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Bittner D, Roesner C, Goeller M, Raaz-Schrauder D, Dey D, Kilian T, Achenbach S, Marwan M. Influence of gender on coronary atherosclerosis and inflammatory biomarker profile: a CT angiographic study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.210] [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 and aims
The burden of coronary atherosclerosis differs between men and women. Beyond traditional cardiovascular risk factors, inflammatory biomarkers can influence plaque formation and progression. We analyzed the influence of gender difference on coronary atherosclerosis and inflammatory cytokines.
Methods
Coronary CT-Angiography was performed in 301 patients and plaque morphology was quantitatively and qualitatively assessed using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). We analyzed total (TPV), non-calcified (NCPV), calcified (CPV) and low-density plaque volume in mm3 (LDPV, defined as plaque attenuation <30HU). Serum was analyzed for various cytokines including Interleukin (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IFNg, CRP, MCP-1, MIP-1a, Eotaxin, G_CSF and GM-CSF using Luminex assay.
Results
Out of 301 patients, 94 (31%) were female and 207 (69%) were male. As compared to women, men were significantly younger (62 vs. 57 years, p<0.001) and showed a higher BMI (28 vs. 26 kg/m2, p=0.005). No differences were seen for hypertension, hyperlipidemia, diabetes, smoking habits and family history of CAD. All plaque characteristics showed significant higher values in men as compared to women (all p<0.05). In men, cytokine profile showed significantly lower serum levels for IL-2 (3.20 [3.20; 7.01] vs. 4.31 [3.20; 9.68]; p=0.01) and Interferon-gamma (3.20 [3.20; 14.72] vs. 8.76 [3.20; 26.26]; p<0.001) and significantly higher levels for MCP-1 (224 [117; 327] vs. 155 [49; 260]; p<0.001). In multivariable logistic regression analysis, Interferon-gamma showed significant inverse association to male gender (OR 0.35; 95% CI: 0.17–0.72; p=0.004), but IL-2 and MCP-1 did not. The association of Interferon-gamma to gender was independent of age (OR 0.57; 95% CI: 0.43–0.76; p<0.001) and BMI (OR 2.12; 95% CI 1.25–3.62; p=0.006)
Conclusion
Coronary plaque volume and morphology significantly differs between men and women and so does the inflammatory cytokine profile. Albeit significantly lower coronary plaque burden in women, serum levels of interferon-gamma - a known pro-inflammatory cytokine - was significantly higher in women with independent association to gender. Whether interferon-gamma plays contradicting roles in the process of coronary atherosclerosis in men and women needs to be explored in future studies to identify potential gender-specific targets for therapeutic interventions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Bittner
- University of Erlangen-Nuremberg, Department of Cardiology , Erlangen , Germany
| | - C Roesner
- University of Erlangen-Nuremberg, Department of Cardiology , Erlangen , Germany
| | - M Goeller
- University of Erlangen-Nuremberg, Department of Cardiology , Erlangen , Germany
| | - D Raaz-Schrauder
- University of Erlangen-Nuremberg, Department of Cardiology , Erlangen , Germany
| | - D Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute , Los Angeles , United States of America
| | - T Kilian
- University of Erlangen-Nuremberg, Department of Cardiology , Erlangen , Germany
| | - S Achenbach
- University of Erlangen-Nuremberg, Department of Cardiology , Erlangen , Germany
| | - M Marwan
- University of Erlangen-Nuremberg, Department of Cardiology , Erlangen , Germany
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Roesner C, Goeller M, Raaz-Schrauder D, Dey D, Kilian T, Achenbach S, Marwan M, Bittner DO. Differences of inflammatory cytokine profile in patients with vulnerable plaque: A coronary CTA study. Atherosclerosis 2022; 350:25-32. [DOI: 10.1016/j.atherosclerosis.2022.04.011] [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] [Received: 08/19/2021] [Revised: 03/24/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
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Bittner D, Roesner C, Kilian T, Goeller M, Dey D, Raaz-Schrauder D, Achenbach S, Marwan M. Independent predictors of major cardiovascular events as quantitatively assessed by coronary CT-angiography: a long-term follow-up analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0160] [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
Introduction
Quantitative CT coronary angiography using semi-automated software provides detailed information about plaque volume and high-risk plaque characteristics, beyond traditional measures like diameter stenosis. We assessed the potential value of plaque quantity and morphology to independently predict MACE in a cohort with long-term follow up.
Methods
In this secondary analysis of 301 symptomatic patients undergoing coronary CTA at baseline, total plaque volume (TPV), non-calcified- (NCPV), calcified- (CPV) and vulnerable coronary plaque volume (in mm3), diameter stenosis (in %) and remodeling index were quantified using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). Patients were followed for major cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction and coronary revascularization. Optimal thresholds for each quantitative CTA measure were computed using CART-algorithm (Classification and Regression Trees).
