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Cao S, Liu Y, Ye J, Wang Y, Wang Z, Li C, Jin T, Wu J, Zong G. The value of D-dimer to lymphocyte ratio in predicting clinical outcomes after percutaneous coronary intervention in ST-segment elevation myocardial infarction patients: A retrospective study. Int Immunopharmacol 2024; 128:111556. [PMID: 38241843 DOI: 10.1016/j.intimp.2024.111556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND D-dimer to lymphocyte ratio (DLR) is a novel composite metric. This study investigated the association between DLR and major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. MATERIALS AND METHODS This retrospective study included 683 STEMI cases treated between January 2018 and June 2021 at a single center. DLR was calculated for each patient. Receiver operating characteristic curves assessed the predictive value of in-hospital and long-term MACEs, with calculated AUC. Based on the optimal DLR cutoff value, the population was categorized into groups for clinical characteristic analysis. Multivariate logistic and COX regression analyses determined factors independently associated with MACEs. Kaplan-Meier estimation method and log-rank tests assessed event-free survival among different DLR groups. Spearman's test explored the correlation between DLR and Gensini score. RESULTS DLR demonstrated an AUC of 0.792 for predicting in-hospital MACEs and 0.708 for long-term MACEs in patients with STEMI. Multivariate logistic regression analysis revealed that a high DLR (cutoff value, 0.47) independently increased the risk of MACEs during hospitalization in patients with STEMI (P = 0.003; odds ratio: 3.015; 95 % CI: 1.438-6.321). Multivariate COX regression showed that a high DLR (cutoff value, 0.34) independently predicted MACEs during long-term follow-up in patients with STEMI (P = 0.011; hazard ratio: 1.724; 95 % CI: 1.135-2.619). Furthermore, DLR exhibited a positive correlation with the Gensini score (P < 0.001). CONCLUSIONS DLR is a valuable predictor for MACEs occurrence in patients with STEMI during hospitalization and long-term follow-up after PCI.
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Affiliation(s)
- Shaoqing Cao
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Yehong Liu
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Jiangping Ye
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Yuqin Wang
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Zhangyu Wang
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Chengsi Li
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Tianhui Jin
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Jiayu Wu
- Neurology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Gangjun Zong
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China.
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Blázquez-Bujeda Á, Ortega M, de Dios E, Gavara J, Perez-Solé N, Molina-Garcia T, Marcos-Garcés V, Diaz A, Chorro FJ, Rios-Navarro C, Bodí V, Ruiz-Sauri A. Changes in the extracellular matrix at microvascular obstruction area after reperfused myocardial infarction: A morphometric study. Ann Anat 2023; 250:152138. [PMID: 37506775 DOI: 10.1016/j.aanat.2023.152138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Extracellular matrix (ECM) suffers substantial alterations after myocardial infarction (MI), including the invasion of leukocyte subtypes. Despite a complete reopening at epicardial level, hypoperfusion within the infarcted myocardium, known as microvascular obstruction (MVO), occurs and exerts a negative impact on ventricular remodeling. In this study, ECM composition at MVO regions was described using a morphometric analysis. METHODS MI was induced in female swine (n = 10) by transitory 90-minute coronary occlusion followed by seven days of reperfusion. Prior to euthanasia, intracoronary thioflavin-S was infused. Within the infarcted myocardium, regions displaying MVO (thioflavin-S-) or no MVO (thioflavin-S+) were isolated and stained to morphometrically compare ECM composition. RESULTS As reflected by cell invasion through ECM, areas with MVO displayed an enlarged presence of neutrophils and lymphocytes, whilst no differences in the amount of macrophages and myofibroblasts were detected compared to infarcted myocardium without MVO. Indeed, those regions with macroscopic MVO showed lower capillary density than areas without MVO. Lastly, a significant reduction in the extension of total collagen, type I, but not type III, collagen, laminin, and fibronectin together with an augmentation of polysaccharides were noted in areas showing MVO compared to those without microvascular injury. CONCLUSIONS ECM composition in infarcted regions with MVO isolated from female swine displays a higher presence of inflammatory infiltrate and polysaccharides as well as reduced number of microvessels and collagen content compared to those areas without microvascular hypoperfusion. These characteristics might underlie the development of adverse ventricular remodeling in MI patients with extensive MVO.
