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Autoantibodies in Atrial Fibrillation-State of the Art. Int J Mol Sci 2023; 24:ijms24031852. [PMID: 36768174 PMCID: PMC9916061 DOI: 10.3390/ijms24031852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. To date, a lot of research has been conducted to investigate the underlying mechanisms of this disease at both molecular and cellular levels. There is increasing evidence suggesting that autoimmunity is an important factor in the initiation and perpetuation of AF. Autoantibodies are thought to play a pivotal role in the regulation of heart rhythm and the conduction system and, therefore, are associated with AF development. In this review, we have summarized current knowledge concerning the role of autoantibodies in AF development as well as their prognostic and predictive value in this disease. The establishment of the autoantibody profile of separate AF patient groups may appear to be crucial in terms of developing novel treatment approaches for those patients; however, the exact role of various autoantibodies in AF is still a matter of ongoing debate.
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An ACE inhibitory peptide from Isochrysis zhanjiangensis exhibits antihypertensive effect via anti-inflammation and anti-apoptosis in HUVEC and hypertensive rats. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Wang J, Li D, Zhang Z, Zhang Y, Lei Z, Jin W, Cao J, Jiao X. Autoantibody against angiotensin II type I receptor induces pancreatic β-cell apoptosis via enhancing autophagy. Acta Biochim Biophys Sin (Shanghai) 2021; 53:784-795. [PMID: 33928341 DOI: 10.1093/abbs/gmab049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
Autoantibody against the angiotensin II type I receptor (AT1-AA) has been found in the serum of patients with diabetes mellitus (DM). However, it remains unclear whether AT1-AA induces β-cell apoptosis and participates in the development of DM. In this study, an AT1-AA-positive rat model was set up by active immunization, and AT1-AA IgG was purified. INS-1 cells were treated with AT1-AA, and cell viability, apoptosis, and autophagy-related proteins were detected by Cell Counting Kit-8 assay, flow cytometry, and western blot analysis, respectively. Results showed that existence of AT1-AA impaired the islet function and increased the apoptosis of pancreatic islet cells in rats, and the autophagy level in rat pancreatic islet tissues tended to increase gradually with the prolongation of immunization time. AT1-AA markedly reduced INS-1 cell viability, promoted cell apoptosis, and decreased insulin secretion in vitro. In addition, the autophagy level was gradually increased along with the prolongation of AT1-AA treatment time. Meanwhile, it was determined that treatment with autophagy inhibitor 3-methyladenine and angiotensin II type 1 receptor (AT1R) blocker telmisartan could improve insulin secretion and apoptosis in vitro and in vivo. In conclusion, it is deduced that upregulation of autophagy contributed to the AT1-AA-induced β-cell apoptosis and islet dysfunction, and AT1R mediated the signal transduction.
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Affiliation(s)
- Jin Wang
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan 030001, China
| | - Dan Li
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan 030001, China
| | - Zhinan Zhang
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan 030001, China
| | - Yan Zhang
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan 030001, China
| | - Zhandong Lei
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan 030001, China
| | - Wenwen Jin
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan 030001, China
| | - Jimin Cao
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan 030001, China
| | - Xiangying Jiao
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan 030001, China
