroemer G, Sedej S. Fine-Tuning Cardiac Insulin-Like Growth Factor 1 Receptor Signaling to Promote Health and Longevity. Circulation 2022; 145:1853-1866. [PMID: 35616058 PMCID: PMC9203038 DOI: 10.1161/circulationaha.122.059863] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/20/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The insulin-like growth factor 1 (IGF1) pathway is a key regulator of cellular metabolism and aging. Although its inhibition promotes longevity across species, the effect of attenuated IGF1 signaling on cardiac aging remains controversial. METHODS We performed a lifelong study to assess cardiac health and lifespan in 2 cardiomyocyte-specific transgenic mouse models with enhanced versus reduced IGF1 receptor (IGF1R) signaling. Male mice with human IGF1R overexpression or dominant negative phosphoinositide 3-kinase mutation were examined at different life stages by echocardiography, invasive hemodynamics, and treadmill coupled to indirect calorimetry. In vitro assays included cardiac histology, mitochondrial respiration, ATP synthesis, autophagic flux, and targeted metabolome profiling, and immunoblots of key IGF1R downstream targets in mouse and human explanted failing and nonfailing hearts, as well. RESULTS Young mice with increased IGF1R signaling exhibited superior cardiac function that progressively declined with aging in an accelerated fashion compared with wild-type animals, resulting in heart failure and a reduced lifespan. In contrast, mice with low cardiac IGF1R signaling exhibited inferior cardiac function early in life, but superior cardiac performance during aging, and increased maximum lifespan, as well. Mechanistically, the late-life detrimental effects of IGF1R activation correlated with suppressed autophagic flux and impaired oxidative phosphorylation in the heart. Low IGF1R activity consistently improved myocardial bioenergetics and function of the aging heart in an autophagy-dependent manner. In humans, failing hearts, but not those with compensated hypertrophy, displayed exaggerated IGF1R expression and signaling activity. CONCLUSIONS Our findings indicate that the relationship between IGF1R signaling and cardiac health is not linear, but rather biphasic. Hence, pharmacological inhibitors of the IGF1 pathway, albeit unsuitable for young individuals, might be worth considering in older adults.
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Affiliation(s)
- Mahmoud Abdellatif
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France (M.A., S.D., G.C., O.K., G.K.)
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France (M.A., S.D., G.C., O.K., G.K.)
- BioTechMed Graz, Austria (M.A., S.J.H., J.V., G.H., P.P.R., T.E., F.M., S.S.)
| | - Viktoria Trummer-Herbst
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
| | - Alexander Martin Heberle
- Institute of Biochemistry and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Austria (A.M.H., J.M.R.P., K.T.)
| | - Alina Humnig
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
| | - Tobias Pendl
- Institute of Molecular Biosciences, NAWI Graz (T.P., S.J.H., T.E., F.M.), Washington University School of Medicine, Saint Louis, MO
| | - Sylvère Durand
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France (M.A., S.D., G.C., O.K., G.K.)
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France (M.A., S.D., G.C., O.K., G.K.)
| | - Giulia Cerrato
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France (M.A., S.D., G.C., O.K., G.K.)
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France (M.A., S.D., G.C., O.K., G.K.)
| | - Sebastian J. Hofer
- BioTechMed Graz, Austria (M.A., S.J.H., J.V., G.H., P.P.R., T.E., F.M., S.S.)
- Institute of Molecular Biosciences, NAWI Graz (T.P., S.J.H., T.E., F.M.), Washington University School of Medicine, Saint Louis, MO
- Field of Excellence BioHealth (S.J.H., T.E., F.M.), Washington University School of Medicine, Saint Louis, MO
| | - Moydul Islam
- University of Graz, Austria. Department of Chemistry (M.I.), Washington University School of Medicine, Saint Louis, MO
- Center for Cardiovascular Research and Cardiovascular Division, Department of Medicine (M.I., A.D.), Washington University School of Medicine, Saint Louis, MO
| | - Julia Voglhuber
- BioTechMed Graz, Austria (M.A., S.J.H., J.V., G.H., P.P.R., T.E., F.M., S.S.)
| | - José Miguel Ramos Pittol
- Institute of Biochemistry and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Austria (A.M.H., J.M.R.P., K.T.)
| | - Oliver Kepp
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France (M.A., S.D., G.C., O.K., G.K.)
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France (M.A., S.D., G.C., O.K., G.K.)
| | - Gerald Hoefler
- Diagnostic and Research Center for Molecular BioMedicine, Diagnostic and Research Institute of Pathology (G.H.), Medical University of Graz, Austria
- BioTechMed Graz, Austria (M.A., S.J.H., J.V., G.H., P.P.R., T.E., F.M., S.S.)
| | - Albrecht Schmidt
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
| | - Peter P. Rainer
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
- BioTechMed Graz, Austria (M.A., S.J.H., J.V., G.H., P.P.R., T.E., F.M., S.S.)
| | - Daniel Scherr
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
| | - Dirk von Lewinski
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
| | - Egbert Bisping
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
| | - Julie R. McMullen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (J.R.M.)
| | - Abhinav Diwan
- Center for Cardiovascular Research and Cardiovascular Division, Department of Medicine (M.I., A.D.), Washington University School of Medicine, Saint Louis, MO
- John Cochran Veterans Affairs Medical Center, Saint Louis, MO (A.D.)
| | - Tobias Eisenberg
- BioTechMed Graz, Austria (M.A., S.J.H., J.V., G.H., P.P.R., T.E., F.M., S.S.)
- Institute of Molecular Biosciences, NAWI Graz (T.P., S.J.H., T.E., F.M.), Washington University School of Medicine, Saint Louis, MO
- Field of Excellence BioHealth (S.J.H., T.E., F.M.), Washington University School of Medicine, Saint Louis, MO
| | - Frank Madeo
- BioTechMed Graz, Austria (M.A., S.J.H., J.V., G.H., P.P.R., T.E., F.M., S.S.)
- Institute of Molecular Biosciences, NAWI Graz (T.P., S.J.H., T.E., F.M.), Washington University School of Medicine, Saint Louis, MO
- Field of Excellence BioHealth (S.J.H., T.E., F.M.), Washington University School of Medicine, Saint Louis, MO
| | - Kathrin Thedieck
- Institute of Biochemistry and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Austria (A.M.H., J.M.R.P., K.T.)
- Department of Pediatrics, Section Systems Medicine of Metabolism and Signaling, University of Groningen, University Medical Center Groningen, The Netherlands (K.T.)
- Department for Neuroscience, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany (K.T.)
| | - Guido Kroemer
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France (M.A., S.D., G.C., O.K., G.K.)
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France (M.A., S.D., G.C., O.K., G.K.)
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, France (G.K.)
| | - Simon Sedej
- Department of Cardiology (M.A., V.T.-H., A.H., J.V., A.S., P.P.R., D.S., D.v.L. E.B., S.S.), Medical University of Graz, Austria
- BioTechMed Graz, Austria (M.A., S.J.H., J.V., G.H., P.P.R., T.E., F.M., S.S.)
- Institute of Physiology, Faculty of Medicine, University of Maribor, Slovenia (S.S.)
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24
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Herrero-Galán E, Martínez-Martín I, Sánchez-González C, Vicente N, Bonzón-Kulichenko E, Calvo E, Suay-Corredera C, Pricolo MR, Fernández-Trasancos Á, Velázquez-Carreras D, Careaga CB, Abdellatif M, Sedej S, Rainer PP, Giganti D, Pérez-Jiménez R, Vázquez J, Alegre-Cebollada J. Basal oxidation of conserved cysteines modulates cardiac titin stiffness and dynamics. Redox Biol 2022; 52:102306. [PMID: 35367810 PMCID: PMC8971355 DOI: 10.1016/j.redox.2022.102306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 01/11/2023] Open
Abstract
Titin, as the main protein responsible for the passive stiffness of the sarcomere, plays a key role in diastolic function and is a determinant factor in the etiology of heart disease. Titin stiffness depends on unfolding and folding transitions of immunoglobulin-like (Ig) domains of the I-band, and recent studies have shown that oxidative modifications of cryptic cysteines belonging to these Ig domains modulate their mechanical properties in vitro. However, the relevance of this mode of titin mechanical modulation in vivo remains largely unknown. Here, we describe the high evolutionary conservation of titin mechanical cysteines and show that they are remarkably oxidized in murine cardiac tissue. Mass spectrometry analyses indicate a similar landscape of basal oxidation in murine and human myocardium. Monte Carlo simulations illustrate how disulfides and S-thiolations on these cysteines increase the dynamics of the protein at physiological forces, while enabling load- and isoform-dependent regulation of titin stiffness. Our results demonstrate the role of conserved cysteines in the modulation of titin mechanical properties in vivo and point to potential redox-based pathomechanisms in heart disease.
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Affiliation(s)
| | | | | | - Natalia Vicente
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Elena Bonzón-Kulichenko
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Enrique Calvo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | | | | | | | | | - Simon Sedej
- Division of Cardiology, Medical University of Graz, Graz, Austria; Faculty of Medicine, University of Maribor, Maribor, Slovenia; BioTechMed Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria
| | - David Giganti
- Department of Biochemistry & Molecular Pharmacology and Institute for Systems Genetics, NYU Langone Health, New York, NY, United States
| | - Raúl Pérez-Jiménez
- CIC NanoGUNE BRTA, San Sebastian, Spain; Ikerbasque Foundation for Science, Bilbao, Spain
| | - Jesús Vázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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25
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Schrempf M, Polat Erdeniz S, Kramer D, Jauk S, Veeranki SPK, Ribitsch W, Leodolter W, Rainer PP. Development of an Architecture to Implement Machine Learning Based Risk Prediction in Clinical Routine: A Service-Oriented Approach. Stud Health Technol Inform 2022; 293:262-269. [PMID: 35592992 DOI: 10.3233/shti220379] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients at risk of developing a disease have to be identified at an early stage to enable prevention. One way of early detection is the use of machine learning based prediction models trained on electronic health records. OBJECTIVES The aim of this project was to develop a software solution to predict cardiovascular and nephrological events using machine learning models. In addition, a risk verification interface for health care professionals was established. METHODS In order to meet the requirements, different tools were analysed. Based on this, a software architecture was created, which was designed to be as modular as possible. RESULTS A software was realised that is able to automatically calculate and display risks using machine learning models. Furthermore, predictions can be verified via an interface adapted to the need of health care professionals, which shows data required for prediction. CONCLUSION Due to the modularised software architecture and the status-based calculation process, different technologies could be applied. This facilitates the installation of the software at multiple health care providers, for which adjustments need to be carried out at one part of the software only.
