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Eveleens Maarse BC, Eggink HM, Warnke I, Bijlsma S, van den Broek TJ, Oosterman JE, Caspers MPM, Sybesma W, Gal P, van Kraaij SJW, Schuren FHJ, Moerland M, Hoevenaars FPM. Impact of fibre supplementation on microbiome and resilience in healthy participants: A randomized, placebo-controlled clinical trial. Nutr Metab Cardiovasc Dis 2024; 34:1416-1426. [PMID: 38499450 DOI: 10.1016/j.numecd.2024.01.028] [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: 09/06/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND AND AIMS The gut microbiome exerts important roles in health, e.g., functions in metabolism and immunology. These functions are often exerted via short-chain fatty acid (SCFA) production by gut bacteria. Studies demonstrating causal relationships between interventions targeting the microbiome and clinical outcomes are limited. This study aimed to show a causal relationship between microbiome modulation through fibre intervention and health. METHODS AND RESULTS This randomized, double-blind, cross-over study included 65 healthy subjects, aged 45-70 years, with increased metabolic risk (i.e., body mass index [BMI] 25-30 kg/m2, low to moderate daily dietary fibre intake, <30g/day). Subjects took daily a fibre mixture of Acacia gum and carrot powder or placebo for 12 weeks, with an 8-week wash-out period. Faecal samples for measurement of SCFAs and microbiome analysis were collected every 4 weeks. Before and after each intervention period subjects underwent the mixed-meal PhenFlex challenge Test (PFT). Health effects were expressed as resilience to the stressors of the PFT and as fasting metabolic and inflammatory state. The fibre mixture exerted microbiome modulation, with an increase in β-diversity (p < 0.001). α-diversity was lower during fibre mixture intake compared to placebo after 4, 8 and 12 weeks (p = 0.002; p = 0.012; p = 0.031). There was no effect observed on faecal SCFA concentrations, nor on any of the primary clinical outcomes (Inflammatory resilience: p = 0.605, Metabolic resilience: p = 0.485). CONCLUSION Although the intervention exerted effects on gut microbiome composition, no effects on SCFA production, on resilience or fasting metabolic and inflammatory state were observed in this cohort. REGISTRATION NUMBER CLINICALTRIALS.GOV: NCT04829396.
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Affiliation(s)
- Boukje C Eveleens Maarse
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - Hannah M Eggink
- TNO, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands
| | - Ines Warnke
- dsm-firmenich, CH-4303, Kaiseraugst, Switzerland
| | - Sabina Bijlsma
- TNO, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands
| | - Tim J van den Broek
- TNO, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands
| | - Johanneke E Oosterman
- TNO, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands
| | - Martien P M Caspers
- TNO, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands
| | | | - Pim Gal
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - Sebastiaan J W van Kraaij
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - Frank H J Schuren
- TNO, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands
| | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - Femke P M Hoevenaars
- TNO, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands.
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Yfanti C, Vestbjerg B, Van't Westende J, Edvardsson N, Monfort LM, Olesen MS, Bentzen BH, Grunnet M, Eveleens Maarse BC, Diness JG, Kemme MJB, Sørensen U, Moerland M, van Esdonk MJ, Klaassen ES, Gal P, Holst AG. A phase 1 trial of AP30663, a K Ca2 channel inhibitor in development for conversion of atrial fibrillation. Br J Clin Pharmacol 2024; 90:1027-1035. [PMID: 37990600 DOI: 10.1111/bcp.15973] [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: 07/05/2022] [Revised: 09/19/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
AIMS AP30663 is a novel compound under development for pharmacological conversion of atrial fibrillation by targeting the small conductance Ca2+ activated K+ (KCa2) channel. The aim of this extension phase 1 study was to test AP30663 at higher single doses compared to the first-in-human trial. METHODS Sixteen healthy male volunteers were randomized into 2 cohorts: 6- and 8-mg/kg intravenous single-dose administration of AP30663 vs. placebo. Safety, pharmacokinetic and pharmacodynamic data were collected. RESULTS AP30663 was associated with mild and transient infusion site reactions with no clustering of other adverse events but with an estimated maximum mean QTcF interval prolongation of 45.2 ms (95% confidence interval 31.5-58.9) in the 6 mg/kg dose level and 50.4 ms (95% confidence interval 36.7-64.0) with 8 mg/kg. Pharmacokinetics was dose proportional with terminal half-life of around 3 h. CONCLUSION AP30663 in doses up to 8 mg/kg was associated with mild and transient infusion site reactions and an increase of the QTcF interval. Supporting Information support that the QTc effect may be explained by an off-target inhibition of the IKr channel.
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Affiliation(s)
| | | | | | - Nils Edvardsson
- Acesion Pharma ApS, Copenhagen, Denmark
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Bo Hjorth Bentzen
- Acesion Pharma ApS, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Denmark
| | | | - Boukje C Eveleens Maarse
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | | | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Pim Gal
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
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Wildenbeest FWH, Hassing GJ, Kemme MJB, Moerland M, Gal P. Heart rate stability in a clinical setting and after a short exercise in healthy male volunteers. Clin Physiol Funct Imaging 2024; 44:36-43. [PMID: 37458374 DOI: 10.1111/cpf.12846] [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: 02/14/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Limited data exist on heart rate stabilization in the domiciled nature of phase I clinical studies, particularly when frequent measurements of QT intervals are involved. The present analysis aimed to evaluate heart rate stability in the domiciled nature of, and stabilization after a short exercise. METHODS Fifty-six healthy male subjects were included in this analysis. Data during a domiciled clinical setting and after a short exercise were analysed. Mean values of 30 s intervals of collected electrocardiographical data (PR, RR, QT and QTcF intervals) during a 10-min supine resting period in a domiciled nature or after walking up and down three stories (100 steps) were compared to baseline values using paired t-tests or compared to the intrasubject standard deviation. RESULTS Stable heart rates and stable QTcF intervals observed immediately upon assuming a supine position in the domiciled clinical setting. After the short exercise, PR interval and RR interval were significantly (p < 0.05) shorter for up to 120 s (mean value -9.8 ± 7.2 ms) and 30 s (-160 ± 165 ms, p < 0.05), respectively. QT and QTcF intervals were significantly (p < 0.05) shorter for up to 90 and 120 s postexercise, respectively. Both QT and QTcF intervals stabilized after 2 min, but QT interval remained prolonged while QTcF interval returned to baseline levels. CONCLUSION In a clinical setting, male volunteers do not require a waiting period for electrocardiographic parameter normalization. However, accurate measurement of these parameters following a short exercise necessitates a minimum 2-min resting interval.
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Affiliation(s)
| | - Gert-Jan Hassing
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
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4
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van Kraaij SJW, Hamblin MR, Pickering G, Giannokopoulos B, Kechemir H, Heinz M, Igracki-Turudic I, Yavuz Y, Rissmann R, Gal P. A Phase 1 randomized, open-label clinical trial to evaluate the effect of a far-infrared emitting patch on local skin perfusion, microcirculation and oxygenation. Exp Dermatol 2024; 33:e14962. [PMID: 37950549 DOI: 10.1111/exd.14962] [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: 05/12/2023] [Revised: 09/06/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
Far-infrared radiation (FIR) has been investigated for reduction of pain and improvement of dermal blood flow. The FIRTECH patch is a medical device designed to re-emit FIR radiated by the body. This phase 1 study was conducted to evaluate the local effects of the FIRTECH patch on local skin perfusion, microcirculation and oxygenation. This prospective, randomized, open-label, parallel designed study admitted 20 healthy participants to a medical research facility for treatment for 31 h on three anatomical locations. During treatment, imaging assessments consisting of laser speckle contrast imaging, near-infrared spectroscopy, side-stream dark-field microscopy, multispectral imaging and thermography were conducted regularly on patch-treated skin and contralateral non-treated skin. The primary endpoint was baseline perfusion increase during treatment on the upper back. Secondary endpoints included change in baseline perfusion, oxygen consumption and temperature of treated versus untreated areas. The primary endpoint was not statistically significantly different between treated and non-treated areas. The secondary endpoints baseline perfusion on the forearm (least square means [LSMs] difference 2.63 PU, 95% CI: 0.97, 4.28), oxygen consumption (LSMs difference: 0.42 arbitrary units [AUs], 95% CI: 0.04, 0.81) and skin temperature (LSMs difference 0.35°C, 95% CI: 0.16, 0.6) were statistically significantly higher in treated areas. Adverse events observed during the study were mild and transient. The vascular response to the FIRTECH patch was short-lived suggesting a non-thermal vasodilatory effect of the patch. The FIRTECH patch was well tolerated, with mild and transient adverse events observed during the study. These results support the therapeutic potential of FIR in future investigations.
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Affiliation(s)
- Sebastiaan J W van Kraaij
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
| | - Gisele Pickering
- Clinical Investigation Center CIC Inserm 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Moritz Heinz
- Research & Development, Sanofi, Chilly-Mazarin, France
| | | | - Yalçin Yavuz
- Centre for Human Drug Research, Leiden, the Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
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5
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van Kraaij SJW, Borghans L, Klaassen ES, Gal P, van der Grond J, Tripp K, Winrow C, Glasser C, Groeneveld GJ. Randomized placebo-controlled crossover study to assess tolerability and pharmacodynamics of zagociguat, a soluble guanylyl cyclase stimulator, in healthy elderly. Br J Clin Pharmacol 2023; 89:3606-3617. [PMID: 37488930 DOI: 10.1111/bcp.15861] [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: 03/13/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
AIMS Dysfunction of nitric oxide-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate signalling is implicated in the pathophysiology of cognitive impairment. Zagociguat is a central nervous system (CNS) penetrant sGC stimulator designed to amplify nitric oxide-cyclic guanosine monophosphate signalling in the CNS. This article describes a phase 1b study evaluating the safety and pharmacodynamic effects of zagociguat. METHODS In this randomized crossover study, 24 healthy participants aged ≥65 years were planned to receive 15 mg zagociguat or placebo once daily for 2 15-day periods separated by a 27-day washout. Adverse events, vital signs, electrocardiograms and laboratory tests were conducted to assess safety. Pharmacokinetics of zagociguat were evaluated in blood and cerebrospinal fluid (CSF). Pharmacodynamic assessments included evaluation of cerebral blood flow, CNS tests, pharmaco-electroencephalography, passive leg movement and biomarkers in blood, CSF and brain. RESULTS Twenty-four participants were enrolled; 12 participants completed both treatment periods, while the other 12 participants completed only 1 treatment period. Zagociguat was well-tolerated and penetrated the blood-brain barrier, with a CSF/free plasma concentration ratio of 0.45 (standard deviation 0.092) measured 5 h after the last dose of zagociguat on Day 15. Zagociguat induced modest decreases in blood pressure. No consistent effects of zagociguat on other pharmacodynamic parameters were detected. CONCLUSION Zagociguat was well-tolerated and induced modest blood pressure reductions consistent with other sGC stimulators. No clear pharmacodynamic effects of zagociguat were detected. Studies in participants with proven reduced cerebral blood flow or CNS function may be an avenue for further evaluation of the compound.
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Affiliation(s)
- Sebastiaan J W van Kraaij
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ken Tripp
- Cyclerion Therapeutics, Cambridge, Massachusetts, USA
| | | | - Chad Glasser
- Cyclerion Therapeutics, Cambridge, Massachusetts, USA
| | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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6
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Goncalves LN, van Velze V, Klok FA, Gal P, Vos RC, Hamming JF, van der Bogt KEA. High on-treatment platelet reactivity in peripheral arterial disease: A systematic review. Vascular 2023:17085381231214324. [PMID: 37950666 DOI: 10.1177/17085381231214324] [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: 11/13/2023]
Abstract
OBJECTIVES To highlight current evidence pertaining to the measurement methods and prevalence of high on-treatment platelet reactivity (HTPR) in patients with PAD, as well as to evaluate the relationship between HTPR and recurrent adverse cardiovascular and limb events in PAD patients. METHODS A systematic review of English-language literature on HTPR in patients with PAD. An electronic literature search of PubMed and Medline was performed in May 2021. RESULTS A total of 29 studies with a total number of 11,201 patients with PAD were identified. HTPR during clopidogrel treatment ranges from 9.8 to 77%, and during aspirin treatment ranges from 4.1 to 50% of PAD patients. HTPR was associated with adverse clinical outcomes. The need for limb revascularisation was higher in patients with HTPR during clopidogrel use. Similarly, HTPR during aspirin use in the PAD population was predictive of adverse cardiovascular events (HR 3.73; 95% CI, 1.43-9.81; p = .007). A wide range of techniques were applied to measure platelet resistance, without consensus on cut-off values. Furthermore, differing patient populations, a variety of antiplatelet regimens, and differing clinical endpoints highlight the high degree of heterogeneity in the studies included in this review. CONCLUSION No consensus on technique or cut-off values for HTPR testing has been reached. Patients with HTPR are potentially at a greater risk of adverse limb-related and cardiovascular events than patients sensitive to antiplatelet therapy illustrating the need for clinical implementation of HTPR testing. Future research must aim for consistent methodology. Adaptation of antiplatelet therapy based on HTPR results requires further exploration.