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Affiliation(s)
| | - Maria Ortega
- INCLIVA Health Research Institute, Valencia, Spain
| | - Elena de Dios
- Department of Medicine, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER)-CV, Madrid, Spain
| | - Jose Gavara
- Centro de Biomateriales e Ingeniería Tisular, Universidad Politécnica de Valencia, Valencia, Spain
| | | | | | - Victor Marcos-Garcés
- INCLIVA Health Research Institute, Valencia, Spain; Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Ana Diaz
- Unidad Central de Investigación Biomédica, Universidad de Valencia, Valencia, Spain
| | - Francisco J Chorro
- INCLIVA Health Research Institute, Valencia, Spain; Department of Medicine, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER)-CV, Madrid, Spain; Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Cesar Rios-Navarro
- Department of Pathology, Universidad de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain.
| | - Vicente Bodí
- INCLIVA Health Research Institute, Valencia, Spain; Department of Medicine, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER)-CV, Madrid, Spain; Cardiology Department, Hospital Clinico Universitario, Valencia, Spain.
| | - Amparo Ruiz-Sauri
- Department of Pathology, Universidad de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain
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Jeyalan V, Austin D, Loh SX, Wangsaputra VK, Spyridopoulos I. Fractalkine/CX 3CR1 in Dilated Cardiomyopathy: A Potential Future Target for Immunomodulatory Therapy? Cells 2023; 12:2377. [PMID: 37830591 PMCID: PMC10571889 DOI: 10.3390/cells12192377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is a cardiac condition with structural and functional impairment, where either the left ventricle or both ventricular chambers are enlarged, coinciding with reduced systolic pump function (reduced ejection fraction, rEF). The prevalence of DCM is more than 1:250 individuals, and mortality largely due to heart failure in two-third of cases, and sudden cardiac death in one-third of patients. Damage to the myocardium, whether from a genetic or environmental cause such as viruses, triggers inflammation and recruits immune cells to the heart to repair the myocardium. Examination of myocardial biopsy tissue often reveals an inflammatory cell infiltrate, T lymphocyte (T cell) infiltration, or other activated immune cells. Despite medical therapy, adverse outcomes for DCM remain. The evidence base and existing literature suggest that upregulation of CX3CR1, migration of immune cells, together with cytomegalovirus (CMV) seropositivity is associated with worse outcomes in patients with dilated cardiomyopathy. We hypothesise that this potentially occurs through cardiac inflammation and fibrosis, resulting in adverse remodelling. Immune modulators to target this pathway may potentially improve outcomes above and beyond current guideline-recommended therapy.
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Affiliation(s)
- Visvesh Jeyalan
- Academic Cardiovascular Unit, The James Cook University Hospital, Middlesbrough TS4 3BW, UK; (V.J.); (D.A.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
| | - David Austin
- Academic Cardiovascular Unit, The James Cook University Hospital, Middlesbrough TS4 3BW, UK; (V.J.); (D.A.)
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Shu Xian Loh
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK;
| | - Vincent Kharisma Wangsaputra
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
- Faculty of Medicine, Universitas Indonesia, Central Jakarta 10430, Indonesia
| | - Ioakim Spyridopoulos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK;
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Pellegrino R, Paganelli R, Di Iorio A, Bandinelli S, Moretti A, Iolascon G, Sparvieri E, Tarantino D, Ferrucci L. Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio: results from InCHIANTI follow-up study. Immun Ageing 2023; 20:46. [PMID: 37667259 PMCID: PMC10476368 DOI: 10.1186/s12979-023-00370-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Neutrophils and lymphocytes represent the larger percentage of all white blood cells, they vary with age, with a progressive increase of the ratio in the first years of life, and then tend to remain at similar levels in steady state condition during adult age. Neutrophils to lymphocytes-ratio (NL-ratio) was proposed as an effective and low-cost marker to monitor and predict the evolution of several clinical conditions. The main objective of the study is to analyze its temporal trend variation, over twenty years' follow-up, according to age, sex, and main clinical diagnosis, in a large representative Italian population. METHODS The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998, and last follow-up visits were made in 2015-18. 1343 out of the 1453 participants enrolled were included, and consented to donate a blood sample. All subjects were assessed and followed for life-style, clinical condition, physical performance, and underwent an instrumental diagnostic session. RESULTS The NL-ratio showed a statistically significant interaction between birth-cohort and time of the study (p-value = 0.005). A gender dimorphism was recognized in the neutrophils absolute count and in the NL-ratio. Moreover, in female participants only, those who reported CHF had lower neutrophil-count and NL-ratio; whereas an increase in creatinine clearance was directly associated with NL-ratio. In male subjects, an increase of BMI was inversely associated with both NL-ratio and neutrophils-count during the follow-up; a similar association but in the opposite direction was observed in female participants. CONCLUSION NL-ratio is a more reliable predictor of healthy aging than absolute lymphocytes and/or neutrophils counts. It is associated with the changes induced by disease, lifestyle, and environmental challenges in the immune system. NL-ratio confirms the gender dimorphism in the occurrence of inflammation-driven diseases, thus providing additional evidence for the necessity of tailored sex-specific measures to prevent and treat such diseases.
