Flow-mediated dilation shows impaired endothelial function in patients with mastocytosis

Case Report: A case of Kounis syndrome induced by iodine contrast agent during coronary angiography

Kounis Syndrome (KS), a seldom-seen adverse reaction to iodine contrast agents, has an incidence that remains unclear. At present, there are no unified guidelines for managing KS either nationally or internationally. Ioversol, a new triiodinated hypotonic nonionic contrast agent, is commonly used in cardiovascular Computed Tomography (CT) and vascular imaging for diagnostic purposes. Its principal adverse reactions encompass fever, dermatological responses, convulsions, respiratory distress, hypersensitivity reactions including KS, and acute renal injury. This paper documents a case of KS induced by an iodine contrast agent during coronary angiography and, at the same time, searches for related literature and carries out a summary analysis in an attempt to provide a dependable reference for clinicians to make accurate diagnoses and treatments.

Clinical value of flow-mediated dilatation of brachial artery in hypertensive disorders complicating pregnancy

Hypertensive disorders complicating pregnancy (HDCP) are common pregnancy-related disorders. In this study, we aimed to study the clinical value of flow-mediated dilation (FMD) in HDCP and its association with endothelial dysfunction and HDCP-related factors. 160 HDCP patients and 120 healthy pregnancies were enrolled in the study. The expressions of endothelial function markers and FMD were determined. In addition, their correlations in HDCP patients were also analyzed using Pearson's correlation analysis. FMD value decreased gradually from normal pregnancy to severe PE. The levels of plasma nitric oxidase (NO) were significantly lower in the HDCP group than those in the control group, while the levels of plasma endothelin-1 (ET-1) were increased dramatically in the HDCP group. Moreover, the levels of placental growth factor (PLGF) in HDCP women were significantly lower, while the soluble FMS-like tyrosine kinase 1 (sFLt-1) levels were markedly higher than those in control. In addition, the FMD value was correlated with the levels of plasma NO, ET-1, PLGF and sFlt1. It was also found that lower levels of FMD correspond to endothelial dysfunction and abnormal concentrations of PLGF and sFlt-1. The FMD value was associated with endothelial function indicators and could be a strong and non-invasive measure to predict HDCP. The association between the FMD values and endothelial function indicators in HDCP could be helpful for the prediction of pregnant hypertension more accurately.

Vascular endothelial dysfunction in gestational diabetes mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) is a common pregnancy-related disorder that pregnant women without diabetes develop glucose tolerance during pregnancy. Endothelial dysfunction is the early event of vascular complications of diabetes. However, the role of endothelial dysfunction in GDM remains unknown. In this study, we hypothesize that there is a correlation between endothelial dysfunction and GDM indexes in the patients.

METHODS

96 GDM patients and 96 gestational week-matched healthy pregnancies with normal glucose tolerance were recruited in our study. The expressions of endothelial function markers, including nitride oxidase (NO) and endothelin-1 (ET-1), as well as flow-mediated dilatation (FMD), were measured. In addition, their correlation in GDM patients were also analyzed using Pearson's correlation analysis.

RESULTS

GDM patients displayed decrease on FMD and serum NO levels with an increase on serum ET-1 secretion in comparison with normal glucose tolerance group. ROC analysis identified the predictive value of FMD, ET-1 and NO for GDM. Furthermore, endothelial dysfunction was correlated with both fasting plasma glucose and plasma glucose levels after 1 h or 2 h of oral glucose tolerance test in GDM patients.

CONCLUSION

Our data indicated that endothelial dysfunction was associated with GDM, and these markers might serve as potential biomarkers for GDM.

Pathophysiological, Cellular, and Molecular Events of the Vascular System in Anaphylaxis

Anaphylaxis is a systemic hypersensitivity reaction that can be life threatening. Mechanistically, it results from the immune activation and release of a variety of mediators that give rise to the signs and symptoms of this pathological event. For years, most of the research in anaphylaxis has focused on the contribution of the immune component. However, approaches that shed light on the participation of other cellular and molecular agents are necessary. Among them, the vascular niche receives the various signals (e.g., histamine) that elicit the range of anaphylactic events. Cardiovascular manifestations such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and cardiac alterations are crucial in the pathophysiology of anaphylaxis and are highly involved to the development of the most severe cases. Specifically, the endothelium, vascular smooth muscle cells, and their molecular signaling outcomes play an essential role downstream of the immune reaction. Therefore, in this review, we synthesized the vascular changes observed during anaphylaxis as well as its cellular and molecular components. As the risk of anaphylaxis exists both in clinical procedures and in routine life, increasing our knowledge of the vascular physiology and their molecular mechanism will enable us to improve the clinical management and how to treat or prevent anaphylaxis.