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Affiliation(s)
| | | | | | - Pim Gal
- Centre for Human Drug Research, Leiden, the Netherlands
| | - Rimke C Vos
- Clinical pharmacology and Toxicology, LUMC, Leiden, the Netherlands
| | - Jaap F Hamming
- Clinical pharmacology and Toxicology, LUMC, Leiden, the Netherlands
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7
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Zhuparris A, Maleki G, van Londen L, Koopmans I, Aalten V, Yocarini IE, Exadaktylos V, van Hemert A, Cohen A, Gal P, Doll RJ, Groeneveld GJ, Jacobs G, Kraaij W. A smartphone- and wearable-based biomarker for the estimation of unipolar depression severity. Sci Rep 2023; 13:18844. [PMID: 37914808 PMCID: PMC10620211 DOI: 10.1038/s41598-023-46075-2] [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: 12/13/2022] [Accepted: 10/27/2023] [Indexed: 11/03/2023] Open
Abstract
Drug development for mood disorders can greatly benefit from the development of robust, reliable, and objective biomarkers. The incorporation of smartphones and wearable devices in clinical trials provide a unique opportunity to monitor behavior in a non-invasive manner. The objective of this study is to identify the correlations between remotely monitored self-reported assessments and objectively measured activities with depression severity assessments often applied in clinical trials. 30 unipolar depressed patients and 29 age- and gender-matched healthy controls were enrolled in this study. Each participant's daily physiological, physical, and social activity were monitored using a smartphone-based application (CHDR MORE™) for 3 weeks continuously. Self-reported depression anxiety stress scale-21 (DASS-21) and positive and negative affect schedule (PANAS) were administered via smartphone weekly and daily respectively. The structured interview guide for the Hamilton depression scale and inventory of depressive symptomatology-clinical rated (SIGHD-IDSC) was administered in-clinic weekly. Nested cross-validated linear mixed-effects models were used to identify the correlation between the CHDR MORE™ features with the weekly in-clinic SIGHD-IDSC scores. The SIGHD-IDSC regression model demonstrated an explained variance (R2) of 0.80, and a Root Mean Square Error (RMSE) of ± 15 points. The SIGHD-IDSC total scores were positively correlated with the DASS and mean steps-per-minute, and negatively correlated with the travel duration. Unobtrusive, remotely monitored behavior and self-reported outcomes are correlated with depression severity. While these features cannot replace the SIGHD-IDSC for estimating depression severity, it can serve as a complementary approach for assessing depression and drug effects outside the clinic.
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Affiliation(s)
- Ahnjili Zhuparris
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands.
- Leiden University Medical Centre (LUMC), Leiden University, Leiden, The Netherlands.
- Leiden Institute of Advanced Computer Science (LIACS), Leiden University, Leiden, The Netherlands.
| | - Ghobad Maleki
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
- Leiden University Medical Centre (LUMC), Leiden University, Leiden, The Netherlands
| | | | - Ingrid Koopmans
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
- Leiden University Medical Centre (LUMC), Leiden University, Leiden, The Netherlands
| | - Vincent Aalten
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Iris E Yocarini
- Leiden Institute of Advanced Computer Science (LIACS), Leiden University, Leiden, The Netherlands
| | - Vasileios Exadaktylos
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
| | - Albert van Hemert
- Leiden University Medical Centre (LUMC), Leiden University, Leiden, The Netherlands
| | - Adam Cohen
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
- Leiden University Medical Centre (LUMC), Leiden University, Leiden, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
- Leiden University Medical Centre (LUMC), Leiden University, Leiden, The Netherlands
| | - Robert-Jan Doll
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
| | - Geert Jan Groeneveld
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
- Leiden University Medical Centre (LUMC), Leiden University, Leiden, The Netherlands
| | - Gabriël Jacobs
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333CL, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Wessel Kraaij
- Leiden Institute of Advanced Computer Science (LIACS), Leiden University, Leiden, The Netherlands
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van Kraaij SJW, Gal P, Borghans LGJM, Klaassen ES, Dijkstra F, Winrow C, Glasser C, Groeneveld GJ. First-in-human trial to assess safety, tolerability, pharmacokinetics, and pharmacodynamics of zagociguat (CY6463), a CNS-penetrant soluble guanylyl cyclase stimulator. Clin Transl Sci 2023; 16:1381-1395. [PMID: 37118895 PMCID: PMC10432884 DOI: 10.1111/cts.13537] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/08/2023] [Accepted: 04/08/2023] [Indexed: 04/30/2023] Open
Abstract
Soluble guanylate cyclase (sGC) and its product, cyclic guanosine monophosphate, play a role in learning and memory formation. Zagociguat (CY6463) is a novel stimulator of sGC being developed for the treatment of neurodegenerative disease. Single zagociguat doses of 0.3, 1, 3, 10, 20, 30, and 50 mg were administered once to healthy participants in a single-ascending-dose phase; then zagociguat 2, 5, 10, and 15 mg was administered q.d. for 14 days in a multiple-ascending-dose phase; and, finally, zagociguat 10 mg was administered once in both fed and fasted state in a food-interaction phase. Safety of zagociguat was evaluated by monitoring treatment-emergent adverse events, suicide risk, vital signs, electrocardiography, and laboratory tests. Pharmacokinetics of zagociguat were assessed through blood, urine, and cerebrospinal fluid sampling. Pharmacodynamic effects of zagociguat were evaluated with central nervous system (CNS) tests and pharmaco-electroencephalography. Zagociguat was well-tolerated across all doses evaluated. Zagociguat exposures increased in a dose-proportional manner. Median time to maximum concentration ranged from 0.8 to 5 h and mean terminal half-life from 52.8 to 67.1 h. CNS penetration of the compound was confirmed by cerebrospinal fluid sampling. Zagociguat induced up to 6.1 mmHg reduction in mean systolic and up to 7.5 mmHg reduction in mean diastolic blood pressure. No consistent pharmacodynamic (PD) effects on neurocognitive function were observed. Zagociguat was well-tolerated, CNS-penetrant, and demonstrated PD activity consistent with other sGC stimulators. The results of this study support further development of zagociguat.
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Affiliation(s)
| | - Pim Gal
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden University Medical CentreLeidenThe Netherlands
| | | | | | - Francis Dijkstra
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden University Medical CentreLeidenThe Netherlands
| | | | | | - Geert Jan Groeneveld
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden University Medical CentreLeidenThe Netherlands
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Bolognani F, Kruithof AC, Schulthess P, Machacek M, de Kam ML, Bergmann KR, van Gent M, Moerland M, Crenn P, Greig G, Gal P. Characterization of the Pharmacokinetic and Pharmacodynamic Profile of Apraglutide, a Glucagon-Like Peptide-2 Analog, in Healthy Volunteers. J Pharmacol Exp Ther 2023:JPET-AR-2023-001582. [PMID: 37316329 DOI: 10.1124/jpet.123.001582] [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: 01/18/2023] [Revised: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
Apraglutide (FE 203799) is a glucagon-like peptide-2 (GLP-2) analog under development for the treatment of intestinal failure associated with short bowel syndrome (SBS-IF) and graft-versus-host disease (GvHD). Compared with native GLP-2, apraglutide has slower absorption, reduced clearance, and higher protein binding, enabling once-weekly dosing. This study evaluated the pharmacokinetic (PK) and pharmacodynamic (PD) profile of apraglutide in healthy adults. Healthy volunteers were randomized to receive 6 weekly subcutaneous (s.c.) administrations of 1, 5, or 10 mg apraglutide or placebo. PK and citrulline samples were collected at multiple timepoints. Kinetic parameters of apraglutide and citrulline were calculated using noncompartmental analysis; repeated PD measures were analyzed with a mixed model of covariance A population PK/PD model was developed that also included data from a previous phase I study in healthy volunteers. Twenty-four subjects were randomized; 23 received all study drug administrations. Mean estimated apraglutide clearance was 16.5‒20.7 L/day and mean volume of distribution was 55.4‒105.0 L. A dose-dependent increase in citrulline plasma concentration was observed, with 5-mg and 10-mg doses inducing higher citrulline levels than 1-mg doses and placebo. PK/PD analysis showed that weekly 5-mg apraglutide induced the maximal citrulline response. Increased plasma citrulline levels were sustained for 10‒17 days after the final apraglutide administration. Apraglutide displays predictable dose-dependent PK and PD profiles, with a 5-mg dose showing significant PD effects. Results suggest that apraglutide has early and enduring effects on enterocyte mass and supports the continued development of weekly s.c. apraglutide for SBS-IF and GvHD patient populations Significance Statement Once-weekly, SC apraglutide results in dose-dependent elevations of plasma citrulline (an enterocyte mass PD marker) with parameters suggesting that apraglutide has lasting effects on enterocyte mass and the potential to provide therapeutic benefits. This is the first report of a model relating GLP-2 agonism and its effects in intestinal mucosa, affording not only the ability to predict pharmacologic effects of GLP-2 analogs but also the exploration of optimal dosing regimens for this drug class across populations with different body weights.
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Affiliation(s)
| | | | | | | | | | | | | | - Matthijs Moerland
- Centre for Human Drug Research; Leiden University Medical Center, Netherlands
| | - Pascal Crenn
- University Paris-Saclay / APHP, Hospital Ambroise Pare, Nutrition Clinique, France
| | | | - Pim Gal
- Centre for Human Drug Research; Leiden University Medical Center, Netherlands
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10
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van Kraaij SJW, Pereira DR, Smal B, Summo L, Konkel A, Lossie J, Busjahn A, Grammatopoulos TN, Klaassen E, Fischer R, Schunck WH, Gal P, Moerland M. Identification of peripheral vascular function measures and circulating biomarkers of mitochondrial function in patients with mitochondrial disease. Clin Transl Sci 2023. [PMID: 37177864 DOI: 10.1111/cts.13530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
The development of pharmacological therapies for mitochondrial diseases is hampered by the lack of tissue-level and circulating biomarkers reflecting effects of compounds on endothelial and mitochondrial function. This phase 0 study aimed to identify biomarkers differentiating between patients with mitochondrial disease and healthy volunteers (HVs). In this cross-sectional case-control study, eight participants with mitochondrial disease and eight HVs matched on age, sex, and body mass index underwent study assessments consisting of blood collection for evaluation of plasma and serum biomarkers, mitochondrial function in peripheral blood mononuclear cells (PBMCs), and an array of imaging methods for assessment of (micro)circulation. Plasma biomarkers GDF-15, IL-6, NT-proBNP, and cTNI were significantly elevated in patients compared to HVs, as were several clinical chemistry and hematology markers. No differences between groups were found for mitochondrial membrane potential, mitochondrial reactive oxygen production, oxygen consumption rate, or extracellular acidification rate in PBMCs. Imaging revealed significantly higher nicotinamide-adenine-dinucleotide-hydrogen (NADH) content in skin as well as reduced passive leg movement-induced hyperemia in patients. This study confirmed results of earlier studies regarding plasma biomarkers in mitochondrial disease and identified several imaging techniques that could detect functional differences at the tissue level between participants with mitochondrial disease and HVs. However, assays of mitochondrial function in PBMCs did not show differences between participants with mitochondrial disease and HVs, possibly reflecting compensatory mechanisms and heterogeneity in mutational load. In future clinical trials, using a mix of imaging and blood-based biomarkers may be advisable, as well as combining these with an in vivo challenge to disturb homeostasis.
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Affiliation(s)
- Sebastiaan J W van Kraaij
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Bastiaan Smal
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | | | | | | | | | | | | | - Wolf-Hagen Schunck
- OMEICOS Therapeutics GmbH, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
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11
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Böttcher M, Düngen HD, Corcea V, Donath F, Fuhr R, Gal P, Mikus G, Trenk D, Coenen M, Pires PV, Maschke C, Aliprantis AO, Besche N, Becker C. Vericiguat: A Randomized, Phase Ib, Placebo-Controlled, Double-Blind, QTc Interval Study in Patients with Chronic Coronary Syndromes. Am J Cardiovasc Drugs 2023; 23:145-155. [PMID: 36633816 PMCID: PMC10006255 DOI: 10.1007/s40256-022-00557-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Vericiguat is indicated for the treatment of symptomatic chronic heart failure in adult patients with reduced ejection fraction who are stabilized after a recent decompensation event. OBJECTIVE To investigate the effects of vericiguat on QT interval in patients with chronic coronary syndromes (CCS). METHODS This was a randomized, phase Ib, placebo-controlled, double-blind, double-dummy, multicenter study. Vericiguat once daily was up-titrated from 2.5 mg to 5 mg and then to 10 mg (treatments A, B, and C) at 14-day intervals. Positive control was moxifloxacin 400 mg (single dose on day 8 or day 50; placebo on other days [treatment D]). We evaluated the placebo-adjusted change from baseline of the Frederica-corrected QTc interval (QTcF), pharmacokinetics, safety, and tolerability of vericiguat. RESULTS In total, 74 patients with CCS, with mean (standard deviation) age 63.4 (8.0) years, were included and 72 patients completed the study. At each timepoint up to 7 h after administration, mean placebo-corrected change in QTcF from baseline was < 6 ms and the upper limit of the two-sided 90% confidence interval of the mean was below the 10-ms threshold for clinical relevance. Moxifloxacin confirmed the assay sensitivity. Median time of maximum concentration of vericiguat was 4.5 h post-dose. The adverse event profile of vericiguat was consistent with its mechanism of action, and the findings did not indicate any safety concerns. CONCLUSIONS As part of an integrative risk assessment, this study demonstrated no clinically relevant corrected QT prolongation with vericiguat 10 mg once daily at steady state. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov number, NCT03504982.
