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Zeller J, Bogner B, McFadyen JD, Kiefer J, Braig D, Pietersz G, Krippner G, Nero TL, Morton CJ, Shing KSCT, Parker MW, Peter K, Eisenhardt SU. Transitional changes in the structure of C-reactive protein create highly pro-inflammatory molecules: Therapeutic implications for cardiovascular diseases. Pharmacol Ther 2022; 235:108165. [PMID: 35247517 DOI: 10.1016/j.pharmthera.2022.108165] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 01/27/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 02/08/2023]
Abstract
C-reactive protein (CRP) is the prototypic acute-phase reactant that has long been recognized almost exclusively as a marker of inflammation and predictor of cardiovascular risk. However, accumulating evidence indicates that CRP is also a direct pathogenic pro-inflammatory mediator in atherosclerosis and cardiovascular diseases. The 'CRP system' consists of at least two protein conformations with distinct pathophysiological functions. The binding of the native, pentameric CRP (pCRP) to activated cell membranes leads to a conformational change resulting in two highly pro-inflammatory isoforms, pCRP* and monomeric CRP (mCRP). The deposition of these pro-inflammatory isoforms has been shown to aggravate the localized tissue injury in a broad range of pathological conditions including atherosclerosis and thrombosis, myocardial infarction, and stroke. Here, we review recent findings on how these structural changes contribute to the inflammatory response and discuss the transitional changes in the structure of CRP as a novel therapeutic target in cardiovascular diseases and overshooting inflammation.
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Affiliation(s)
- J Zeller
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany; Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - B Bogner
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - J D McFadyen
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Kiefer
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - D Braig
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany; Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - G Pietersz
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G Krippner
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - T L Nero
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - C J Morton
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - K S Cheung Tung Shing
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - M W Parker
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia; ACRF Rational Drug Discovery Centre, St. Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia.
| | - K Peter
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Immunology, Monash University, Melbourne, Victoria, Australia.
| | - S U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany.
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Weixler V, Peter K, Judith L, Murin P, Mi-Young C, Del Nido PJ, Photiadis J, Friehs I. Endothelial-to-Mesenchymal Transition as Underlying Mechanism for the Formation of Double-Chambered Right Ventricle. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742901] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- V. Weixler
- German Heart Institute Berlin, Berlin, Deutschland
| | - K. Peter
- German Heart Institute Berlin, Berlin, Deutschland
| | - L. Judith
- Institut Für Pathologie Charité, Berlin, Deutschland
| | - P. Murin
- Augustenburger Platz 1, Berlin, Deutschland
| | - C. Mi-Young
- German Heart Institute Berlin, Berlin, Deutschland
| | - P. J. Del Nido
- Pediatric Cardiac Surgery, Boston Children's Hospital, Boston, United States
| | | | - I. Friehs
- Pediatric Cardiac Surgery, Boston Children's Hospital, Boston, United States
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Al-Mukhtar O, Peter K, Gooley R, Farouque O, Van Gaal W, Hiew C, Layland J, Oqueli E, Lefkovits J, Brennan A, Reid C, Walton A, Stub D, Kaye D, Lo S, Cox N, Chan W. Contemporary Practice of Heparin Prescription and Its Monitoring via Activated Clotting Time in Percutaneous Coronary Intervention in Victoria, Australia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.571] [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: 10/16/2022]
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Fernando H, Nehme Z, Milne C, O'Brien J, Bernard S, Stephenson M, Myles P, Lefkovits J, Peter K, Brennan A, Dinh D, Andrew E, Taylor A, Smith K, Stub D. LidocAine Versus Opioids In MyocarDial Infarction: The AVOID-2 Randomised Controlled Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.349] [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: 10/16/2022]
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Rahman M, Garcia N, Loh Y, Marks D, Banakh I, Jagadeesan P, Cameron N, Yung-Chih C, Costa M, Peter K, Cleland H, Akbarzadeh S. A platelet-derived hydrogel improves neovascularisation in full thickness wounds. Acta Biomater 2021; 136:199-209. [PMID: 34587524 DOI: 10.1016/j.actbio.2021.09.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022]
Abstract
Platelets are a reservoir of growth factors, cytokines and chemokines involved in spontaneous wound repair. In this study, a platelet-rich and fibrin-rich hydrogel was generated from expired platelet components that would have otherwise been transfused. The material contained physiological concentrations of transforming growth factor β1 (TGF-β1, platelet-derived growth factor AB (PDGF-AB), PDGF-BB, insulin-like growth factor-1 (IGF-1), fibroblast growth factor 2 (FGF-2), and epidermal growth factor (EGF). The effect of the hydrogel on wound repair was investigated in SKH-1 mice. Full thickness dorsal wounds were created on the mice and treated with the hydrogel at various concentrations. Immunohistochemical staining with CD31 (endothelial cell marker) revealed that wounds treated with the hydrogel showed significantly enhanced vascularisation in the wound bed. Moreover, high levels of interleukin-6 (IL-6) and KC (IL-8 functional homologue) in treated wounds were sustained over a longer period of time, compared to untreated wounds. We postulate that sustained IL-6 is a driver, at least partly, of enhanced vascularisation in full thickness wounds treated with the hydrogel. Future work is needed to explore whether this hydrogel can be utilised as a treatment option when vascularisation is a critical limitation. STATEMENT OF SIGNIFICANCE: The economic cost of wound repair is estimated in billions of dollars each year. In many cases time required to vascularise wounds is a major contributor to slow wound repair. In this study, we developed a blood-derived platelet- and fibrin-rich hydrogel. It contains a number of growth factors actively involved in spontaneous wound healing. This hydrogel significantly improved dermal repair and vascularisation in a full-thickness wound mouse model. This study provides an action mechanism for modulation of localised inflammation.
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Nan Tie E, Fernando H, Nehme Z, Dinh D, Andrew E, Brennan A, Zaman S, Liew D, Stephenson M, Lefkovits J, Peter K, Duffy SJ, Shaw J, Smith K, Stub D. Sex differences in pre-hospital analgesia and outcomes in patients presenting with acute coronary syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2778] [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
Opioid analgesia remains the mainstay of pain management in acute coronary syndromes (ACS). Significant sex differences persist in ACS presentation, management and outcomes, but the impact of sex-differences on pre-hospital pain management of ACS with opioids is unknown. There is increasing awareness of the importance of pre-hospital factors in ACS, as well as emerging concerns with opioid use impairing the gastrointestinal absorption of oral P2Y12 inhibitors.
Purpose
This study examined if sex-differences in pre-hospital pain scores, opioid administration and clinical outcomes exist in ACS patients.
