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Gurung S, Timmermand OV, Perocheau D, Gil-Martinez AL, Minnion M, Touramanidou L, Fang S, Messina M, Khalil Y, Spiewak J, Barber AR, Edwards RS, Pinto PL, Finn PF, Cavedon A, Siddiqui S, Rice L, Martini PGV, Ridout D, Heywood W, Hargreaves I, Heales S, Mills PB, Waddington SN, Gissen P, Eaton S, Ryten M, Feelisch M, Frassetto A, Witney TH, Baruteau J. mRNA therapy corrects defective glutathione metabolism and restores ureagenesis in preclinical argininosuccinic aciduria. Sci Transl Med 2024; 16:eadh1334. [PMID: 38198573 PMCID: PMC7615535 DOI: 10.1126/scitranslmed.adh1334] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 10/06/2023] [Indexed: 01/12/2024]
Abstract
The urea cycle enzyme argininosuccinate lyase (ASL) enables the clearance of neurotoxic ammonia and the biosynthesis of arginine. Patients with ASL deficiency present with argininosuccinic aciduria, an inherited metabolic disease with hyperammonemia and a systemic phenotype coinciding with neurocognitive impairment and chronic liver disease. Here, we describe the dysregulation of glutathione biosynthesis and upstream cysteine utilization in ASL-deficient patients and mice using targeted metabolomics and in vivo positron emission tomography (PET) imaging using (S)-4-(3-18F-fluoropropyl)-l-glutamate ([18F]FSPG). Up-regulation of cysteine metabolism contrasted with glutathione depletion and down-regulated antioxidant pathways. To assess hepatic glutathione dysregulation and liver disease, we present [18F]FSPG PET as a noninvasive diagnostic tool to monitor therapeutic response in argininosuccinic aciduria. Human hASL mRNA encapsulated in lipid nanoparticles improved glutathione metabolism and chronic liver disease. In addition, hASL mRNA therapy corrected and rescued the neonatal and adult Asl-deficient mouse phenotypes, respectively, enhancing ureagenesis. These findings provide mechanistic insights in liver glutathione metabolism and support clinical translation of mRNA therapy for argininosuccinic aciduria.
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Affiliation(s)
- Sonam Gurung
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | | | - Dany Perocheau
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Ana Luisa Gil-Martinez
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Loukia Touramanidou
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Sherry Fang
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Martina Messina
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Youssef Khalil
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Justyna Spiewak
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Abigail R Barber
- School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Richard S Edwards
- School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Patricia Lipari Pinto
- Santa Maria's Hospital, Lisbon North University Hospital Center, 1649-028 Lisbon, Portugal
| | | | | | | | - Lisa Rice
- Moderna Inc., Cambridge, MA 02139, USA
| | | | - Deborah Ridout
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Wendy Heywood
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Ian Hargreaves
- Pharmacy and Biomolecular Sciences, Liverpool John Moore University, Liverpool L3 5UG, UK
| | - Simon Heales
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Philippa B Mills
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Simon N Waddington
- EGA Institute for Women's Health, University College London, London WC1E 6HX, UK
- Wits/SAMRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of Witswatersrand, Braamfontein, 2000 Johannesburg, South Africa
| | - Paul Gissen
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- National Institute of Health Research Great Ormond Street Biomedical Research Centre, London WC1N 1EH, UK
| | - Simon Eaton
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Mina Ryten
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | | | - Timothy H Witney
- School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Julien Baruteau
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- National Institute of Health Research Great Ormond Street Biomedical Research Centre, London WC1N 1EH, UK
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2
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Luo Y, Chatre L, Melhem S, Al-Dahmani ZM, Homer NZM, Miedema A, Deelman LE, Groves MR, Feelisch M, Morton NM, Dolga A, van Goor H. Thiosulfate sulfurtransferase deficiency promotes oxidative distress and aberrant NRF2 function in the brain. Redox Biol 2023; 68:102965. [PMID: 38000344 DOI: 10.1016/j.redox.2023.102965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Thiosulfate sulfurtransferase (TST, EC 2.8.1.1) was discovered as an enzyme that detoxifies cyanide by conversion to thiocyanate (rhodanide) using thiosulfate as substrate; this rhodanese activity was subsequently identified to be almost exclusively located in mitochondria. More recently, the emphasis regarding its function has shifted to hydrogen sulfide metabolism, antioxidant defense, and mitochondrial function in the context of protective biological processes against oxidative distress. While TST has been described to play an important role in liver and colon, its function in the brain remains obscure. In the present study, we therefore sought to address its potential involvement in maintaining cerebral redox balance in a murine model of global TST deficiency (Tst-/- mice), primarily focusing on characterizing the biochemical phenotype of TST loss in relation to neuronal activity and sensitivity to oxidative stress under basal conditions. Here, we show that TST deficiency is associated with a perturbation of the reactive species interactome in the brain cortex secondary to altered ROS and RSS (specifically, polysulfide) generation as well as mitochondrial OXPHOS remodeling. These changes were accompanied by aberrant Nrf2-Keap1 expression and thiol-dependent antioxidant function. Upon challenging mice with the redox-active herbicide paraquat (25 mg/kg i.p. for 24 h), Tst-/- mice displayed a lower antioxidant capacity compared to wildtype controls (C57BL/6J mice). These results provide a first glimpse into the molecular and metabolic changes of TST deficiency in the brain and suggest that pathophysiological conditions associated with aberrant TST expression and/or activity renders neurons more susceptible to oxidative stress-related malfunction.
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Affiliation(s)
- Yang Luo
- University of Groningen, Department of Molecular Pharmacology, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, Groningen, the Netherlands; University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
| | - Laurent Chatre
- Université de Caen Normandie, CNRS, Normandie University, ISTCT UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Shaden Melhem
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Zayana M Al-Dahmani
- University of Groningen, Department of Pharmacy, Drug Design, Groningen, the Netherlands
| | - Natalie Z M Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, University of Edinburgh/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburghh, United Kingdom
| | - Anneke Miedema
- University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
| | - Leo E Deelman
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands
| | - Matthew R Groves
- University of Groningen, Department of Pharmacy, Drug Design, Groningen, the Netherlands
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Nicholas M Morton
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Systems Health and Integrated Metabolic Research, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Amalia Dolga
- University of Groningen, Department of Molecular Pharmacology, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, Groningen, the Netherlands
| | - Harry van Goor
- University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands.
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Dushianthan A, Clark HW, Brealey D, Pratt D, Fink JB, Madsen J, Moyses H, Matthews L, Hussell T, Djukanovic R, Feelisch M, Postle AD, Grocott MPW. A randomized controlled trial of nebulized surfactant for the treatment of severe COVID-19 in adults (COVSurf trial). Sci Rep 2023; 13:20946. [PMID: 38017061 PMCID: PMC10684757 DOI: 10.1038/s41598-023-47672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Abstract
SARS-CoV-2 directly targets alveolar epithelial cells and can lead to surfactant deficiency. Early reports suggested surfactant replacement may be effective in improving outcomes. The aim of the study to assess the feasibility and efficacy of nebulized surfactant in mechanically ventilated COVID-19 patients. Patients were randomly assigned to receive open-labelled bovine nebulized surfactant or control (ratio 3-surfactant: 2-control). This was an exploratory dose-response study starting with 1080 mg of surfactant delivered at 3 time points (0, 8 and 24 h). After completion of 10 patients, the dose was reduced to 540 mg, and the frequency of nebulization was increased to 5/6 time points (0, 12, 24, 36, 48, and an optional 72 h) on the advice of the Trial Steering Committee. The co-primary outcomes were improvement in oxygenation (change in PaO2/FiO2 ratio) and ventilation index at 48 h. 20 patients were recruited (12 surfactant and 8 controls). Demographic and clinical characteristics were similar between groups at presentation. Nebulized surfactant administration was feasible. There was no significant improvement in oxygenation at 48 h overall. There were also no differences in secondary outcomes or adverse events. Nebulized surfactant administration is feasible in mechanically ventilated patients with COVID-19 but did not improve measures of oxygenation or ventilation.
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Affiliation(s)
- Ahilanandan Dushianthan
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK.
- General Intensive Care Unit, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
| | - Howard W Clark
- University College London Hospital, London, UK
- University College London Hospital Biomedical Research Centre, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - David Brealey
- University College London Hospital, London, UK
- University College London Hospital Biomedical Research Centre, London, UK
| | - Danny Pratt
- Southampton NIHR Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | | | - Jens Madsen
- University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Helen Moyses
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
- General Intensive Care Unit, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Lewis Matthews
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
- General Intensive Care Unit, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Tracy Hussell
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Ratko Djukanovic
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Martin Feelisch
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Anthony D Postle
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
- General Intensive Care Unit, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
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4
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Clark AD, Cumpstey AF, Santolini J, Jackson AA, Feelisch M. Uncoupled redox stress: how a temporal misalignment of redox-regulated processes and circadian rhythmicity exacerbates the stressed state. Open Biol 2023; 13:230151. [PMID: 37669692 PMCID: PMC10480010 DOI: 10.1098/rsob.230151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Diurnal and seasonal rhythmicity, entrained by environmental and nutritional cues, is a vital part of all life on Earth operating at every level of organization; from individual cells, to multicellular organisms, whole ecosystems and societies. Redox processes are intrinsic to physiological function and circadian regulation, but how they are integrated with other regulatory processes at the whole-body level is poorly understood. Circadian misalignment triggered by a major stressor (e.g. viral infection with SARS-CoV-2) or recurring stressors of lesser magnitude such as shift work elicit a complex stress response that leads to desynchronization of metabolic processes. This in turn challenges the system's ability to achieve redox balance due to alterations in metabolic fluxes (redox rewiring). We infer that the emerging 'alternative redox states' do not always revert readily to their evolved natural states; 'Long COVID' and other complex disorders of unknown aetiology are the clinical manifestations of such rearrangements. To better support and successfully manage bodily resilience to major stress and other redox challenges needs a clear perspective on the pattern of the hysteretic response for the interaction between the redox system and the circadian clock. Characterization of this system requires repeated (ideally continuous) recording of relevant clinical measures of the stress responses and whole-body redox state (temporal redox phenotyping). The human/animal body is a complex 'system of systems' with multi-level buffering capabilities, and it requires consideration of the wider dynamic context to identify a limited number of stress-markers suitable for routine clinical decision making. Systematically mapping the patterns and dynamics of redox biomarkers along the stressor/disease trajectory will provide an operational model of whole-body redox regulation/balance that can serve as basis for the identification of effective interventions which promote health by enhancing resilience.
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Affiliation(s)
- Anna D. Clark
- Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Andrew F. Cumpstey
- Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Jérôme Santolini
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Sud, Universite Paris-Saclay, F-91198, Gif-sur-Yvette Cedex, France
| | - Alan A. Jackson
- Human Nutrition, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Martin Feelisch
- Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
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5
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Feelisch M, Clark AD, Cumpstey AF, Santolini J, Jackson AA. Long COVID: Potential role of the Reactive Species Interactome. J Infect 2023; 87:280-281. [PMID: 37442375 DOI: 10.1016/j.jinf.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Biomedical Research Center, University Hospital Southampton, NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
| | - Anna D Clark
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Biomedical Research Center, University Hospital Southampton, NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Andrew F Cumpstey
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Biomedical Research Center, University Hospital Southampton, NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Jérôme Santolini
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ Paris-Sud, Université Paris-Saclay, F-91198 Gif-sur-Yvette Cedex, France
| | - Alan A Jackson
- Institute of Human Nutrition, University of Southampton and University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK
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6
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Wallis TJM, Minnion M, Freeman A, Bates A, Otto JM, Wootton SA, Fletcher SV, Grocott MPW, Feelisch M, Jones MG, Jack S. Individualised Exercise Training Enhances Antioxidant Buffering Capacity in Idiopathic Pulmonary Fibrosis. Antioxidants (Basel) 2023; 12:1645. [PMID: 37627640 PMCID: PMC10451244 DOI: 10.3390/antiox12081645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Exercise training is recommended for patients with idiopathic pulmonary fibrosis (IPF); however, the mechanism(s) underlying its physiological benefits remain unclear. We investigated the effects of an individualised aerobic interval training programme on exercise capacity and redox status in IPF patients. IPF patients were recruited prospectively to an 8-week, twice-weekly cardiopulmonary exercise test (CPET)-derived structured responsive exercise training programme (SRETP). Systemic redox status was assessed pre- and post-CPET at baseline and following SRETP completion. An age- and sex-matched non-IPF control cohort was recruited for baseline comparison only. At baseline, IPF patients (n = 15) had evidence of increased oxidative stress compared with the controls as judged by; the plasma reduced/oxidised glutathione ratio (median, control 1856 vs. IPF 736 p = 0.046). Eleven IPF patients completed the SRETP (median adherence 88%). Following SRETP completion, there was a significant improvement in exercise capacity assessed via the constant work-rate endurance time (+82%, p = 0.003). This was accompanied by an improvement in post-exercise redox status (in favour of antioxidants) assessed via serum total free thiols (median increase, +0.26 μmol/g protein p = 0.005) and total glutathione concentration (+0.73 μM p = 0.03), as well as a decrease in post-exercise lipid peroxidation products (-1.20 μM p = 0.02). Following SRETP completion, post-exercise circulating nitrite concentrations were significantly lower compared with baseline (-0.39 μM p = 0.04), suggestive of exercise-induced nitrite utilisation. The SRETP increased both endurance time and systemic antioxidant capacity in IPF patients. The observed reduction in nitrite concentrations provides a mechanistic rationale to investigate nitrite/nitrate supplementation in IPF patients.
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Affiliation(s)
- Tim J. M. Wallis
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
| | - Magdalena Minnion
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
| | - Anna Freeman
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
| | - Andrew Bates
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
- Department of Critical Care and Anaesthesia, University Hospital Southampton, Southampton SO16 6YD, UK
| | - James M. Otto
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
- Department of Critical Care and Anaesthesia, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Stephen A. Wootton
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
- NIHR Southampton Biomedical Research Centre, Nutrition and Metabolism, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Sophie V. Fletcher
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
| | - Michael P. W. Grocott
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
- Department of Critical Care and Anaesthesia, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Martin Feelisch
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
| | - Mark G. Jones
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
- Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Sandy Jack
- NIHR Southampton Biomedical Research Centre, Respiratory and Critical Care, University Hospital Southampton, Southampton SO16 6YD, UK; (M.M.); (A.F.); (A.B.); (J.M.O.); (S.V.F.); (M.P.W.G.); (M.F.); (M.G.J.); (S.J.)
- Academic School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
- Department of Critical Care and Anaesthesia, University Hospital Southampton, Southampton SO16 6YD, UK
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Stevens JL, McKenna HT, Filipe H, Lau L, Fernandez BO, Murray AJ, Feelisch M, Martin DS. Perioperative redox changes in patients undergoing hepato-pancreatico-biliary cancer surgery. Perioper Med (Lond) 2023; 12:35. [PMID: 37430377 DOI: 10.1186/s13741-023-00325-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Tissue injury induces inflammation and the surgical stress response, which are thought to be central to the orchestration of recovery or deterioration after surgery. Enhanced formation of reactive oxygen and nitrogen species accompanies the inflammatory response and triggers separate but integrated reduction/oxidation (redox) pathways that lead to oxidative and/or nitrosative stress (ONS). Quantitative information on ONS in the perioperative period is scarce. This single-centre exploratory study investigated the effects of major surgery on ONS and systemic redox status and their potential associations with postoperative morbidity. METHODS Blood was collected from 56 patients at baseline, end of surgery (EoS) and the first postoperative day (day-1). Postoperative morbidity was recorded using the Clavien-Dindo classification and further categorised into minor, moderate and severe. Plasma/serum measures included markers of lipid oxidation (thiobarbituric acid-reactive substances; TBARS, 4-hydroxynonenal; 4-HNE, 8-iso-prostaglandin F2⍺; 8-isoprostanes). Total reducing capacity was measured using total free thiols (TFTs) and ferric-reducing ability of plasma (FRAP). Nitric oxide (NO) formation/metabolism was measured using cyclic guanosine monophosphate (cGMP), nitrite, nitrate and total nitroso-species (RxNO). Interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-⍺) were measured to evaluate inflammation. RESULTS Both oxidative stress (TBARS) and nitrosative stress (total nitroso-species) increased from baseline to EoS (+14%, P = 0.003 and +138%, P < 0.001, respectively), along with an increase in overall reducing capacity (+9%, P = 0.03) at EoS and protein-adjusted total free thiols (+12%, P = 0.001) at day-1 after surgery. Nitrite, nitrate and cGMP concentrations declined concomitantly from baseline to day-1. Baseline nitrate was 60% higher in the minor morbidity group compared to severe (P = 0.003). The increase in intraoperative TBARS was greater in severe compared to minor morbidity (P = 0.01). The decline in intraoperative nitrate was more marked in the minor morbidity group compared to severe (P < 0.001), whereas the cGMP decline was greatest in the severe morbidity group (P = 0.006). CONCLUSION In patients undergoing major HPB surgery, intraoperative oxidative and nitrosative stress increased, with a concomitant increase in reductive capacity. Baseline nitrate was inversely associated with postoperative morbidity, and the hallmarks of poor postoperative outcome include changes in both oxidative stress and NO metabolism.
