Peripheral blood mononuclear cell hyperresponsiveness in patients with premature myocardial infarction without traditional risk factors

Role of inflammation and haemostasis on aetiology and prognosis in young patients with ischaemic stroke: study protocol of the Observational Dutch Young Symptomatic StrokE study-EXTended (ODYSSEY-nEXT) - a multicentre prospective cohort study

INTRODUCTION

The cause of ischaemic stroke at a young age remains unknown in 30% of cases, highlighting the need to identify hidden causes and risk factors in young patients. Transient and chronic risk factors may interact with the inflammatory and haemostatic systems, potentially driving key mechanisms in the pathogenesis. The 'Observational Dutch Young StrokE study-Extended' (ODYSSEY-nEXT) aims to enhance our understanding of these complex interactions through detailed phenotyping of the immune and haemostatic system and explore their relationship with long-term prognosis.

METHODS AND ANALYSIS

The ODYSSEY-nEXT is a multicentre prospective controlled cohort study of patients aged 18-50 years with a first neuroimaging-proven ischaemic stroke or transient ischaemic attack and healthy controls. We aim to include a total of 200 patients and 60 controls between January 2023 and January 2027. Blood samples will be collected within 72 hours after the index event and at 3 months to assess inflammatory and haemostatic markers. In a subgroup of 20 patients, whole blood analysis will be performed to investigate ex vivo immune cell functionality, the capacity of platelets to release granules and thrombin generation. All patients will complete a questionnaire about trigger and risk factors. Advanced intracranial and extracranial vessel wall imaging with MRI will be performed within a week. Long-term prognosis will be monitored through annual questionnaires about recurrent events for ten years.

ETHICS AND DISSEMINATION

This study was approved by the Medical Ethical Committee region 'Oost-Nederland' (NL77518.091.21) and will adhere to the Declaration of Helsinki and its later amendments. Participants have to provide written informed consent, but in cases where the patient cannot sign due to physical limitations as a result of the stroke, such as paresis, verbal consent is obtained from the patient and a legal representative will be asked to sign the consent form on their behalf. The findings of this study will be disseminated to healthcare professionals and the scientific community through peer-reviewed publications and to participants through accessible formats such as summary reports or newsletters.

TRIAL REGISTRATION NUMBER

NCT05853796.

The alpha 7 nicotinic acetylcholine receptor agonist PHA 568487 dampens inflammation in PBMCs from patients with newly discovered coronary artery disease

The alpha 7 nicotinic acetylcholine receptor (α7nAChR) regulates inflammation in experimental models and is expressed in human peripheral blood mononuclear cells (PBMCs) and in human atherosclerotic plaques. However, its role in regulating inflammation in patients with cardiovascular disease is unknown. This study aims to investigate whether α7nAChR stimulation can reduce the inflammatory response in PBMCs from patients with newly diagnosed coronary artery disease (CAD). Human PBMCs, extracted from patients with verified CAD (n = 38) and control participants with healthy vessels (n = 38), were challenged in vitro with lipopolysaccharide (LPS) in combination with the α7nAChR agonist PHA 568487. Cytokine levels of the supernatants were analyzed using a multiplex immunoassay. Patients in the CAD group were reexamined after 6 mo. The immune response to LPS did not differ between PBMCs from control and CAD groups. α7nAChR stimulation decreased TNFα in both control and CAD groups. The most pronounced effect of α7nAChR stimulation was observed in patients with CAD at their first visit, where 15 of 17 cytokines were decreased [IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-12 (p70), IL-17A, G-CSF, GM-CSF, IFN-γ, MCP-1, MIP-1β, and TNFα]. In conclusion, stimulation with α7nAChR agonist PHA 568487 dampens the inflammatory response in human PBMCs. This finding suggests that the anti-inflammatory properties of the α7nAChR may have a role in treating CAD.NEW & NOTEWORTHY The α7nAChR is an important regulator of inflammation; however, its anti-inflammatory function in patients with newly diagnosed coronary artery disease (CAD) remains unclear. We demonstrate that stimulation of α7nAChR with PHA 568487 attenuates the inflammatory response in immune cells extracted from healthy controls and patients with newly diagnosed CAD, with a more pronounced effect observed in patients with CAD. This suggests that the anti-inflammatory properties of α7nAChR may have a role in treating chronic inflammatory diseases.