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Affiliation(s)
| | - Hans-Dirk Düngen
- Department of Internal Medicine, Cardiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Vasile Corcea
- Department of Cardiac Surgery, PMSI Clinical Republican Hospital "T. Mosneaga", Chisinau, Republic of Moldova
| | | | - Rainard Fuhr
- Early Phase Clinical Unit, Parexel, Berlin, Germany
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
- Clinical Pharmacology and Toxicology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd Mikus
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dietmar Trenk
- Department University Heart Center Campus Bad Krozingen, Clinics of Cardiology and Angiology-Clinical Pharmacology, University Medical Center Freiburg, Freiburg, Germany
| | - Martin Coenen
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | | | | | - Antonios Othon Aliprantis
- Translational Medicine, Merck & Co., Inc., Rahway, New Jersey, USA
- Pioneering Medicines, Flagship Pioneering, Boston, Massachusetts, USA
| | - Nina Besche
- Chrestos Concept GmbH & Co. KG, Essen, Germany
| | - Corina Becker
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany.
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12
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Saghari M, Gal P, Grievink HW, Klaassen ES, Itano A, McHale D, Moerland M. Impact of oral administration of single strain Lactococcus lactis spp. cremoris on immune responses to keyhole limpet hemocyanin immunization and gut microbiota: A randomized placebo-controlled trial in healthy volunteers. Front Immunol 2022; 13:1009304. [PMID: 36582231 PMCID: PMC9793106 DOI: 10.3389/fimmu.2022.1009304] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Lactococcus lactis spp. cremoris has been associated with promising immunomodulatory results in preclinical trials. The aim of this study was to investigate the pharmacodynamic (PD) effects of three monoclonal microbial formulations of L. lactis spp. cremoris (EDP1066) on the immune response to keyhole limpet hemocyanin (KLH). Potential effects on the gut microbiota were also investigated. Methods The trial was registered on Netherlands Trial Register (trial ID NL7519, https://trialsearch.who.int). Eighty-one healthy subjects (median 28, range 18-59 years) were randomized to 28 days of enteric-coated capsules at five doses (n = 13) (1.5 * 1012 total cells daily), freeze-dried powder at one dose (n = 12) (3.0 * 1011 total cells daily) or five doses (n = 12), minitablets at one dose (n = 12) or five doses (n = 12), or placebo (n = 20) prior to KLH immunization. Antibody responses and circulating regulatory T cells (Tregs) were measured after KLH immunization, and skin responses were evaluated after a KLH rechallenge by laser speckle contrast imaging and multispectral imaging. Ex vivo lymphocyte (phytohemagglutinin) and monocyte (lipopolysaccharide (LPS)) cytokine release assays were explored in the minitablet-treated groups only. The prevalence of L. lactis spp. cremoris in the gastrointestinal tract and the impact on the fecal microbiota were assessed by qPCR and 16S rRNA sequencing, respectively. Results Repeated-measures analysis of covariances revealed no significant treatment effects on the antibody responses to KLH, number of Tregs, or KLH skin rechallenge outcomes. Ex vivo LPS-driven cytokine responses in whole blood were lower in the low dose minitablet group compared to placebo: tumor necrosis factor (estimated difference (ED) from placebo: -44.2%, 95% confidence interval (CI) -65.3% to -10.3%), interleukin (IL)-1β (ED -41.4%, 95% CI -63.5% to -5.8%), and IL-6 (ED -39.2%, 95% CI -56.8% to -14.5%). The fecal presence of L. lactis spp. cremoris increased during treatment by all EDP1066 formulations and normalized 5 days after the last dose. Microbiome α-diversity did not change by the treatments compared to placebo. Discussion The EDP1066 formulations did not affect the immune response to KLH immunization in healthy individuals. However, exposure to L. lactis spp. cremoris in minitablet formulation impacted ex vivo whole blood LPS cytokine response. The clinical impact of these effects awaits further investigations. Netherlands Trial Register trialsearch.who.int, trial ID NL7519.
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Affiliation(s)
- Mahdi Saghari
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
- Leiden University Medical Centre (LUMC), Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
- Leiden University Medical Centre (LUMC), Leiden, Netherlands
| | - Hendrika W. Grievink
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
- Leiden Academic Centre for Drug Research (LACDR), Leiden, Netherlands
| | | | - Andrea Itano
- Evelo Biosciences Inc., Cambridge, MA, United States
| | - Duncan McHale
- Evelo Biosciences Inc., Cambridge, MA, United States
| | - Matthijs Moerland
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
- Leiden University Medical Centre (LUMC), Leiden, Netherlands
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13
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Hassing GJ, van Esdonk MJ, van Westen GJP, Cohen AF, Burggraaf J, Gal P. Dose escalations in phase I studies: Feasibility of interpreting blinded pharmacodynamic data. Br J Clin Pharmacol 2022; 88:5412-5419. [PMID: 35895751 DOI: 10.1111/bcp.15473] [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: 04/02/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS During phase I study conduct, blinded data are reviewed to predict the safety of increasing the dose level. The aim of the present study was to describe the probability that effects are observed in blinded evaluations of data in a simulated phase I study design. METHODS An application was created to simulate blinded pharmacological response curves over time for 6 common safety/efficacy measurements in phase I studies for 1 or 2 cohorts (6 active, 2 placebo per cohort). Effect sizes between 0 and 3 between-measurement standard deviations (SDs) were simulated. Each set of simulated graphs contained the individual response and mean ± SD over time. Reviewers (n = 34) reviewed a median of 100 simulated datasets and indicated whether an effect was present. RESULTS Increasing effect sizes resulted in a higher chance of the effect being identified by the blinded reviewer. On average, 6% of effect sizes of 0.5 between-measurement SD were correctly identified, increasing to 72% in 3.0 between-measurement SD effect sizes. In contrast, on average 92-95% of simulations with no effect were correctly identified, with little effect of between-measurement variability in single cohort simulations. Adding a dataset of a second cohort at half the simulated dose did not appear to improve the interpretation. CONCLUSION Our analysis showed that effect sizes <2× the between-measurement SD of the investigated outcome frequently go unnoticed by blinded reviewers, indicating that the weight given to these blinded analyses in current phase I practice is inappropriate and should be re-evaluated.
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Affiliation(s)
- Gerardus J Hassing
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Adam F Cohen
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Center, Leiden, the Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Center, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Center, Leiden, the Netherlands
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14
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Grievink HW, Smit V, Huisman BW, Gal P, Yavuz Y, Klerks C, Binder CJ, Bot I, Kuiper J, Foks AC, Moerland M. Cardiovascular risk factors: The effects of ageing and smoking on the immune system, an observational clinical study. Front Immunol 2022; 13:968815. [PMID: 36189218 PMCID: PMC9519851 DOI: 10.3389/fimmu.2022.968815] [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: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Currently immunomodulatory compounds are under investigation for use in patients with cardiovascular disease, caused by atherosclerosis. These trials, using recurrent cardiovascular events as endpoint, require enrollment of large patient groups. We investigated the effect of key risk factors for atherosclerosis development, ageing and smoking, on the immune system, with the objective to identify biomarkers differentiating between human populations, and potentially serving as endpoints for future phase 1B trials with immunomodulatory compounds. Blood was collected from young healthy volunteers (aged 18-25 years, n=30), young smokers (18-25 years, n=20), elderly healthy volunteers (>60 years, n=20), heavy smokers (>45 years, 15 packyears, n=11) and patients with stable coronary artery disease (CAD) (>60 years, n=27). Circulating immune cell subsets were characterized by flow cytometry, and collected plasma was evaluated by proteomics (Olink). Clear ageing effects were observed, mostly illustrated by a lower level in CD8+ and naïve CD4+ and CD8+ T cells, with an increase in CD4+ and CD8+ effector memory T cells in elderly healthy volunteers compared to young healthy volunteers. Heavy smokers showed a more inflammatory cellular phenotype, especially a shift in Th1/Th2 ratio: higher Th1 and lower Th2 percentages compared to young healthy volunteers. A significant decrease in circulating atheroprotective oxLDL-specific IgM was found in patients with CAD compared to young healthy volunteers. Elevated pro-inflammatory and chemotactic proteins TREM1 and CCL11 were observed in elderly volunteers compared to young volunteers. In addition, heavy smokers had an increase in pro-inflammatory cytokine IL-6 and lysosomal protein LAMP3. These data show that ageing and smoking are associated with an inflammatory immunophenotype, and that heavy smokers or aged individuals may serve as potential populations for future clinical trials investigating immunomodulatory drugs targeted for cardiovascular disease.
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Affiliation(s)
- H. W. Grievink
- Centre for Human Drug Research, Leiden, Netherlands
- Division of BioTherapeutics, Leiden Academic Center for Drug Research, Leiden University, Leiden, Netherlands
| | - V. Smit
- Division of BioTherapeutics, Leiden Academic Center for Drug Research, Leiden University, Leiden, Netherlands
| | - B. W. Huisman
- Centre for Human Drug Research, Leiden, Netherlands
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden, Netherlands
| | - P. Gal
- Centre for Human Drug Research, Leiden, Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Y. Yavuz
- Centre for Human Drug Research, Leiden, Netherlands
| | - C. Klerks
- Centre for Human Drug Research, Leiden, Netherlands
| | - C. J. Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - I. Bot
- Division of BioTherapeutics, Leiden Academic Center for Drug Research, Leiden University, Leiden, Netherlands
| | - J. Kuiper
- Division of BioTherapeutics, Leiden Academic Center for Drug Research, Leiden University, Leiden, Netherlands
| | - A. C. Foks
- Division of BioTherapeutics, Leiden Academic Center for Drug Research, Leiden University, Leiden, Netherlands
| | - M. Moerland
- Centre for Human Drug Research, Leiden, Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: M. Moerland,
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15
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Saghari M, Gal P, Gilbert S, Yateman M, Porter‐Brown B, Brennan N, Quaratino S, Wilson R, Grievink HW, Klaassen ES, Bergmann KR, Burggraaf J, Doorn MB, Powell J, Moerland M, Rissmann R. OX40L Inhibition Suppresses KLH‐driven Immune Responses in Healthy Volunteers: A Randomized Controlled Trial Demonstrating Proof‐of‐Pharmacology for KY1005. Clin Pharmacol Ther 2022; 111:1121-1132. [PMID: 35092305 PMCID: PMC9314635 DOI: 10.1002/cpt.2539] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Abstract
The safety, tolerability, immunogenicity, and pharmacokinetic (PK) profile of an anti‐OX40L monoclonal antibody (KY1005, currently amlitelimab) were evaluated. Pharmacodynamic (PD) effects were explored using keyhole limpet hemocyanin (KLH) and tetanus toxoid (TT) immunizations. Sixty‐four healthy male subjects (26.5 ± 6.0 years) were randomized to single doses of 0.006, 0.018, or 0.05 mg/kg, or multiple doses of 0.15, 0.45, 1.35, 4, or 12 mg/kg KY1005, or placebo (6:2). Serum KY1005 concentrations were measured. Antibody responses upon KLH and TT immunizations and skin response upon intradermal KLH administration were performed. PD data were analyzed using repeated measures analysis of covariances (ANCOVAs) and post hoc exposure‐response modeling. No serious adverse events occurred and all adverse events were temporary and of mild or moderate severity. A nonlinear increase in mean serum KY1005 concentrations was observed (median time to maximum concentration (Tmax) ~ 4 hours, geometric mean terminal half‐life (t½) ~ 24 days). Cutaneous blood perfusion (estimated difference (ED) −13.4 arbitrary unit (AU), 95% confidence interval (CI) −23.0 AU to −3.8 AU) and erythema quantified as average redness (ED −0.23 AU, 95% CI −0.35 AU to −0.11 AU) decreased after KY1005 treatment at doses of 0.45 mg/kg and above. Exposure‐response analysis displayed a statistically significant treatment effect on anti‐KLH antibody titers (IgG maximum effect (Emax) −0.58 AU, 95% CI −1.10 AU to −0.06 AU) and skin response (erythema Emax −0.20 AU, 95% CI −0.29 AU to −0.11 AU). Administration of KY1005 demonstrated an acceptable safety and tolerability profile and PK analyses displayed a nonlinear profile of KY1005. Despite the observed variability, skin challenge response after KY1005 treatment indicated pharmacological activity of KY1005. Therefore, KY1005 shows potential as a novel pharmacological treatment in immune‐mediated disorders.