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Affiliation(s)
- Jia L Stevens
- Division of Surgery and Interventional Science, Royal Free Hospital, University College London, London, NW3 2QG, UK.
- Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free Hospital, London, NW3 2QG, UK.
| | - Helen T McKenna
- Peninsula Medical School, University of Plymouth, John Bull Building, Plymouth, PL6 8BU, Devon, UK
| | - Helder Filipe
- Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free Hospital, London, NW3 2QG, UK
| | - Laurie Lau
- Clinical & Experimental Sciences and Integrative Physiology and Critical Illness Group, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences and Integrative Physiology and Critical Illness Group, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Andrew J Murray
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Martin Feelisch
- Clinical & Experimental Sciences and Integrative Physiology and Critical Illness Group, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Daniel S Martin
- Division of Surgery and Interventional Science, Royal Free Hospital, University College London, London, NW3 2QG, UK
- Peninsula Medical School, University of Plymouth, John Bull Building, Plymouth, PL6 8BU, Devon, UK
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8
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Rhodes AML, Ali S, Minnion M, Lee LH, Joseph BM, Ndzo J, Clarke NMP, Feelisch M, Aarvold A. An Explorative Study into the Aetiology of Developmental Dysplasia of the Hip Using Targeted Urine Metabolomics. Antioxidants (Basel) 2023; 12:antiox12030538. [PMID: 36978785 PMCID: PMC10045260 DOI: 10.3390/antiox12030538] [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] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is the most prevalent congenital musculoskeletal disorder, yet its cause remains unknown. Adequate nutrient provision and coordinated electron exchange (redox) processes are critical for foetal growth and tissue development. This novel study sought to explore specific biochemical pathways in skeletal development for potential involvement in the aetiology of DDH. Spot urine samples were collected from infants, aged 13–61 days, with and without DDH. Ion chromatography-mass spectrometry was used to quantify thiosulphate, sulphate, nitrate, and phosphate, whilst nitrite was quantified using high-performance liquid chromato-graphy. Thiobarbituric acid reactive substances (TBARS) were measured as markers of lipid peroxidation. Creatinine and osmolality were determined by a 96-well plate assay and micro-osmometer to potentially normalise values for renal function, lean body mass, and hydration status. Urine samples were analysed from 99 babies: 30 with DDH and 69 age-matched non-DDH controls. Thiosulphate, TBARS, and creatinine concentrations differed between the DDH group and the controls (p = 0.025, 0.015, and 0.004 respectively). Urine osmolality was significantly lower in DDH compared to the controls (p = 0.036), indicative of the production of a more diluted urine in DDH infants. Following adjustment for osmolality, significant differences became apparent in urinary sulphate levels in DDH (p = 0.035) whereas all other parameters were similar between the groups. This is the first study to assess the potential role of these inorganic anions in DDH. The higher levels of sulphate found in infants with DDH suggests either enhanced intake from milk, increased endogenous formation, or impaired renal reabsorption. This investigation demonstrates the power of urine metabolomics and highlights the importance of normalisation for hydration status to disentangle developmental disorders. Our results strongly suggest that DDH is a systemic disease associated with altered uptake, formation, or handling of sulphate. There is potential for new opportunities in the prevention or treatment of DDH via nutritional intervention.
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Affiliation(s)
- Amanda M. L. Rhodes
- Orthopaedic Surgery, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Sehrish Ali
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ling H. Lee
- Southampton Children’s Hospital, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Brijil M. Joseph
- Southampton Children’s Hospital, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Judwin Ndzo
- Southampton Children’s Hospital, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Nicholas M. P. Clarke
- Department of Paediatric Orthopaedics, University of Southampton, Southampton SO16 6YD, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton, Southampton SO16 6YD, UK
- Correspondence: (M.F.); (A.A.)
| | - Alexander Aarvold
- Southampton Children’s Hospital, University Hospital Southampton, Southampton SO16 6YD, UK
- Correspondence: (M.F.); (A.A.)
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9
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Griffiths K, Ida T, Morita M, Lamb RJ, Lee JJ, Frenneaux MP, Fukuto JM, Akaike T, Feelisch M, Madhani M. Cysteine hydropersulfide reduces lipid peroxidation and protects against myocardial ischaemia-reperfusion injury - Are endogenous persulfides mediators of ischaemic preconditioning? Redox Biol 2023; 60:102605. [PMID: 36657187 PMCID: PMC9860408 DOI: 10.1016/j.redox.2023.102605] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Earlier studies revealed the presence of cysteine persulfide (CysSSH) and related polysulfide species in various mammalian tissues. CysSSH has both antioxidant and oxidant properties, modulates redox-dependent signal transduction and has been shown to mitigate oxidative stress. However, its functional relevance in the setting of myocardial ischaemia-reperfusion injury (IRI) remains unknown. The present study was undertaken to (1) study the dynamics of production and consumption of persulfides under normoxic and hypoxic conditions in the heart, and (2) determine whether exogenous administration of the CysSSH donor, cysteine trisulfide (Cys-SSS-Cys) at the onset of reperfusion rescues functional impairment and myocardial damage by interfering with lipid peroxidation. Utilising a well-established ex vivo Langendorff murine model, we here demonstrate that endogenous tissue concentrations of CysSSH are upregulated when oxygen supply is compromised (global myocardial ischaemia) and rapidly restored to baseline levels upon reperfusion, suggestive of active regulation. In a separate set of experiments, exogenous administration of Cys-SSS-Cys for 10 min at the onset of reperfusion was found to decrease malondialdehyde (MDA) concentrations, formation of 4-hydroxynonenal (4-HNE) protein adducts and rescue the heart from injury. Cys-SSS-Cys also restored post-ischaemic cardiac function, improving both coronary flow and left ventricular developed pressure (LVDP). Taken together, these results support the notion that endogenous CysSSH plays an important role as a "redox preconditioning" agent to combat the oxidative insult in myocardial IRI.
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Affiliation(s)
- Kayleigh Griffiths
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tomoaki Ida
- Department of Environmental Medicine and Molecular Toxicology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Masanobu Morita
- Department of Environmental Medicine and Molecular Toxicology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Reece J Lamb
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jordan J Lee
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Jon M Fukuto
- Department of Chemistry, Sonoma State University, California, USA
| | - Takaaki Akaike
- Department of Environmental Medicine and Molecular Toxicology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Melanie Madhani
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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10
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Bourgonje AR, Kloska D, Grochot-Przęczek A, Feelisch M, Cuadrado A, van Goor H. Personalized redox medicine in inflammatory bowel diseases: an emerging role for HIF-1α and NRF2 as therapeutic targets. Redox Biol 2023; 60:102603. [PMID: 36634466 PMCID: PMC9841059 DOI: 10.1016/j.redox.2023.102603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
Inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), are intimately associated with inflammation and overproduction of reactive oxygen species (ROS). Temporal and inter-individual variabilities in disease activity and response to therapy pose significant challenges to diagnosis and patient care. Discovery and validation of truly integrative biomarkers would benefit from embracing redox metabolomics approaches with prioritization of central regulatory hubs. We here make a case for applying a personalized redox medicine approach that aims to selectively inhibit pathological overproduction and/or altered expression of specific enzymatic sources of ROS without compromising physiological function. To this end, improved 'clinical-omics integration' may help to better understand which particular redox signaling pathways are disrupted in what patient. Pharmacological interventions capable of activating endogenous antioxidant defense systems may represent viable therapeutic options to restore local/systemic redox status, with HIF-1α and NRF2 holding particular promise in this context. Achieving the implementation of clinically meaningful mechanism-based biomarkers requires development of easy-to-use, robust and cost-effective tools for secure diagnosis and monitoring of treatment efficacy. Ultimately, matching redox-directed pharmacological interventions to individual patient phenotypes using predictive biomarkers may offer new opportunities to break the therapeutic ceiling in IBD.
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Affiliation(s)
- Arno R. Bourgonje
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Corresponding author.
| | - Damian Kloska
- Malopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland
| | - Anna Grochot-Przęczek
- Department of Medical Biotechnology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Antonio Cuadrado
- Instituto de Investigaciones Biomédicas “Alberto Sols” UAM-CSIC. Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), ISCIII, Madrid, Spain
| | - Harry van Goor
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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11
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Weller RB, Macintyre IM, Melville V, Farrugia M, Feelisch M, Webb DJ. The effect of daily UVA phototherapy for 2 weeks on clinic and 24-h blood pressure in individuals with mild hypertension. J Hum Hypertens 2022:10.1038/s41371-022-00729-2. [PMID: 35931819 DOI: 10.1038/s41371-022-00729-2] [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] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/21/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
Abstract
Latitude and season determine exposure to ultraviolet radiation and correlate with population blood pressure. Evidence for Vitamin D causing this relationship is inconsistent, and temperature changes are only partly responsible for BP variation. In healthy individuals, a single irradiation with 20 J/cm2 UVA mobilises NO from cutaneous stores to the circulation, causes arterial vasodilatation, and elicits a transient fall in BP. We, therefore, tested whether low-dose daily UVA phototherapy might be an effective treatment for mild hypertension. 13 patients with untreated high-normal or stage 1 hypertension (BP 130-159/85-99 mm Hg), confirmed by 24-h ambulatory blood pressure (ABP), were recruited. Using home phototherapy lamps they were either exposed to 5 J/cm2 full body UVA (320-410 nm) radiation each day for 14 days, or sham-irradiated with lamps filtered to exclude wavelengths <500 nm. After a washout period of 3 ± 1 week, the alternate irradiation was delivered. 24-h ABP was measured on day 0 before either irradiation sequence and on day 14. Clinic BP was recorded on day 0, and within 90 min of irradiation on day 14. There was no effect on 24-h ABP following UVA irradiation. Clinic BP shortly after irradiation fell with UVA (-8.0 ± 2.9/-3.8 ± 1.1 mm Hg p = 0.034/0.029) but not sham irradiation (1.1 ± 3.0/0.9 ± 1.5 mm Hg). Once daily low-dose UVA does not control mildly elevated BP although it produces a transient fall shortly after irradiation. More frequent exposure to UVA might be effective. Alternatively, UVB, which photo-releases more NO from skin, could be tried.
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Affiliation(s)
- Richard B Weller
- Centre for Inflammation Research and Edinburgh Skin Network, University of Edinburgh, Edinburgh, UK.
| | - Iain M Macintyre
- Department of Nephrology, Royal Infirmary of Edinburgh, Edinburgh, UK.,University Clinical Research Centre, Western General Hospital, Edinburgh, UK
| | - Vanessa Melville
- University Clinical Research Centre, Western General Hospital, Edinburgh, UK
| | - Michael Farrugia
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David J Webb
- University Clinical Research Centre, Western General Hospital, Edinburgh, UK.,Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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12
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Feelisch M, Cortese-Krott MM, Santolini J, Wootton SA, Jackson AA. Systems redox biology in health and disease. EXCLI J 2022; 21:623-646. [PMID: 35721574 PMCID: PMC9203981 DOI: 10.17179/excli2022-4793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022]
Abstract
Living organisms need to be able to cope with environmental challenges and other stressors and mount adequate responses that are as varied as the spectrum of those challenges. Understanding how the multi-layered biological stress responses become integrated across and between different levels of organization within an organism can provide a different perspective on the nature and inter-relationship of complex systems in health and disease. We here compare two concepts which have been very influential in stress research: Selye's 'General Adaptation Syndrome' and Sies's 'Oxidative Stress' paradigm. We show that both can be embraced within a more general framework of 'change and response'. The 'Reactive Species Interactome' allows each of these to be considered as distinct but complementary aspects of the same system, representative of roles at different levels of organization within a functional hierarchy. The versatile chemistry of sulfur - exemplified by hydrogen sulfide, glutathione and proteinous cysteine thiols - enriched by its interactions with reactive oxygen, nitrogen and sulfur species, would seem to sit at the heart of the 'Redox Code' and underpin the ability of complex organisms to cope with stress.
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Affiliation(s)
- Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Biomedical Research Center, University Hospital Southampton, NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Miriam M Cortese-Krott
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Jérôme Santolini
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ Paris-Sud, Université Paris-Saclay, F-91198, Gif-sur-Yvette Cedex, France
| | - Stephen A Wootton
- Institute of Human Nutrition, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Alan A Jackson
- Institute of Human Nutrition, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
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13
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Nogueira RC, Minnion M, Clark AD, Dyson A, Tanus-Santos JE, Feelisch M. On the origin of nitrosylated hemoglobin in COVID-19: Endothelial NO capture or redox conversion of nitrite?: Experimental results and a cautionary note on challenges in translational research. Redox Biol 2022; 54:102362. [PMID: 35709537 PMCID: PMC9181201 DOI: 10.1016/j.redox.2022.102362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 01/02/2023] Open
Abstract
In blood, the majority of endothelial nitric oxide (NO) is scavenged by oxyhemoglobin, forming nitrate while a small part reacts with dissolved oxygen to nitrite; another fraction may bind to deoxyhemoglobin to generate nitrosylhemoglobin (HbNO) and/or react with a free cysteine to form a nitrosothiol. Circulating nitrite concentrations in healthy individuals are 200-700 nM, and can be even lower in patients with endothelial dysfunction. Those levels are similar to HbNO concentrations ([HbNO]) recently reported, whereby EPR-derived erythrocytic [HbNO] was lower in COVID-19 patients compared to uninfected subjects with similar cardiovascular risk load. We caution the values reported may not reflect true (patho)physiological concentrations but rather originate from complex chemical interactions of endogenous nitrite with hemoglobin and ascorbate/N-acetylcysteine. Using an orthogonal detection method, we find baseline [HbNO] to be in the single-digit nanomolar range; moreover, we find that these antioxidants, added to blood collection tubes to prevent degradation, artificially generate HbNO. Since circulating nitrite also varies with lifestyle, dietary habit and oral bacterial flora, [HbNO] may not reflect endothelial activity alone. Thus, its use as early marker of NO-dependent endothelial dysfunction to stratify COVID-19 patient risk may be premature. Moreover, oxidative stress not only impairs NO formation/bioavailability, but also shifts the chemical landscape into which NO is released, affecting its downstream metabolism. This compromises the endothelium’s role as gatekeeper of tissue nutrient supply and modulator of blood cell function, challenging the body’s ability to maintain redox balance. Further studies are warranted to clarify whether the nature of vascular dysfunction in COVID-19 is solely of endothelial nature or also includes altered erythrocyte function. Nitrosylhemoglobin (HbNO) has recently been suggested as marker of endothelial dysfunction in COVID-19. Blood was processed with N-acetylcysteine + ascorbate to enable detection of endogenous HbNO. We find that addition of NAC + Asc to blood gives rise to artefactual HbNO formation when nitrite is present. Our results suggest this method requires further optimisation before it can be used for stratification of patient risk.
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Affiliation(s)
- Renato C Nogueira
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Brazil; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Anna D Clark
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, UK
| | - Alex Dyson
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College London, London, SE1 9NH, UK
| | - José E Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Brazil
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, UK.