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Tammelin K, Lundgren A, Holmberg M, Andersson B, Nyström HF. β1-adrenergic and Muscarinic Acetylcholine Type 2 Receptor Antibodies are Increased in Graves' Hyperthyroidism and Decrease During Antithyroid Therapy. Exp Clin Endocrinol Diabetes 2021; 129:783-790. [PMID: 33434937 DOI: 10.1055/a-1342-2853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the association between autoantibodies to G-protein-coupled receptors with effect on the cardiovascular system and the cardiac biomarker N-terminal pro-brain natriuretic peptide reflecting heart function in Graves' disease. DESIGN AND METHODS Sixty premenopausal women with Graves' disease were analyzed for IgG autoantibodies against β1-adrenergic, muscarinic acetylcholine type 2 and angiotensin II type 1 receptors using enzyme-linked immunosorbent assays based on cell membranes overexpressing receptors in their native conformations. N-terminal pro-brain natriuretic peptide and heart symptoms were analyzed in hyperthyroidism and after 7.5 months of antithyroid treatment. Matched thyroid healthy controls were also assessed. RESULTS Serum levels of antibodies against the β1-adrenergic and the muscarinic acetylcholine type 2 receptors were higher in hyperthyroid patients than in controls (median β1-adrenergic receptor antibodies 1.9 [IQR 1.3-2.7] vs. 1.1 [0.8-1.7] μg/mL, P<0.0001; muscarinic acetylcholine type 2 receptor 20.5 [14.0-38.3] vs. 6.0 [3.2-9.9] U/mL, P<0.0001). These antibodies decreased in euthyroidism (P<0.01), but were still higher than in controls (P<0.01). Angiotensin II type 1 receptor levels did not differ. N-terminal pro-brain natriuretic peptide was higher in hyperthyroidism (240 [134-372] vs. <35 [<35-67] ng/L, P<0.0001), normalized after treatment and did not correlate with autoantibodies. CONCLUSION Autoantibodies against the β1-adrenergic and the muscarinic acetylcholine type 2 receptors were increased in Graves' patients, decreased with treatment, but did not correlate with cardiac function. However, an autoimmune effect on the heart cannot be excluded in subpopulations, as the functional properties of the analyzed antibodies remain to be determined.
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Affiliation(s)
- Karin Tammelin
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anna Lundgren
- Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Biomedicine, Sahlgrenska Academy, Department of Microbiology and Immunology, University of Gothenburg, Sweden
| | - Mats Holmberg
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,ANOVA, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Andersson
- Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Filipsson Nyström
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, Gothenburg, Sweden
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Liu F, Yang G, Guo R, Xue L, Wang L, Guo J, Yang X. Increased levels of angiotensin II type 1 receptor autoantibodies in female infertility. Syst Biol Reprod Med 2020; 67:160-167. [PMID: 33073626 DOI: 10.1080/19396368.2020.1829172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this study, the level of serum anti-angiotensin II type 1 receptor autoantibodies (AT1-AA) was determined. It was found that the positive rate of AT1-AA in serum of infertile women is higher than that of healthy non-pregnant women. Spearman correlation analysis showed that AT1-AA was negatively correlated with oocyte maturation rate (r = -0.29, P < 0.01) and AT1-AA was positively correlated with IL-6 (r = 0.68, P < 0.01). Logistic regression analysis showed that age, BMI, type of infertility, years of infertility, history of poor pregnancy outcome, condition of fallopian tube, and polycystic ovary syndrome were not factors influencing the level of AT1-AA in the serum of infertile patients. The results indicated that AT1-AA was involved in the pathological changes of infertile women. AT1-AA may be related to oocyte maturation disorder, ovulation disorder. Interestingly it appears to induce an inflammatory reaction, although the specific mechanism is not clear. However, the level of AT1-AA is not affected by individual differences in infertile patients.Abbreviations: E2:estradiol; P:progesterone; RAS:Renin-angiotensin system; Ovras:renin-angiotensin system; ACE1:angiotensin-converting enzyme-1; AngII:angiotensin II; AT1R:Angiotensin II type 1 Receptor; BMI:Body Mass Index; AT1-A:anti-angiotensin II type 1 receptor autoantibodies.