Methods
Patients presenting with ACS via ambulance (2014–2018) that underwent percutaneous coronary intervention (PCI) were prospectively collected via the Victorian Cardiac Outcomes Registry (VCOR), the Melbourne Interventional Group (MIG), and linked to the Ambulance Victoria database. The primary outcome was 30-day major adverse cardiac events (MACE). Secondary outcomes were descriptive analyses of pre-hospital pain score, intravenous morphine equivalent analgesic dosing, plus predictors of MACE and Thrombolysis In Myocardial Infarction (TIMI) 0–1 flow pre-PCI using logistic regression.
Results
10,547 patients were included (female: 2,775 [26.3%]). Opioids were administered to 1,585 (57%) females and 5,068 (65%) males (p<0.001). Adjusted 30-day MACE was similar between opioid groups in both sexes (female: OR 1.21, CI 0.82–1.79, p=0.34; male: OR 0.89, 0.68–1.16, p=0.40). Median pain score at presentation was 6 (IQR 4,8) for both sexes. Median opioid dose was 2.5 mg (IQR 0,10) in females and 5 mg (IQR 0,10) in males (p<0.001), with similar pain relief achieved. Adjusted rates of TIMI 0–1 pre-PCI were higher in patients administered opioids (female: OR 2.83, CI 2.14–3.56, p<0.001; male: OR 2.95, CI 2.49–3.49, p<0.001).
Conclusions
Female patients undergoing PCI received less opioid analgesia, but no sex-differences in pre-hospital pain scores were seen. Opioid administration was associated with impaired antegrade flow in the culprit artery in both sexes, but not short-term MACE. Randomised trials evaluating the clinical implications of opioid administration in ACS with sex subgroup analyses are needed to guide clinical practice.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Melbourne Interventional GroupVictorian Cardiac Outcomes Registry
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Affiliation(s)
- E Nan Tie
- Monash University, Melbourne, Australia
| | - H Fernando
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - Z Nehme
- Monash University, Melbourne, Australia
| | - D Dinh
- Monash University, Melbourne, Australia
| | - E Andrew
- Monash University, Melbourne, Australia
| | - A Brennan
- Monash University, Melbourne, Australia
| | - S Zaman
- Westmead Hospital, Sydney, Australia
| | - D Liew
- Monash University, Melbourne, Australia
| | | | - J Lefkovits
- Royal Melbourne Hospital, Melbourne, Australia
| | - K Peter
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - S J Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - J Shaw
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - K Smith
- Monash University, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
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Fernando H, Duong T, Huynh K, Noonan J, Shaw J, Duffy S, Nehme Z, Smith K, Myles P, Meikle P, Peter K, Stub D. Lignocaine versus opioids in coronary intervention: assessing antiplatelet activity and ticagrelor levels (LOCAL) study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2991] [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
Opioid analgesia impairs the bioavailability and antiplatelet effect of oral P2Y12 inhibitors prompting investigation of mitigation strategies including identifying alternative analgesic agents.
Purpose
To assess the impact of intravenous fentanyl and lignocaine on the bioavailability and antiplatelet effect of ticagrelor in patients with unstable angina and non-ST elevation myocardial infarction, as well as their procedural analgesic efficacy and safety.
Methods
The LOCAL trial was a prospective, single centre, double-blind, randomized, controlled trial where intravenous lignocaine was the experimental analgesic agent assessed in this trial compared to intravenous fentanyl as procedural analgesia during coronary angiography and percutaneous coronary intervention. Patients with an indication for dual antiplatelet therapy and no contraindication were given 180mg of ticagrelor orally as integral tablets with 250 mL of tap water at the end of the case. Blood was sampled at time 0, 0.5, 1, 2 and 4 hours post administration of ticagrelor for pharmacokinetic and comprehensive pharmacodynamic analysis.
Results
Seventy patients undergoing coronary angiography with an indication for ticagrelor loading were included in the pharmacokinetic and pharmacodynamic analysis. Plasma ticagrelor levels at 2 h post loading dose were significantly lower in the fentanyl compared to lignocaine treatment arm (476 vs. 792 ng/mL, p=0.02, see figure 1). The area under the plasma-time curves for ticagrelor (987 vs. 2189 ng.h/mL, p=0.001) and its active metabolite (173 vs. 394 ng.h/mL, p<0.001) were both significantly lower in the fentanyl arm. Platelet reactivity assessed by the VerifyNow assay was higher at all time points after baseline in the fentanyl compared to lignocaine arm. The VASP flow cytometry assay demonstrated higher platelet reactivity at 2 hours in the fentanyl group (40% vs. 22% platelet reactivity index, p=0.001). The Multiplate Analyzer demonstrated higher platelet reactivity in the fentanyl arm at 60 minutes (43 vs. 26 area under the curve units, p=0.001) as did expression of activated platelet GpIIb/IIIa receptor (2829 vs. 1426 geometric mean fluorescence intensity (GMFI), p=0.006) and P-selectin (439 vs. 211 GMFI, p=0.001). High on-treatment platelet reactivity (HPR) was significantly higher in the fentanyl arm at 60 min using the MPA (41% vs. 9%, p=0.002) and 120 min using the VFN (30% vs. 3%, p=0.003) and VASP (37% vs. 6%, p=0.002) assays (see figure 2). Both drugs were well tolerated with a high level of patient satisfaction (fentanyl 94% vs. lignocaine 97%, p=0.56).
Conclusion(s)
Unlike fentanyl, lignocaine does not impair the bioavailability or delay the antiplatelet effect of ticagrelor. Both drugs were well tolerated and effective with a high level of patient satisfaction for procedural analgesia. Systemic pain medication during PCI should be reconsidered and if performed, lignocaine is a beneficial alternative to fentanyl.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): TBA Figure 1. Ticagrelor and AM pharmacokineticsFigure 2. Ticagrelor pharmacodynamics
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Affiliation(s)
- H Fernando
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - T Duong
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - K Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J Noonan
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J Shaw
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - S Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - Z Nehme
- Monash University, Melbourne, Australia
| | - K Smith
- Monash University, Melbourne, Australia
| | - P Myles
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - P Meikle
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - K Peter
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
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Fernando H, Duong T, Huynh K, Noonan J, Shaw J, Duffy S, Nehme Z, Smith K, Myles P, Meikle P, Peter K, Stub D. Lignocaine Versus Opioids in Coronary Intervention: Assessing Antiplatelet Activity and Ticagrelor Levels (LOCAL) Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.007] [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: 11/28/2022]
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9
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Nan Tie E, Fernando H, Nehme Z, Dinh D, Andrew E, Brennan A, Zaman S, Liew D, Stephenson M, Lefkovits J, Peter K, Duffy S, Shaw J, Smith K, Stub D. Sex Differences in Pre-hospital Analgesia and Outcomes in Patients Presenting with Acute Coronary Syndromes. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.329] [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: 10/20/2022]
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Kyaw T, Loveland P, Kanellakis P, Cao A, Huang A, Peter K, Toh B, Bobik A. Alarmin-activated B cells accelerate atherosclerosis after myocardial infarction via plasma cell-immunoglobulin dependent mechanisms. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3793] [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
Introduction
Myocardial infarction (MI) accelerates atherosclerosis and for years greatly increases the risk of recurrent cardiovascular events, such as stroke and MI. B cell-derived autoantibodies produced in response to MI also persist for years.