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14
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Maassen H, Said MY, Frenay ARS, Koning A, Post A, Riphagen IJ, Heiner-Fokkema MR, Drabert K, Fernandez BO, Gans ROB, van den Berg E, Navis G, Tsikas D, Feelisch M, Bakker SJL, van Goor H. Nitric oxide and long-term outcomes after kidney transplantation: Results of the TransplantLines cohort study. Nitric Oxide 2022; 125-126:1-11. [PMID: 35660109 DOI: 10.1016/j.niox.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022]
Abstract
Impaired endogenous nitric oxide (NO) production may contribute to graft failure and premature mortality in kidney transplant recipients (KTR). We investigated potential associations of 24-h urinary NOx (NO3- + NO2-) excretion (uNOx) with long-term outcomes. uNOx was determined by HPLC and GC-MS in 698 KTR and in 132 kidney donors before and after donation. Additionally, we measured urinary nitroso species (RXNO) by gas-phase chemiluminescence. Median uNOx was lower in KTR compared to kidney donors (688 [393-1076] vs. 1301 [868-1863] before donation and 1312 [982-1853] μmol/24h after donation, P < 0.001). During median follow-up of 5.4 [4.8-6.1] years, 150 KTR died (61 due to cardiovascular disease) and 83 experienced graft failure. uNOx was inversely associated with all-cause mortality (HR per doubling of uNOx: 0.84 [95% CI 0.75-0.93], P < 0.001) and cardiovascular mortality (HR 0.78 [95% CI 0.67-0.92], P = 0.002). The association of uNOx with graft failure was lost when adjusted for renal function (HR per doubling of uNOx: 0.89 [95% CI 0.76-1.05], P = 0.17). There were no significant associations of urinary RXNO with outcomes. Our study suggests that KTR have lower NO production than healthy subjects and that lower uNOx is associated with a higher risk of all-cause and cardiovascular mortality.
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Affiliation(s)
- Hanno Maassen
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - M Yusof Said
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Anne-Roos S Frenay
- Department of Gynecology and Obstetrics, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Anne Koning
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Adrian Post
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Ineke J Riphagen
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M Rebecca Heiner-Fokkema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kathrin Drabert
- Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, Hannover, Germany
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine and NIHR Southampton Biomedical Research Centre, Southampton General Hospital, United Kingdom
| | - Reinold O B Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Else van den Berg
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Dimitrios Tsikas
- Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, Hannover, Germany
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine and NIHR Southampton Biomedical Research Centre, Southampton General Hospital, United Kingdom
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, the Netherlands.
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15
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Hennis PJ, Cumpstey AF, O'Doherty AF, Fernandez BO, Gilbert-Kawai ET, Mitchell K, Moyses H, Cobb A, Meale P, Pöhnl H, Mythen MG, Grocott MPW, Levett DZH, Martin DS, Feelisch M. Dietary Nitrate Supplementation Does Not Alter Exercise Efficiency at High Altitude - Further Results From the Xtreme Alps Study. Front Physiol 2022; 13:827235. [PMID: 35295581 PMCID: PMC8918982 DOI: 10.3389/fphys.2022.827235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Nitrate supplementation in the form of beetroot juice (BRJ) ingestion has been shown to improve exercise tolerance during acute hypoxia, but its effect on exercise physiology remains unstudied during sustained terrestrial high altitude exposure. We hypothesized that performing exercise at high altitude would lower circulating nitrate and nitrite levels and that BRJ ingestion would reverse this phenomenon while concomitantly improving key determinants of aerobic exercise performance. Methods Twenty seven healthy volunteers (21 male) underwent a series of exercise tests at sea level (SL, London, 75 m) and again after 5-8 days at high altitude (HA, Capanna Regina Margherita or "Margherita Hut," 4,559 m). Using a double-blind protocol, participants were randomized to consume a beetroot/fruit juice beverage (three doses per day) with high levels of nitrate (∼0.18 mmol/kg/day) or a nitrate-depleted placebo (∼11.5 μmoles/kg/day) control drink, from 3 days prior to the exercise trials until completion. Submaximal constant work rate cycle tests were performed to determine exercise efficiency and a maximal incremental ramp exercise test was undertaken to measure aerobic capacity, using breath-by-breath pulmonary gas exchange measurements throughout. Concentrations of nitrate, nitrite and nitrosation products were quantified in plasma samples collected at 5 timepoints during the constant work rate tests. Linear mixed modeling was used to analyze data. Results At both SL and HA, plasma nitrate concentrations were elevated in the nitrate supplementation group compared to placebo (P < 0.001) but did not change throughout increasing exercise work rate. Delta exercise efficiency was not altered by altitude exposure (P = 0.072) or nitrate supplementation (P = 0.836). V̇O2peak decreased by 24% at high altitude (P < 0.001) and was lower in the nitrate-supplemented group at both sea level and high altitude compared to placebo (P = 0.041). Dietary nitrate supplementation did not alter other peak exercise variables or oxygen consumption at anaerobic threshold. Circulating nitrite and S-nitrosothiol levels unexpectedly rose in a few individuals right after cessation of exercise at high altitude. Conclusion Whilst regularly consumed during an 8 days expedition to terrestrial high altitude, nitrate supplementation did not alter exercise efficiency and other exercise physiological variables, except decreasing V̇O2peak. These results and those of others question the practical utility of BRJ consumption during prolonged altitude exposure.
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Affiliation(s)
- Philip J Hennis
- Centre for Altitude Space and Extreme Environment Medicine, University College London Hospital NIHR Biomedical Research Centre, Institute of Sport, Exercise and Health, London, United Kingdom.,SHAPE Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Andrew F Cumpstey
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Alasdair F O'Doherty
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Bernadette O Fernandez
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Edward T Gilbert-Kawai
- Centre for Altitude Space and Extreme Environment Medicine, University College London Hospital NIHR Biomedical Research Centre, Institute of Sport, Exercise and Health, London, United Kingdom
| | - Kay Mitchell
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Helen Moyses
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alexandra Cobb
- Centre for Altitude Space and Extreme Environment Medicine, University College London Hospital NIHR Biomedical Research Centre, Institute of Sport, Exercise and Health, London, United Kingdom
| | - Paula Meale
- Centre for Altitude Space and Extreme Environment Medicine, University College London Hospital NIHR Biomedical Research Centre, Institute of Sport, Exercise and Health, London, United Kingdom
| | - Helmut Pöhnl
- AURAPA Würzungen GmbH, Bietigheim-Bissingen, Germany
| | - Monty G Mythen
- Centre for Altitude Space and Extreme Environment Medicine, University College London Hospital NIHR Biomedical Research Centre, Institute of Sport, Exercise and Health, London, United Kingdom
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Denny Z H Levett
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Daniel S Martin
- Centre for Altitude Space and Extreme Environment Medicine, University College London Hospital NIHR Biomedical Research Centre, Institute of Sport, Exercise and Health, London, United Kingdom.,Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
| | - Martin Feelisch
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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16
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Pavitt MJ, Lewis A, Buttery SC, Fernandez BO, Mikus-Lelinska M, Banya WAS, Feelisch M, Polkey MI, Hopkinson NS. Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX, a double-blind, placebo-controlled, randomised cross-over study. Thorax 2021; 77:968-975. [PMID: 34853156 DOI: 10.1136/thoraxjnl-2021-217147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/23/2021] [Accepted: 11/04/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Dietary nitrate supplementation improves skeletal muscle oxygen utilisation and vascular endothelial function. We hypothesised that these effects might be sufficient to improve exercise performance in patients with COPD and hypoxia severe enough to require supplemental oxygen. METHODS We conducted a single-centre, double-blind, placebo-controlled, cross-over study, enrolling adults with COPD who were established users of long-term oxygen therapy. Participants performed an endurance shuttle walk test, using their prescribed oxygen, 3 hours after consuming either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate) or placebo (nitrate-depleted BRJ). Treatment order was allocated (1:1) by computer-generated block randomisation. MEASUREMENTS The primary outcome was endurance shuttle walk test time. The secondary outcomes included area under the curve to isotime for fingertip oxygen saturation and heart rate parameters during the test, blood pressure, and endothelial function assessed using flow-mediated dilatation. Plasma nitrate and nitrite levels as well as FENO were also measured. MAIN RESULTS 20 participants were recruited and all completed the study. Nitrate-rich BRJ supplementation prolonged exercise endurance time in all participants as compared with placebo: median (IQR) 194.6 (147.5-411.7) s vs 159.1 (121.9-298.5) s, estimated treatment effect 62 (33-106) s (p<0.0001). Supplementation also improved endothelial function: NR-BRJ group +4.1% (-1.1% to 14.8%) vs placebo BRJ group -5.0% (-10.6% to -0.6%) (p=0.0003). CONCLUSION Acute dietary nitrate supplementation increases exercise endurance in patients with COPD who require supplemental oxygen.Trial registration number ISRCTN14888729.
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Affiliation(s)
- Matthew J Pavitt
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam Lewis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Winston A S Banya
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Martin Feelisch
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton Hospital, London, UK
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17
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Freeman A, Cellura D, Minnion M, Fernandez BO, Spalluto CM, Levett D, Bates A, Wallis T, Watson A, Jack S, Staples KJ, Grocott MPW, Feelisch M, Wilkinson TMA. Exercise Training Induces a Shift in Extracellular Redox Status with Alterations in the Pulmonary and Systemic Redox Landscape in Asthma. Antioxidants (Basel) 2021; 10:antiox10121926. [PMID: 34943027 PMCID: PMC8750917 DOI: 10.3390/antiox10121926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/25/2022] Open
Abstract
Redox dysregulation and oxidative stress have been implicated in asthma pathogenesis. Exercise interventions improve symptoms and reduce inflammation in asthma patients, but the underlying mechanisms remain unclear. We hypothesized that a personalised exercise intervention would improve asthma control by reducing lung inflammation through modulation of local and systemic reactive species interactions, thereby increasing antioxidant capacity. We combined deep redox metabolomic profiling with clinical assessment in an exploratory cohort of six female patients with symptomatic asthma and studied their responses to a metabolically targeted exercise intervention over 12 weeks. Plasma antioxidant capacity and circulating nitrite levels increased following the intervention (p = 0.028) and lowered the ratio of reduced to oxidised glutathione (p = 0.029); this was accompanied by improvements in physical fitness (p = 0.046), symptoms scores (p = 0.020), quality of life (p = 0.046), lung function (p = 0.028), airway hyperreactivity (p = 0.043), and eosinophilic inflammation (p = 0.007). Increased physical fitness correlated with improved plasma antioxidant capacity (p = 0.019), peak oxygen uptake and nitrite changes (p = 0.005), the latter also associated with reductions in peripheral blood eosinophil counts (p = 0.038). Thus, increases in “redox resilience” may underpin the clinical benefits of exercise in asthma. An improved understanding of exercise-induced alterations in redox regulation offers opportunities for greater treatment personalisation and identification of new treatment targets.
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Affiliation(s)
- Anna Freeman
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
- Correspondence:
| | - Doriana Cellura
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Magdalena Minnion
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Bernadette O. Fernandez
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Cosma Mirella Spalluto
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Denny Levett
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Andrew Bates
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Timothy Wallis
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Alastair Watson
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Sandy Jack
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Karl J. Staples
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Michael P. W. Grocott
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Tom M. A. Wilkinson
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
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18
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Feelisch M, Cumpstey AF, Clark AD, Santolini J, Jackson AA. Response to Verd and Verd Re: "COVID-19: A Redox Disease-What a Stress Pandemic Can Teach Us About Resilience and What We May Learn from the Reactive Species Interactome About Its Treatment". Antioxid Redox Signal 2021; 35:1271-1272. [PMID: 34269622 DOI: 10.1089/ars.2021.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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]
Affiliation(s)
- Martin Feelisch
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Andrew F Cumpstey
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Anna D Clark
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jérôme Santolini
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Sud, Universite Paris-Saclay, Gif-sur-Yvette Cedex, France
| | - Alan A Jackson
- Human Nutrition, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, United Kingdom
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19
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Cumpstey AF, Clark AD, Santolini J, Jackson AA, Feelisch M. COVID-19: A Redox Disease-What a Stress Pandemic Can Teach Us About Resilience and What We May Learn from the Reactive Species Interactome About Its Treatment. Antioxid Redox Signal 2021; 35:1226-1268. [PMID: 33985343 DOI: 10.1089/ars.2021.0017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Significance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), affects every aspect of human life by challenging bodily, socioeconomic, and political systems at unprecedented levels. As vaccines become available, their distribution, safety, and efficacy against emerging variants remain uncertain, and specific treatments are lacking. Recent Advances: Initially affecting the lungs, COVID-19 is a complex multisystems disease that disturbs the whole-body redox balance and can be long-lasting (Long-COVID). Numerous risk factors have been identified, but the reasons for variations in susceptibility to infection, disease severity, and outcome are poorly understood. The reactive species interactome (RSI) was recently introduced as a framework to conceptualize how cells and whole organisms sense, integrate, and accommodate stress. Critical Issues: We here consider COVID-19 as a redox disease, offering a holistic perspective of its effects on the human body, considering the vulnerability of complex interconnected systems with multiorgan/multilevel interdependencies. Host/viral glycan interactions underpin SARS-CoV-2's extraordinary efficiency in gaining cellular access, crossing the epithelial/endothelial barrier to spread along the vascular/lymphatic endothelium, and evading antiviral/antioxidant defences. An inflammation-driven "oxidative storm" alters the redox landscape, eliciting epithelial, endothelial, mitochondrial, metabolic, and immune dysfunction, and coagulopathy. Concomitantly reduced nitric oxide availability renders the sulfur-based redox circuitry vulnerable to oxidation, with eventual catastrophic failure in redox communication/regulation. Host nutrient limitations are crucial determinants of resilience at the individual and population level. Future Directions: While inflicting considerable damage to health and well-being, COVID-19 may provide the ultimate testing ground to improve the diagnosis and treatment of redox-related stress diseases. "Redox phenotyping" of patients to characterize whole-body RSI status as the disease progresses may inform new therapeutic approaches to regain redox balance, reduce mortality in COVID-19 and other redox diseases, and provide opportunities to tackle Long-COVID. Antioxid. Redox Signal. 35, 1226-1268.
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Affiliation(s)
- Andrew F Cumpstey
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Anna D Clark
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jérôme Santolini
- Institute for Integrative Biology of the Cell (I2BC), Biochemistry, Biophysics and Structural Biology, CEA, CNRS, Université Paris-Sud, Universite Paris-Saclay, Gif-sur-Yvette, France
| | - Alan A Jackson
- Human Nutrition, University of Southampton and University Hospital Southampton, Southampton, United Kingdom
| | - Martin Feelisch
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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20
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Reijrink M, De Boer SA, Van Roon AM, Slart RHJA, Fernandez BO, Feelisch M, Heerspink HJL, Van Goor H, Hillebrands JL, Mulder DJ. Plasma Nitrate Levels Are Related to Metabolic Syndrome and Are Not Altered by Treatment with DPP-4 Inhibitor Linagliptin: A Randomised, Placebo-Controlled Trial in Patients with Early Type 2 Diabetes Mellitus. Antioxidants (Basel) 2021; 10:antiox10101548. [PMID: 34679685 PMCID: PMC8533083 DOI: 10.3390/antiox10101548] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/25/2023] Open
Abstract
The depletion of nitrate and nitrite, stable nitric oxide (NO) end-products, promotes adipose tissue dysfunction and insulin resistance (IR). Dipeptidyl peptidase-4 (DPP-4) inhibitors have the potentially beneficial side effect of increasing NO availability. In this study, nitrate and nitrite levels and the effects of DPP-4 inhibitor linagliptin were investigated in relation to metabolic syndrome (MetS) markers. Treatment-naive patients with early type 2 diabetes mellitus (T2DM) (n = 40, median age 63 IQR (55–67) years, 63% male, mean HbA1c 45 ± 4.4 mmol/mol) were randomized (1:1) to linagliptin (5 mg/day) or placebo. MetS-related markers (body mass index (BMI), triglycerides, HOMA-IR, gamma-glutamyltransferase (GGT), C-reactive protein (CRP), and adiponectin), plasma levels of nitrate, nitrite, total free thiols (TFT) and vegetable intake were estimated at baseline and after 4 and 26 weeks of treatment. Plasma nitrate, but not nitrite, correlated positively with vegetable intake (r = 0.38, p = 0.018) and was inversely associated with HOMA-IR (r = −0.44, p = 0.006), BMI (r = −0.35, p = 0.028), GGT (r = −0.37, p = 0.019) and CRP (r = −0.34, p = 0.034). The relationship between nitrate and HOMA-IR remained significant after adjusting for BMI, CRP, vegetable intake and GGT. With stable vegetable intake, nitrate and nitrite, TFT, adipokines and CRP did not change after 26 weeks of linagliptin treatment. While plasma nitrate is inversely associated with MetS, linagliptin treatment does not significantly influence nitrate and nitrite concentrations, oxidative stress, adipose tissue function and systemic inflammation.
