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Mulholland M, Depuydt MAC, Jakobsson G, Ljungcrantz I, Grentzmann A, To F, Bengtsson E, Jaensson Gyllenbäck E, Grönberg C, Rattik S, Liberg D, Schiopu A, Björkbacka H, Kuiper J, Bot I, Slütter B, Engelbertsen D. Interleukin-1 receptor accessory protein blockade limits the development of atherosclerosis and reduces plaque inflammation. Cardiovasc Res 2024:cvae046. [PMID: 38563353 DOI: 10.1093/cvr/cvae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 01/12/2024] [Accepted: 02/01/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS The interleukin-1 receptor accessory protein (IL1RAP) is a co-receptor required for signalling through the IL-1, IL-33, and IL-36 receptors. Using a novel anti-IL1RAP-blocking antibody, we investigated the role of IL1RAP in atherosclerosis. METHODS AND RESULTS Single-cell RNA sequencing data from human atherosclerotic plaques revealed the expression of IL1RAP and several IL1RAP-related cytokines and receptors, including IL1B and IL33. Histological analysis showed the presence of IL1RAP in both the plaque and adventitia, and flow cytometry of murine atherosclerotic aortas revealed IL1RAP expression on plaque leucocytes, including neutrophils and macrophages. High-cholesterol diet fed apolipoprotein E-deficient (Apoe-/-) mice were treated with a novel non-depleting IL1RAP-blocking antibody or isotype control for the last 6 weeks of diet. IL1RAP blockade in mice resulted in a 20% reduction in subvalvular plaque size and limited the accumulation of neutrophils and monocytes/macrophages in plaques and of T cells in adventitia, compared with control mice. Indicative of reduced plaque inflammation, the expression of several genes related to leucocyte recruitment, including Cxcl1 and Cxcl2, was reduced in brachiocephalic arteries of anti-IL1RAP-treated mice, and the expression of these chemokines in human plaques was mainly restricted to CD68+ myeloid cells. Furthermore, in vitro studies demonstrated that IL-1, IL-33, and IL-36 induced CXCL1 release from both macrophages and fibroblasts, which could be mitigated by IL1RAP blockade. CONCLUSION Limiting IL1RAP-dependent cytokine signalling pathways in atherosclerotic mice reduces plaque burden and plaque inflammation, potentially by limiting plaque chemokine production.
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Affiliation(s)
- Megan Mulholland
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
| | - Marie A C Depuydt
- Leiden Academic Centre for Drug Research, Division of Biotherapeutics, Leiden University, Leiden, The Netherlands
| | - Gabriel Jakobsson
- Department of Translational Medicine, Cardiac Inflammation, Lund University, Malmö, Sweden
| | - Irena Ljungcrantz
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
| | - Andrietta Grentzmann
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
| | - Fong To
- Department of Clinical Sciences, Cardiovascular Research-Matrix and Inflammation in Atherosclerosis, Lund University, Malmö, Sweden
| | - Eva Bengtsson
- Department of Clinical Sciences, Cardiovascular Research-Matrix and Inflammation in Atherosclerosis, Lund University, Malmö, Sweden
- Department of Biomedical Science, Malmö University, Malmö, Sweden
- Biofilms-Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | | | | | - Sara Rattik
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
- Cantargia AB, Lund, Sweden
| | | | - Alexandru Schiopu
- Department of Translational Medicine, Cardiac Inflammation, Lund University, Malmö, Sweden
| | - Harry Björkbacka
- Department of Clinical Sciences, Cardiovascular Research-Cellular Metabolism and Inflammation, Lund University, Malmö, Sweden
| | - Johan Kuiper
- Leiden Academic Centre for Drug Research, Division of Biotherapeutics, Leiden University, Leiden, The Netherlands
| | - Ilze Bot
- Leiden Academic Centre for Drug Research, Division of Biotherapeutics, Leiden University, Leiden, The Netherlands
| | - Bram Slütter
- Leiden Academic Centre for Drug Research, Division of Biotherapeutics, Leiden University, Leiden, The Netherlands
| | - Daniel Engelbertsen
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
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Jakobsson G, Andersson H, Chew M, Schiopu A. Reply to "Potential confounders in linking elevated S100A8/A9 to left ventricular dysfunction in septic shock patients". Crit Care 2024; 28:9. [PMID: 38167162 PMCID: PMC10762927 DOI: 10.1186/s13054-023-04789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
| | - Henrik Andersson
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michelle Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alexandru Schiopu
- Department of Translational Medicine, Lund University, Lund, Sweden.
- Cardiac Inflammation Research Group, Clinical Research Center, 91:12, Jan Waldenströms Gata 35, 21 428, Malmö, Sweden.
- Department of Internal Medicine, Skane University Hospital, Lund, Sweden.
- Nicolae Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania.
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Schiopu A, Björkbacka H, Narasimhan G, Loong BJ, Engström G, Melander O, Orho-Melander M, Nilsson J. Elevated soluble LOX-1 predicts risk of first-time myocardial infarction. Ann Med 2023; 55:2296552. [PMID: 38134912 PMCID: PMC10763917 DOI: 10.1080/07853890.2023.2296552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND There is an unmet clinical need for novel therapies addressing the residual risk in patients receiving guideline preventive therapy for coronary heart disease. Experimental studies have identified a pro-atherogenic role of the oxidized LDL receptor LOX-1. We investigated the association between circulating soluble LOX-1 (sLOX-1) and the risk for development of myocardial infarction. METHODS The study subjects (n = 4658) were part of the Malmö Diet and Cancer study. The baseline investigation was carried out 1991-1994 and the incidence of cardiovascular events monitored through national registers during a of 19.5 ± 4.9 years follow-up. sLOX-1 and other biomarkers were analyzed by proximity extension assay and ELISA in baseline plasma. RESULTS Subjects in the highest tertile of sLOX-1 had an increased risk of myocardial infarction (hazard ratio (95% CI) 1.76 (1.40-2.21) as compared with those in the lowest tertile. The presence of cardiovascular risk factors was related to elevated sLOX-1, but the association between sLOX-1 and risk of myocardial infarction remained significant when adjusting for risk factors. CONCLUSIONS In this prospective population study we found an association between elevated sLOX-1, the presence of carotid disease and the risk for first-time myocardial infarction. Taken together with previous experimental findings of a pro-atherogenic role of LOX-1, this observation supports LOX-1 inhibition as a possible target for prevention of myocardial infarction.
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Affiliation(s)
- Alexandru Schiopu
- Department of Clinical Sciences Malmö, Lund University, Sweden
- Department of Transitional Science, Lund University, Sweden
| | | | | | - Bi Juin Loong
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | | | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Sweden
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Tomas L, Katra P, Badn W, Andersson L, Nilsson J, Schiopu A, Engelbertsen D, Gonçalves I, Bengtsson E, Björkbacka H. Invariant natural killer T cells and incidence of first-time coronary events: a nested case-control study. Eur Heart J Open 2023; 3:oead094. [PMID: 38025652 PMCID: PMC10630548 DOI: 10.1093/ehjopen/oead094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023]
Abstract
Aims Invariant natural killer T (iNKT) cells, a T cell subset that is CD1d-restricted and expresses a semi-invariant T cell receptor, have been proposed to contribute to dyslipidaemia-driven cardiovascular disease due to their ability to specifically recognize lipid antigens. Studies in mice have attributed pro-atherogenic properties to iNKT cells, but studies in humans investigating associations of iNKT cells with incident coronary events (CE) are lacking. Methods and results Here, we used flow cytometry to enumerate circulating iNKT cells (CD3+ CD1d-PBS57-Tetramer+) in a case-control cohort nested within the prospective population-based Malmö Diet and Cancer Study (n = 416) to explore associations with incident first-time CE during a median follow-up of 14 years. We found a significant inverse association between CD4- and CD8- double negative (DN) iNKT cells and incident CE, with an odds ratio of 0.62 [95% confidence interval (CI) 0.38-0.99; P = 0.046] comparing the highest vs. the lowest tertile of DN iNKT cells. The association remained significant after adjustment for cardiovascular risk factors with an odds ratio of 0.57 (95% CI 0.33-0.99; P = 0.046). In contrast, total iNKT cells were not significantly associated with incident CE after adjustment, with an odds ratio of 0.74 (95% CI 0.43-1.27; P = 0.276). Conclusion Our findings indicate that animal studies suggesting an atherosclerosis-promoting role for iNKT cells may not translate to human cardiovascular disease as our data show an association between high circulating numbers of DN iNKT cells and decreased risk of incident CE.
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Affiliation(s)
- Lukas Tomas
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Pernilla Katra
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Wiaam Badn
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Linda Andersson
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Alexandru Schiopu
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Lund, Sweden
| | - Daniel Engelbertsen
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Isabel Gonçalves
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Eva Bengtsson
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
- Faculty of Health and Society, Malmö University, Malmö, Sweden
- Biofilms – Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Harry Björkbacka
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
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Jakobsson G, Papareddy P, Andersson H, Mulholland M, Bhongir R, Ljungcrantz I, Engelbertsen D, Björkbacka H, Nilsson J, Manea A, Herwald H, Ruiz-Meana M, Rodríguez-Sinovas A, Chew M, Schiopu A. Therapeutic S100A8/A9 blockade inhibits myocardial and systemic inflammation and mitigates sepsis-induced myocardial dysfunction. Crit Care 2023; 27:374. [PMID: 37773186 PMCID: PMC10540409 DOI: 10.1186/s13054-023-04652-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND AND AIMS The triggering factors of sepsis-induced myocardial dysfunction (SIMD) are poorly understood and are not addressed by current treatments. S100A8/A9 is a pro-inflammatory alarmin abundantly secreted by activated neutrophils during infection and inflammation. We investigated the efficacy of S100A8/A9 blockade as a potential new treatment in SIMD. METHODS The relationship between plasma S100A8/A9 and cardiac dysfunction was assessed in a cohort of 62 patients with severe sepsis admitted to the intensive care unit of Linköping University Hospital, Sweden. We used S100A8/A9 blockade with the small-molecule inhibitor ABR-238901 and S100A9-/- mice for therapeutic and mechanistic studies on endotoxemia-induced cardiac dysfunction in mice. RESULTS In sepsis patients, elevated plasma S100A8/A9 was associated with left-ventricular (LV) systolic dysfunction and increased SOFA score. In wild-type mice, 5 mg/kg of bacterial lipopolysaccharide (LPS) induced rapid plasma S100A8/A9 increase and acute LV dysfunction. Two ABR-238901 doses (30 mg/kg) administered intraperitoneally with a 6 h interval, starting directly after LPS or at a later time-point when LV dysfunction is fully established, efficiently prevented and reversed the phenotype, respectively. In contrast, dexamethasone did not improve cardiac function compared to PBS-treated endotoxemic controls. S100A8/A9 inhibition potently reduced systemic levels of inflammatory mediators, prevented upregulation of inflammatory genes and restored mitochondrial function in the myocardium. The S100A9-/- mice were protected against LPS-induced LV dysfunction to an extent comparable with pharmacologic S100A8/A9 blockade. The ABR-238901 treatment did not induce an additional improvement of LV function in the S100A9-/- mice, confirming target specificity. CONCLUSION Elevated S100A8/A9 is associated with the development of LV dysfunction in severe sepsis patients and in a mouse model of endotoxemia. Pharmacological blockade of S100A8/A9 with ABR-238901 has potent anti-inflammatory effects, mitigates myocardial dysfunction and might represent a novel therapeutic strategy for patients with severe sepsis.
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Affiliation(s)
- Gabriel Jakobsson
- Department of Translational Medicine, Lund University, Lund, Sweden
- Cardiac Inflammation Research Group, Clinical Research Center, 91:12, Jan Waldenströms Gata 35, 21 428, Malmö, Sweden
| | | | - Henrik Andersson
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Megan Mulholland
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Ravi Bhongir
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Irena Ljungcrantz
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | | | - Harry Björkbacka
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Adrian Manea
- Nicolae Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania
| | - Heiko Herwald
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Marisol Ruiz-Meana
- Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rodríguez-Sinovas
- Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Michelle Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alexandru Schiopu
- Department of Translational Medicine, Lund University, Lund, Sweden.
- Nicolae Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania.
- Department of Internal Medicine, Skane University Hospital, Lund, Sweden.
- Cardiac Inflammation Research Group, Clinical Research Center, 91:12, Jan Waldenströms Gata 35, 21 428, Malmö, Sweden.
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Arévalo Martínez M, Ritsvall O, Bastrup JA, Celik S, Jakobsson G, Daoud F, Winqvist C, Aspberg A, Rippe C, Maegdefessel L, Schiopu A, Jepps TA, Holmberg J, Swärd K, Albinsson S. Vascular smooth muscle-specific YAP/TAZ deletion triggers aneurysm development in mouse aorta. JCI Insight 2023; 8:e170845. [PMID: 37561588 PMCID: PMC10544211 DOI: 10.1172/jci.insight.170845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
Inadequate adaption to mechanical forces, including blood pressure, contributes to development of arterial aneurysms. Recent studies have pointed to a mechanoprotective role of YAP and TAZ in vascular smooth muscle cells (SMCs). Here, we identified reduced expression of YAP1 in human aortic aneurysms. Vascular SMC-specific knockouts (KOs) of YAP/TAZ were thus generated using the integrin α8-Cre (Itga8-Cre) mouse model (i8-YT-KO). i8-YT-KO mice spontaneously developed aneurysms in the abdominal aorta within 2 weeks of KO induction and in smaller arteries at later times. The vascular specificity of Itga8-Cre circumvented gastrointestinal effects. Aortic aneurysms were characterized by elastin disarray, SMC apoptosis, and accumulation of proteoglycans and immune cell populations. RNA sequencing, proteomics, and myography demonstrated decreased contractile differentiation of SMCs and impaired vascular contractility. This associated with partial loss of myocardin expression, reduced blood pressure, and edema. Mediators in the inflammatory cGAS/STING pathway were increased. A sizeable increase in SOX9, along with several direct target genes, including aggrecan (Acan), contributed to proteoglycan accumulation. This was the earliest detectable change, occurring 3 days after KO induction and before the proinflammatory transition. In conclusion, Itga8-Cre deletion of YAP and TAZ represents a rapid and spontaneous aneurysm model that recapitulates features of human abdominal aortic aneurysms.