Results
Complete follow-up was available for 234 (78%) patients. The mean age was 59±10 years. Over a median follow-up of 10.7 years, the composite outcome occurred in 34 (15%) patients (5 patients with cardiovascular death, 6 with myocardial infarction, 26 with revascularization). Patients experiencing MACE had more frequently hypertension (p=0.03) and a higher Framingham risk score (p=0.002). Survival anaylsis using cox proportional hazard ratios showed significant univariate associations between MACE and TPV (HR 5.16; 95% CI 1.58–16.89; p=0.007), NCPV (HR 4.83; 95% CI 1.45–15.81; p=0.009), CPV (HR 2.86; 95% CI 1.39–5.86; p=0.004), vulnerable plaque volume (HR 3.35; 95% CI 1.52–7.41; p=0.003), diameter stenosis (HR 5.19; 95% CI 2.64–10.22; p<0.001) and remodeling index (HR 4.24; 95% CI 2.03–8.86; p<0.001). In multivariable cox regression analysis diameter stenosis (HR 3.70; 95% CI 1.72–7.93; p=0.001) and remodeling index (HR 2.69; 95% CI 1.19–6.09; p=0.018) remained significant independent predictors of MACE, adjusted for Framingham risk score (HR 2.56; 95% CI 1.26–5.22; p=0.010), however plaque volume and plaque subcomponents did not.
Conclusion
On long term follow-up, remodeling index and coronary diameter stenosis obtained by quantitative coronary CT angiography independently predicted MACE on multivariable assessment. More comprehensive plaque assessment algorithms including plaque volume as well as plaque subcomponents were significantly associated with MACE in univariate, but not multivariate analysis after adjustment for diameter stenosis and remodeling index.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Bittner
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
| | - C Roesner
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
| | - T Kilian
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
| | - M Goeller
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
| | - D Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, United States of America
| | - D Raaz-Schrauder
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
| | - S Achenbach
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
| | - M Marwan
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
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Roesner C, Göller M, Dey D, Raaz-Schrauder D, Achenbach S, Marwan M, Bittner D. Monocyte Chemoattractant Protein-1, Interleukin-1a And Interleukin-17 And Their Conflicting Association With Vulnerable Plaque:a Coronary Cta Study. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.265] [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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5
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Goeller M, Achenbach S, Herrmann N, Bittner D, Ammon F, Kilian T, Smolka S, Uehlein S, Moshage M, Raaz-Schrauder D, Dey D, Marwan M. The association of pericoronary adipose tissue attenuation with major adverse cardiac events (MACE) and atherosclerosis-relevant inflammatory mediators. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0152] [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
Increased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) is a new imaging biomarker to detect coronary inflammation derived from routine coronary CT angiography (CTA).
Purpose
We aimed to investigate a potential association between RCA PCAT attenuation and i) serum levels of atherosclerosis-relevant cytokines, ii) different grades of coronary calcification iii) future coronary revascularization within the same coronary artery and iV) MACE (defined by revascularization, myocardial infarction (MI) and/or cardiac death).
Methods
In 293 stable individuals (59.0±9.8 years, 69% males) with intermediate likelihood for coronary artery disease (CAD) blood was drawn and subsequently analyzed for different atherosclerosis-relevant cytokines interleukin (IL)-2, IL- 4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IP-10, CRP, MCP-1, MIP-1a, Eotaxin and GM-CSF, followed by coronary calcium scoring (CCS) in non-contrast CT followed by CTA. PCAT CT attenuation (HU) was measured around the RCA (10 to 50 mm from RCA ostium) and the proximal 40 mm of the left anterior descending artery (LAD) and the circumflex artery (LCX) using semi-automated software. Increased RCA PCAT attenuation was defined as PCAT attenuation above the highest quartile (>−73.5 HU). A long-term follow-up over 9.6 years was performed.
Results
PCAT attenuation was similar in different grades of coronary calcification (CAC=0,-80.3 HU; CAC 1–99, −79.2 HU; CAC 100–400, −79.5 HU; CAC >400, −81.0 HU; p>0.05). Adipocytokine MCP-1 (r=0.23, p<0.01) and pro-inflammatory mediator IL-7 (r=0.12, p=0.04) correlated positively with RCA PCAT attenuation, whereas anti-inflammatory mediators Il-4, -10 and -13 correlated inversely (each r<−0.12, each p<0.05). In patients with increased RCA PCAT attenuation the serum levels of MCP-1 were increased (2.37 vs. 2.20, p<0.01), whereas anti-inflammatory mediators IL-4 and -13 were reduced (each p<0.05). 40 patients experienced MACE during follow-up. In multivariable Cox regression analysis, when adjusted by age, gender, baseline medications, obstructive coronary stenosis and CCS, the highest quartiles of PCAT attenuation are an independent predictor of MACE (HR 7.9, p=0.035). In patients with percutaneous coronary intervention (PCI) of the RCA during follow-up, RCA PCAT attenuation was increased at baseline CTA (−73.1 vs −80.2 HU, p=0.008). In patients with PCI of the LAD or LCX during follow-up, PCAT attenuation of LAD and LCX were not increased at baseline CTA (p>0.05).