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Affiliation(s)
- Melanie Reijrink
- Medical Center Groningen, Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, 9713 Groningen, The Netherlands; (M.R.); (S.A.D.B.); (A.M.V.R.)
| | - Stefanie A. De Boer
- Medical Center Groningen, Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, 9713 Groningen, The Netherlands; (M.R.); (S.A.D.B.); (A.M.V.R.)
| | - Anniek M. Van Roon
- Medical Center Groningen, Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, 9713 Groningen, The Netherlands; (M.R.); (S.A.D.B.); (A.M.V.R.)
| | - Riemer H. J. A. Slart
- Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, 9713 Groningen, The Netherlands;
- Department of Biomedical Photoacustic Imaging (BMPI), University of Twente, 7522 Enschede, The Netherlands
| | - Bernadette O. Fernandez
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, SO17 1BJ Southamptonc, UK; (B.O.F.); (M.F.)
| | - Martin Feelisch
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, SO17 1BJ Southamptonc, UK; (B.O.F.); (M.F.)
| | - Hiddo J. L. Heerspink
- Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, University of Groningen, 9713 Groningen, The Netherlands;
| | - Harry Van Goor
- Medical Center Groningen, Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, 9713 Groningen, The Netherlands; (H.V.G.); (J.-L.H.)
| | - Jan-Luuk Hillebrands
- Medical Center Groningen, Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, 9713 Groningen, The Netherlands; (H.V.G.); (J.-L.H.)
| | - Douwe J. Mulder
- Medical Center Groningen, Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, 9713 Groningen, The Netherlands; (M.R.); (S.A.D.B.); (A.M.V.R.)
- Correspondence:
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21
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Leo F, Suvorava T, Heuser SK, Li J, LoBue A, Barbarino F, Piragine E, Schneckmann R, Hutzler B, Good ME, Fernandez BO, Vornholz L, Rogers S, Doctor A, Grandoch M, Stegbauer J, Weitzberg E, Feelisch M, Lundberg JO, Isakson BE, Kelm M, Cortese-Krott MM. Red Blood Cell and Endothelial eNOS Independently Regulate Circulating Nitric Oxide Metabolites and Blood Pressure. Circulation 2021; 144:870-889. [PMID: 34229449 PMCID: PMC8529898 DOI: 10.1161/circulationaha.120.049606] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Current paradigms suggest that nitric oxide (NO) produced by endothelial cells (ECs) via endothelial nitric oxide synthase (eNOS) in the vessel wall is the primary regulator of blood flow and blood pressure. However, red blood cells (RBCs) also carry a catalytically active eNOS, but its role is controversial and remains undefined. This study aimed to elucidate the functional significance of red cell eNOS compared to EC eNOS for vascular hemodynamics and NO metabolism. Methods: We generated tissue-specific "loss-" and "gain-of-function" models for eNOS by using cell-specific Cre-induced gene inactivation or reactivation. We created two founder lines carrying a floxed eNOS (eNOSflox/flox) for Cre-inducible knock out (KO), as well as gene construct with an inactivated floxed/inverted exon (eNOSinv/inv) for a Cre-inducible knock in (KI), which respectively allow targeted deletion or reactivation of eNOS in erythroid cells (RBC eNOS KO or RBC eNOS KI mice) or endothelial cells (EC eNOS KO or EC eNOS KI mice). Vascular function, hemodynamics, and NO metabolism were compared ex vivo and in vivo. Results: The EC eNOS KOs exhibited significantly impaired aortic dilatory responses to acetylcholine, loss of flow-mediated dilation (FMD), and increased systolic and diastolic blood pressure. RBC eNOS KO mice showed no alterations in acetylcholine-mediated dilation or FMD but were hypertensive. Treatment with the NOS inhibitor L-NAME further increased blood pressure in RBC eNOS KOs, demonstrating that eNOS in both ECs and RBCs contributes to blood pressure regulation. While both EC eNOS KOs and RBC eNOS KOs had lower plasma nitrite and nitrate concentrations, the levels of bound NO in RBCs were lower in RBC eNOS KOs as compared to EC eNOS KOs. Crucially, reactivation of eNOS in ECs or RBCs rescues the hypertensive phenotype of the eNOSinv/inv mice, while the levels of bound NO were restored only in RBC eNOS KI mice. Conclusions:These data reveal that eNOS in ECs and RBCs contribute independently to blood pressure homeostasis.
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Affiliation(s)
- Francesca Leo
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Tatsiana Suvorava
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany; Department of Cardiology Pneumology and Angiology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Sophia K Heuser
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Junjie Li
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Anthea LoBue
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Frederik Barbarino
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Eugenia Piragine
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany; Department of Pharmacy, University of Pisa, Pisa, Italy
| | - Rebekka Schneckmann
- Department of Pharmacology and Clinical Pharmacology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Beate Hutzler
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Miranda E Good
- Robert M. Berne Cardiovascular Research Center, Department of Molecular Physiology and Biophysics, University of Virginia School of Medicine, Charlottesville, VA; Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Lukas Vornholz
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Stephen Rogers
- Department of Pediatrics, Center for Blood Oxygen Transport and Hemostasis, University of Maryland School of Medicine, MD
| | - Allan Doctor
- Department of Pediatrics, Center for Blood Oxygen Transport and Hemostasis, University of Maryland School of Medicine, MD
| | - Maria Grandoch
- Department of Pharmacology and Clinical Pharmacology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Eddie Weitzberg
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jon O Lundberg
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Brant E Isakson
- Robert M. Berne Cardiovascular Research Center, Department of Molecular Physiology and Biophysics, University of Virginia School of Medicine, Charlottesville, VA
| | - Malte Kelm
- Department of Cardiology Pneumology and Angiology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Miriam M Cortese-Krott
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Angiology, Medical Faculty, Heinrich-Heine-University, Universitätsstrasse 1, 40225 Düsseldorf, Germany; Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden; Department of Cardiology Pneumology and Angiology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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22
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Mincham KT, Panchal K, Hart PH, Lucas RM, Feelisch M, Weller RB, Matthews VB, Strickland DH, Gorman S. Metabolic dysfunction induced by a high-fat diet modulates hematopoietic stem and myeloid progenitor cells in brown adipose tissue of mice. Immunol Cell Biol 2021; 99:749-766. [PMID: 33866598 DOI: 10.1111/imcb.12460] [Citation(s) in RCA: 1] [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: 11/04/2020] [Revised: 02/05/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
Brown adipose tissue (BAT) may be an important metabolic regulator of whole-body glucose. While important roles have been ascribed to macrophages in regulating metabolic functions in BAT, little is known of the roles of other immune cells subsets, particularly dendritic cells (DCs). Eating a high-fat diet may compromise the development of hematopoietic stem and progenitor cells (HSPCs)-which give rise to DCs-in bone marrow, with less known of its effects in BAT. We have previously demonstrated that ongoing exposure to low-dose ultraviolet radiation (UVR) significantly reduced the 'whitening' effect of eating a high-fat diet upon interscapular (i) BAT of mice. Here, we examined whether this observation may be linked to changes in the phenotype of HSPCs and myeloid-derived immune cells in iBAT and bone marrow of mice using 12-colour flow cytometry. Many HSPC subsets declined in both iBAT and bone marrow with increasing metabolic dysfunction. Conversely, with rising adiposity and metabolic dysfunction, conventional DCs (cDCs) increased in both of these tissues. When compared with a low-fat diet, consumption of a high-fat diet significantly reduced proportions of myeloid, common myeloid and megakaryocyte-erythrocyte progenitors in iBAT, and short-term hematopoietic stem cells in bone marrow. In mice fed the high-fat diet, exposure to low-dose UVR significantly reduced proportions of cDCs in iBAT, independently of nitric oxide release from irradiated skin [blocked using the scavenger 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide potassium salt (cPTIO)], but did not significantly modify HSPC subsets in either tissue. Further studies are needed to determine whether changes in these cell populations contribute towards metabolic dysfunction .
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Affiliation(s)
- Kyle T Mincham
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Kunjal Panchal
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Prue H Hart
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Richard B Weller
- University of Edinburgh, MRC Centre for Inflammation Research, Edinburgh, Scotland
| | - Vance B Matthews
- School of Biomedical Science - Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia
| | | | - Shelley Gorman
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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23
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Soren O, Rineh A, Silva DG, Cai Y, Howlin RP, Allan RN, Feelisch M, Davies JC, Connett GJ, Faust SN, Kelso MJ, Webb JS. Cephalosporin nitric oxide-donor prodrug DEA-C3D disperses biofilms formed by clinical cystic fibrosis isolates of Pseudomonas aeruginosa. J Antimicrob Chemother 2021; 75:117-125. [PMID: 31682251 PMCID: PMC6910178 DOI: 10.1093/jac/dkz378] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 04/11/2019] [Revised: 07/16/2019] [Accepted: 08/02/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives The cephalosporin nitric oxide (NO)-donor prodrug DEA-C3D (‘DiEthylAmin-Cephalosporin-3′-Diazeniumdiolate’) has been shown to initiate the dispersal of biofilms formed by the Pseudomonas aeruginosa laboratory strain PAO1. In this study, we investigated whether DEA-C3D disperses biofilms formed by clinical cystic fibrosis (CF) isolates of P. aeruginosa and its effect in combination with two antipseudomonal antibiotics, tobramycin and colistin, in vitro. Methods β-Lactamase-triggered release of NO from DEA-C3D was confirmed using a gas-phase chemiluminescence detector. MICs for P. aeruginosa clinical isolates were determined using the broth microdilution method. A crystal violet staining technique and confocal laser scanning microscopy were used to evaluate the effects of DEA-C3D on P. aeruginosa biofilms alone and in combination with tobramycin and colistin. Results DEA-C3D was confirmed to selectively release NO in response to contact with bacterial β-lactamase. Despite lacking direct, cephalosporin/β-lactam-based antibacterial activity, DEA-C3D was able to disperse biofilms formed by three P. aeruginosa clinical isolates. Confocal microscopy revealed that DEA-C3D in combination with tobramycin produces similar reductions in biofilm to DEA-C3D alone, whereas the combination with colistin causes near complete eradication of P. aeruginosa biofilms in vitro. Conclusions DEA-C3D is effective in dispersing biofilms formed by multiple clinical isolates of P. aeruginosa and could hold promise as a new adjunctive therapy to patients with CF.
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Affiliation(s)
- Odel Soren
- National Biofilms Innovation Centre, University of Southampton, Southampton SO17 1BJ, UK.,Biological Sciences and Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Ardeshir Rineh
- Molecular Horizons and School of Chemistry & Molecular Bioscience, University of Wollongong, NSW, 2522, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, 2522, Australia
| | - Diogo G Silva
- National Biofilms Innovation Centre, University of Southampton, Southampton SO17 1BJ, UK.,Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Yuming Cai
- National Biofilms Innovation Centre, University of Southampton, Southampton SO17 1BJ, UK.,Biological Sciences and Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Robert P Howlin
- Biological Sciences and Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation, Southampton SO16 6YD, UK
| | - Raymond N Allan
- National Biofilms Innovation Centre, University of Southampton, Southampton SO17 1BJ, UK.,Biological Sciences and Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation, Southampton SO16 6YD, UK
| | - Martin Feelisch
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Jane C Davies
- Cystic Fibrosis Trust Strategic Research Centre and National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Gary J Connett
- National Biofilms Innovation Centre, University of Southampton, Southampton SO17 1BJ, UK.,Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation, Southampton SO16 6YD, UK
| | - Saul N Faust
- National Biofilms Innovation Centre, University of Southampton, Southampton SO17 1BJ, UK.,Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation, Southampton SO16 6YD, UK
| | - Michael J Kelso
- Molecular Horizons and School of Chemistry & Molecular Bioscience, University of Wollongong, NSW, 2522, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, 2522, Australia
| | - Jeremy S Webb
- National Biofilms Innovation Centre, University of Southampton, Southampton SO17 1BJ, UK.,Biological Sciences and Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation, Southampton SO16 6YD, UK
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24
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Nguyen ITN, Wiggenhauser LM, Bulthuis M, Hillebrands JL, Feelisch M, Verhaar MC, van Goor H, Joles JA. Cardiac Protection by Oral Sodium Thiosulfate in a Rat Model of L-NNA-Induced Heart Disease. Front Pharmacol 2021; 12:650968. [PMID: 33935760 PMCID: PMC8082682 DOI: 10.3389/fphar.2021.650968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/11/2021] [Indexed: 12/21/2022] Open
Abstract
Hypertension contributes to cardiac damage and remodeling. Despite the availability of renin-angiotensin system inhibitors and other antihypertensive therapies, some patients still develop heart failure. Novel therapeutic approaches are required that are effective and without major adverse effects. Sodium Thiosulfate (STS), a reversible oxidation product of hydrogen sulfide (H2S), is a promising pharmacological entity with vasodilator and anti-oxidant potential that is clinically approved for the treatment of calciphylaxis and cyanide poisoning. We hypothesized that Sodium Thiosulfate improves cardiac disease in an experimental hypertension model and sought to investigate its cardioprotective effects by direct comparison to the ACE-inhibitor lisinopril, alone and in combination, using a rat model of chronic nitric oxide (NO) deficiency. Systemic nitric oxide production was inhibited in Sprague Dawley rats by administering N-ω-nitro-l-arginine (L-NNA) with the food for three weeks, leading to progressive hypertension, cardiac dysfunction and remodeling. We observed that STS, orally administered via the drinking water, ameliorated L-NNA-induced heart disease. Treatment with STS for two weeks ameliorated hypertension and improved systolic function, left ventricular hypertrophy, cardiac fibrosis and oxidative stress, without causing metabolic acidosis as is sometimes observed following parenteral administration of this drug. STS and lisinopril had similar protective effects that were not additive when combined. Our findings indicate that oral intervention with a H2S donor such as STS has cardioprotective properties without noticeable side effects.
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Affiliation(s)
- Isabel T N Nguyen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lucas M Wiggenhauser
- Department of Pathology and Medical Biology, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | - Marian Bulthuis
- Department of Pathology and Medical Biology, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, Southampton General Hospital and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
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25
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Dóka É, Arnér ESJ, Schmidt EE, Dick TP, van der Vliet A, Yang J, Szatmári R, Ditrói T, Wallace JL, Cirino G, Olson K, Motohashi H, Fukuto JM, Pluth MD, Feelisch M, Akaike T, Wink DA, Ignarro LJ, Nagy P. Comment on "Evidence that the ProPerDP method is inadequate for protein persulfidation detection due to lack of specificity". Sci Adv 2021; 7:7/17/eabe7006. [PMID: 33883133 PMCID: PMC8059920 DOI: 10.1126/sciadv.abe7006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/03/2021] [Indexed: 05/02/2023]
Abstract
The recent report by Fan et al alleged that the ProPerDP method is inadequate for the detection of protein persulfidation. Upon careful evaluation of their work, we conclude that the claim made by Fan et al is not supported by their data, rather founded in methodological shortcomings. It is understood that the ProPerDP method generates a mixture of cysteine-containing and non-cysteine-containing peptides. Instead, Fan et al suggested that the detection of non-cysteine-containing peptides indicates nonspecific alkylation at noncysteine residues. However, if true, then such peptides would not be released by reduction and therefore not appear as products in the reported workflow. Moreover, the authors' biological assessment of ProPerDP using Escherichia coli mutants was based on assumptions that have not been confirmed by other methods. We conclude that Fan et al did not rigorously assess the method and that ProPerDP remains a reliable approach for analyses of protein per/polysulfidation.
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Affiliation(s)
- Éva Dóka
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, 1122 Budapest, Hungary
| | - Elias S J Arnér
- Department of Selenoprotein Research, National Institute of Oncology, 1122 Budapest, Hungary
- Department of Medical Biochemistry and Biophysics, Division of Biochemistry, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Edward E Schmidt
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, MT 59717, USA
| | - Tobias P Dick
- Division of Redox Regulation, DKFZ-ZMBH Alliance, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Albert van der Vliet
- Department of Pathology and Laboratory Medicine, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Jing Yang
- State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Proteome Research Center, Beijing Institute of Lifeomics, 102206 Beijing, China
| | - Réka Szatmári
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, 1122 Budapest, Hungary
| | - Tamás Ditrói
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, 1122 Budapest, Hungary
| | - John L Wallace
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4N1, Canada
- Antibe Therapeutics Inc., Toronto, ON M5R 1B2, Canada
| | - Giuseppe Cirino
- Department of Pharmacy, University of Naples Federico II, Naples 80138, Italy
| | - Kenneth Olson
- Department of Physiology, Indiana University School of Medicine-South Bend, South Bend, IN 46617, USA
| | - Hozumi Motohashi
- Department of Gene Expression Regulation, Institute of Development, Aging and Cancer, Tohoku University, 980-8575 Sendai, Japan
| | - Jon M Fukuto
- Department of Chemistry, Sonoma State University, Rohnert Park, Sonoma, CA 94928, USA
| | - Michael D Pluth
- Department of Chemistry and Biochemistry, Materials Science Institute, Institute of Molecular Biology, University of Oregon, Eugene, OR 97403, USA
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, and University Hospital Southampton NHS Foundation Trust, University of Southampton, SO16 6YD Southampton, UK
| | - Takaaki Akaike
- Department of Environmental Medicine and Molecular Toxicology, Tohoku University Graduate School of Medicine, 980-8575 Sendai, Japan
| | - David A Wink
- Chemical and Molecular Inflammation Section, Cancer and Inflammation Program, National Cancer Institute, Frederick, MD 21702, USA
| | - Louis J Ignarro
- University of California, Los Angeles School of Medicine, Beverly Hills, CA 90212, USA
| | - Péter Nagy
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, 1122 Budapest, Hungary.