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Affiliation(s)
- Mahdi Saghari
- Centre for Human Drug Research Leiden the Netherlands
- Leiden University Medical Centre Leiden the Netherlands
| | - Pim Gal
- Centre for Human Drug Research Leiden the Netherlands
- Leiden University Medical Centre Leiden the Netherlands
| | | | | | | | | | | | | | - Hendrika W. Grievink
- Centre for Human Drug Research Leiden the Netherlands
- Leiden Academic Centre for Drug Research Leiden the Netherlands
| | | | | | - Jacobus Burggraaf
- Centre for Human Drug Research Leiden the Netherlands
- Leiden University Medical Centre Leiden the Netherlands
- Leiden Academic Centre for Drug Research Leiden the Netherlands
| | - Martijn B.A. Doorn
- Department of Dermatology Erasmus Medical Centre Rotterdam the Netherlands
| | | | - Matthijs Moerland
- Centre for Human Drug Research Leiden the Netherlands
- Leiden University Medical Centre Leiden the Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research Leiden the Netherlands
- Leiden University Medical Centre Leiden the Netherlands
- Leiden Academic Centre for Drug Research Leiden the Netherlands
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16
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Elzinga WO, Prins S, Borghans LGJM, Gal P, Vargas GA, Groeneveld GJ, Doll RJ. Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial. JMIR Form Res 2021; 5:e31890. [PMID: 34967757 PMCID: PMC8759015 DOI: 10.2196/31890] [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: 07/09/2021] [Revised: 08/12/2021] [Accepted: 11/21/2021] [Indexed: 01/07/2023] Open
Abstract
Background Although electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life. Objective The aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial. Methods The data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates. Results Sleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94). Conclusions We demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects. Trial Registration Netherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002
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Affiliation(s)
| | - Samantha Prins
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden University Medical Center, Leiden, Netherlands
| | | | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden University Medical Center, Leiden, Netherlands
| | | | - Geert J Groeneveld
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden University Medical Center, Leiden, Netherlands
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17
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Boettcher MF, Duengen HD, Corcea V, Donath F, Fuhr R, Gal P, Mikus G, Trenk D, Werner N, Pires P, Maschke C, Aliprantis A, Besche N, Becker C. Vericiguat: a QTc interval study in patients with coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0922] [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
Background
Vericiguat is a soluble guanylate cyclase stimulator developed for the treatment of symptomatic chronic heart failure (HF) in adult patients with ejection fraction less than 45% who had a previous decompensation event. Guidelines on QT studies recommend evaluation of investigational drugs at supratherapeutic exposures in healthy volunteers. We anticipated that supratherapeutic doses of vericiguat would decrease blood pressure. We conducted an adjusted QT study using the therapeutic range of vericiguat in patients with coronary artery disease (CAD), who were expected to be more haemodynamically stable with fewer confounders (e.g., on the electrocardiogram) than a HF population.
Purpose
To assess the effect of vericiguat 10 mg once-daily on placebo-adjusted change from baseline of the Fridericia-corrected QT interval (QTcF) in patients with stable CAD.
Methods
This was a randomised, Phase Ib, placebo-controlled, double blind, double-dummy, multicentre study (NCT03504982). Test drug was vericiguat once-daily (up-titrated from 2.5 mg to 5 mg and then to 10 mg [treatments A, B, C] at 14-day intervals). The positive control was moxifloxacin 400 mg (single dose on Day 8 or Day 50 with placebo on other days [treatment D]; Figure). Patients were randomised to one of two sequences.
We evaluated QTcF interval prolongation potential of vericiguat at increasing doses up to 10 mg, steady state. We investigated the pharmacokinetics, safety and tolerability of vericiguat. A clinically meaningful effect was defined as a QTcF change from baseline >10 ms relative to placebo. Assay sensitivity for moxifloxacin was confirmed by the lower limit of the 90% confidence interval (CI) of the time-matched, baseline-adjusted mean difference to placebo exceeding 5 ms at >1 time point.
Results
A total of 74 patients (66 males and 8 females) with CAD, mean (standard deviation) age 63.4 (8.0) years, were included. Mean difference between vericiguat and placebo in QTcF change from baseline (≤7 h post-dose) was <6 ms; no upper limit of the 90% CIs crossed the threshold of 10 ms. Lower limits of the two-sided 90% CI of the differences between moxifloxacin and placebo in QTcF change from baseline were >5 ms at 3 of 4 time points (Table).
Peak plasma concentration (Cmax) of vericiguat following administration of vericiguat 10 mg was 322 μg/l and median time of maximum concentration (Tmax) was 4.5 h post-dose, in line with concentrations observed following administration of vericiguat 10 mg to patients with HF [1]. For moxifloxacin 400 mg, Cmax was 1960 μg/l and median Tmax was 3 h post-dose, in line with previously reported values [2]. Vericiguat up to 10 mg was generally safe and well tolerated.
Conclusion
This study supports the assessment that administration of vericiguat 10 mg is not associated with clinically meaningful QTc prolongation. These data contribute to the overall safety profile of vericiguat for the treatment of patients with HF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Funding was provided by Bayer AG, Berlin, Germany, and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA QTc study design
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Affiliation(s)
| | - H.-D Duengen
- Charite Universitatsmedizin Berlin, Department of Internal Medicine, Cardiology, Berlin, Germany
| | - V Corcea
- PMSI Clinical Republican Hospital “T. Mosneaga”, Department of Cardiac Surgery, Chisinau, Moldova (Republic of)
| | - F Donath
- SocraTec R&D GmbH, Erfurt, Germany
| | - R Fuhr
- PAREXEL, DRK Hospital Berlin, Berlin, Germany
| | - P Gal
- Centre for Human Drug Research, Leiden, Netherlands (The)
| | - G Mikus
- University Hospital of Heidelberg, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany
| | - N Werner
- University Hospital Bonn, Heart Center, Department of Medicine II, Bonn, Germany
| | - P.V Pires
- Bayer AG, Research & Development, Wuppertal, Germany
| | - C Maschke
- Bayer AG, Study Management, Wuppertal, Germany
| | - A.O Aliprantis
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - N Besche
- Chrestos Concept GmbH & Co. KG, Essen, Germany
| | - C Becker
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
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18
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Eveleens Maarse BC, Graff C, Kanters JK, van Esdonk MJ, Kemme MJB, In 't Veld AE, Jansen MAA, Moerland M, Gal P. Effect of hydroxychloroquine on the cardiac ventricular repolarization: A randomized clinical trial. Br J Clin Pharmacol 2021; 88:1054-1062. [PMID: 34327732 PMCID: PMC8444885 DOI: 10.1111/bcp.15013] [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: 05/07/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022] Open
Abstract
Aims Hydroxychloroquine has been suggested as possible treatment for severe acute respiratory syndrome‐coronavirus‐2. Studies reported an increased risk of QTcF‐prolongation after treatment with hydroxychloroquine. The aim of this study was to analyse the concentration‐dependent effects of hydroxychloroquine on the ventricular repolarization, including QTcF‐duration and T‐wave morphology. Methods Twenty young (≤30 y) and 20 elderly (65–75 y) healthy male subjects were included. Subjects were randomized to receive either a total dose of 2400 mg hydroxychloroquine over 5 days, or placebo (ratio 1:1). Follow‐up duration was 28 days. Electrocardiograms (ECGs) were recorded as triplicate at baseline and 4 postdose single recordings, followed by hydroxychloroquine concentration measurements. ECG intervals (RR, QRS, PR, QTcF, J‐Tpc, Tp‐Te) and T‐wave morphology, measured with the morphology combination score, were analysed with a prespecified linear mixed effects concentration–effect model. Results There were no significant associations between hydroxychloroquine concentrations and ECG characteristics, including RR‐, QRS‐ and QTcF‐interval (P = .09, .34, .25). Mean ΔΔQTcF‐interval prolongation did not exceed 5 ms and the upper limit of the 90% confidence interval did not exceed 10 ms at the highest measured concentrations (200 ng/mL). There were no associations between hydroxychloroquine concentration and the T‐wave morphology (P = .34 for morphology combination score). There was no significant effect of age group on ECG characteristics. Conclusion In this study, hydroxychloroquine did not affect ventricular repolarization, including the QTcF‐interval and T‐wave morphology, at plasma concentrations up to 200 ng/mL. Based on this analysis, hydroxychloroquine does not appear to increase the risk of QTcF‐induced arrhythmias.
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Affiliation(s)
- Boukje C Eveleens Maarse
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Aliede E In 't Veld
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
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19
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Fienieg B, Hassing GJ, van der Wall HEC, van Westen GJP, Kemme MJB, Adiyaman A, Elvan A, Burggraaf J, Gal P. The association between body temperature and electrocardiographic parameters in normothermic healthy volunteers. Pacing Clin Electrophysiol 2020; 44:44-53. [PMID: 33179782 PMCID: PMC7894493 DOI: 10.1111/pace.14120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/14/2020] [Accepted: 11/01/2020] [Indexed: 12/19/2022]
Abstract
Background Previous studies reported that hypo‐ and hyperthermia are associated with several atrial and ventricular electrocardiographical parameters, including corrected QT (QTc) interval. Enhanced characterization of variations in QTc interval and normothermic body temperature aids in better understanding the underlying mechanism behind drug induced QTc interval effects. The analysis’ objective was to investigate associations between body temperature and electrocardiographical parameters in normothermic healthy volunteers. Methods Data from 3023 volunteers collected at our center were retrospectively analyzed. Subjects were considered healthy after review of collected data by a physician, including a normal tympanic body temperature (35.5‐37.5°C) and in sinus rhythm. A linear multivariate model with body temperature as a continuous was performed. Another multivariate analysis was performed with only the QT subintervals as independent variables and body temperature as dependent variable. Results Mean age was 33.8 ± 17.5 years and mean body temperature was 36.6 ± 0.4°C. Body temperature was independently associated with age (standardized coefficient [SC] = −0.255, P < .001), female gender (SC = +0.209, P < .001), heart rate (SC = +0.231, P < .001), P‐wave axis (SC = −0.051, P < .001), J‐point elevation in lead V4 (SC = −0.121, P < .001), and QTcF duration (SC = −0.061, P = .002). In contrast, other atrial and atrioventricular (AV) nodal parameters were not independently associated with body temperature. QT subinterval analysis revealed that only QRS duration (SC = −0.121, P < .001) was independently associated with body temperature. Conclusion Body temperature in normothermic healthy volunteers was associated with heart rate, P‐wave axis, J‐point amplitude in lead V4, and ventricular conductivity, the latter primarily through prolongation of the QRS duration.
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Affiliation(s)
| | | | - Hein E C van der Wall
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
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20
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Hassing G, Fienieg B, Van Der Wall H, Van Westen G, Kemme M, Adiyaman A, Elvan A, Burggraaf J, Gal P. The association between body temperature and electrocardiographic parameters in normothermic healthy volunteers. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0377] [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
Introduction
Previous studies have observed that hypo- and hyperthermia are associated with several atrial and ventricular electrocardiographical parameters, including the corrected QT interval. Preclinical studies have shown that drugs that exert an effect on body temperature also exert an effect on the corrected QT interval. Therefore, increased characterization in healthy humans of the association between the corrected QT interval and body temperature within the normal body temperature range aids in understanding the mechanism behind drug induced corrected QT interval effects. The objective of this analysis was to evaluate the association between body temperature and electrocardiographical parameters in normothermic healthy volunteers.
Methods
Data from 3023 volunteers collected at our center were analyzed. Only subjects considered healthy after review of collected data by a physician, including a normal tympanic body temperature (35.5–37.5 °C) and in sinus rhythm, were included in the analysis. Subjects were divided into body temperature quartiles for analysis and a linear multivariate model with body temperature as a continuous was performed. Another multivariate analysis was performed with only the QT subintervals as independent variables and body temperature as dependent variable.
Results
Mean age was 33.8±17.5 years and mean body temperature was 36.6±0.4 °C. Body temperature was independently associated with age (standardized coefficient (SC)=−0.252, P<0.001), gender (SC=+0.208, P<0.001), heart rate (SC=+0.230, P<0.001), J-point elevation in lead V4 (SC=−0.118, P<0.001), and Fridericia corrected QT interval (SC=−0.061, P=0.002). Atrial and AV nodal parameters were not independently associated with body temperature. The effects of temperature on the surface ECG are displayed in figure 1. QT subinterval analysis revealed that only QRS duration (SC=−0.121, P<0.001) was independently associated with body temperature.