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Affiliation(s)
| | - Olivia Ritsvall
- Vascular Physiology Environment, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Joakim Armstrong Bastrup
- Vascular Biology Group, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Selvi Celik
- Molecular Cardiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Gabriel Jakobsson
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fatima Daoud
- Vascular Physiology Environment, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Christopher Winqvist
- Vascular Physiology Environment, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Anders Aspberg
- Rheumatology and Molecular Skeletal Biology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Catarina Rippe
- Vascular Physiology Environment, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Lars Maegdefessel
- Department of Medicine, Karolinska Institute, Stockholm, Sweden, and
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar - Technical University Munich (TUM), Munich, Germany
| | - Alexandru Schiopu
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital Lund, Lund, Sweden, and
- Nicolae Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania
| | - Thomas A. Jepps
- Vascular Biology Group, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johan Holmberg
- Vascular Physiology Environment, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Karl Swärd
- Vascular Physiology Environment, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Sebastian Albinsson
- Vascular Physiology Environment, Department of Experimental Medical Science, Lund University, Lund, Sweden
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Michelsen HÖ, Henriksson P, Wallert J, Bäck M, Sjölin I, Schlyter M, Hagström E, Kiessling A, Held C, Hag E, Nilsson L, Schiopu A, Zaman MJ, Leosdottir M. Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction: The Perfect-CR study. Int J Cardiol 2023; 371:40-48. [PMID: 36089158 DOI: 10.1016/j.ijcard.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI. METHODS In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8 mmol/L, blood pressure (BP) <140/90 mmHg and smoking abstinence. RESULTS The strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78-2.50]; 2.45 [1.91-2.99]), having a psychologist in the CR team (1.62 [1.36-1.87]; 2.05 [1.67-2.44]), extended opening hours (2.13 [2.00-2.27]; 1.50 [0.91-2.10]), adequate facilities (1.54 [0.91-2.18]; 1.89 [1.38-2.40]), and having a medical director (1.70 [0.91-2.48]; 1.46 [1.04-1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39-4.51]) and having no history of hypertension (2.93 [2.60-3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66-2.10]; 1.46 [1.14-1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95-2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07-2.88]) and group education (1.92 [1.43-2-42]), and no cardiovascular disease history (2.13 [1.78-2.48]). CONCLUSIONS We identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.
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Affiliation(s)
- Halldora Ögmundsdottir Michelsen
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - John Wallert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Maria Bäck
- Department of Occupational therapy and Physiotherapy, Sahlgrenska University Hospital Gothenburg, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingela Sjölin
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Mona Schlyter
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Emma Hag
- Department of Internal Medicine, County hospital Ryhov, Jönköping, Sweden
| | - Lennart Nilsson
- Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Alexandru Schiopu
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Lund, Sweden; Department of Pathology, University of Medicine Pharmacy Sciences and Technology of Targu-Mures, Targu-Mures, Romania
| | - M Justin Zaman
- Cardiac Centre, West Suffolk Hospital, Bury St Edmunds, UK
| | - Margret Leosdottir
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
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Du F, Ding Z, Rönnow CF, Rahman M, Schiopu A, Thorlacius H. S100A9 induces reactive oxygen species-dependent formation of neutrophil extracellular traps in abdominal sepsis. Exp Cell Res 2022; 421:113405. [PMID: 36328195 DOI: 10.1016/j.yexcr.2022.113405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/27/2022] [Indexed: 12/29/2022]
Abstract
Recent evidence suggests that targeting S100A9 reduces pathological inflammation in abdominal sepsis. Herein, we investigated the role of S100A9 in neutrophil extracellular trap (NET) formation in septic lung damage. NETs were detected by electron microscopy in the lung and by confocal microscopy in vitro. Stimulation of isolated mouse bone marrow-derived neutrophils with S100A9 triggered formation of NETs. Blocking TLR4 and RAGE reduced S100A9-induced generation of NETs and DNA-histone complexes. Moreover, S100A9 challenge increased generation of reactive oxygen species (ROS) in bone marrow neutrophils. Co-incubation with the NADPH oxidase inhibitor not only decreased ROS formation but also attenuated induction of DNA-histone complexes in S100A9-stimulated neutrophils. Abdominal sepsis was induced by cecal ligation and puncture (CLP) in male C57BL/6 mice. Administration of the S100A9 inhibitor ABR-238901 decreased CLP-induced formation of NETs in lungs and DNA-histone complexes in plasma. In addition, transmission electron microscopy revealed that S100A9 was abundantly expressed on NETs in the lungs in CLP mice. By use of intravital microscopy, we found that local injection of NETs increased leukocyte adhesion and migration in the mouse cremaster muscle microvasculature. Notably, treatment with ABR-238901 attenuated NET-induced leukocyte adhesion and extravasation in the cremaster muscle, suggesting that NET-associated S100A9 promotes leukocyte recruitment in vivo. Taken together, these novel findings suggest that S100A9 triggers ROS-dependent formation of NETs via TLR4 and RAGE signaling in neutrophils. Moreover, S100A9 regulates both formation of NETs and NET-induced leukocyte recruitment in vivo. Thus, targeting S100A9 might be useful to ameliorate lung damage in abdominal sepsis.
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Affiliation(s)
- Feifei Du
- Department of Clinical Sciences, Malmö, Section for Surgery, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Zhiyi Ding
- Department of Clinical Sciences, Malmö, Section for Surgery, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Carl-Fredrik Rönnow
- Department of Clinical Sciences, Malmö, Section for Surgery, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Milladur Rahman
- Department of Clinical Sciences, Malmö, Section for Surgery, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Alexandru Schiopu
- Department of Clinical Sciences, Malmö, Lund University, 21428, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, 22185, Lund, Sweden
| | - Henrik Thorlacius
- Department of Clinical Sciences, Malmö, Section for Surgery, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden.
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Mulholland M, Jakobsson G, Ljungcrantz I, Grentzmann A, Grönberg C, Rattik S, Schiopu A, Björkbacka H, Engelbertsen D. IL-1RAP blockade reduces atherosclerosis and limits plaque inflammation. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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10
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Vlad M, Mares R, Lazar A, Manea SA, Preda B, Simionescu M, Schiopu A, Manea A. Monocyte-derived macrophages mediate S100a8/A9-induced oxidative stress and inflammation in the ischemic myocardium. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Jakobsson G, Mulholland M, Grentzmann A, Ljungcrantz I, Rattik S, Engelbertsen D, Schiopu A. S100A9 blockade ameliorates cardiac dysfunction and reduces myocardial immune infiltration in experimental autoimmune myocarditis. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Swedish Heart and Lung Foundation and Swedish Research Council
Background/Introduction
Autoimmune myocarditis is characterized by non-ischemic inflammatory heart injury, leading to myocardial damage and impaired cardiac function. S100A9 is an inflammatory alarmin present in large amounts in neutrophils. The role of S100A9 as a potential treatment target in myocarditis has not been fully explored.
Aim
We sought to investigate the impact of S100A9 blockade in experimental autoimmune myocarditis and assess the effects of treatment on cardiac function and immune infiltration.
Methods
BALB/C mice were immunized with αMHC peptide emulsified in Complete Freunds Adjuvant at day 0 and day 7 to induce the disease. The water-soluble small-molecule S100A9 blocker ABR-238901 was given continuously in drinking water starting on day 7. Echocardiography was performed weekly from day 21 to day 42 (n=11/group). For flow cytometry analysis, mice were sacrificed at day 21 (n=10/group).
Results
S100A9 blockade improved left ventricular ejection fraction [52.33% vs 44.87% on day 42 (p<0.001)]. Cardiac output was significantly improved on day 21 (12.69 vs 11.05 mL/min, p<0.05). We found a significant reduction of inflammatory cardiac infiltrates at day 21, characterized by reduced number of macrophages (p<0.05), neutrophils (p<0.01) and CD4+ T cells (p<0.05). The cardiac draining lymph nodes contained fewer dendritic cells (p<0.01), T cells (p<0.05), as well as reduced numbers of inflammatory CD4+ cells producing IL-17 (p<0.05).
Conclusion
Therapeutic S100A9 blockade inhibits inflammatory cardiac infiltration and improves cardiac function in experimental autoimmune myocarditis. Our findings highlight the important role of S100A9 in the pathogenesis of myocarditis and identify S100A9 blockade as a possible novel therapeutic avenue.
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Affiliation(s)
| | | | | | | | - S Rattik
- Lund University , Malmo , Sweden
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12
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Boteanu RM, Suica VI, Uyy E, Ivan L, Cerveanu-Hogas A, Mares RG, Simionescu M, Schiopu A, Antohe F. Short-Term Blockade of Pro-Inflammatory Alarmin S100A9 Favorably Modulates Left Ventricle Proteome and Related Signaling Pathways Involved in Post-Myocardial Infarction Recovery. Int J Mol Sci 2022; 23:ijms23095289. [PMID: 35563680 PMCID: PMC9103348 DOI: 10.3390/ijms23095289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 02/01/2023] Open
Abstract
Prognosis after myocardial infarction (MI) varies greatly depending on the extent of damaged area and the management of biological processes during recovery. Reportedly, the inhibition of the pro-inflammatory S100A9 reduces myocardial damage after MI. We hypothesize that a S100A9 blockade induces changes of major signaling pathways implicated in post-MI healing. Mass spectrometry-based proteomics and gene analyses of infarcted mice left ventricle were performed. The S100A9 blocker (ABR-23890) was given for 3 days after coronary ligation. At 3 and 7 days post-MI, ventricle samples were analyzed versus control and Sham-operated mice. Blockade of S100A9 modulated the expressed proteins involved in five biological processes: leukocyte cell–cell adhesion, regulation of the muscle cell apoptotic process, regulation of the intrinsic apoptotic signaling pathway, sarcomere organization and cardiac muscle hypertrophy. The blocker induced regulation of 36 proteins interacting with or targeted by the cellular tumor antigen p53, prevented myocardial compensatory hypertrophy, and reduced cardiac markers of post-ischemic stress. The blockade effect was prominent at day 7 post-MI when the quantitative features of the ventricle proteome were closer to controls. Blockade of S100A9 restores key biological processes altered post-MI. These processes could be valuable new pharmacological targets for the treatment of ischemic heart. Mass spectrometry data are available via ProteomeXchange with identifier PXD033683.
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Affiliation(s)
- Raluca Maria Boteanu
- Department of Proteomics, Institute of Cellular Biology and Pathology “N. Simionescu” of the Romanian Academy, 050568 Bucharest, Romania; (R.M.B.); (V.-I.S.); (E.U.); (L.I.); (A.C.-H.); (M.S.)
| | - Viorel-Iulian Suica
- Department of Proteomics, Institute of Cellular Biology and Pathology “N. Simionescu” of the Romanian Academy, 050568 Bucharest, Romania; (R.M.B.); (V.-I.S.); (E.U.); (L.I.); (A.C.-H.); (M.S.)
| | - Elena Uyy
- Department of Proteomics, Institute of Cellular Biology and Pathology “N. Simionescu” of the Romanian Academy, 050568 Bucharest, Romania; (R.M.B.); (V.-I.S.); (E.U.); (L.I.); (A.C.-H.); (M.S.)
| | - Luminita Ivan
- Department of Proteomics, Institute of Cellular Biology and Pathology “N. Simionescu” of the Romanian Academy, 050568 Bucharest, Romania; (R.M.B.); (V.-I.S.); (E.U.); (L.I.); (A.C.-H.); (M.S.)
| | - Aurel Cerveanu-Hogas
- Department of Proteomics, Institute of Cellular Biology and Pathology “N. Simionescu” of the Romanian Academy, 050568 Bucharest, Romania; (R.M.B.); (V.-I.S.); (E.U.); (L.I.); (A.C.-H.); (M.S.)
| | - Razvan Gheorghita Mares
- Department of Pathophysiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (R.G.M.); (A.S.)
| | - Maya Simionescu
- Department of Proteomics, Institute of Cellular Biology and Pathology “N. Simionescu” of the Romanian Academy, 050568 Bucharest, Romania; (R.M.B.); (V.-I.S.); (E.U.); (L.I.); (A.C.-H.); (M.S.)
| | - Alexandru Schiopu
- Department of Pathophysiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (R.G.M.); (A.S.)
- Department of Clinical Sciences Malmö, Lund University, 21428 Malmö, Sweden
| | - Felicia Antohe
- Department of Proteomics, Institute of Cellular Biology and Pathology “N. Simionescu” of the Romanian Academy, 050568 Bucharest, Romania; (R.M.B.); (V.-I.S.); (E.U.); (L.I.); (A.C.-H.); (M.S.)
