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Toft A, Sjödin S, Simonsen AH, Ejlerskov P, Roos P, Musaeus CS, Henriksen EE, Nielsen TT, Brinkmalm A, Blennow K, Zetterberg H, Nielsen JE. Endo-lysosomal protein concentrations in CSF from patients with frontotemporal dementia caused by CHMP2B mutation. Alzheimers Dement (Amst) 2023; 15:e12402. [PMID: 36815874 PMCID: PMC9936136 DOI: 10.1002/dad2.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 02/19/2023]
Abstract
Introduction Increasing evidence implicates proteostatic dysfunction as an early event in the development of frontotemporal dementia (FTD). This study aimed to explore potential cerebrospinal fluid (CSF) biomarkers associated with the proteolytic systems in genetic FTD caused by CHMP2B mutation. Methods Combining solid-phase extraction and parallel reaction monitoring mass spectrometry, a panel of 47 peptides derived from 20 proteins was analyzed in CSF from 31 members of the Danish CHMP2B-FTD family. Results Compared with family controls, mutation carriers had significantly higher levels of complement C9, lysozyme and transcobalamin II, and lower levels of ubiquitin, cathepsin B, and amyloid precursor protein. Discussion Lower CSF ubiquitin concentrations in CHMP2B mutation carriers indicate that ubiquitin levels relate to the specific disease pathology, rather than all-cause neurodegeneration. Increased lysozyme and complement proteins may indicate innate immune activation. Altered levels of amyloid precursor protein and cathepsins have previously been associated with impaired lysosomal proteolysis in FTD. Highlights CSF markers of proteostasis were explored in CHMP2B-mediated frontotemporal dementia (FTD).31 members of the Danish CHMP2B-FTD family were included.We used solid-phase extraction and parallel reaction monitoring mass spectrometry.Six protein levels were significantly altered in CHMP2B-FTD compared with controls.Lower CSF ubiquitin levels in patients suggest association with disease mechanisms.
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Affiliation(s)
- Anders Toft
- Neurogenetics Clinic & Research LabDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Simon Sjödin
- Laboratory of Clinical ChemistrySahlgrenska University HospitalGothenburgSweden
| | - Anja Hviid Simonsen
- Neurogenetics Clinic & Research LabDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Patrick Ejlerskov
- Neurogenetics Clinic & Research LabDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Peter Roos
- Neurogenetics Clinic & Research LabDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Christian Sandøe Musaeus
- Neurogenetics Clinic & Research LabDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Emil Elbæk Henriksen
- Neurogenetics Clinic & Research LabDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Troels Tolstrup Nielsen
- Neurogenetics Clinic & Research LabDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Ann Brinkmalm
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Kaj Blennow
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden,Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiologythe Sahlgrenska Academy at the University of GothenburgMölndalSweden
| | - Henrik Zetterberg
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden,Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiologythe Sahlgrenska Academy at the University of GothenburgMölndalSweden,Department of Neurodegenerative DiseaseUCL Institute of NeurologyQueen SquareLondonUK,UK Dementia Research Institute at UCLLondonUK,Hong Kong Center for Neurodegenerative DiseasesClear Water BayHong KongChina
| | - Jørgen Erik Nielsen
- Neurogenetics Clinic & Research LabDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
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2
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Haukedal H, Corsi GI, Gadekar VP, Doncheva NT, Kedia S, de Haan N, Chandrasekaran A, Jensen P, Schiønning P, Vallin S, Marlet FR, Poon A, Pires C, Agha FK, Wandall HH, Cirera S, Simonsen AH, Nielsen TT, Nielsen JE, Hyttel P, Muddashetty R, Aldana BI, Gorodkin J, Nair D, Meyer M, Larsen MR, Freude K. Golgi fragmentation - One of the earliest organelle phenotypes in Alzheimer's disease neurons. Front Neurosci 2023; 17:1120086. [PMID: 36875643 PMCID: PMC9978754 DOI: 10.3389/fnins.2023.1120086] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Alzheimer's disease (AD) is the most common cause of dementia, with no current cure. Consequently, alternative approaches focusing on early pathological events in specific neuronal populations, besides targeting the well-studied amyloid beta (Aβ) accumulations and Tau tangles, are needed. In this study, we have investigated disease phenotypes specific to glutamatergic forebrain neurons and mapped the timeline of their occurrence, by implementing familial and sporadic human induced pluripotent stem cell models as well as the 5xFAD mouse model. We recapitulated characteristic late AD phenotypes, such as increased Aβ secretion and Tau hyperphosphorylation, as well as previously well documented mitochondrial and synaptic deficits. Intriguingly, we identified Golgi fragmentation as one of the earliest AD phenotypes, indicating potential impairments in protein processing and post-translational modifications. Computational analysis of RNA sequencing data revealed differentially expressed genes involved in glycosylation and glycan patterns, whilst total glycan profiling revealed minor glycosylation differences. This indicates general robustness of glycosylation besides the observed fragmented morphology. Importantly, we identified that genetic variants in Sortilin-related receptor 1 (SORL1) associated with AD could aggravate the Golgi fragmentation and subsequent glycosylation changes. In summary, we identified Golgi fragmentation as one of the earliest disease phenotypes in AD neurons in various in vivo and in vitro complementary disease models, which can be exacerbated via additional risk variants in SORL1.
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Affiliation(s)
- Henriette Haukedal
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Giulia I Corsi
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.,Center for Non-coding RNA in Technology and Health, University of Copenhagen, Frederiksberg, Denmark
| | - Veerendra P Gadekar
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.,Center for Non-coding RNA in Technology and Health, University of Copenhagen, Frederiksberg, Denmark
| | - Nadezhda T Doncheva
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.,Center for Non-coding RNA in Technology and Health, University of Copenhagen, Frederiksberg, Denmark.,Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Shekhar Kedia
- Centre for Neuroscience, Indian Institute of Science, Bengaluru, India
| | - Noortje de Haan
- Copenhagen Center for Glycomics, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Abinaya Chandrasekaran
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Pia Jensen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Pernille Schiønning
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Sarah Vallin
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Frederik Ravnkilde Marlet
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anna Poon
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Carlota Pires
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Fawzi Khoder Agha
- Copenhagen Center for Glycomics, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans H Wandall
- Copenhagen Center for Glycomics, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanna Cirera
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Anja Hviid Simonsen
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Troels Tolstrup Nielsen
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Erik Nielsen
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Poul Hyttel
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Ravi Muddashetty
- Institute for Stem Cell Science and Regenerative Medicine, Bengaluru, India
| | - Blanca I Aldana
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Gorodkin
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.,Center for Non-coding RNA in Technology and Health, University of Copenhagen, Frederiksberg, Denmark
| | - Deepak Nair
- Centre for Neuroscience, Indian Institute of Science, Bengaluru, India
| | - Morten Meyer
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Martin Røssel Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Kristine Freude
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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Chandrasekaran A, Dittlau KS, Corsi GI, Haukedal H, Doncheva NT, Ramakrishna S, Ambardar S, Salcedo C, Schmidt SI, Zhang Y, Cirera S, Pihl M, Schmid B, Nielsen TT, Nielsen JE, Kolko M, Kobolák J, Dinnyés A, Hyttel P, Palakodeti D, Gorodkin J, Muddashetty RS, Meyer M, Aldana BI, Freude KK. Astrocytic reactivity triggered by defective autophagy and metabolic failure causes neurotoxicity in frontotemporal dementia type 3. Stem Cell Reports 2021; 16:2736-2751. [PMID: 34678206 PMCID: PMC8581052 DOI: 10.1016/j.stemcr.2021.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 03/30/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022] Open
Abstract
Frontotemporal dementia type 3 (FTD3), caused by a point mutation in the charged multivesicular body protein 2B (CHMP2B), affects mitochondrial ultrastructure and the endolysosomal pathway in neurons. To dissect the astrocyte-specific impact of mutant CHMP2B expression, we generated astrocytes from human induced pluripotent stem cells (hiPSCs) and confirmed our findings in CHMP2B mutant mice. Our data provide mechanistic insights into how defective autophagy causes perturbed mitochondrial dynamics with impaired glycolysis, increased reactive oxygen species, and elongated mitochondrial morphology, indicating increased mitochondrial fusion in FTD3 astrocytes. This shift in astrocyte homeostasis triggers a reactive astrocyte phenotype and increased release of toxic cytokines, which accumulate in nuclear factor kappa b (NF-κB) pathway activation with increased production of CHF, LCN2, and C3 causing neurodegeneration. FTD3 iPSC-derived astrocytes display impaired autophagy Impaired autophagy affects mitochondria turnover, glucose hypometabolism and TCA cycle FTD3 astrocytes contribute to reactive gliosis by increased C3, LCN2, IL6, and IL8 Reactive astrocyte phenotypes are present in both in vitro and in vivo models
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Affiliation(s)
- Abinaya Chandrasekaran
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark
| | - Katarina Stoklund Dittlau
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark
| | - Giulia I Corsi
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark; Center for Non-coding RNA in Technology and Health, University of Copenhagen, Frederiksberg 1871, Denmark
| | - Henriette Haukedal
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark
| | - Nadezhda T Doncheva
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark; Center for Non-coding RNA in Technology and Health, University of Copenhagen, Frederiksberg 1871, Denmark; Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen 2200, Denmark
| | - Sarayu Ramakrishna
- Institute for Stem Cell Science and Regenerative Medicine, Bangalore 560065, India; The University of Trans-Disciplinary Health Sciences and Technology, Bangalore 560064, India
| | - Sheetal Ambardar
- Institute for Stem Cell Science and Regenerative Medicine, Bangalore 560065, India; National Center for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Claudia Salcedo
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark
| | - Sissel I Schmidt
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Yu Zhang
- Department of Experimental Medical Science, Wallenberg Center for Molecular Medicine and Lund Stem Cell Center, Lund University, Lund 22184, Sweden
| | - Susanna Cirera
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark
| | - Maria Pihl
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark
| | | | - Troels Tolstrup Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Jørgen E Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
| | | | | | - Poul Hyttel
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark
| | - Dasaradhi Palakodeti
- Institute for Stem Cell Science and Regenerative Medicine, Bangalore 560065, India
| | - Jan Gorodkin
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark; Center for Non-coding RNA in Technology and Health, University of Copenhagen, Frederiksberg 1871, Denmark
| | - Ravi S Muddashetty
- Institute for Stem Cell Science and Regenerative Medicine, Bangalore 560065, India
| | - Morten Meyer
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; Department of Neurology, Odense University Hospital, 5000 Odense, Denmark
| | - Blanca I Aldana
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark
| | - Kristine K Freude
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg 1870, Denmark.