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Affiliation(s)
- Michael Schrempf
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria.,Medical University of Graz, Graz, Austria
| | | | - Diether Kramer
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria
| | - Stefanie Jauk
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria
| | - Sai P K Veeranki
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria
| | - Werner Ribitsch
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria.,Medical University of Graz, Graz, Austria
| | - Werner Leodolter
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria.,Medical University of Graz, Graz, Austria
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26
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Bergler-Klein J, Rainer PP, Wallner M, Zaruba MM, Dörler J, Böhmer A, Buchacher T, Frey M, Adlbrecht C, Bartsch R, Gyöngyösi M, Fürst UM. Cardio-oncology in Austria: cardiotoxicity and surveillance of anti-cancer therapies : Position paper of the Heart Failure Working Group of the Austrian Society of Cardiology. Wien Klin Wochenschr 2022; 134:654-674. [PMID: 35507087 PMCID: PMC9065248 DOI: 10.1007/s00508-022-02031-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 02/07/2023]
Abstract
Survival in cancer is continuously improving due to evolving oncological treatment. Therefore, cardiovascular short-term and long-term side effects gain crucial importance for overall outcome. Cardiotoxicity not only presents as heart failure, but also as treatment-resistant hypertension, acute coronary ischemia with plaque rupture or vasospasm, thromboembolism, arrhythmia, pulmonary hypertension, diastolic dysfunction, acute myocarditis and others. Recent recommendations have proposed baseline cardiac risk assessment and surveillance strategies. Major challenges are the availability of monitoring and imaging resources, including echocardiography with speckle tracking longitudinal strain (GLS), serum biomarkers such as natriuretic peptides (NT-proBNP) and highly sensitive cardiac troponins. This Austrian consensus encompasses cardiotoxicity occurrence in frequent antiproliferative cancer drugs, radiotherapy, immune checkpoint inhibitors and cardiac follow-up considerations in cancer survivors in the context of the Austrian healthcare setting. It is important to optimize cardiovascular risk factors and pre-existing cardiac diseases without delaying oncological treatment. If left ventricular ejection fraction (LVEF) deteriorates during cancer treatment (from >10% to <50%), or myocardial strain decreases (>15% change in GLS), early initiation of cardioprotective therapies (angiotensin-converting enzyme inhibitors, angiotensin or beta receptor blockers) is recommended, and LVEF should be reassessed before discontinuation. Lower LVEF cut-offs were recently shown to be feasible in breast cancer patients to enable optimal anticancer treatment. Interdisciplinary cardio-oncology cooperation is pivotal for optimal management of cancer patients.
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Affiliation(s)
- Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Medical University of Graz, Graz, Austria.,Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Marc-Michael Zaruba
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Dörler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Internal Medicine and Cardiology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Armin Böhmer
- Department of Internal Medicine 1, Krems University Clinic, Krems, Austria
| | - Tamara Buchacher
- Department of Internal Medicine and Cardiology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Maria Frey
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Rupert Bartsch
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ursula-Maria Fürst
- Department of Internal Medicine, Hospital of the Brothers of St. John of God (Krankenhaus Barmherzige Brüder) Salzburg, Salzburg, Austria
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27
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Rech L, Abdellatif M, Pöttler M, Stangl V, Mabotuwana N, Hardy S, Rainer PP. Small molecule STING inhibition improves myocardial infarction remodeling. Life Sci 2022; 291:120263. [PMID: 34971697 DOI: 10.1016/j.lfs.2021.120263] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 01/31/2023]
Abstract
AIMS Myocardial infarction (MI) is a major global cause of death. Massive cell death leads to inflammation, which is necessary for ensuing wound healing. Extensive inflammation, however, promotes infarct expansion and adverse remodeling. The DNA sensing receptor cyclic GMP-AMP synthase and its downstream signaling effector stimulator of interferon genes (cGAS-STING) is central in innate immune reactions in infections or autoimmunity. Cytosolic double-strand DNA activates the pathway and down-stream inflammatory responses. Recent papers demonstrated that this pathway is also active following MI and that its genetic targeting improves outcome. Thus, we investigated if pharmacologic pathway inhibition is protective after MI in order to test its translational potential. MAIN METHODS We investigated novel and selective small-molecule STING inhibitors that inhibit STING palmitoylation and multimerization and thereby downstream pathway activation in a preclinical murine MI model. We assessed structural and functional cardiac remodeling, infarct expansion and fibrosis, as well as cardiomyocyte hypertrophy and the expression of inflammatory genes. KEY FINDINGS Pharmacologic STING inhibition did not reduce mortality due to myocardial rupture in non-reperfused MI. Infarct size at day one was comparable. However, three weeks of pharmacologic STING inhibition after reperfused MI decreased infarct expansion and scarring, increased left ventricular systolic function to levels approaching normal values, and reduced myocardial hypertrophy. SIGNIFICANCE Selective small-molecule STING inhibition after myocardial infarction has the potential to improve wound healing responses and pathological remodeling and thereby attenuate the development of ischemic heart failure.
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Affiliation(s)
- Lavinia Rech
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Mahmoud Abdellatif
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Maria Pöttler
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Nishani Mabotuwana
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sean Hardy
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria.
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28
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Papadaki M, Kampaengsri T, Barrick SK, Campbell SG, von Lewinski D, Rainer PP, Harris SP, Greenberg MJ, Kirk JA. Myofilament glycation in diabetes reduces contractility by inhibiting tropomyosin movement, is rescued by cMyBPC domains. J Mol Cell Cardiol 2022; 162:1-9. [PMID: 34487755 PMCID: PMC8766917 DOI: 10.1016/j.yjmcc.2021.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/22/2021] [Revised: 07/21/2021] [Accepted: 08/19/2021] [Indexed: 01/17/2023]
Abstract
Diabetes doubles the risk of developing heart failure (HF). As the prevalence of diabetes grows, so will HF unless the mechanisms connecting these diseases can be identified. Methylglyoxal (MG) is a glycolysis by-product that forms irreversible modifications on lysine and arginine, called glycation. We previously found that myofilament MG glycation causes sarcomere contractile dysfunction and is increased in patients with diabetes and HF. The aim of this study was to discover the molecular mechanisms by which MG glycation of myofilament proteins cause sarcomere dysfunction and to identify therapeutic avenues to compensate. In humans with type 2 diabetes without HF, we found increased glycation of sarcomeric actin compared to non-diabetics and it correlated with decreased calcium sensitivity. Depressed calcium sensitivity is pathogenic for HF, therefore myofilament glycation represents a promising therapeutic target to inhibit the development of HF in diabetics. To identify possible therapeutic targets, we further defined the molecular actions of myofilament glycation. Skinned myocytes exposed to 100 μM MG exhibited decreased calcium sensitivity, maximal calcium-activated force, and crossbridge kinetics. Replicating MG's functional affects using a computer simulation of sarcomere function predicted simultaneous decreases in tropomyosin's blocked-to-closed rate transition and crossbridge duty cycle were consistent with all experimental findings. Stopped-flow experiments and ATPase activity confirmed MG decreased the blocked-to-closed transition rate. Currently, no therapeutics target tropomyosin, so as proof-of-principal, we used a n-terminal peptide of myosin-binding protein C, previously shown to alter tropomyosin's position on actin. C0C2 completely rescued MG-induced calcium desensitization, suggesting a possible treatment for diabetic HF.
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Affiliation(s)
- Maria Papadaki
- Department of Cell and Molecular Physiology, Loyola University of Chicago, Maywood, Illinois, USA
| | - Theerachat Kampaengsri
- Department of Cell and Molecular Physiology, Loyola University of Chicago, Maywood, Illinois, USA
| | - Samantha K. Barrick
- Department of Biochemistry and Molecular Biophysics, Washington University in St Louis, St Louis, Missouri, USA
| | - Stuart G. Campbell
- Department of Bioengineering, Yale University, New Haven, Connecticut, USA
| | | | - Peter P. Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Samantha P. Harris
- Department of Cellular and Molecular Medicine, The University of Arizona, Tucson, Arizona, USA
| | - Michael J. Greenberg
- Department of Biochemistry and Molecular Biophysics, Washington University in St Louis, St Louis, Missouri, USA
| | - Jonathan A. Kirk
- Department of Cell and Molecular Physiology, Loyola University of Chicago, Maywood, Illinois, USA,Corresponding Author: Jonathan A. Kirk, Ph.D., Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of Medicine, Center for Translational Research and Education, Room 522, 2160 S. First Ave., Maywood, IL 60153, Ph: 708-216-6348,
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29
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Rech L, Abdellatif M, Poettler M, Stangl V, Ulcar E, Ablasser A, Rainer PP. STING inhibition in myocardial remodelling following myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3242] [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: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial infarction (MI) is one of the prevalent causes of death in the world, with some patients developing heart failure from myocardial remodelling after infarction. Inflammatory processes trigger remodelling post-MI. One inflammatory factor is Type 1 Interferon which can be released by cytosolic dsDNA, sensed via the STING-receptor. The aim of this study was to reduce this inflammatory response by inhibiting the STING-receptor and thus reduce post-infarctional remodelling.
Methods
Surgery was performed to trigger infarction for 30 minutes by ligating of the proximal LAD in 22 wildtype male mice (C57BL6/J), another 10 mice have undergone sham operation. Echocardiographic assessment of the endocardial systolic fractional area change (FAC) was carried out before, one day after and three weeks after surgery. The mice with ligation were separated into two groups with eleven individuals each, as well as the sham operated mice in five each group. One group was treated with the STING-Inhibitor while the other received a control substance. Treatment was applied intraperitoneally once per day for three weeks.
Results
– Procedural success was good as evidenced by immediate FAC decline in MI animals.
– One day post-op no significant difference in FAC and infarct size can be seen between the two groups of MI mice
– Three weeks post-op a highly significant difference in FAC can be observed in the group treated with STING-Inhibitor compared to the control group in the MI mice
– The sham operated mice never showed any difference between the groups at any time.