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Affiliation(s)
- Fang Liu
- Reproductive Department of Taiyuan Central Hospital, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Guifang Yang
- Reproductive Department of Taiyuan Central Hospital, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruixia Guo
- Reproductive Department of Taiyuan Central Hospital, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Li Xue
- Reproductive Department of Taiyuan Central Hospital, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Lijuan Wang
- Reproductive Department of Taiyuan Central Hospital, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Jingjing Guo
- Reproductive Department of Taiyuan Central Hospital, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoli Yang
- Reproductive Department of Taiyuan Central Hospital, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
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Holmberg MO, Malmgren H, Berglund P, Bunketorp-Käll L, Heckemann RA, Johansson B, Klasson N, Olsson E, Skau S, Nystrom Filipsson H. Structural brain changes in hyperthyroid Graves' disease: protocol for an ongoing longitudinal, case-controlled study in Göteborg, Sweden-the CogThy project. BMJ Open 2019; 9:e031168. [PMID: 31685507 PMCID: PMC6858258 DOI: 10.1136/bmjopen-2019-031168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Cognitive impairment and reduced well-being are common manifestations of Graves' disease (GD). These symptoms are not only prevalent during the active phase of the disease but also often prevail for a long time after hyperthyroidism is considered cured. The pathogenic mechanisms involved in these brain-derived symptoms are currently unknown. The overall aim of the CogThy study is to identify the mechanism behind cognitive impairment to be able to recognise GD patients at risk. METHODS AND ANALYSIS The study is a longitudinal, single-centre, case-controlled study conducted in Göteborg, Sweden on premenopausal women with newly diagnosed GD. The subjects are examined: at referral, at inclusion and then every 3.25 months until 15 months. Examinations include: laboratory measurements; eye evaluation; neuropsychiatric and neuropsychological testing; structural MRI of the whole brain, orbits and medial temporal lobe structures; functional near-infrared spectroscopy of the cerebral prefrontal cortex and self-assessed quality of life questionnaires. The primary outcome measure is the change in medial temporal lobe structure volume. Secondary outcome measures include neuropsychological, neuropsychiatric, hormonal and autoantibody variables. The study opened for inclusion in September 2012 and close for inclusion in October 2019. It will provide novel information on the effect of GD on medial temporal lobe structures and cerebral cortex functionality as well as whether these changes are associated with cognitive and affective impairment, hormonal levels and/or autoantibody levels. It should lead to a broader understanding of the underlying pathogenesis and future treatment perspectives. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Regional Ethical Review Board in Göteborg, Sweden. The results will be actively disseminated through peer-reviewed journals, national and international conference presentations and among patient organisations after an appropriate embargo time. TRIAL REGISTRATION NUMBER 44321 at the public project database for research and development in Västra Götaland County, Sweden (https://www.researchweb.org/is/vgr/project/44321).
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Affiliation(s)
- Mats Olof Holmberg
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Göteborg, Sweden
| | - Helge Malmgren
- Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Göteborg, Sweden
- MedTech West, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Peter Berglund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Lina Bunketorp-Käll
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Rolf A Heckemann
- Division of Brain Sciences, Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Göteborg, Sweden
| | - Birgitta Johansson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Niklas Klasson
- MedTech West, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Erik Olsson
- Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Göteborg, Sweden
| | - Simon Skau
- MedTech West, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Helena Nystrom Filipsson
- Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Göteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
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Turan E, Can I, Turan Y, Uyar M, Cakır M. COMPARISON OF CARDIAC ARRHYTHMIA TYPES BETWEEN HYPERTHYROID PATIENTS WITH GRAVES' DISEASE AND TOXIC NODULAR GOITER. ACTA ENDOCRINOLOGICA-BUCHAREST 2018; 14:324-329. [PMID: 31149279 DOI: 10.4183/aeb.2018.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose Previous studies have demonstrated the relationship between hyperthyroidism and increased risk of cardiac arrhythmias. The most common causes of hyperthyroidism are Graves' disease (GD) and toxic nodular goiter (TNG). The aim of our study was to demonstrate if the underlying mechanism of hyperthyroidism, in other words autoimmunity, has an impact on the type of cardiac arrhythmias accompanying hyperthyroidism. Method Twenty patients with TNG and 16 patients with GD who had overt hyperthyroidism were included in the study. Age, sex, thyroid hormone levels, thyroid autoantibody positivity, thyroid ultrasonography and scintigraphy results were recorded. 24-hour Holter ECG monitoring was performed in all patients. Results Mean age was significantly higher in the TNG group compared to the GD group (62.9±11.5 vs. 48.9±8.6 years, p=0.001). Free T3 was significantly higher (7.87±3.90 vs. 5.21±1.53 pg/mL, p=0.033) in the GD group while free T4 and TSH levels were similar between the two groups. In 24-hour Holter ECG recordings nonsustained ventricular tachycardia (VT) rates were significantly higher in the GD group than in TNG group [18.75% (n=3/16) vs. 0% (n=0/20), respectively, (p=0.043)]. Paroxysmal atrial fibrillation (AF) rates were significantly higher in the TNG group compared to GD group [(30% (n=6/20) vs. 0% (n=0/16), respectively, (p=0.016)]. Conclusion Although free T3 levels were lower, paroxysmal AF rates were found significantly higher in the TNG group which may be associated with significantly higher age of this group. On the other hand, higher rate of nonsustained VT in the GD group may be related to either significantly higher free T3 levels or autoimmunity.
