Relationship between PCSK9 and endothelial function in patients with acute myocardial infarction

PCSK9 in Vascular Aging and Age-Related Diseases

The aging process significantly contributes to human disease, and as worldwide life expectancy increases, addressing the challenges of aging and age-related cardiovascular diseases is becoming increasingly urgent. Vascular aging is a key link between aging and the development of age-related diseases. Recent studies indicate that proprotein convertase subtilisin/kexin type 9 (PCSK9), a type of protein involved in the metabolism of lipids, is crucial in modulating vascular aging by affecting the physiological functioning of vascular cells. PCSK9 is linked to lipid metabolism and chronic inflammation and is involved in regulating senescence-related activities, including migration, proliferation, apoptosis, and differentiation. These factors contribute to the aging of vascular cells and age-related vascular diseases, including atherosclerosis, hypertension, coronary artery disease, and cerebrovascular diseases. Given its involvement in these processes, this article provides a comprehensive summary of PCSK9's regulatory functions in vascular aging, highlighting potential therapeutic targets for combating age-related cardiovascular diseases.

Fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) relationship in patients with chronic or stabilized acute coronary syndromes

AIMS

To investigate the influence of index of microcirculatory resistance (IMR) on fractional flow reserve (FFR) and adenosine-induced hyperemia (ΔPd/Pa-FFR) in patients with chronic (CCS) or stabilized acute coronary syndromes (ACS), utilizing various IMR threshold values.

METHODS

Data were extracted from two ongoing Italian registries involving patients with CCS or stabilized ACS who underwent a #FullPhysiology approach [Pd/Pa, FFR, IMR, coronary flow reserve (CFR)] by bolus thermodilution technique in the left anterior descending artery. Correlations between IMR and both FFR and ΔPd/Pa-FFR were analyzed both globally and within three IMR-defined groups: Group 1 (IMR <25), Group 2 (25 ≤ IMR <40), and Group 3 (IMR ≥40). A multiple linear regression was employed to adjust for confounding factors.

RESULTS

Of 275 patients, 163 were in Group 1, 60 in Group 2, and 52 in Group 3. Globally, a weak but significant correlation was observed between IMR and both FFR (r = 0.170, p < 0.01) and ΔPd/Pa-FFR (r = -0.159, p < 0.01). After stratification only patients in Group 3 exhibited a significant and more pronounced, though still weak, correlation between FFR and IMR (r = 0.387, p < 0.01) coupled with a reduction of ΔPd/Pa-FFR as IMR values increased (r = -0.411, p < 0.01). After adjustment, a significant increase of 0.01 in FFR values was observed for every 14-unit rise in IMR (p < 0.01) in Group 3.

CONCLUSIONS

FFR appears particularly influenced by elevated IMR values (≥40) highlighting the importance of the #FullPhysiology approach in understanding epicardial and microvascular contribution of myocardial ischemia.

Disulfidptosis-related gene in acute myocardial infarction and immune microenvironment analysis: A bioinformatics analysis and validation

Disulfidptosis is a newly discovered method of cell death. However, no studies have fully elucidated the role of disulfidptosis-related genes (DSRGs) in acute myocardial infarction (AMI). The potential role of DSRGs in AMI was analyzed through a comprehensive bioinformatics approach. Finally, hub genes were verified in vitro by qPCR. Sixteen DE-DSRGs were in the AMI. Thereafter, seven hub genes were determined by machine learning algorithms, which had potential diagnostic value in AMI. The risk model showed a robust diagnostic value (area under curve, AUC = 0.940). Prognostic analysis revealed the potential prognostic value of INF2 and CD2AP. Immune landscape analysis showed that hub genes were closely related to the immune microenvironment. By predictive analysis, we obtained four miRNAs, thirteen small molecule drugs, and five TFs closely related to hub genes. Experimental verification revealed that Slc3a2 and Inf2 were significantly up-regulated and Dstn was significantly down-regulated in the hypoxic model. Our study demonstrated that DSRGs are disorderedly expressed in AMI and identified seven hub genes through machine learning. In addition, a diagnostic model was constructed based on hub genes, providing a new perspective for the early diagnosis of AMI.

Exploring research trends and hotspots on PCSK9 inhibitor studies: a bibliometric and visual analysis spanning 2007 to 2023

Background

Following the identification of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, research in this area has experienced significant growth. However, a thorough bibliometric analysis of this burgeoning field remains conspicuously absent. The current study aims to delineate research hotspots and anticipate future trends on PCSK9 inhibitors employing bibliometric analysis.