– Fibrosis and Cross sectinal area significantly reduced in treated MI group compared to control
– Ifi44 and Cxcl10 expression levels in the infarct area showed significant reduction in the inhibitor MI group compared to the control MI group after three weeks
Conclusion
STING-Inhibitor potentially improves outcome after a myocardial infarction.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Area Network on Cardiovasczlar Diseases (ERA-CVD) PhD-Program Molecular Medicine - Medical Unviersity of Graz
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Affiliation(s)
- L Rech
- Medical University of Graz, Cardiology, Graz, Austria
| | - M Abdellatif
- Medical University of Graz, Cardiology, Graz, Austria
| | - M Poettler
- Medical University of Graz, Cardiology, Graz, Austria
| | - V Stangl
- Medical University of Graz, Pathology, Graz, Austria
| | - E Ulcar
- Medical University of Graz, Pathology, Graz, Austria
| | - A Ablasser
- Swiss Federal Institute of Technology of Lausanne, Lausanne, Switzerland
| | - P P Rainer
- Medical University of Graz, Cardiology, Graz, Austria
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30
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Sokolski M, Trenson S, Sokolska JM, D'Amario D, Meyer P, Poku NK, Biering-Sørensen T, Højbjerg Lassen MC, Skaarup KG, Barge-Caballero E, Pouleur AC, Stolfo D, Sinagra G, Ablasser K, Muster V, Rainer PP, Wallner M, Chiodini A, Heiniger PS, Mikulicic F, Schwaiger J, Winnik S, Cakmak HA, Gaudenzi M, Mapelli M, Mattavelli I, Paul M, Cabac-Pogorevici I, Bouleti C, Lilliu M, Minoia C, Dauw J, Costa J, Celik A, Mewton N, Montenegro CEL, Matsue Y, Loncar G, Marchel M, Bechlioulis A, Michalis L, Dörr M, Prihadi E, Schoenrath F, Messroghli DR, Mullens W, Lund LH, Rosano GMC, Ponikowski P, Ruschitzka F, Flammer AJ. Heart failure in COVID-19: the multicentre, multinational PCHF-COVICAV registry. ESC Heart Fail 2021; 8:4955-4967. [PMID: 34533287 PMCID: PMC8653014 DOI: 10.1002/ehf2.13549] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
Aims We assessed the outcome of hospitalized coronavirus disease 2019 (COVID‐19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. Methods and results International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID‐19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF‐COVICAV). The primary endpoint was in‐hospital mortality. Of 1974 patients hospitalized with COVID‐19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in‐hospital mortality was 25% (n = 323/1282 deaths). In‐hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non‐HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P < 0.001). After adjusting, HF remained associated with in‐hospital mortality (OR 1.45 [95% confidence interval: 1.01–2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in‐hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24–4.29], P < 0.001). Conclusions Hospitalized COVID‐19 patients with HF are at increased risk for in‐hospital death. In‐hospital worsening of HF or acute HF de novo are common and associated with a further increase in in‐hospital mortality.
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Affiliation(s)
- Mateusz Sokolski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Sander Trenson
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Justyna M Sokolska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Philippe Meyer
- Cardiology Service, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Nana K Poku
- Cardiology Service, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mats C Højbjerg Lassen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer G Skaarup
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Eduardo Barge-Caballero
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), A Coruña, Spain
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Davide Stolfo
- Cardiovascular Department, University Hospital of Trieste - ASUGI, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, University Hospital of Trieste - ASUGI, Trieste, Italy
| | - Klemens Ablasser
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Viktoria Muster
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Medical University of Graz, Graz, Austria.,Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
| | - Alessandra Chiodini
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Pascal S Heiniger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Fran Mikulicic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Judith Schwaiger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Huseyin A Cakmak
- Department of Cardiology, Mustafakemalpasa State Hospital, Bursa, Turkey
| | - Margherita Gaudenzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Matthias Paul
- Heart Center Lucerne, Luzerner Kantonsspital (LUKS), Luzern, Switzerland
| | - Irina Cabac-Pogorevici
- Department of Cardiology, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
| | - Claire Bouleti
- Cardiology Department, Clinical Investigation Center (CIC) INSERM 1402, Poitiers Hospital, Poitiers University, Poitiers, France
| | - Marzia Lilliu
- Division of Infectious Diseases, Azienda ULSS 9, M. Magalini Hospital, Verona, Italy
| | - Chiara Minoia
- Emergency Department, Public Health Company Valle Olona, Busto Arsizio, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Doctoral School for Medicine and Life sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Jérôme Costa
- Department of Cardiology, Reims University Hospital Centre, Reims, France
| | - Ahmet Celik
- Department of Cardiology, Mersin University Medical Faculty, Mersin, Turkey
| | - Nathan Mewton
- Cardiovascular Hospital Louis Pradel, Department of Heart Failure, Hospices Civils de Lyon, Lyon, France.,Clinical Investigation Center, Inserm 1407, Lyon, France.,CARMEN Inserm 1060, Claude Bernard University Lyon, Lyon, France
| | - Carlos E L Montenegro
- PROCAPE- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brazil
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michal Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aris Bechlioulis
- 2nd Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Lampros Michalis
- 2nd Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | | | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Daniel R Messroghli
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany.,Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
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31
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Abstract
Inflammation plays a central role in cardiovascular diseases (CVD). One pathway under investigation is the innate immune DNA sensor cyclic GMP-AMP synthase (cGAS) and its downstream receptor stimulator of interferon genes (STING). cGAS-STING upregulates type I interferons in response to pathogens. Recent studies show that also self-DNA may activate cGAS-STING, for instance, DNA released from nuclei or mitochondria during obesity or myocardial infarction. Here, we focus on emerging evidence describing the interaction of cGAS-STING with cardiovascular risk factors and disease. We also touch on translational therapeutic opportunities and potential further investigations.
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Affiliation(s)
- Lavinia Rech
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
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Abdellatif M, Trummer-Herbst V, Koser F, Durand S, Adão R, Vasques-Nóvoa F, Freundt JK, Voglhuber J, Pricolo MR, Kasa M, Türk C, Aprahamian F, Herrero-Galán E, Hofer SJ, Pendl T, Rech L, Kargl J, Anto-Michel N, Ljubojevic-Holzer S, Schipke J, Brandenberger C, Auer M, Schreiber R, Koyani CN, Heinemann A, Zirlik A, Schmidt A, von Lewinski D, Scherr D, Rainer PP, von Maltzahn J, Mühlfeld C, Krüger M, Frank S, Madeo F, Eisenberg T, Prokesch A, Leite-Moreira AF, Lourenço AP, Alegre-Cebollada J, Kiechl S, Linke WA, Kroemer G, Sedej S. Nicotinamide for the treatment of heart failure with preserved ejection fraction. Sci Transl Med 2021; 13:13/580/eabd7064. [PMID: 33568522 DOI: 10.1126/scitranslmed.abd7064] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/05/2020] [Accepted: 01/12/2021] [Indexed: 12/17/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent and intractable form of cardiac decompensation commonly associated with diastolic dysfunction. Here, we show that diastolic dysfunction in patients with HFpEF is associated with a cardiac deficit in nicotinamide adenine dinucleotide (NAD+). Elevating NAD+ by oral supplementation of its precursor, nicotinamide, improved diastolic dysfunction induced by aging (in 2-year-old C57BL/6J mice), hypertension (in Dahl salt-sensitive rats), or cardiometabolic syndrome (in ZSF1 obese rats). This effect was mediated partly through alleviated systemic comorbidities and enhanced myocardial bioenergetics. Simultaneously, nicotinamide directly improved cardiomyocyte passive stiffness and calcium-dependent active relaxation through increased deacetylation of titin and the sarcoplasmic reticulum calcium adenosine triphosphatase 2a, respectively. In a long-term human cohort study, high dietary intake of naturally occurring NAD+ precursors was associated with lower blood pressure and reduced risk of cardiac mortality. Collectively, these results suggest NAD+ precursors, and especially nicotinamide, as potential therapeutic agents to treat diastolic dysfunction and HFpEF in humans.
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Affiliation(s)
- Mahmoud Abdellatif
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | | | - Franziska Koser
- Institute of Physiology II, University of Münster, Münster 48149, Germany
| | - Sylvère Durand
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif 94805, France.,Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France, Paris 75006, France
| | - Rui Adão
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria.,Department of Surgery and Physiology, Cardiovascular Research and Development Centre (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Francisco Vasques-Nóvoa
- Department of Surgery and Physiology, Cardiovascular Research and Development Centre (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Johanna K Freundt
- Institute of Physiology II, University of Münster, Münster 48149, Germany
| | - Julia Voglhuber
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria.,BioTechMed Graz, Graz 8010, Austria
| | | | - Michael Kasa
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Clara Türk
- Institute for Genetics, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne 50931, Germany.,Center for Molecular Medicine (CMMC), University of Cologne, Cologne 50931, Germany
| | - Fanny Aprahamian
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif 94805, France.,Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France, Paris 75006, France
| | - Elías Herrero-Galán
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid 28029, Spain
| | - Sebastian J Hofer
- Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Tobias Pendl
- Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Lavinia Rech
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Julia Kargl
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Graz 8010, Austria
| | | | - Senka Ljubojevic-Holzer
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria.,BioTechMed Graz, Graz 8010, Austria
| | - Julia Schipke
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover 30625, Germany
| | - Christina Brandenberger
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover 30625, Germany
| | - Martina Auer
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, Graz 8010, Austria.,Division of Cell Biology, Histology and Embryology, Medical University of Graz, Graz 8010, Austria
| | - Renate Schreiber
- Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Chintan N Koyani
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Akos Heinemann
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Graz 8010, Austria
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Albrecht Schmidt
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Dirk von Lewinski
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Daniel Scherr
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Peter P Rainer
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria.,BioTechMed Graz, Graz 8010, Austria
| | | | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover 30625, Germany
| | - Marcus Krüger
- Institute for Genetics, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne 50931, Germany.,Center for Molecular Medicine (CMMC), University of Cologne, Cologne 50931, Germany
| | - Saša Frank
- BioTechMed Graz, Graz 8010, Austria.,Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, Graz 8010, Austria
| | - Frank Madeo
- BioTechMed Graz, Graz 8010, Austria.,Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Tobias Eisenberg
- BioTechMed Graz, Graz 8010, Austria.,Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Andreas Prokesch
- BioTechMed Graz, Graz 8010, Austria.,Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, Graz 8010, Austria.,Division of Cell Biology, Histology and Embryology, Medical University of Graz, Graz 8010, Austria
| | - Adelino F Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular Research and Development Centre (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - André P Lourenço
- Department of Surgery and Physiology, Cardiovascular Research and Development Centre (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | | | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck 6020, Austria.,VASCage, Research Centre for Promoting Vascular Health in the Ageing Community, Innsbruck 6020, Austria
| | - Wolfgang A Linke
- Institute of Physiology II, University of Münster, Münster 48149, Germany
| | - Guido Kroemer
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif 94805, France. .,Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France, Paris 75006, France.,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris 75015, France.,Suzhou Institute for Systems Medicine, Chinese Academy of Sciences, Suzhou 215000, China.,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Solna 17164, Sweden
| | - Simon Sedej
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria. .,BioTechMed Graz, Graz 8010, Austria.,Faculty of Medicine, University of Maribor, Maribor 2000, Slovenia
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33
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Schrempf M, Kramer D, Jauk S, Veeranki SPK, Leodolter W, Rainer PP. Machine Learning Based Risk Prediction for Major Adverse Cardiovascular Events. Stud Health Technol Inform 2021; 279:136-143. [PMID: 33965930 DOI: 10.3233/shti210100] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with major adverse cardiovascular events (MACE) such as myocardial infarction or stroke suffer from frequent hospitalizations and have high mortality rates. By identifying patients at risk at an early stage, MACE can be prevented with the right interventions. OBJECTIVES The aim of this study was to develop machine learning-based models for the 5-year risk prediction of MACE. METHODS The data used for modelling included electronic medical records of more than 128,000 patients including 29,262 patients with MACE. A feature selection based on filter and embedded methods resulted in 826 features for modelling. Different machine learning methods were used for modelling on the training data. RESULTS A random forest model achieved the best calibration and discriminative performance on a separate test data set with an AUROC of 0.88. CONCLUSION The developed risk prediction models achieved an excellent performance in the test data. Future research is needed to determine the performance of these models and their clinical benefit in prospective settings.