Conclusion
Body temperature in normothermic healthy volunteers was associated with heart rate, J-point amplitude in lead V4 and ventricular conductivity, primarily through a prolongation of the QRS duration. In contrast, atrial and AV nodal ECG parameters were not independently associated with body temperature.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G.J Hassing
- Centre for Human Drug Research, Leiden, Netherlands (The)
| | - B Fienieg
- Independent, Arnhem, Netherlands (The)
| | | | - G.J.P Van Westen
- Leiden Academic Center for Drug Researh, Leiden, Netherlands (The)
| | - M.J.B Kemme
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - A Adiyaman
- Isala Hospital, Zwolle, Netherlands (The)
| | - A Elvan
- Isala Hospital, Zwolle, Netherlands (The)
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands (The)
| | - P Gal
- Centre for Human Drug Research, Leiden, Netherlands (The)
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21
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Saghari M, Gal P, Ziagkos D, Burggraaf J, Powell JF, Brennan N, Rissmann R, van Doorn MBA, Moerland M. A randomized controlled trial with a delayed-type hypersensitivity model using keyhole limpet haemocyanin to evaluate adaptive immune responses in man. Br J Clin Pharmacol 2020; 87:1953-1962. [PMID: 33025648 PMCID: PMC8056735 DOI: 10.1111/bcp.14588] [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: 07/13/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 01/12/2023] Open
Abstract
AIMS Keyhole limpet haemocyanin (KLH) immunization is a clinical model for the evaluation of human antibody responses. The current study evaluated the anti-KLH antibody response after KLH immunization and the delayed-type hypersensitivity response following intradermal KLH administration, using objective imaging techniques. METHODS Healthy male subjects aged 24.5 ± 5.4 years were randomized to intramuscular immunization with 100 μg KLH (n = 12) or placebo (n = 3). Anti-KLH antibody (Ig) M and IgG titres were determined before and every 7 days after KLH immunization for a total of 28 days. Twenty-one days after the immunization, all subjects received 1 μg KLH intradermally. Prior to and 2 days after intradermal KLH administration, skin blood perfusion, erythema and oedema were quantified using noninvasive imaging tools. Repeated measures ANCOVAs were used to analyse data. RESULTS Anti-KLH IgM and IgG titres increased after KLH immunization compared to placebo (estimated difference [ED]: 37%, 95% confidence interval [CI]: 19-51% and ED: 68%, 95% CI: 56-76% respectively). Upon intradermal KLH administration an increase in skin blood perfusion (ED: 10.9 arbitrary units (AU), 95% CI: 1.4-20.4 AU) and erythema (ED: 0.3 AU, 95% CI: 0.1-0.5 AU) was observed in KLH-immunized subjects compared to placebo. CONCLUSION KLH immunization followed by intradermal KLH administration resulted in increased anti-KLH IgM and IgG titres and a delayed-type hypersensitivity response quantified by an increase in skin blood perfusion and erythema. Using noninvasive imaging tools the KLH model has the potential to serve as an objective tool to study the pharmacodynamics of T-cell-directed immunomodulatory drugs.
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Affiliation(s)
- Mahdi Saghari
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | | | | | - Robert Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | | | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
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22
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Hijma HJ, Moss LM, Gal P, Ziagkos D, de Kam ML, Moerland M, Groeneveld GJ. Challenging the challenge: A randomized controlled trial evaluating the inflammatory response and pain perception of healthy volunteers after single-dose LPS administration, as a potential model for inflammatory pain in early-phase drug development. Brain Behav Immun 2020; 88:515-528. [PMID: 32305572 DOI: 10.1016/j.bbi.2020.04.033] [Citation(s) in RCA: 10] [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: 12/27/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND AIMS Following an infection, cytokines not only regulate the acute immune response, but also contribute to symptoms such as inflammatory hyperalgesia. We aimed to characterize the acute inflammatory response induced by a human endotoxemia model, and its effect on pain perception using evoked pain tests in two different dose levels. We also attempted to determine whether combining a human endotoxemia challenge with measurement of pain thresholds in healthy subjects could serve as a model to study drug effects on inflammatory pain. METHODS AND RESULTS This was a placebo-controlled, randomized, cross-over study in 24 healthy males. Twelve subjects were administered a bolus of 1 ng/kg LPS intravenously, and twelve 2 ng/kg LPS. Before days of placebo/LPS administration, subjects completed a full study day without study drug administration, but with identical pain threshold testing. Blood sampling and evoked pain tests (electrical burst and -stair, heat, pressure, and cold pressor test) were performed pre-dose and at frequent intervals up to 10hr post-dose. Data were analysed with a repeated-measures ANCOVA. For both dose levels, LPS induced an evident acute inflammatory response, but did not significantly affect any of the pain modalities. In a post-hoc analysis, lowering of pain thresholds was observed in the first 3 h after dosing, corresponding with the peak of the acute inflammatory response around 1-3 h post-dose. CONCLUSION Mild acute systemic inflammation, as induced by 1 ng/kg and 2 ng/kg LPS intravenous administration, did not significantly change pain thresholds in this study. The endotoxemia model in combination with evoked pain tests is not suitable to study acute inflammatory hyperalgesia in healthy males.
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Affiliation(s)
- H J Hijma
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - L M Moss
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - P Gal
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - D Ziagkos
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands.
| | - M L de Kam
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands.
| | - M Moerland
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - G J Groeneveld
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
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23
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Gal P, Klaassen ES, Bergmann KR, Saghari M, Burggraaf J, Kemme MJB, Sylvest C, Sørensen U, Bentzen BH, Grunnet M, Diness JG, Edvardsson N. First Clinical Study with AP30663 - a K Ca 2 Channel Inhibitor in Development for Conversion of Atrial Fibrillation. Clin Transl Sci 2020; 13:1336-1344. [PMID: 32725783 PMCID: PMC7719388 DOI: 10.1111/cts.12835] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 02/26/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022] Open
Abstract
Pharmacological cardioversion of atrial fibrillation (AF) is frequently inefficacious. AP30663, a small conductance Ca2+ activated K+ (KCa2) channel blocker, prolonged the atrial effective refractory period in preclinical studies and subsequently converted AF into normal sinus rhythm. This first‐in‐human study evaluated the safety and tolerability, and pharmacokinetic (PK) and pharmacodynamic (PD) effects were explored. Forty‐seven healthy male volunteers (23.7 ± 3.0 years) received AP30663 intravenously in ascending doses. Due to infusion site reactions, changes to the formulation and administration were implemented in the latter 24 volunteers. Extractions from a 24‐hour continuous electrocardiogram were used to evaluate the PD effect of AP30663. Data were analyzed with a repeated measure analysis of covariance, noncompartmental analysis, and concentration‐effect analysis. In total, 33 of 34 adverse events considered related to AP30663 exposure were related to the infusion site, mild in severity, and temporary in nature, although full recovery took up to 110 days. After formulation and administration changes, the local infusion site reaction remained, but the median duration was shorter despite higher dose levels. AP30663 displayed a less than dose proportional increase in peak plasma concentration (Cmax) and a terminal half‐life of around 5 hours. In healthy volunteers, no effect of AP30663 was observed on electrocardiographic parameters, other than a concentration‐dependent effect on the corrected QT Fridericia’s formula interval (+18.8 ± 4.3 ms for the highest dose level compared with time matched placebo). In conclusion, administration of AP30663, a novel KCa2 channel inhibitor, was safe and well‐tolerated systemically in humans, supporting further development in patients with AF undergoing cardioversion.
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Affiliation(s)
- Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Mahdi Saghari
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands.,Leiden Academic Center for Drug Research, Leiden, The Netherlands
| | | | | | | | | | | | | | - Nils Edvardsson
- Acesion Pharma ApS, Copenhagen, Denmark.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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24
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Heuberger JAAC, Posthuma JJ, Ziagkos D, Rotmans JI, Daniels JMA, Gal P, Stuurman FE, Spronk HMH, Ten Cate H, Burggraaf J, Moerland M, Cohen AF. Additive effect of erythropoietin use on exercise-induced endothelial activation and hypercoagulability in athletes. Eur J Appl Physiol 2020; 120:1893-1904. [PMID: 32537688 PMCID: PMC7340646 DOI: 10.1007/s00421-020-04419-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
Purpose Recombinant human erythropoietin (rHuEPO) is known to increase thrombotic risk in patients and might have similar effects in athletes abusing the drug. rHuEPO is prohibited by anti-doping legislation, but this risk has not been investigated thoroughly. This analysis was designed to evaluate whether rHuEPO impacts hemostatic profile and endothelial and platelet activation markers in trained subjects, and whether the combination with exercise affects exercise induced alterations. Methods This double-blind, randomized, placebo-controlled trial enrolled healthy, trained male cyclists aged 18–50 years. Participants were randomly allocated (1:1) to receive subcutaneous injections of rHuEPO (epoetin-β; mean dose 6000 IU per week) or placebo (0.9% NaCl) for 8 weeks. Subjects performed five maximal exercise tests and a road race, coagulation and endothelial/platelet markers were measured at rest and directly after each exercise effort. Results rHuEPO increased P-selectin (+ 7.8% (1.5–14.5), p = 0.02) and E-selectin (+ 8.6% (2.0–15.7), p = 0.01) levels at rest. Maximal exercise tests significantly influenced all measured coagulation and endothelial/platelet markers, and in the rHuEPO group maximal exercise tests led to 15.3% ((7.0–24.3%), p = 0.0004) higher E-selectin and 32.1% ((4.6–66.8%), p = 0.0207) higher Platelet factor 4 (PF4) levels compared to the placebo group. Conclusion In conclusion, rHuEPO treatment resulted in elevated E- and P-selectin levels in trained cyclists, indicating enhanced endothelial activation and/or platelet reactivity. Exercise itself induces hypercoagulability, and the combination of rHuEPO and exercise increased E-selectin and PF4 levels more than either intervention alone. Based on this, exercise potentially increases thrombotic risk, a risk that might be enhanced in combination with rHuEPO use. Electronic supplementary material The online version of this article (10.1007/s00421-020-04419-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jelle J Posthuma
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Dimitrios Ziagkos
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Frederik E Stuurman
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Henri M H Spronk
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Matthijs Moerland
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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25
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Hassing GJ, Kemme MJB, Gal P. Letter to the Editor. Ann Noninvasive Electrocardiol 2020; 25:e12755. [PMID: 32125055 PMCID: PMC7358843 DOI: 10.1111/anec.12755] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/26/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
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26
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Gal P, Frohlichova L, Coma M, Pafcuga I, Suca H, Grossova I, Hribikova Z, Sticova E, Zajicek R. Early Changes during Skin Repair Using Tissue-Engineered Dermal Template in a Full-Thickness Burn. Folia Biol (Praha) 2020; 66:161-168. [PMID: 34087972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Rapid wound closure in extensively burned patients has remained one of the major unresolved issues of medicine. Integra® is the most widely established artificial skin, which is composed of a porous matrix of cross-linked bovine collagen and chondroitin 6-sulphate covered by a semi-permeable silicone layer. We present here a (immuno)histological study of a severely burned patient with a full-thickness burn treated with a tissue-engineered dermal template (Integra®) and split-thickness skin graft-based protocol. Immunohistochemical investigation of the artificial dermis revealed that immune cell infiltration reached its peak on day 10. Tissue immunophenotyping found an increase in CD3+ cells over the course of the study as well as CD4 and CD8 positivity on day 40, indicating remaining T-cell subpopulations. We observed weak/no infiltration of NK cells (CD56+). In conclusion, the use of bi-layer Integra® represents a feasible and safe procedure resulting in formation of non-irritating dermal substitutes.
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Affiliation(s)
- P Gal
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Královské Vinohrady, Prague, Czech Republic
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc., Košice, Slovak Republic
- Laboratory of Cell Interactions, Center of Clinical and Preclinical Research MediPark, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - L Frohlichova
- Department of Pathology, Louis Pasteur University Hospital, Košice, Slovak Republic
| | - M Coma
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc., Košice, Slovak Republic
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - I Pafcuga
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Královské Vinohrady, Prague, Czech Republic
| | - H Suca
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Královské Vinohrady, Prague, Czech Republic
| | - I Grossova
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Královské Vinohrady, Prague, Czech Republic
| | - Z Hribikova
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc., Košice, Slovak Republic
| | - E Sticova
- Department of Pathology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Clinical and Transplant Pathology Department, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - R Zajicek
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Královské Vinohrady, Prague, Czech Republic
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27
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Lachova V, Mitrengova P, Melegova N, Smetana K, Gal P. Genistein Induces Bcl-2 Expression in Human Dermal Microvascular Endothelial Cells: a Short Report. Folia Biol (Praha) 2020; 66:142-147. [PMID: 33745261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
It has been shown previously that oestradiol protects the vascular network, leading to increased skin flap viability associated with Bcl-2, VEGF and FGF-2 up-regulation. We have shown that genistein, a natural selective oestrogen receptor modulator, also increases skin flap viability in rats and induces Bcl-2 expression in human umbilical vein endothelial cells. In the present study we aimed to answer the question whether genistein increases expression of Bcl-2, a potent anti-apoptotic protein, in human dermal microvascular endothelial cells (HMVEC-d) as well. Our results showed that administration of genistein induces Bcl-2 expression in a concentration-dependent manner. Cell co-treatment with genistein and anti-ER compounds (MPP, PHTPP, ICI, G-15) diminished the observed positive effect of genistein on Bcl-2 expression. The decrease in Bcl-2 expression in HMVEC-d was most prominent after co-treatment with ICI (nuclear ER antagonist/ GPR30 agonist) and PHTPP (selective ER-β antagonist). In conclusion, genistein increases Bcl-2 expression in HMVEC-d, contributing to its protective effect on the skin flap viability. However, the question whether the mechanism is ER-specific (via ER-β) has to be answered in further studies using a model of gene silencing or genetically modified cells.