Conclusions
The information captured by PCAT attenuation is independent of coronary calcification and showed a trend towards a weak association with serum levels of atherosclerosis-relevant inflammatory biomarkers. Increased RCA PCAT attenuation is an independent predictor of MACE and could guide future prevention strategies in stable patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Goeller
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - S Achenbach
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - N Herrmann
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - D Bittner
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - F Ammon
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - T Kilian
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - S Smolka
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - S Uehlein
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - M Moshage
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - D Raaz-Schrauder
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - D Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, United States of America
| | - M Marwan
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
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Göller M, Achenbach S, Herrmann N, Bittner DO, Ammon F, Kilian T, Smolka S, Podzus J, Troebs M, Raaz-Schrauder D, Dey D, Marwan M. Pericoronary Adipose Tissue CT Attenuation And Its Association With Coronary Calcification And Serum Levels Of Pro- And Anti-inflammatory Mediators. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2019.12.022] [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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Schacher NM, Raaz-Schrauder D, Pasutto F, Stumpfe FM, Tauchi M, Dietel B, Achenbach S, Urschel K. Impact of single nucleotide polymorphisms in the VEGFR2 gene on endothelial cell activation under non‑uniform shear stress. Int J Mol Med 2019; 44:1366-1376. [PMID: 31432097 PMCID: PMC6713417 DOI: 10.3892/ijmm.2019.4301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) in vascular endothelial growth factor receptor 2 (VEGFR2) are associated with coronary artery disease, hypertension and myocardial infarction. However, their association with atherosclerosis remains to be fully elucidated. The purpose of the present study was to determine whether SNPs are involved in atherogenesis, by analyzing their impact on human umbilical vein endothelial cells (HUVECs) under laminar and non‑uniform shear stress in a well‑established in vitro model that simulates shear stress‑induced proatherogenic processes at vessel bifurcations. All experiments were performed using freshly isolated HUVECs. Three SNPs in the VEGFR2 gene (rs1870377 T>A, rs2071559 A>G and rs2305948 C>T) were genotyped and the expression levels of VEGFR2 were semi‑quantitatively determined using western blotting. Subsequently, the HUVECs were seeded in bifurcating flow‑through cell culture slides and flow (9.6 ml/min) was applied for 19 h, including tumor necrosis factor‑α stimulation during the final 2 h of flow. The protein expression levels of VCAM‑1, E‑selectin and VEGFR2 and the adhesion of THP‑1 cells were analyzed in laminar and non‑uniform shear stress regions. Data were analyzed for associations with the respective SNPs. The total expression of VEGFR2 was significantly lower under non‑uniform shear stress than under laminar shear stress conditions, independent of the genotype. The expression of VEGFR2 between the different shear stress patterns was not significantly altered by the different SNPs. The expression levels of VCAM‑1 and E‑selectin were lower in the A/A genotype compared with those in other genotypes in rs1870377 T>A and rs2071559 A>G. In conclusion, the results suggested that SNPs within the VEGFR2 gene have a significant impact on shear stress‑related endothelial activation.
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Affiliation(s)
- Nora M Schacher
- Department of Medicine 2‑Cardiology and Angiology, Erlangen University Hospital, Friedrich‑Alexander University Erlangen‑Nürnberg, D‑91054 Erlangen, Germany
| | - Dorette Raaz-Schrauder
- Department of Medicine 2‑Cardiology and Angiology, Erlangen University Hospital, Friedrich‑Alexander University Erlangen‑Nürnberg, D‑91054 Erlangen, Germany
| | - Francesca Pasutto
- Institute of Human Genetics, Friedrich‑Alexander University Erlangen‑Nürnberg, D‑91051 Erlangen, Germany
| | - Florian M Stumpfe
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen‑EMN, Friedrich‑Alexander University Erlangen‑Nürnberg, D‑91054 Erlangen, Germany
| | - Miyuki Tauchi
- Department of Medicine 2‑Cardiology and Angiology, Erlangen University Hospital, Friedrich‑Alexander University Erlangen‑Nürnberg, D‑91054 Erlangen, Germany
| | - Barbara Dietel
- Department of Medicine 2‑Cardiology and Angiology, Erlangen University Hospital, Friedrich‑Alexander University Erlangen‑Nürnberg, D‑91054 Erlangen, Germany
| | - Stephan Achenbach
- Department of Medicine 2‑Cardiology and Angiology, Erlangen University Hospital, Friedrich‑Alexander University Erlangen‑Nürnberg, D‑91054 Erlangen, Germany
| | - Katharina Urschel
- Department of Medicine 2‑Cardiology and Angiology, Erlangen University Hospital, Friedrich‑Alexander University Erlangen‑Nürnberg, D‑91054 Erlangen, Germany
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Hug K, Tauchi M, Raaz-Schrauder D, Stumpfe F, Achenbach S, Dietel-Schor B, Urschel K. Shear Stress-Dependent Expression Of Glypican-4 And Heparan Sulfate In Different Primary Human Endothelial Cells. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.821] [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: 10/26/2022]