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Affiliation(s)
- Michael Schrempf
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
| | - Diether Kramer
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
| | - Stefanie Jauk
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria.,Medical University of Graz, Graz, Austria
| | - Sai P K Veeranki
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
| | - Werner Leodolter
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
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34
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Zach D, Ablasser K, Kolesnik E, Hoeller V, Fruhwald F, Prüller F, Reiter C, Beham-Schmid C, Lipp R, Rainer PP, Zirlik A, Wölfler A, Verheyen N. Advanced isolated light chain amyloid cardiomyopathy with negative immunofixation and normal free light chain ratio. ESC Heart Fail 2021; 8:3397-3402. [PMID: 33960730 PMCID: PMC8318415 DOI: 10.1002/ehf2.13381] [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: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 12/22/2022] Open
Abstract
Amyloid light chain (AL) cardiomyopathy is the most malignant specific cardiomyopathy. According to international recommendations, it should be ruled out non‐invasively using the serum free light chain (FLC) ratio and immunofixation electrophoresis in both serum and urine. Here, we report on a 69‐year‐old female patient with new‐onset heart failure with mid‐range ejection fraction. Cardiac imaging was highly suggestive of cardiac amyloidosis. Amyloid scintigraphy showed faint myocardial tracer uptake according to Perugini Score 1, but immunofixation was negative and the FLC ratio was normal, despite a slight increase in lambda FLCs. Endomyocardial biopsy revealed advanced myocardial lambda immunoglobulin light chain deposition. Clinically relevant extracardiac amyloid organ infiltration could not be detected. Conclusively, non‐invasive testing can in rare cases fail to exclude isolated AL amyloid cardiomyopathy. We suggest that even slight increases in serum lambda or kappa FLCs should be considered abnormal in suspected cardiac amyloidosis if non‐invasive testing delivers discrepant results.
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Affiliation(s)
- David Zach
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, A-8036, Austria
| | - Klemens Ablasser
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, A-8036, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, A-8036, Austria
| | - Viktoria Hoeller
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, A-8036, Austria
| | - Friedrich Fruhwald
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, A-8036, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | | | - Rainer Lipp
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, A-8036, Austria
| | - Andreas Zirlik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, A-8036, Austria
| | - Albert Wölfler
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nicolas Verheyen
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, A-8036, Austria
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35
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Schmid J, Kamml C, Zweiker D, Hatz D, Schmidt A, Reiter U, Toth GG, Fuchsjäger M, Zirlik A, Binder JS, Rainer PP. Cardiac Magnetic Resonance Imaging Right Ventricular Longitudinal Strain Predicts Mortality in Patients Undergoing TAVI. Front Cardiovasc Med 2021; 8:644500. [PMID: 34026866 PMCID: PMC8137844 DOI: 10.3389/fcvm.2021.644500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/19/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Right ventricular (RV) function predicts survival in numerous cardiac conditions, including left heart disease. The reference standard for non-invasive assessment of RV function is cardiac magnetic resonance imaging (CMR). The aim of this study was to investigate the association between pre-procedural CMR-derived RV functional parameters and mortality in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: Patients scheduled for TAVI were recruited to undergo pre-procedural CMR. Volumetric function and global longitudinal and circumferential strain (GLS and GCS) of the RV and left ventricle (LV) were measured. The association with the primary endpoint (1-year all-cause mortality) was analyzed with Cox regression. Results: Of 133 patients undergoing CMR, 113 patients were included in the analysis. Mean age was 81.8 ± 5.8 years, and 65% were female. Median follow-up was 3.9 [IQR 2.3–4.7] years. All-cause and cardiovascular mortality was 14 and 12% at 1 year, and 28 and 20% at 3 years, respectively. One-year all-cause mortality was significantly predicted by RV GLS [HR = 1.109 (95% CI: 1.023–1.203); p = 0.012], RV ejection fraction [HR = 0.956 (95% CI: 0.929–0.985); p = 0.003], RV end-diastolic volume index [HR = 1.009 (95% CI: 1.001–1.018); p = 0.025], and RV end-systolic volume index [HR = 1.010 (95% CI: 1.003–1.017); p = 0.005]. In receiver operating characteristic (ROC) analysis for 1-year all-cause mortality, the area under the curve was 0.705 (RV GLS) and 0.673 (RV EF). Associations decreased in strength at longer follow-up. None of the LV parameters was associated with mortality. Conclusions: RV function predicts intermediate-term mortality in TAVI patients while LV parameters were not associated with outcomes. Inclusion of easily obtainable RV GLS may improve future risk scores.
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Affiliation(s)
- Johannes Schmid
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Claus Kamml
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - David Zweiker
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Third Medical Department of Cardiology and Intensive Care, Wilhelminenhospital, Vienna, Austria
| | - Dominik Hatz
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Gabor G Toth
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Andreas Zirlik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Josepha S Binder
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
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36
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Spray L, Park C, Cormack S, Mohammed A, Panahi P, Boag S, Bennaceur K, Sopova K, Richardson G, Stangl VM, Rech L, Rainer PP, Ramos GC, Hofmann U, Stellos K, Spyridopoulos I. The Fractalkine Receptor CX 3CR1 Links Lymphocyte Kinetics in CMV-Seropositive Patients and Acute Myocardial Infarction With Adverse Left Ventricular Remodeling. Front Immunol 2021; 12:605857. [PMID: 34046028 PMCID: PMC8147691 DOI: 10.3389/fimmu.2021.605857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/20/2021] [Indexed: 01/10/2023] Open
Abstract
Aims Latent cytomegalovirus (CMV) infection is associated with adverse cardiovascular outcomes. Virus-specific CX3CR1+ effector memory T-cells may be instrumental in this process due to their pro-inflammatory properties. We investigated the role of CX3CR1 (fractalkine receptor) in CMV-related lymphocyte kinetics and cardiac remodeling in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Methods and Results We retrospectively analysed lymphocyte count, troponin, and survival in 4874 STEMI/pPCI patients, evaluated lymphocyte kinetics during reperfusion in a prospective cohort, and obtained sequential cardiac MRI (cMRI) to assess remodeling. Pre-reperfusion lymphopenia independently predicted mortality at 7.5 years. Prior to reperfusion, CCR7+ T-lymphocytes appeared to be depleted. After reperfusion, T-lymphocytes expressing CX3CR1 were depleted predominantly in CMV-seropositive patients. During ischaemia/reperfusion, a drop in CX3CR1+ T-lymphocytes was significantly linked with microvascular obstruction in CMV+ patients, suggesting increased fractalkine-receptor interaction. At 12 weeks, CMV+ patients displayed adverse LV remodeling. Conclusion We show that lymphopenia occurs before and after reperfusion in STEMI by different mechanisms and predicts long-term outcome. In CMV+ patients, increased fractalkine induction and sequestration of CX3CR1+ T-cells may contribute to adverse remodeling, suggesting a pro-inflammatory pathomechanism which presents a novel therapeutic target.
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Affiliation(s)
- Luke Spray
- Cardiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Catherine Park
- Translational and Clinical Research Institute, Cardiovascular Biology and Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Suzanne Cormack
- Cardiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Ashfaq Mohammed
- Cardiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Pedram Panahi
- Translational and Clinical Research Institute, Cardiovascular Biology and Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Stephen Boag
- Translational and Clinical Research Institute, Cardiovascular Biology and Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Karim Bennaceur
- Translational and Clinical Research Institute, Cardiovascular Biology and Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Kateryna Sopova
- Cardiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Cardiovascular Biology and Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Gavin Richardson
- Biosciences Institute, Cardiovascular Biology and Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Verena M. Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Lavinia Rech
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Peter P. Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | - Gustavo Campos Ramos
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Hofmann
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Konstantinos Stellos
- Cardiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Biosciences Institute, Cardiovascular Biology and Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Ioakim Spyridopoulos
- Cardiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Cardiovascular Biology and Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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37
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Ljubojević-Holzer S, Kraler S, Djalinac N, Abdellatif M, Voglhuber J, Schipke J, Schmidt M, Kling KM, Franke GT, Herbst V, Zirlik A, von Lewinski D, Scherr D, Rainer PP, Kohlhaas M, Nickel A, Mühlfeld C, Maack C, Sedej S. Loss of autophagy protein ATG5 impairs cardiac capacity in mice and humans through diminishing mitochondrial abundance and disrupting Ca2+ cycling. Cardiovasc Res 2021; 118:1492-1505. [PMID: 33752242 PMCID: PMC9074988 DOI: 10.1093/cvr/cvab112] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Aims Autophagy protects against the development of cardiac hypertrophy and failure. While aberrant Ca2+ handling promotes myocardial remodelling and contributes to contractile dysfunction, the role of autophagy in maintaining Ca2+ homeostasis remains elusive. Here, we examined whether Atg5 deficiency-mediated autophagy promotes early changes in subcellular Ca2+ handling in ventricular cardiomyocytes, and whether those alterations associate with compromised cardiac reserve capacity, which commonly precedes the onset of heart failure. Methods and results RT–qPCR and immunoblotting demonstrated reduced Atg5 gene and protein expression and decreased abundancy of autophagy markers in hypertrophied and failing human hearts. The function of ATG5 was examined using cardiomyocyte-specific Atg5-knockout mice (Atg5−/−). Before manifesting cardiac dysfunction, Atg5−/− mice showed compromised cardiac reserve in response to β-adrenergic stimulation. Consequently, effort intolerance and maximal oxygen consumption were reduced during treadmill-based exercise tolerance testing. Mechanistically, cellular imaging revealed that Atg5 deprivation did not alter spatial and functional organization of intracellular Ca2+ stores or affect Ca2+ cycling in response to slow pacing or upon acute isoprenaline administration. However, high-frequency stimulation exposed stunted amplitude of Ca2+ transients, augmented nucleoplasmic Ca2+ load, and increased CaMKII activity, especially in the nuclear region of hypertrophied Atg5−/− cardiomyocytes. These changes in Ca2+ cycling were recapitulated in hypertrophied human cardiomyocytes. Finally, ultrastructural analysis revealed accumulation of mitochondria with reduced volume and size distribution, meanwhile functional measurements showed impaired redox balance in Atg5−/− cardiomyocytes, implying energetic unsustainability due to overcompensation of single mitochondria, particularly under increased workload. Conclusion Loss of cardiac Atg5-dependent autophagy reduces mitochondrial abundance and causes subtle alterations in subcellular Ca2+ cycling upon increased workload in mice. Autophagy-related impairment of Ca2+ handling is progressively worsened by β-adrenergic signalling in ventricular cardiomyocytes, thereby leading to energetic exhaustion and compromised cardiac reserve.