Methods

A systematic search was conducted in the Web of Science Core Collection (WoSCC) to identify scholarly articles and reviews pertaining to PCSK9 inhibitors, yielding 1,812 documents. Data extraction was followed by analysis and visualization using Excel, VOSviewer, and CiteSpace software.

Results

A total of 1,812 publications were included in the final analysis. Ray, KK from the UK was the most prolific author, followed by Pordy, R from the USA. The USA led in publication output [number of publications (Np):776] and number of citations without self-citations (Nc) at 34,289, as well as an H-index of 93. "Cardiovascular System Cardiology" emerged as the predominant subject area. Amgen and the Journal of Clinical Lipidology were identified as the most active institution and journal, respectively. Keywords such as "lipoprotein(a)," "bempedoic acid," "percutaneous coronary intervention," "inclisiran," "peripheral artery disease," "mortality," and "endothelial dysfunction" are gaining prominence in the field.

Conclusion

The research on PCSK9 inhibitors is experiencing a sustained growth trajectory. The USA exerts considerable influence in this area, with the Journal of Clinical Lipidology expected to feature more groundbreaking studies. Research on "lipoprotein(a)", "bempedoic acid", "percutaneous coronary intervention", "peripheral artery disease", and "endothelial dysfunction" are poised to become focal points of future investigation.

Serum from COVID-19 patients promotes endothelial cell dysfunction through protease-activated receptor 2

BACKGROUND

Endothelial dysfunction plays a central role in the pathophysiology of COVID-19 and is closely linked to the severity and mortality of the disease. The inflammatory response to SARS-CoV-2 infection can alter the capacity of the endothelium to regulate vascular tone, immune responses, and the balance between anti-thrombotic and pro-thrombotic properties. However, the specific endothelial pathways altered during COVID-19 still need to be fully understood.

OBJECTIVE

In this study, we sought to identify molecular changes in endothelial cells induced by circulating factors characteristic of COVID-19.

METHODS AND RESULTS

To this aim, we cultured endothelial cells with sera from patients with COVID-19 or non-COVID-19 pneumonia. Through transcriptomic analysis, we were able to identify a distinctive endothelial phenotype that is induced by sera from COVID-19 patients. We confirmed and expanded this observation in vitro by showing that COVID-19 serum alters functional properties of endothelial cells leading to increased apoptosis, loss of barrier integrity, and hypercoagulability. Furthermore, we demonstrated that these endothelial dysfunctions are mediated by protease-activated receptor 2 (PAR-2), as predicted by transcriptome network analysis validated by in vitro functional assays.

CONCLUSION

Our findings provide the rationale for further studies to evaluate whether targeting PAR-2 may be a clinically effective strategy to counteract endothelial dysfunction in COVID-19.

Soluble PCSK9 Inhibition: Indications, Clinical Impact, New Molecular Insights and Practical Approach-Where Do We Stand?

Current research on cardiovascular prevention predominantly focuses on risk-stratification and management of patients with coronary artery disease (CAD) to optimize their prognosis. Several basic, translational and clinical research efforts aim to determine the etiological mechanisms underlying CAD pathogenesis and to identify lifestyle-dependent metabolic risk factors or genetic and epigenetic parameters responsible for CAD occurrence and/or progression. A log-linear association between the absolute exposure of LDL cholesterol (LDL-C) and the risk of atherosclerotic cardio-vascular disease (ASCVD) was well documented over the year. LDL-C was identified as the principal enemy to fight against, and soluble proprotein convertase subtilisin kexin type 9 (PCSK9) was attributed the role of a powerful regulator of blood LDL-C levels. The two currently available antibodies (alirocumab and evolocumab) against PCSK9 are fully human engineered IgG that bind to soluble PCSK9 and avoid its interaction with the LDLR. As documented by modern and dedicated "game-changer" trials, antibodies against soluble PCSK9 reduce LDL-C levels by at least 60 percent when used alone and up to 85 percent when used in combination with high-intensity statins and/or other hypolipidemic therapies, including ezetimibe. Their clinical indications are well established, but new areas of use are advocated. Several clues suggest that regulation of PCSK9 represents a cornerstone of cardiovascular prevention, partly because of some pleiotropic effects attributed to these newly developed drugs. New mechanisms of PCSK9 regulation are being explored, and further efforts need to be put in place to reach patients with these new therapies. The aim of this manuscript is to perform a narrative review of the literature on soluble PCSK9 inhibitor drugs, with a focus on their indications and clinical impact.