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Kuehn C, Tauchi M, Furtmair R, Urschel K, Raaz-Schrauder D, Neumann AL, Frohberger SJ, Hoerauf A, Regus S, Lang W, Sagban TA, Stumpfe FM, Achenbach S, Hübner MP, Dietel B. Filarial extract of Litomosoides sigmodontis induces a type 2 immune response and attenuates plaque development in hyperlipidemic ApoE-knockout mice. FASEB J 2019; 33:6497-6513. [PMID: 30807258 DOI: 10.1096/fj.201800947rr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A type 1 immune response is involved in atherosclerosis progression, whereas the role of a type 2 polarization, especially with regard to an enhanced T helper (Th)2 cell differentiation, is still unclear. Helminths trigger type 2 immune responses, protecting the host from inflammatory disorders. We investigated whether an increased type 2 polarization by administration of Litomosoides sigmodontis adult worm extract (LsAg) affects atherosclerosis in apolipoprotein E-deficient (ApoE-/-) mice. Injections of 50 µg LsAg, i.p. into ApoE-/- mice induced a type 2 immune response shown by increased frequencies of peritoneal eosinophils and alternatively activated macrophages. To analyze the effect of LsAg on atherosclerosis initiation, ApoE-/- mice received a high-fat diet for 12 wk and weekly injections of 50 µg LsAg from wk 5 to 12. Therapeutic effects on advanced atherosclerosis were analyzed in mice that were fed a high-fat diet for 12 wk followed by 12 wk of normal chow and weekly LsAg injections. Both preventive and therapeutic LsAg application significantly decreased plaque size. Therapeutic treatment even caused regression of plaque size and macrophage density in the aortic root and reduced Th1-specific gene expression and intraplaque inflammation. In addition, plaque size after therapeutic treatment was inversely correlated with plaque-infiltrated alternatively activated macrophages. In vitro, LsAg treatment of HUVECs reduced intracellular levels of phosphorylated NF-κB-p65, IκB-α, and JNK1/2. In bifurcation flow-through slides, THP-1 cell adhesion to a HUVEC monolayer was decreased by LsAg in regions of nonuniform shear stress. Applying inhibitors of the respective kinases suggests JNK1/2 inhibition is involved in the suppressed cell adhesion. A switch to an enhanced type 2 immune response by LsAg exerts antiatherogenic effects on murine plaque development, indicating a protective role of a hampered type 1 polarization. In vitro, LsAg affects endothelial signaling pathways, among which JNK1/2 inhibition seems to be involved in the suppression of monocytic cell adhesion under proatherogenic shear stress.-Constanze, K., Tauchi, M., Furtmair, R., Urschel, K., Raaz-Schrauder, D., Neumann, A.-L., Frohberger, S. J., Hoerauf, A., Regus, S., Lang, W., Sagban, T. A., Stumpfe, F. M., Achenbach, S., Hübner, M. P., Dietel, B. Filarial extract of Litomosoides sigmodontis induces a type 2 immune response and attenuates plaque development in hyperlipidemic ApoE-knockout mice.
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Affiliation(s)
- Constanze Kuehn
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander-University (FAU) Erlangen-Nuernberg, Erlangen, Germany
| | - Miyuki Tauchi
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander-University (FAU) Erlangen-Nuernberg, Erlangen, Germany
| | - Roman Furtmair
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander-University (FAU) Erlangen-Nuernberg, Erlangen, Germany
| | - Katharina Urschel
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander-University (FAU) Erlangen-Nuernberg, Erlangen, Germany
| | - Dorette Raaz-Schrauder
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander-University (FAU) Erlangen-Nuernberg, Erlangen, Germany
| | - Anna-Lena Neumann
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Stefan J Frohberger
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
| | - Susanne Regus
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Tolga Atilla Sagban
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Sana-Klinikum Hameln-Pyrmont, Hameln, Germany
| | | | - Stephan Achenbach
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander-University (FAU) Erlangen-Nuernberg, Erlangen, Germany
| | - Marc P Hübner
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Barbara Dietel
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander-University (FAU) Erlangen-Nuernberg, Erlangen, Germany
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Urschel K, Hug K, Raaz-Schrauder D, Stumpfe FM, Tauchi M, Achenbach S, Dietel-Schor B. P3775Shear stress dependent expression of glypican-4 and heparan sulfate in human endothelial cells. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3775] [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: 11/14/2022] Open
Affiliation(s)
- K Urschel
- University of Erlangen-Nuremberg, Cardiology and Angiology, Erlangen, Germany
| | - K Hug
- University of Erlangen-Nuremberg, Cardiology and Angiology, Erlangen, Germany
| | - D Raaz-Schrauder
- University of Erlangen-Nuremberg, Cardiology and Angiology, Erlangen, Germany
| | - F M Stumpfe
- University of Erlangen-Nuremberg, Obstetrics and Gynecology, Erlangen, Germany
| | - M Tauchi
- University of Erlangen-Nuremberg, Cardiology and Angiology, Erlangen, Germany
| | - S Achenbach
- University of Erlangen-Nuremberg, Cardiology and Angiology, Erlangen, Germany
| | - B Dietel-Schor
- University of Erlangen-Nuremberg, Cardiology and Angiology, Erlangen, Germany
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Uderhardt S, Ackermann JA, Fillep T, Hammond VJ, Willeit J, Santer P, Mayr M, Biburger M, Miller M, Zellner KR, Stark K, Zarbock A, Rossaint J, Schubert I, Mielenz D, Dietel B, Raaz-Schrauder D, Ay C, Gremmel T, Thaler J, Heim C, Herrmann M, Collins PW, Schabbauer G, Mackman N, Voehringer D, Nadler JL, Lee JJ, Massberg S, Rauh M, Kiechl S, Schett G, O'Donnell VB, Krönke G. Correction: Enzymatic lipid oxidation by eosinophils propagates coagulation, hemostasis, and thrombotic disease. J Exp Med 2018; 215:1003. [PMID: 29463570 PMCID: PMC5839750 DOI: 10.1084/jem.2016107002142018c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hell M, Achenbach S, Yoo I, Franke J, Blachutzik F, Roether J, Graf V, Raaz-Schrauder D, Marwan M, Schlundt C. 3D printing for sizing left atrial appendage closure device: head-to-head comparison with computed tomography and transoesophageal echocardiography. EUROINTERVENTION 2017; 13:1234-1241. [DOI: 10.4244/eij-d-17-00359] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Raaz-Schrauder D, Klinghammer L, Lichtenstern D, Schlundt C, Achenbach S. P701Association of CRP receptor polymorphisms with culprit lesion morphology in patients with acute myocardial infarction as first manifestation of coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p701] [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: 11/13/2022] Open