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Affiliation(s)
- Senka Ljubojević-Holzer
- Department of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
| | - Simon Kraler
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Nataša Djalinac
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Julia Voglhuber
- Department of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
| | - Julia Schipke
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Marlene Schmidt
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Katharina-Maria Kling
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Greta Therese Franke
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Viktoria Herbst
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Daniel Scherr
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Michael Kohlhaas
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Alexander Nickel
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Christoph Maack
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Simon Sedej
- Department of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
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38
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Tomin T, Schittmayer M, Sedej S, Bugger H, Gollmer J, Honeder S, Darnhofer B, Liesinger L, Zuckermann A, Rainer PP, Birner-Gruenberger R. Mass Spectrometry-Based Redox and Protein Profiling of Failing Human Hearts. Int J Mol Sci 2021; 22:ijms22041787. [PMID: 33670142 PMCID: PMC7916846 DOI: 10.3390/ijms22041787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
Oxidative stress contributes to detrimental functional decline of the myocardium, leading to the impairment of the antioxidative defense, dysregulation of redox signaling, and protein damage. In order to precisely dissect the changes of the myocardial redox state correlated with oxidative stress and heart failure, we subjected left-ventricular tissue specimens collected from control or failing human hearts to comprehensive mass spectrometry-based redox and quantitative proteomics, as well as glutathione status analyses. As a result, we report that failing hearts have lower glutathione to glutathione disulfide ratios and increased oxidation of a number of different proteins, including constituents of the contractile machinery as well as glycolytic enzymes. Furthermore, quantitative proteomics of failing hearts revealed a higher abundance of proteins responsible for extracellular matrix remodeling and reduced abundance of several ion transporters, corroborating contractile impairment. Similar effects were recapitulated by an in vitro cell culture model under a controlled oxygen atmosphere. Together, this study provides to our knowledge the most comprehensive report integrating analyses of protein abundance and global and peptide-level redox state in end-stage failing human hearts as well as oxygen-dependent redox and global proteome profiles of cultured human cardiomyocytes.
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Affiliation(s)
- Tamara Tomin
- Faculty of Technical Chemistry, Institute of Chemical Technologies and Analytics, Vienna University of Technology-TU Wien, Getreidemarkt 9/164, 1060 Vienna, Austria;
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Stiftingtalstrasse 6, 8010 Graz, Austria; (S.H.); (B.D.); (L.L.)
- BiotechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria;
| | - Matthias Schittmayer
- Faculty of Technical Chemistry, Institute of Chemical Technologies and Analytics, Vienna University of Technology-TU Wien, Getreidemarkt 9/164, 1060 Vienna, Austria;
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Stiftingtalstrasse 6, 8010 Graz, Austria; (S.H.); (B.D.); (L.L.)
- BiotechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria;
- Correspondence: (M.S.); (P.P.R.); (R.B.-G.)
| | - Simon Sedej
- BiotechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria;
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.B.); (J.G.)
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Heiko Bugger
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.B.); (J.G.)
| | - Johannes Gollmer
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.B.); (J.G.)
| | - Sophie Honeder
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Stiftingtalstrasse 6, 8010 Graz, Austria; (S.H.); (B.D.); (L.L.)
- BiotechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria;
| | - Barbara Darnhofer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Stiftingtalstrasse 6, 8010 Graz, Austria; (S.H.); (B.D.); (L.L.)
- BiotechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria;
| | - Laura Liesinger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Stiftingtalstrasse 6, 8010 Graz, Austria; (S.H.); (B.D.); (L.L.)
- BiotechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria;
| | - Andreas Zuckermann
- Cardiac Transplantation, Department of Cardiac Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria;
| | - Peter P. Rainer
- BiotechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria;
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.B.); (J.G.)
- Correspondence: (M.S.); (P.P.R.); (R.B.-G.)
| | - Ruth Birner-Gruenberger
- Faculty of Technical Chemistry, Institute of Chemical Technologies and Analytics, Vienna University of Technology-TU Wien, Getreidemarkt 9/164, 1060 Vienna, Austria;
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Stiftingtalstrasse 6, 8010 Graz, Austria; (S.H.); (B.D.); (L.L.)
- BiotechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria;
- Correspondence: (M.S.); (P.P.R.); (R.B.-G.)
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Barennes P, Quiniou V, Shugay M, Egorov ES, Davydov AN, Chudakov DM, Uddin I, Ismail M, Oakes T, Chain B, Eugster A, Kashofer K, Rainer PP, Darko S, Ransier A, Douek DC, Klatzmann D, Mariotti-Ferrandiz E. Benchmarking of T cell receptor repertoire profiling methods reveals large systematic biases. Nat Biotechnol 2021; 39:236-245. [PMID: 32895550 DOI: 10.1038/s41587-020-0656-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/28/2020] [Indexed: 12/13/2022]
Abstract
Monitoring the T cell receptor (TCR) repertoire in health and disease can provide key insights into adaptive immune responses, but the accuracy of current TCR sequencing (TCRseq) methods is unclear. In this study, we systematically compared the results of nine commercial and academic TCRseq methods, including six rapid amplification of complementary DNA ends (RACE)-polymerase chain reaction (PCR) and three multiplex-PCR approaches, when applied to the same T cell sample. We found marked differences in accuracy and intra- and inter-method reproducibility for T cell receptor α (TRA) and T cell receptor β (TRB) TCR chains. Most methods showed a lower ability to capture TRA than TRB diversity. Low RNA input generated non-representative repertoires. Results from the 5' RACE-PCR methods were consistent among themselves but differed from the RNA-based multiplex-PCR results. Using an in silico meta-repertoire generated from 108 replicates, we found that one genomic DNA-based method and two non-unique molecular identifier (UMI) RNA-based methods were more sensitive than UMI methods in detecting rare clonotypes, despite the better clonotype quantification accuracy of the latter.
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Affiliation(s)
- Pierre Barennes
- Sorbonne Université, INSERM, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (i2B), Paris, France
| | - Valentin Quiniou
- Sorbonne Université, INSERM, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (i2B), Paris, France
| | - Mikhail Shugay
- Center of Life Sciences, Skoltech, Moscow, Russia
- Genomics of Adaptive Immunity Department, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Evgeniy S Egorov
- Genomics of Adaptive Immunity Department, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia
| | - Alexey N Davydov
- Adaptive Immunity Group, Central European Institute of Technology, Brno, Czechia
| | - Dmitriy M Chudakov
- Center of Life Sciences, Skoltech, Moscow, Russia
- Genomics of Adaptive Immunity Department, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, Moscow, Russia
- Adaptive Immunity Group, Central European Institute of Technology, Brno, Czechia
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, UK
| | - Mazlina Ismail
- Division of Infection and Immunity, University College London, London, UK
| | - Theres Oakes
- Division of Infection and Immunity, University College London, London, UK
| | - Benny Chain
- Division of Infection and Immunity, University College London, London, UK
| | - Anne Eugster
- DFG-Centre for Regenerative Therapies Dresden, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Karl Kashofer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Samuel Darko
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Amy Ransier
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Daniel C Douek
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David Klatzmann
- Sorbonne Université, INSERM, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (i2B), Paris, France
| | - Encarnita Mariotti-Ferrandiz
- Sorbonne Université, INSERM, Immunology-Immunopathology-Immunotherapy (i3), Paris, France.
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (i2B), Paris, France.
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Schmid J, Rainer PP. Reply to: More data about cardiac and neurologic findings would be useful. ESC Heart Fail 2021; 8:1729-1730. [PMID: 33474822 PMCID: PMC8006683 DOI: 10.1002/ehf2.13212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/02/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Johannes Schmid
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria.,Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz, 8036, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
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41
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Deak AT, Ionita F, Kirsch AH, Odler B, Rainer PP, Kramar R, Kubatzki MP, Eberhard K, Berghold A, Rosenkranz AR. Impact of cardiovascular risk stratification strategies in kidney transplantation over time. Nephrol Dial Transplant 2021; 35:1810-1818. [PMID: 33022711 PMCID: PMC7538198 DOI: 10.1093/ndt/gfaa131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/02/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Kidney transplant recipients exhibit a dramatically increased cardiovascular (CV) risk. In 2007, Austrian centres implemented a consensus of comprehensive CV screening programme prior to kidney transplantation (KT). The consensus placed a particular emphasis on screening for coronary artery disease (CAD) with cardiac computed tomography (CT) or coronary angiography (CAG) in patients with diabetes mellitus, known CAD or those having multiple conventional CV risk factors. Here, we investigate if this affected risk stratification and post-transplant CV outcomes. METHODS In a retrospective chart review, we evaluated 551 KTs performed from 2003 to 2015 in our centre. Patients were categorized into three groups: KT before (2003-07), directly after (2008-11) and 5 years after (2012-15) implementation of the consensus. We analysed clinical characteristics, the rate of cardiac CTs and CAGs prior to KT as well as major adverse cardiac events (MACEs) during a 2-year follow-up after KT. RESULTS The three study groups showed a homogeneous distribution of comorbidities and age. Significantly more cardiac CTs (13.6% versus 10.2% versus 44.8%; P = 0.002) and CAGs (39.6% versus 43.9% versus 56.2%; P = 0.003) were performed after the consensus. Coronary interventions were performed during 42 out of 260 CAGs (16.2%), the cumulative 2-year MACE incidence was 8.7%. Regarding MACE occurrence, no significant difference between the three groups was found. CONCLUSION CV risk stratification has become more rigorous and invasive after the implementation of the consensus; however, this was not associated with an improvement in CV outcome.