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4
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Toft A, Roos P, Jääskeläinen O, Musaeus CS, Henriksen EE, Johannsen P, Nielsen TT, Herukka SK, Hviid Simonsen A, Nielsen JE. Serum Neurofilament Light in Patients with Frontotemporal Dementia Caused by CHMP2B Mutation. Dement Geriatr Cogn Disord 2021; 49:533-538. [PMID: 33626531 DOI: 10.1159/000513877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/09/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The potential of neurofilament light (NfL) as a blood-based biomarker is currently being investigated in autosomal dominant neurodegenerative disease. This study explores the clinical utility of serum-NfL in frontotemporal dementia due to CHMP2B mutation (FTD-3). METHODS This cross-sectional study included serum and CSF data from 38 members of the Danish FTD-3 family: 12 affected CHMP2B mutation carriers, 10 presymptomatic carriers, and 16 noncarriers. Serum-NfL levels measured by single-molecule array (Simoa) technology were tested for associations with the clinical groups and clinical parameters. Serum and CSF data were compared, and CSF/serum-albumin ratio was included as a measure of blood-brain barrier (BBB) function. RESULTS Serum-NfL concentrations were significantly increased in symptomatic CHMP2B mutation carriers compared to presymptomatic carriers and in both groups compared to healthy family controls. Serum-NfL levels appear to increase progressively with age in presymptomatic carriers, and this is perhaps followed by a change in trajectory when patients become symptomatic. Measurements of NfL in serum and CSF were highly correlated and fold-changes in serum and CSF between clinical groups were similar. Increase in serum-NFL levels was correlated with reduced ACE-score. Higher CSF/serum-albumin ratios were demonstrated in FTD-3 patients, but this did not affect the significant associations between serum-NfL and clinical groups. CONCLUSION Serum-NfL could be utilized as an accurate surrogate marker of CSF levels to segregate symptomatic CHMP2B carriers, presymptomatic carriers, and non-carriers. The observed indication of BBB dysfunction in FTD-3 patients did not confound this use of serum-NfL. The results support the occurrence of mutation-related differences in NfL dynamics in familial FTD.
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Affiliation(s)
- Anders Toft
- Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, Copenhagen, Denmark,
| | - Peter Roos
- Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, Copenhagen, Denmark
| | - Olli Jääskeläinen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Ritva, Finland
| | | | - Emil Elbæk Henriksen
- Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, Copenhagen, Denmark
| | | | | | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Ritva, Finland
| | - Anja Hviid Simonsen
- Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, Copenhagen, Denmark
| | - Jørgen Erik Nielsen
- Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, Copenhagen, Denmark
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5
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Karlsson WK, Højgaard JLS, Vilhelmsen A, Crone C, Andersen B, Law I, Møller LB, Nielsen TT, Nielsen EN, Krag T, Svenstrup K, Nielsen JE. Novel Homozygous Truncating Variant Widens the Spectrum of Early-Onset Multisystemic SYNE1 Ataxia. Cerebellum 2021; 21:514-519. [PMID: 34318393 DOI: 10.1007/s12311-021-01308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
Pathogenic variants in the SYNE1 gene are associated with a phenotypic spectrum spanning from late-onset, slowly progressive, relatively pure ataxia to early-onset, fast progressive multisystemic disease. Since its first description in 2007 as an adult-onset ataxia in French Canadian families, subsequent identification of patients worldwide has widened the clinical spectrum and increased the number of identified pathogenic variants. We report a 20-year-old Faroese female with early-onset progressive gait problems, weakness, dysphagia, slurred speech, orthostatic dizziness, and urge incontinence. Neurological examination revealed mild cognitive deficits, dysarthria, broken slow pursuit, hypometric saccades, weakness with spasticity, hyperreflexia, absent ankle reflexes, ataxia, and wide-based, spastic gait. Magnetic resonance imaging displayed atrophy of the cerebellum, brainstem, and spinal cord. Severely prolonged central motor conduction time and lower motor neuron involvement was demonstrated electrophysiologically. Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed hypometabolism of the cerebellum and right frontal lobe. Muscle biopsy revealed chronic neurogenic changes and near-absent immunostaining for Nesprin-1. Next-generation sequencing revealed a previously undescribed homozygous truncating, likely pathogenic variant in the SYNE1 gene. The patient's mother and paternal grandfather were heterozygous carriers of the variant. Her father's genotype was unobtainable. We expand the list of likely pathogenic variants in SYNE1 ataxia with a novel homozygous truncating variant with proximity to the C-terminus and relate it to a phenotype comprising early-onset cerebellar deficits, upper and lower motor neuron involvement and cognitive deficits. Also, we report novel findings of focally reduced frontal lobe FDG-PET uptake and motor evoked potential abnormalities suggestive of central demyelination.
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Affiliation(s)
- William Kristian Karlsson
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.
| | - Joan Lilja Sunnleyg Højgaard
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Anna Vilhelmsen
- Department of Psychiatry, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Clarissa Crone
- Department of Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Andersen
- Department of Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Birk Møller
- Department of Clinical Genetics, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Troels Tolstrup Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Emilie Neerup Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Thomas Krag
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Department of Neurology, Copenhagen Neuromuscular Center, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Svenstrup
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Department of Neurology, Copenhagen Neuromuscular Center, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Erik Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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6
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Roos P, Johannsen P, Lindquist SG, Brown J, Stokholm J, Waldemar G, Duno M, Nielsen TT, Nielsen JE. P3-274: MODIFIERS OF AGE-AT-ONSET IN FRONTOTEMPORAL DEMENTIA LINKED TO CHROMOSOME 3 (FTD-3). Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3305] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Peter Roos
- Danish Dementia Research Centre; Rigshospitalet; Copenhagen Denmark
| | - Peter Johannsen
- Danish Dementia Research Centre; Rigshospitalet; Copenhagen Denmark
| | | | - Jerry Brown
- Addenbrooke's Hospital; Cambridge United Kingdom
| | - Jette Stokholm
- Danish Dementia Research Centre; Rigshospitalet; Copenhagen Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre; Rigshospitalet; Copenhagen Denmark
| | - Morten Duno
- Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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7
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Clayton EL, Mancuso R, Nielsen TT, Mizielinska S, Holmes H, Powell N, Norona F, Larsen JO, Milioto C, Wilson KM, Lythgoe MF, Ourselin S, Nielsen JE, Johannsen P, Holm I, Collinge J, Oliver PL, Gomez-Nicola D, Isaacs AM. Early microgliosis precedes neuronal loss and behavioural impairment in mice with a frontotemporal dementia-causing CHMP2B mutation. Hum Mol Genet 2017; 26:873-887. [PMID: 28093491 PMCID: PMC5409096 DOI: 10.1093/hmg/ddx003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 09/16/2016] [Accepted: 01/03/2017] [Indexed: 01/13/2023] Open
Abstract
Frontotemporal dementia (FTD)-causing mutations in the CHMP2B gene lead to the generation of mutant C-terminally truncated CHMP2B. We report that transgenic mice expressing endogenous levels of mutant CHMP2B developed late-onset brain volume loss associated with frank neuronal loss and FTD-like changes in social behaviour. These data are the first to show neurodegeneration in mice expressing mutant CHMP2B and indicate that our mouse model is able to recapitulate neurodegenerative changes observed in FTD. Neuroinflammation has been increasingly implicated in neurodegeneration, including FTD. Therefore, we investigated neuroinflammation in our CHMP2B mutant mice. We observed very early microglial proliferation that develops into a clear pro-inflammatory phenotype at late stages. Importantly, we also observed a similar inflammatory profile in CHMP2B patient frontal cortex. Aberrant microglial function has also been implicated in FTD caused by GRN, MAPT and C9orf72 mutations. The presence of early microglial changes in our CHMP2B mutant mice indicates neuroinflammation may be a contributing factor to the neurodegeneration observed in FTD.
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Affiliation(s)
- Emma L Clayton
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Renzo Mancuso
- Biological Sciences, University of Southampton, Southampton General Hospital, South Laboratory and Pathology Block, Tremona Road, Southampton SO166YD, UK
| | - Troels Tolstrup Nielsen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Sarah Mizielinska
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Holly Holmes
- Centre for Advanced Biomedical Imaging, Division of Medicine and Institute of Child Health, University College London, 72 Huntley Street, London WC1E 6DD, UK
| | - Nicholas Powell
- Centre for Advanced Biomedical Imaging, Division of Medicine and Institute of Child Health, University College London, 72 Huntley Street, London WC1E 6DD, UK.,Faculty of Health and Medical Sciences, Department of Neuroscience and Pharmacology, Panum Institute, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Frances Norona
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Jytte Overgaard Larsen
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, UK
| | - Carmelo Milioto
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Katherine M Wilson
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Mark F Lythgoe
- Centre for Advanced Biomedical Imaging, Division of Medicine and Institute of Child Health, University College London, 72 Huntley Street, London WC1E 6DD, UK
| | - Sebastian Ourselin
- Faculty of Health and Medical Sciences, Department of Neuroscience and Pharmacology, Panum Institute, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Jörgen E Nielsen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark.,Section of Neurogenetics, Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Johannsen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Ida Holm
- Laboratory for Experimental Neuropathology, Department of Pathology, Randers Hospital, DK-8930 Randers NØ, Denmark.,Institute of Clinical Medicine, Aarhus University, DK-8000 Aarhus C, Denmark
| | - John Collinge
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.,MRC Prion Unit, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | | | - Peter L Oliver
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford OX1 3PT, UK
| | - Diego Gomez-Nicola
- Biological Sciences, University of Southampton, Southampton General Hospital, South Laboratory and Pathology Block, Tremona Road, Southampton SO166YD, UK
| | - Adrian M Isaacs
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Clayton EL, Mizielinska S, Edgar JR, Nielsen TT, Marshall S, Norona FE, Robbins M, Damirji H, Holm IE, Johannsen P, Nielsen JE, Asante EA, Collinge J, Isaacs AM. Frontotemporal dementia caused by CHMP2B mutation is characterised by neuronal lysosomal storage pathology. Acta Neuropathol 2015; 130:511-23. [PMID: 26358247 PMCID: PMC4575387 DOI: 10.1007/s00401-015-1475-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 12/13/2022]
Abstract
Mutations in the charged multivesicular body protein 2B (CHMP2B) cause frontotemporal dementia (FTD). We report that mice which express FTD-causative mutant CHMP2B at physiological levels develop a novel lysosomal storage pathology characterised by large neuronal autofluorescent aggregates. The aggregates are an early and progressive pathology that occur at 3 months of age and increase in both size and number over time. These autofluorescent aggregates are not observed in mice expressing wild-type CHMP2B, or in non-transgenic controls, indicating that they are a specific pathology caused by mutant CHMP2B. Ultrastructural analysis and immuno- gold labelling confirmed that they are derived from the endolysosomal system. Consistent with these findings, CHMP2B mutation patient brains contain morphologically similar autofluorescent aggregates. These aggregates occur significantly more frequently in human CHMP2B mutation brain than in neurodegenerative disease or age-matched control brains. These data suggest that lysosomal storage pathology is the major neuronal pathology in FTD caused by CHMP2B mutation. Recent evidence suggests that two other genes associated with FTD, GRN and TMEM106B are important for lysosomal function. Our identification of lysosomal storage pathology in FTD caused by CHMP2B mutation now provides evidence that endolysosomal dysfunction is a major degenerative pathway in FTD.