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14
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Raaz-Schrauder D, Schrauder MG, Stumpf C, Lewczuk P, Kilian T, Dietel B, Garlichs CD, Schlundt C, Achenbach S, Klinghammer L. Plasma levels of sRANKL and OPG are associated with atherogenic cytokines in patients with intermediate cardiovascular risk. Heart Vessels 2017; 32:1304-1313. [PMID: 28567553 DOI: 10.1007/s00380-017-0998-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/21/2016] [Accepted: 05/26/2017] [Indexed: 12/29/2022]
Abstract
Osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) are regulators of bone remodeling, but are also considered to play important roles in coronary artery disease (CAD). This study evaluated potential associations of soluble (s) RANKL and OPG with atherosclerosis-relevant cytokines. Blood was collected from 414 individuals who presented to our hospital with intermediate likelihood for CAD for further examination. Plasma concentrations of total sRANKL, OPG, and 20 cytokines were measured using sandwich-type enzyme-linked immunoassays (ELISAs; OPG and sRANKL) and Luminex laser-based fluorescence analysis and correlated with each other. The plasma levels of interferon-γ (IFN-γ) and the T-helper cell 2 cytokines interleukin-4 (IL-4) and IL-13 showed a positive correlation with sRANKL. The association with sRANKL levels was negative for IFN-γ-induced protein-10 (IP-10) and monocyte chemotactic protein-1 (MCP-1). The strongest independent association with sRANKL in multivariable analyses was found for IFN-γ (positive) and IP-10 (negative), while IL-13 showed a positive and independent association with OPG plasma levels. OPG and sRANKL plasma levels correlate strongly and independently with specific circulating atherosclerosis-related cytokines in patients with intermediate cardiovascular risk.
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Affiliation(s)
- Dorette Raaz-Schrauder
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology and Angiology, Erlangen University Hospital, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Michael G Schrauder
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christian Stumpf
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology and Angiology, Erlangen University Hospital, Ulmenweg 18, 91054, Erlangen, Germany
| | - Piotr Lewczuk
- Friedrich-Alexander University Erlangen-Nürnberg(FAU), Department of Psychiatry and Psychotherapy, Erlangen, University Hospital, Erlangen, Germany.,Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland.,Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland
| | - Tobias Kilian
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology and Angiology, Erlangen University Hospital, Ulmenweg 18, 91054, Erlangen, Germany
| | - Barbara Dietel
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology and Angiology, Erlangen University Hospital, Ulmenweg 18, 91054, Erlangen, Germany
| | | | - Christian Schlundt
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology and Angiology, Erlangen University Hospital, Ulmenweg 18, 91054, Erlangen, Germany
| | - Stephan Achenbach
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology and Angiology, Erlangen University Hospital, Ulmenweg 18, 91054, Erlangen, Germany
| | - Lutz Klinghammer
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology and Angiology, Erlangen University Hospital, Ulmenweg 18, 91054, Erlangen, Germany
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15
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Uderhardt S, Ackermann JA, Fillep T, Hammond VJ, Willeit J, Santer P, Mayr M, Biburger M, Miller M, Zellner KR, Stark K, Zarbock A, Rossaint J, Schubert I, Mielenz D, Dietel B, Raaz-Schrauder D, Ay C, Gremmel T, Thaler J, Heim C, Herrmann M, Collins PW, Schabbauer G, Mackman N, Voehringer D, Nadler JL, Lee JJ, Massberg S, Rauh M, Kiechl S, Schett G, O'Donnell VB, Krönke G. Enzymatic lipid oxidation by eosinophils propagates coagulation, hemostasis, and thrombotic disease. J Exp Med 2017; 214:2121-2138. [PMID: 28566277 PMCID: PMC5502424 DOI: 10.1084/jem.20161070] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 02/12/2017] [Accepted: 04/19/2017] [Indexed: 01/20/2023] Open
Abstract
Blood coagulation is essential for physiological hemostasis but simultaneously contributes to thrombotic disease. However, molecular and cellular events controlling initiation and propagation of coagulation are still incompletely understood. In this study, we demonstrate an unexpected role of eosinophils during plasmatic coagulation, hemostasis, and thrombosis. Using a large-scale epidemiological approach, we identified eosinophil cationic protein as an independent and predictive risk factor for thrombotic events in humans. Concurrent experiments showed that eosinophils contributed to intravascular thrombosis by exhibiting a strong endogenous thrombin-generation capacity that relied on the enzymatic generation and active provision of a procoagulant phospholipid surface enriched in 12/15-lipoxygenase-derived hydroxyeicosatetraenoic acid-phosphatidylethanolamines. Our findings reveal a previously unrecognized role of eosinophils and enzymatic lipid oxidation as regulatory elements that facilitate both hemostasis and thrombosis in response to vascular injury, thus identifying promising new targets for the treatment of thrombotic disease.