Purpose
We investigated the role of B cells in adaptive immune responses to MI.
Methods
We used an apolipoprotein-E-deficient (ApoE−/−) mouse model of MI-accelerated atherosclerosis to assess the importance of B cells using loss and gain of function approaches. In loss of function experiment, after inducing an MI we depleted B cells using an anti-CD20 antibody. Gain of function experiments involve transfers of purified MI-B cells from different donor mice, isolated one week after MI, into atherosclerotic ApoE−/− mice.
Results
Depletion of B cells in MI mice prevented immunoglobulin G accumulation in plaques and MI-induced acceleration of atherosclerosis. Adoptive transfer of wildtype MI-B cells into atherosclerotic ApoE−/− mice greatly increased IgG accumulation in plaque and accelerated atherosclerosis in recipient mice. Cytokines that promote humoral immunity were also greatly increased in B cells activated by MI. These cells formed germinal centres within the spleen where they differentiated into antibody-producing plasma cells. Transfer of MI-B cells deficient in Blimp-1, the transcriptional repressor that drives their terminal differentiation to antibody-producing plasma cells failed to accelerate atherosclerosis in recipient mice. Alarmins released from infarcted heart were responsible for activation of B cells via toll-like receptors; transfer of MI-B cells deficient in MyD88, the canonical adaptor protein for inflammatory signaling downstream of toll-like receptors, prevented acceleration of atherosclerosis in recipient mice.
Conclusion
Our data implicate early B cell activation and autoantibodies as a central cause for accelerated atherosclerosis post MI and identifies novel therapeutic strategies towards preventing recurrent cardiovascular events such as MI and stroke.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council of Australia
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Affiliation(s)
- T Kyaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - P Loveland
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - P Kanellakis
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A Cao
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A Huang
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - K Peter
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - B.H Toh
- Monash University, Medicine, Melbourne, Australia
| | - A Bobik
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Fernando H, Nehme Z, Peter K, Bernard S, Stephenson M, Bray J, Cameron P, Ellims A, Taylor A, Kaye D, Smith K, Stub D. 869 Prehospital Opioid Dose and Myocardial Injury in Patients With ST-Elevation Myocardial Infarction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.876] [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: 11/16/2022]
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Fernando S, Schwarz N, Chen Y, Skoumbourdis T, Williamson A, Toledo-Flores D, Dimasi C, Sargeant T, Manavis J, Tan J, Bursill C, Nicholls S, Peter K, Psaltis P. 723 Colchicine Exerts Anti-Atherosclerotic and Plaque-Stabilising Effects in Mice by Inhibiting Macrophage Foam Cell Formation and Cholesterol Crystal-Induced NLRP3 Activation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.730] [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: 10/23/2022]
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Maier A, Jakob K, Von Elverfeldt D, Braig M, Bienert T, Peter K, Klingel K, Bode C, Von Zur Muehlen C. 4323Detection of early inflammation in myocarditis by molecular magnetic resonance imaging of activated platelets. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0160] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
A noninvasive imaging strategy for diagnosis and localization of early myocarditis would be of great clinical interest. However, resolution of current imaging techniques is limited. Platelets play an important role in inflammatory processes but the role in myocarditis is unknown. Therefore, the aim of this project was to examine the role of platelets in myocarditis and establish a sensitive non-invasive molecular MRI in-vivo imaging strategy for diagnosis of myocarditis with a contrast agent against activated platelets in mice.
Methods
Myocarditis was induced by subcutaneous injection of an emulsion of porcine cardiac myosin and complete freud's adjuvant (CFA) in Balb/c mice. Inflammatory activity was targeted with a contrast agent against activated platelets consisting of microparticles of iron oxide (MPIO) conjugated to a single chain antibody directed against ligand-induced binding sites (LIBS) on activated glycoprotein IIb/IIIa (=LIBS-MPIO). In comparison, we applied an unspecific control antibody linked to microparticles of iron oxide (control-MPIO) and injected LIBS-MPIO to mice subjected to incomplete freud's adjuvant (iCFA). All imaging results were correlated to immunohistochemistry findings.
Results
Histological evaluation showed significantly higher binding of LIBS-MPIOs to platelet enriched, CD41-positive inflamed myocardium two days after induction of myocarditis in comparison to later time points (7d, 14d, 21d) (p<0.05) and control-MPIO (p<0.05) injection. In iCFA injected mice no significant LIBS-MPIO binding was found (p<0.05). In 3D in-vivo MRI we could specifically detect focal signal effects in LIBS-MPIO injected mice 2 days after induction of myocarditis, whereas in control-MPIO injected mice no signal effect was visible. Quantification of the myocardial MRI signal confirmed a signal decrease after LIBS-MPIO injection and significant fewer signals in comparison to control-MPIO injection (p<0.05).
As a perspective, we also found CD41 positive areas in histology of human myocarditis specimens.
Conclusions
Platelets are involved in the inflammation of myocarditis. Molecular MRI with LIBS-MPIO can image them at an early time point. This noninvasive imaging strategy is of clinical interest for both diagnostic and prognostic purposes, and highlights the potential of molecular MRI for characterization of cardiovascular pathologies such as myocardial inflammation.
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Affiliation(s)
- A Maier
- University of Freiburg, University Heart Center Freiburg, Freiburg, Germany
| | - K Jakob
- University of Freiburg, University Heart Center Freiburg, Freiburg, Germany
| | | | - M Braig
- University of Freiburg, Freiburg im Breisgau, Germany
| | - T Bienert
- University of Freiburg, Freiburg im Breisgau, Germany
| | - K Peter
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - K Klingel
- University Hospital of Tubingen, Cardiopathology, Institute for Pathology and Neuropathology, Tubingen, Germany
| | - C Bode
- University of Freiburg, University Heart Center Freiburg, Freiburg, Germany
| | - C Von Zur Muehlen
- University of Freiburg, University Heart Center Freiburg, Freiburg, Germany
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14
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Chen YC, Doma V, Reimark R, Ying YL, Peter K. P4610Gut microbiome and atherosclerotic plaque instability: does choline consumption in red meat influence plaque stability? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0993] [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
Myocardial infarction is the major cause of deaths worldwide. Gut bacteria can process choline as abundant in red meat and subsequently converted by flavin containing monooxygenase in the liver to trimethylamin-N-oxide (TMAO) metabolite, which is strongly associated with cardiovascular events.