- Department of Anatomy and Histology, University of Veterinary Medicine, 1078 Budapest, Hungary
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26
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McKenna HT, O'Brien KA, Fernandez BO, Minnion M, Tod A, McNally BD, West JA, Griffin JL, Grocott MP, Mythen MG, Feelisch M, Murray AJ, Martin DS. Divergent trajectories of cellular bioenergetics, intermediary metabolism and systemic redox status in survivors and non-survivors of critical illness. Redox Biol 2021; 41:101907. [PMID: 33667994 PMCID: PMC7937570 DOI: 10.1016/j.redox.2021.101907] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/06/2021] [Accepted: 02/16/2021] [Indexed: 02/01/2023] Open
Abstract
Background Numerous pathologies result in multiple-organ failure, which is thought to be a direct consequence of compromised cellular bioenergetic status. Neither the nature of this phenotype nor its relevance to survival are well understood, limiting the efficacy of modern life-support. Methods To explore the hypothesis that survival from critical illness relates to changes in cellular bioenergetics, we combined assessment of mitochondrial respiration with metabolomic, lipidomic and redox profiling in skeletal muscle and blood, at multiple timepoints, in 21 critically ill patients and 12 reference patients. Results We demonstrate an end-organ cellular phenotype in critical illness, characterized by preserved total energetic capacity, greater coupling efficiency and selectively lower capacity for complex I and fatty acid oxidation (FAO)-supported respiration in skeletal muscle, compared to health. In survivors, complex I capacity at 48 h was 27% lower than in non-survivors (p = 0.01), but tended to increase by day 7, with no such recovery observed in non-survivors. By day 7, survivors’ FAO enzyme activity was double that of non-survivors (p = 0.048), in whom plasma triacylglycerol accumulated. Increases in both cellular oxidative stress and reductive drive were evident in early critical illness compared to health. Initially, non-survivors demonstrated greater plasma total antioxidant capacity but ultimately higher lipid peroxidation compared to survivors. These alterations were mirrored by greater levels of circulating total free thiol and nitrosated species, consistent with greater reductive stress and vascular inflammation, in non-survivors compared to survivors. In contrast, no clear differences in systemic inflammatory markers were observed between the two groups. Conclusion Critical illness is associated with rapid, specific and coordinated alterations in the cellular respiratory machinery, intermediary metabolism and redox response, with different trajectories in survivors and non-survivors. Unravelling the cellular and molecular foundation of human resilience may enable the development of more effective life-support strategies.
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Affiliation(s)
- Helen T McKenna
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, NW3 2QG, UK; Intensive Care Unit, Royal Free Hospital, London, NW3 2QG, UK; Peninsula Medical School, University of Plymouth, John Bull Building, Derriford, Plymouth, PL6 8BU, UK
| | - Katie A O'Brien
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Magdalena Minnion
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Adam Tod
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Ben D McNally
- Department of Biochemistry and the Cambridge Systems Biology Centre, University of Cambridge, CB2 1GA, UK
| | - James A West
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Department of Medicine, Jeffrey Cheah Biomedical Centre, University of Cambridge, CB2 0RE, UK
| | - Julian L Griffin
- Department of Biochemistry and the Cambridge Systems Biology Centre, University of Cambridge, CB2 1GA, UK; Section of Biomolecular Medicine, Department of Digestion, Metabolism and Reproduction, Imperial College London, SW7 2AZ, UK
| | - Michael P Grocott
- Anaesthesia Perioperative and Critical Care Research Group, Southampton National Institute of Health Research Biomedical Research Centre, University Hospital Southampton, SO16 6YD, UK
| | - Michael G Mythen
- University College London Hospitals and Great Ormond Street, National Institute of Health Research Biomedical Research Centres, London, WC1N 1EH, UK
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK; Anaesthesia Perioperative and Critical Care Research Group, Southampton National Institute of Health Research Biomedical Research Centre, University Hospital Southampton, SO16 6YD, UK
| | - Andrew J Murray
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK.
| | - Daniel S Martin
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, NW3 2QG, UK; Intensive Care Unit, Royal Free Hospital, London, NW3 2QG, UK; Peninsula Medical School, University of Plymouth, John Bull Building, Derriford, Plymouth, PL6 8BU, UK
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27
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Griffiths K, Lee JJ, Frenneaux MP, Feelisch M, Madhani M. Nitrite and myocardial ischaemia reperfusion injury. Where are we now? Pharmacol Ther 2021; 223:107819. [PMID: 33600852 DOI: 10.1016/j.pharmthera.2021.107819] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease remains the leading cause of death worldwide despite major advances in technology and treatment, with coronary heart disease (CHD) being a key contributor. Following an acute myocardial infarction (AMI), it is imperative that blood flow is rapidly restored to the ischaemic myocardium. However, this restoration is associated with an increased risk of additional complications and further cardiomyocyte death, termed myocardial ischaemia reperfusion injury (IRI). Endogenously produced nitric oxide (NO) plays an important role in protecting the myocardium from IRI. It is well established that NO mediates many of its downstream functions through the 'canonical' NO-sGC-cGMP pathway, which is vital for cardiovascular homeostasis; however, this pathway can become impaired in the face of inadequate delivery of necessary substrates, in particular L-arginine, oxygen and reducing equivalents. Recently, it has been shown that during conditions of ischaemia an alternative pathway for NO generation exists, which has become known as the 'nitrate-nitrite-NO pathway'. This pathway has been reported to improve endothelial dysfunction, protect against myocardial IRI and attenuate infarct size in various experimental models. Furthermore, emerging evidence suggests that nitrite itself provides multi-faceted protection, in an NO-independent fashion, against a myriad of pathophysiologies attributed to IRI. In this review, we explore the existing pre-clinical and clinical evidence for the role of nitrate and nitrite in cardioprotection and discuss the lessons learnt from the clinical trials for nitrite as a perconditioning agent. We also discuss the potential future for nitrite as a pre-conditioning intervention in man.
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Affiliation(s)
- Kayleigh Griffiths
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Jordan J Lee
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Michael P Frenneaux
- Norwich Medical School, University of East Anglia, Bob Champion Research and Education Building, Norwich Research Park, Norwich NR4 7UQ, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Melanie Madhani
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
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Lespagnol E, Tagougui S, Fernandez BO, Zerimech F, Matran R, Maboudou P, Berthoin S, Descat A, Kim I, Pawlak-Chaouch M, Boissière J, Boulanger E, Feelisch M, Fontaine P, Heyman E. Circulating biomarkers of nitric oxide bioactivity and impaired muscle vasoreactivity to exercise in adults with uncomplicated type 1 diabetes. Diabetologia 2021; 64:325-338. [PMID: 33219433 DOI: 10.1007/s00125-020-05329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/29/2020] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS Early compromised endothelial function challenges the ability of individuals with type 1 diabetes to perform normal physical exercise. The exact mechanisms underlying this vascular limitation remain unknown, but may involve either formation or metabolism of nitric oxide (NO), a major vasodilator, whose activity is known to be compromised by oxidative stress. METHODS Muscle microvascular reactivity (near-infrared spectroscopy) to an incremental exhaustive bout of exercise was assessed in 22 adults with uncomplicated type 1 diabetes (HbA1c 64.5 ± 15.7 mmol/mol; 8.0 ± 1.4%) and in 21 healthy individuals (18-40 years of age). NO-related substrates/metabolites were also measured in the blood along with other vasoactive compounds and oxidative stress markers; measurements were taken at rest, at peak exercise and after 15 min of recovery. Demographic characteristics, body composition, smoking status and diet were comparable in both groups. RESULTS Maximal oxygen uptake was impaired in individuals with type 1 diabetes compared with in healthy participants (35.6 ± 7.7 vs 39.6 ± 6.8 ml min-1 kg-1, p < 0.01) despite comparable levels of habitual physical activity (moderate to vigorous physical activity by accelerometery, 234.9 ± 160.0 vs 280.1 ± 114.9 min/week). Compared with non-diabetic participants, individuals with type 1 diabetes also displayed a blunted exercise-induced vasoreactivity (muscle blood volume at peak exercise as reflected by ∆ total haemoglobin, 2.03 ± 5.82 vs 5.33 ± 5.54 μmol/l; interaction 'exercise' × 'group', p < 0.05); this was accompanied by lower K+ concentration (p < 0.05), reduced plasma L-arginine (p < 0.05)-in particular when HbA1c was high (mean estimation: -4.0, p < 0.05)-and lower plasma urate levels (p < 0.01). Nonetheless, exhaustive exercise did not worsen lipid peroxidation or other oxidative stress biomarkers, and erythrocytic enzymatic antioxidant resources were mobilised to a comparable extent in both groups. Nitrite and total nitrosation products, which are potential alternative NO sources, were similarly unaltered. Graphical abstract CONCLUSIONS/INTERPRETATION: Participants with uncomplicated type 1 diabetes displayed reduced availability of L-arginine, the essential substrate for enzymatic nitric oxide synthesis, as well as lower levels of the major plasma antioxidant, urate. Lower urate levels may reflect a defect in the activity of xanthine oxidase, an enzyme capable of producing NO from nitrite under hypoxic conditions. Thus, both canonical and non-canonical NO production may be reduced. However, neither of these changes exacerbated exercise-induced oxidative stress. TRIAL REGISTRATION clinicaltrials.gov NCT02051504.
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Affiliation(s)
- Elodie Lespagnol
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Sémah Tagougui
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Farid Zerimech
- CHU Lille, Institut Pasteur de Lille, ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Université Lille, Lille, France
| | - Régis Matran
- CHU Lille, Institut Pasteur de Lille, ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Université Lille, Lille, France
| | - Patrice Maboudou
- CHU de Lille, Laboratoire de Biochimie et Biologie Moléculaire, Pôle de Biologie Pathologie Génétique, Lille, France
| | - Serge Berthoin
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Amandine Descat
- CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Université Lille, Lille, France
| | - Isabelle Kim
- CHU de Lille, Laboratoire de Biochimie et Biologie Moléculaire, Pôle de Biologie Pathologie Génétique, Lille, France
| | - Mehdi Pawlak-Chaouch
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Julien Boissière
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Eric Boulanger
- Inserm, CHU Lille, Pasteur Institute of Lille, U1167 - RID-AGE, Université Lille, Lille, France
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Pierre Fontaine
- Department of Diabetology, Lille University Hospital, EA 4489, Lille, France
| | - Elsa Heyman
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France.
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Kooman JP, Stenvinkel P, Shiels PG, Feelisch M, Canaud B, Kotanko P. The oxygen cascade in patients treated with hemodialysis and native high-altitude dwellers: lessons from extreme physiology to benefit patients with end-stage renal disease. Am J Physiol Renal Physiol 2020; 320:F249-F261. [PMID: 33356957 DOI: 10.1152/ajprenal.00540.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients treated with hemodialysis (HD) repeatedly undergo intradialytic low arterial oxygen saturation and low central venous oxygen saturation, reflecting an imbalance between upper body systemic oxygen supply and demand, which are associated with increased mortality. Abnormalities along the entire oxygen cascade, with impaired diffusive and convective oxygen transport, contribute to the reduced tissue oxygen supply. HD treatment impairs pulmonary gas exchange and reduces ventilatory drive, whereas ultrafiltration can reduce tissue perfusion due to a decline in cardiac output. In addition to these factors, capillary rarefaction and reduced mitochondrial efficacy can further affect the balance between cellular oxygen supply and demand. Whereas it has been convincingly demonstrated that a reduced perfusion of heart and brain during HD contributes to organ damage, the significance of systemic hypoxia remains uncertain, although it may contribute to oxidative stress, systemic inflammation, and accelerated senescence. These abnormalities along the oxygen cascade of patients treated with HD appear to be diametrically opposite to the situation in Tibetan highlanders and Sherpa, whose physiology adapted to the inescapable hypobaric hypoxia of their living environment over many generations. Their adaptation includes pulmonary, vascular, and metabolic alterations with enhanced capillary density, nitric oxide production, and mitochondrial efficacy without oxidative stress. Improving the tissue oxygen supply in patients treated with HD depends primarily on preventing hemodynamic instability by increasing dialysis time/frequency or prescribing cool dialysis. Whether dietary or pharmacological interventions, such as the administration of L-arginine, fermented food, nitrate, nuclear factor erythroid 2-related factor 2 agonists, or prolyl hydroxylase 2 inhibitors, improve clinical outcome in patients treated with HD warrants future research.
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Affiliation(s)
- Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Paul G Shiels
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Martin Feelisch
- Clinical and Experimental Sciences and Integrative Physiology and Critical Illness Group, Faculty of Medicine, Southampton General Hospital and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Bernard Canaud
- Montpellier University, School of Medicine, Montpellier, France & Global Medical Office, Fresenius Medical Care, Bad Homburg, Germany
| | - Peter Kotanko
- Renal Research Institute, New York, New York.,Icahn School of Medicine at Mount Sinai, New York, New York
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Bogdándi V, Ditrói T, Bátai IZ, Sándor Z, Minnion M, Vasas A, Galambos K, Buglyó P, Pintér E, Feelisch M, Nagy P. Nitrosopersulfide (SSNO -) Is a Unique Cysteine Polysulfidating Agent with Reduction-Resistant Bioactivity. Antioxid Redox Signal 2020; 33:1277-1294. [PMID: 32316739 DOI: 10.1089/ars.2020.8049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims: The aim of the present study was to investigate the biochemical properties of nitrosopersulfide (SSNO-), a key intermediate of the nitric oxide (NO)/sulfide cross talk. Results: We obtained corroborating evidence that SSNO- is indeed a major product of the reaction of S-nitrosothiols with hydrogen sulfide (H2S). It was found to be relatively stable (t1/2 ∼1 h at room temperature) in aqueous solution of physiological pH, stabilized by the presence of excess sulfide and resistant toward reduction by other thiols. Furthermore, we here show that SSNO- escapes the reducing power of the NADPH-driven biological reducing machineries, the thioredoxin and glutathione reductase systems. The slow decomposition of SSNO- produces inorganic polysulfide species, which effectively induce per/polysulfidation on glutathione or protein cysteine (Cys) residues. Our data also demonstrate that, in contrast to the transient activation by inorganic polysulfides, SSNO- induces long-term potentiation of TRPA1 (transient receptor potential ankyrin 1) channels, which may be due to its propensity to generate a slow flux of polysulfide in situ. Innovation: The characterized properties of SSNO- would seem to represent unique features in cell signaling by enabling sulfur and nitrogen trafficking within the reducing environment of the cytosol, with targeted release of both NO and polysulfide equivalents. Conclusion: SSNO- is a surprisingly stable bioactive product of the chemical interaction of S-nitrosothiol species and H2S that is resistant to reduction by the thioredoxin and glutathione systems. As well as generating NO, it releases inorganic polysulfides, enabling transfer of sulfane sulfur species to peptide/protein Cys residues. The sustained activation of TRPA1 channels by SSNO- is most likely linked to all these properties.