- Correspondence: ; Tel.: +40-213-192-737
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13
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Ögmundsdóttir Michelsen H, Sjölin I, Bäck M, Gonzalez Garcia M, Olsson A, Sandberg C, Schiopu A, Leósdóttir M. Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial. J Med Internet Res 2022; 24:e25224. [PMID: 35357316 PMCID: PMC9015765 DOI: 10.2196/25224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/09/2021] [Accepted: 12/28/2021] [Indexed: 01/20/2023] Open
Abstract
Background Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. Objective This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care). Methods All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables. Results There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic −27.7 vs −16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic −25.3 vs −16.4 mm Hg; P=.02, and diastolic −13.4 vs −9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25. Conclusions Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation. Trial Registration ClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-3118-1
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Affiliation(s)
- Halldóra Ögmundsdóttir Michelsen
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
| | - Ingela Sjölin
- Department of Cardiology, Skane University Hospital, Malmö, Sweden
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Manuel Gonzalez Garcia
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Anneli Olsson
- Department of Cardiology, Skane University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Camilla Sandberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Alexandru Schiopu
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skane University Hospital, Lund, Sweden
| | - Margrét Leósdóttir
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Cardiology, Skane University Hospital, Malmö, Sweden
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14
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Danet R, Rimbas RC, Bratu V, Magda S, Mihalcea D, Mihaila S, Lungeanu L, Velcea A, Gheorghiu L, Dragoi R, Corlan A, Schiopu A, Simionescu M, Vinereanu D. Systemic inflammation in the acute myocardial infarction can predict early negative left ventricular remodeling assessed by myocardial work analysis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): UEFISCDI
Background. Left ventricular (LV) remodeling after acute myocardial infarction (AMI) is an important predictor of heart failure (HF). Systemic inflammatory response in the acute phase of AMI is of particular interest, while the relation to the remodeling process is still under debate. New imaging techniques derived from speckle tracking echocardiography (STE), such as myocardial work (MW), are attractive tools since they can detect myocardial remodeling before decrease of global LVEF. However, there is insufficient data regarding MW in AMI patients, and its relation to the inflammatory process.
Methods. We assessed 57 patients (53 ± 9 years, 45 men, 64% smokers, 59% hypertensive, 54% with type 2 diabetes) with AMI, by clinical, 2D echo, and STE. Biomarkers panel was evaluated within the first 24 hours from admission: hsTpI and CRP. A second visit with clinical and echo assessment was performed at 6-8 weeks from the baseline visit. Exclusion criteria were unstable patients, non-sinus rhythm, significant valvular disease (>grade 2), other significant pathologies leading to decreased life expectancy, and low quality 2DE. At both visits, global longitudinal stain (GLS) and MW by 2DSTE were measured, on top of conventional echo parameters: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) (Figure 1: upper panel - an example of a patient with increase of GWE from baseline to visit 2 ; lower panel - an example of a patient with decrease of the GWE from baseline to visit 2).
Results. At baseline, myocardial necrosis by hsTpI significantly corelated with GLS (r = 0.44, p = 0.001) and MW (GWI: r=-0.44, p = 0.001; GCW: r=-0.40, p = 0.002), but not with LVEF. However, systemic inflammation by CRP did not correlate with LVEF or any of the STE parameters. Interestingly, systemic inflammation by CRP significantly correlated with changes of MW between the two visits: for GWE r=-0.53, p < 0.001; and for GWW r = 0.48, p < 0.001 (Figure 2). A CRP level >28 mg/l was able to predict decrease of GWE from baseline to visit 2.
Conclusions. Magnitude of necrosis, expressed by hsTpI, corelates only with GLS and MW parameters, but not with LVEF. CRP level in the acute phase of AMI correlates with myocardial work changes, as an early marker of negative LV remodeling. Abstract Figure 1 Abstract Figure 2
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Affiliation(s)
- R Danet
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - RC Rimbas
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - V Bratu
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - S Magda
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - D Mihalcea
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - S Mihaila
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - L Lungeanu
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - A Velcea
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - L Gheorghiu
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - R Dragoi
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - A Corlan
- University Emergency Hospital of Bucharest, Bucharest, Romania
| | - A Schiopu
- Lund University, Skane University Hospital Lund, Malmo, Sweden
| | - M Simionescu
- Institute of Cellular Biology & Pathology Nicolae Simionescu, Bucharest, Romania
| | - D Vinereanu
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
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15
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Yndigegn T, Gilje P, Dankiewicz J, Mokhtari A, Isma N, Holmqvist J, Schiopu A, Ravn-Fischer A, Hofmann R, Szummer K, Jernberg T, James SK, Gale CP, Fröbert O, Mohammad MA. Safety of early hospital discharge following admission with ST-elevation myocardial infarction treated with percutaneous coronary intervention: a nationwide cohort study. EUROINTERVENTION 2022; 17:1091-1099. [PMID: 34338642 PMCID: PMC9725020 DOI: 10.4244/eij-d-21-00501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Second Primary Angioplasty in Myocardial Infarction (PAMI-II) risk score is recommended by guidelines to identify low-risk patients with ST-elevation myocardial infarction (STEMI) for an early discharge strategy. AIMS We aimed to assess the safety of early discharge (≤2 days) for low-risk STEMI patients treated with primary percutaneous coronary intervention (PCI). METHODS Using nationwide data from the SWEDEHEART registry, we identified patients with STEMI treated with primary PCI during the period 2009-2017, of whom 8,092 (26.4%) were identified as low risk with the PAMI-II score. Low-risk patients were stratified according to their length of hospital stay (≤2 days vs >2 days). The primary endpoint was major adverse cardiovascular events (MACE, including death, reinfarction treated with PCI, stroke or heart failure hospitalisation) at one year, assessed using a Cox proportional hazards model with propensity score as well as an inverse probability weighting propensity score of average treatment effect to adjust for confounders. RESULTS A total of 1,449 (17.9%) patients were discharged ≤2 days from admission. After adjustment, the one-year MACE rate was not higher for patients discharged at >2 days from admission than for patients discharged ≤2 days (4.3% vs 3.2%; adjusted HR 1.31, 95% confidence interval [CI]: 0.92-1.87, p=0.14), and no difference was observed regarding any of the individual components of the main outcome. Results were consistent across all subgroups with no difference in MACE between early and late discharge patients. CONCLUSIONS Nationwide observational data suggest that early discharge of low-risk patients with STEMI treated with PCI is not associated with an increase in one-year MACE.
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Affiliation(s)
- Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Patrik Gilje
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Josef Dankiewicz
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Arash Mokhtari
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Nazim Isma
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Jasminka Holmqvist
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Alexandru Schiopu
- Department of Internal Medicine, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Annika Ravn-Fischer
- Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Department of Cardiology, University of Gothenburg, Gothenburg, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Karolina Szummer
- Department of Medicine (Huddinge), Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Stefan K. James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Medicine, University of Leeds, Leeds, United Kingdom,Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Moman A. Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221 85 Lund, Sweden
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16
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Ding Z, Du F, Averitt V RG, Jakobsson G, Rönnow CF, Rahman M, Schiopu A, Thorlacius H. Targeting S100A9 Reduces Neutrophil Recruitment, Inflammation and Lung Damage in Abdominal Sepsis. Int J Mol Sci 2021; 22:12923. [PMID: 34884728 PMCID: PMC8658007 DOI: 10.3390/ijms222312923] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 02/07/2023] Open
Abstract
S100A9, a pro-inflammatory alarmin, is up-regulated in inflamed tissues. However, the role of S100A9 in regulating neutrophil activation, inflammation and lung damage in sepsis is not known. Herein, we hypothesized that blocking S100A9 function may attenuate neutrophil recruitment in septic lung injury. Male C57BL/6 mice were pretreated with the S100A9 inhibitor ABR-238901 (10 mg/kg), prior to cercal ligation and puncture (CLP). Bronchoalveolar lavage fluid (BALF) and lung tissue were harvested for analysis of neutrophil infiltration as well as edema and CXC chemokine production. Blood was collected for analysis of membrane-activated complex-1 (Mac-1) expression on neutrophils as well as CXC chemokines and IL-6 in plasma. Induction of CLP markedly increased plasma levels of S100A9. ABR-238901 decreased CLP-induced neutrophil infiltration and edema formation in the lung. In addition, inhibition of S100A9 decreased the CLP-induced up-regulation of Mac-1 on neutrophils. Administration of ABR-238901 also inhibited the CLP-induced increase of CXCL-1, CXCL-2 and IL-6 in plasma and lungs. Our results suggest that S100A9 promotes neutrophil activation and pulmonary accumulation in sepsis. Targeting S100A9 function decreased formation of CXC chemokines in circulation and lungs and attenuated sepsis-induced lung damage. These novel findings suggest that S100A9 plays an important pro-inflammatory role in sepsis and could be a useful target to protect against the excessive inflammation and lung damage associated with the disease.
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Affiliation(s)
- Zhiyi Ding
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 21428 Malmö, Sweden; (Z.D.); (F.D.); (R.G.A.V.); (C.-F.R.); (M.R.)
| | - Feifei Du
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 21428 Malmö, Sweden; (Z.D.); (F.D.); (R.G.A.V.); (C.-F.R.); (M.R.)
| | - Richard Garland Averitt V
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 21428 Malmö, Sweden; (Z.D.); (F.D.); (R.G.A.V.); (C.-F.R.); (M.R.)
| | - Gabriel Jakobsson
- Department of Clinical Sciences, Malmö, Lund University, 21428 Malmö, Sweden; (G.J.); (A.S.)
| | - Carl-Fredrik Rönnow
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 21428 Malmö, Sweden; (Z.D.); (F.D.); (R.G.A.V.); (C.-F.R.); (M.R.)
| | - Milladur Rahman
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 21428 Malmö, Sweden; (Z.D.); (F.D.); (R.G.A.V.); (C.-F.R.); (M.R.)
| | - Alexandru Schiopu
- Department of Clinical Sciences, Malmö, Lund University, 21428 Malmö, Sweden; (G.J.); (A.S.)
- Department of Internal Medicine, Skåne University Hospital, 22185 Lund, Sweden
| | - Henrik Thorlacius
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 21428 Malmö, Sweden; (Z.D.); (F.D.); (R.G.A.V.); (C.-F.R.); (M.R.)
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17
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Schiopu A, Svedlund S, Yndigegn T, Varma V, Ongstad EL, Collen A, George RT, Wang X, Goncalves I, Nilsson J, Gan LM. Elevated soluble lectin-like oxidised low-density lipoprotein receptor-1 (sLOX-1) associated with increased risk for heart failure and MACE after an acute coronary event. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The lectin-like oxidised low-density lipoprotein receptor (LOX-1) is involved in atherosclerotic plaque inflammation and vulnerability. Plasma levels of soluble LOX-1 (sLOX-1) have previously been associated with increased risk for recurrent coronary events and mortality in patients with acute coronary syndrome (ACS).
Purpose
To assess the association of sLOX-1 with the development of heart failure (HF) post-ACS.
Methods
We measured sLOX-1 in 524 patients with ACS within 24 hours after the acute event. A subgroup of 97 of these patients completed a follow-up echocardiogram after one year. The incidence of HF-related hospitalisation and recurrent major adverse cardiovascular events (MACE), defined as recurrent ACS or cardiovascular death, was followed for a mean period of two years. In a separate cohort of 363 patients with ACS and percutaneous coronary intervention (PCI), we studied the correlations between sLOX-1, coronary flow reserve, left ventricular systolic function and systemic inflammation at two follow-up visits within four weeks and 16 weeks post-ACS, respectively.
Results
Baseline sLOX-1 was positively associated with the risk of HF and MACE, independently of traditional cardiovascular risk factors, revascularisation and medication. The hazard ratios and 95% confidence intervals were 1.57 (1.10–2.23), p=0.012 for HF and 1.36 (1.08–1.71), p=0.009 for MACE per standard deviation baseline sLOX-1 increase. Elevated sLOX-1 was also negatively associated with lower-left ventricular ejection fraction at one year (r=−0.263, p=0.009). In the second ACS cohort, we found that plasma sLOX-1 measured at the two follow-up visits was negatively associated with coronary flow reserve and left ventricular systolic function, and positively correlated with biomarkers of systemic inflammation and cardiac overload.
Conclusion
Elevated sLOX-1 is associated with the development of HF and recurrent cardiovascular events in patients with ACS. Although this association study cannot confirm causality, the results suggest LOX-1 as a potential biomarker and treatment target in patients with ACS.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): • Swedish Research Council • The Swedish Heart and Lung foundation• Swedish Foundation for Strategic Research Dnr IRC15-0067 • Marianne and Marcus Wallenberg Foundation • Bundy Academy at Lund University
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Affiliation(s)
- A Schiopu
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - S Svedlund
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T Yndigegn
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - V Varma
- Translational Science and Experimental Medicine, Research and Early Development, CVRM, AstraZeneca, Gaithersburg, MD, United States of America
| | - E L Ongstad
- Bioscience Cardiovascular, Research and Early Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, United States of America
| | - A Collen
- Projects, Research and Early Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - R T George
- Early Clinical Development, Research and Early Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, United States of America
| | - X Wang
- Translational Science and Experimental Medicine, Research and Early Development, CVRM, AstraZeneca, Gaithersburg, MD, United States of America
| | - I Goncalves
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - J Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - L M Gan
- Early Clinical Development, Research and Early Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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18
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Ogmundsdottir Michelsen H, Henriksson P, Wallert J, Back M, Sjolin I, Schlyter M, Hagstrom E, Kiessling A, Held C, Hag E, Nilsson L, Schiopu A, Zaman MJ, Leosdottir M. Organizational and patient-level predictors for reaching key risk factor targets in cardiac rehabilitation after myocardial infarction – the perfect-CR study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The benefits of specific cardiac rehabilitation (CR) programme components on patient outcomes after myocardial infarction (MI) remain unclear, as does their relative predictive strength compared to patient-level predictors.
Purpose
To identify CR organizational and patient-level predictors for reaching risk factor targets at one-year post-MI.
Methods
This was an observational survey- and registry-based study. Data on CR organization at all 78 CR centres in Sweden was collected in 2016 and merged with individual patient data from nationwide registries (n=7549, median age 64 years, 24% females). Cross-validation resampled orthogonal partial least squares discriminant analysis identified predictors for reaching treatment targets for low-density lipoprotein-cholesterol (LDL-C<1.8 mmol/L), blood pressure (BP<140/90 mmHg) and smoking abstinence (yes/no). Predictors with Variables of Importance for the Projection (VIP) value >0.8 and 95% confidence intervals (CI) excluding zero, were considered meaningful.