Key Message

Anaphylaxis, the most severe allergic reaction, involves a variety of immune and non-immune molecular signals that give rise to its pathophysiological manifestations. Importantly, the vascular system is engaged in processes relevant to anaphylactic events such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and decreased cardiac output. The novelty of this review focuses on the fact that new studies will greatly improve the understanding of anaphylaxis when viewed from a vascular molecular angle and specifically from the endothelium. This knowledge will improve therapeutic options to treat or prevent anaphylaxis.

New Biomarkers in Anaphylaxis (Beyond Tryptase)

Purpose of Review

The purpose of this review is to provide a better understanding of anaphylaxis pathophysiology and describe the underlying mechanisms, effector cells, and the potential biomarkers involved depending on the anaphylaxis endotypes.

Recent Findings

New insight into the potential relevance of pathways others than IgE-dependent anaphylaxis has been unraveled, as well as other biomarkers than tryptase, such as the role of platelet activation factor, basogranulin, dipeptidyl peptidase I, CCL-2, and other cytokines.

Summary

Gaining knowledge of all the mediators and cellular activation/communication pathways involved in each endotype of anaphylaxis will allow the application of precision medicine in patients with anaphylactic reactions, providing insights to the most appropriate approach in each case and helping to stratify severity and risk prediction.

Association of enhanced circulating trimethylamine N-oxide with vascular endothelial dysfunction in periodontitis patients

BACKGROUND

Accumulating evidences indicate that periodontitis is closely associated with endothelial dysfunction. Trimethylamine-N-oxide (TMAO), a harmful microbiota generated metabolite, has been implicated as a nontraditional risk factor for impaired endothelial function. However, whether increased circulating levels of TMAO in periodontitis patients induces endothelial dysfunction remains unknown.

METHODS

Patients with periodontitis and periodontally healthy controls were enrolled. Periodontal inflamed surface area (PISA) was calculated to assess the inflammatory burden posed by periodontitis. The circulating TMAO was measured by high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS). Vascular endothelial function including peripheral endothelial progenitor cells (EPCs), brachial arterial flow-mediated vasodilation (FMD), and brachial-ankle pulse wave velocity (baPWV) were assessed. We also isolated and cultured EPCs from participants' peripheral blood to investigate the effect of TMAO on EPC functions in vitro.

RESULTS

One hundred and twenty two patients with Stage III-IV periodontitis and 81 healthy controls were included. Patients with periodontitis presented elevated TMAO (P = 0.002), lower EPCs (P = 0.025), and declined FMD levels (P = 0.005). The TMAO concentrations were correlated with reduced circulating EPCs and FMD levels. Moreover, TMAO can injury EPCs function in vitro, and may induce cell pyroptosis via Bax/caspase-3/GSDME pathway.

CONCLUSIONS

The present study demonstrates for the first time that circulating TMAO levels are increased in patients with Stage III-IV periodontitis, and correlated with vascular endothelial dysfunction. These findings may provide a novel insight into the mechanism of vascular endothelial dysfunction in patient with periodontitis via TMAO-downregulated EPC functions.

Impaired endothelial function irrespective of systemic inflammation or atherosclerosis in mastocytosis

BACKGROUND

Knowledge on endothelial dysfunction and its relation to atherosclerosis in mastocytosis is limited.

OBJECTIVE

To investigate the endothelial function in mastocytosis by flow-mediated dilatation (FMD) and biomarkers related to vascular endothelia and to evaluate its relationship with the presence of subclinical atherosclerosis by carotid intima media thickness (CIMT).

METHODS

A total of 49 patients with mastocytosis and 25 healthy controls (HCs) were included. The FMD and CIMT during transthoracic echocardiography biomarkers including endocan, endothelin-1, and vascular endothelial growth factor (VEGF) were measured in the sera of participants. Tumor necrosis factor-alpha, interleukin 6, and high-sensitive C-reactive protein were determined as inflammatory biomarkers.