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Affiliation(s)
- E Turan
- Necmettin Erbakan University, Faculty of Medicine, Endocrinology and Metabolic Disorder, Konya, Turkey
| | - I Can
- Necmettin Erbakan University, Faculty of Medicine, Cardiology, Konya, Turkey
| | - Y Turan
- Necmettin Erbakan University, Faculty of Medicine, Cardiology, Konya, Turkey
| | - M Uyar
- Necmettin Erbakan University, Faculty of Medicine, Public Health, Konya, Turkey
| | - M Cakır
- Necmettin Erbakan University, Faculty of Medicine, Endocrinology, Konya, Turkey
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de Souza MVL, de Fátima Dos Santos Teixeira P, Vaisman M, Xavier SS. Is CHA 2DS 2-VASc appropriate for hyperthyroid patients with atrial fibrillation? Implications of adding a transesophageal echocardiography evaluation. Int J Cardiol 2016; 228:919-925. [PMID: 27912200 DOI: 10.1016/j.ijcard.2016.11.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/09/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anticoagulation remains a controversial issue among hyperthyroid patients with atrial fibrillation (AF). We aimed to evaluate the prevalence of the thrombogenic milieu (TM), detected using transesophageal echocardiography (TEE), among patients with AF related to hyperthyroidism, and to correlate these findings with the clinical embolic risk classification (CHA2DS2-VASc). METHODS CHA2DS2-VASc score, thyroid hormonal status, time since hyperthyroidism diagnosis, transthoracic echocardiography (TTE) and TEE were assessed in 47 consecutive patients aged between 18 and 65years with AF related to hyperthyroidism. The following TEE parameters defined TM: dense spontaneous echo contrast, thrombi, or left atrial appendage (LAA) blood flow velocities <0.20m/s. Non-classic TM was defined as non-dense SEC plus LAA flow velocity 0.20-0.40m/s. RESULTS Pulmonary hypertension was present in 39/47 (81.4%) and TM in 22/47 (46.8%) patients. Despite a low CHA2DS2-VASc score of 0/1, 10 of 19 (52.6%) patients had a TM, whereas 16 of 28 (57.1%) patients with score ≥2 had none. The probability of having a TM did not correlate with CHA2DS2-VASc scores. On regression binary analysis, hyperthyroidism diagnosed more than 12months previous was independently associated with non-classic TM (p=0.031). CONCLUSION Among patients younger than 65years of age with AF related to hyperthyroidism, pulmonary hypertension and TM on TEE were highly prevalent. There was no association between CHA2DS2-VASc with TEE markers of TM. Thyroid status, especially longer duration of hyperthyroidism might influence thrombogenic abnormalities. TEE adds useful information that may change antithrombotic therapy if otherwise guided solely by clinical risk classification.