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Affiliation(s)
- Stefan Uderhardt
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jochen A Ackermann
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tobias Fillep
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Victoria J Hammond
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, Wales, UK.,Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Manuel Mayr
- King's British Heart Foundation Centre, Kings College, London, England, UK
| | - Markus Biburger
- Department of Biology, Institute of Genetics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Meike Miller
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany
| | - Katie R Zellner
- Department of Biochemistry and Molecular Biology, Division of Pulmonary Medicine, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Konstantin Stark
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Jan Rossaint
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Irene Schubert
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany
| | - Dirk Mielenz
- Department of Internal Medicine 3, Division of Molecular Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Barbara Dietel
- Department of Cardiology and Angiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Dorette Raaz-Schrauder
- Department of Cardiology and Angiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Johannes Thaler
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Christian Heim
- Department of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Herrmann
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter W Collins
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, Wales, UK.,Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Gernot Schabbauer
- Institute for Physiology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Nigel Mackman
- Department Medicine, University of North Carolina, Chapel Hill, NC
| | - David Voehringer
- Department of Infection Biology, Institute for Clinical Microbiology, Immunology, and Hygiene, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jerry L Nadler
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA
| | - James J Lee
- Department of Biochemistry and Molecular Biology, Division of Pulmonary Medicine, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany
| | - Manfred Rauh
- Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Valerie B O'Donnell
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, Wales, UK.,Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Gerhard Krönke
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany .,Nikolaus Fiebiger Center of Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
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16
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Macha K, Kloska S, Dörfler A, Raaz-Schrauder D, Schwab S, Köhrmann M, Seifert F. [Cerebrovascular complications of immunologically mediated heparin-induced thrombocytopenia]. Fortschr Neurol Psychiatr 2014; 82:149-154. [PMID: 24615586 DOI: 10.1055/s-0034-1365923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Immunologically mediated heparin-induced thrombocytopenia (HIT) is a thrombotic disease caused by antibodies occurring after heparin exposure. Thrombocytopenia occurs within a few days after heparin exposure, about half of HIT-patients develop venous or arterial thrombotic complications. Neurological complications of HIT are mainly ischaemic stroke and sinus vein thrombosis. To ensure the primary clinical diagnosis functional and immunological assays for antibody detection are available. The probability for the occurrence of HIT depends on the nature of heparin employed (LMWH vs. UFH) and individual patient characteristics such as gender and primary disease (medical vs. surgical patients). In the case of suspected HIT heparin administration should be discontinued immediately and replaced by an alternative anticoagulation to prevent the expansion or development of further thrombotic complications. Herein we report a case of a patient suffering from HIT-associated embolic cerebral ischaemic stroke.
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Affiliation(s)
- K Macha
- Neurologische Klinik, Universitätsklinikum Erlangen
| | - S Kloska
- Neuroradiologische Abteilung, Universitätsklinikum Erlangen
| | - A Dörfler
- Neuroradiologische Abteilung, Universitätsklinikum Erlangen
| | - D Raaz-Schrauder
- Medizinische Klinik 2, Kardiologie und Angiologie, Universitätsklinikum Erlangen
| | - S Schwab
- Neurologische Klinik, Universitätsklinikum Erlangen
| | - M Köhrmann
- Neurologische Klinik, Universitätsklinikum Erlangen
| | - F Seifert
- Neurologische Klinik, Universitätsklinikum Erlangen
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17
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Raaz-Schrauder D, Ekici AB, Klinghammer L, Stumpf C, Achenbach S, Herrmann M, Reis A, Garlichs CD. The proinflammatory effect of C-reactive protein on human endothelial cells depends on the FcγRIIa genotype. Thromb Res 2013; 133:426-32. [PMID: 24440139 DOI: 10.1016/j.thromres.2013.12.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 08/08/2013] [Revised: 12/18/2013] [Accepted: 12/20/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The stimulatory effects of CRP (C-reactive protein) on endothelial cells are mainly mediated via FcγRIIa. This receptor exists in two different allotypes bearing either arginine (R131) or histidine (H131) at the extracellular amino acid position 131 of the mature protein, but only FcγRIIa-R131 displays high avidity for CRP. This study investigated the role of the FcγRIIa genotype in CRP-stimulated endothelial cells. MATERIALS AND METHODS We tested the effects of CRP on expression of the adhesion molecules ICAM-1, VCAM-1, and E-selectin, as well as the endothelial release of pro-inflammatory molecules as a function of the FcγRIIa-genotype (FcγRIIa-H/H131, FcγRIIa-H/R131, FcγRIIa-R/R131) in HUVEC (Human Umbilical Vein Endothelial Cells). HUVEC were grouped according to their FcγRIIa status by genotyping with an allele specific nested-PCR. The expression of ICAM-1, VCAM-1, and E-selectin on HUVEC was detected by flow cytometry. The release of soluble markers (sCD40L, IL-6, IL-8, MCP-1, tPA, sP-selectin, and sVCAM-1) was measured using a multiplex assay for flow cytometry. RESULTS AND CONCLUSIONS CRP-stimulated expression of ICAM-1 and E-selectin was dependent on the specific FcγRIIa-genotype, with most pronounced induction in HUVEC with the FcγRIIa-R/R genotype, followed by H/R and H/H. In accordance with this finding, the supernatants of stimulated HUVEC with the R/R genotype showed significantly higher levels of tPA, MCP-1, and IL-6. Our data show that CRP stimulates the expression of adhesion molecules and the release of soluble markers by HUVEC as a function of the FcγRIIa-genotype. These findings could be relevant in the context of risk stratification in patients with cardiovascular disease.