Results
Of the 71 analysed organizational variables, 36 were identified as meaningful predictors for reaching LDL-C and 35 for BP targets (Figure 1). The strongest predictors (VIP [95% CI]) for LDL-C and BP were: offering psychosocial management at initial CR assessment 2.09 [1.70–2.49]; 2.34 [1.90–2.78], having a CR team psychologist 1.59 [1.28–1.91]; 2.00 [1.46–2.55], having extended CR centre opening hours 2.17 [1.95–2.40]; 1.51 [1.03–2.00], staff reporting satisfaction with CR centre facilities 1.55 [1.07–2.04]; 1.96 [1.64–2.28], having a medical director 1.71 [1.45–1.97]; 1.47 [1.07–1.87], nurses using protocols for antihypertensive and/or lipid lowering medication adjustment 1.58 [1.35–1.81]; 1.56 [1.03–2.08], having operational team meetings 1.36 [1.08–1.64]; 1.34 [0.99–1.70], and using audit data for quality improvement 1.00 [0.79–1.20]; 1.27 [0.99–1.56]. Offering pre-exercise-based CR (exCR) assessment and different modes of exCR were predictors for reaching both targets. The strongest patient-level predictor of reaching LDL-C target was low baseline LDL-C 3.90 [3.25–4.56], and for BP it was having no history of hypertension 2.93 [2.74–3.12]. Second, participation in exCR was the strongest predictor for both outcomes 1.60 [0.83–2.37]; 1.50 [1.15–1.86]. For smoking abstinence, 5 organizational variables were identified as meaningful predictors, the strongest being prescription of varenicline by the centre physicians 1.98 [0.13–3.84] (Figure 2). The strongest patient-level predictors were exCR participation 2.51 [2.24–2.79] and socioeconomic status variables e.g., income 1.67 [1.28–2.06], living with partner 1.47 [0.84–2.09] and education 0.80 [0.48–1.12].
Conclusion
The study identified multiple CR organizational and patient-level predictors for reaching key risk factor targets one-year post-MI. The results might contribute to defining the optimal composition of comprehensive CR programmes.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1) The Swedish Research Council for Health, Working Life and Welfare (FORTE)2) The Swedish Heart and Lung Foundation (Hjärt Lung Fonden)
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Affiliation(s)
| | - P Henriksson
- Karolinska Institute, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - J Wallert
- Karolinska Institute, Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden
| | - M Back
- Sahlgrenska University Hospital, Department of Occupational therapy and Physiotherapy, Gothenburg, Sweden
| | - I Sjolin
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
| | - M Schlyter
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - A Kiessling
- Karolinska Institute, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - E Hag
- Ryhov County Hospital, Department of Internal Medicine, Jonkoping, Sweden
| | - L Nilsson
- Linkoping University, Department of Health Medicine and Caring Sciences, Linkoping, Sweden
| | - A Schiopu
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - M J Zaman
- James Paget Hospitals, Department of Cardiology, Norfolk, United Kingdom
| | - M Leosdottir
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
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19
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Mihaila AC, Ciortan L, Macarie RD, Vadana M, Cecoltan S, Preda MB, Hudita A, Gan AM, Jakobsson G, Tucureanu MM, Barbu E, Balanescu S, Simionescu M, Schiopu A, Butoi E. Transcriptional Profiling and Functional Analysis of N1/N2 Neutrophils Reveal an Immunomodulatory Effect of S100A9-Blockade on the Pro-Inflammatory N1 Subpopulation. Front Immunol 2021; 12:708770. [PMID: 34447377 PMCID: PMC8384118 DOI: 10.3389/fimmu.2021.708770] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/23/2021] [Indexed: 12/21/2022] Open
Abstract
Neutrophils have been classically viewed as a homogenous population. Recently, neutrophils were phenotypically classified into pro-inflammatory N1 and anti-inflammatory N2 sub-populations, but the functional differences between the two subtypes are not completely understood. We aimed to investigate the phenotypic and functional differences between N1 and N2 neutrophils, and to identify the potential contribution of the S100A9 alarmin in neutrophil polarization. We describe distinct transcriptomic profiles and functional differences between N1 and N2 neutrophils. Compared to N2, the N1 neutrophils exhibited: i) higher levels of ROS and oxidative burst, ii) increased activity of MPO and MMP-9, and iii) enhanced chemotactic response. N1 neutrophils were also characterized by elevated expression of NADPH oxidase subunits, as well as activation of the signaling molecules ERK and the p65 subunit of NF-kB. Moreover, we found that the S100A9 alarmin promotes the chemotactic and enzymatic activity of N1 neutrophils. S100A9 inhibition with a specific small-molecule blocker, reduced CCL2, CCL3 and CCL5 chemokine expression and decreased MPO and MMP-9 activity, by interfering with the NF-kB signaling pathway. Together, these findings reveal that N1 neutrophils are pro-inflammatory effectors of the innate immune response. Pharmacological blockade of S100A9 dampens the function of the pro-inflammatory N1 phenotype, promoting the alarmin as a novel target for therapeutic intervention in inflammatory diseases.
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Affiliation(s)
- Andreea C Mihaila
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Letitia Ciortan
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Razvan D Macarie
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Mihaela Vadana
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Sergiu Cecoltan
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Mihai Bogdan Preda
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Ariana Hudita
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Ana-Maria Gan
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Gabriel Jakobsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Monica M Tucureanu
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Elena Barbu
- Departament of Cardiology, Elias Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Serban Balanescu
- Departament of Cardiology, Elias Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Maya Simionescu
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
| | - Alexandru Schiopu
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Pathophysiology, University of Medicine, Pharmacy, Sciences and Technology of Targu-Mures, Targu-Mures, Romania
| | - Elena Butoi
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", Bucharest, Romania
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20
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Vlad L, Manea S, Mares R, Lazar A, Preda B, Simionescu M, Schiopu A, Manea A. Pharmacological inhibition of the alarmin S100A9 reduces NADPH oxidase expression and oxidative stress in the infarcted myocardium in mice. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Manea SA, Vlad L, Mares R, Lazar A, Preda B, Schiopu A, Simionescu M, Manea A. Myeloid cell-derived S100A9 modulates the expression of histone methylation epigenetic enzymes in the myocardium after permanent ischemia in mice. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Rattik S, Jakobsson G, Grönberg C, Birkedal GS, Millrud CR, Thuring C, Pettersson NF, Falk HH, Schiopu A, Liberg D. Blocking IL1, IL33 and IL36 signaling by an anti-IL1RAP antibody is an efficient anti-inflammatory treatment that improves heart function in a model of autoimmune myocarditis. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.18.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Abstract
The IL1 receptor accessory protein (IL1RAP) is a coreceptor for the IL1, IL33, and IL36 receptors. We have developed a fully humanized antibody (CAN10) that binds IL1RAP with high affinity and disrupts IL1α, IL1β, IL33, IL36α, IL36β and IL36γ signaling without inducing ADCC. CAN10 is currently undergoing preclinical development in preparation for clinical studies.
The efficacy of IL1RAP-blockade as an anti-inflammatory treatment was investigated in a mouse model of acute peritonitis (i.p injection of MSU crystals). A CAN10 surrogate (mCAN10) decreased the recruitment of neutrophils and monocytes to the peritoneum as well as the production of e.g IL6 and KC. Blocking only IL1α/β had similar effects but notably, mCAN10 also induced additional anti-inflammatory responses including reductions in e.g IL5 and eotaxin. In addition, mCAN10, but not anti-IL1β, reduced skin inflammation in a mouse model of psoriasis. Taken together, these results indicate that blocking IL1RAP is a potent anti-inflammatory strategy that is qualitatively different from blocking IL1α/β alone.
IL1, IL33 and IL36 may have disease promoting roles in myocarditis, an inflammatory heart disease with no available treatment. Therefore, we investigated if IL1RAP blockade can counteract inflammation and decline in heart function in a model of autoimmune myocarditis (EAM). EAM was induced by immunizing Balb/C mice with αMHC peptide on day 0 and 7. Treatment with mCAN10 or isotype control started day 7 and heart function was analyzed by echocardiography at days 0, 28 and 42. Interestingly, anti-inflammatory treatment with mCAN10 potently counteracted the decline in heart function. These studies highlight the potential of blocking IL1RAP to treat inflammatory diseases.
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Affiliation(s)
- Sara Rattik
- 1Cantargia AB, Sweden
- 2Lund University, Sweden
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23
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Mulholland M, Jakobsson G, Sundius L, Ljungcrantz I, Rattik S, Bengtsson E, Schiopu A, Nilsson J, Herter J, Björkbacka H, Lichtman AH, Engelbertsen D. Atherosclerotic plaque T cells produce cytokines but do not exhibit signs of T-cell receptor-mediated activation. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.13.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Abstract
T-cell activation in the atherosclerotic plaque has been proposed to be a key event promoting lesion inflammation and destabilization. Although T cells and antigen-presenting cells are present in the plaque, it is unclear whether primary activation or secondary re-activation of T cells occurs in the lesion. We sought to quantify and characterize activated plaque T-cells in experimental atherosclerosis utilizing transgenic reporter mice of TCR-signalling (Nur77-GFP) or cytokine production (IFN-γ-YFP). As has been previously described, splenic Nur77hi T cells displayed markers consistent with a recently activated phenotype (PD-1+CD44+). Importantly, we observed very low levels of Nur77hi CD4+ or CD8+ T cells in the atherosclerotic aorta of Nur77-GFP-Apoe−/− mice compared to other tissues. In line with these findings, adoptive transfer of splenic Nur77-GFP CD4+ T cells to lymphodeficient atherosclerotic Rag1−/−Apoe−/− mice revealed markedly lower levels of Nur77hi T cells in plaque compared to lymphoid organs 10 weeks post-transfer, suggesting limited TCR-mediated activation in plaques. Conversely, analysis of atherosclerotic plaques from Apoe−/−IFN-γ-YFP reporter mice demonstrated robust IFN-γ production by CD4+ and CD8+ T cells. Altogether these results indicate that levels of cytokine release are above that of TCR-mediated T-cell activation, suggesting that antigen-driven activation of T cells in the plaque is not key for mediating T-cell driven atherosclerosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jan Herter
- 2Ctr. for Molec. Med., Univ. of Cologne, Germany
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24
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Holm Nielsen S, Shami A, Jonasson L, Swahn E, Auf Dem Keller U, Genovese F, Karsdal M, Grufman H, Yndigegn T, Schiopu A, Nilsson J, Edsfeldt A, Alfredsson J, Goncalves I. Collagen remodeling markers show differentiated expression in patients with ST- and non-ST elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Following acute myocardial infarction (MI), the left ventricle undergoes molecular and extracellular matrix (ECM) changes. The ECM is a dynamic structure with a potential role in cardiac remodeling post-MI. Collagens are the major components of both cardiac and arterial ECM.
Purpose
We evaluated circulating levels of type I, IV and VI collagen fragments in two cohorts of patients with acute MI to investigate collagen turnover post-MI. The cohorts were Malmö AMI in elderly (MAMI-Y) and Assessing Platelet Activity in Coronary Heart Disease (APACHE).
Methods
Serum was collected from 190 patients from the discovery cohort (MAMI-Y: mean age 74, SD 10.8) at four timepoints: admission when MI, after 3–6 days, 6 weeks, 12 months; citrate plasma was collected from 142 patients from the validation cohort (APACHE: mean age 65, SD 11.6) at four timepoints: hospitalization, 3 days, 7–9 days, 6 months. The biomarkers of matrix metalloproteinase (MMP)-mediated degradation of type I collagen (C1M), MMP-mediated degradation of type IV collagen (C4M) and formation of type VI collagen (PRO-C6) were measured at all timepoints (immunosorbent assays). Differences in the markers at the different timepoints were calculated using repeated measures ANOVA.
Results
Circulating levels of the formation biomarker PRO-C6 significantly increased from baseline and remained high at all three following timepoints in both MAMI-Y and APACHE studies (all p<0.001). In contrast, the degradation biomarkers C1M and C4M showed a similar pattern of an initial increase 3 days post-MI followed by a decrease over time, with C1M in MAMI-Y and both C1M and C4M in APACHE having returned to baseline level by the final timepoint. Circulating baseline levels of PRO-C6 correlated with age (r=0.397, p<0.0001 in MAMI-Y, r=0.427, p<0.0001 in APACHE). Categorizing the subjects into ST elevation MI (STEMI; MAMI-Y: N=67, APACHE: N=71) or non-ST elevation MI (NSTEMI; MAMI-Y: N=130, APACHE: N=52) revealed that a correlation with age remained in both subgroups (r=0.443, p<0.0001 and r=0.325, p<0.0001, respectively, in MAMI-Y, and r=0.516, p<0.0001 and r=0.316, p=0.023, respectively, in APACHE). Moreover, PRO-C6 was elevated in STEMI patients that had previously experienced an MI in both cohorts (MAMI-Y: p=0.017, APACHE: p=0.016). C1M and C4M levels were not different in patients with prior MI in any of the cohorts. No association was found between any biomarker and gender or diabetes. Echocardiography showed a correlation between baseline levels of C1M and ejection fraction (r=0.228, p=0.023) in the whole MAMI-Y cohort and among NSTEMI, but not among STEMI, subjects (r=0.337, p=0.004).
Conclusions
We observed changes in circulating fragments reflecting collagen turnover in the acute phase post-MI, more pronounced in STEMI patients. This may indicate that STEMI patients have more active collagen remodeling than NSTEMI patients and may have more altered left ventricle function and remodeling.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by the Danish Research Foundation “den danske forskningsfond”, the Innovation foundation (Innovationsfonden), Swedish Research Council, Swedish Heart and Lung Foundation, Swedish Society for Medical Research, Swedish Society of Medicine, the Crafoord Foundation, the Åke Wiberg foundation and the Stroke foundation.