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Affiliation(s)
- Marcus Vinicius Leitão de Souza
- Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Mario Vaisman
- Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio Salles Xavier
- Division of Cardiology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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The influence of immunoglobulin class G from blood plasma of patients with stroke on the activity of some parameters of hemostasis system. Blood Coagul Fibrinolysis 2016; 27:876-881. [PMID: 26825622 DOI: 10.1097/mbc.0000000000000497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Today, cardiovascular diseases are one of the main causes of disability of the population. Most of the illnesses, including stroke, are accompanied by the appearance immunoglobulin G (IgG) in the blood circulation. According to the literature sources and previous experiments, it is known that IgG made influence on the hemostasis system. Objectives of the investigation are pure enzymes: thrombin, factor X, proenzyme of protein C and prothrombin under the influence of IgG fraction that were separated from the plasma of patients with atherothrombotic and cardioembolic ischemic stroke and patients with other neurological diseases. IgG was separated by affinity chromatography. Disc electrophoresis was used to control antibodies' purity. The main goal of the experiment is to test the potential influence of all fractions of separated IgG on the process of hydrolysis of specific chromogenic substrates by the key factors of the hemostasis system such as thrombin, factor X and protein C. The appearance of IgG in the blood stream during the atherothrombotic and cardioembolic ischemic stroke and other neurological diseases was proved. Concentration of the IgG in plasma of patients with cardioembolic ischemic stroke was significantly higher compared with healthy donors, whereas the IgG in plasma of patients with atherothrombotic ischemic stroke and other neurological disorders was not significantly different. Their potential ability to influence the enzymes such as thrombin, factor X, proenzyme of protein C and prothrombin was shown. It was proved that the antibody fractions of all experimental groups significantly accelerate the process of splitting chromogenic substrate by thrombin but inhibited cleavage of a specific chromogenic substrate by protein C.
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Vascular hypothesis revisited: Role of stimulating antibodies against angiotensin and endothelin receptors in the pathogenesis of systemic sclerosis. Autoimmun Rev 2016; 15:690-4. [DOI: 10.1016/j.autrev.2016.03.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 12/21/2022]
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Lei J, Li Y, Zhang S, Wu Y, Wang P, Liu H. The Prognostic Role of Angiotensin II Type 1 Receptor Autoantibody in Non-Gravid Hypertension and Pre-eclampsia: A Meta-analysis and Our Studies. Medicine (Baltimore) 2016; 95:e3494. [PMID: 27124051 PMCID: PMC4998714 DOI: 10.1097/md.0000000000003494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Angiotensin II type 1 receptor autoantibody (AT1-AA) is found in patients with non-gravid hypertension or pre-eclampsia, but the relationship is uncertain.The aim of the present study was to assess the association between AT1-AA and high blood pressure using meta-analysis, and to evaluate the prognosis value of AT1-AA for hypertensive diseases.Literature search from PubMed, Embase, and Cochrane databases were conducted using keywords "hypertension" or "pre-eclampsia," "angiotensin II receptor type 1 autoantibody," and its aliases from April 1999 to December 2015.Studies evaluating the association between AT1-AA and non-gravid hypertension or pre-eclampsia were included in this analysis. The quality of the eligible studies was assessed based on the Newcastle-Ottawa Scale with some modifications.Two researchers then independently reviewed all included studies and extracted all relevant data. Association between AT1-AA and hypertension was tested with pooled odds ratios (ORs) and 95% confidence intervals (CIs). Finally, we evaluated whether AT1-AA predicted the prognosis of hypertension by using a summary receiver-operating characteristic (ROC) curve and sensitivity analysis.Ten studies were finally included in this meta-analysis. AT1-AA showed more significant association with pre-eclampsia than that with non-gravid hypertension (pooled OR 32.84, 95% CI 17.19-62.74; and pooled OR 4.18, 95% CI 2.20-7.98, respectively). Heterogeneity among studies was also detected probably due to different hypertensive subtypes and AT1-AA measuring methods. Area under summary ROC curve (AUC) of pre-eclampsia was 0.92 (sensitivity 0.76; specificity 0.86). Area under the ROC curve of overall hypertensive diseases or non-gravid hypertension was lower than that of pre-eclampsia (0.86 and 0.72, respectively) with lower sensitivities (0.46 and 0.26, respectively).The major limitation of this analysis was the publication bias due to lack of unpublished data and the language limitation during literature search. Prospective study with large simple size and specific measuring data collection are needed to enhance our findings in the future.Our analysis confirms that elevated AT1-AA in serum is significantly associated with hypertensive disorder, especially pre-eclampsia. AT1-AA may be a valuable indicator for poorer prognosis of patients with pre-eclampsia, and could be used in patients with hypertensive disease for risk evaluation and making individual treatment decision.