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Affiliation(s)
- Andras T Deak
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Francesca Ionita
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Alexander H Kirsch
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Balazs Odler
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Reinhard Kramar
- Austrian Dialysis and Transplant Registry, Innsbruck, Austria
| | - Michael P Kubatzki
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Katharina Eberhard
- Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
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42
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Bonderman D, Pölzl G, Ablasser K, Agis H, Aschauer S, Auer-Grumbach M, Binder C, Dörler J, Duca F, Ebner C, Hacker M, Kain R, Kammerlander A, Koschutnik M, Kroiss AS, Mayr A, Nitsche C, Rainer PP, Reiter-Malmqvist S, Schneider M, Schwarz R, Verheyen N, Weber T, Zaruba MM, Badr Eslam R, Hülsmann M, Mascherbauer J. Diagnosis and treatment of cardiac amyloidosis: an interdisciplinary consensus statement. Wien Klin Wochenschr 2020; 132:742-761. [PMID: 33270160 PMCID: PMC7732807 DOI: 10.1007/s00508-020-01781-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
The prevalence and significance of cardiac amyloidosis have been considerably underestimated in the past; however, the number of patients diagnosed with cardiac amyloidosis has increased significantly recently due to growing awareness of the disease, improved diagnostic capabilities and demographic trends. Specific therapies that improve patient prognosis have become available for certain types of cardiac amyloidosis. Thus, the earliest possible referral of patients with suspicion of cardiac amyloidosis to an experienced center is crucial to ensure rapid diagnosis, early initiation of treatment, and structured patient care. This requires intensive collaboration across several disciplines, and between resident physicians and specialized centers. The aim of this consensus statement is to provide guidance for the rapid and efficient diagnosis and treatment of light-chain amyloidosis and transthyretin amyloidosis, which are the most common forms of cardiac amyloidosis.
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Affiliation(s)
- Diana Bonderman
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
| | - Gerhard Pölzl
- Department of Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Innsbruck, Austria
| | - Klemens Ablasser
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Hermine Agis
- Department of Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Stefan Aschauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Michaela Auer-Grumbach
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Jakob Dörler
- Department of Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Innsbruck, Austria
| | - Franz Duca
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Ebner
- Internal Department II of Cardiology, Angiology and Internal Intensive Medicine, Elisabethinen Hospital, Linz, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Andreas Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Matthias Schneider
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Roland Schwarz
- Specialist in Internal Medicine and Cardiology, Ried im Innkreis, Austria
| | - Nicolas Verheyen
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Thomas Weber
- Department of Internal Medicine 2 (Cardiology & Intensive Care), University Teaching Hospital Klinikum Wels-Grieskirchen, Wels, Austria
| | - Marc Michael Zaruba
- Department of Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Innsbruck, Austria
| | - Roza Badr Eslam
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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Prasch J, Bernhart E, Reicher H, Kollroser M, Rechberger GN, Koyani CN, Trummer C, Rech L, Rainer PP, Hammer A, Malle E, Sattler W. Myeloperoxidase-Derived 2-Chlorohexadecanal Is Generated in Mouse Heart during Endotoxemia and Induces Modification of Distinct Cardiomyocyte Protein Subsets In Vitro. Int J Mol Sci 2020; 21:ijms21239235. [PMID: 33287422 PMCID: PMC7730634 DOI: 10.3390/ijms21239235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
Sepsis is a major cause of mortality in critically ill patients and associated with cardiac dysfunction, a complication linked to immunological and metabolic aberrations. Cardiac neutrophil infiltration and subsequent release of myeloperoxidase (MPO) leads to the formation of the oxidant hypochlorous acid (HOCl) that is able to chemically modify plasmalogens (ether-phospholipids) abundantly present in the heart. This reaction gives rise to the formation of reactive lipid species including aldehydes and chlorinated fatty acids. During the present study, we tested whether endotoxemia increases MPO-dependent lipid oxidation/modification in the mouse heart. In hearts of lipopolysaccharide-injected mice, we observed significantly higher infiltration of MPO-positive cells, increased fatty acid content, and formation of 2-chlorohexadecanal (2-ClHDA), an MPO-derived plasmalogen modification product. Using murine HL-1 cardiomyocytes as in vitro model, we show that exogenously added HOCl attacks the cellular plasmalogen pool and gives rise to the formation of 2-ClHDA. Addition of 2-ClHDA to HL-1 cardiomyocytes resulted in conversion to 2-chlorohexadecanoic acid and 2-chlorohexadecanol, indicating fatty aldehyde dehydrogenase-mediated redox metabolism. However, a recovery of only 40% indicated the formation of non-extractable (protein) adducts. To identify protein targets, we used a clickable alkynyl analog, 2-chlorohexadec-15-yn-1-al (2-ClHDyA). After Huisgen 1,3-dipolar cycloaddition of 5-tetramethylrhodamine azide (N3-TAMRA) and two dimensional-gel electrophoresis (2D-GE), we were able to identify 51 proteins that form adducts with 2-ClHDyA. Gene ontology enrichment analyses revealed an overrepresentation of heat shock and chaperone, energy metabolism, and cytoskeletal proteins as major targets. Our observations in a murine endotoxemia model demonstrate formation of HOCl-modified lipids in the heart, while pathway analysis in vitro revealed that the chlorinated aldehyde targets specific protein subsets, which are central to cardiac function.
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Affiliation(s)
- Jürgen Prasch
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria; (J.P.); (E.B.); (H.R.); (C.N.K.); (C.T.); (E.M.)
| | - Eva Bernhart
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria; (J.P.); (E.B.); (H.R.); (C.N.K.); (C.T.); (E.M.)
| | - Helga Reicher
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria; (J.P.); (E.B.); (H.R.); (C.N.K.); (C.T.); (E.M.)
| | | | - Gerald N. Rechberger
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria;
- Center for Explorative Lipidomics, BioTechMed Graz, 8010 Graz, Austria
| | - Chintan N. Koyani
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria; (J.P.); (E.B.); (H.R.); (C.N.K.); (C.T.); (E.M.)
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8010 Graz, Austria; (L.R.); (P.P.R.)
| | - Christopher Trummer
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria; (J.P.); (E.B.); (H.R.); (C.N.K.); (C.T.); (E.M.)
| | - Lavinia Rech
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8010 Graz, Austria; (L.R.); (P.P.R.)
| | - Peter P. Rainer
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8010 Graz, Austria; (L.R.); (P.P.R.)
| | - Astrid Hammer
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria;
| | - Ernst Malle
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria; (J.P.); (E.B.); (H.R.); (C.N.K.); (C.T.); (E.M.)
| | - Wolfgang Sattler
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria; (J.P.); (E.B.); (H.R.); (C.N.K.); (C.T.); (E.M.)
- Center for Explorative Lipidomics, BioTechMed Graz, 8010 Graz, Austria
- Correspondence: ; Tel.: +43-316-385-71950
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de Boer RA, Hulot J, Tocchetti CG, Aboumsallem JP, Ameri P, Anker SD, Bauersachs J, Bertero E, Coats AJ, Čelutkienė J, Chioncel O, Dodion P, Eschenhagen T, Farmakis D, Bayes‐Genis A, Jäger D, Jankowska EA, Kitsis RN, Konety SH, Larkin J, Lehmann L, Lenihan DJ, Maack C, Moslehi JJ, Müller OJ, Nowak‐Sliwinska P, Piepoli MF, Ponikowski P, Pudil R, Rainer PP, Ruschitzka F, Sawyer D, Seferovic PM, Suter T, Thum T, van der Meer P, Van Laake LW, von Haehling S, Heymans S, Lyon AR, Backs J. Common mechanistic pathways in cancer and heart failure. A scientific roadmap on behalf of the Translational Research Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2020; 22:2272-2289. [PMID: 33094495 PMCID: PMC7894564 DOI: 10.1002/ejhf.2029] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/13/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022] Open
Abstract
The co-occurrence of cancer and heart failure (HF) represents a significant clinical drawback as each disease interferes with the treatment of the other. In addition to shared risk factors, a growing body of experimental and clinical evidence reveals numerous commonalities in the biology underlying both pathologies. Inflammation emerges as a common hallmark for both diseases as it contributes to the initiation and progression of both HF and cancer. Under stress, malignant and cardiac cells change their metabolic preferences to survive, which makes these metabolic derangements a great basis to develop intersection strategies and therapies to combat both diseases. Furthermore, genetic predisposition and clonal haematopoiesis are common drivers for both conditions and they hold great clinical relevance in the context of personalized medicine. Additionally, altered angiogenesis is a common hallmark for failing hearts and tumours and represents a promising substrate to target in both diseases. Cardiac cells and malignant cells interact with their surrounding environment called stroma. This interaction mediates the progression of the two pathologies and understanding the structure and function of each stromal component may pave the way for innovative therapeutic strategies and improved outcomes in patients. The interdisciplinary collaboration between cardiologists and oncologists is essential to establish unified guidelines. To this aim, pre-clinical models that mimic the human situation, where both pathologies coexist, are needed to understand all the aspects of the bidirectional relationship between cancer and HF. Finally, adequately powered clinical studies, including patients from all ages, and men and women, with proper adjudication of both cancer and cardiovascular endpoints, are essential to accurately study these two pathologies at the same time.