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Affiliation(s)
- S Holm Nielsen
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - A Shami
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - L Jonasson
- Linkoping University, Cardiology, University Hospital and Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - E Swahn
- Linkoping University, Cardiology, University Hospital and Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - U Auf Dem Keller
- Technical University of Denmark, Biomedicine and Biotechnology, Lyngby, Denmark
| | - F Genovese
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - M Karsdal
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - H Grufman
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - T Yndigegn
- Lund University, Clinical Sciences Malmö and Department of Cardiology, Malmö, Sweden
| | - A Schiopu
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - J Nilsson
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - A Edsfeldt
- Lund University, Clinical Sciences Malmö and Department of Cardiology, Malmö, Sweden
| | - J Alfredsson
- Linkoping University, Cardiology, University Hospital and Health, Medicine and Caring Sciences, Linkoping, Sweden
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25
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Ogmundsdottir Michelsen H, Sjolin I, Back M, Gonzalez M, Olsson A, Sandberg C, Schiopu A, Leosdottir M. Effect of a lifestyle-focused electronic patient support application on risk factor management in post-myocardial infarction patients – a randomized controlled trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac rehabilitation (CR) is central in reducing morbidity and mortality after myocardial infarction (MI). However, the fulfillment of guideline recommended CR targets is unsatisfactory. eHealth offers new possibilities to improve clinical care.
Purpose
The aim of this study was to assess the efficacy of a mobile device application to support adherence to lifestyle advice and self-control of risk factors as a complement to traditional CR after MI.
Method
This unblinded multi-centre randomized controlled trial included 150 patients with MI (81% men, 60.4±8.8 years). All patients in the intervention (INT) and control (CON) groups participated in a 1-year CR program. Additionally, INT patients (n=101) received access to the mobile device application for 25 weeks post-MI where information about lifestyle (i.e., diet, physical activity, smoking), modifiable risk factors (i.e., weight, blood pressure (BP)), and symptoms could be registered. The software provided direct positive feedback and lifestyle advice. Data was reviewed twice weekly by the CR nurse. The primary outcome was change in sub-maximal exercise capacity (W) between an exercise test 2-weeks post MI and at follow-up 4 month later. Secondary outcomes included changes in lifestyle and modifiable risk factors including body mass index, waist circumference, blood-lipids, fasting glucose and HbA1c, between baseline and 2-week, 2-month and 1-year follow-up visits. Regression analysis was used, adjusting for relevant baseline variables.
Results
Participation in CR was high, with 96% of INT patients and 98% of the CON patients attending the 1-year follow-up visit. Forty-six percent of the INT patients and 57% of the CON patients attended centre-based exercise training (p=0.1). In the INT group 86% logged data in the application at least once. Adherence, defined as logging data at least twice per week, was 92% in week 1 and 57% in week 25. There was a numerical trend toward better exercise capacity improvement in the INT group (INT +14.4±19.0 vs. CON +10.3±16.1 W, p=0.2) although differences were non-significant. INT patients achieved larger BP reduction at 2-weeks (systolic) and 2-months (systolic and diastolic) (Figure). At 2-months 70% vs. 46% of smokers in the INT vs CON groups had quit smoking, and at 1-year the respective percentages were 57% vs. 36%. The number of smokers in the study was however low (n=33) and the differences non-significant. For other secondary endpoints no differences were observed.
Conclusion
Complementing CR with a mobile device application improved BP during the first months after MI, and non-significant trends towards better exercise capacity and higher smoking cessation rates were observed. Even though the differences were non-significant in our small study sample, they indicate that using eHealth in the form of a mobile device application could clinically benefit post-MI patients participating in CR.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Governmental funding of clinical research within the National Health Services in Sweden.
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Affiliation(s)
| | - I Sjolin
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - M Back
- Linkoping University, Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linkoping, Sweden
| | - M Gonzalez
- Umea University, Department of Public Health and Clinical Medicine, Cardiology, Umea, Sweden
| | - A Olsson
- Skane University Hospital, Department of Cardiology, Clinical Sciences, Lund, Sweden
| | - C Sandberg
- Umea University, Department of Public Health and Clinical Medicine, Cardiology, Umea, Sweden
| | - A Schiopu
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - M Leosdottir
- Lund University, Department of Clinical Sciences, Malmo, Sweden
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26
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Grauen Larsen H, Sjogren M, Engstrom G, Nilsson P, Orho-Melander M, Nilsson J, Melander O, Schiopu A. The Gly82Ser polymorphism in the receptor for advanced glycation end products is associated with increased risk for coronary events in the general population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Activation of the receptor for advanced glycation end products (RAGE) by AGEs and various immune mediators has pro-inflammatory and pro-atherogenic effects. RAGE also exists in a soluble form, sRAGE, that acts as a decoy receptor for RAGE ligands. Low plasma sRAGE has previously been found to be associated with a higher risk for major adverse coronary events (MACE) in the population.
Purpose
The purpose of our study was to examine the causality of the association, by exploring whether genetic variants that influence sRAGE are associated with atherosclerosis progression and incident MACE and mortality in the population.
Methods
We performed a genome-wide association study (GWAS) in 4192 individuals from a randomly selected subgroup of a population-based cohort. Subsequently, we explored the associations between the identified single nucleotide polymorphims (SNPs) associated with plasma sRAGE levels, baseline intima media thickness (IMT) and IMT progression in the common carotid artery during a median follow-up of 16.5 years. Further, we analyzed the prospective relationships between the sRAGE-associated SNPs, incident MACE and mortality in the entire population-based cohort of 29245 individuals. The median follow-up time from baseline was 21.2 years for MACE and 21.6 years for total mortality (time to event or end of follow-up).
Results
We found the minor alleles of two single nucleotide polymorphisms (SNPs), rs2070600 and rs204993, to be independently associated with lower plasma sRAGE. While rs204993 is a silent intronic mutation, rs2070600 is known to cause a Gly82Ser polymorphism in the ligand binding domain, enhancing RAGE propensity for activation. In Cox regression analyses, we found an association between the minor T (vs. C) allele of rs2070600 and increased risk for first-time MACE [HR 1.12 (1.02–1.23); P=0.023]. The association was independent of traditional cardiovascular risk factors, blood pressure-lowering medication and lipid-lowering medication at baseline. rs204993 was not associated with MACE. Neither SNP was associated with carotid IMT at baseline or with IMT progression. We did not identify any relationships with total mortality.
Conclusions
We demonstrate for the first time an independent link between a genetic RAGE determinant and the risk for MACE in the population. Despite both identified SNPs being associated with lower sRAGE levels, only the functional rs2070600 mutation was associated with MACE, suggesting that the link is probably due to the enhancement of RAGE function rather than to the sRAGE lowering effect.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): This study was supported by grants from the Swedish Research Council and the Swedish Heart and Lung foundation.
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Affiliation(s)
- H Grauen Larsen
- Lund University, Department of Clinical Sciences Malmö, Malmo, Sweden
| | - M Sjogren
- Lund University, Department of Clinical Sciences Malmö, Malmo, Sweden
| | - G Engstrom
- Lund University, Department of Clinical Sciences Malmö, Malmo, Sweden
| | - P.M Nilsson
- Lund University, Department of Clinical Sciences Malmö, Malmo, Sweden
| | - M Orho-Melander
- Lund University, Department of Clinical Sciences Malmö, Malmo, Sweden
| | - J Nilsson
- Lund University, Department of Clinical Sciences Malmö, Malmo, Sweden
| | - O Melander
- Lund University, Department of Clinical Sciences Malmö, Malmo, Sweden
| | - A Schiopu
- Lund University, Department of Clinical Sciences Malmö, Malmo, Sweden
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27
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Marinković G, Koenis DS, de Camp L, Jablonowski R, Graber N, de Waard V, de Vries CJ, Goncalves I, Nilsson J, Jovinge S, Schiopu A. S100A9 Links Inflammation and Repair in Myocardial Infarction. Circ Res 2020; 127:664-676. [PMID: 32434457 DOI: 10.1161/circresaha.120.315865] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
RATIONALE The alarmin S100A9 has been identified as a potential therapeutic target in myocardial infarction. Short-term S100A9 blockade during the inflammatory phase post-myocardial infarction inhibits systemic and cardiac inflammation and improves cardiac function long term. OBJECTIVE To evaluate the impact of S100A9 blockade on postischemic cardiac repair. METHODS AND RESULTS We assessed cardiac function, hematopoietic response, and myeloid phagocyte dynamics in WT (wild type) C57BL/6 mice with permanent coronary artery ligation, treated with the specific S100A9 blocker ABR-238901 for 7 or 21 days. In contrast to the beneficial effects of short-term therapy, extended S100A9 blockade led to progressive deterioration of cardiac function and left ventricle dilation. The treatment reduced the proliferation of Lin-Sca-1+c-Kit+ hematopoietic stem and progenitor cells in the bone marrow and the production of proreparatory CD150+CD48-CCR2+ hematopoietic stem cells. Monocyte trafficking from the spleen to the myocardium and subsequent phenotype switching to reparatory Ly6CloMerTKhi macrophages was also impaired, leading to inefficient efferocytosis, accumulation of apoptotic cardiomyocytes, and a larger myocardial scar. The transcription factor Nur77 (Nr4a1 [nuclear receptor subfamily 4 group A member 1]) mediates the transition from inflammatory Ly6Chi monocytes to reparatory Ly6Clo macrophages. S100A9 upregulated the levels and activity of Nur77 in monocytes and macrophages in vitro and in Ly6Chi/int monocytes in vivo, and S100A9 blockade antagonized these effects. Finally, the presence of reparatory macrophages in the myocardium was also impaired in S100A9-/- mice with permanent myocardial ischemia, leading to depressed cardiac function long term. CONCLUSIONS We show that S100A9 plays an important role in both the inflammatory and the reparatory immune responses to myocardial infarction. Long-term S100A9 blockade negatively impacts cardiac recovery and counterbalances the beneficial effects of short-term therapy. These results define a therapeutic window targeting the inflammatory phase for optimal effects of S100A9 blockade as potential immunomodulatory treatment in acute myocardial infarction.
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Affiliation(s)
- Goran Marinković
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (G.M., I.G., J.N., A.S.)
| | - Duco Steven Koenis
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, the Netherlands (D.S.K., V.d.W., C.J.d.V.)
| | - Lisa de Camp
- DeVos Cardiovascular Research Program, Van Andel Institute, Grand Rapids, MI (L.d.C., N.G., S.J.)
| | | | - Naomi Graber
- DeVos Cardiovascular Research Program, Van Andel Institute, Grand Rapids, MI (L.d.C., N.G., S.J.)
| | - Vivian de Waard
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, the Netherlands (D.S.K., V.d.W., C.J.d.V.)
| | - Carlie Jacoba de Vries
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, the Netherlands (D.S.K., V.d.W., C.J.d.V.)
| | - Isabel Goncalves
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (G.M., I.G., J.N., A.S.).,Department of Cardiology, Skane University Hospital, Sweden (I.G.)
| | - Jan Nilsson
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (G.M., I.G., J.N., A.S.)
| | - Stefan Jovinge
- DeVos Cardiovascular Research Program, Van Andel Institute, Grand Rapids, MI (L.d.C., N.G., S.J.).,DeVos Cardiovascular Research Program, Fredrik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (S.J.).,Cardiovascular Institute, Stanford University, CA (S.J.)
| | - Alexandru Schiopu
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (G.M., I.G., J.N., A.S.).,University of Medicine, Pharmacy, Sciences and Technology of Targu-Mures, Romania (A.S.).,Department of Internal Medicine, Skane University Hospital, Sweden (A.S.)
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28
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Tomas L, Bengtsson E, Andersson L, Badn W, Tengryd C, Persson A, Edsfeldt A, Nilsson PM, Schiopu A, Nilsson J, Gonçalves I, Björkbacka H. Low Levels of CD4
+
CD28
null
T Cells at Baseline Are Associated With First-Time Coronary Events in a Prospective Population-Based Case-Control Cohort. Arterioscler Thromb Vasc Biol 2020; 40:426-436. [DOI: 10.1161/atvbaha.119.313032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective:
CD4
+
CD28
null
T cells have been shown to be associated with recurrent coronary events and suggested as potential biomarker and therapeutic target. It is unknown whether CD4
+
CD28
null
T cells associate with first-time cardiovascular events. We examined CD4
+
CD28
null
T cells in a prospective population-based cohort and in patients with advanced atherosclerosis.
Approach and Results:
CD4
+
CD28
null
T cells were quantified in 272 individuals experiencing a first-time coronary event during up to 17 years of follow-up and 272 age- and sex-matched controls in a case-control study, nested within the population-based Malmö Diet and Cancer study. The highest tertile of CD4
+
CD28
null
T cells was associated with a lower incidence of first-time coronary events compared with the lowest tertile (odds ratio, 0.48 [95% CI, 0.29–0.79],
P
=0.004) when adjusting for Framingham risk factors. This association remained significant for events recorded after >9 years of follow-up, when most coronary events occurred, but not during the first 9 years of follow-up, despite similar odds ratio. Additionally, we analyzed CD4
+
CD28
null
T cells in 201 patients with advanced atherosclerosis undergoing carotid endarterectomy. The adjusted hazard ratio for cardiovascular events in patients with advanced atherosclerosis was 2.11 (95% CI, 1.10–4.05,
P
=0.024), comparing the highest with the lowest CD4
+
CD28
null
T-cell tertile.
Conclusions:
Our findings reveal complex associations between CD4
+
CD28
null
T cells and cardiovascular disease. Although we confirm the reported positive associations with an adverse prognosis in patients with already established disease, the opposite associations with first-time coronary events in the population-based cohort may limit the clinical use of CD4
+
CD28
null
T cells.
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Affiliation(s)
- Lukas Tomas
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
| | - Eva Bengtsson
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
| | - Linda Andersson
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
| | - Wiaam Badn
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
| | - Christoffer Tengryd
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
| | - Ana Persson
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
| | - Andreas Edsfeldt
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden (A.E., A.S, I.G.)
| | - Peter M. Nilsson
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
| | - Alexandru Schiopu
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden (A.E., A.S, I.G.)
| | - Jan Nilsson
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
| | - Isabel Gonçalves
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden (A.E., A.S, I.G.)
| | - Harry Björkbacka
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (L.T., E.B., L.A., W.B., C.T., A.P., A.E., P.M.N., A.S., J.N., I.G., H.B.)