Aim
To investigate the gut microbiome and its association with atherosclerotic plaque instability.
Methods
Forty-eight Apolipoprotein E deficient mice were randomly divided into two groups and two time points, fed with a high fat diet (containing either 0.4% choline or 3% choline) at 12 weeks of age, for 7 weeks or for 14 weeks. All mice underwent Tandem Stenosis (TS) surgery to induce the development of unstable plaques. Stool samples were collected directly from the colon. Measurements of gut microbes were performed by AGRF diversity profiling. After bacterial genomic DNA isolation, 16S rRNA were sequenced by targeting 27F-519R (V1-V3) and 341F-806R (V3-V4) on the Illumina MiSeq platform. Vessel segments of TS were histologically processed and plaque composition of lipid, collagen, and intraplaque hemorrhage (marker of unstable plaques) were performed by a series of chemical staining and immunohistochemistry.
Results
Monocytes and granulocytes in mouse blood were significantly increased in the high choline group (p<0.05, unpaired t-test) after 7 weeks of high fat diet (21% fat, 0.15% Cholesterol, 3% Choline). Profiling of gut microbiota showed that Fimicutes were down regulated in the high choline group (p<0.05, unpaired t-test). Within Phylum Fimicutes, only Clostridia (class) Clostridiales (order) were significantly downregulated. Interestingly, histological analysis of TS segments showed that TER-119 (intraplaque haemorrhage marker) and CD42c (platelet marker) were significantly increased in the high choline group, indicating atherosclerotic plaques are more unstable and prone to rupture (p<0.05, unpaired t-test). Nevertheless, CD68 (Foam cells) in plaques, and total atherosclerotic plaque burden in the aortic sinus and aortic arch were not affected by the elevated levels of choline consumption.
Conclusion
Choline intake increases circulating monocytes and granulocyte numbers in the blood but not in the atherosclerotic plaque itself. Whereas the total plaque burden is not changed by an increased choline intake, the reduction of Fimicutes, Clostridia and Clostridiales seems to contribute to atherosclerotic plaque instability.
Acknowledgement/Funding
Heart Foundation 2018 Future Leader Fellowship (2018 FLF) ID: 102068 Chen
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Affiliation(s)
- Y.-C Chen
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - V Doma
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - R Reimark
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Y.-L Ying
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - K Peter
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Jonson M, Nyström S, Sandberg A, Carlback M, Michno W, Hanrieder J, Starkenberg A, Peter K, Nilsson R, Thor S, Hammarström P. Amyloid fibril polymorphism and cell-specific toxicity in vivo. Amyloid 2019; 26:136-137. [PMID: 31343327 DOI: 10.1080/13506129.2019.1582488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/26/2022]
Affiliation(s)
- Maria Jonson
- a IFM-Department of Chemistry, Linköping University , Linköping , Sweden
| | - Sofie Nyström
- a IFM-Department of Chemistry, Linköping University , Linköping , Sweden
| | - Alexander Sandberg
- a IFM-Department of Chemistry, Linköping University , Linköping , Sweden
| | - Marcus Carlback
- a IFM-Department of Chemistry, Linköping University , Linköping , Sweden
| | - Wojciech Michno
- b Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg , Mölndal , Sweden
| | - Jörg Hanrieder
- b Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg , Mölndal , Sweden.,c Department of Molecular Neuroscience, Institute of Neurology, University College London , London , UK
| | - Annika Starkenberg
- d Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden
| | | | - R Nilsson
- a IFM-Department of Chemistry, Linköping University , Linköping , Sweden
| | - Stefan Thor
- d Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden
| | - Per Hammarström
- a IFM-Department of Chemistry, Linköping University , Linköping , Sweden
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Wang X, Ziegler M, Hohmann JD, Searle AK, Abraham MK, Nandurkar H, Peter K. P942Restoring of heart function after myocardial infarction using activated platelets targeted drugs. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p942] [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: 11/13/2022] Open
Affiliation(s)
- X Wang
- Baker IDI Heart and Diabetes Institute, Atherothrombosis and Vascular Biology, Melbourne, Australia
| | - M Ziegler
- Baker IDI Heart and Diabetes Institute, Atherothrombosis and Vascular Biology, Melbourne, Australia
| | - J D Hohmann
- Baker IDI Heart and Diabetes Institute, Atherothrombosis and Vascular Biology, Melbourne, Australia
| | - A K Searle
- Baker IDI Heart and Diabetes Institute, Atherothrombosis and Vascular Biology, Melbourne, Australia
| | - M.-K Abraham
- Baker IDI Heart and Diabetes Institute, Atherothrombosis and Vascular Biology, Melbourne, Australia
| | - H Nandurkar
- Monash University, Medicine, Melbourne, Australia
| | - K Peter
- Baker IDI Heart and Diabetes Institute, Atherothrombosis and Vascular Biology, Melbourne, Australia
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17
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Robinson S, Follo M, Haenel D, Mauler M, Stallmann D, Tewari M, Duerschmied D, Peter K, Bode C, Ahrens I, Hortmann M. Droplet digital PCR as a novel detection method for quantifying microRNAs in acute myocardial infarction. Int J Cardiol 2018; 257:247-254. [DOI: 10.1016/j.ijcard.2017.10.111] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/22/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022]
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18
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Huang A, Chen Y, Lim B, Yao J, Bobik A, Peter K. Therapeutic Targeting of the Alarmin, HMGB1, Safely and Effectively Prevents Arterial Thrombosis Through Inhibition Of NET Formation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.693] [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: 11/28/2022]
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Flierl U, Nero TL, Lim B, Andrews RK, Parker MW, Gardiner EE, Peter K. Targeting of C-type lectin-like receptor 2 or P2Y12 for the prevention of platelet activation by immunotherapeutic CpG oligodeoxynucleotides: comment. J Thromb Haemost 2018; 16:181-185. [PMID: 29052937 DOI: 10.1111/jth.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- U Flierl
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - T L Nero
- St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
- Bio21 Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - B Lim
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - R K Andrews
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - M W Parker
- St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
- Bio21 Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - E E Gardiner
- ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - K Peter
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Günther F, Heidt T, Kramer M, Khanicheh E, Klibanov AL, Geibel-Zehender A, Ferrante EA, Hilgendorf I, Wolf D, Zirlik A, Reinöhl J, Bode C, Peter K, Kaufmann BA, Mühlen CVZ. Dual targeting improves capture of ultrasound microbubbles towards activated platelets but yields no additional benefit for imaging of arterial thrombosis. Sci Rep 2017; 7:14898. [PMID: 29097799 PMCID: PMC5668440 DOI: 10.1038/s41598-017-15080-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/20/2017] [Indexed: 01/13/2023] Open
Abstract
Platelets can be found on the surface of inflamed and ruptured atherosclerotic plaques. Thus, targeting of activated platelets may allow for molecular imaging of vulnerable atherosclerotic lesions. We here investigated microbubbles (MB) functionalized with the selectin ligand sialyl Lewisa individually (MBsLea) or dually with sLea and an antibody targeting ligand-induced binding sites of the activated GPIIb/IIIa receptor (MBDual). Assessed by in vitro flow chamber, targeted MB exhibited increased adhesion to platelets as compared to MBControl. While MBsLea rolled slowly on the platelets’ surface, MBDual enhanced the percentage of firm adhesion. In vivo, MB were investigated by ultrasound in a model of ferric chloride induced non-occlusive carotid artery thrombosis. MBsLea and MBDual revealed a higher ultrasound mean acoustic intensity than MBControl (p < 0.05), however MBDual demonstrated no additional increase in mean signal intensity as compared to MBsLea. The degree of carotid artery stenosis on histology correlated well with the ultrasound acoustic intensity of targeted MB (p < 0.05). While dual targeting of MB using fast binding carbohydrate polymers and specific antibodies is a promising strategy to support adhesion to activated platelets under arterial shear stress, these advantages seem not readily translatable to in vivo models.