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Affiliation(s)
- Emma L Clayton
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sarah Mizielinska
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - James R Edgar
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 0XY, UK
| | - Troels Tolstrup Nielsen
- Neurogenetics Research Laboratory, Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Marshall
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Frances E Norona
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Miranda Robbins
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Hana Damirji
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Ida E Holm
- Laboratory for Experimental Neuropathology, Department of Pathology, Randers Hospital, 8930, Randers NØ, Denmark
- Institute of Clinical Medicine, Aarhus University, 8000, Aarhus C, Denmark
| | - Peter Johannsen
- Memory Clinic, Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen E Nielsen
- Neurogenetics Research Laboratory, Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Memory Clinic, Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cellular and Molecular Medicine, Section of Neurogenetics, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Emmanuel A Asante
- MRC Prion Unit, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - John Collinge
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- MRC Prion Unit, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Adrian M Isaacs
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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Ejlerskov P, Rasmussen I, Nielsen TT, Bergström AL, Tohyama Y, Jensen PH, Vilhardt F. Tubulin polymerization-promoting protein (TPPP/p25α) promotes unconventional secretion of α-synuclein through exophagy by impairing autophagosome-lysosome fusion. J Biol Chem 2013; 288:17313-35. [PMID: 23629650 DOI: 10.1074/jbc.m112.401174] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aggregation of α-synuclein can be promoted by the tubulin polymerization-promoting protein/p25α, which we have used here as a tool to study the role of autophagy in the clearance of α-synuclein. In NGF-differentiated PC12 catecholaminergic nerve cells, we show that de novo expressed p25α co-localizes with α-synuclein and causes its aggregation and distribution into autophagosomes. However, p25α also lowered the mobility of autophagosomes and hindered the final maturation of autophagosomes by preventing their fusion with lysosomes for the final degradation of α-synuclein. Instead, p25α caused a 4-fold increase in the basal level of α-synuclein secreted into the medium. Secretion was strictly dependent on autophagy and could be up-regulated (trehalose and Rab1A) or down-regulated (3-methyladenine and ATG5 shRNA) by enhancers or inhibitors of autophagy or by modulating minus-end-directed (HDAC6 shRNA) or plus-end-directed (Rab8) trafficking of autophagosomes along microtubules. Finally, we show in the absence of tubulin polymerization-promoting protein/p25α that α-synuclein release was modulated by dominant mutants of Rab27A, known to regulate exocytosis of late endosomal (and amphisomal) elements, and that both lysosomal fusion block and secretion of α-synuclein could be replicated by knockdown of the p25α target, HDAC6, the predominant cytosolic deacetylase in neurons. Our data indicate that unconventional secretion of α-synuclein can be mediated through exophagy and that factors, which increase the pool of autophagosomes/amphisomes (e.g. lysosomal disturbance) or alter the polarity of vesicular transport of autophagosomes on microtubules, can result in an increased release of α-synuclein monomer and aggregates to the surroundings.
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Affiliation(s)
- Patrick Ejlerskov
- Department of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, 2200 Copenhagen N, Denmark
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Aidt FH, Nielsen SMB, Kanters J, Pesta D, Nielsen TT, Nørremølle A, Hasholt L, Christiansen M, Hagen CM. Dysfunctional mitochondrial respiration in the striatum of the Huntington's disease transgenic R6/2 mouse model. PLoS Curr 2013; 5. [PMID: 23568011 PMCID: PMC3614423 DOI: 10.1371/currents.hd.d8917b4862929772c5a2f2a34ef1c201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Metabolic dysfunction and mitochondrial involvement are recognised as part of the pathology in Huntington's Disease (HD). Post-mortem examinations of the striatum from end-stage HD patients have shown a decrease in the in vitro activity of complexes II, III and IV of the electron transport system (ETS). In different models of HD, evidence of enzyme defects have been reported in complex II and complex IV using enzyme assays. However, such assays are highly variable and results have been inconsistent.
We investigated the integrated ETS function ex vivo using a sensitive high-resolution respirometric (HRR) method. The O2 flux in a whole-cell sample combined with the addition of mitochondrial substrates, uncouplers and inhibitors enabled us to accurately quantitate the function of individual mitochondrial complexes in intact mitochondria, while retaining mitochondrial regulation and compensatory mechanisms.
We used HRR to examine the mitochondrial function in striata from 12-week old R6/2 mice expressing exon 1 of human HTT with 130 CAG repeats. A significant reduction in complex II and complex IV flux control ratios was found in the R6/2 mouse striatum at 12 weeks of age compared to controls, confirming previous findings obtained with spectrophotometric enzyme assays.
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Affiliation(s)
- Frederik Heurlin Aidt
- Institute of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Copenhagen; Section of Molecular Medicine, Department of Clinical Biochemistry, Genetics and Immunology, Statens Serum Institut, Copenhagen, Denmark
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Stokholm J, Teasdale TW, Johannsen P, Nielsen JE, Nielsen TT, Isaacs A, Brown JM, Gade A. Cognitive impairment in the preclinical stage of dementia in FTD-3 CHMP2B mutation carriers: a longitudinal prospective study. J Neurol Neurosurg Psychiatry 2013; 84:170-6. [PMID: 23142962 DOI: 10.1136/jnnp-2012-303813] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 11/04/2022]
Abstract
OBJECTIVE AND METHODS A longitudinal study spanning over 8 years and including 17 asymptomatic individuals with CHMP2B mutations was conducted to assess the earliest neuropsychological changes in autosomal dominant neurodegenerative disease frontotemporal dementia (FTD) linked to chromosome 3 (FTD-3). Subjects were assessed with neuropsychological tests in 2002, 2005 and 2010. RESULTS Cross-sectional analyses showed that the mutation carriers scored lower on tests of psychomotor speed, working memory, executive functions and verbal memory than a control group consisting of not-at-risk family members and spouses. Longitudinal analyses showed a gradual decline in psychomotor speed, working memory capacity and global executive measures in the group of non-demented mutation carriers that was not found in the control group. In contrast, there were no significant group differences in domain scores on memory or visuospatial functions. On an individual level the cognitive changes over time varied considerably. CONCLUSION Subjects with CHMP2B mutation show cognitive changes dominated by executive dysfunctions, years before they fulfil diagnostic criteria of FTD. However, there is great heterogeneity in the individual cognitive trajectories.
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Affiliation(s)
- Jette Stokholm
- Memory Disorders Research Group, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, N6702, 9 Blegdamsvej, Copenhagen 2100, Denmark.
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Nielsen TT, Mizielinska S, Hasholt L, Isaacs AM, Nielsen JE. Reversal of pathology in CHMP2B-mediated frontotemporal dementia patient cells using RNA interference. J Gene Med 2013; 14:521-9. [PMID: 22786763 DOI: 10.1002/jgm.2649] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Frontotemporal dementia is the second most common form of young-onset dementia after Alzheimer's disease, and several genetic forms of frontotemporal dementia are known. A rare genetic variant is caused by a point mutation in the CHMP2B gene. CHMP2B is a component of the ESCRT-III complex, which is involved in endosomal trafficking of proteins targeted for degradation in lysosomes. Mutations in CHMP2B result in abnormal endosomal structures in patient fibroblasts and patient brains, probably through a gain-of-function mechanism, suggesting that the endosomal pathway plays a central role in the pathogenesis of the disease. METHODS In the present study, we used lentiviral vectors to efficiently knockdown CHMP2B by delivering microRNA embedded small hairpin RNAs. RESULTS We show that CHMP2B can be efficiently knocked down in patient fibroblasts using an RNA interference approach and that the knockdown causes reversal of the abnormal endosomal phenotype observed in patient fibroblasts. CONCLUSIONS This is the first description of a treatment that reverses the cellular pathology caused by mutant CHMP2B and suggests that RNA interference might be a feasible therapeutic strategy. Furthermore, it provides the first proof of a direct link between the disease-causing mutation and the cellular phenotype in cells originating from CHMP2B mutation patients.
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Affiliation(s)
- Troels Tolstrup Nielsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark.
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Nielsen TT, Svenstrup K, Budtz-Jørgensen E, Eiberg H, Hasholt L, Nielsen JE. ATXN2 with intermediate-length CAG/CAA repeats does not seem to be a risk factor in hereditary spastic paraplegia. J Neurol Sci 2012; 321:100-2. [DOI: 10.1016/j.jns.2012.07.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/07/2012] [Accepted: 07/17/2012] [Indexed: 10/28/2022]
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Nielsen TT, Mardosiene S, Løkkegaard A, Stokholm J, Ehrenfels S, Bech S, Friberg L, Nielsen JK, Nielsen JE. Severe and rapidly progressing cognitive phenotype in a SCA17-family with only marginally expanded CAG/CAA repeats in the TATA-box binding protein gene: a case report. BMC Neurol 2012; 12:73. [PMID: 22889412 PMCID: PMC3475097 DOI: 10.1186/1471-2377-12-73] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 12/12/2011] [Accepted: 08/06/2012] [Indexed: 11/17/2022] Open
Abstract
Background The autosomal dominant spinocerebellar ataxias (SCAs) confine a group of rare and heterogeneous disorders, which present with progressive ataxia and numerous other features e.g. peripheral neuropathy, macular degeneration and cognitive impairment, and a subset of these disorders is caused by CAG-repeat expansions in their respective genes. The diagnosing of the SCAs is often difficult due to the phenotypic overlap among several of the subtypes and with other neurodegenerative disorders e.g. Huntington’s disease. Case presentation We report a family in which the proband had rapidly progressing cognitive decline and only subtle cerebellar symptoms from age 42. Sequencing of the TATA-box binding protein gene revealed a modest elongation of the CAG/CAA-repeat of only two repeats above the non-pathogenic threshold of 41, confirming a diagnosis of SCA17. Normally, repeats within this range show reduced penetrance and result in a milder disease course with slower progression and later age of onset. Thus, this case presented with an unusual phenotype. Conclusions The current case highlights the diagnostic challenge of neurodegenerative disorders and the need for a thorough clinical and paraclinical examination of patients presenting with rapid cognitive decline to make a precise diagnosis on which further genetic counseling and initiation of treatment modalities can be based.
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Affiliation(s)
- Troels Tolstrup Nielsen
- Memory Disorders Research Group, Neurogenetics Clinic, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Horvath L, van Marion I, Taï K, Nielsen TT, Lundberg C. Knockdown of GAD67 protein levels normalizes neuronal activity in a rat model of Parkinson's disease. J Gene Med 2011; 13:188-97. [PMID: 21449035 DOI: 10.1002/jgm.1555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Dopamine depletion of the striatum is one of the hallmarks of Parkinson's disease. The loss of dopamine upregulates GAD67 expression in the striatal projection neurons and causes other changes in the activity of the basal ganglia circuit. METHODS To normalize the GAD67 expression in the striatum after dopamine depletion, we developed several lentiviral vectors that express RNA interference (RNAi) directed against GAD67 mitochondrial RNA. The vectors were injected into the striatum of hemiparkinsonian rats and the level of GAD67 protein as well as a marker of neuronal activity, mtCO1, was analyzed using western blots. RESULTS Unilateral lesions of the dopamine neurons in substantia nigra resulted in an increased level of GAD67 protein in the ipsilateral striatum. Furthermore, we detected significantly higher levels of mtCO1, after dopamine depletion in the striatum. Using a lentiviral vectors with a synthetic miRNA scaffold to deliver RNAi, we were able to normalize the GAD67 protein levels in the parkinsonian rat striatum. In addition, we were able to normalize the increased neural activity, which resulted from the loss of dopamine as measured by the marker mtCO1. CONCLUSIONS We conclude that RNAi directed against GAD67 may be a valid approach to correct the dysregulation of the basal ganglia circuit in a rat model of Parkinson's disease. The possibility to correct for a loss of dopamine using nondopamimetic tools is interesting because it may be more directed towards the casual mechanisms of the motor symptoms.