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Affiliation(s)
- Virág Bogdándi
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, Budapest, Hungary
| | - Tamás Ditrói
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, Budapest, Hungary
| | - István Zoárd Bátai
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Sándor
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Anita Vasas
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, Budapest, Hungary.,Department of Inorganic and Analytical Chemistry, University of Debrecen, Debrecen, Hungary
| | - Klaudia Galambos
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, Budapest, Hungary
| | - Péter Buglyó
- Department of Inorganic and Analytical Chemistry, University of Debrecen, Debrecen, Hungary
| | - Erika Pintér
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Péter Nagy
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, Budapest, Hungary
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Dushianthan A, Clark H, Madsen J, Mogg R, Matthews L, Berry L, de la Serna JB, Batchelor J, Brealey D, Hussell T, Porter J, Djukanovic R, Feelisch M, Postle A, Grocott MPW. Nebulised surfactant for the treatment of severe COVID-19 in adults (COV-Surf): A structured summary of a study protocol for a randomized controlled trial. Trials 2020; 21:1014. [PMID: 33302976 PMCID: PMC7726271 DOI: 10.1186/s13063-020-04944-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES SARS-Cov-2 virus preferentially binds to the Angiotensin Converting Enzyme 2 (ACE2) on alveolar epithelial type II cells, initiating an inflammatory response and tissue damage which may impair surfactant synthesis contributing to alveolar collapse, worsening hypoxia and leading to respiratory failure. The objective of this study is to evaluate the feasibility, safety and efficacy of nebulised surfactant in COVID-19 adult patients requiring mechanical ventilation for respiratory failure. TRIAL DESIGN This study is a dose-escalating randomized open-label clinical trial of 20 COVID-19 patients. PARTICIPANTS This study is conducted in two centres: University Hospital Southampton and University College London Hospitals. Eligible participants are aged ≥18, hospitalised with COVID-19 (confirmed by PCR), who require endotracheal intubation and are enrolled within 24 hours of mechanical ventilation. For patients unable to consent, assent is obtained from a personal legal representative (PerLR) or professional legal representative (ProfLR) prior to enrolment. The following are exclusion criteria: imminent expected death within 24 hours; specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary hemorrhage); known or suspected pregnancy; stage 4 chronic kidney disease or requiring dialysis (i.e., eGFR < 30); liver failure (Child-Pugh Class C); anticipated transfer to another hospital, which is not a study site, within 72 hours; current or recent (within 1 month) participation in another study that, in the opinion of the investigator, would prevent enrollment for safety reasons; and declined consent or assent. INTERVENTION AND COMPARATOR Intervention: The study is based on an investigational drug/device combination product. The surfactant product is Bovactant (Alveofact®), a natural animal derived (bovine) lung surfactant formulated as a lyophilized powder in 108 mg vials and reconstituted to 45 mg/mL in buffer supplied in a prefilled syringe. It is isolated by lung lavage and, by weight, is a mixture of: phospholipid (75% phosphatidylcholine, 13% phosphatidylglycerol, 3% phosphatidylethanolamine, 1% phosphatidylinositol and 1% sphingomyelin), 5% cholesterol, 1% lipid-soluble surfactant-associated proteins (SP-B and SP-C), very low levels of free fatty acid, lyso-phosphatidylcholine, water and 0.3% calcium. The Drug Delivery Device is the AeroFact-COVID™ nebulizer, an investigational device based on the Aerogen® Solo vibrating mesh nebulizer. The timing and escalation dosing plans for the surfactant are as follows. Cohort 1: Three patients will receive 10 vials (1080 mg) each of surfactant at dosing times of 0 hours, 8 hours and 24 hours. 2 controls with no placebo intervention. Cohort 2: Three patients will receive 10 vials (1080 mg) of surfactant at dosing times of 0 hours and 8 hours, and 30 vials (3240 mg) at a dosing time of 24 hours. 2 controls with no placebo intervention. Cohort 3: Three patients will receive 10 vials (1080 mg) of surfactant at a dosing time of 0 hours, and 30 vials (3240 mg) at dosing times of 8 hours and 24 hours. 2 controls with no placebo intervention. Cohort 4: Three patients will receive 30 (3240 mg) vials each of surfactant at dosing times of 0 hours, 8 hours and 24 hours. 2 controls. 2 controls with no placebo intervention. The trial steering committee, advised by the data monitoring committee, will review trial progression and dose escalation/maintenance/reduction after each cohort is completed (48-hour primary outcome timepoint reached) based on available feasibility, adverse event, safety and efficacy data. The trial will not be discontinued on the basis of lack of efficacy. The trial may be stopped early on the basis of safety or feasibility concerns. Comparator: No placebo intervention. All participants will receive usual standard of care in accordance with the local policies for mechanically ventilated patients and all other treatments will be left to the discretion of the attending physician. MAIN OUTCOMES The co-primary outcome is the improvement in oxygenation (PaO2/FiO2 ratio) and pulmonary ventilation (Ventilation Index (VI), where VI = [RR x (PIP - PEEP) × PaCO2]/1000) at 48 hours after study initiation. The secondary outcomes include frequency and severity of adverse events (AEs), Adverse Device Effects (ADEs), Serious Adverse Events (SAEs) and Serious Adverse Device Events (SADEs), change in pulmonary compliance, change in positive end-expiratory pressure (PEEP) requirement of ventilatory support at 24 and 48 hours after study initiation, clinical improvement defined by time to one improvement point on the ordinal scale described in the WHO master protocol (2020) recorded while hospitalised, days of mechanical ventilation, mechanical ventilator free days (VFD) at day 21, length of intensive care unit stay, number of days hospitalised and mortality at day 28. Exploratory end points will include quantification of SARS-CoV-2 viral load from tracheal aspirates using PCR, surfactant dynamics (synthesis and turnover) and function (surface tension reduction) from deep tracheal aspirate samples (DTAS), surfactant phospholipid concentrations in plasma and DTAS, inflammatory markers (cellular and cytokine) in plasma and DTAS, and blood oxidative stress markers. RANDOMISATION After informed assent, patients fulfilling inclusion criteria will be randomised to 3:2 for the treatment and control arms using an internet-based block randomization service (ALEA tool for clinical trials, FormsVision BV) in combination with electronic data collection. Randomisation will be done by the recruiting centre with a unique subject identifier specific to that centre. BLINDING (MASKING) This is an open-labelled unblinded study. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) The total sample size is 20 COVID-19 mechanically ventilated patients (12 intervention; 8 control). TRIAL STATUS Current protocol version is V2 dated 5th of June 2020. The recruitment is currently ongoing and started on the 14th of October 2020. The anticipated study completion date is November 2021. TRIAL REGISTRATION ClinicalTrials.gov: NCT04362059 (Registered 24 April 2020), EUDAMED number: CIV-GB-20-06-033328, EudraCT number: 2020-001886-35 (Registered 11 May 2020) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
- Ahilanandan Dushianthan
- Respiratory and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK. .,Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
| | - Howard Clark
- UCLH Biomedical Research Centre Infection and Immunity Theme, 149 Tottenham Court Road, London, W1T 7DN, UK.,EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London Hospital, Room 343, Medical School Building, 74, Huntley Street, London, WC1E 6AU, UK
| | - Jens Madsen
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London Hospital, Room 343, Medical School Building, 74, Huntley Street, London, WC1E 6AU, UK
| | - Robin Mogg
- Bill and Melinda Gates Medical Research Institute, 245 Main Street, Cambridge, MA02142, USA
| | - Lewis Matthews
- Respiratory and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Lee Berry
- Respiratory and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Jorge Bernardino de la Serna
- National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, London, SW7 2AZ, UK.,NIHR Imperial Biomedical Research Centre, London, SW7 2AZ, UK
| | - James Batchelor
- Clinical Informatics Research Unit (CIRU), University of Southampton, MP852, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - David Brealey
- Critical Care, University College Hospitals London, 235, Euston Road, London, NW1 2BU, UK
| | - Tracy Hussell
- The Lydia Becker Institute for Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Joanna Porter
- UCL Respiratory, University College London and Interstitial Lung Disease Service, University College London NHS Foundation Trust, London, UK
| | - Ratko Djukanovic
- Respiratory and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Martin Feelisch
- Respiratory and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Anthony Postle
- Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Michael P W Grocott
- Respiratory and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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Oldman AH, Martin DS, Feelisch M, Grocott MPW, Cumpstey AF. Effects of perioperative oxygen concentration on oxidative stress in adult surgical patients: a systematic review. Br J Anaesth 2020; 126:622-632. [PMID: 33246583 PMCID: PMC8014946 DOI: 10.1016/j.bja.2020.09.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/25/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background The fraction of inspired oxygen (FiO2) administered during general anaesthesia varies widely despite international recommendations to administer FiO2 0.8 to all anaesthetised patients to reduce surgical site infections (SSIs). Anaesthetists remain concerned that high FiO2 administration intraoperatively may increase harm, possibly through increased oxidative damage and inflammation, resulting in more complications and worse outcomes. In previous systematic reviews associations between FiO2 and SSIs have been inconsistent, but none have examined how FiO2 affects perioperative oxidative stress. We aimed to address this uncertainty by reviewing the available literature. Methods EMBASE, MEDLINE, and Cochrane databases were searched from inception to March 9, 2020 for RCTs comparing higher with lower perioperative FiO2 and quantifying oxidative stress in adults undergoing noncardiac surgery. Candidate studies were independently screened by two reviewers and references hand-searched. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias tool. Results From 19 438 initial results, seven trials (n=422) were included. Four studies reported markers of oxidative stress during Caesarean section (n=328) and three reported oxidative stress during elective colon surgery (n=94). Risk of bias was low (four studies) to moderate (three studies). Pooled results suggested high FiO2 was associated with greater malondialdehyde, protein-carbonyl concentrations and reduced xanthine oxidase concentrations, together with reduced antioxidant markers such as superoxide dismutase and total sulfhydryl levels although total antioxidant status was unchanged. Conclusions Higher FiO2 may be associated with elevated oxidative stress during surgery. However, limited studies have specifically reported biomarkers of oxidation. Given the current clinical controversy concerning perioperative oxygen therapy, further research is urgently needed in this area.
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Affiliation(s)
- Alexander H Oldman
- Critical Care Research Group, Southampton National Institute of Health Research, Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Daniel S Martin
- University of Plymouth, Plymouth Science Park, Plymouth, UK; Intensive Care Unit, Royal Free Hospital, London, UK
| | - Martin Feelisch
- Critical Care Research Group, Southampton National Institute of Health Research, Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Michael P W Grocott
- Critical Care Research Group, Southampton National Institute of Health Research, Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Andrew F Cumpstey
- Critical Care Research Group, Southampton National Institute of Health Research, Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
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Olson KR, Briggs A, Devireddy M, Iovino NA, Skora NC, Whelan J, Villa BP, Yuan X, Mannam V, Howard S, Gao Y, Minnion M, Feelisch M. Green tea polyphenolic antioxidants oxidize hydrogen sulfide to thiosulfate and polysulfides: A possible new mechanism underpinning their biological action. Redox Biol 2020; 37:101731. [PMID: 33002760 PMCID: PMC7527747 DOI: 10.1016/j.redox.2020.101731] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/11/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022] Open
Abstract
Matcha and green tea catechins such as (−)-epicatechin (EC), (−)-epigallocatechin (EGC) and (−)-epigallocatechin gallate (EGCG) have long been studied for their antioxidant and health-promoting effects. Using specific fluorophores for H2S (AzMC) and polysulfides (SSP4) as well as IC-MS and UPLC-MS/MS-based techniques we here show that popular Japanese and Chinese green teas and select catechins all catalytically oxidize hydrogen sulfide (H2S) to polysulfides with the potency of EGC > EGCG >> EG. This reaction is accompanied by the formation of sulfite, thiosulfate and sulfate, consumes oxygen and is partially inhibited by the superoxide scavenger, tempol, and superoxide dismutase but not mannitol, trolox, DMPO, or the iron chelator, desferrioxamine. We propose that the reaction proceeds via a one-electron autoxidation process during which one of the OH-groups of the catechin B-ring is autooxidized to a semiquinone radical and oxygen is reduced to superoxide, either of which can then oxidize HS− to thiyl radicals (HS•) which react to form hydrogen persulfide (H2S2). H2S oxidation reduces the B-ring back to the hydroquinone for recycling while the superoxide is reduced to hydrogen peroxide (H2O2). Matcha and catechins also concentration-dependently and rapidly produce polysulfides in HEK293 cells with the potency order EGCG > EGC > EG, an EGCG threshold of ~300 nM, and an EC50 of ~3 μM, suggesting green tea also acts as powerful pro-oxidant in vivo. The resultant polysulfides formed are not only potent antioxidants, but elicit a cascade of secondary cytoprotective effects, and we propose that many of the health benefits of green tea are mediated through these reactions. Remarkably, all green tea leaves constitutively contain small amounts of H2S2.
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Affiliation(s)
- Kenneth R Olson
- Indiana University School of Medicine - South Bend, South Bend, IN, 46617, USA; Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA.
| | - Austin Briggs
- Indiana University School of Medicine - South Bend, South Bend, IN, 46617, USA; Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Monesh Devireddy
- Indiana University School of Medicine - South Bend, South Bend, IN, 46617, USA
| | - Nicholas A Iovino
- Indiana University School of Medicine - South Bend, South Bend, IN, 46617, USA; Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Nicole C Skora
- Indiana University School of Medicine - South Bend, South Bend, IN, 46617, USA; Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Jenna Whelan
- Indiana University School of Medicine - South Bend, South Bend, IN, 46617, USA; Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Brian P Villa
- Indiana University School of Medicine - South Bend, South Bend, IN, 46617, USA; Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Xiaotong Yuan
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Varun Mannam
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Scott Howard
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Yan Gao
- Indiana University School of Medicine - South Bend, South Bend, IN, 46617, USA
| | - Magdalena Minnion
- NIHR Southampton Biomedical Research Center, University of Southampton, Southampton, General Hospital, Southampton, SO16 6YD, UK; Clinical & Experimental Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Martin Feelisch
- NIHR Southampton Biomedical Research Center, University of Southampton, Southampton, General Hospital, Southampton, SO16 6YD, UK; Clinical & Experimental Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
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Feelisch M, Akaike T, Griffiths K, Ida T, Prysyazhna O, Goodwin JJ, Gollop ND, Fernandez BO, Minnion M, Cortese-Krott MM, Borgognone A, Hayes RM, Eaton P, Frenneaux MP, Madhani M. Long-lasting blood pressure lowering effects of nitrite are NO-independent and mediated by hydrogen peroxide, persulfides, and oxidation of protein kinase G1α redox signalling. Cardiovasc Res 2020; 116:51-62. [PMID: 31372656 PMCID: PMC6918062 DOI: 10.1093/cvr/cvz202] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS Under hypoxic conditions, nitrite (NO2-) can be reduced to nitric oxide (NO) eliciting vasorelaxation. However, nitrite also exerts vasorelaxant effects of potential therapeutic relevance under normal physiological conditions via undetermined mechanisms. We, therefore, sought to investigate the mechanism(s) by which nitrite regulates the vascular system in normoxia and, specifically, whether the biological effects are a result of NO generation (as in hypoxia) or mediated via alternative mechanisms involving classical downstream targets of NO [e.g. effects on protein kinase G1α (PKG1α)]. METHODS AND RESULTS Ex vivo myography revealed that, unlike in thoracic aorta (conduit vessels), the vasorelaxant effects of nitrite in mesenteric resistance vessels from wild-type (WT) mice were NO-independent. Oxidants such as H2O2 promote disulfide formation of PKG1α, resulting in NO- cyclic guanosine monophosphate (cGMP) independent kinase activation. To explore whether the microvascular effects of nitrite were associated with PKG1α oxidation, we used a Cys42Ser PKG1α knock-in (C42S PKG1α KI; 'redox-dead') mouse that cannot transduce oxidant signals. Resistance vessels from these C42S PKG1α KI mice were markedly less responsive to nitrite-induced vasodilation. Intraperitoneal (i.p.) bolus application of nitrite in conscious WT mice induced a rapid yet transient increase in plasma nitrite and cGMP concentrations followed by prolonged hypotensive effects, as assessed using in vivo telemetry. In the C42S PKG1α KI mice, the blood pressure lowering effects of nitrite were lower compared to WT. Increased H2O2 concentrations were detected in WT resistance vessel tissue challenged with nitrite. Consistent with this, increased cysteine and glutathione persulfide levels were detected in these vessels by mass spectrometry, matching the temporal profile of nitrite's effects on H2O2 and blood pressure. CONCLUSION Under physiological conditions, nitrite induces a delayed and long-lasting blood pressure lowering effect, which is NO-independent and occurs via a new redox mechanism involving H2O2, persulfides, and PKG1α oxidation/activation. Targeting this novel pathway may provide new prospects for anti-hypertensive therapy.