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Affiliation(s)
- F Günther
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - T Heidt
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Kramer
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - E Khanicheh
- University Hospital of Basel, Basel, Switzerland
| | | | - A Geibel-Zehender
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - E A Ferrante
- National Institute of Health, NHLBI, Bethesda, USA
| | - I Hilgendorf
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Wolf
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Zirlik
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Reinöhl
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Bode
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - K Peter
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - B A Kaufmann
- University Hospital of Basel, Basel, Switzerland
| | - C von Zur Mühlen
- Heart Center Freiburg University and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Hortmann M, Robinson S, Mohr M, Haenel D, Mauler M, Stallmann D, Reinoehl J, Duerschmied D, Peter K, Bode C, Ahrens I. Circulating HtrA2 as a novel biomarker for mitochondrial induced cardiomyocyte apoptosis and ischemia-reperfusion injury in ST-segment elevation myocardial infarction. Int J Cardiol 2017; 243:485-491. [DOI: 10.1016/j.ijcard.2017.05.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 11/16/2022]
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Wolf D, Anto Michel N, Blankenbach H, Bode C, Peter K, Zirlik A. 3854Leukocyte mobilization through CD40L/Mac-1 drives cardiovascular inflammation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3854] [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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24
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Chen Y, Htun N, Lim B, Schneider H, Stocker R, Peter K. P686Near infrared autofluorescence is a unique feature of vulnerable atherosclerotic plaques. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p686] [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: 11/14/2022] Open
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25
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Wang X, Searle A, Chen Y, Peter K. P6268Downregulation of vascular cell adhesion molecule-1 using targeted microbubbles for the delivery of microRNA-126: treatment and prevention of abdominal aortic aneurysm. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6268] [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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26
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Molloy CP, Yao Y, Kammoun H, Bonnard T, Hoefer T, Alt K, Tovar-Lopez F, Rosengarten G, Ramsland PA, van der Meer AD, van den Berg A, Murphy AJ, Hagemeyer CE, Peter K, Westein E. Shear-sensitive nanocapsule drug release for site-specific inhibition of occlusive thrombus formation. J Thromb Haemost 2017; 15:972-982. [PMID: 28267256 DOI: 10.1111/jth.13666] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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] [Received: 07/15/2016] [Indexed: 11/29/2022]
Abstract
Essentials Vessel stenosis due to large thrombus formation increases local shear 1-2 orders of magnitude. High shear at stenotic sites was exploited to trigger eptifibatide release from nanocapsules. Local delivery of eptifibatide prevented vessel occlusion without increased tail bleeding times. Local nanocapsule delivery of eptifibatide may be safer than systemic antiplatelet therapies. SUMMARY Background Myocardial infarction and stroke remain the leading causes of mortality and morbidity. The major limitation of current antiplatelet therapy is that the effective concentrations are limited because of bleeding complications. Targeted delivery of antiplatelet drug to sites of thrombosis would overcome these limitations. Objectives Here, we have exploited a key biomechanical feature specific to thrombosis, i.e. significantly increased blood shear stress resulting from a reduction in the lumen of the vessel, to achieve site-directed delivery of the clinically used antiplatelet agent eptifibatide by using shear-sensitive phosphatidylcholine (PC)-based nanocapsules. Methods PC-based nanocapsules (2.8 × 1012 ) with high-dose encapsulated eptifibatide were introduced into microfluidic blood perfusion assays and into in vivo models of thrombosis and tail bleeding. Results Shear-triggered nanocapsule delivery of eptifibatide inhibited in vitro thrombus formation selectively under stenotic and high shear flow conditions above a shear rate of 1000 s-1 while leaving thrombus formation under physiologic shear rates unaffected. Thrombosis was effectively prevented in in vivo models of vessel wall damage. Importantly, mice infused with shear-sensitive antiplatelet nanocapsules did not show prolonged bleeding times. Conclusions Targeted delivery of eptifibatide by shear-sensitive nanocapsules offers site-specific antiplatelet potential, and may form a basis for developing more potent and safer antiplatelet drugs.