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Affiliation(s)
- Lazlo Horvath
- CNS Gene Therapy Unit, Wallenberg Neuroscience Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
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Kristiansen SB, Løfgren B, Nielsen JM, Støttrup NB, Buhl ES, Nielsen-Kudsk JE, Nielsen TT, Rungby J, Flyvbjerg A, Bøtker HE. Comparison of two sulfonylureas with high and low myocardial K(ATP) channel affinity on myocardial infarct size and metabolism in a rat model of type 2 diabetes. Diabetologia 2011; 54:451-8. [PMID: 21104069 DOI: 10.1007/s00125-010-1970-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 10/04/2010] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS Sulfonylureas (SUs) may impair outcome in patients with acute coronary syndrome. Most experimental studies of the myocardial effects of SU treatment are performed in non-diabetic models. We compared the effect of two widely used SUs, glibenclamide (gb) and gliclazide (gc), with high and low myocardial K(ATP) channel affinity, respectively, at therapeutic concentrations on infarct size, left ventricular (LV) function and myocardial glycogen, lactate and alanine content before and after ischaemia/reperfusion (I/R). METHODS Non-diabetic Wistar and diabetic Goto-Kakizaki rat hearts were investigated in a Langendorff preparation. Gb (0.1 μmol/l) and gc (1.0 μmol/l) were administrated throughout the study. Infarct size was evaluated after 120 min of reperfusion. Myocardial metabolite content was measured before and after ischaemia. RESULTS Infarct size was smaller in diabetic hearts than in non-diabetic hearts (0.33 ± 0.03 vs 0.51 ± 0.05, p < 0.05). Gb increased infarct size (0.54 ± 0.04 vs 0.33 ± 0.03, p < 0.05) and reduced post-ischaemic LV developed pressure (60 ± 3 vs 76 ± 3 mmHg, p < 0.05) and coronary flow (4.9 ± 0.5 vs 7.1 ± 0.4 ml min(-1) g(-1), p < 0.05) in gb-treated diabetic rats compared with untreated diabetic rats. On comparing gb-treated diabetic rats with untreated diabetic rats, glycogen content was reduced before (9.1 ± 0.6 vs 13.6 ± 1.0 nmol/mg wet weight, p < 0.01) and after ischaemia (0.9 ± 0.2 vs 1.8 ± 0.2 nmol/mg wet weight, p < 0.05), and lactate (4.8 ± 0.4 vs 3.2 ± 0.3 nmol/mg wet weight, p < 0.01) and alanine (1.38 ± 0.12 vs 0.96 ± 0.09 nmol/mg wet weight, p < 0.05) contents were increased during reperfusion. Gc-treatment of diabetic and non-diabetic rats did not affect any of the measured variables. CONCLUSIONS/INTERPRETATIONS Gb, but not gc, exacerbates I/R injury and deteriorates LV function in diabetic hearts. These effects of gb on diabetic hearts may be due to detrimental effects on myocardial carbohydrate metabolism.
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Affiliation(s)
- S B Kristiansen
- Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.
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Lie RH, Stoettrup N, Sloth E, Hasenkam JM, Kroyer R, Nielsen TT. Post-conditioning with cyclosporine A fails to reduce the infarct size in an in vivo porcine model. Acta Anaesthesiol Scand 2010; 54:804-13. [PMID: 20455870 DOI: 10.1111/j.1399-6576.2010.02241.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cyclosporine A has generated intense interest in the field of cardioprotection due to its ability to protect the mitochondria at reperfusion by blocking the opening of the mitochondrial permeability transition pore. The aim of our study was to examine the cardioprotective effect of Sandimmun, a clinically available formulation of cyclosporine A, in an in vivo large mammal model. METHODS Forty-eight pigs were randomly allocated to one of three groups: (i) Control group (Con, n=19), (ii) Cyclosporine group, (Cyclo, n=19) Sandimmun 10 mg/kg i.v. bolus 5 min before reperfusion and (iii) Pre-conditioning group (Precon, n=10) two cycles of 10 min ischemia interspersed with 30-min reperfusion. The study was further sub-divided into a metabolic protocol, evaluating myocardial metabolism by measuring changes in the interstitial lactate concentration, and a coronary flow protocol. All animals were subjected to 40 min of left anterior descending coronary artery occlusion, followed by 180 min of reperfusion before histochemical staining and assessment of infarct size by planimetry. RESULTS Infarct sizes were measured as: Con 51.4 +/- 16.5%, Cyclo 47.3 +/- 15.7% and Precon 2.4 +/- 3.6%, with no significant difference between the Con and Cyclo groups but a highly significant difference between the Precon and Cyclo and Con groups (P<0.0001 for both comparisons). In the Cyclo group, the interstitial lactate concentration was significantly increased compared with the Con group at 6-min reperfusion, although significantly lower at 14 min presumably due to accelerated washout. CONCLUSION In this large animal model, a 10 mg/kg bolus administration of Sandimmun 5 min before reperfusion did not reduce the infarct size.
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Affiliation(s)
- R H Lie
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
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Boesgaard TW, Nielsen TT, Josefsen K, Hansen T, Jørgensen T, Pedersen O, Nørremølle A, Nielsen JE, Hasholt L. Huntington's disease does not appear to increase the risk of diabetes mellitus. J Neuroendocrinol 2009; 21:770-6. [PMID: 19602103 DOI: 10.1111/j.1365-2826.2009.01898.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Huntington's disease (HD) is an autosomal, dominantly inherited, neurodegenerative disorder characterised by neurological, cognitive and psychiatric symptoms. HD has been associated with diabetes mellitus, which is, to some extent, supported by studies in transgenic HD mice. In transgenic mice, the severity of the diabetic phenotype appears to correlate with the length of a polyglutamine expansion in the protein huntingtin. In the present study, we investigated the association between diabetes mellitus and HD by performing an oral glucose-tolerance test (OGTT) to evaluate the glucose-tolerance status and OGTT-related insulin release in 14 HD patients. Furthermore, we expressed N-terminal huntingtin fragments with different polyglutamine lengths in an insulinoma-cell line (INS-1E) to investigate how mutant huntingtin influences glucose-stimulated insulin release in vitro. We found no difference between a group of early- and middle-stage HD patients and a large group of control individuals in any of the assessed variables. However, the glucose-stimulated induction of insulin release was significantly reduced in the insulinoma-cell line expressing highly expanded huntingtin compared to cells expressing huntingtin with modestly elongated polyglutamine stretches. These data indicate that insulin release from beta-cells expressing mutant huntingtin appears to be polyglutamine length-dependent, and that polyglutamine lengths within the range normally found in adult onset HD do not influence insulin release. This challenges the assumption of an increased risk of diabetes among HD patients, although our results do not exclude a changed glucose tolerance in end-stage HD patients or in patients with juvenile onset HD. It also raises the question of which extent transgenic mice models reflect the pathology of human HD in this regard.
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Povlsen JA, Løfgren B, Rasmussen LE, Nielsen JM, Nørregaard R, Kristiansen SB, Bøtker HE, Nielsen TT. CARDIOPROTECTIVE EFFECT OF l-GLUTAMATE IN OBESE TYPE 2 DIABETIC ZUCKER FATTY RATS. Clin Exp Pharmacol Physiol 2009; 36:892-8. [DOI: 10.1111/j.1440-1681.2009.05166.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lund O, Nielsen TT, Rønne K, Schifter S. Pulmonary embolism: long-term follow-up after treatment with full-dose heparin, streptokinase or embolectomy. Acta Med Scand 2009; 221:61-71. [PMID: 3565086 DOI: 10.1111/j.0954-6820.1987.tb01246.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The study comprises 74 patients alive 30 days after the start of treatment of pulmonary embolism with heparin (n = 32), streptokinase (n = 22) or embolectomy (n = 20). The cumulative 5-year survival was 100% in the embolectomy group, compared to 75 +/- 7% (SE) in the medically treated patients (p less than 0.05). Cancer caused 78% of the late deaths. At follow-up 0.5-8.7 years after treatment the treatment groups were indistinguishable as regards right-sided heart catheterization data, pulmonary artery rest-obstruction, right ventricular diameter and wall thickness, ventilatory function and ECG changes. The embolectomized patients were in a more favourable NYHA classification level than the medically treated. Chronic pulmonary artery hypertension was found in 75% of patients with greater than or equal to 3 anamnestic recurrent embolic episodes before diagnosis compared to 8% of patients with less than or equal to 2 recurrent episodes (p less than 0.001). Patients with irreversible cardiocirculatory shock before embolectomy all had abnormal pulmonary vascular resistance (greater than 1.5 mmHg/l/min), depressed ventilatory function and more than 25% reduced pulmonary perfusion at follow-up. The major prognostic factors thus were cancer, the number of recurrent episodes and the degree of cardiocirculatory affection in the acute event. Although the embolectomized patients were the most affected initially, they had a good prognosis. This led us to extend our indications for embolectomy to include all patients with central emboli, irrespective of the degree of cardiocirculatory impairment.
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Thomassen A, Nielsen TT, Bagger JP, Charles P, Løvgreen NA, Sørensen NS. Circadian plasma citrate rhythms in juvenile diabetics. Acta Med Scand 2009; 210:163-71. [PMID: 7293834 DOI: 10.1111/j.0954-6820.1981.tb09795.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Postabsorptive plasma concentrations of citrate, glucose, lactate, free fatty acids (FFA), ketone bodies and free insulin were measured once weekly for 5 weeks in 18 male juvenile diabetics. The circadian rhythms of the same substances were followed in 12 male diabetics. In 8 of them, daily rhythms were measured twice, before and after plasma glucose was lowered by increasing insulin doses. In the postabsorptive state, the mean plasma citrate concentration of the diabetics, 117 mumol/l (range 65--160), did not differ from that of non-diabetics despite two- to threefold higher levels of plasma glucose, FFA and ketone bodies in diabetics. Daily plasma citrate profile in diabetics showed peak concentrations in the morning and late afternoon. Citrate level throughout the day fell after increased insulin administration, whereas the diurnal pattern remained unchanged. Both the week-to-week coefficient of variation (mean 10%) and the diurnal coefficient of variation (mean 17%) of plasma citrate were below those of any other substances measured (p less than 0.001). Postabsorptive citrate concentration correlated negatively to the diurnal variation of plasma glucose whether diabetic control was apparently good or poor. The results support the idea that plasma citrate level reflects intracellular citrate regulation of glucose utilization. In spite of an interindividual range of 100%, individual citrate level was remarkably constant. Postabsorptive plasma citrate concentration is proposed as a control marker of lability of circulating glucose in insulin-treated diabetics.
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Abstract
Plasma citrate was determined in 12 obese subjects who underwent total fasting for 10 days. Mean plasma citrate concentration rose significantly from 128 before to 205 micro mol/1 on the 10th day of fasting. Plasma citrate rose continuously during fasting in seven subjects in whom daily determinations were carried out. The 24-hour urinary citrate excretion was followed in six subjects. A significant decrease was found from 2.91 mmol/24 h in the prefasting state to 0.25 mmol/24 h at the end of the fast. Intravenous glucose tolerance test were performed before and on the 10th day of fasting. Kivgtt decreased significantly and was inversely related to plasma citrate concentration on the 10th day of fasting. The results agree well with the concept that an increased citrate level of tissues is of regulatory importance for the decreased glucose utilization during fasting in man.