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Affiliation(s)
- Raffaello Pellegrino
- Department of Scientific Research, Off-Campus Semmelweis University, Campus Ludes, 6912, Lugano-Pazzallo, Switzerland
| | - Roberto Paganelli
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry, University "G. d'Annunzio", Viale Abruzzo 322, 66100, Chieti-Pescara, Italy.
| | | | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | | | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, 21224, Baltimore, MD, USA
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Pellegrino R, Paganelli R, Di Iorio A, Bandinelli S, Moretti A, Iolascon G, Sparvieri E, Tarantino D, Ferrucci L. Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio. Results from InCHIANTI follow-up study. RESEARCH SQUARE 2023:rs.3.rs-3111431. [PMID: 37461588 PMCID: PMC10350238 DOI: 10.21203/rs.3.rs-3111431/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Neutrophils and lymphocytes represent the larger percentage of all white bloodcells, they vary with age, with a progressive increase of the ratio in the first years of life, and then tend to remain at similar levels in steady state condition during adult age. Neutrophils to lymphocytes-ratio (NL-ratio) was proposed as an effective and low-cost marker to monitor and predict the evolution of severalclinical conditions. The main objective of the study is to analyze its temporal trend variation, over twenty years' follow-up, according to age, sex, and main clinical diagnosis, in a large representative Italian population. Methods The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998, and last follow-up visits were made in 2015-18. 1343 out of the 1453 participants enrolled were included, and consented to donate a blood sample. All subjects were assessed and followed for life-style, clinical condition, physical performance, and underwent an instrumental diagnostic session. Results The NL-ratio showed a statistically significant interaction between birth-cohort and time of the study (p-value=0.005). A gender dimorphism was recognized in the neutrophils absolute count and in the NL-ratio. Moreover, in female participants only, those who reported CHF had lower neutrophil-count and NL-ratio; whereas an increase in creatinine clearance was directly associated with NL-ratio. In male subjects, an increase of BMI was inversely associated with both NL-ratio and neutrophils-count during the follow-up; a similar association but in the opposite direction was observed in female participants. Conclusion NL-ratio is a more reliable predictor of healthy aging than absolute lymphocytes and/or neutrophils counts. It is associated with the changes induced by disease, lifestyle, and environmental challenges in the immune system. NL-ratio confirms the gender dimorphism in the occurrence of inflammation-driven diseases, thus providing additional evidence for the necessity of tailored sex-specific measures to prevent and treat such diseases.
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Affiliation(s)
- Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano-Pazzallo, Switzerland
| | - Roberto Paganelli
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry; University "G. d'Annunzio"; 66100 - ChietiPescara, Italy
| | | | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138 - Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138 - Naples, Italy
| | | | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, USA, Baltimore, MD 21224, USA
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Pellegrino R, Paganelli R, Iorio AD, Bandinelli S, Moretti A, Iolascon G, Sparvieri E, Tarantino D, Ferrucci L. Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio. Results from InCHIANTI follow-up study. RESEARCH SQUARE 2023:rs.3.rs-3111431. [PMID: 37461588 PMCID: PMC10350238 DOI: 10.21203/rs.3.rs-3111431/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background Neutrophils and lymphocytes represent the larger percentage of all white bloodcells, they vary with age, with a progressive increase of the ratio in the first years of life, and then tend to remain at similar levels in steady state condition during adult age. Neutrophils to lymphocytes-ratio (NL-ratio) was proposed as an effective and low-cost marker to monitor and predict the evolution of severalclinical conditions. The main objective of the study is to analyze its temporal trend variation, over twenty years' follow-up, according to age, sex, and main clinical diagnosis, in a large representative Italian population. Methods The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998, and last follow-up visits were made in 2015-18. 1343 out of the 1453 participants enrolled were included, and consented to donate a blood sample. All subjects were assessed and followed for life-style, clinical condition, physical performance, and underwent an instrumental diagnostic session. Results The NL-ratio showed a statistically significant interaction between birth-cohort and time of the study (p-value=0.005). A gender dimorphism was recognized in the neutrophils absolute count and in the NL-ratio. Moreover, in female participants only, those who reported CHF had lower neutrophil-count and NL-ratio; whereas an increase in creatinine clearance was directly associated with NL-ratio. In male subjects, an increase of BMI was inversely associated with both NL-ratio and neutrophils-count during the follow-up; a similar association but in the opposite direction was observed in female participants. Conclusion NL-ratio is a more reliable predictor of healthy aging than absolute lymphocytes and/or neutrophils counts. It is associated with the changes induced by disease, lifestyle, and environmental challenges in the immune system. NL-ratio confirms the gender dimorphism in the occurrence of inflammation-driven diseases, thus providing additional evidence for the necessity of tailored sex-specific measures to prevent and treat such diseases.