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Affiliation(s)
- V Lachova
- Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic
| | - P Mitrengova
- Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic
| | - N Melegova
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
- Laboratory of Cell Interactions, Center of Clinical and Preclinical Research MediPark, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - K Smetana
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
- BIOCEV, Vestec, Czech Republic
| | - P Gal
- Laboratory of Cell Interactions, Center of Clinical and Preclinical Research MediPark, Pavol Jozef Šafárik University, Košice, Slovak Republic
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc., Košice, Slovak Republic
- Prague Burn Centre, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
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28
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Chelu MG, King JB, Kholmovski EG, Ma J, Gal P, Marashly Q, AlJuaid MA, Kaur G, Silver MA, Johnson KA, Suksaranjit P, Wilson BD, Han FT, Elvan A, Marrouche NF. Atrial Fibrosis by Late Gadolinium Enhancement Magnetic Resonance Imaging and Catheter Ablation of Atrial Fibrillation: 5-Year Follow-Up Data. J Am Heart Assoc 2019; 7:e006313. [PMID: 30511895 PMCID: PMC6405558 DOI: 10.1161/jaha.117.006313] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Late gadolinium enhancement magnetic resonance imaging is an effective tool for assessment of atrial fibrosis. The degree of left atrial fibrosis is a good predictor of atrial fibrillation (AF) ablation success at 1 year, but the association between left atrial fibrosis and long‐term ablation success has not been studied. Methods and Results Late gadolinium enhancement magnetic resonance images of sufficient quality to quantify atrial fibrosis were obtained before the first AF ablation in 308 consecutive patients. Left atrial fibrosis was classified in 4 Utah stages (I, 0–10%; II, 10–20%; III, 20–30%; and IV, >30%). Patients were followed up for up to 5 years until the time of first arrhythmia recurrence or second ablation. A total of 308 patients were included; the mean age was 64.5±12.1 years, and 63.4% were men. During follow‐up, 157 patients experienced an arrhythmia recurrence and 106 patients underwent a repeated ablation. A graded effect was observed in which patients with more advanced atrial fibrosis were more likely to experience recurrent AF (hazard ratio for stage IV versus stage I, 2.73; 95% confidence interval, 1.57–4.75) and undergo a repeated ablation (proportional odds ratio for stage IV versus stage I, 5.19; 95% confidence interval, 2.12–12.69). Conclusions The degree of left atrial fibrosis predicts the success of AF ablation at up to 5 years follow‐up. In patients with advanced atrial fibrosis, AF ablation is associated with a high procedural failure rate.
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Affiliation(s)
- Mihail G Chelu
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,2 Section of Cardiac Electrophysiology Cardiovascular Medicine Division University of Utah School of Medicine Salt Lake City UT
| | - Jordan B King
- 3 Pharmacy Department Kaiser Permanente Colorado Aurora CO.,4 Division of Health Systems Innovation and Research Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT
| | - Eugene G Kholmovski
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,5 Department of Radiology and Imaging Sciences University of Utah Salt Lake City UT
| | - Junjie Ma
- 6 Department of Pharmacotherapy College of Pharmacy University of Utah Salt Lake City UT
| | - Pim Gal
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,7 Department of Cardiology Isala Hospital Zwolle the Netherlands.,8 Centre for Human Drug Research Leiden the Netherlands
| | - Qussay Marashly
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,9 Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Mossab A AlJuaid
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,9 Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Gagandeep Kaur
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT
| | - Michelle A Silver
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT
| | - Kara A Johnson
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT
| | - Promporn Suksaranjit
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,2 Section of Cardiac Electrophysiology Cardiovascular Medicine Division University of Utah School of Medicine Salt Lake City UT
| | - Brent D Wilson
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,2 Section of Cardiac Electrophysiology Cardiovascular Medicine Division University of Utah School of Medicine Salt Lake City UT
| | - Frederick T Han
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,2 Section of Cardiac Electrophysiology Cardiovascular Medicine Division University of Utah School of Medicine Salt Lake City UT
| | - Arif Elvan
- 6 Department of Pharmacotherapy College of Pharmacy University of Utah Salt Lake City UT
| | - Nassir F Marrouche
- 1 Comprehensive Arrhythmia and Research Management Center Division of Cardiology Cardiovascular Medicine Division Salt Lake City UT.,2 Section of Cardiac Electrophysiology Cardiovascular Medicine Division University of Utah School of Medicine Salt Lake City UT
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29
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Hassing GJ, van der Wall HEC, van Westen GJP, Kemme MJB, Adiyaman A, Elvan A, Burggraaf J, Gal P. Blood pressure-related electrocardiographic findings in healthy young individuals. Blood Press 2019; 29:113-122. [PMID: 31711320 DOI: 10.1080/08037051.2019.1673149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Elevated blood pressure induces electrocardiographic changes and is associated with an increase in cardiovascular disease later in life compared to normal blood pressure levels. The purpose of this study was to evaluate the association between normal to high normal blood pressure values (90-139/50-89 mmHg) and electrocardiographic parameters related to cardiac changes in hypertension in healthy young adults.Methods: Data from 1449 volunteers aged 18-30 years collected at our centre were analyzed. Only subjects considered healthy by a physician after review of collected data with systolic blood pressure values between 90 and 139 mmHg and diastolic blood pressure values between 50 and 89 mmHg were included. Subjects were divided into groups with 10 mmHg systolic blood pressure increment between groups for analysis of electrocardiographic differences. Backward multivariate regression analysis with systolic and diastolic blood pressure as a continuous variable was performed.Results: The mean age was 22.7 ± 3.0 years, 73.7% were male. P-wave area, ventricular activation time, QRS-duration, Sokolow-Lyon voltages, Cornell Product, J-point-T-peak duration corrected for heart rate and maximum T-wave duration were significantly different between systolic blood pressure groups. In the multivariate model with gender, body mass index and cholesterol, ventricular rate (standardized coefficient (SC): +0.182, p < .001), ventricular activation time in lead V6 (SC= +0.065, p = .048), Sokolow-Lyon voltage (SC= +0.135, p < .001), and Cornell product (SC= +0.137, p < .001) were independently associated with systolic blood pressure, while ventricular rate (SC= +0.179, p < .001), P-wave area in lead V1 (SC= +0.079, p = .020), and Cornell product (SC= +0.091, p = .006) were independently associated with diastolic blood pressure.Conclusion: Blood pressure-related electrocardiographic changes were observed incrementally in a healthy young population with blood pressure in the normal range. These changes were an increased ventricular rate, increased atrial surface area, ventricular activation time and increased ventricular hypertrophy indices on a standard 12 lead electrocardiogram.
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Affiliation(s)
| | - Hein E C van der Wall
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
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30
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Heuberger JAAC, van Eenoo P, Rotmans JI, Gal P, Stuurman FE, Post TE, Daniels JMA, Ram H, de Hon O, Burggraaf J, Cohen AF. Sensitivity and specificity of detection methods for erythropoietin doping in cyclists. Drug Test Anal 2019; 11:1290-1301. [PMID: 31232530 PMCID: PMC6790592 DOI: 10.1002/dta.2665] [Citation(s) in RCA: 5] [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: 12/03/2018] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 11/12/2022]
Abstract
Recombinant human erythropoietin (rHuEPO) is used as doping a substance. Anti‐doping efforts include urine and blood testing and monitoring the athlete biological passport (ABP). As data on the performance of these methods are incomplete, this study aimed to evaluate the performance of two common urine assays and the ABP. In a randomized, double‐blinded, placebo‐controlled trial, 48 trained cyclists received a mean dose of 6000 IU rHuEPO (epoetin β) or placebo by weekly injection for eight weeks. Seven timed urine and blood samples were collected per subject. Urine samples were analyzed by sarcosyl‐PAGE and isoelectric focusing methods in the accredited DoCoLab in Ghent. A selection of samples, including any with false presumptive findings, underwent a second sarcosyl‐PAGE confirmation analysis. Hematological parameters were used to construct a module similar to the ABP and analyzed by two evaluators from an Athlete Passport Management Unit. Sensitivity of the sarcosyl‐PAGE and isoelectric focusing assays for the detection of erythropoietin abuse were 63.8% and 58.6%, respectively, with a false presumptive finding rate of 4.3% and 6%. None of the false presumptive findings tested positive in the confirmation analysis. Sensitivity was highest between 2 and 6 days after dosing, and dropped rapidly outside this window. Sensitivity of the ABP was 91.3%. Specificity of the urine assays was high; however, the detection window of rHuEPO was narrow, leading to questionable sensitivity. The ABP, integrating longitudinal data, is more sensitive, but there are still subjects that evade detection. Combining these methods might improve performance, but will not resolve all observed shortcomings.
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Affiliation(s)
| | | | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Titiaan E Post
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | - Herman Ram
- Anti-Doping Authority the Netherlands, Capelle aan den IJssel, Netherlands
| | - Olivier de Hon
- Anti-Doping Authority the Netherlands, Capelle aan den IJssel, Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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31
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Hassing GJ, van der Wall HEC, van Westen GJP, Kemme MJB, Adiyaman A, Elvan A, Burggraaf J, Gal P. Body mass index related electrocardiographic findings in healthy young individuals with a normal body mass index. Neth Heart J 2019; 27:506-512. [PMID: 31111455 PMCID: PMC6773792 DOI: 10.1007/s12471-019-1282-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION An increased body mass index (BMI) (>25 kg/m2) is associated with a wide range of electrocardiographic changes. However, the association between electrocardiographic changes and BMI in healthy young individuals with a normal BMI (18.5-25 kg/m2) is unknown. The aim of this study was to evaluate the association between BMI and electrocardiographic parameters. METHODS Data from 1,290 volunteers aged 18 to 30 years collected at our centre were analysed. Only subjects considered healthy by a physician after review of collected data with a normal BMI and in sinus rhythm were included in the analysis. Subjects with a normal BMI (18.5-25 kg/m2) were divided into BMI quartiles analysis and a backward multivariate regression analysis with a normal BMI as a continuous variable was performed. RESULTS Mean age was 22.7 ± 3.0 years, mean BMI was 22.0, and 73.4% were male. There were significant differences between the BMI quartiles in terms of maximum P-wave duration, P-wave balance, total P-wave area in lead V1, PR-interval duration, and heart axis. In the multivariate model maximum P-wave duration (standardised coefficient (SC) = +0.112, P < 0.001), P-wave balance in lead V1 (SC = +0.072, P < 0.001), heart axis (SC = -0.164, P < 0.001), and Sokolow-Lyon voltage (SC = -0.097, P < 0.001) were independently associated with BMI. CONCLUSION Increased BMI was related with discrete electrocardiographic alterations including an increased P-wave duration, increased P-wave balance, a leftward shift of the heart axis, and decreased Sokolow-Lyon voltage on a standard twelve lead electrocardiogram in healthy young individuals with a normal BMI.
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Affiliation(s)
- G J Hassing
- Centre for Human Drug Research, Leiden, The Netherlands
| | - H E C van der Wall
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - G J P van Westen
- Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - M J B Kemme
- Department of Cardiology, VU Medical Center, Amsterdam, The Netherlands
| | - A Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - A Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - P Gal
- Centre for Human Drug Research, Leiden, The Netherlands.
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32
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van der Stuijt W, Gal P, Kemme MJB, Burggraaf J. Effect of short-term fasting on electrocardiographic parameters. Ann Noninvasive Electrocardiol 2019; 24:e12643. [PMID: 30938028 PMCID: PMC6850084 DOI: 10.1111/anec.12643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/10/2019] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION During early drug development trials, electrocardiograms (ECGs) in healthy volunteers who are in a fasting state are evaluated to screen for possible adverse cardiac effects. However, the effect of the duration of fasting on electrocardiographic parameters is largely unknown. We compared the effects of fasting on standard 12-lead electrocardiographic recordings. METHODS Electrocardiograms were available for 432 healthy subjects (mean age 28.5 ± 12.5; 88.9% male) who participated in early drug development studies after 4- and 10-hr fasting. All ECGs were automatically analyzed for conduction intervals and wave amplitudes with the Marquette 12SL algorithm and compared among fasting duration. Mixed model analyses were used to identify confounding variables. RESULTS After 10 hr of fasting, compared to after 4 hr of fasting, mean P-wave duration and amplitude were reduced by 1.95 ± 1.48 ms and 2.18 ± 2.75 μV, mean R wave and S wave amplitude were decreased by 25.83 ± 31.16 μV and 55.39 ± 78.72 μV, mean QRS duration was decreased by 1.84 ± 6.61 ms, and mean T-wave duration and amplitude were decreased by 2.06 ± 0.72 ms and 9.36 ± 17.21 μV (lead II). The mean PR interval was prolonged by 4.26 ± 17.67 ms, the ventricular rate was reduced by 3.64 ± 8.61 min, and QTcF was reduced by 3.87 ± 14.50 ms. These observations persisted after correction for demographics, electrolytes, blood pressure, heart rate variability, and diurnal variation. CONCLUSION The present analysis showed that 10-hr fasting compared to 4-hr fasting resulted in changes to the surface ECG, consisting of a reduced wave amplitude and duration and increased isoelectric interval duration.