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Affiliation(s)
- Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Takaaki Akaike
- Department of Environmental Medicine and Molecular Toxicology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Kayleigh Griffiths
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Tomoaki Ida
- Department of Environmental Medicine and Molecular Toxicology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Oleksandra Prysyazhna
- King's College of London, School of Cardiovascular Medicine & Sciences, The British Heart Foundation Centre of Excellence, The Rayne Institute, St Thomas' Hospital, London, SE1 7EH, UK
| | - Joanna J Goodwin
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Nicholas D Gollop
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Norwich Medical School, University of East Anglia, Bob Champion Research and Education Building, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Bernadette O Fernandez
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Miriam M Cortese-Krott
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, 40225, Germany
| | - Alessandra Borgognone
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rosie M Hayes
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Philip Eaton
- King's College of London, School of Cardiovascular Medicine & Sciences, The British Heart Foundation Centre of Excellence, The Rayne Institute, St Thomas' Hospital, London, SE1 7EH, UK
| | - Michael P Frenneaux
- Norwich Medical School, University of East Anglia, Bob Champion Research and Education Building, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Melanie Madhani
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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Affiliation(s)
- Christopher Torrens
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
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Alfredsson L, Armstrong BK, Butterfield DA, Chowdhury R, de Gruijl FR, Feelisch M, Garland CF, Hart PH, Hoel DG, Jacobsen R, Lindqvist PG, Llewellyn DJ, Tiemeier H, Weller RB, Young AR. Insufficient Sun Exposure Has Become a Real Public Health Problem. Int J Environ Res Public Health 2020; 17:E5014. [PMID: 32668607 PMCID: PMC7400257 DOI: 10.3390/ijerph17145014] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022]
Abstract
This article aims to alert the medical community and public health authorities to accumulating evidence on health benefits from sun exposure, which suggests that insufficient sun exposure is a significant public health problem. Studies in the past decade indicate that insufficient sun exposure may be responsible for 340,000 deaths in the United States and 480,000 deaths in Europe per year, and an increased incidence of breast cancer, colorectal cancer, hypertension, cardiovascular disease, metabolic syndrome, multiple sclerosis, Alzheimer's disease, autism, asthma, type 1 diabetes and myopia. Vitamin D has long been considered the principal mediator of beneficial effects of sun exposure. However, oral vitamin D supplementation has not been convincingly shown to prevent the above conditions; thus, serum 25(OH)D as an indicator of vitamin D status may be a proxy for and not a mediator of beneficial effects of sun exposure. New candidate mechanisms include the release of nitric oxide from the skin and direct effects of ultraviolet radiation (UVR) on peripheral blood cells. Collectively, this evidence indicates it would be wise for people living outside the tropics to ensure they expose their skin sufficiently to the sun. To minimize the harms of excessive sun exposure, great care must be taken to avoid sunburn, and sun exposure during high ambient UVR seasons should be obtained incrementally at not more than 5-30 min a day (depending on skin type and UV index), in season-appropriate clothing and with eyes closed or protected by sunglasses that filter UVR.
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Affiliation(s)
- Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institute, 171 77 Stockholm, Sweden;
| | - Bruce K. Armstrong
- School of Population and Global Health, The University of Western Australia, Perth 6009, Australia;
| | - D. Allan Butterfield
- Department of Chemistry and Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, USA;
| | - Rajiv Chowdhury
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK;
| | - Frank R. de Gruijl
- Department of Dermatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
| | - Martin Feelisch
- Clinical & Experimental Sciences, University of Southampton Medical School and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK;
| | - Cedric F. Garland
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA 92093, USA;
| | - Prue H. Hart
- Telethon Kids Institute, University of Western Australia, Perth 6872, Australia;
| | - David G. Hoel
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ramune Jacobsen
- Department of Pharmacy, University of Copenhagen, DK-2100 Copenhagen, Denmark;
| | - Pelle G. Lindqvist
- Department of Clinical Science and Education, Karolinska Institute, 171 77 Stockholm, Sweden;
| | - David J. Llewellyn
- College of Medicine and Health, University of Exeter Medical School, Exeter EX1 2LU, UK;
| | - Henning Tiemeier
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02115, USA;
| | - Richard B. Weller
- Centre for Inflammation Research, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Antony R. Young
- St John’s Institute of Dermatology, King’s College London, London SE1 9RT, UK;
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37
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Bourgonje AR, Feelisch M, Faber KN, Pasch A, Dijkstra G, van Goor H. Oxidative Stress and Redox-Modulating Therapeutics in Inflammatory Bowel Disease. Trends Mol Med 2020; 26:1034-1046. [PMID: 32620502 DOI: 10.1016/j.molmed.2020.06.006] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [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: 04/12/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with the production of reactive species that target cysteine redox switches in proteins, thereby affecting gene regulation, DNA damage, ion transport, intermediary metabolism, and mitochondrial function. Precursors of reactive species are derived from organic and inorganic compounds and their cofactors, including amino acids, vitamins, oxygen, nitrite, and sulfate. Nutrition and the gut microbiome fuel this process to a significant extent. The production of reactive species in IBD is reflected by a reduction in systemic free thiols, the major components of the antioxidant machinery. Systemic free thiols are amenable to nutritional or therapeutic intervention. This opens up future avenues for therapeutic modulation of redox status in IBD.
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Affiliation(s)
- Arno R Bourgonje
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Martin Feelisch
- Clinical and Experimental Sciences, University of Southampton School of Medicine and National Institute of Health Research (NIHR) Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Klaas Nico Faber
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andreas Pasch
- Institute for Physiology and Pathophysiology, Johannes Kepler University Linz, Linz, Austria
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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38
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Nguyen ITN, Klooster A, Minnion M, Feelisch M, Verhaar MC, van Goor H, Joles JA. Sodium thiosulfate improves renal function and oxygenation in L-NNA-induced hypertension in rats. Kidney Int 2020; 98:366-377. [PMID: 32605800 DOI: 10.1016/j.kint.2020.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 08/26/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/12/2022]
Abstract
Sodium thiosulfate, a reversible oxidation product of hydrogen sulfide, has vasodilating and anti-oxidative properties, making it an attractive agent to alleviate damaging effects of hypertension. In experimental settings, inhibition of nitric oxide synthase causes hypertension, renal dysfunction and damage. We hypothesized that thiosulfate would attenuate renal injury and improve renal function, hemodynamics and the efficiency of oxygen utilization for sodium reabsorption in hypertensive renal disease. Additionally, thiosulfate co-administration would further improve these variables when compared to inhibiting the renin-angiotensin system alone. Nitric oxide synthase was inhibited in Sprague Dawley rats by administering N-ω-nitro-L-arginine (L-NNA) in the food for three weeks. After one week, rats were split into two groups; without and with thiosulfate in the drinking water. In a parallel study, rats given N-ω-nitro-L-arginine and the angiotensin converting enzyme inhibitor lisinopril at a relatively low dose in their food were divided into two groups; without and with thiosulfate in the drinking water. Treatment with thiosulfate alleviated hypertension (mean 190 vs. 229 mmHg), lowered plasma urea (mean 11.3 vs. 20.0 mmol/L) and improved the terminal glomerular filtration rate (mean 503 vs. 260 μl/min/100 gbw), effective renal plasma flow (mean 919 vs. 514 μl/min/100 gbw) and oxygen utilization for sodium reabsorption (mean 14.3 vs. 8.6 μmol/μmol). Combining thiosulfate with lisinopril further lowered renal vascular resistance (mean 43 vs. 63 mmHg/ml/min/100 gbw) and prevented glomerulosclerosis. Thus, our results suggest that thiosulfate has therapeutic potential in hypertensive renal disease and might be of value when added to standard antihypertensive therapies.
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Affiliation(s)
- Isabel T N Nguyen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Astrid Klooster
- Department of Pathology and Medical Biology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, Southampton General Hospital and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, Southampton General Hospital and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.
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Weller RB, Wang Y, He J, Maddux FW, Usvyat L, Zhang H, Feelisch M, Kotanko P. Does Incident Solar Ultraviolet Radiation Lower Blood Pressure? J Am Heart Assoc 2020; 9:e013837. [PMID: 32106744 PMCID: PMC7335547 DOI: 10.1161/jaha.119.013837] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
Background Hypertension remains a leading global cause for premature death and disease. Most treatment guidelines emphasize the importance of risk factors, but not all are known, modifiable, or easily avoided. Population blood pressure correlates with latitude and is lower in summer than winter. Seasonal variations in sunlight exposure account for these differences, with temperature believed to be the main contributor. Recent research indicates that UV light enhances nitric oxide availability by mobilizing storage forms in the skin, suggesting incident solar UV radiation may lower blood pressure. We tested this hypothesis by exploring the association between environmental UV exposure and systolic blood pressure (SBP) in a large cohort of chronic hemodialysis patients in whom SBP is determined regularly. Methods and Results We studied 342 457 patients (36% black, 64% white) at 2178 US dialysis centers over 3 years. Incident UV radiation and temperature data for each clinic location were retrieved from the National Oceanic and Atmospheric Administration database. Linear mixed effects models with adjustment for ambient temperature, sex/age, body mass index, serum Na+/K+ and other covariates were fitted to each location and combined estimates of associations calculated using the DerSimonian and Laird procedure. Pre-dialysis SBP varied by season and was ≈4 mm Hg higher in black patients. Temperature, UVA and UVB were all linearly and inversely associated with SBP. This relationship remained statistically significant after correcting for temperature. Conclusions In hemodialysis patients, in addition to environmental temperature, incident solar UV radiation is associated with lower SBP. This raises the possibility that insufficient sunlight is a new risk factor for hypertension, perhaps even in the general population.
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Affiliation(s)
- Richard B. Weller
- Center for Inflammation ResearchUniversity of EdinburghUnited Kingdom
| | - Yuedong Wang
- Department of Statistics & Applied ProbabilityUniversity of California ‐ Santa BarbaraSanta BarbaraCA
| | - Jingyi He
- Department of Statistics & Applied ProbabilityUniversity of California ‐ Santa BarbaraSanta BarbaraCA
| | | | - Len Usvyat
- Integrated Care AnalyticsFresenius Medical Care North AmericaWalthamMA
| | | | - Martin Feelisch
- Clinical & Experimental SciencesFaculty of Medicine, and Institute for Life SciencesSouthampton General HospitalUniversity of SouthamptonUnited Kingdom
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40
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Terstappen F, Clarke SM, Joles JA, Ross CA, Garrett MR, Minnion M, Feelisch M, van Goor H, Sasser JM, Lely AT. Sodium Thiosulfate in the Pregnant Dahl Salt-Sensitive Rat, a Model of Preeclampsia. Biomolecules 2020; 10:biom10020302. [PMID: 32075042 PMCID: PMC7072460 DOI: 10.3390/biom10020302] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 11/16/2022] Open
Abstract
Aberrant production of hydrogen sulfide (H2S) has been linked to preeclampsia. We hypothesized that sodium thiosulfate (STS), a H2S donor, reduces hypertension and proteinuria, and diminishes fetal growth restriction in the Dahl salt-sensitive (S) rat, a spontaneous model of superimposed preeclampsia. In addition to a control group (n = 13), two groups received STS via drinking water at a dose of 2 g (n = 9) or 3 g per kg body weight per day (n = 8) from gestational day (GD) 10 to 20. Uterine artery resistance index was measured (GD18), urinary protein excretion rate was determined (GD19), and blood pressure and fetal outcomes were evaluated (GD20). At 2 g, STS had no effect on preeclamptic symptoms or fetal outcome. At 3 g, STS reduced maternal hypertension (121.8 ± 3.0 vs. 136.3 ± 2.9), but increased proteinuria (89 ± 15 vs. 56 ± 5 mg/24h), and relative kidney weight (0.86 ± 0.04 vs. 0.73 ± 0.02%). Fetal/placental weight ratio was reduced (3.83 ± 0.07 vs. 4.31 ± 0.08) without affecting litter size. No differences in uterine artery flow or renal histological damage were noted across treatment groups. While these data suggest a promising antihypertensive effect that could imply prolongation of preeclamptic pregnancies, the unfavorable effects on proteinuria, kidney weight, and fetal/placental weight ratio implies that clinical implementation of STS is contra-indicated until safety for mother and child can be verified.
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Affiliation(s)
- Fieke Terstappen
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands; (S.M.C.); (A.T.L.)
- Department of Developmental Origins of Disease (DDOD), Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-88-757-7251
| | - Sinéad M. Clarke
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands; (S.M.C.); (A.T.L.)
| | - Jaap A. Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands;
| | - Courtney A Ross
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA; (C.A.R.); (M.R.G.); (J.M.S.)
| | - Michael R. Garrett
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA; (C.A.R.); (M.R.G.); (J.M.S.)
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (M.M.); (M.F.)
- NIHR Southampton Biomedical Research Center, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (M.M.); (M.F.)
- NIHR Southampton Biomedical Research Center, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands;
| | - Jennifer M. Sasser
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA; (C.A.R.); (M.R.G.); (J.M.S.)
| | - A. Titia Lely
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands; (S.M.C.); (A.T.L.)
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41
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Ntessalen M, Procter NEK, Feelisch M, Crichton PG, Frenneaux MP. Reply to TA Schiffer et al. Am J Clin Nutr 2020; 111:487-488. [PMID: 32016355 DOI: 10.1093/ajcn/nqz317] [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: 11/13/2022] Open
Affiliation(s)
- Maria Ntessalen
- From the Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Nathan E K Procter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Martin Feelisch
- From the Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Paul G Crichton
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Michael P Frenneaux
- From the Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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42
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Dhamrait GK, Panchal K, Fleury NJ, Abel TN, Ancliffe MK, Crew RC, Croft K, Fernandez BO, Minnion M, Hart PH, Lucas RM, Mark PJ, Feelisch M, Weller RB, Matthews V, Gorman S. Characterising nitric oxide-mediated metabolic benefits of low-dose ultraviolet radiation in the mouse: a focus on brown adipose tissue. Diabetologia 2020; 63:179-193. [PMID: 31713010 DOI: 10.1007/s00125-019-05022-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
Abstract
AIMS/HYPOTHESIS Exposure to sunlight has the potential to suppress metabolic dysfunction and obesity. We previously demonstrated that regular exposure to low-doses of ultraviolet radiation (UVR) reduced weight gain and signs of diabetes in male mice fed a high-fat diet, in part via release of nitric oxide from skin. Here, we explore further mechanistic pathways through which low-dose UVR exerts these beneficial effects. METHODS We fed mice with a luciferase-tagged Ucp1 gene (which encodes uncoupling protein-1 [UCP-1]), referred to here as the Ucp1 luciferase transgenic mouse ('Thermomouse') a high-fat diet and examined the effects of repeated exposure to low-dose UVR on weight gain and development of metabolic dysfunction as well as UCP-1-dependent thermogenesis in interscapular brown adipose tissue (iBAT). RESULTS Repeated exposure to low-dose UVR suppressed the development of glucose intolerance and hepatic lipid accumulation via dermal release of nitric oxide while also reducing circulating IL-6 (compared with mice fed a high-fat diet only). Dietary nitrate supplementation did not mimic the effects of low-dose UVR. A single low dose of UVR increased UCP-1 expression (by more than twofold) in iBAT of mice fed a low-fat diet, 24 h after exposure. However, in mice fed a high-fat diet, there was no effect of UVR on UCP-1 expression in iBAT (compared with mock-treated mice) when measured at regular intervals over 12 weeks. More extensive circadian studies did not identify any substantial shifts in UCP-1 expression in mice exposed to low-dose UVR, although skin temperature at the interscapular site was reduced in UVR-exposed mice. The appearance of cells with a white adipocyte phenotype ('whitening') in iBAT induced by consuming the high-fat diet was suppressed by exposure to low-dose UVR in a nitric oxide-dependent fashion. Significant shifts in the expression of important core gene regulators of BAT function (Dio2, increased more than twofold), fatty acid transport (increased Fatp2 [also known as Slc27a2]), lipolysis (decreased Atgl [also known as Pnpla2]), lipogenesis (decreased Fasn) and inflammation (decreased Tnf), and proportions of macrophages (increased twofold) were observed in iBAT of mice exposed to low-dose UVR. These effects were independent of nitric oxide released from skin. CONCLUSIONS/INTERPRETATION Our results suggest that non-burning (low-dose) UVR suppresses the BAT 'whitening', steatotic and pro-diabetic effects of consuming a high-fat diet through skin release of nitric oxide, with some metabolic and immune pathways in iBAT regulated by UVR independently of nitric oxide.
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Affiliation(s)
- Gursimran K Dhamrait
- Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, WA, 6782, Australia
| | - Kunjal Panchal
- Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, WA, 6782, Australia
| | - Naomi J Fleury
- Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, WA, 6782, Australia
| | - Tamara N Abel
- Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, WA, 6782, Australia
| | - Mathew K Ancliffe
- Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, WA, 6782, Australia
| | - Rachael C Crew
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Kevin Croft
- School of Biomedical Science - Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Bernadette O Fernandez
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Prue H Hart
- Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, WA, 6782, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
| | - Peter J Mark
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Richard B Weller
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Vance Matthews
- School of Biomedical Science - Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Shelley Gorman
- Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, WA, 6782, Australia.