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Affiliation(s)
- Dorette Raaz-Schrauder
- Department of Cardiology and Angiology, University Hospital Erlangen, Erlangen, Germany.
| | - Arif B Ekici
- Institute of Human Genetics, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lutz Klinghammer
- Department of Cardiology and Angiology, University Hospital Erlangen, Erlangen, Germany
| | - Christian Stumpf
- Department of Cardiology and Angiology, University Hospital Erlangen, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology and Angiology, University Hospital Erlangen, Erlangen, Germany
| | - Martin Herrmann
- Department of Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
| | - André Reis
- Institute of Human Genetics, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christoph D Garlichs
- Department of Cardiology and Angiology, University Hospital Erlangen, Erlangen, Germany
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18
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Klinghammer L, Urschel K, Cicha I, Lewczuk P, Raaz-Schrauder D, Achenbach S, Garlichs CD. Impact of telmisartan on the inflammatory state in patients with coronary atherosclerosis – Influence on IP-10, TNF-α and MCP-1. Cytokine 2013; 62:290-6. [DOI: 10.1016/j.cyto.2013.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/20/2012] [Accepted: 02/01/2013] [Indexed: 01/06/2023]
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Abstract
Background and Purpose—
Patients with acute cerebrovascular events are susceptible to serious cardiac arrhythmias, but data on the time course and the determinants of their onset are scarce.
Methods—
The prospective Stroke-Arrhythmia-Monitoring-Database (SAMBA) assessed cardiac arrhythmias with need for urgent evaluation and treatment in 501 acute neurovascular patients during the first 72 hours after admission to a monitored stroke unit. Arrhythmias were systematically detected by structured processing of telemetric data. Time of arrhythmia onset and predisposing factors were investigated.
Results—
Significant cardiac arrhythmias occurred in 25.1% of all patients. Incidence was highest during the first 24 hours after admission. Serious arrhythmic tachycardia (ventricular or supraventricular >130 beats/min) was more frequent than bradycardic arrhythmia (sinus-node dysfunction, bradyarrhythmia, or atrioventricular block °II and °III). Arrhythmias were independently associated with higher age and severer neurological deficits as measured by the National Institutes of Health Stroke Scale on admission.
Conclusions—
The risk for significant cardiac arrhythmia after an acute cerebrovascular event is highest during the first 24 hours of care and declines with time during the first 3 days. Along with established vascular risk factors, the National Institutes of Health Stroke Scale may be considered for a stratified allocation of monitoring capabilities.
Clinical Trial Registration—
URL:
www.clinicaltrials.gov
. Unique identifier: NCT01177748.
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Affiliation(s)
- Bernd Kallmünzer
- From the Departments of Neurology (B.K., L.B., N.K., T.B., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Lorenz Breuer
- From the Departments of Neurology (B.K., L.B., N.K., T.B., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Nicolas Kahl
- From the Departments of Neurology (B.K., L.B., N.K., T.B., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Tobias Bobinger
- From the Departments of Neurology (B.K., L.B., N.K., T.B., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Dorette Raaz-Schrauder
- From the Departments of Neurology (B.K., L.B., N.K., T.B., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Hagen Bernhard Huttner
- From the Departments of Neurology (B.K., L.B., N.K., T.B., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Stefan Schwab
- From the Departments of Neurology (B.K., L.B., N.K., T.B., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Martin Köhrmann
- From the Departments of Neurology (B.K., L.B., N.K., T.B., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
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Raaz-Schrauder D, Ekici AB, Munoz LE, Klinghammer L, Voll RE, Leusen JHW, van de Winkel JGJ, Reis A, Schett G, Garlichs CD, Herrmann M. Patients with unstable angina pectoris show an increased frequency of the Fc gamma RIIa R131 allele. Autoimmunity 2012; 45:556-64. [PMID: 22559288 DOI: 10.3109/08916934.2012.682665] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with Systemic Lupus Erythematosus (SLE) carry an increased risk for the development of coronary artery disease (CAD). The R131 allele of the Fc gamma receptor IIa (FcγRIIa) is associated with SLE incidence and disease severity but also with CAD. Compared to stable angina pectoris (SAP) the unstable angina (UAP), as a manifestation of destabilizing CAD, is associated with increased risk of persistent instability, myocardial infarction, and death. Identification of clinically relevant determinants for unstable angina promises reduction of UAP-associated mortality in patients with SLE. We conducted a clinical study among 553 consecutive patients with stable angina pectoris (n = 330) and unstable angina pectoris (n = 223). All patients were genotyped for a frequent functional variant at position 131 of the mature FcγRIIa. UAP, but not SAP was significantly associated with the R/R131 genotype (P < 0.001). In troponin-negative patients with angina carrying the R/R131 genotype the odds ratio for suffering from UAP was 4.02 (95% confidence interval, 2.52-6.41) compared to those with non-R/R131 genotypes. In a multivariable analysis, the R/R131 genotype independently predicted the risk for development of UAP in a model adjusted for classical atherogenic risk factors. Our data imply that risk stratification of SLE- and other high risk patients with troponin-negative angina could be significantly improved by FcγRIIa genotyping.