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Lie RH, Hasenkam JM, Nielsen TT, Poulsen R, Sloth E. Post-conditioning reduces infarct size in an open-chest porcine acute ischemia-reperfusion model. Acta Anaesthesiol Scand 2008; 52:1188-93. [PMID: 18823456 DOI: 10.1111/j.1399-6576.2008.01756.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Timely reperfusion is a prerequisite for myocardial salvage; however, re-oxygenation of the ischemic myocardium initiates reperfusion injury. Post-conditioning diminishes the detrimental aftermath of an acute myocardial infarction through alleviation of reperfusion injury. Ischemic post-conditioning consists of a series of brief interruptions in the coronary blood supply that has to be applied within the first minutes after re-establishing the coronary flow. METHODS Sixteen female mixed Danish Landrace and Yorkshire pigs weighing 20 kg were included. The heart was exposed through a midline sternotomy. A snare was positioned around the left anterior descending coronary artery downstream of the second diagonal branch. After randomization to either no treatment (control group) or treatment by ischemic post-conditioning (post-conditioning group), the pigs underwent 45 min of ischemia and 180 min of reperfusion. The post-conditioning group had a post-conditioning algorithm applied consisting of 15 s of reperfusion alternating with 15 s of re-occlusion repeated 10 times. RESULTS The groups were comparable with regard to body weight, hemodynamics and the size of the area at risk. The post-conditioning group had an absolute reduction in infarct size of 18.1% [confidence interval (CI): 6.2: 30.0%] compared with the control group (P=0.0056). In the post-conditioning group, infarction developed in 39.6+/-12.0% (1 SD) of the area at risk compared with 57.8+/-10.2% (1 SD) in the control group. CONCLUSION When ischemic post-conditioning was applied at reperfusion, we found an absolute reduction in infarct size of 18.1% presumably attributable to a diminished reperfusion injury. The model we have developed is suitable for further studies of this promising intervention.
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Affiliation(s)
- R H Lie
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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Terkelsen CJ, Christiansen EH, Sorensen JT, Kristensen SD, Lassen JF, Thuesen L, Andersen HR, Vach W, Nielsen TT. Primary PCI as the preferred reperfusion therapy in STEMI: it is a matter of time. Heart 2008; 95:362-9. [DOI: 10.1136/hrt.2007.139493] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Andersen MS, Nielsen TT, Christensen EF. A study of police operated dispatch to acute coronary syndrome cases arising from 112 emergency calls in Aarhus county, Denmark. Emerg Med J 2007; 23:705-6. [PMID: 16921086 PMCID: PMC2564217 DOI: 10.1136/emj.2006.034652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The accuracy of the Danish police operated "112" emergency call system was studied. Dispatch of the anaesthesiologist staffed mobile emergency care unit (MECU) to acute coronary syndrome (ACS) cases was used as an indicator of accuracy of dispatch to life threatening emergencies. METHODS This was an observational cohort study of patients given a 112 system report of heart attack and patients with a provisional diagnosis of ACS made on scene by the MECU. Sensitivity, specificity, and positive predictive value with 95% confidence intervals (CI) were calculated. RESULTS There were 341 reports of "heart attack" and 205 patients with ACS. Sensitivity was 75% (95% CI 68% to 80%) specificity 90% (89% to 92%) and positive predictive value 45% (40% to 50%). CONCLUSION The accuracy of 112 dispatch of the MECU was found to be moderate. We suggest more training of dispatch staff and medical supervision.
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Affiliation(s)
- M S Andersen
- Department of Anaesthesia and Intensive Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Mortensen UM, Nielsen-Kudsk JE, Sondergaard HM, Jakobsen P, Jensen BS, Schmitz O, Nielsen TT. Effect of the oral hypoglycaemic sulphonylurea glibenclamide, a blocker of ATP-sensitive potassium channels, on walking distance in patients with intermittent claudication. Diabet Med 2006; 23:327-30. [PMID: 16492219 DOI: 10.1111/j.1464-5491.2006.01797.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The oral hypoglycaemic sulphonylurea glibenclamide stimulates endogenous insulin secretion through blockade of ATP-sensitive potassium (KATP) channels on pancreatic beta cells, but also blocks cardiovascular KATP channels, leading to increased peripheral vascular resistance and reduced peripheral blood flow in non-diabetic subjects. Therefore, this study examined whether a single oral dose of glibenclamide adversely affected the pain-free or maximal walking distance in patients with intermittent claudication. METHODS In a double-blind, randomized crossover study, 12 non-diabetic patients with intermittent claudication were given a single oral dose of glibenclamide (5.25 mg) or placebo separated by a washout period of 1 week. A treadmill test was carried out 180 min after glibenclamide/placebo intake for determination of pain-free and maximal walking distance. Plasma glucose concentrations were kept constant by an euglycemic clamp. Changes in ankle/brachial blood pressure index (ABI), serum insulin, and serum glibenclamide were also assessed. RESULTS The pain-free walking distance was 62.8 +/- 9.8 metres (mean +/- sem) after glibenclamide and 52.6 +/- 5.9 metres after placebo (P = 0.52). The maximal walking distance was 142.7 +/- 18.7 metres after glibenclamide and 132.6 +/- 16.6 metres after placebo (P = 0.23). The ABI was not significantly changed by glibenclamide compared with placebo. Serum glibenclamide was 0.51 +/- 0.08 microm 180 min after administration of the drug. Glibenclamide produced an 8-fold increase in circulating insulin compared with placebo (P < 0.001). CONCLUSIONS Glibenclamide given as a single oral dose commonly used in glucose-lowering drug therapy does not reduce pain-free or maximal walking distance in non-diabetic patients with intermittent claudication.
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Affiliation(s)
- U M Mortensen
- Department of Cardiology B, Aarhus University Hospital, Aarhus, Denmark
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27
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Abstract
In the era of primary PCI, a strategy of admitting patients to the nearest hospital should be obsolete. Instead, a prehospital diagnostic strategy should be implemented in order to: (1) refer patients directly to interventional centres, thereby eliminating delay at local hospitals; (2) alert the interventional centre, thereby reducing door to balloon times; (3) initiate adjunctive medication in the prehospital phase.
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Affiliation(s)
- H R Andersen
- Department of Cardiology B, Skejby University Hospital, DK-8200 Aarhus N, Denmark.
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Johnsen SP, Videbaek J, Pedersen L, Steffensen R, Videbaek R, Niemann T, Nielsen TT, Sørensen HT. Survival trends among Danish patients undergoing coronary angiography for known or suspected ischaemic heart disease: a population based follow up study, 1992-2000. Heart 2005; 92:27-31. [PMID: 15814596 PMCID: PMC1860976 DOI: 10.1136/hrt.2004.053314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine, from population based clinical data, changes in the survival of Danish patients examined by coronary angiography for known or suspected ischaemic heart disease (IHD) during the 1990s. DESIGN Follow up study. SETTING The departments of cardiology at Rigshospitalet, Copenhagen University Hospital, and Skejby Hospital, Aarhus University Hospital, Denmark. PATIENTS Patients with IHD (n = 7021) who underwent first time coronary angiography in 1992, 1996, or 2000. MAIN OUTCOMES MEASURES Three year survival was compared between cohorts and with that of the general population. Cox proportional hazards regression was used to estimate mortality ratios adjusted for differences in patient characteristics. RESULTS Survival improved substantially--for example, adjusted mortality ratio was 0.69 (95% confidence interval (CI) 0.55 to 0.87) when comparing patients from 2000 with patients from 1992. The absolute standardised survival rates after three years of follow up were 87.1% (95% CI 85.4% to 88.8%), 89.9% (95% CI 88.5% to 91.3%), and 91.2% (95% CI 90.3% to 92.1%) among patients examined in 1992, 1996, and 2000, respectively. The improvement was not explained by the improvement in overall survival in the general population during the study period. CONCLUSIONS The survival of Danish patients with known or suspected IHD appears to have improved substantially during the 1990s.
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Affiliation(s)
- S P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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Abstract
Pharmacological and technological advances in surgical and interventional coronary treatment modalities have shown reduced cardiovascular mortality in non-diabetic patients, but diabetic patients have not gained the same benefit of invasive treatment as non-diabetics. Although early studies suggest a poorer outcome after angioplasty than after coronary by-pass grafting (CABG) in diabetic patients, more recent studies including improved pharmacological therapy and stent implantation seem to justify increased use of revascularization by percutaneous coronary intervention (PCI) in diabetics with stable and unstable coronary syndromes as the relative benefit in long-term survival, non-fatal myocardial infarction and cerebrovascular accidents is similar. However, diabetic patients are still subject to higher morbidity and mortality after revascularization with CABG and PCI. This is related to increased co-morbidity, metabolic dysregulation, difficulties in obtaining complete revascularization, and more frequent appearance of new lesions as well as restenosis and hemostatic abnormalities. Drug-eluting stents appear to reduce the risk of restenosis, and aggressive antithrombotics also tend to improve the outcome. Unsolved problems are the significance of incomplete revascularization and whether a PCI strategy is associated with a procedure induced progression of the native diabetic vascular disease in treated or untreated vessels. Trials addressing adjunctive treatment and long-term clinical outcome specifically in diabetic patients should clarify these questions.
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Affiliation(s)
- T T Nielsen
- Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus Denmark.
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Affiliation(s)
- S D Kristensen
- Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus N, Denmark.
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31
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Kristiansen SB, Løfgren B, Støttrup NB, Khatir D, Nielsen-Kudsk JE, Nielsen TT, Bøtker HE, Flyvbjerg A. Ischaemic preconditioning does not protect the heart in obese and lean animal models of type 2 diabetes. Diabetologia 2004; 47:1716-21. [PMID: 15480537 DOI: 10.1007/s00125-004-1514-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 06/10/2004] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS The prevalence of type 2 diabetes mellitus is increasing worldwide with obese diabetic patients constituting the majority of this population. Type 2 diabetes is associated with increased morbidity and mortality after acute myocardial infarction. Previous experimental studies of ischaemia-reperfusion tolerance in diabetes have only been performed in animal models of type 1 diabetes mellitus, yielding conflicting data. The aim of the present study was to characterise and compare the tolerance to ischaemia and effects of ischaemic preconditioning (IPC) in hearts from obese Zucker diabetic fatty (ZDF) and lean Goto-Kakizaki (GK) type 2 diabetic rats, using non-obese Zucker and Wistar rats as respective controls. METHODS The two rat strains were divided into 8 groups. The ZDF study (n=47) consisted of: Control -IPC, Control +IPC, ZDF -IPC and ZDF +IPC. The GK study (n=38) consisted of: Control -IPC, Control +IPC, GK -IPC and GK +IPC. Hearts, which were studied in a Langendorff preparation perfused with Krebs-Henseleit buffer, were subjected or not to IPC (+IPC, -IPC) before 50 minutes of regional ischaemia and 120 minutes reperfusion. RESULTS Ischaemic reperfusion injury was smaller in obese (p<0.05) and lean (p<0.05) type 2 diabetic animals than in their respective control animals. IPC reduced ischaemic reperfusion injury during reperfusion in non-diabetic control rats (p<0.01), but failed to protect hearts from both diabetic animal models. Post-ischaemic haemodynamic recovery was impaired in the ZDF rats compared to both control and GK rats (p<0.05). CONCLUSIONS/INTERPRETATION Ischaemic preconditioning does not protect hearts from obese or lean type 2 diabetic animals. However, the susceptibility of the type 2 diabetic myocardium to ischaemic damage is lower than in non-diabetic hearts. The method described here could be used as a tool to study the pathogenesis of increased cardiovascular morbidity and mortality in type 2 diabetes.