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29
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Grauen Larsen H, Marinkovic G, Nilsson PM, Nilsson J, Engström G, Melander O, Orho-Melander M, Schiopu A. High Plasma sRAGE (Soluble Receptor for Advanced Glycation End Products) Is Associated With Slower Carotid Intima-Media Thickness Progression and Lower Risk for First-Time Coronary Events and Mortality. Arterioscler Thromb Vasc Biol 2020; 39:925-933. [PMID: 30917679 DOI: 10.1161/atvbaha.118.312319] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective- RAGE (receptor for advanced glycation end products) and EMMPRIN (extracellular matrix metalloproteinase inducer) are immune receptors for proinflammatory mediators. These receptors can also be found in a soluble form in the circulation. Soluble RAGE (sRAGE) has shown atheroprotective properties in animal studies, possibly by acting as a decoy receptor for its ligands. Whether sEMMPRIN (soluble EMMPRIN) has similar roles is unknown. We hypothesized that sRAGE and sEMMPRIN might be associated with vascular disease progression, incident coronary events, and mortality. Approach and Results- We measured baseline sRAGE and sEMMPRIN in 4612 cardiovascular disease-free individuals from the population-based Malmö Diet and Cancer cohort. Measurements of intima-media thickness in the common carotid artery were performed at inclusion and after a median of 16.5 years. sRAGE was negatively correlated with carotid intima-media thickness progression, independently of traditional cardiovascular risk factors, kidney function, and hsCRP (high sensitive C-reactive protein). Additionally, sRAGE was associated with decreased risk for major adverse coronary events (hazard ratio=0.90 [0.82-0.97]; P=0.009) and mortality (hazard ratio=0.93 [0.88-0.99]; P=0.011) during a follow-up period of 21 years. The relationship with mortality was independent of all considered potential confounders. We found no correlations between EMMPRIN, intima-media thickness progression, or prognosis. Conclusions- Individuals with high levels of circulating sRAGE have a slower rate of carotid artery disease progression and a better prognosis. Although its predictive value was too weak to promote sRAGE as a useful clinical biomarker in the population, the findings support further research into the potential anti-inflammatory and atheroprotective properties of this soluble receptor.
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Affiliation(s)
- Helena Grauen Larsen
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (H.G.L., G.M., P.M.N., J.N., G.E., O.M., M.O.-M., A.S.)
- Department of Cardiology, Skane University Hospital, Sweden (H.G.L., A.S.)
| | - Goran Marinkovic
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (H.G.L., G.M., P.M.N., J.N., G.E., O.M., M.O.-M., A.S.)
| | - Peter M Nilsson
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (H.G.L., G.M., P.M.N., J.N., G.E., O.M., M.O.-M., A.S.)
| | - Jan Nilsson
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (H.G.L., G.M., P.M.N., J.N., G.E., O.M., M.O.-M., A.S.)
| | - Gunnar Engström
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (H.G.L., G.M., P.M.N., J.N., G.E., O.M., M.O.-M., A.S.)
| | - Olle Melander
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (H.G.L., G.M., P.M.N., J.N., G.E., O.M., M.O.-M., A.S.)
| | - Marju Orho-Melander
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (H.G.L., G.M., P.M.N., J.N., G.E., O.M., M.O.-M., A.S.)
| | - Alexandru Schiopu
- From the Department of Clinical Sciences Malmö, Lund University, Sweden (H.G.L., G.M., P.M.N., J.N., G.E., O.M., M.O.-M., A.S.)
- Department of Cardiology, Skane University Hospital, Sweden (H.G.L., A.S.)
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30
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Leosdottir M, Sjolin I, Sandberg C, Olsson A, Back M, Schiopu A, Gonzalez M, Ogmundsdottir Michelsen H. P2684Blood pressure lowering by using a self-care focused smartphone application for patients after myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We have previously shown that complementing traditional cardiac rehabilitation (CR) with a web-based smartphone application designed to support self-control of risk factors can improve secondary prevention outcomes, including lower blood pressure (BP).
Purpose
To explore possible explanations for better BP control among patients with myocardial infarction (MI) receiving access to a smartphone application as a complement to traditional CR, compared to patients receiving traditional CR alone.
Methods
Data from a multi-centre randomized controlled trial that included 150 patients with MI (81% men, 60.4±8.8 years) was used. All patients participated in traditional CR. In addition, patients in the intervention group (APP, n=101) had access to the application. Patients received automated positive feedback on normal values and all registered data was viewed by CR nurses twice weekly. As previously reported, APP patients achieved a 9 mmHg larger reduction in systolic BP than usual care (UC) patients at 2-months follow-up (p=0.02). In the current analysis we assessed differences between APP and UC patients in the number of visits and telephone contacts with the CR clinic, number of reported BP measurements and number and type of interventions on account of out-of-range BP during the first 6 months of follow-up, using Mann-Whitney and chi-square tests.
Results
There was no difference in the median (IQR) number of visits to a CR nurse or physician (APP 2 (2–3) vs UC 2 (2–3), p=0.8) or telephone contacts ((APP 2 (1–4) vs UC 2 (1–4), p=0.8) between the groups. Approximately one in ten telephone contacts were initiated because of BP, with no difference between the groups (p=0.8). Out of 101 APP patients 75 reported BP values through the application, ranging from 1–175 BP values/patient (median 6 (IQR 0–34)). Most measurements (90%) were normal. Grouping clinic visits, telephone contacts due to BP and BP reports through the application as a composite for the number of BP measurements the CR personnel were exposed to during follow-up, there was a significant difference between the groups (APP 9 (4–36) vs UC 3 (2–3), p<0.0001). There was a small non-significant difference between the groups in the proportion of patients where an intervention was performed by the CR nurse on account of out-of-range BP (i.e. medication adjustments, new measurement scheduled) (APP 22% vs UC 12%, p=0.1).
Conclusion
While CR personnel were exposed to significantly more BP measurements from patients using a self-care focused smartphone application as a complement to traditional CR, most BP measurements reported through the application were normal and there was no difference in the number of interventions performed on account of out-of-range BP values. Automated positive feedback on in-range BP measurements, increased patient responsibility with better adherence to BP lowering medication could be possible explanations to improved BP control.
Acknowledgement/Funding
The faculty of Medicine, Lund University, Lund, Sweden
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Affiliation(s)
- M Leosdottir
- Skane University Hospital, Department of Cardiology and Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - I Sjolin
- Skane University Hospital, Department of Cardiology and Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - C Sandberg
- Umea University, Heart centre and Department of Public Health and Clinical Medicine, Cardiology, Umea, Sweden
| | - A Olsson
- Skane University Hospital, Department of Cardiology and Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - M Back
- Linkoping University, Department of Medical and Health Sciences, Division of Physiotherapy, Linkoping, Sweden
| | - A Schiopu
- Skane University Hospital, Department of Cardiology and Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - M Gonzalez
- Commonwealth Scientific Research and Industrial Organization, Brisbane, Australia
| | - H Ogmundsdottir Michelsen
- Skane University Hospital, Department of Cardiology and Department of Clinical Sciences, Lund University, Malmo, Sweden
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31
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Grauen Larsen H, Nilsson PM, Nilsson J, Engstrom G, Melander O, Orho-Melander M, Schiopu A. P5510High plasma sRAGE is associated with slower carotid intima media thickness progression and lower risk for first-time coronary events and mortality. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The receptor for advanced glycation end products (RAGE) and the extracellular matrix metalloproteinase inducer (EMMPRIN) are immune receptors for pro-inflammatory mediators. These receptors can also be found in a soluble form in the circulation. Soluble RAGE (sRAGE) has shown atheroprotective properties in animal studies, by acting as a decoy receptor for its ligands. Whether sEMMPRIN has similar roles is unknown.
Purpose
The purpose of our study was to investigate the associations between sRAGE and sEMMPRIN in plasma and the progression of vascular disease, incident coronary events and mortality in the general population.
Methods
We measured baseline sRAGE and sEMMPRIN in 4612 cardiovascular disease-free middle aged individuals from a population-based cohort. Measurements of intima media thickness (IMT) in the common carotid artery were performed at inclusion and after a median of 16.5 years. Incident major adverse coronary events (MACE) and mortality were recorded during a follow-up period of 21 years.
Results
sRAGE was negatively correlated with the progression of carotid IMT, independently of traditional cardiovascular risk factors, kidney function and hsCRP. Additionally, sRAGE was associated with decreased risk for MACE [HR=0.91 (0.83–0.99); p=0.031] and total mortality [HR=0.92 (0.87–0.99); p=0.017] in multivariate Cox regression analyses. We found no correlations between EMMPRIN, IMT progression or prognosis.
Conclusion
We show that individuals with high levels of circulating sRAGE have a slower rate of carotid artery disease progression, and a lower risk for coronary events and mortality. These findings support further research into the potential atheroprotective properties of sRAGE.
Acknowledgement/Funding
This study was supported by grants from the Swedish Research Council, Marianne and Marcus Wallenberg Foundation, Swedish Heart and Lung Foundation
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Affiliation(s)
- H Grauen Larsen
- Lund University, Institution for clinical science, Malmö, Malmo, Sweden
| | - P M Nilsson
- Lund University, Institution for clinical science, Malmö, Malmo, Sweden
| | - J Nilsson
- Lund University, Institution for clinical science, Malmö, Malmo, Sweden
| | - G Engstrom
- Lund University, Institution for clinical science, Malmö, Malmo, Sweden
| | - O Melander
- Lund University, Institution for clinical science, Malmö, Malmo, Sweden
| | - M Orho-Melander
- Lund University, Institution for clinical science, Malmö, Malmo, Sweden
| | - A Schiopu
- Lund University, Institution for clinical science, Malmö, Malmo, Sweden
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32
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Georgakis MK, Malik R, Björkbacka H, Pana TA, Demissie S, Ayers C, Elhadad MA, Fornage M, Beiser A, Benjamin EJ, Boekholdt MS, Engström G, Herder C, Hoogeveen RC, Koenig W, Melander O, Orho-Melander M, Schiopu A, Söderholm M, Wareham N, Ballantyne CM, Peters A, Seshadri S, Myint PK, Nilsson J, de Lemos JA, Dichgans M. Circulating Monocyte Chemoattractant Protein-1 and Risk of Stroke: Meta-Analysis of Population-Based Studies Involving 17 180 Individuals. Circ Res 2019; 125:773-782. [PMID: 31476962 PMCID: PMC6763364 DOI: 10.1161/circresaha.119.315380] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rationale: Proinflammatory cytokines have been identified as potential targets for lowering vascular risk. Experimental evidence and Mendelian randomization suggest a role of MCP-1 (monocyte chemoattractant protein-1) in atherosclerosis and stroke. However, data from large-scale observational studies are lacking. Objective: To determine whether circulating levels of MCP-1 are associated with risk of incident stroke in the general population. Methods and Results: We used previously unpublished data on 17 180 stroke-free individuals (mean age, 56.7±8.1 years; 48.8% men) from 6 population-based prospective cohort studies and explored associations between baseline circulating MCP-1 levels and risk of any stroke, ischemic stroke, and hemorrhagic stroke during a mean follow-up interval of 16.3 years (280 522 person-years at risk; 1435 incident stroke events). We applied Cox proportional-hazards models and pooled hazard ratios (HRs) using random-effects meta-analyses. After adjustments for age, sex, race, and vascular risk factors, higher MCP-1 levels were associated with increased risk of any stroke (HR per 1-SD increment in ln-transformed MCP-1, 1.07; 95% CI, 1.01-1.14). Focusing on stroke subtypes, we found a significant association between baseline MCP-1 levels and higher risk of ischemic stroke (HR, 1.11 [1.02-1.21]) but not hemorrhagic stroke (HR, 1.02 [0.82-1.29]). The results followed a dose-response pattern with a higher risk of ischemic stroke among individuals in the upper quartiles of MCP-1 levels as compared with the first quartile (HRs, second quartile: 1.19 [1.00-1.42]; third quartile: 1.35 [1.14-1.59]; fourth quartile: 1.38 [1.07-1.77]). There was no indication for heterogeneity across studies, and in a subsample of 4 studies (12 516 individuals), the risk estimates were stable after additional adjustments for circulating levels of IL (interleukin)-6 and high-sensitivity CRP (C-reactive protein). Conclusions: Higher circulating levels of MCP-1 are associated with increased long-term risk of stroke. Our findings along with genetic and experimental evidence suggest that MCP-1 signaling might represent a therapeutic target to lower stroke risk.Visual Overview: An online visual overview is available for this article.