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Affiliation(s)
- C P Molloy
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Y Yao
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - H Kammoun
- Haematopoiesis and Leukocyte Biology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - T Bonnard
- Nano Biotechnology Laboratory, Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - T Hoefer
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - K Alt
- Nano Biotechnology Laboratory, Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - F Tovar-Lopez
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - G Rosengarten
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - P A Ramsland
- School of Science, RMIT University, Bundoora, Victoria, Australia
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
- Department of Immunology, Monash University, Melbourne, Victoria, Australia
- Department of Surgery at Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - A D van der Meer
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - A van den Berg
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - A J Murphy
- Haematopoiesis and Leukocyte Biology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - C E Hagemeyer
- Nano Biotechnology Laboratory, Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - K Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - E Westein
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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27
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Pätzold M, Andert T, Hahn M, Asmar SW, Barriot JP, Bird MK, Häusler B, Peter K, Tellmann S, Grün E, Weissman PR, Sierks H, Jorda L, Gaskell R, Preusker F, Scholten F. A homogeneous nucleus for comet 67P/Churyumov-Gerasimenko from its gravity field. Nature 2016; 530:63-5. [PMID: 26842054 DOI: 10.1038/nature16535] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 12/10/2015] [Indexed: 11/09/2022]
Abstract
Cometary nuclei consist mostly of dust and water ice. Previous observations have found nuclei to be low-density and highly porous bodies, but have only moderately constrained the range of allowed densities because of the measurement uncertainties. Here we report the precise mass, bulk density, porosity and internal structure of the nucleus of comet 67P/Churyumov-Gerasimenko on the basis of its gravity field. The mass and gravity field are derived from measured spacecraft velocity perturbations at fly-by distances between 10 and 100 kilometres. The gravitational point mass is GM = 666.2 ± 0.2 cubic metres per second squared, giving a mass M = (9,982 ± 3) × 10(9) kilograms. Together with the current estimate of the volume of the nucleus, the average bulk density of the nucleus is 533 ± 6 kilograms per cubic metre. The nucleus appears to be a low-density, highly porous (72-74 per cent) dusty body, similar to that of comet 9P/Tempel 1. The most likely composition mix has approximately four times more dust than ice by mass and two times more dust than ice by volume. We conclude that the interior of the nucleus is homogeneous and constant in density on a global scale without large voids. The high porosity seems to be an inherent property of the nucleus material.
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Affiliation(s)
- M Pätzold
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Abteilung Planetenforschung, 50931 Köln, Germany
| | - T Andert
- Institut für Raumfahrttechnik und Weltraumnutzung, Universität der Bundeswehr München, 85577 Neubiberg, Germany
| | - M Hahn
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Abteilung Planetenforschung, 50931 Köln, Germany
| | - S W Asmar
- Jet Propulsion Laboratory, Caltech, Pasadena, California 91109, USA
| | - J-P Barriot
- Université de la Polynésie Francaise, Faaa, Tahiti
| | - M K Bird
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Abteilung Planetenforschung, 50931 Köln, Germany
| | - B Häusler
- Institut für Raumfahrttechnik und Weltraumnutzung, Universität der Bundeswehr München, 85577 Neubiberg, Germany
| | - K Peter
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Abteilung Planetenforschung, 50931 Köln, Germany
| | - S Tellmann
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Abteilung Planetenforschung, 50931 Köln, Germany
| | - E Grün
- Max-Planck-Institut für Kernphysik, 69117 Heidelberg, Germany
| | - P R Weissman
- Planetary Science Institute, 1700 East Fort Lowell Suite 106, Tucson, Arizona 85719, USA
| | - H Sierks
- Max-Planck-Institut für Sonnensystemforschung, 37077 Göttingen, Germany
| | - L Jorda
- Laboratoire d'Astrophysique de Marseille, 13388 Marseille, France
| | - R Gaskell
- Planetary Science Institute, 1700 East Fort Lowell Suite 106, Tucson, Arizona 85719, USA
| | - F Preusker
- Institut für Planetenforschung, Deutsches Zentrum für Luft- und Raumfahrt (DLR) Berlin-Adlershof, 12489 Berlin, Germany
| | - F Scholten
- Institut für Planetenforschung, Deutsches Zentrum für Luft- und Raumfahrt (DLR) Berlin-Adlershof, 12489 Berlin, Germany
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28
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Hohmann JD, Peter K. Activated-platelet targeting of CD39 as a potential way forward. The quest for efficient antithrombotic therapy without associated bleeding complications. Hamostaseologie 2015; 36:17-25. [PMID: 26328528 DOI: 10.5482/hamo-14-12-0085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 12/29/2014] [Accepted: 08/27/2015] [Indexed: 01/20/2023] Open
Abstract
UNLABELLED Antiplatelet therapy is given to millions of patients and has saved numerous lives. However, it is also associated with complications including fatal bleedings. Clinically used antiplatelet drugs seem to follow the rule of an inherent link of improved anti-thrombotic potency with increased risk of bleeding complications. Therefore, there is an ongoing quest to develop drugs that are able to break this link that has prevented many patients from receiving antiplatelet protection and has resulted in substantial mortality and morbidity. We describe a new antiplatelet approach that is based on an recombinant antibody protein, a drug format that has recently attracted major interest. Two unique components are genetically combined in this molecule: 1) The ecto-nucleoside triphosphate diphosphohydrolase NTPDase CD39, which enzymatically degrades ATP and ADP to AMP, which is then further degraded to adenosine by the endothelially expressed CD73. Thereby, the platelet activating ADP is reduced and replaced by the platelet inhibiting adenosine resulting in a strong antiplatelet effect. 2) A single-chain antibody (scFv) that specifically binds to the activated GPIIb/IIIa receptor and thus allows targeting to activated platelets. The described fusion protein results in strong enrichment of CD39's antiplatelet effect, resulting in potent inhibition of platelet adhesion and aggregation and thrombosis in mice. The activated platelet targeting allows using a low systemic concentration that does not interfere with normal haemostasis and thus does not cause bleeding time prolongation in mice. CONCLUSION We describe a new antiplatelet approach that promises to deliver strong localized antithrombotic effects without associated bleeding problems.