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Affiliation(s)
- Rudolf A. de Boer
- Department of CardiologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Jean‐Sébastien Hulot
- Université de Paris, PARCC, INSERMParisFrance
- CIC1418 and DMU CARTE, AP‐HP, Hôpital Européen Georges‐PompidouParisFrance
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center of Clinical and Translational ResearchFederico II UniversityNaplesItaly
| | | | - Pietro Ameri
- Department of Internal Medicine and Center of Excellence for Biomedical ResearchUniversity of GenovaGenoaItaly
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Stefan D. Anker
- Department of Cardiology & Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK), Partner Site BerlinCharité‐Universitätsmedizin Berlin (Campus CVK)BerlinGermany
| | - Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Edoardo Bertero
- Comprehensive Heart Failure CenterUniversity Clinic WürzburgWürzburgGermany
| | | | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’University of Medicine Carol DavilaBucharestRomania
| | | | - Thomas Eschenhagen
- Institute of Experimental Pharmacology and ToxicologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Partner Site Hamburg/Kiel/Lübeck, DZHK (German Centre for Cardiovascular Research)HamburgGermany
| | - Dimitrios Farmakis
- University of Cyprus Medical SchoolNicosiaCyprus
- Cardio‐Oncology Clinic, Heart Failure Unit, Department of CardiologyAthens University Hospital ‘Attikon’, National and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Antoni Bayes‐Genis
- Heart Failure Unit and Cardiology DepartmentHospital Universitari Germans Trias i Pujol, CIBERCVBadalonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- CIBER CardiovascularInstituto de Salud Carlos IIIMadridSpain
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT)University Hospital HeidelbergHeidelbergGermany
| | - Ewa A. Jankowska
- Department of Heart Diseases, Wroclaw Medical University, and Centre for Heart DiseasesUniversity HospitalWroclawPoland
| | - Richard N. Kitsis
- Departments of Medicine (Cardiology) and Cell BiologyWilf Family Cardiovascular Research Institute, Albert Einstein Cancer Center, Albert Einstein College of MedicineNew YorkNYUSA
| | - Suma H. Konety
- Cardiovascular Division, Cardio‐Oncology Program, Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | | | - Lorenz Lehmann
- Cardio‐Oncology Unit, Department of CardiologyUniversity of HeidelbergHeidelbergGermany
- DZHK (German Centre for Cardiovascular Research), partner siteHeidelberg/MannheimGermany
- DKFZ (German Cancer Research Center)HeidelbergGermany
| | - Daniel J. Lenihan
- Cardio‐Oncology Center of Excellence, Cardiovascular DivisionWashington University in St. LouisSt. LouisMOUSA
| | - Christoph Maack
- Comprehensive Heart Failure CenterUniversity Clinic WürzburgWürzburgGermany
| | - Javid J. Moslehi
- Division of Cardiovascular Medicine and OncologyCardio‐Oncology Program, Vanderbilt University Medical Center and Vanderbilt‐Ingram Cancer CenterNashvilleTNUSA
| | - Oliver J. Müller
- Department of Internal Medicine IIIUniversity of KielKielGermany
- DZHK (German Centre for Cardiovascular Research), partner siteHamburg/Kiel/LübeckGermany
| | - Patrycja Nowak‐Sliwinska
- School of Pharmaceutical SciencesUniversity of Geneva, Institute of Pharmaceutical Sciences of Western Switzerland, University of GenevaGenevaSwitzerland
- Translational Research Center in OncohaematologyGenevaSwitzerland
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, and Centre for Heart DiseasesUniversity HospitalWroclawPoland
| | - Radek Pudil
- 1st Department Medicine‐CardioangiologyUniversity Hospital and Medical FacultyHradec KraloveCzech Republic
| | - Peter P. Rainer
- Medical University of GrazUniversity Heart Center – Division of CardiologyGrazAustria
| | - Frank Ruschitzka
- Department of CardiologyUniversity Hospital Zurich, University Heart CenterZurichSwitzerland
| | - Douglas Sawyer
- Center for Molecular Medicine, Maine Medical Center Research InstituteMaine Medical CenterScarboroughMEUSA
| | - Petar M. Seferovic
- University of Belgrade Faculty of Medicine, Serbian Academy of Sciences and ArtsBelgradeSerbia
| | - Thomas Suter
- Swiss Cardiovascular CentreBern UniversityBernSwitzerland
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS)Hannover Medical SchoolHannoverGermany
| | - Peter van der Meer
- Department of CardiologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Linda W. Van Laake
- Division Heart and Lungs and Regenerative Medicine CentreUniversity Medical Centre Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart CenterUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
- Department of Cardiovascular SciencesCentre for Molecular and Vascular Biology, KU LeuvenLeuvenBelgium
| | - Alexander R. Lyon
- Cardio‐Oncology Service, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College LondonLondonUK
| | - Johannes Backs
- Institute of Experimental CardiologyHeidelberg University HospitalHeidelbergGermany
- DZHK (German Centre for Cardiovascular Research), partner siteHeidelberg/MannheimGermany
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45
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Ranek MJ, Oeing C, Sanchez-Hodge R, Kokkonen-Simon KM, Dillard D, Aslam MI, Rainer PP, Mishra S, Dunkerly-Eyring B, Holewinski RJ, Virus C, Zhang H, Mannion MM, Agrawal V, Hahn V, Lee DI, Sasaki M, Van Eyk JE, Willis MS, Page RC, Schisler JC, Kass DA. CHIP phosphorylation by protein kinase G enhances protein quality control and attenuates cardiac ischemic injury. Nat Commun 2020; 11:5237. [PMID: 33082318 PMCID: PMC7575552 DOI: 10.1038/s41467-020-18980-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
Proteotoxicity from insufficient clearance of misfolded/damaged proteins underlies many diseases. Carboxyl terminus of Hsc70-interacting protein (CHIP) is an important regulator of proteostasis in many cells, having E3-ligase and chaperone functions and often directing damaged proteins towards proteasome recycling. While enhancing CHIP functionality has broad therapeutic potential, prior efforts have all relied on genetic upregulation. Here we report that CHIP-mediated protein turnover is markedly post-translationally enhanced by direct protein kinase G (PKG) phosphorylation at S20 (mouse, S19 human). This increases CHIP binding affinity to Hsc70, CHIP protein half-life, and consequent clearance of stress-induced ubiquitinated-insoluble proteins. PKG-mediated CHIP-pS20 or expressing CHIP-S20E (phosphomimetic) reduces ischemic proteo- and cytotoxicity, whereas a phospho-silenced CHIP-S20A amplifies both. In vivo, depressing PKG activity lowers CHIP-S20 phosphorylation and protein, exacerbating proteotoxicity and heart dysfunction after ischemic injury. CHIP-S20E knock-in mice better clear ubiquitinated proteins and are cardio-protected. PKG activation provides post-translational enhancement of protein quality control via CHIP.
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Affiliation(s)
- Mark J Ranek
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Christian Oeing
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Rebekah Sanchez-Hodge
- Division of Cardiology, McAllister Heart Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kristen M Kokkonen-Simon
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Danielle Dillard
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - M Imran Aslam
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Peter P Rainer
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036, Graz, Austria
| | - Sumita Mishra
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Brittany Dunkerly-Eyring
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Ronald J Holewinski
- Cedar Sinai Medical Center, Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, 8700 Beverly Blvd, AHSP A9229, Los Angeles, CA, 90048, USA
| | - Cornelia Virus
- Division of Cardiology, McAllister Heart Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Huaqun Zhang
- Department of Chemistry and Biochemistry, Miami University, Oxford, OH, 45056, USA
| | - Matthew M Mannion
- Department of Chemistry and Biochemistry, Miami University, Oxford, OH, 45056, USA
| | - Vineet Agrawal
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Virginia Hahn
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Dong I Lee
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Masayuki Sasaki
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
| | - Jennifer E Van Eyk
- Cedar Sinai Medical Center, Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, 8700 Beverly Blvd, AHSP A9229, Los Angeles, CA, 90048, USA
| | - Monte S Willis
- Division of Cardiology, McAllister Heart Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Richard C Page
- Department of Chemistry and Biochemistry, Miami University, Oxford, OH, 45056, USA
| | - Jonathan C Schisler
- Division of Cardiology, McAllister Heart Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA.
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46
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Rainer PP. The pulse of fibroblasts: circadian rhythm in pulmonary fibrosis development. Cardiovasc Res 2020; 116:e134-e135. [PMID: 32845965 DOI: 10.1093/cvr/cvaa236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter P Rainer
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria, and BioTechMed, Graz, Austria
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47
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Schmid J, Beer M, Berghold A, Stojakovic T, Scharnagl H, Dieplinger B, Quasthoff S, Binder JS, Rainer PP. Cardiac involvement in a cross-sectional cohort of myotonic dystrophies and other skeletal myopathies. ESC Heart Fail 2020; 7:1900-1908. [PMID: 32476276 PMCID: PMC7373928 DOI: 10.1002/ehf2.12763] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/10/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Cardiac involvement in myopathies that primarily affect the skeletal muscle is variable and may be subtle, necessitating sensitive diagnostic approaches. Here, we describe the prevalence of cardiac abnormalities in a cohort of patients with skeletal muscle disease presenting at a tertiary care neuromuscular centre. Methods and results We systematically investigated patients with skeletal myopathies and comprehensively analysed their cardiac phenotype including 24 h electrocardiogram, echocardiography with strain analyses, contrast‐enhanced cardiac magnetic resonance imaging, and, if at increased risk of coronary artery disease, computed tomography coronary angiography. We prospectively screened 91 patients with diverse skeletal myopathies and enrolled 73 patients. The most pronounced cardiac involvement was present in patients with dystrophic myopathies (cardiac abnormalities in 59% of patients). We analysed myotonic dystrophies (n = 29) in more detail and found prolonged QRS (99.4 ± 15.6 vs. 91.5 ± 10.3 ms; P = 0.027) and QTc times (441.1 ± 28.1 vs. 413.0 ± 23.3 ms; P < 0.001) and increased left atrial size (27.28 ± 3.9 vs. 25.0 ± 3.2 mm/m2; P = 0.021) when compared with healthy controls. Left ventricular systolic function was reduced (ejection fraction < 55%) in 31% of myotonic dystrophies, while only 4% had an ejection fraction < 50%. Apical peak systolic longitudinal strain was slightly reduced (P = 0.023). Conclusions Screening for cardiac involvement in the skeletal muscle disease seems prudent particularly in patients with dystrophic myopathies. In the subset of myotonic dystrophy patients, QRS and QTc times as well as myocardial strain may be useful parameters. Their potential for predicting cardiac adverse events needs further evaluation.
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Affiliation(s)
- Johannes Schmid
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Meinrad Beer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Benjamin Dieplinger
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Seilerstaette 4, 4010, Linz, Austria
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Josepha S Binder
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
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48
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Koyani CN, Plastira I, Sourij H, Hallström S, Schmidt A, Rainer PP, Bugger H, Frank S, Malle E, von Lewinski D. Empagliflozin protects heart from inflammation and energy depletion via AMPK activation. Pharmacol Res 2020; 158:104870. [PMID: 32434052 DOI: 10.1016/j.phrs.2020.104870] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/28/2022]
Abstract
AIMS Sodium-glucose co-transporter 2 (SGLT2) were originally developed as kidney-targeting anti-diabetic drugs. However, due to their beneficial cardiac off-target effects (as SGLT2 is not expressed in the heart), these antagonists currently receive intense clinical interest in the context of heart failure (HF) in patients with or without diabetes mellitus (DM). Since the mechanisms by which these beneficial effects are mediated are still unclear yet, inflammation that is present in DM and HF has been proposed as a potential pharmacological intervention strategy. Therefore, we tested the hypothesis that the SGLT2 inhibitor, empagliflozin, displays anti-inflammatory potential along with its glucose-lowering property. METHODS AND RESULTS Lipopolysaccharide (LPS) was used to induce inflammation in vitro and in vivo. In cardiomyocytes and macrophages empagliflozin attenuated LPS-induced TNFα and iNOS expression. Analysis of intracellular signalling pathways suggested that empagliflozin activates AMP kinase (AMPK) in both cell types with or without LPS-treatment. Moreover, the SGLT2 inhibitor increased the expression of anti-inflammatory M2 marker proteins in LPS-treated macrophages. Additionally, empagliflozin-mediated AMPK activation prevented LPS-induced ATP/ADP depletion. In vivo administration of LPS in mice impaired cardiac contractility and aortic endothelial relaxation in response to acetylcholine, whereby co-administration of empagliflozin preserved cardiovascular function. These findings were accompanied by improved cardiac AMPK phosphorylation and ATP/ADP, reduced cardiac iNOS, plasma TNFα and creatine kinase MB levels. CONCLUSION Our data identify a novel cardio protective mechanism of SGLT2 inhibitor, empagliflozin, suggesting that AMPK activation-mediated energy repletion and reduced inflammation contribute to the observed cardiovascular benefits of the drug in HF.