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Affiliation(s)
- S B Kristiansen
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, Aarhus N, Denmark.
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Terkelsen CJ, Lassen JF, Nørgaard BL, Gerdes JC, Nielsen TT, Andersen HR. Are we underestimating the full potential of early thrombolytic treatment in patients with acute myocardial infarction? Heart 2003; 89:483-4. [PMID: 12695445 PMCID: PMC1767659 DOI: 10.1136/heart.89.5.483] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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] [Indexed: 11/04/2022] Open
Abstract
Use of the Boersma curve in order to describe the beneficial effect of thrombolytic treatment at different treatment delays seems questionable, because the curve may underestimate the favourable prognostic effects of early thrombolysis in patients with acute myocardial infarction
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Affiliation(s)
- C J Terkelsen
- Department of Cardiology, Skejby University Hospital, Aarhus, Denmark.
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Terkelsen CJ, Nørgaard BL, Lassen JF, Gerdes JC, Ankersen JP, Rømer F, Nielsen TT, Andersen HR. Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction. J Intern Med 2002; 252:412-20. [PMID: 12528759 DOI: 10.1046/j.1365-2796.2002.01051.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In patients with acute myocardial infarction (AMI), considerable time elapses from symptom onset until initiation of thrombolytic therapy or primary percutaneous coronary intervention. Prehospital diagnosing can reduce time delays, and remote diagnosing using telemedicine may be appropriate in areas and countries where ambulances are not staffed with physicians. OBJECTIVES To evaluate whether it was technically feasible for physicians at a remote university hospital to diagnose ST-segment-elevation-AMI (AMI(STelev)) in patients suspected of AMI, who were transported by ambulances to a local hospital. To determine associated prehospital delays and in-hospital treatment delays. METHODS Patients carried in telemetry equipped ambulances had 12-lead electrocardiograms (ECGs) acquired as soon as possible. En route to the local hospital the ECGs were transmitted to a remote university hospital, by use of the GSM-system. The physician on call at the university hospital interviewed the patients, who were provided with cellular phone headsets, and alerted the local hospital if signs of AMI(STelev), bundle-branch-block-AMI or malignant arrhythmia were detected. Patients transported by traditional ambulances were included in a prospective control group. RESULTS In 214 (86%) of 250 patients prehospital diagnosing was successful. Geographically related transmission problems were the primary reason for failure. Ninety-eight per cent of transmitted electrocardiograms and obtained history takings were technically acceptable for diagnostic purposes. Door-to-needle times were shorter amongst patients with AMI(STelev) who were subjected to prehospital diagnosing (n = 13) as compared with patients transported by traditional ambulances (n = 14) (38 vs. 81 min) (P = 0.004). CONCLUSIONS It was technically feasible to use telemedicine for remote prehospital diagnosing of patients suspected of AMI. Patients subjected to prehospital diagnosing had shorter door-to-needle times compared with a prospective control group.
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Affiliation(s)
- C J Terkelsen
- Department of Internal Medicine, Silkeborg Central Hospital, Silkeborg, Denmark
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Nielsen TT, Trottier NL, Stein HH, Bellaver C, Easter RA. The effect of litter size and day of lactation on amino acid uptake by the porcine mammary glands. J Anim Sci 2002; 80:2402-11. [PMID: 12350018 DOI: 10.2527/2002.8092402x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Twelve multiparous sows (PIC Camborough 15; parity >2) were used to investigate the relationship between litter size and day of lactation, and plasma amino acid (AA) arteriovenous differences (A-VD), AA uptake, and plasma flow across the mammary glands. Sows were assigned randomly to one of the following litter sizes: 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or 14 pigs per litter by cross fostering on d 2 postpartum. All sows were surgically fitted with catheters in the carotid artery and the main mammary vein. Matched arteriovenous blood samples were obtained on d 9, 12, 15, 18, 21, and 24 postpartum. Daily mammary uptake of AA was based on the product of plasma A-VD and daily mammary plasma flow (MPF). Daily MPF was estimated using the Fick method based on lysine conservation across the gland, and daily milk production. For the majority of AA, as litter size increased, A-VD did not increase, except for alanine (P < 0.05, linear and quadratic) and valine (P < 0.1; trend; linear and quadratic). As day of lactation increased, A-VD for the majority of AA increased (P < 0.05, linear and quadratic) except for arginine, lysine, and phenylalanine. As litter size increased, net daily mammary AA uptake increased for all indispensable AA (P = 0.001 to P < 0.05, linear and quadratic), excepting arginine. Milk production increased with increasing litter size (P < 0.001, linear) and with increasing day of lactation (P < 0.05, quadratic). Daily MPF increased (P < 0.05, linear) with increasing litter size, but did not change during the period measured from d 9 to 24. In conclusion, litter size appears to be a major determinant of net mammary AA uptake with daily mammary plasma flow a driving variable, whereas AA A-VD is a function of day of lactation and a major variable in determining net AA uptake with advancement of lactation.
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Affiliation(s)
- T T Nielsen
- Royal Veterinary and Agricultural University, Copenhagen, Denmark
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Schroeder AP, Houlind K, Pedersen EM, Nielsen TT, Egeblad H. Serial magnetic resonance imaging of global and regional left ventricular remodeling during 1 year after acute myocardial infarction. Cardiology 2002; 96:106-14. [PMID: 11740140 DOI: 10.1159/000049092] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Biplane long-axis cine MRI was performed in 51 patients 1, 13, 26, and 52 weeks after their first AMI. LV mass index (LVMI) was significantly increased 1 week after AMI (84.3 +/- 16.9 vs. 68.1 +/- 11.4 g/m(2) controls, n = 48, p < 0.001), presumably owing to edema of the infarcted myocardium. Six months after AMI, LVMI decreased to 76.5 +/- 16.4 g/m(2), but had again augmented after 1 year (81.8 +/- 17.3 g/m(2), p < 0.05), suggesting late, compensatory left ventricular hypertrophy. In patients treated with primary percutaneous transluminal coronary angioplasty, LVMI decreased 5% over 1 year, while LVMI increased 10% in patients receiving thrombolysis (p < 0.05). In the entire population, the global increase in LVMI 1 year after AMI seemed to reflect global cavity dilatation with unchanged thickness of the vital myocardium. In conclusion, in patients receiving contemporary treatment, LV remodeling only partially complied with the classical patho-anatomical concept.
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Affiliation(s)
- A P Schroeder
- Department of Cardiology, Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark.
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36
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Wiggers H, Egeblad H, Nielsen TT, Bøtker HE. Prediction of reversible myocardial dysfunction by positron emission tomography, low-dose dobutamine echocardiography, resting ECG, and exercise testing. Cardiology 2002; 96:32-7. [PMID: 11701938 DOI: 10.1159/000047383] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We studied different algorithms to identify patients with heart failure who could potentially benefit from revascularization. Thirty-five coronary artery bypass (graft) patients with an ejection fraction of 35 +/- 7% underwent preoperative 18F-fluoro-2-deoxyglucose positron emission tomography (PET), low-dose dobutamine echocardiography (LDDE), and exercise testing. Follow-up by echocardiography and coronary angiography was performed 6 months after coronary artery bypass grafting. The sensitivity for prediction of reversible myocardial dysfunction was highest for PET and for ST depression or angina pectoris during exercise testing (100 and 93%, p = NS), 71% for LDDE (p < 0.05 vs. PET), and 50% for resting ECG (p < 0.02 vs. PET and exercise test). The specificity did not differ between LDDE (81%), PET (67%), and resting ECG (71%), but was lowest for exercise testing (33%; p < 0.02 vs. PET, LDDE, and resting ECG). Accuracies were: PET 80%, LDDE 77%, exercise testing 62%, and resting ECG 58% (p < 0.05 vs. PET). In patients with a negative exercise test, recovery was unlikely, and further viability testing may not be needed. In patients with a positive test, recovery may occur, and additional PET or LDDE should be performed. In these cases, PET with an 18F-fluoro-deoxyglucose uptake of > or =70% as the criterion for viability yields optimum diagnostic characteristics. This strategy awaits further evaluation in larger patient populations with heart failure.
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Affiliation(s)
- H Wiggers
- Department of Cardiology, Skejby Hospital, Aarhus University Hospitals, Aarhus, Denmark.
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Mortensen UM, Nielsen-Kudsk JE, Andersen HR, Nielsen TT. [Spontaneous dissection of the left main coronary arteries in three women]. Ugeskr Laeger 2001; 163:6919-20. [PMID: 11766507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Spontaneous dissection of the coronary artery is a rare cause of sudden death and myocardial infarction. We report three cases in women aged 32, 38, and 55 years. One patient was one week post partum. In one case all three coronary arteries were involved. Two patients underwent coronary artery bypass grafting and one died of acute heart failure. The epidemiology, aetiology, and clinical manifestations are briefly described. We suggest that coronary angiography should be considered in young women with acute myocardial infarction and few risk factors of atherosclerosis.
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Affiliation(s)
- U M Mortensen
- Arhus Universitetshospital, Skejby Sygehus, hjertemedicinsk afdeling B.
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Schroeder AP, Houlind K, Pedersen EM, Nielsen TT, Egeblad H. Biplane long-axis magnetic resonance imaging. Survey projections for rapid estimation of left ventricular mass and global function. SCAND CARDIOVASC J 2001; 35:385-93. [PMID: 11837518 DOI: 10.1080/14017430152754871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the accuracy and precision of biplane long-axis magnetic resonance imaging (MRI) and two-dimensional (2D)-echocardiography, for the assessment of left ventricular (LV) mass and volumes, with multislice short-axis MRI as reference standard. DESIGN Forty-five cardiac patients and four volunteers with varying LV dilatation and hypertrophy were examined by biplane long-axis gradient-echo MRI, 2D-echocardiography, and multiple short-axis gradient-echo MRI. RESULTS Compared with multislice MRI, the accuracy, i.e. the coefficient of variation (c.v.) of inter-method differences of measured variables, was median 15.7% for biplane MRI and 18.5% for 2D-echocardiography. The precision, expressed as the c.v. of repeated measurements, was median 8.5% for multislice MRI, 9.5% for biplane MRI and 12.4% for 2D-echocardiography. For the determination of LV mass index, MRI was significantly more precise (c.v.: 6.0-8.4%) than 2D-echocardiography (c.v.: 13.7-14.3%, p < 0.05). CONCLUSION Biplane long-axis MRI is a fast and simplified method, offering the advantage of displaying anatomy and function in recognizable projections. For the estimation of LV mass and volumes, biplane MRI had an acceptable accuracy, and a precision that did not differ significantly from that of multislice MRI.