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Affiliation(s)
| | - K Peter
- Prof. Karlheinz Peter, Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road Central, Melbourne, Victoria 8008, Australia,
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Ta H, Prabhu S, Leitner E, Jia F, Putnam K, Bassler N, Peter K, Hagemeyer C. Targeted molecular imaging and cell homing in cardiovascular disease via antibody-sortagging. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Meier S, Pütz G, Massing U, Hagemeyer C, von Elverfeldt D, Meißner M, Ardipradja K, Barnert S, Peter K, Bode C, Schubert R, von zur Muhlen C. Immuno-magnetoliposomes targeting activated platelets as a potentially human-compatible MRI contrast agent for targeting atherothrombosis. Biomaterials 2015; 53:137-48. [DOI: 10.1016/j.biomaterials.2015.02.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 02/13/2015] [Accepted: 02/19/2015] [Indexed: 11/26/2022]
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Htun NM, Peter K. Non-vitamin K antagonist oral anticoagulants (NOACs) in the cardiac catherisation laboratory: Friends or Foes? Thromb Haemost 2015; 114:214-6. [PMID: 25995026 DOI: 10.1160/th15-04-0298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | - K Peter
- Prof. Karlheinz Peter, Baker IDI Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria 3004, Australia, Tel.:+61 3 8532 1490, Fax: +61 3 8532 1100, E-mail:
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Peter K, Van Ackern K, Berend D, Buchert W, Kersting KH, Kraatz J, Lutz H, Schade W. Acute preoperative hemodilution patients. Bibl Haematol 2015:260-9. [PMID: 52357 DOI: 10.1159/000398123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Zaldivia M, Rivera J, Marusic P, McCartney D, Lee R, Htun N, Flierl U, Duval J, Hammond L, Schlaich M, Peter K. Renal denervation reduces monocyte activation in human hypertension. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.039] [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: 11/30/2022]
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McLellan A, Schlaich M, Taylor A, Prabhu S, Hering D, Hammond L, Marusic P, Duval J, Sata Y, Ellims A, Peter K, Shaw J, Walton A, Kalman J, Kistler P. Reverse cardiac remodelling following renal denervation - atrial electrophysiologic and structural changes associated with blood pressure lowering. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.321] [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: 10/23/2022]
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35
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Ngu P, Fernando H, Liew J, Dart A, Wark J, Peter K, Shaw J. Randomised double blind placebo controlled study to determine the effects of vitamin D supplementation on platelet and vascular function in patients with vitamin D insufficiency and atherosclerotic disease. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.122] [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: 10/23/2022]
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36
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Kluenker E, Faymonville J, Peter K, Moeller M, Hopmann C. Reactive extrusion processing of polypropylene/SiO2 nanocomposites by in situ synthesis of the nanofillers: Experiments and properties. POLYMER 2014. [DOI: 10.1016/j.polymer.2014.08.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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37
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Westein E, Yao J, Peter K. Flow sensitive anti-thrombotic nanoparticles site specifically inhibit thrombosis at atherosclerotic plaque geometries. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.197] [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: 11/17/2022]
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38
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Fritch JR, Peter K, Vollhardt C. The Reaction of (Dicarbonyl)(η5-Cyclopentadienyl)Cobalt with Bis(trimethylsilyl)ethyne. A One-Step Synthesis of Tetrakis(trimethylsilyl)butatriene. Isr J Chem 2013. [DOI: 10.1002/ijch.198500082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Krohn-Grimberghe M, Von Elverfeldt D, Neudorfer I, Peter K, Gawaz M, Bode CH, Von Zur Muehlen C. Development of a novel triple-target imaging strategy for the characterization of plaque inflammation in ApoE-/- mice. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5360] [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: 11/13/2022] Open
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Meier A, Duerschmied D, Von Elverfeldt D, Heidt T, Peter K, Bode C, Von Zur Muhlen C. Simultaneous molecular imaging of activated platelets and myocardial necrosis allows in vivo evaluation of ischemia-reperfusion injury in mice by magnetic resonance imaging. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5361] [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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Affiliation(s)
- N M Htun
- Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Withers P, Fillingim MO, Lillis RJ, Häusler B, Hinson DP, Tyler GL, Pätzold M, Peter K, Tellmann S, Witasse O. Observations of the nightside ionosphere of Mars by the Mars Express Radio Science Experiment (MaRS). ACTA ACUST UNITED AC 2012. [DOI: 10.1029/2012ja018185] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Armstrong PCJ, Hu H, Rivera J, Rigby S, Chen YC, Howden BP, Gardiner E, Peter K. Staphylococcal superantigen-like protein 5 induces thrombotic and bleeding complications in vivo: inhibition by an anti-SSL5 antibody and the glycan Bimosiamose. J Thromb Haemost 2012; 10:2607-9. [PMID: 23039170 DOI: 10.1111/jth.12022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
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Krajewski S, Kurz J, Neumann B, Greiner TO, Stolz A, Balkau B, Peter K, Unertl K, Wendel HP, Straub A. Short-acting P2Y12 blockade to reduce platelet dysfunction and coagulopathy during experimental extracorporeal circulation and hypothermia. Br J Anaesth 2012; 108:912-21. [PMID: 22369765 DOI: 10.1093/bja/aer518] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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] Open
Abstract
BACKGROUND Extracorporeal circulation (ECC) and hypothermia are routinely used in cardiac surgery to maintain stable circulatory parameters and to increase the ischaemic tolerance of the patient. However, ECC and hypothermia cause platelet activation and dysfunction possibly followed by a devastating coagulopathy. Stimulation of the adenosinediphosphate (ADP) receptor P(2)Y(12) plays a pivotal role in platelet activation. This experimental study tested P(2)Y(12) receptor blockade as an approach to protect platelets during ECC. METHODS Human blood was treated with the short-acting P(2)Y(12) blocker cangrelor (1 µM, t(1/2)<5 min) or the P(2)Y(12) inhibitor 2-MeSAMP (100 µM) and circulated in an ex vivo ECC model at normothermia (37°C) and hypothermia (28°C). Before and after circulation, markers of platelet activation and of coagulation (thrombin-antithrombin complex generation) were analysed. During hypothermic ECC in pigs, the effect of reversible P(2)Y(12) blockade on platelet function was evaluated by cangrelor infusion (0.075 µg kg(-1) min(-1)). RESULTS During ex vivo hypothermic ECC, P(2)Y(12) blockade inhibited platelet granule release (P<0.01), platelet-granulocyte binding (P<0.05), and platelet loss (P<0.001), whereas no effects on platelet-ECC binding, platelet CD42bα expression, glycoprotein IIb/IIIa activation, or thrombin-antithrombin complex generation were observed. During hypothermic ECC in pigs, cangrelor inhibited platelet-fibrinogen binding (P<0.05) and ADP-induced platelet aggregation (P<0.001). Platelet function was rapidly restored after termination of cangrelor infusion. CONCLUSIONS P(2)Y(12) blockade by cangrelor prevents platelet activation during ECC and hypothermia. Owing to its short half-life, platelet inhibition can be well controlled, thus potentially reducing bleeding complications. This novel pharmacological strategy has the potential to reduce complications associated with ECC and hypothermia.
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Affiliation(s)
- S Krajewski
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany.