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Affiliation(s)
- Marios K. Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich
- Graduate School for Systemic Neurosciences (GSN), Ludwig-Maximilians-University LMU, Munich
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich
| | | | - Tiberiu Alexandru Pana
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen
| | - Serkalem Demissie
- Biostatistics, Boston University School of Public Health, Boston MA
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA
| | - Colby Ayers
- Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mohamed A. Elhadad
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg
- German Research Center for Cardiovascular Disease (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, University of Texas Health Science Center, Houston, TX
| | - Alexa Beiser
- Biostatistics, Boston University School of Public Health, Boston MA
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA
- Neurology, Boston University School of Medicine
| | - Emelia J. Benjamin
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA
- Medicine, Boston University School of Medicine
- Epidemiology, Boston University School of Public Health
| | | | | | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf
- German Center for Diabetes Research (DZD), Partner Düsseldorf
- Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf
| | | | - Wolfgang Koenig
- German Research Center for Cardiovascular Disease (DZHK), Partner site Munich Heart Alliance, Munich, Germany
- Deutsches Herzzentrum München, Technische Universität München
- Institute of Epidemiology and Biostatistics, University of Ulm, Ulm, Germany
| | | | | | - Alexandru Schiopu
- Clinical Sciences, Malmö, Lund University, Malmö
- Cardiology, Skåne University Hospital, Malmö, Sweden
| | | | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg
| | - Sudha Seshadri
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA
- Medicine, Boston University School of Medicine
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio
| | - Phyo K. Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen
| | - Jan Nilsson
- Clinical Sciences, Malmö, Lund University, Malmö
| | - James A. de Lemos
- Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich
- Munich Cluster for Systems Neurology (SyNergy)
- German Centre for Neurodegenerative Diseases (DZNE)
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Ögmundsdottir Michelsen H, Sjölin I, Schlyter M, Hagström E, Kiessling A, Henriksson P, Held C, Hag E, Nilsson L, Bäck M, Schiopu A, Zaman MJ, Leosdottir M. Cardiac rehabilitation after acute myocardial infarction in Sweden – evaluation of programme characteristics and adherence to European guidelines: The Perfect Cardiac Rehabilitation (Perfect-CR) study. Eur J Prev Cardiol 2019; 27:18-27. [DOI: 10.1177/2047487319865729] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background While patient performance after participating in cardiac rehabilitation programmes after acute myocardial infarction is regularly reported through registry and survey data, information on cardiac rehabilitation programme characteristics is less well described. Aim The aim of this study was to evaluate Swedish cardiac rehabilitation programme characteristics and adherence to European Guidelines on Cardiovascular Disease Prevention. Method Cardiac rehabilitation programme characteristics at all 78 cardiac rehabilitation centres in Sweden in 2016 were surveyed using a web-based questionnaire (100% response rate). The questions were based on core components of cardiac rehabilitation as recommended by European Guidelines. Results There was a wide variation in programme duration (2–14 months). All programmes reported offering an individual post-discharge visit with a nurse, and 90% ( n = 70) did so within three weeks from discharge. Most programmes offered centre-based exercise training ( n = 76, 97%) and group educational sessions ( n = 61, 78%). All programmes reported to the national audit, SWEDEHEART, and 60% ( n = 47) reported that performance was regularly assessed using audit data, to improve quality of care. Ninety-six per cent ( n = 75) had a core team consisting of a cardiologist, a physiotherapist and a nurse and 76% ( n = 59) reported having a medical director. Having other allied healthcare professionals included in the cardiac rehabilitation team varied. Forty per cent ( n = 31) reported having regular team meetings where nurses, physiotherapists and cardiologist could discuss patient cases. Conclusion The overall quality of cardiac rehabilitation programmes provided in Sweden is high. Still, there are several areas of potential improvement. Monitoring programme characteristics as well as patient outcomes might improve programme quality and patient outcomes both at a local and a national level.
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Affiliation(s)
| | - Ingela Sjölin
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mona Schlyter
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Emma Hag
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Lennart Nilsson
- Department of Medical and Health Sciences, Linköping University, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Sweden
| | - Alexandru Schiopu
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - M Justin Zaman
- Department of Cardiology, James Paget University Hospital, Gorleston-on-Sea, Great Yarmouth, Norfolk, UK
| | - Margret Leosdottir
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
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Marinković G, Grauen Larsen H, Yndigegn T, Szabo IA, Mares RG, de Camp L, Weiland M, Tomas L, Goncalves I, Nilsson J, Jovinge S, Schiopu A. Inhibition of pro-inflammatory myeloid cell responses by short-term S100A9 blockade improves cardiac function after myocardial infarction. Eur Heart J 2019; 40:2713-2723. [DOI: 10.1093/eurheartj/ehz461] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/20/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Neutrophils have both detrimental and beneficial effects in myocardial infarction (MI), but little is known about the underlying pathways. S100A8/A9 is a pro-inflammatory alarmin abundantly expressed in neutrophils that is rapidly released in the myocardium and circulation after myocardial ischaemia. We investigated the role of S100A8/A9 in the innate immune response to MI.
Methods and results
In 524 patients with acute coronary syndrome (ACS), we found that high plasma S100A8/A9 at the time of the acute event was associated with lower left ventricular ejection fraction (EF) at 1-year and increased hospitalization for heart failure (HF) during follow-up. In wild-type C57BL/6 mice with MI induced by permanent coronary artery ligation, treatment with the S100A9 blocker ABR-238901 during the inflammatory phase of the immune response inhibited haematopoietic stem cell proliferation and myeloid cell egression from the bone marrow. The treatment reduced the numbers of neutrophils and monocytes/macrophages in the myocardium, promoted an anti-inflammatory environment, and significantly improved cardiac function compared with MI controls. To mimic the clinical scenario, we further confirmed the effects of the treatment in a mouse model of ischaemia/reperfusion. Compared with untreated mice, 3-day ABR-238901 treatment significantly improved left ventricular EF (48% vs. 35%, P = 0.002) and cardiac output (15.7 vs. 11.1 mL/min, P = 0.002) by Day 21 post-MI.
Conclusion
Short-term S100A9 blockade inhibits inflammation and improves cardiac function in murine models of MI. As an excessive S100A8/A9 release is linked to incident HF, S100A9 blockade might represent a feasible strategy to improve prognosis in ACS patients.
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Affiliation(s)
- Goran Marinković
- Department of Clinical Sciences Malmö, Lund University, CRC 91:12, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Helena Grauen Larsen
- Department of Cardiology, Skane University Hospital Malmö, Carl-Bertil Laurells gata 9, SE-214 28 Malmö, Sweden
| | - Troels Yndigegn
- Department of Cardiology, Skane University Hospital Malmö, Carl-Bertil Laurells gata 9, SE-214 28 Malmö, Sweden
| | - Istvan Adorjan Szabo
- Department of Pathophysiology, University of Medicine, Pharmacy, Sciences and Technology of Targu-Mures, Gheorghe Marinescu str. 38, 540139 Targu-Mures, Romania
| | - Razvan Gheorghita Mares
- Department of Pathophysiology, University of Medicine, Pharmacy, Sciences and Technology of Targu-Mures, Gheorghe Marinescu str. 38, 540139 Targu-Mures, Romania
| | - Lisa de Camp
- DeVos Cardiovascular Research Program, Van Andel Institute, 333 Bostwick Ave NE, Grand Rapids, MI 49503, USA
| | - Matthew Weiland
- DeVos Cardiovascular Research Program, Van Andel Institute, 333 Bostwick Ave NE, Grand Rapids, MI 49503, USA
| | - Lukas Tomas
- Department of Clinical Sciences Malmö, Lund University, CRC 91:12, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Isabel Goncalves
- Department of Clinical Sciences Malmö, Lund University, CRC 91:12, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
- Department of Cardiology, Skane University Hospital Malmö, Carl-Bertil Laurells gata 9, SE-214 28 Malmö, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, CRC 91:12, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
| | - Stefan Jovinge
- DeVos Cardiovascular Research Program, Van Andel Institute, 333 Bostwick Ave NE, Grand Rapids, MI 49503, USA
- DeVos Cardiovascular Research Program, Fredrik Meijer Heart & Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA
- Cardiovascular Institute, Stanford Medical School, 265 Campus Drive, Stanford, CA 94305, USA
| | - Alexandru Schiopu
- Department of Clinical Sciences Malmö, Lund University, CRC 91:12, Jan Waldenströms gata 35, SE-214 28, Malmö, Sweden
- Department of Cardiology, Skane University Hospital Malmö, Carl-Bertil Laurells gata 9, SE-214 28 Malmö, Sweden
- Department of Pathophysiology, University of Medicine, Pharmacy, Sciences and Technology of Targu-Mures, Gheorghe Marinescu str. 38, 540139 Targu-Mures, Romania
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Grauen Larsen H, Yndigegn T, Marinkovic G, Grufman H, Mares R, Nilsson J, Goncalves I, Schiopu A. The soluble receptor for advanced glycation end-products (sRAGE) has a dual phase-dependent association with residual cardiovascular risk after an acute coronary event. Atherosclerosis 2019; 287:16-23. [PMID: 31181415 DOI: 10.1016/j.atherosclerosis.2019.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/18/2019] [Accepted: 05/23/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS The pro-inflammatory alarmin S100A12 (EN-RAGE) and the soluble form of its receptor, the receptor for advanced glycation endproducts (sRAGE), have diverging roles in cardiovascular disease. In experimental studies, S100A12 promoted atherosclerosis while sRAGE treatment was anti-atherogenic and reduced myocardial infarction size by scavenging RAGE ligands. Here, we aimed to explore the links between S100A12, sRAGE, and long-term prognosis after an acute coronary syndrome (ACS). METHODS We measured S100A12 and sRAGE in 524 patients within 24 h after an ACS, and again 6 weeks later in a subgroup of 114 patients. This subgroup also completed a follow-up echocardiography after 1 year. The median follow-up time for recurrent major adverse cardiovascular events (MACE), defined as recurrent ACS or cardiovascular death, was 25.7 ± 12.6 months. RESULTS In Cox proportional hazard analyses, baseline S100A12 and sRAGE were positively associated with the risk of MACE, independently of traditional cardiovascular risk factors. The association between sRAGE and MACE remained significant after additional adjustment for troponin T, NT-proBNP and hsCRP [HR 95%CI for highest versus lowest tertile 3.2 (1.5-6.5), p = 0.002]. High sRAGE was also associated with deteriorating left ventricular function and an increased rate of heart failure hospitalization post-discharge. In contrast, patients with increasing sRAGE at 6 weeks compared to baseline had lower incidence of recurrent ACS. CONCLUSIONS Our data suggest that sRAGE has a dual, phase-dependent association with residual cardiovascular risk after ACS. These findings are important for the design and interpretation of future studies on sRAGE as biomarker and potential treatment in ACS patients.
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Affiliation(s)
- Helena Grauen Larsen
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö, Lund University, CRC 91:12 Jan Waldenströms gata 35, 214 28, Malmö, Sweden; Department of Cardiology, Skane University Hospital Malmö, Sweden
| | - Troels Yndigegn
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö, Lund University, CRC 91:12 Jan Waldenströms gata 35, 214 28, Malmö, Sweden
| | - Goran Marinkovic
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö, Lund University, CRC 91:12 Jan Waldenströms gata 35, 214 28, Malmö, Sweden
| | - Helena Grufman
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö, Lund University, CRC 91:12 Jan Waldenströms gata 35, 214 28, Malmö, Sweden
| | - Razvan Mares
- University of Medicine, Pharmacy, Sciences and Technology of Tirgu-Mures, 38 Gh. Marinescu Str., Tirgu-Mures, Romania
| | - Jan Nilsson
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö, Lund University, CRC 91:12 Jan Waldenströms gata 35, 214 28, Malmö, Sweden
| | - Isabel Goncalves
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö, Lund University, CRC 91:12 Jan Waldenströms gata 35, 214 28, Malmö, Sweden; Department of Cardiology, Skane University Hospital Malmö, Sweden
| | - Alexandru Schiopu
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö, Lund University, CRC 91:12 Jan Waldenströms gata 35, 214 28, Malmö, Sweden; Department of Cardiology, Skane University Hospital Malmö, Sweden; University of Medicine, Pharmacy, Sciences and Technology of Tirgu-Mures, 38 Gh. Marinescu Str., Tirgu-Mures, Romania.
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Gonzalez M, Sjölin I, Bäck M, Ögmundsdottir Michelsen H, Tanha T, Sandberg C, Schiopu A, Leosdottir M. Effect of a lifestyle-focused electronic patient support application for improving risk factor management, self-rated health, and prognosis in post-myocardial infarction patients: study protocol for a multi-center randomized controlled trial. Trials 2019; 20:76. [PMID: 30678709 PMCID: PMC6346565 DOI: 10.1186/s13063-018-3118-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 12/08/2018] [Indexed: 11/23/2022] Open
Abstract
Background Cardiac rehabilitation (CR) programs addressing risk factor management, educational interventions, and exercise contribute to reduce mortality after myocardial infarction (MI). However, the fulfillment of guideline-recommended CR targets is currently unsatisfactory. eHealth, i.e., the use of electronic communication for healthcare, including the use of mobile smartphone applications combined with different sensors and interactive computerized programs, offers a new array of possibilities to provide clinical care. The present study aims to assess the efficacy of a web-based application (app) designed to support persons in adhering to lifestyle advice and medication as a complement to traditional CR programs for improvement of risk factors and clinical outcomes in patients with MI compared with usual care. Methods/design An open-label multi-center randomized controlled trial is being conducted at different CR centers from three Swedish University Hospitals. The aim is to include 150 patients with MI < 75 years of age who are confident smartphone and/or Internet users. In addition to participation in CR programs according to the usual routine at each center, patients randomized to the intervention arm will receive access to the web-based app. A CR nurse reviews the patients’ self-reported data twice weekly through a medical interface at the clinic. The primary outcome of the study will be change in submaximal exercise capacity (in watts) between 2 and 4 weeks after discharge and when the patient has completed his/her exercise program at the CR center, usually around 3–6 months post-discharge. Secondary outcomes include changes in self-reported physical activity, objectively assessed physical activity by accelerometry, self-rated health, dietary, and smoking habits, body mass index, blood pressure, blood lipids, and glucose/HbA1c levels between inclusion and follow-up visits during the first year post-MI. Additionally, we will assess uptake and adherence to the application, the number of CR staff contacts, and the incidence of cardiovascular events at 1 and 3 years after the MI. Patient recruitment started in 2016, and the first study results are expected in the beginning of 2019. Discussion The present study will add evidence to whether electronic communication can be used to improve traditional CR programs for patients after MI. Trial registration ClinicalTrials.gov, NCT03260582. Retrospectively registered on 24 August 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3118-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel Gonzalez
- Heart Center and Department of Public Health and Clinical Medicine, Cardiology, Umeå University, Umeå, Sweden.,Commonwealth Scientific Research and Industrial Organisation (CSIRO), Brisbane, Australia
| | - Ingela Sjölin
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Cardiology, Skane University Hospital, 205 02, Malmö, Sweden
| | - Maria Bäck
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Halldora Ögmundsdottir Michelsen
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Cardiology, Skane University Hospital, 205 02, Malmö, Sweden
| | - Tina Tanha
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Cardiology, Skane University Hospital, 205 02, Malmö, Sweden
| | - Camilla Sandberg
- Heart Center and Department of Public Health and Clinical Medicine, Cardiology, Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy Umeå University, Umeå, Sweden
| | - Alexandru Schiopu
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Cardiology, Skane University Hospital, 205 02, Malmö, Sweden
| | - Margret Leosdottir
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. .,Department of Cardiology, Skane University Hospital, 205 02, Malmö, Sweden.