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Affiliation(s)
- Willeke van der Stuijt
- Leiden University Medical Centre, Leiden, The Netherlands.,Centre for Human Drug Research, Leiden, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Michiel J B Kemme
- Centre for Human Drug Research, Leiden, The Netherlands.,Cardiology Department, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
| | - Jacobus Burggraaf
- Leiden University Medical Centre, Leiden, The Netherlands.,Centre for Human Drug Research, Leiden, The Netherlands
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33
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Birkhoff WAJ, Heuberger JAAC, Post TE, Gal P, Stuurman FE, Burggraaf J, Cohen AF. Recombinant human erythropoietin does not affect several microvascular parameters in well-trained cyclists. Physiol Rep 2018; 6:e13924. [PMID: 30592183 PMCID: PMC6308108 DOI: 10.14814/phy2.13924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 12/23/2022] Open
Abstract
Recombinant human erythropoietin (rHuEPO) has been used as a performance-enhancing agent by athletes in a variety of sports. The resulting increase in hematocrit levels leads to increased blood viscosity and can affect blood flow, potentially increasing the athlete's risk of developing health complications. However, the actual effects of using rHuEPO on microvascular blood flow and post-occlusive reactive hyperemia are currently unknown. We therefore evaluated the effect of rHuEPO on the cutaneous microcirculation in well-trained cyclists using laser speckle contrast imaging (LSCI). This study was part of a randomized, double-blind, placebo-controlled, parallel trial designed to investigate the effects of rHuEPO in 47 well-trained adult cyclists (age 18-50 years). Subjects received a weekly dose of either rHuEPO or placebo for 8 weeks, and LSCI was performed at baseline, after a maximal exercise test in week 6, and before maximal exercise in week 8. Endpoints included basal blood flux, maximum post-occlusion reperfusion, and time to return to baseline. Despite an increase in hematocrit levels in the rHuEPO-treated group, we found no statistically significant difference in microvascular function measured between the rHuEPO-treated group and the placebo group. Our results suggest that the increased hematocrit levels in rHuEPO-treated well-trained cyclists are not associated with changes in microvascular blood flow or post-occlusive reactive hyperemia measured using LSCI.
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Affiliation(s)
- Willem A. J. Birkhoff
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden University Medical CenterLeidenThe Netherlands
| | | | - Titiaan E. Post
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden Academic Centre for Drug ResearchLeidenThe Netherlands
| | - Pim Gal
- Centre for Human Drug ResearchLeidenThe Netherlands
| | | | - Jacobus Burggraaf
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden Academic Centre for Drug ResearchLeidenThe Netherlands
| | - Adam F. Cohen
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden University Medical CenterLeidenThe Netherlands
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van Fenema EM, Gal P, van de Griend MV, Jacobs GE, Cohen AF. A Pilot Study Evaluating the Physiological Parameters of Performance-Induced Stress in Undergraduate Music Students. Digit Biomark 2018; 1:118-125. [PMID: 32095753 DOI: 10.1159/000485469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/17/2017] [Indexed: 11/19/2022] Open
Abstract
Music performance anxiety (MPA) is a specific condition for musicians. Although it can have a negative influence on their music careers, little attention is paid to this phenomenon both in the professional environment and in stress research. In the current pilot study, insight was gained into the physiology of the autonomic stress response related to anxiety in musicians when performing on stage by using a wearable biosensor patch for registration of a range of physiological parameters. Also, the validity of two different psychometric questionnaires in objectifying the stress response on stage to predict the individual stress response was explored. The autonomic physiological parameters (heart rate, respiratory rate, skin temperature) of 11 violists and violinists were collected while performing on stage and in resting state using the VitalConnect HealthPatch®. In addition, scores on validated questionnaires in research on MPA (State Anxiety Inventory, Kenny Music Performance Anxiety Inventory, Short Form Health Survey) were collected in order to try to objectify the magnitude of the subjective level of both MPA and experienced stress. The registration of the autonomic parameters showed a significant increase in heart rate, respiratory rate, and stress level from resting state measurements during stage performance. Analysis of heart rate variability showed a shift from indices of parasympathetic nervous system activity during baseline measurements towards indices of sympathetic nervous system activity during stress measurements. Surprisingly, none of the questionnaires was correlated to the physiological stress parameters on stage. In conclusion, the wearable biosensor patch proved to be an adequate tool to assess physiological stress parameters on stage. The different questionnaires did not contribute to the prediction of its occurrence in a group of musicians.
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Affiliation(s)
- Esther M van Fenema
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Maxime V van de Griend
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Centre for Human Drug Research, Leiden, The Netherlands
| | - Gabriel E Jacobs
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Centre for Human Drug Research, Leiden, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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35
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Heuberger JAAC, Rotmans JI, Gal P, Stuurman FE, Daniels JMA, de Kam ML, Cohen AF. Erythropoietin on cycling performance - Authors' reply. Lancet Haematol 2017; 4:e462-e464. [PMID: 28962681 DOI: 10.1016/s2352-3026(17)30181-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | | | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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36
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Heuberger JAAC, Rotmans JI, Gal P, Stuurman FE, van 't Westende J, Post TE, Daniels JMA, Moerland M, van Veldhoven PLJ, de Kam ML, Ram H, de Hon O, Posthuma JJ, Burggraaf J, Cohen AF. Effects of erythropoietin on cycling performance of well trained cyclists: a double-blind, randomised, placebo-controlled trial. Lancet Haematol 2017; 4:e374-e386. [PMID: 28669689 DOI: 10.1016/s2352-3026(17)30105-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Substances that potentially enhance performance (eg, recombinant human erythropoietin [rHuEPO]) are considered doping and are therefore forbidden in sports; however, the scientific evidence behind doping is frequently weak. We aimed to determine the effects of rHuEPO treatment in well trained cyclists on maximal, submaximal, and race performance and on safety, and to present a model clinical study for doping research on other substances. METHODS We did this double-blind, randomised, placebo-controlled trial at the Centre for Human Drug Research in Leiden (Netherlands). We enrolled healthy, well trained but non-professional male cyclists aged 18-50 years and randomly allocated (1:1) them to receive abdominal subcutaneous injections of rHuEPO (epoetin β; mean dose 6000 IU per week) or placebo (0·9% NaCl) for 8 weeks. Randomisation was stratified by age groups (18-34 years and 35-50 years), with a code generated by a statistician who was not masked to the study. The primary outcome was exercise performance, measured as maximal power output (Pmax), maximal oxygen consumption VO2 max, and gross efficiency in maximal exercise tests with 25 W increments per 5 min, as lactate threshold and ventilatory threshold 1 (VT1) and 2 (VT2) at submaximal levels during the maximal exercise test, and as mean power, VO2, and heart rate in the submaximal exercise tests at the highest mean power output for 45 min in a laboratory setting and in a race to the Mont Ventoux (France) summit, using intention-to-treat analyses. The trial is registered with the Dutch Trial Registry (Nederlands Trial Register), number NTR5643. FINDINGS Between March 7, 2016, and April 13, 2016, we randomly assigned 48 participants to the rHuEPO group (n=24) or the placebo group (n=24). Mean haemoglobin concentration (9·6 mmol/L vs 9·0 mmol/L [estimated difference 0·6, 95% CI 0·4 to 0·8]) and maximal power output (351·55 W vs 341·23 W [10·32, 3·47 to 17·17]), and VO2 max (60·121 mL/min per kg vs 57·415 mL/min per kg [2·707, 0·911 to 4·503]) in a maximal exercise test were higher in the rHuEPO group compared with the placebo group. Submaximal exercise test parameters mean power output (283·18 W vs 277·28 W [5·90, -0·87 to 12·67]) and VO2 (50·288 mL/min per kg vs 49·642 mL/min per kg [0·646, -1·307 to 2·600]) at day 46, and Mont Ventoux race times (1 h 40 min 32 s vs 1 h 40 min 15 s [0·3%, -8·3 to 9·6]) did not differ between groups. All adverse events were grade 1-2 and were similar between both groups. No events of grade 3 or worse were observed. INTERPRETATION Although rHuEPO treatment improved a laboratory test of maximal exercise, the more clinically relevant submaximal exercise test performance and road race performance were not affected. This study shows that clinical studies with doping substances can be done adequately and safely and are relevant in determining effects of alleged performance-enhancing drugs. FUNDING Centre for Human Drug Research, Leiden.
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Affiliation(s)
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Juliëtte van 't Westende
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Titiaan E Post
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | | | | | | | - Herman Ram
- Anti-Doping Authority of the Netherlands, Capelle aan de IJssel, Netherlands
| | - Olivier de Hon
- Anti-Doping Authority of the Netherlands, Capelle aan de IJssel, Netherlands
| | - Jelle J Posthuma
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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37
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Chlibek R, Smetana J, Sosovickova R, Fabianova K, Zavadilova J, Dite P, Gal P, Naplava P, Lzicarova D. Seroepidemiology of whooping cough in the Czech Republic: estimates of incidence of infection in adults. Public Health 2017. [PMID: 28646697 DOI: 10.1016/j.puhe.2017.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/19/2022]
Abstract
OBJECTIVES Despite widespread vaccination programmes, pertussis remains a significant health burden in many countries. Low awareness of the disease, the high rate of asymptomatic cases in adults and difficulties with diagnosis could explain the under-reporting of pertussis. The lack of data on actual incidence constitutes an obstacle for public health authorities for the implementation of a vaccination strategy against pertussis in adults. The aim of this study was to evaluate the seroprevalence of antibodies against Bordetella pertussis infection in adults and to estimate the actual incidence of the disease compared with the reported incidence. STUDY DESIGN Prospective, multicentre seroprevalence study. METHODS The study was conducted in 2000 adult subjects aged ≥18 years who had not received pertussis vaccination within the last 5 years. All enrolled subjects provided a blood sample for serum testing of IgG antibodies against pertussis toxin, performed by enzyme-linked immunosorbent assay, to indicate if they had an acute infection or if they had been infected with pertussis within the last 12 months or earlier. Results were validated in accordance with the guidelines of the European Sero-epidemiology Network 2 and were expressed in ESEN units/ml. RESULTS A positive concentration of anti-pertussis toxin antibodies, indicating previous pertussis infection, was demonstrated in 39.9% (n = 799) of all study subjects, and 0.40% (n = 8) of subjects had a concentration suggestive of a recent infection (within the last 12 months). The highest antibody seroprevalence was observed in subjects aged 18-29 years (1.46%). No cases of acute infection were detected. CONCLUSIONS During the study period, the reported incidence of pertussis in the adult population was 0.84/100,000 inhabitants. Based on the seroprevalence results from this study, it is estimated that the actual incidence of pertussis could be as much as 699/100,000 inhabitants. The actual incidence of pertussis in adults in the Czech Republic could therefore be at least 200-fold higher than the reported incidence. These findings support the need for pertussis vaccination in the adult population.