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Samuel R, Zimmet H, Hopper I, Paukovics G, Wang B, Zannettino A, Kaye D, Peter K, Bassler N, Krum H. Are Circulating Adult Stem Cell Levels Increased in Acute Decompensated Heart Failure? Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.185] [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: 10/28/2022]
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Fries M, Peter K. Nachruf auf Max Harry Weil. Anaesthesist 2011. [DOI: 10.1007/s00101-011-1960-6] [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: 11/27/2022]
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Ahrens I, Domeij H, Eisenhardt SU, Topcic D, Albrecht M, Leitner E, Viitaniemi K, Jowett JB, Lappas M, Bode C, Haviv I, Peter K. Opposing effects of monomeric and pentameric C-reactive protein on endothelial progenitor cells. Basic Res Cardiol 2011; 106:879-95. [PMID: 21562922 PMCID: PMC3149664 DOI: 10.1007/s00395-011-0191-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 04/12/2011] [Accepted: 04/29/2011] [Indexed: 12/17/2022]
Abstract
C-reactive protein (CRP) has been linked to the pathogenesis of atherosclerosis. The dissociation of native, pentameric (p)CRP to monomeric (m)CRP on the cell membrane of activated platelets has recently been demonstrated. The dissociation of pCRP to mCRP may explain local pro-inflammatory reactions at the site of developing atherosclerotic plaques. As a biomarker, pCRP predicts cardiovascular adverse events and so do reduced levels and function of circulating endothelial progenitor cells (EPCs). We hypothesised that mCRP and pCRP exert a differential effect on EPC function and differentiation. EPCs were treated with mCRP or pCRP for 72 h, respectively. Phenotypical characterisation was done by flow cytometry and immunofluorescence microscopy, while the effect of mCRP and pCRP on gene expression was examined by whole-genome gene expression analysis. The functional capacity of EPCs was determined by colony forming unit (CFU) assay and endothelial tube formation assay. Double staining for acetylated LDL and ulex lectin significantly decreased in cells treated with pCRP. The length of tubuli in a matrigel assay with HUVECs decreased significantly in response to pCRP, but not to mCRP. The number of CFUs increased after pCRP treatment. RNA expression profiling demonstrated that mCRP and pCRP cause highly contradictory gene regulation. Interferon-responsive genes (IFI44L, IFI44, IFI27, IFI 6, MX1, OAS2) were among the highly up-regulated genes after mCRP, but not after pCRP treatment. In conclusion, EPC phenotype, genotype and function were differentially affected by mCRP and pCRP, strongly arguing for differential roles of these two CRP conformations. The up-regulation of interferon-inducible genes in response to mCRP may constitute a mechanism for the local regulation of EPC function.
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Affiliation(s)
- I Ahrens
- Department of Cardiology and Angiology, University Hospital Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany.
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Ta HT, Prabhu S, Leitner E, Jia F, von Elverfeldt D, Jackson KE, Heidt T, Nair AKN, Pearce H, von Zur Muhlen C, Wang X, Peter K, Hagemeyer CE. Enzymatic single-chain antibody tagging: a universal approach to targeted molecular imaging and cell homing in cardiovascular disease. Circ Res 2011; 109:365-73. [PMID: 21700932 DOI: 10.1161/circresaha.111.249375] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
RATIONALE Antibody-targeted delivery of imaging agents can enhance the sensitivity and accuracy of current imaging techniques. Similarly, homing of effector cells to disease sites increases the efficacy of regenerative cell therapy while reducing the number of cells required. Currently, targeting can be achieved via chemical conjugation to specific antibodies, which typically results in the loss of antibody functionality and in severe cell damage. An ideal conjugation technique should ensure retention of antigen-binding activity and functionality of the targeted biological component. OBJECTIVE To develop a biochemically robust, highly reproducible, and site-specific coupling method using the Staphylococcus aureus sortase A enzyme for the conjugation of a single-chain antibody (scFv) to nanoparticles and cells for molecular imaging and cell homing in cardiovascular diseases. This scFv specifically binds to activated platelets, which play a pivotal role in thrombosis, atherosclerosis, and inflammation. METHODS AND RESULTS The conjugation procedure involves chemical and enzyme-mediated coupling steps. The scFv was successfully conjugated to iron oxide particles (contrast agents for magnetic resonance imaging) and to model cells. Conjugation efficiency ranged between 50% and 70%, and bioactivity of the scFv after coupling was preserved. The targeting of scFv-coupled cells and nanoparticles to activated platelets was strong and specific as demonstrated in in vitro static adhesion assays, in a flow chamber system, in mouse intravital microscopy, and in in vivo magnetic resonance imaging of mouse carotid arteries. CONCLUSIONS This unique biotechnological approach provides a versatile and broadly applicable tool for procuring targeted regenerative cell therapy and targeted molecular imaging in cardiovascular and inflammatory diseases and beyond.
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Affiliation(s)
- H T Ta
- Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Fernando H, Dart AM, Peter K, Shaw JA. Proton pump inhibitors, genetic polymorphisms and response to clopidogrel therapy. Thromb Haemost 2011; 105:933-44. [PMID: 21544314 DOI: 10.1160/th10-11-0715] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 03/14/2011] [Indexed: 12/14/2022]
Abstract
Clopidogrel has become part of the mainstay of therapy for acute coronary syndromes and in patients post stenting. Clopidogrel is a pro drug and is metabolised by liver enzymes, particularly CYP2C19, into its active form. A considerable proportion of patients have a poor response to clopidogrel and this may be due to several factors. Genetic polymorphisms involved in clopidogrel's absorption, metabolism and activity at the platelet may interfere with its antiplatelet actions. Further, proton pump inhibitors (PPI) may interfere with clopidogrel's actions by functionally reducing the ability of CYP2C19 to convert clopidogrel to its active metabolite. By attenuating clopidogrel's actions, both polymorphisms and drug interactions may increase the risk of thrombotic events during clopidogrel therapy. This review will explore the current evidence relating to the association between PPIs, genetic polymorphisms and poor response to clopidogrel. Routine genetic testing cannot be recommended for patients receiving dual antiplatelet therapy (DAPT). However, it may have a role for patients with an episode of stent thrombosis, prior to planned high-risk stenting or major bleeding. Regarding concomitant clopidogrel and PPI therapy, it is recommended that only patients with previous gastrointestinal (GI) bleeding or multiple risk factors for GI bleeding should be prescribed gastroprotection. This is due to the uncertainty surrounding the clinical significance of this interaction given the discordant biochemical and clinical data, conflicting results from observational studies and the limitations of the COGENT study. Pantoprazole seems least likely to interact with clopidogrel and most suitable for use in patients receiving DAPT.
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Affiliation(s)
- H Fernando
- Department of Cardiovascular Medicine, Alfred Hospital/Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Hagemeyer C, Jia F, Wong V, Yohakim D, Huang D, Wang X, Peter K. A Novel Targeted Recombinant Plasminogen Activator Allows Efficient and Safe Simultaneous Blockage of Activated Platelets and Fibrinolysis. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.057] [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: 10/18/2022]
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