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Affiliation(s)
- A P Schroeder
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, Denmark.
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Buus NH, Bøttcher M, Hermansen F, Sander M, Nielsen TT, Mulvany MJ. Influence of nitric oxide synthase and adrenergic inhibition on adenosine-induced myocardial hyperemia. Circulation 2001; 104:2305-10. [PMID: 11696470 DOI: 10.1161/hc4401.098293] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial perfusion during adenosine-induced hyperemia is used both in clinical diagnosis of coronary heart disease and for scientific investigations of the myocardial microcirculation. The objective of this study was to clarify whether adenosine-induced hyperemia is dependent on endothelial NO production or is influenced by adrenergic mechanisms. METHODS AND RESULTS In 12 healthy men, myocardial perfusion was measured with PET in 2 protocols performed in random order, each including 3 perfusion measurements. First, perfusion was measured at rest. Second, either saline or the NO synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME, 4 mg/kg) was infused, and perfusion during adenosine-induced hyperemia was determined. Last, in both protocols, the alpha-receptor blocker phentolamine was infused, and perfusion during adenosine-induced hyperemia was determined again. Resting perfusion was similar in the 2 protocols (0.69+/-0.14 and 0.66+/-0.18 mL. min(-1). g(-1)). L-NAME increased mean arterial blood pressure by 12+/-7 mm Hg (P<0.01) and reduced heart rate by 16+/-7 bpm (P<0.01). Adenosine-induced hyperemia (1.90+/-0.33 mL. min(-1). g(-1)) was attenuated by L-NAME (1.50+/-0.55 mL. min(-1). g(-1), P<0.01). The addition of phentolamine had no effect on the adenosine-induced hyperemia (2.10+/-0.34 mL. min(-1). g(-1), P=NS). In the presence of L-NAME, however, when the adenosine response was attenuated, phentolamine was able to increase hyperemic perfusion (2.05+/-0.44 mL. min(-1). g(-1), P<0.05). CONCLUSIONS Inhibition of endogenous NO synthesis attenuates myocardial perfusion during adenosine-induced hyperemia, indicating that coronary vasodilation by adenosine is partly endothelium dependent. alpha-Adrenergic blockade has no effect on adenosine-induced hyperemia unless NO synthesis is inhibited.
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Affiliation(s)
- N H Buus
- Center for Clinical Pharmacology, Department of Cardiology, PET Center, Aarhus University Hospital, Denmark.
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Schroeder AP, Houlind K, Pedersen EM, Thuesen L, Nielsen TT, Egeblad H. Magnetic resonance imaging seems safe in patients with intracoronary stents. J Cardiovasc Magn Reson 2001; 2:43-9. [PMID: 11545106 DOI: 10.3109/10976640009148672] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We elucidated whether exposure to cardiac magnetic resonance imaging (MRI) of patients with implanted intracoronary stents is associated with increased risk of stent-thrombosis, stent-restenosis, or other cardiovascular complications. Forty-seven patients admitted with acute myocardial infarction (AMI) were studied. Twenty-three were included in a serial cardiac MRI study, using 1.5-T scanners with standard gradient systems. The remaining patients were control subjects who were matched for age and gender with the MRI group. All patient had intracoronary stents implanted in connection with primary angioplastic treatment (PTCA) of AMI (n = 21), secondary PTCA procedures due to recurrent angina (n = 22), or both (n = 4). In the MRI group (n = 23, aged 58 +/- 10 yr), MRI was carried out one to five times in each patient a median of 166 days (range, 1-501) after stent implantation. The control group comprised 24 patients, ages 59 +/- 11 yr. The incidences of stent-thrombosis, stent-restenosis, and other cardiovascular complications did not differ statistically significantly between the two groups. In the MRI group, stent-related thrombosis (n = 1) or restenosis (n = 7) was observed in eight cases a median of 102 days (range, 7-547) after MR examination and a median of 318 days (range, 138-713) after stent implantation, compared with nine cases in the control group (thrombosis, n = 1; restenosis, n = 8) observed a median of 147 days (range, 1-267) after stent implantation. No acute thromboembolic or other complication occurred in immediate connection with MRI. The follow-up time was 21.3 +/- 4.5 months. This small study shows no evidence of an MRI-related risk of stent-restenosis or other cardiovascular complications, not even if cardiac MRI is performed early after stent implantation.
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Affiliation(s)
- A P Schroeder
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
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Kaltoft A, Bøttcher M, Sand NP, Flø C, Nielsen TT, Rehling M. 99mTc-Sestamibi SPECT is a useful technique for viability detection: results of a comparison with NH3/FDG PET. SCAND CARDIOVASC J 2001; 35:245-51. [PMID: 11759118 DOI: 10.1080/14017430152581350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Assessment of myocardial viability by 99mTc-Sestamibi Single Photon Emission Computerized Tomography (SPECT) has been suggested as a more readily available and cheaper alternative to Positron Emission Tomography (PET) with 13N-ammonia (NH3) and 18F-fluoro-deoxy-glucose (FDG). We hypothesized that a semi-quantitative evaluation by SPECT could delineate myocardial viability with an acceptable concordance to PET. DESIGN Fifty patients (age 57+/-7 years; ejection fraction 28 +/- 8%), with ischemic cardiomyopathy, underwent SPECT and PET imaging in random order. Viability by SPECT was defined as a defect size <50% of the segment area, or a defect representing > or =50% of the segment but with a mean activity > or =50% of peak activity. PET viability was defined as a perfusion score >2 and FDG score < or =2 (five-point scale, 0 = normal, 4 = absent activity). RESULTS By segmental comparison to PET. SPECT yielded a sensitivity and specificity of 87% and 82% for detection of viable myocardium. The positive and negative predictive values were 96% and 58%, respectively. CONCLUSION In patients with severe ischemic cardiomyopathy 99mTc-Sestamibi SPECT can delineate viable myocardium with an acceptable segmental concordance to NH3/FDG PET.
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Affiliation(s)
- A Kaltoft
- Department of Nuclear Medicine, Aarhus University Hospital, Denmark. .
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Abstract
Experiments were conducted to determine the effect of the physiological condition of swine on standardized ileal digestibility coefficients (SID). The apparent ileal digestibility coefficients were determined for crude protein and amino acids in six feed ingredients (corn, barley, wheat, soybean meal, canola meal, and meat and bone meal) in growing pigs and in gestating and lactating sows. Growing pigs and lactating sows were given free access to their diets, whereas gestating sows were allowed to consume only 2 kg of feed daily. The nonspecific (basal) endogenous losses of protein and amino acids were determined under similar feeding regimens after feeding a protein-free diet. The SID for crude protein and amino acids were calculated by correcting the apparent ileal digestibility coefficients for the nonspecific endogenous losses of protein and amino acids. With a few exceptions, there were no differences (P > 0.05) in the SID for crude protein and amino acids between growing pigs and lactating sows. Overall, gestating sows had higher (P < 0.05) SID for crude protein and all amino acids, except for tryptophan and aspartate, compared with growing pigs. Likewise, the SID of most amino acids obtained by gestating sows were higher (P < 0.05) than those obtained by lactating sows. Interactions (P < 0.05) between animals and diets were observed for gestating sows compared with growing pigs as well as gestating sows compared with lactating sows. As a consequence, it is not possible to extrapolate data from one feed ingredient to another. On most occasions, the lowest SID among the indispensable amino acids was calculated for threonine, valine, and lysine. It is concluded that gestating sows fed 2 kg of feed per day have higher standardized digestibility coefficients than do growing pigs and lactating sows given free access to their diets. This difference may be due to differences in daily feed intake rather than to the physiological status of the animals.
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Affiliation(s)
- H H Stein
- Department of Animal and Range Sciences, South Dakota State University, Brookings 57007, USA.
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Maeng M, Olesen PG, Emmertsen NC, Thorwest M, Nielsen TT, Kristensen BO, Falk E, Andersen HR. Time course of vascular remodeling, formation of neointima and formation of neoadventitia after angioplasty in a porcine model. Coron Artery Dis 2001; 12:285-93. [PMID: 11428537 DOI: 10.1097/00019501-200106000-00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular remodeling is the major cause of restenosis after coronary balloon angioplasty but the pathophysiology of this process is not known. OBJECTIVE To examine the time courses of vascular remodeling, formation of neointima and adventitial changes after coronary angioplasty. DESIGN An experimental study on pigs using coronary angiography, intravascular ultrasound (IVUS), and histology. METHODS Deep vessel-wall injury was induced by conventional balloon angioplasty in the circumflex and right coronary arteries, and by retraction of a chain-encircled balloon in the left anterior descending artery. Angiography in all three arteries and IVUS measurements in circumflex and left anterior descending arteries were performed before and after angioplasty, and at follow-up on days 0, 1, 4, 7, 14, 28, and 56 (n = 5 in each group). Serial IVUS measurements were used to determine vascular remodeling. Formation of neointima and neoadventitia was measured by histomorphometry. RESULTS Angiographically evident loss of lumen and ultrasonographically detectable constrictive remodeling occurred between day 7 and day 28. IVUS measurements showed that late loss of lumen (days 28 and 56) was correlated to vascular remodeling but not to the increase in wall area (neointima plus media). Histomorphometry revealed that neointima was present from day 7 and that amount of neointima increased up to day 28. Area of adventitia increased during the first 4 days and remained unchanged thereafter. Adventitial neovascularization by vasa vasorum was observed from day 4 onward. CONCLUSIONS Formation of neoadventitia precedes late loss of lumen, constrictive remodeling, and formation of neointima. The time course of vascular remodeling coincides with growth of neointima rather than with changes in the adventitia.