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Kallmünzer B, Breuer L, Hering C, Raaz-Schrauder D, Kollmar R, Huttner HB, Schwab S, Köhrmann M. A Structured Reading Algorithm Improves Telemetric Detection of Atrial Fibrillation After Acute Ischemic Stroke. Stroke 2012; 43:994-9. [DOI: 10.1161/strokeaha.111.642199] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bernd Kallmünzer
- From the Departments of Neurology (B.K., L.B., C.H., R.K., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Lorenz Breuer
- From the Departments of Neurology (B.K., L.B., C.H., R.K., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Christiane Hering
- From the Departments of Neurology (B.K., L.B., C.H., R.K., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Dorette Raaz-Schrauder
- From the Departments of Neurology (B.K., L.B., C.H., R.K., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Rainer Kollmar
- From the Departments of Neurology (B.K., L.B., C.H., R.K., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Hagen B. Huttner
- From the Departments of Neurology (B.K., L.B., C.H., R.K., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Stefan Schwab
- From the Departments of Neurology (B.K., L.B., C.H., R.K., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
| | - Martin Köhrmann
- From the Departments of Neurology (B.K., L.B., C.H., R.K., H.B.H., S.S., M.K.) and Cardiology (D.R.-S.), University Medical Center Erlangen, Erlangen, Germany
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Erdmann J, Willenborg C, Nahrstaedt J, Preuss M, Konig IR, Baumert J, Linsel-Nitschke P, Gieger C, Tennstedt S, Belcredi P, Aherrahrou Z, Klopp N, Loley C, Stark K, Hengstenberg C, Bruse P, Freyer J, Wagner AK, Medack A, Lieb W, Grosshennig A, Sager HB, Reinhardt A, Schafer A, Schreiber S, El Mokhtari NE, Raaz-Schrauder D, Illig T, Garlichs CD, Ekici AB, Reis A, Schrezenmeir J, Rubin D, Ziegler A, Wichmann HE, Doering A, Meisinger C, Meitinger T, Peters A, Schunkert H. Genome-wide association study identifies a new locus for coronary artery disease on chromosome 10p11.23. Eur Heart J 2010; 32:158-68. [DOI: 10.1093/eurheartj/ehq405] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Teupser D, Baber R, Ceglarek U, Scholz M, Illig T, Gieger C, Holdt LM, Leichtle A, Greiser KH, Huster D, Linsel-Nitschke P, Schäfer A, Braund PS, Tiret L, Stark K, Raaz-Schrauder D, Fiedler GM, Wilfert W, Beutner F, Gielen S, Grosshennig A, König IR, Lichtner P, Heid IM, Kluttig A, El Mokhtari NE, Rubin D, Ekici AB, Reis A, Garlichs CD, Hall AS, Matthes G, Wittekind C, Hengstenberg C, Cambien F, Schreiber S, Werdan K, Meitinger T, Loeffler M, Samani NJ, Erdmann J, Wichmann HE, Schunkert H, Thiery J. Genetic regulation of serum phytosterol levels and risk of coronary artery disease. ACTA ACUST UNITED AC 2010; 3:331-9. [PMID: 20529992 DOI: 10.1161/circgenetics.109.907873] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Phytosterols are plant-derived sterols that are taken up from food and can serve as biomarkers of cholesterol uptake. Serum levels are under tight genetic control. We used a genomic approach to study the molecular regulation of serum phytosterol levels and potential links to coronary artery disease (CAD). METHODS AND RESULTS A genome-wide association study for serum phytosterols (campesterol, sitosterol, brassicasterol) was conducted in a population-based sample from KORA (Cooperative Research in the Region of Augsburg) (n=1495) with subsequent replication in 2 additional samples (n=1157 and n=1760). Replicated single-nucleotide polymorphisms (SNPs) were tested for association with premature CAD in a metaanalysis of 11 different samples comprising 13 764 CAD cases and 13 630 healthy controls. Genetic variants in the ATP-binding hemitransporter ABCG8 and at the blood group ABO locus were significantly associated with serum phytosterols. Effects in ABCG8 were independently related to SNPs rs4245791 and rs41360247 (combined P=1.6 x 10(-50) and 6.2 x 10(-25), respectively; n=4412). Serum campesterol was elevated 12% for each rs4245791 T-allele. The same allele was associated with 40% decreased hepatic ABCG8 mRNA expression (P=0.009). Effects at the ABO locus were related to SNP rs657152 (combined P=9.4x10(-13)). Alleles of ABCG8 and ABO associated with elevated phytosterol levels displayed significant associations with increased CAD risk (rs4245791 odds ratio, 1.10; 95% CI, 1.06 to 1.14; P=2.2 x 10(-6); rs657152 odds ratio, 1.13; 95% CI, 1.07 to 1.19; P=9.4 x 10(-6)), whereas alleles at ABCG8 associated with reduced phytosterol levels were associated with reduced CAD risk (rs41360247 odds ratio, 0.84; 95% CI, 0.78 to 0.91; P=1.3 x 10(-5)). CONCLUSION Common variants in ABCG8 and ABO are strongly associated with serum phytosterol levels and show concordant and previously unknown associations with CAD.
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Affiliation(s)
- Daniel Teupser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig, Germany.
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Raaz-Schrauder D, Klinghammer L, Ekici A, Herrmann M, Daniel W, Reis A, Garlichs C. P91 INSTABILITY OF CORONARY PLAQUES IS CLINICALLY AND ANGIOGRAPHICALLY ASSOCIATED WITH SPECIFIC CRP-RECEPTOR SUBTYPE. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70158-6] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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