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Affiliation(s)
- Chintan N Koyani
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Ioanna Plastira
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Harald Sourij
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; Center for Biomarker Research in Medicine, 8036 Graz, Austria
| | - Seth Hallström
- Division of Physiological Chemistry, Otto Loewi Research Center, Medical University Graz, 8010 Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Heiko Bugger
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Saša Frank
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Ernst Malle
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
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49
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Wallner M, Eaton DM, Berretta RM, Liesinger L, Schittmayer M, Gindlhuber J, Wu J, Jeong MY, Lin YH, Borghetti G, Baker ST, Zhao H, Pfleger J, Blass S, Rainer PP, von Lewinski D, Bugger H, Mohsin S, Graier WF, Zirlik A, McKinsey TA, Birner-Gruenberger R, Wolfson MR, Houser SR. HDAC inhibition improves cardiopulmonary function in a feline model of diastolic dysfunction. Sci Transl Med 2020; 12:eaay7205. [PMID: 31915304 PMCID: PMC7065257 DOI: 10.1126/scitranslmed.aay7205] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/23/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major health problem without effective therapies. This study assessed the effects of histone deacetylase (HDAC) inhibition on cardiopulmonary structure, function, and metabolism in a large mammalian model of pressure overload recapitulating features of diastolic dysfunction common to human HFpEF. Male domestic short-hair felines (n = 31, aged 2 months) underwent a sham procedure (n = 10) or loose aortic banding (n = 21), resulting in slow-progressive pressure overload. Two months after banding, animals were treated daily with suberoylanilide hydroxamic acid (b + SAHA, 10 mg/kg, n = 8), a Food and Drug Administration-approved pan-HDAC inhibitor, or vehicle (b + veh, n = 8) for 2 months. Echocardiography at 4 months after banding revealed that b + SAHA animals had significantly reduced left ventricular hypertrophy (LVH) (P < 0.0001) and left atrium size (P < 0.0001) versus b + veh animals. Left ventricular (LV) end-diastolic pressure and mean pulmonary arterial pressure were significantly reduced in b + SAHA (P < 0.01) versus b + veh. SAHA increased myofibril relaxation ex vivo, which correlated with in vivo improvements of LV relaxation. Furthermore, SAHA treatment preserved lung structure, compliance, blood oxygenation, and reduced perivascular fluid cuffs around extra-alveolar vessels, suggesting attenuated alveolar capillary stress failure. Acetylation proteomics revealed that SAHA altered lysine acetylation of mitochondrial metabolic enzymes. These results suggest that acetylation defects in hypertrophic stress can be reversed by HDAC inhibitors, with implications for improving cardiac structure and function in patients.
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Affiliation(s)
- Markus Wallner
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Division of Cardiology, Medical University of Graz, Graz 8036, Austria
- Center for Biomarker Research in Medicine, CBmed GmbH, Graz 8010, Austria
| | - Deborah M Eaton
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Remus M Berretta
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Laura Liesinger
- Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz 8036, Austria
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz 8036, Austria
- Omics Center Graz, BioTechMed-Graz, Graz 8010, Austria
| | - Matthias Schittmayer
- Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz 8036, Austria
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz 8036, Austria
- Omics Center Graz, BioTechMed-Graz, Graz 8010, Austria
| | - Juergen Gindlhuber
- Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz 8036, Austria
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz 8036, Austria
- Omics Center Graz, BioTechMed-Graz, Graz 8010, Austria
| | - Jichuan Wu
- CENTRe: Consortium for Environmental and Neonatal Therapeutics Research, Lewis Katz School of Medicine, Department of Physiology, Department of Thoracic Medicine and Surgery, Pediatrics, Center for Inflammation, Translational and Clinical Lung Research, Temple University, Philadelphia, PA 19140, USA
| | - Mark Y Jeong
- Department of Medicine, Division of Cardiology and Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ying H Lin
- Department of Medicine, Division of Cardiology and Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Giulia Borghetti
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Sandy T Baker
- CENTRe: Consortium for Environmental and Neonatal Therapeutics Research, Lewis Katz School of Medicine, Department of Physiology, Department of Thoracic Medicine and Surgery, Pediatrics, Center for Inflammation, Translational and Clinical Lung Research, Temple University, Philadelphia, PA 19140, USA
| | - Huaqing Zhao
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Jessica Pfleger
- Center for Translational Medicine, Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Sandra Blass
- Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz 8036, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Heiko Bugger
- Division of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Sadia Mohsin
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Wolfgang F Graier
- Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz 8036, Austria
| | - Andreas Zirlik
- Division of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Timothy A McKinsey
- Department of Medicine, Division of Cardiology and Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ruth Birner-Gruenberger
- Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz 8036, Austria
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz 8036, Austria
- Omics Center Graz, BioTechMed-Graz, Graz 8010, Austria
- Institute of Chemical Technology and Analytical Chemistry, Vienna University of Technology, Vienna 1060, Austria
| | - Marla R Wolfson
- CENTRe: Consortium for Environmental and Neonatal Therapeutics Research, Lewis Katz School of Medicine, Department of Physiology, Department of Thoracic Medicine and Surgery, Pediatrics, Center for Inflammation, Translational and Clinical Lung Research, Temple University, Philadelphia, PA 19140, USA
| | - Steven R Houser
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA.
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50
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Barbieri F, Senoner T, Holfeld J, Semsroth S, Lambert T, Zweiker D, Theurl T, Rainer PP, Schmidt A, Feuchtner GM, Steinwender C, Hoppe U, Mueller S, Grimm M, Dichtl W. P4665High sensitivity troponin t and n-terminal pro brain natriuretic peptide plasma levels predict long-term postoperative survival in patients with severe aortic stenosis admitted for valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Optimal timing of valve implantation in patients with severe aortic stenosis (AS) is under debate, considering the subjective nature of symptom onset. We aimed to investigate the pre-procedural value of routinely available cardiac biomarkers in predicting postoperative long-term outcome in a large cohort undergoing either surgical or transcatheter aortic valve implantation.
Methods
The Tyrolean Aortic Stenosis Study-2 (TASS-2) group, a consortium of four university hospital centers in Austria, analysed pre-procedural high-sensitivity troponin T (hsTnT) and N-terminal pro brain natriuretic peptide (NT-proBNP) plasma levels in 3595 patients admitted for valve implantation because of severe aortic stenosis since 2007.
Results
Transcatheter aortic valve implantation was performed in 1517 (42.2%) of patients. During a median follow-up of 2.93 (1.91–4.92) years, 919 patients (25.6%) died, among them 556 (15.5%) due to cardiovascular causes. In multivariate cox regression analysis - adjusting for STS risk score (intermediate risk 4–8%, high risk >8%), degree of left ventricular systolic dysfunction (ejection fraction 30–50% and <30%), atrial fibrillation, sex, age, renal function, COPD, arterial hypertension, diabetes mellitus, concomitant significant coronary artery disease and type of procedure (surgical aortic valve replacement or transcatheter aortic valve implantation) - pre-procedural hsTnT as well as NT-proBNP plasma levels were strong independent predictors for postoperative survival: hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.07–3.11, P=0.028 for mildly to moderately elevated hsTnT (14–50 ng/l); HR 2.80, CI 1.61–4.89, P<0.001 for severely elevated hsTnT (>50 ng/l); HR 1.38, CI 1.06–1.81, P=0.018 for mildly to moderately elevated NT-proBNP (defined by an increase of up to threefold of age- and sex-corrected normal range); HR 1.68, CI 1.29–2.18, P<0.001 for severely elevated NT-proBNP (defined by an increase of more than threefold of age- and sex-corrected normal range). For direct comparison of these two biomarkers a second cox regression model was conducted including only hsTnT and NT-proBNP revealing the strength of hsTnT as a predictive biomarker: HR 2.20, 95% CI 1.29–3.77, P=0.004 for minimally elevated hsTnT (5–13.99 ng/l); HR 4.05, CI 2.41–6.82, P<0.001 for mildly to moderately elevated hsTnT (14–50 ng/l); HR 8.63, CI 5.07–14.70, P<0.001 for severely elevated hsTnT (>50 ng/l); HR 1.47, CI 1.13–1.91, P=0.004 for mildly to moderately elevated NT-proBNP; HR 1.96, CI 1.54–2.51, P<0.001 for severely elevated NT-proBNP.
Conclusion
hsTNT and NT-proBNP strongly predict long-term postoperative survival in patients with severe AS admitted for valve implantation.
Acknowledgement/Funding
This work was supported by the Tiroler Wissenschaftsförderung: grant number TWF-2017-1-5, GZ: UNI-0404-2104
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Affiliation(s)
- F Barbieri
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - T Senoner
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - J Holfeld
- Innsbruck Medical University, Department of cardiac surgery, Innsbruck, Austria
| | - S Semsroth
- Innsbruck Medical University, Department of cardiac surgery, Innsbruck, Austria
| | - T Lambert
- General Hospital (AKH) of Linz, Department of cardiology, Linz, Austria
| | - D Zweiker
- Medical University of Graz, Department of cardiology, Graz, Austria
| | - T Theurl
- Paracelsus Private Medical University, University clinic of Internal Medicine II, Salzburg, Austria
| | - P P Rainer
- Medical University of Graz, Department of cardiology, Graz, Austria
| | - A Schmidt
- Medical University of Graz, Department of cardiology, Graz, Austria
| | - G M Feuchtner
- Innsbruck Medical University, Department of radiology, Innsbruck, Austria
| | - C Steinwender
- General Hospital (AKH) of Linz, Department of cardiology, Linz, Austria
| | - U Hoppe
- Paracelsus Private Medical University, University clinic of Internal Medicine II, Salzburg, Austria
| | - S Mueller
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - M Grimm
- Innsbruck Medical University, Department of cardiac surgery, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
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