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Lagerstedt JO, Dalla-Riva J, Marinkovic G, Del Giudice R, Engelbertsen D, Burlin J, Petrlova J, Lindahl M, Bernfur K, Melander O, Nilsson J, Schiopu A. Anti-ApoA-I IgG antibodies are not associated with carotid artery disease progression and first-time cardiovascular events in middle-aged individuals. J Intern Med 2019; 285:49-58. [PMID: 30028049 DOI: 10.1111/joim.12817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE IgG antibodies against apolipoprotein A-I (ApoA-I) have been found to be elevated in subjects from the general population with clinically manifest cardiovascular disease and in myocardial infarction patients with an adverse prognosis. Here, we investigated whether these antibodies are prospectively associated with carotid artery disease progression and with the risk for first-time cardiovascular events in individuals with no previous history of cardiovascular disease. APPROACH AND RESULTS We selected 383 subjects from the cardiovascular cohort of Malmö Diet and Cancer study who suffered a coronary event during a median follow-up period of 15.4 (10.3-16.4) years and 395 age- and sex-matched controls. None of the study participants had a previous history of coronary artery disease or stroke. Anti-ApoA-I IgG were measured by ELISA in serum samples collected at baseline. Intima-media thickness (IMT) was measured in the common carotid artery and in the carotid bifurcation at baseline and after 15.9 (±1.5) years. We found no associations between anti-ApoA-I IgG and carotid artery IMT at baseline or with IMT progression during follow-up. In Cox proportional hazards analyses adjusted for traditional cardiovascular risk factors, the hazard ratio (HR 95%CI) for the primary outcome, incident coronary events, was 0.97 (0.75-1.25), P = 0.782, in subjects with anti-ApoA-I IgG within the highest tertile compared with the lowest tertile. Similarly, we did not find any associations with the secondary outcome, incident first-time stroke. CONCLUSIONS Serum autoantibodies against ApoA-I do not correlate with disease progression and adverse events in cardiovascular disease-free individuals from the general population.
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Affiliation(s)
- J O Lagerstedt
- Medical Protein Science Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - J Dalla-Riva
- Medical Protein Science Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - G Marinkovic
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - R Del Giudice
- Medical Protein Science Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - D Engelbertsen
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - J Burlin
- Medical Protein Science Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - J Petrlova
- Medical Protein Science Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - M Lindahl
- Medical Protein Science Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - K Bernfur
- Department of Biochemistry and Structural Biology, Lund University, Lund, Sweden
| | - O Melander
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - J Nilsson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - A Schiopu
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Cardiology, Skåne University Hospital Malmö, Malmö, Sweden
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Ögmundsdottir Michelsen H, Nilsson M, Scherstén F, Sjölin I, Schiopu A, Leosdottir M. Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study. BMC Cardiovasc Disord 2018; 18:167. [PMID: 30111283 PMCID: PMC6094912 DOI: 10.1186/s12872-018-0907-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/09/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. METHOD This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. RESULTS Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). CONCLUSION A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients.
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Affiliation(s)
- Halldora Ögmundsdottir Michelsen
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Marie Nilsson
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
| | - Fredrik Scherstén
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
| | - Ingela Sjölin
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Alexandru Schiopu
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Margret Leosdottir
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
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Schlyter M, Ogmundsdottir Michelsen H, Sjolin I, Hag E, Hagstrom E, Nilsson L, Kiessling A, Henriksson P, Held C, Schiopu A, Zaman MJ, Leosdottir M. 410Treatment targets for systolic blood pressure are more often reached at cardiac rehabilitation centres where nurses adjust blood pressure medication doses - the Perfect-CR study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Schlyter
- Malmo University, Department of Clinical Sciences and Department of Cardiology, Lund University and Skane University H, Malmo, Sweden
| | - H Ogmundsdottir Michelsen
- Lund University and Skane University Hospital, Department of Clinical Sciences Malmo and Department of Cardiology, Malmo, Sweden
| | - I Sjolin
- Lund University and Skane University Hospital, Department of Clinical Sciences Malmo and Department of Cardiology, Malmo, Sweden
| | - E Hag
- Department of Internal Medicine, County hospital Ryhov, Jönköping, Sweden, Jönköping, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - L Nilsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, Linköping, Sweden
| | - A Kiessling
- Department of Clinical Sciences Danderyd Hospital and the Karolinska Institute, Stockholm, Sweden, Stockholm, Sweden
| | - P Henriksson
- Department of Clinical Sciences Danderyd Hospital and the Karolinska Institute, Stockholm, Sweden, Stockholm, Sweden
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - A Schiopu
- Lund University and Skane University Hospital, Department of Clinical Sciences Malmo and Department of Cardiology, Malmo, Sweden
| | - M J Zaman
- James Paget University Hospital, Department of Cardiology, Norfolk, United Kingdom
| | - M Leosdottir
- Lund University and Skane University Hospital, Department of Clinical Sciences Malmo and Department of Cardiology, Malmo, Sweden
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Schiopu A, Marinkovic G, DeCamp L, Winkler L, Nilsson J, Jovinge S. The S100A8/A9 alarmin stimulates myeloid cell response and promotes cardiac repair after myocardial infarction. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yndigegn T, Isaksson E, Mokthari A, Ekelund U, Erlinge D, Schiopu A. P1733Fibroblast growth factor-23 (FGF23), an early biomarker of sublinical kidney dysfunction, is associated with poor prognosis in acute coronary syndrome patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Abstract
Acute myocardial infarction (AMI) is a disease associated with high morbidity and mortality. Currently there are no available treatments specifically targeting the post-ischemic myocardial processes that lead to heart failure and recurrent coronary events. The innate immune system plays a central role in the two consecutive phases that follow an acute ischemic event: the inflammatory phase and the reparatory phase. The inflamatory phase involves a massive infiltration of neutrophils and inflammatory Ly6Chi monocytes into the injured myocardium. The reparatory phase is orchestrated by reparatory Ly6Clo macrophages that clear necrotic and apoptotic cells through efferocytosis, secrete anti-inflammatory mediators and stimulate fibrosis and repair. Important recent studies provided proof that Ly6Chi monocytes that enter the myocardium in the inflammatory phase upregulate the orphan nuclear receptor Nr4a1 and switch phenotype to Ly6CloNr4a1hi reparatory macrophages. Additionally, neutrophils have been shown to promote cardiac recovery by upregulating expression of the efferocytosis receptor MerTK on reparatory macrophages. A finely tuned balance between the inflammatory and the reparatory phases is thus essential for limiting myocardial damage and promoting efficient recovery. Treatment strategies targeting only the inflammatory phase have so far failed to improve prognosis in AMI patients. A detailed understanding of the interplay between the two phases of the innate immune response is paramount for designing efficient therapies able to improve post- AMI prognosis. In the current review, we summarize the state-of-the-art of the field and discuss previous therapeutic attempts and currently ongoing clinical trials targeting innate immune mechanisms in AMI patients.
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Affiliation(s)
- Razvan Gheorghita Mares
- University of Medicine and Pharmacy Targu Mures, 38 Gheorghe Marinescu Street, 540139, Targu Mures , Romania
| | - Goran Marinkovic
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund , Sweden
| | | | - Alexandru Schiopu
- University of Medicine and Pharmacy Targu Mures , Romania
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences Malmö , Lund University, Sweden
- Department of Cardiology, Skane University Hospital Malmö, Malmö , Sweden
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Engelbertsen D, Rattik S, Wigren M, Vallejo J, Marinkovic G, Schiopu A, Björkbacka H, Nilsson J, Bengtsson E. IL-1R and MyD88 signalling in CD4+ T cells promote Th17 immunity and atherosclerosis. Cardiovasc Res 2017; 114:180-187. [DOI: 10.1093/cvr/cvx196] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The role of CD4+ T cells in atherosclerosis has been shown to be dependent on cytokine cues that regulate lineage commitment into mature T helper sub-sets. In this study, we tested the roles of IL-1R1 and MyD88 signalling in CD4+ T cells in atherosclerosis.
Methods and results
We transferred apoe-/-myd88+/+ or apoe-/-myd88-/- CD4+ T cells to T- and B-cell-deficient rag1-/-apoe-/- mice fed high fat diet. Mice given apoe-/-myd88-/- CD4+ T cells exhibited reduced atherosclerosis compared with mice given apoe-/-myd88+/+ CD4+ T cells. CD4+ T cells from apoe-/-myd88-/- produced less IL-17 but similar levels of IFN-γ. Treatment of human CD4+ T cells with a MyD88 inhibitor inhibited IL-17 secretion in vitro. Transfer of il1r1-/- CD4+ T cells recapitulated the phenotype seen by transfer of myd88-/- CD4+ T cells with reduced lesion development and a reduction in Th17 and IL-17 production compared with wild type CD4+ T cell recipients. Relative collagen content of lesions was reduced in mice receiving il1r1-/- CD4+ T cells.
Conclusion
We demonstrate that both IL1R and MyD88 signalling in CD4+ T cells promote Th17 immunity, plaque growth and may regulate plaque collagen levels.
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Affiliation(s)
- Daniel Engelbertsen
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, USA
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sara Rattik
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- Center for Systems Biology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Maria Wigren
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jenifer Vallejo
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Goran Marinkovic
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Alexandru Schiopu
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Harry Björkbacka
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Eva Bengtsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Schiopu A, Marinkovic G, De Camp L, Winkler L, Mares R, Cotoi O, Nilsson J, Jovinge S. P4026Short-term blockade of the S100A8/A9 alarmin in the immediate post-myocardial infarction period inhibits acute myocardial inflammation and preserves myocardial repair. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ogmundsdottir Michelsen H, Hagstrom E, Sjolin I, Schlyter M, Kiessling A, Held C, Hag E, Nilsson L, Schiopu A, Zaman M, Leosdottir M. P4912Swedish cardiac rehabilitation programmes; a descriptive nationwide analysis - the perfect CR study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marinkovic G, Winkler L, Kefene L, Nilsson J, Jovinge S, Schiopu A. The alarmin complex S100A8/9 as a potential therapeutic target after myocardial infarction. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Grauen Larsen H, Schiopu A, Jonasson L. P1775Stress-induced release of the pro-inflammatory alarmin S100A8/A9 in patients with coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schlyter M, Ogmundsottir Michelsen H, Sjolin I, Hag E, Hagstrom E, Nilsson L, Kiessling A, Held C, Schiopu A, Zaman M, Leosdottir M. P2499Myocardial infarction patients more often reach treatment goals for low-density lipoprotein at centres where cardiac rehabilitation nurses adjust statins - the Perfect-CR study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ogmundsdottir Michelsen H, Hagstrom E, Sjolin I, Schlyter M, Kiessling A, Held C, Hag E, Nilsson L, Schiopu A, Zaman M, Leosdottir M. P3429Correlations between components of cardiac rehabilitation and attaining risk factor goals after myocardial infarction - the Perfect-CR study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mokhtari A, Lindahl B, Schiopu A, Yndigegn T, Khoshnood A, Gilje P, Ekelund U. A 0-Hour/1-Hour Protocol for Safe, Early Discharge of Chest Pain Patients. Acad Emerg Med 2017; 24:983-992. [PMID: 28500753 DOI: 10.1111/acem.13224] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Guidelines recommend a 0-hour/1-hour high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There are, however, little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0-hour/1-hour hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and electrocardiogram (ECG) for ruling out major adverse cardiac events (MACE) within 30 days. METHODS This prospective observational study enrolled consecutive emergency department (ED) chest pain patients. TIMI score variables, ED physicians' assessments of the ECG, and 0- and 1-hour hs-cTnT were collected. Thirty-day MACE was defined as acute myocardial infarction (AMI), unstable angina (UA), cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause. RESULTS A total of 1,020 patients were included in the final analysis. The combination of an adapted TIMI score ≤1, a nonischemic ECG, and either a 0-hour hs-cTnT < 5 ng/L or a 0-hour hs-cTnT < 12 ng/L combined with a 1-hour increase < 3 ng/L identified 432 (42.4%) patients as very low risk with a negative predictive value of 99.5% (95% confidence interval [CI] = 98.3%-99.9%) and a negative likelihood ratio of 0.04 (95% CI = 0.01-0.14) for 30-day MACE. The ADP missed only two patients with UA and no patients with AMI or other forms of MACE. CONCLUSION An ADP using the guideline recommended 0-hour/1-hour hs-cTnT strategy rapidly identified patients with a very low risk of 30-day MACE including UA where no further cardiac testing would be needed. This could potentially allow safe early discharge of about 40% of ED chest pain patients.
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Affiliation(s)
- Arash Mokhtari
- Department of Internal and Emergency Medicine; Skåne University Hospital; Lund
- Department of Cardiology; Lund University; Skåne University Hospital; Lund
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center; Uppsala University; Uppsala Sweden
| | - Alexandru Schiopu
- Department of Cardiology; Lund University; Skåne University Hospital; Lund
| | - Troels Yndigegn
- Department of Cardiology; Lund University; Skåne University Hospital; Lund
| | - Ardavan Khoshnood
- Department of Internal and Emergency Medicine; Skåne University Hospital; Lund
| | - Patrik Gilje
- Department of Cardiology; Lund University; Skåne University Hospital; Lund
| | - Ulf Ekelund
- Department of Internal and Emergency Medicine; Skåne University Hospital; Lund
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