RESULTS

The mean FMD % was lower in the patients than HCs (11.26% ± 5.85% vs 17.84% ± 5.27% P < .001) and was the lowest in the advanced systemic mastocytosis and smoldering systemic mastocytosis group among the patients (P = .03). The median value of VEGF was considerably higher in patients than HCs (73.30 pg/mL; minimum-maximum 32.46-295.29 pg/mL vs 46.64 pg/mL; minimum-maximum, 11.09-99.86 pg/mL; P = .001) and it was the highest in the advanced systemic mastocytosis and smoldering systemic mastocytosis group (P = .01). The FMD was inversely correlated with endocan (r = -0.390; P = .006), endothelin-1 (r = -0.363; P = .01) and VEGF (r = -0.402; P = .004) but there were no correlations between FMD and tumor necrosis factor-alpha, interleukin 6, and high-sensitive C-reactive protein. No differences in CIMT values between patients and HCs and no correlation between CIMT and the biomarkers were observed.

CONCLUSION

Endothelial dysfunction in mastocytosis becomes evident with decreased FMD and elevated serum VEGF in the absence of atherosclerosis or systemic inflammation and is related to disease severity.

Vascular endothelial growth factors and angiopoietins as new players in mastocytosis

Mastocytosis is a disorder characterized by the abnormal proliferation and/or accumulation of mast cells in different organs. More than 90% of patients with systemic mastocytosis have a gain-of-function mutation in codon 816 of the KIT receptor on mast cells (MCs). The symptoms of mastocytosis patients are related to the MC-derived mediators that exert local and distant effects. MCs produce angiogenic and lymphangiogenic factors, including vascular endothelial growth factors (VEGFs) and angiopoietins (ANGPTs). Serum concentrations of VEGF-A, VEGF-C, VEGF-D, ANGPT1 and ANGPT2 were determined in 64 mastocytosis patients and 64 healthy controls. Intracellular concentrations and spontaneous release of these mediators were evaluated in the mast cell lines ROSA^{KIT WT} and ROSA ^{KIT D816V} and in human lung mast cells (HLMCs). VEGF-A, ANGPT1, ANGPT2 and VEGF-C concentrations were higher in mastocytosis patients compared to controls. The VEGF-A, ANGPT2 and VEGF-C concentrations were correlated with the symptom severity. ANGPT1 concentrations were increased in all patients compared to controls. ANGPT2 levels were correlated with severity of clinical variants and with tryptase levels. VEGF-A, ANGPT1 and VEGF-C did not differ between indolent and advanced mastocytosis. ROSA^{KIT WT}, ROSA^{KIT D816V} and HLMCs contained and spontaneously released VEGFs and ANGPTs. Serum concentrations of VEGFs and ANGPTs are altered in mastocytosis patients.

Olfactory Function Is Impaired in Patients with Mastocytosis

BACKGROUND

Mastocytosis is a clinically heterogeneous disorder associated with abnormal mast cell accumulation in different organs. No data are available as regards the assessment of olfactory function and its association with mastocytosis.

OBJECTIVE

The aim of the study was first to investigate odor threshold, discrimination, and identification in patients with mastocytosis compared with age-matched healthy controls (HC), and furthermore, to correlate olfactory function with the other clinical symptoms of mastocytosis.

METHODS

Eighty-one participants were enrolled: 41 patients with mastocytosis (23 males and 18 females; mean age, 47.95 years; standard deviation [SD], 14.7 years) were compared with 40 HC (23 males and 17 females; mean age, 47.88 years; SD, 14.6 years). Olfactory function among participants was evaluated using the "Sniffin' Sticks" test for odor detection threshold (OT), odor discrimination (OD), and odor identification (OI).

RESULTS

Patients with systemic mastocytosis showed a significant decrease in the total olfactory function (Threshold-Discrimination-Identification [TDI] score), OT, OD, and OI compared with HC. A significant negative correlation was observed only between TDI score and serum tryptase concentration (μg/L). No correlation was observed between disease duration versus OT, OD, OI, and TDI score.

CONCLUSIONS

Our results suggest that the olfactory function is impaired in patients compared with HC; a significant negative correlation was found between TDI score and the level of serum tryptase. Olfactory dysfunction in mastocytosis may be considered among the clinical manifestations contributing to the burden of this disease.