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Rios-Navarro C, Dios ED, Forteza MJ, Bodi V. Unraveling the thread of uncontrolled immune response in COVID-19 and STEMI: an emerging need for knowledge sharing. Am J Physiol Heart Circ Physiol 2021; 320:H2240-H2254. [PMID: 33844596 PMCID: PMC8384574 DOI: 10.1152/ajpheart.00934.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The outbreak of severe acute respiratory syndrome coronavirus 2 that first emerged in Wuhan in December 2019 has resulted in the devastating pandemic of coronavirus disease 2019, creating an emerging need for knowledge sharing. Meanwhile, myocardial infarction is and will probably remain the foremost cause of death in the Western world throughout the coming decades. Severe deregulation of the immune system can unnecessarily expand the inflammatory response and participate in target and multiple organ failure, in infection but also in critical illness. Indeed, the course and fate of inflammatory cells observed in severe ST-elevation myocardial infarction (neutrophilia, monocytosis, and lymphopenia) almost perfectly mirror those recently reported in severe coronavirus disease 2019. A pleiotropic proinflammatory imbalance hampers adaptive immunity in favor of uncontrolled innate immunity and is associated with poorer structural and clinical outcomes. The goal of the present review is to gain greater insight into the cellular and molecular mechanisms underlying this canonical activation and downregulation of the two arms of the immune response in both entities, to better understand their pathophysiology and to open the door to innovative therapeutic options. Knowledge sharing can pave the way for therapies with the potential to significantly reduce mortality in both infectious and noninfectious scenarios.
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Affiliation(s)
- Cesar Rios-Navarro
- INCLIVA Health Research Institute, University of Valencia, Valencia, Spain
| | - Elena de Dios
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red-Cardiovascular, University of Valencia, Valencia, Spain
| | - Maria J Forteza
- Department of Medicine, Center of Molecular Medicine, Cardiovascular Medicine Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Vicente Bodi
- INCLIVA Health Research Institute, University of Valencia, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red-Cardiovascular, University of Valencia, Valencia, Spain.,Cardiology Department, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
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de Dios E, Rios-Navarro C, Pérez-Solé N, Gavara J, Marcos-Garcés V, Forteza MJ, Oltra R, Vila JM, Chorro FJ, Bodi V. Overexpression of genes involved in lymphocyte activation and regulation are associated with reduced CRM-derived cardiac remodelling after STEMI. Int Immunopharmacol 2021; 95:107490. [PMID: 33677257 DOI: 10.1016/j.intimp.2021.107490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 11/19/2022]
Abstract
AIMS Lymphopenia after ST-segment elevation myocardial infarction (STEMI) correlates with deleterious cardiac consequences and worse prognosis. An in-depth examination of genes implicated in lymphocyte proliferation, activation and regulation and their association with short- and long-term cardiac structure and function is therefore of great interest. METHODS Peripheral blood mononuclear cells were isolated from 10 control subjects and 64 patients with a first STEMI treated with primary percutaneous coronary intervention and submitted to cardiac magnetic resonance after 1 week and 6 months. mRNA expression of genes implicated in lymphocyte activation (CD25 and CD69) and regulation [programmed death (PD)-1 and cytotoxic T-lymphocyte antigen (CTLA)-4] were determined by qRT-PCR. RESULTS In comparison to controls, STEMI patients showed heightened mRNA expression of CD25 and lower PD-1 and CTLA-4 96 h after coronary reperfusion. Patients with extensive infarctions (>30% of left ventricular mass) at 1 week displayed a notable reduction in CD25, CD69, PD-1, and CTLA-4 expression (p < 0.05). However, CD25 was the only predictor of 1-week extensive infarct size in multivariate logistic regression analysis (odds ratio 0.019; 95% confidence interval [0.001-0.505]; p = 0.018). Regarding long-term ventricular function, mRNA expression of CD25 under the mean value was associated with worse ventricular function and more adverse remodelling. CONCLUSIONS Following STEMI, heightened expression of genes expressed in regulatory T cells (CD25 and CD69) and immune checkpoints (PD-1 and CTLA-4) correlates with a better short- and long-term cardiac structure and function. Advancing understanding of the pathophysiology of lymphopenia and evaluating novel immunomodulatory therapies will help translate these results into future clinical trials.
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Affiliation(s)
- Elena de Dios
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), 28029 Madrid, Spain; Medicine Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | | | | | - Jose Gavara
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain
| | | | - Maria J Forteza
- Cardiovascular Medicine Unit, Center of Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, 171 77 Stockholm, Sweden
| | - Ricardo Oltra
- Intensive Care Unit, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - José M Vila
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; Physiology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Francisco J Chorro
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), 28029 Madrid, Spain; Medicine Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Institute of Health Research-INCLIVA, 46010 Valencia, Spain; Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, Spain
| | - Vicente Bodi
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), 28029 Madrid, Spain; Medicine Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Institute of Health Research-INCLIVA, 46010 Valencia, Spain; Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, Spain.
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