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Affiliation(s)
- R Chlibek
- Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic.
| | - J Smetana
- Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - R Sosovickova
- Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - K Fabianova
- Centre for Epidemiology and Microbiology, National Health Institute, Prague, Czech Republic
| | - J Zavadilova
- National Reference Laboratory for Pertussis and Diphtheria, National Health Institute, Prague, Czech Republic
| | - P Dite
- Military Health Institute, Prague, Czech Republic
| | - P Gal
- Military Health Institute, Prague, Czech Republic
| | - P Naplava
- Military Health Institute, Prague, Czech Republic
| | - D Lzicarova
- National Reference Laboratory for Pertussis and Diphtheria, National Health Institute, Prague, Czech Republic
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38
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Chelu MG, King JB, Kholmovski EG, Ma J, Gal P, Kaur G, Silver MA, Johnson KA, Suksaranjit P, Wilson BD, Han FT, Arif E, Marrouche NF. 1364LGE-MRI atrial fibrosis predicts 5 year outcome of atrial fibrillation ablation. Europace 2017. [DOI: 10.1093/ehjci/eux157.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Gal P, Buist TJ, Smit JJJ, Adiyaman A, Ramdat Misier AR, Delnoy PPHM, Elvan A. Effective contact and outcome after pulmonary vein isolation in novel circular multi-electrode atrial fibrillation ablation. Neth Heart J 2016; 25:16-23. [PMID: 27752967 PMCID: PMC5179364 DOI: 10.1007/s12471-016-0907-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 12/01/2022] Open
Abstract
Introduction Pulmonary vein (PV) reconnection is frequently the cause of recurrence of atrial fibrillation (AF) after ablation. The second-generation gold multi-electrode ablation (Gold-MEA) catheter has a new design possibly resulting in improved lesion formation compared with its predecessor. We aimed to determine the association between effective radiofrequency applications with the Gold-MEA catheter and outcome after AF ablation. Methods 50 consecutive patients with paroxysmal AF underwent Gold-MEA (PVAC GOLDTM, Medtronic Inc.) ablation. The Gold-MEA catheter was navigated to the PV ostium by fluoroscopy. Duty-cycled radiofrequency ablations were performed at all PV ostia. Lesions were considered transmural when electrode temperature was >50 °C and power >3 W for >30 seconds. After the ablation procedure, patients visited the outpatient clinic at 3‑month intervals including 24-hour Holter ECGs. Results Mean age was 56 years. All PVs were acutely isolated with the Gold-MEA catheter. Procedure time was 111 ± 22 minutes, ablation time was 24 ± 6.7 minutes and fluoroscopy time was 20 ± 8.1 minutes. No procedure-related complications were observed. One year after ablation, 60 % of patients were still free of arrhythmia recurrences after a single PV isolation attempt. The number of transmural lesions was associated with arrhythmia-free survival: 25.0 % in <72 transmural lesions, 64.3 % in 72–108 transmural lesions and 71.4 % in >108 transmural lesions (p = 0.029). Conclusion PV isolation can be performed successfully with the Gold-MEA catheter, with a favourable safety profile. Transmurality of lesions was associated with ablation success and may improve AF ablation success.
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Affiliation(s)
- P Gal
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | - T J Buist
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | - J J J Smit
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | - A Adiyaman
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | | | - P P H M Delnoy
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | - A Elvan
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
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40
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de Jong MR, Adiyaman A, Gal P, Smit JJJ, Delnoy PPH, Heeg JE, van Hasselt BA, Lau EO, Persu A, Staessen JA, Ramdat Misier AR, Steinberg JS, Elvan A. Renal Nerve Stimulation–Induced Blood Pressure Changes Predict Ambulatory Blood Pressure Response After Renal Denervation. Hypertension 2016; 68:707-14. [DOI: 10.1161/hypertensionaha.116.07492] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/19/2016] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) response to renal denervation (RDN) is highly variable and its effectiveness debated. A procedural end point for RDN may improve consistency of response. The objective of the current analysis was to look for the association between renal nerve stimulation (RNS)–induced BP increase before and after RDN and changes in ambulatory BP monitoring (ABPM) after RDN. Fourteen patients with drug-resistant hypertension referred for RDN were included. RNS was performed under general anesthesia at 4 sites in the right and left renal arteries, both before and immediately after RDN. RNS-induced BP changes were monitored and correlated to changes in ambulatory BP at a follow-up of 3 to 6 months after RDN. RNS resulted in a systolic BP increase of 50±27 mm Hg before RDN and systolic BP increase of 13±16 mm Hg after RDN (
P
<0.001). Average systolic ABPM was 153±11 mm Hg before RDN and decreased to 137±10 mm Hg at 3- to 6-month follow-up (
P
=0.003). Changes in RNS-induced BP increase before versus immediately after RDN and changes in ABPM before versus 3 to 6 months after RDN were correlated, both for systolic BP (
R
=0.77,
P
=0.001) and diastolic BP (
R
=0.79,
P
=0.001). RNS-induced maximum BP increase before RDN had a correlation of
R
=0.61 (
P
=0.020) for systolic and
R
=0.71 (
P
=0.004) for diastolic ABPM changes. RNS-induced BP changes before versus after RDN were correlated with changes in 24-hour ABPM 3 to 6 months after RDN. RNS should be tested as an acute end point to assess the efficacy of RDN and predict BP response to RDN.
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Affiliation(s)
- Mark R. de Jong
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Ahmet Adiyaman
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Pim Gal
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jaap Jan J. Smit
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Peter Paul H.M. Delnoy
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jan-Evert Heeg
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Boudewijn A.A.M. van Hasselt
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Elizabeth O.Y. Lau
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Alexandre Persu
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jan A. Staessen
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Anand R. Ramdat Misier
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jonathan S. Steinberg
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Arif Elvan
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
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de Jong MR, Hoogerwaard AF, Gal P, Adiyaman A, Smit JJJ, Delnoy PPH, Ramdat Misier AR, van Hasselt BA, Heeg JE, le Polain de Waroux JB, Lau EO, Staessen JA, Persu A, Elvan A. Persistent Increase in Blood Pressure After Renal Nerve Stimulation in Accessory Renal Arteries After Sympathetic Renal Denervation. Hypertension 2016; 67:1211-7. [DOI: 10.1161/hypertensionaha.115.06604] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/22/2016] [Indexed: 12/17/2022]
Abstract
Blood pressure response to renal denervation is highly variable, and the proportion of responders is disappointing. This may be partly because of accessory renal arteries too small for denervation, causing incomplete ablation. Renal nerve stimulation before and after renal denervation is a promising approach to assess completeness of renal denervation and may predict blood pressure response to renal denervation. The objective of the current study was to assess renal nerve stimulation–induced blood pressure increase before and after renal sympathetic denervation in main and accessory renal arteries of anaesthetized patients with drug-resistant hypertension. The study included 21 patients. Nine patients had at least 1 accessory renal artery in which renal denervation was not feasible. Renal nerve stimulation was performed in the main arteries of all patients and in accessory renal arteries of 6 of 9 patients with accessory arteries, both before and after renal sympathetic denervation. Renal nerve stimulation before renal denervation elicited a substantial increase in systolic blood pressure, both in main (25.6±2.9 mm Hg;
P
<0.001) and accessory (24.3±7.4 mm Hg;
P
=0.047) renal arteries. After renal denervation, renal nerve stimulation–induced systolic blood pressure increase was blunted in the main renal arteries (Δ systolic blood pressure, 8.6±3.7 mm Hg;
P
=0.020), but not in the nondenervated renal accessory renal arteries (Δ systolic blood pressure, 27.1±7.6 mm Hg;
P
=0.917). This residual source of renal sympathetic tone may result in persistent hypertension after ablation and partly account for the large response variability.
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Affiliation(s)
- Mark R. de Jong
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Annemiek F. Hoogerwaard
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Pim Gal
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Ahmet Adiyaman
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Jaap Jan J. Smit
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Peter Paul H.M. Delnoy
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Anand R. Ramdat Misier
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Boudewijn A.A.M. van Hasselt
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Jan-Evert Heeg
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Jean-Benoit le Polain de Waroux
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Elizabeth O.Y. Lau
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Jan A. Staessen
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Alexandre Persu
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Arif Elvan
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
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Buist TJ, Gal P, Ottervanger JP, Smit JJJ, Ramdat Misier AR, Delnoy PPHM, Adiyaman A, Jager PL, Elvan A. Association between pulmonary vein orientation and ablation outcome in patients undergoing multi-electrode ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2016; 10:251-7. [DOI: 10.1016/j.jcct.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 12/07/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Elvan A, de Jong M, Hoogerwaard A, Gal P, Adiyaman A, Jan Smit J, Delnoy P, Ramdat Misier A, van Hasselt B, Heeg JE, de Waroux JBP, Lau E, Staessen J, Persu A. PERSISTENT INCREASE IN BLOOD PRESSURE FOLLOWING RENAL NERVE STIMULATION IN ACCESSORY RENAL ARTERIES AFTER SYMPATHETIC RENAL DENERVATION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Elvan A, de Jong M, Adiyaman A, Gal P, Smit JJ, Delnoy P, Heeg JE, van Hasselt B, Lau E, Persu A, Staessen J, Misier AR, Steinberg J. RENAL NERVE STIMULATION INDUCED BLOOD PRESSURE CHANGES ARE STRONGLY CORRELATED WITH RENAL DENERVATION INDUCED CHANGES IN 24-HOUR BLOOD PRESSURE DURING FOLLOW-UP. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Carrizo A, Lamelas P, Echeverri NP, Gal P, Elvan A, Morillo C. PHASED ARRAY PULMONARY VEIN ISOLATION VS RADIOFREQUENCY CATHETER ABLATION FOR ATRIAL FIBRILLATION: A NON-INFERIORITY SYSTEMATIC REVIEW AND META-ANALYSIS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gal P, Marrouche NF. Magnetic resonance imaging of atrial fibrosis: redefining atrial fibrillation to a syndrome. Eur Heart J 2015; 38:14-19. [DOI: 10.1093/eurheartj/ehv514] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/21/2015] [Accepted: 09/07/2015] [Indexed: 11/14/2022] Open
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Gal P, Smit JJJ, Adiyaman A, Ramdat Misier AR, Delnoy PPH, Elvan A. A new circular mapping-guided approach for endoscopic laser balloon pulmonary vein isolation. IJC Heart & Vasculature 2015; 8:68-72. [PMID: 28785682 PMCID: PMC5497291 DOI: 10.1016/j.ijcha.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/15/2015] [Accepted: 05/17/2015] [Indexed: 11/03/2022]
Abstract
Background Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is performed with the endoscopically assisted laser balloon ablation system (EAS). We hypothesized that placement of a circular mapping catheter (CMC) in the pulmonary vein (PV) distal to the laser balloon during ablation is feasible and safe. Methods Out of 58 included patients, 37 underwent mapping-guided EAS PVI, with the CMC inside the PV during laser ablation, and 21 patients underwent standard EAS PVI, with the CMC outside the PV during laser ablation. Results Mean age was 56 years and 81% had paroxysmal AF. In the mapping-guided ablation group, 91% of PVs were isolated with the CMC in the PV during EAS ablation, isolation was completed in 9% of PVs after the CMC was removed from the PV. After passing a learning curve in 18 patients, a significant drop in unsuccessfully isolated PVs was observed in the mapping guided EAS PVI group (15% to 4%, P = 0.020). No major complications were seen in the mapping-guided EAS PVI group. However, in the standard EAS PVI group, laser ablation was complicated by a temporary phrenic nerve palsy in 1 patient. After a median follow-up of 16.7 months, there was no statistical difference in AF free survival among treatment groups (mapping-guided: 56% vs. 52%, P = 0.875). Conclusion Mapping guided EAS PVI with a distal CMC in the PV during laser ablation is feasible and seems safe as the standard EAS PVI approach.
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Gal P, Parlak E, Demirel F, Adiyaman A, Ten Berg J, van 't Hof AWJ, Elvan A. Prognostic significance of incident atrial fibrillation following STEMI depends on the timing of atrial fibrillation. Neth Heart J 2015; 23:430-5. [PMID: 26021618 PMCID: PMC4547948 DOI: 10.1007/s12471-015-0709-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Indexed: 01/02/2023] Open
Abstract
Atrial fibrillation (AF) is associated with short-term mortality after ST-elevation myocardial infarction (STEMI), but there is limited data on the temporal association between AF and mortality after STEMI. A total of 830 patients were included (age: 62 ± 12 years, 76 % male). Patients with new-onset AF < 30 days after STEMI were divided among three subgroups: AF on the day of admission, AF 24–72 h and AF > 72 h after admission. Thirty-day mortality was assessed by telephone and via the municipal population registry. Twenty patients died < 30 days after admission. In 41 patients, AF was detected on the day of admission, in 14 patients 24–72 h after admission and in 18 patients > 72 h after admission. Mortality was higher in patients with AF on the day of admission (7.3 vs 2.2 %, p = 0.036) and 24–72 h after admission (14.3 vs 1.4 %, p < 0.001), but not in patients with AF > 72 h after admission (0 vs 1.1 %, p > 0.999). Age (odds ratio (OR) 1.123, p < 0.001), Killip class (adjusted OR 8.341, p < 0.001), AF on the day of admission (OR 3.585, p = 0.049) and 24–72 h after admission (OR 11.515, p = 0.003) were, amongst other variables, associated with an increased 30-day mortality. In conclusion, only new-onset incident AF during the first 72 h after admission was associated with 30-day mortality in STEMI patients.
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Affiliation(s)
- P Gal
- Cardiology Departments, Isala, Zwolle, The Netherlands
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Gal P, Elvan A. Reply to the letter from Kumar et al.: Maastricht experience with the second-generation endoscopic laser balloon ablation system for the atrial fibrillation. Neth Heart J 2015; 23:379-80. [PMID: 26135226 PMCID: PMC4497983 DOI: 10.1007/s12471-015-0726-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- P. Gal
- Cardiology Department of the Isala, Isala Klinieken, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - A. Elvan
- Cardiology Department of the Isala, Isala Klinieken, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
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Benedict A, Ishak J, Gal P, Proskorovsky I, Cappelleri J, Everiss T, Jones H, Hughes R, Jenkins A. THU0207 Comparative Analysis of the Effectiveness of anti-TNF Therapies in Non-Radiographic Axial Spondyloarthritis Using Novel Statistical Techniques: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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