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Affiliation(s)
- M Maeng
- Department of Cardiology, Skejby University Hospital and Institute of Experimental Clinical Research, Aarhus University, Denmark
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Clemmensen P, Grande P, Nielsen WB, Madsen JK, Saunamäki K, Kassis E, Thayssen P, Eriksen U, Rasmussen K, Haunsø S, Nielsen TT, Haghfelt T, Wagner GS. Evolving non-Q wave versus Q wave myocardial infarction after thrombolysis: a high risk population benefitting from early revascularization. A DANAMI substudy. J Electrocardiol 2001; 33 Suppl:65-6. [PMID: 11265738 DOI: 10.1054/jelc.2000.20340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- P Clemmensen
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
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Madsen JK, Nielsen TT. [Unstable angina pectoris and non-Q-myocardial infarction. The Danish Society of Cardiology]. Ugeskr Laeger 2001; 163:1712. [PMID: 11284412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- J K Madsen
- Hjertecentret, H:S Rigshospitalet, DK-2100 København ø
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Randsbaek F, Kimose HH, Hansen SB, Jacobsen B, Bøtker HE, Nielsen TT. Captopril improves oxygen and glucose extraction in pig hearts during reperfusion after cold cardioplegic storage. SCAND CARDIOVASC J 2001; 34:201-8. [PMID: 10872711 DOI: 10.1080/14017430050142260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The purpose of this study was to evaluate the haemodynamic and metabolic effects of captopril during reperfusion of pig hearts following 360 min global hypothermic cardioplegia and storage (HCS). The hearts were perfused with one litre of cold crystalloid cardioplegia (Bretschneider solution no. 3), excised and stored in saline at 4 degrees C for 360 min. The hearts were then reperfused with blood in a modified Langendorff model for 60 min. Left ventricular function, myocardial blood flow, and arteriovenous differences in oxygen, glucose and lactate were monitored intraoperatively and during reperfusion. Two groups of hearts were studied. Group I (captopril treated, n = 9): the pigs were pre-medicated with increasing oral doses of captopril for 3 weeks (12.5 mg-150 mg daily) and an intravenous dose (25 mg) upon arrival at the laboratory. Captopril was added to the cardioplegia (1000 microg/l) and to the reperfusion media (1000 microg/l). Group II (controls, n = 8): the pigs were given no premedication, captopril-free cardioplegia and the hearts were reperfused with captopril-free blood. Captopril increased myocardial oxygen and glucose extraction during reperfusion (p < 0.05 for both) while lactate remained unchanged after 360 min HCS. Treatments with captopril increased developed left ventricular pressure (DLVP) and relaxation (-dP/dtmax) during reperfusion (p < 0.05 for both), while contractility (+dP/dtmax) was unchanged. Heart rate was reduced in captopril-treated hearts (p < 0.05) while myocardial blood flow (MBF) was similar in the two groups. Captopril administration prior to and during HCS and postcardioplegic reperfusion improves oxygen and glucose extraction in large spontaneously beating porcine hearts during reperfusion. The underlying mechanisms seem to involve metabolic modulation, since myocardial uptake of oxygen and glucose was increased in the absence of changes in myocardial blood flow.
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Affiliation(s)
- F Randsbaek
- Department of Cardiology, Aarhus University Hospital at Skejby, University of Aarhus, Denmark.
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Bøttcher M, Madsen MM, Refsgaard J, Buus NH, Dørup I, Nielsen TT, Sørensen K. Peripheral flow response to transient arterial forearm occlusion does not reflect myocardial perfusion reserve. Circulation 2001; 103:1109-14. [PMID: 11222474 DOI: 10.1161/01.cir.103.8.1109] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasonographic evaluation of systemic arterial function is widely available, and a close relation of endothelial function in the coronary and brachial arteries has been documented. It is unknown, however, whether a similar correlation exists for their 2 microcirculatory territories and thus whether assessment of the systemic microcirculation can be used similarly as a surrogate marker of myocardial perfusion. METHODS AND RESULTS Twenty-three patients with documented coronary artery disease (CAD; 66+/-9 years old, 18 men), 16 patients with syndrome X (SX; 56+/-5 years old, 13 women), and 45 healthy control subjects (C; 34+/-9 years old, 22 men) were studied. Myocardial perfusion was measured at rest and after dipyridamole (0.56 mg. kg(-1). min(-1) over 4 minutes) by PET, and brachial artery blood flow was measured at rest and after transient forearm ischemia by standard Doppler ultrasound techniques. Dipyridamole increased myocardial perfusion in all groups (mL. g(-1). min(-1): CAD, 0.89+/-0.27 versus 1.62+/-0.67, P:<0.001; SX, 0.82+/-0.16 versus 1.67+/-0.49, P:<0.001; and C, 0.82+/-0.15 versus 2.32+/-0.64, P:<0.001). Postocclusion forearm flow increased similarly in all groups (CAD, 52+/-18 versus 174+/-77 mL/min, P:<0.001; SX, 49+/-29 versus 202+/-82 mL/min, P:<0.001; and C, 61+/-34 versus 229+/-108 mL/min, P:<0.001). No significant correlations were found between peripheral and myocardial microcirculatory beds for either resting flow, hyperemic flow, or flow reserve in any of the groups (r(2)<0.1, P:=NS). CONCLUSIONS The peripheral perfusion responses to transient forearm ischemia do not correlate with dipyridamole-induced myocardial hyperemia. The lack of correlation indicates different mechanisms of microvascular activation or regulation and confirms that extrapolations between findings in the 2 vascular beds are not suitable.
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Affiliation(s)
- M Bøttcher
- Department of Cardiology B, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark.
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Maeng M, den Heijer P, Olesen PG, Emmertsen NC, Nielsen TT, Falk E, Andersen HR. Histopathologic validation of in-vivo angioscopic observation of coronary thrombus after angioplasty in a porcine model. Coron Artery Dis 2001; 12:53-9. [PMID: 11211166 DOI: 10.1097/00019501-200102000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coronary angioscopy has been reported to be superior to angiography and intravascular ultrasound for detecting intracoronary thrombus. However, in-vivo histopathologic validation of angioscopic detection of intracoronary thrombus had not been performed. OBJECTIVE To perform histopathologic validation of in-vivo angioscopic detection of coronary thrombus. DESIGN An experimental, blinded comparison of angioscopy and histopathology. METHODS Coronary angioscopy was performed from 0 to 14 days after angioplasty in 39 porcine coronary arteries. When thrombus was detected by angioscopy, it was subclassified into white, mixed red-white, or red thrombus according to color. By histopathology the presence of thrombus was determined and subclassified into platelet-rich, mixed platelet-erythrocyte, or erythrocyte-rich thrombus. RESULTS Angioscopy correctly classified 19 of 21 coronary thrombi (sensitivity 90%) but incorrectly classified nine of 18 arteries without formation of thrombus as having a thrombus (specificity 50%). Positive and negative predictive values were 68 and 82%, respectively. The angioscopic subclassification of thrombus into white, mixed red-white, or red thrombi was not correlated to the corresponding histopathologic morphology (platelet-rich, mixed platelet-erythrocyte, or erythrocyte-rich) of the observed thrombi (chi2 test: P = 0.5). CONCLUSIONS Angioscopic detection of thrombus in vivo had high sensitivity and negative predictive value but low-to-moderate specificity and positive predictive value. Visual assessment of color of angioscopically detected thrombi seemed not to reflect histopathologic morphology of thrombus according to the definitions used in the present study.
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Affiliation(s)
- M Maeng
- Department of Cardiology, Skejby University Hospital, and Institute of Experimental Clinical Research, Arhus University, Denmark
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Wiggers H, Noreng M, Paulsen PK, Bøttcher M, Egeblad H, Nielsen TT, Bøtker HE. Energy stores and metabolites in chronic reversibly and irreversibly dysfunctional myocardium in humans. J Am Coll Cardiol 2001; 37:100-8. [PMID: 11153723 DOI: 10.1016/s0735-1097(00)01059-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Our goal was to study metabolic energy stores and lactate content in chronic reversibly and irreversibly dysfunctional myocardium. BACKGROUND It is unknown whether metabolism is deranged in chronic reversibly and irreversibly dysfunctional myocardium in humans. Semiquantitative histological examinations have shown altered mitochondrial morphology and glycogen accumulation in dysfunctional regions. METHODS We studied 25 patients with a mean ejection fraction of 38 +/- 9% scheduled for coronary artery bypass surgery. Regional perfusion and metabolism were assessed by positron emission tomography, and regional function was assessed by echocardiography. Perioperative myocardial biopsies were obtained from a control region and from a dysfunctional region. We analyzed biopsies for contents of noncollagen protein (NCP), ATP, ADP, AMP, glycogen and lactate. Six months after surgery we assessed wall motion by echocardiography to group patients in those with (n = 11) and without (n = 14) functional improvement. RESULTS Reversibly dysfunctional myocardium had reduced perfusion (0.59 +/- 0.16 vs. 0.69 +/- 0.20 ml/g/min, p < 0.05), similar glucose-tracer uptake (92 +/- 12 and 95 +/- 14%), ATP/ADP ratio (2.4 +/- 1.1 and 2.4 +/- 0.7), glycogen content (631 +/- 174 and 632 +/- 148 nmol/microg NCP) and lactate levels (59 +/- 27 and 52 +/- 29 nmol/microg NCP) compared with control regions. Irreversibly dysfunctional regions (n = 14) had severely reduced perfusion (0.48 +/- 0.15 vs. 0.72 +/- 0.12 ml/g/min, p < 0.001) and glucose-tracer uptake (52 +/- 16 vs. 94 +/- 15%, p < 0.001), reduced ATP/ADP ratio (1.5 +/- 0.9 vs. 2.3 +/- 0.9, p < 0.05), similar glycogen content (579 +/- 265 vs. 593 +/- 127 nmol/microg NCP) and increased lactate levels (114 +/- 52 vs. 89 +/- 24 nmol/microg NCP, p < 0.01) compared with control regions. CONCLUSIONS Contents of metabolic energy stores and lactate in chronic reversibly dysfunctional myocardium were preserved. In contrast, energy stores were depleted in myocardium without functional recovery after revascularization.
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Affiliation(s)
- H Wiggers
- Department of Cardiology, Skejby Hospital, Aarhus, Denmark.
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Wiggers H, Nielsen TT, Bøttcher M, Egeblad H, Bøtker HE. Positron emission tomography and low-dose dobutamine echocardiography in the prediction of postrevascularization improvement in left ventricular function and exercise parameters. Am Heart J 2000; 140:928-36. [PMID: 11099997 DOI: 10.1067/mhj.2000.110766] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We studied the value of low-dose dobutamine echocardiography (LDDE) and positron emission tomography (PET) in predicting improvement of left ventricular function and exercise parameters after revascularization. METHODS Forty-six consecutive patients with ischemic heart disease and an ejection fraction (EF) of 35% +/- 7% were included. Before revascularization, the patients underwent exercise testing and myocardial viability testing by LDDE and fluoride 18-fluoro-2-deoxyglucose PET. Six months after revascularization they underwent coronary angiography to study graft patency, and echocardiographic examination and the exercise test were repeated. RESULTS In the prediction of the presence or absence of improved postrevascularization function in left ventricular regions with patent grafts, PET was more sensitive than LDDE (42/52 regions [81%] vs 27/52 regions [51%], P <.01), whereas LDDE was more specific than PET (187/209 regions [89%] vs 118/209 regions [56%], P <.001). Improvement of regional myocardial dysfunction was found in 19 patients, but their global left ventricular function did not improve significantly (EF 34% +/- 6% and 36% +/- 7%). In the remaining 27 patients with irreversible dysfunction, EF decreased (EF 36% +/- 7% vs 32% +/- 8%, P <.05). Among patients with reversible myocardial dysfunction, the rate pressure product (RPP) increased after revascularization (19,522 +/- 5474 vs 26,190 +/- 5610 mm Hg/min, P <.01), whereas the RPP did not change in patients with irreversible myocardial dysfunction (21,546 +/- 5450 and 22,774 +/- 8249 mm Hg/min). The number of PET viable segments was a predictor of the postoperative increase in the RPP in univariate (P <.04) and multivariate analyses (P <.001). In contrast, LDDE did not bear any prognostic information about improvement in the RPP. CONCLUSIONS This study confirms earlier findings of higher sensitivity and lower specificity of PET compared with LDDE in predicting improvement of regional left ventricular function after revascularization. However, the feasibility of predicting postrevascularization improvement of exercise parameters seems unique for PET. The potential prognostic value of this finding needs further investigation.
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Affiliation(s)
- H Wiggers
- Department of Cardiology, Skejby Hospital, Aarhus University Hospitals, Aarhus, Denmark.
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