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Affiliation(s)
- Jinghui Lei
- From the Department of Physiology & Pathophysiology (JL, SZ, YW, PW, HL), School of Basic Medical Sciences, Capital Medical University, Beijing, China; Centers for Metabolic Disease Research (YL), Cardiovascular Research, and Thrombosis Research, Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA; Beijing Key Laboratory of Cardiovascular Diseases and Related Metabolic Dysfunction (JL, SZ, YW, PW, HL), Capital Medical University; and Department of Cardiology (HL), Capital Medical University, Beijing, China
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Tsymbaliuk I, Unukovych D, Shvets N, Dinets A. Cardiovascular complications secondary to Graves' disease: a prospective study from Ukraine. PLoS One 2015; 10:e0122388. [PMID: 25803030 PMCID: PMC4372210 DOI: 10.1371/journal.pone.0122388] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/21/2015] [Indexed: 12/26/2022] Open
Abstract
Background Graves’ disease (GD) is a common cause of hyperthyroidism resulting in development of thyrotoxic heart disease (THD). Objectives to assess cardiovascular disorders and health related quality of life (HRQoL) in patients with THD secondary to GD. Patients and Methods All patients diagnosed with THD secondary to GD between January 2011 and December 2013 were eligible for this study. Clinical assessment was performed at baseline and at the follow-up visit after the restoring of euthyroid state. HRQoL was studied with a questionnaire EQ-5D-5L. Results Follow-up data were available for 61 patients, but only 30 patients with THD secondary to GD were consented to participate in investigation of their HRQoL. The frequency of cardiovascular complications was significantly reduced as compared before and after the antithyroid therapy as follows: resting heart rate (122 vs. 74 bpm), blood pressure: systolic (155 vs. 123 mm Hg), diastolic (83 vs. 66 mm Hg), supraventricular premature contractions (71% vs. 7%), atrial fibrillation (72% vs. 25%), congestive heart failure (69% vs. 20%), thyrotoxic cardiomyopathy (77% vs. 26%), all p<0.01. Anti-TSH receptor antibodies were determined as independent predictor of left ventricular geometry changes, (b-coefficient = 0.04, 95%CI 0.01–0.07, p = 0.02). HRQoL was improved in all domains and self-rated health increased from 43 to 75 units by visual analogue score (p<0.001). Conclusions Restoring of euthyroid state in patients with GD is associated with significant elimination of cardiovascular disorders and improvement of HRQoL. To our knowledge this is the first study evaluating Ukrainian patients with THD secondary to GD with focus on HRQoL.
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Affiliation(s)
- Iryna Tsymbaliuk
- Department of Therapy, Shupyk National Medical Academy of Postgraduate Education, 04112 Kiev, Ukraine
- Department of Functional Diagnostic, Kyiv City Teaching Endocrinological Center, 01034 Kiev, Ukraine
| | - Dmytro Unukovych
- Department of Surgery #4, Bogomolets National Medical University, 01601 Kiev, Ukraine
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Nataliia Shvets
- Department of Therapy, Shupyk National Medical Academy of Postgraduate Education, 04112 Kiev, Ukraine
- Department of Functional Diagnostic, Kyiv City Teaching Endocrinological Center, 01034 Kiev, Ukraine
| | - Andrii Dinets
- Department of Surgery #4, Bogomolets National Medical University, 01601 Kiev, Ukraine
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
- * E-mail:
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