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Ntessalen M, Procter NEK, Schwarz K, Loudon BL, Minnion M, Fernandez BO, Vassiliou VS, Vauzour D, Madhani M, Constantin‐Teodosiu D, Horowitz JD, Feelisch M, Dawson D, Crichton PG, Frenneaux MP. Inorganic nitrate and nitrite supplementation fails to improve skeletal muscle mitochondrial efficiency in mice and humans. Am J Clin Nutr 2020; 111:79-89. [PMID: 31599928 PMCID: PMC6944528 DOI: 10.1093/ajcn/nqz245] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/03/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Inorganic nitrate, abundant in leafy green vegetables and beetroot, is thought to have protective health benefits. Adherence to a Mediterranean diet reduces the incidence and severity of coronary artery disease, whereas supplementation with nitrate can improve submaximal exercise performance. Once ingested, oral commensal bacteria may reduce nitrate to nitrite, which may subsequently be reduced to nitric oxide during conditions of hypoxia and in the presence of "nitrite reductases" such as heme- and molybdenum-containing enzymes. OBJECTIVE We aimed to explore the putative effects of inorganic nitrate and nitrite on mitochondrial function in skeletal muscle. METHODS Mice were subjected to a nitrate/nitrite-depleted diet for 2 wk, then supplemented with sodium nitrate, sodium nitrite, or sodium chloride (1 g/L) in drinking water ad libitum for 7 d before killing. Skeletal muscle mitochondrial function and expression of uncoupling protein (UCP) 3, ADP/ATP carrier protein (AAC) 1 and AAC2, and pyruvate dehydrogenase (PDH) were assessed by respirometry and Western blotting. Studies were also undertaken in human skeletal muscle biopsies from a cohort of coronary artery bypass graft patients treated with either sodium nitrite (30-min infusion of 10 μmol/min) or vehicle [0.9% (wt:vol) saline] 24 h before surgery. RESULTS Neither sodium nitrate nor sodium nitrite supplementation altered mitochondrial coupling efficiency in murine skeletal muscle, and expression of UCP3, AAC1, or AAC2, and PDH phosphorylation status did not differ between the nitrite and saline groups. Similar results were observed in human samples. CONCLUSIONS Sodium nitrite failed to improve mitochondrial metabolic efficiency, rendering this mechanism implausible for the purported exercise benefits of dietary nitrate supplementation. This trial was registered at clinicaltrials.gov as NCT04001283.
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Affiliation(s)
- Maria Ntessalen
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Nathan E K Procter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Konstantin Schwarz
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Brodie L Loudon
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Magdalena Minnion
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | | | - David Vauzour
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Melanie Madhani
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Dumitru Constantin‐Teodosiu
- Medical Research Council/Arthritis Research UK Centre for Musculoskeletal Ageing Research, National Institute for Health Research Nottingham Biomedical Research Centre, School of Life Sciences, Nottingham University Medical School, Nottingham, United Kingdom
| | - John D Horowitz
- Department of Cardiology, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Dana Dawson
- Department of Cardiology, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Paul G Crichton
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Michael P Frenneaux
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom,Norwich Medical School, University of East Anglia, Norwich, United Kingdom,Address correspondence to MPF (E-mail: )
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Lespagnol E, Dauchet L, Pawlak-Chaouch M, Balestra C, Berthoin S, Feelisch M, Roustit M, Boissière J, Fontaine P, Heyman E. Early Endothelial Dysfunction in Type 1 Diabetes Is Accompanied by an Impairment of Vascular Smooth Muscle Function: A Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:203. [PMID: 32362871 PMCID: PMC7180178 DOI: 10.3389/fendo.2020.00203] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 01/10/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background: A large yet heterogeneous body of literature exists suggesting that endothelial dysfunction appears early in type 1 diabetes, due to hyperglycemia-induced oxidative stress. The latter may also affect vascular smooth muscles (VSM) function, a layer albeit less frequently considered in that pathology. This meta-analysis aims at evaluating the extent, and the contributing risk factors, of early endothelial dysfunction, and of the possible concomitant VSM dysfunction, in type 1 diabetes. Methods: PubMed, Web of Sciences, Cochrane Library databases were screened from their respective inceptions until October 2019. We included studies comparing vasodilatory capacity depending or not on endothelium (i.e., endothelial function or VSM function, respectively) in patients with uncomplicated type 1 diabetes and healthy controls. Results: Fifty-eight articles studying endothelium-dependent function, among which 21 studies also assessed VSM, were included. Global analyses revealed an impairment of standardized mean difference (SMD) (Cohen's d) of endothelial function: -0.61 (95% CI: -0.79, -0.44) but also of VSM SMD: -0.32 (95% CI: -0.57, -0.07). The type of stimuli used (i.e., exercise, occlusion-reperfusion, pharmacological substances, heat) did not influence the impairment of the vasodilatory capacity. Endothelial dysfunction appeared more pronounced within macrovascular than microvascular beds. The latter was particularly altered in cases of poor glycemic control [HbA1c > 67 mmol/mol (8.3%)]. Conclusions: This meta-analysis not only corroborates the presence of an early impairment of endothelial function, even in response to physiological stimuli like exercise, but also highlights a VSM dysfunction in children and adults with type 1 diabetes. Endothelial dysfunction seems to be more pronounced in large than small vessels, fostering the debate on their relative temporal appearance.
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Affiliation(s)
- Elodie Lespagnol
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Luc Dauchet
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Mehdi Pawlak-Chaouch
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Costantino Balestra
- Environmental and Occupational (Integrative) Physiology Laboratory, Haute École Bruxelles-Brabant HE2B, Brussels, Belgium
| | - Serge Berthoin
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Matthieu Roustit
- Univ. Grenoble Alpes, HP2, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Julien Boissière
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Pierre Fontaine
- Département d'endocrinologie, Diabète et maladies métaboliques, Hôpital Huriez, Université de Lille, Lille, France
| | - Elsa Heyman
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
- *Correspondence: Elsa Heyman
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Abstract
Reactive oxygen species (ROS) are essential for cellular signaling and physiological function. An imbalance between ROS production and antioxidant protection results in a state of oxidative stress (OS), which is associated with perturbations in reduction/oxidation (redox) regulation, cellular dysfunction, organ failure, and disease. The pathophysiology of OS is closely interlinked with inflammation, mitochondrial dysfunction, and, in the case of surgery, ischemia/reperfusion injury (IRI). Perioperative OS is a complex response that involves patient, surgical, and anesthetic factors. The magnitude of tissue injury inflicted by the surgery affects the degree of OS, and both duration and nature of the anesthetic procedure applied can modify this. Moreover, the interindividual susceptibility to the impact of OS is likely to be highly variable and potentially linked to underlying comorbidities. The pathological link between OS and postoperative complications remains unclear, in part due to the complexities of measuring ROS- and OS-mediated damage. Exogenous antioxidant use and exercise have been shown to modulate OS and may have potential as countermeasures to improve postoperative recovery. A better understanding of the underlying mechanisms of OS, redox signaling, and regulation can provide an opportunity for patient-specific phenotyping and development of targeted interventions to reduce the disruption that surgery can cause to our physiology. Anesthesiologists are in a unique position to deliver countermeasures to OS and improve physiological resilience. To shy away from a process so fundamental to the welfare of these patients would be foolhardy and negligent, thus calling for an improved understanding of this complex facet of human biology.
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Affiliation(s)
- Jia L Stevens
- From the Division of Surgery and Interventional Science, Royal Free Hospital, University College London, London, United Kingdom
- Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free Hospital, London, United Kingdom
| | - Martin Feelisch
- Clinical and Experimental Sciences and Integrative Physiology and Critical Illness Group, Faculty of Medicine, Southampton General Hospital and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Daniel S Martin
- From the Division of Surgery and Interventional Science, Royal Free Hospital, University College London, London, United Kingdom
- Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free Hospital, London, United Kingdom
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Cumpstey AF, Hennis PJ, Gilbert-Kawai ET, Fernandez BO, Grant D, Jenner W, Poudevigne M, Moyses H, Levett DZ, Cobb A, Meale P, Mitchell K, Pöhnl H, Mythen MG, Grocott MP, Martin DS, Feelisch M. Effects of dietary nitrate supplementation on microvascular physiology at 4559 m altitude - A randomised controlled trial (Xtreme Alps). Nitric Oxide 2019; 94:27-35. [PMID: 31604146 PMCID: PMC6970220 DOI: 10.1016/j.niox.2019.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/28/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022]
Abstract
Native highlanders (e.g. Sherpa) demonstrate remarkable hypoxic tolerance, possibly secondary to higher levels of circulating nitric oxide (NO) and increased microcirculatory blood flow. As part of the Xtreme Alps study (a randomised placebo-controlled trial of dietary nitrate supplementation under field conditions of hypobaric hypoxia), we investigated whether dietary supplementation with nitrate could improve NO availability and microvascular blood flow in lowlanders. Plasma measurements of nitrate, nitrite and nitroso species were performed together with measurements of sublingual (sidestream dark-field camera) and forearm blood flow (venous occlusion plethysmography) in 28 healthy adult volunteers resident at 4559 m for 1 week; half receiving a beetroot-based high-nitrate supplement and half receiving an identically-tasting low nitrate ‘placebo’. Dietary supplementation increased plasma nitrate concentrations 4-fold compared to the placebo group, both at sea level (SL; 19.2 vs 76.9 μM) and at day 5 (D5) of high altitude (22.9 vs 84.3 μM, p < 0.001). Dietary nitrate supplementation also significantly increased both plasma nitrite (0.78 vs. 0.86 μM SL, 0.31 vs. 0.41 μM D5, p = 0.03) and total nitroso product (11.3 vs. 19.7 nM SL, 9.7 vs. 12.3 nM D5, p < 0.001) levels both at sea level and at 4559 m. However, plasma nitrite concentrations were more than 50% lower at 4559 m compared to sea level in both treatment groups. Despite these significant changes, dietary nitrate supplementation had no effect on any measured read-outs of sublingual or forearm blood flow, even when environmental hypoxia was experimentally reversed using supplemental oxygen. In conclusion, dietary nitrate supplementation does not improve microcirculatory function at 4559 m. Xtreme Alps is a randomised controlled field study of dietary nitrate at altitude. Dietary nitrate significantly increased plasma nitrate, nitrite & nitroso species. No changes in sublingual blood flow were seen in response to high dietary nitrate. Dietary nitrate did not alter forearm blood flow under any experimental condition. Dietary nitrate supplementation did not improve microcirculatory function at 4559 m
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Affiliation(s)
- Andrew F Cumpstey
- Critical Care Research Area, Southampton, NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Philip J Hennis
- UCL Centre for Altitude, Space and Extreme Environment (CASE) Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport Exercise & Health, 170 Tottenham Court Road, London, W1T 7HA, UK
| | - Edward T Gilbert-Kawai
- UCL Centre for Altitude, Space and Extreme Environment (CASE) Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport Exercise & Health, 170 Tottenham Court Road, London, W1T 7HA, UK
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Warwick Medical School, Division of Metabolic and Vascular Health, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Daniel Grant
- UCL Centre for Altitude, Space and Extreme Environment (CASE) Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport Exercise & Health, 170 Tottenham Court Road, London, W1T 7HA, UK
| | - William Jenner
- UCL Centre for Altitude, Space and Extreme Environment (CASE) Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport Exercise & Health, 170 Tottenham Court Road, London, W1T 7HA, UK
| | - Matthieu Poudevigne
- Clinical & Experimental Sciences, Faculty of Medicine, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Helen Moyses
- Clinical & Experimental Sciences, Faculty of Medicine, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Denny Zh Levett
- Critical Care Research Area, Southampton, NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Alexandra Cobb
- UCL Centre for Altitude, Space and Extreme Environment (CASE) Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport Exercise & Health, 170 Tottenham Court Road, London, W1T 7HA, UK
| | - Paula Meale
- UCL Centre for Altitude, Space and Extreme Environment (CASE) Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport Exercise & Health, 170 Tottenham Court Road, London, W1T 7HA, UK
| | - Kay Mitchell
- Critical Care Research Area, Southampton, NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Helmut Pöhnl
- AURAPA, Paul-Heidelbauer-Straße 26, 74321, Bietigheim-Bissingen, Germany
| | - Monty G Mythen
- UCL Centre for Altitude, Space and Extreme Environment (CASE) Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport Exercise & Health, 170 Tottenham Court Road, London, W1T 7HA, UK
| | - Michael Pw Grocott
- Critical Care Research Area, Southampton, NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Daniel S Martin
- UCL Centre for Altitude, Space and Extreme Environment (CASE) Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport Exercise & Health, 170 Tottenham Court Road, London, W1T 7HA, UK.
| | - Martin Feelisch
- Critical Care Research Area, Southampton, NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK; Clinical & Experimental Sciences, Faculty of Medicine, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Warwick Medical School, Division of Metabolic and Vascular Health, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
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Borgognone A, Shantsila E, Worrall SM, Prompunt E, Loka T, Loudon BL, Chimen M, Ed Rainger G, Lord JM, Turner A, Nightingale P, Feelisch M, Kirchhof P, Lip GYH, Watson SP, Frenneaux MP, Madhani M. Nitrite circumvents platelet resistance to nitric oxide in patients with heart failure preserved ejection fraction and chronic atrial fibrillation. Cardiovasc Res 2019; 114:1313-1323. [PMID: 29659727 PMCID: PMC6054254 DOI: 10.1093/cvr/cvy087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/09/2018] [Indexed: 12/18/2022] Open
Abstract
Aims Heart failure (HF) is a pro-thrombotic state. Both platelet and vascular responses to nitric oxide (NO) donors are impaired in HF patients with reduced ejection fraction (HFrEF) compared with healthy volunteers (HVs) due to scavenging of NO, and possibly also reduced activity of the principal NO sensor, soluble guanylate cyclase (sGC), limiting the therapeutic potential of NO donors as anti-aggregatory agents. Previous studies have shown that nitrite inhibits platelet activation presumptively after its reduction to NO, but the mechanism(s) involved remain poorly characterized. Our aim was to compare the effects of nitrite on platelet function in HV vs. HF patients with preserved ejection fraction (HFpEF) and chronic atrial fibrillation (HFpEF–AF), vs. patients with chronic AF without HF, and to assess whether these effects occur independent of the interaction with other formed elements of blood. Methods and results Platelet responses to nitrite and the NO donor sodium nitroprusside (SNP) were compared in age-matched HV controls (n = 12), HFpEF–AF patients (n = 29), and chronic AF patients (n = 8). Anti-aggregatory effects of nitrite in the presence of NO scavengers/sGC inhibitor were determined and vasodilator-stimulated phosphoprotein (VASP) phosphorylation was assessed using western blotting. In HV and chronic AF, both nitrite and SNP inhibited platelet aggregation in a concentration-dependent manner. Inhibition of platelet aggregation by the NO donor SNP was impaired in HFpEF-AF patients compared with healthy and chronic AF individuals, but there was no impairment of the anti-aggregatory effects of nitrite. Nitrite circumvented platelet NO resistance independently of other blood cells by directly activating sGC and phosphorylating VASP. Conclusion We here show for the first time that HFpEF-AF (but not chronic AF without HF) is associated with marked impairment of platelet NO responses due to sGC dysfunction and nitrite circumvents the ‘platelet NO resistance’ phenomenon in human HFpEF, at least partly, by acting as a direct sGC activator independent of NO.
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Affiliation(s)
- Alessandra Borgognone
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Eduard Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham B18 7QH, UK
| | - Sophie M Worrall
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Eakkapote Prompunt
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Thomas Loka
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Brodie L Loudon
- Norwich Medical School, University of East Anglia, Norwich NR4 7UQ, UK
| | - Myriam Chimen
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - G Ed Rainger
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Ashley Turner
- Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham B18 7QH, UK
| | - Peter Nightingale
- Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TT, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham B18 7QH, UK
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham B18 7QH, UK
| | - Steve P Watson
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | | | - Melanie Madhani
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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van den Born JC, Frenay ARS, Koning AM, Bachtler M, Riphagen IJ, Minovíc I, Feelisch M, Dekker MM, Bulthuis MLC, Gansevoort RT, Hillebrands JL, Pasch A, Bakker SJL, van Goor H. Urinary Excretion of Sulfur Metabolites and Risk of Cardiovascular Events and All-Cause Mortality in the General Population. Antioxid Redox Signal 2019; 30:1999-2010. [PMID: 29905081 DOI: 10.1089/ars.2017.7040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aims: Thiosulfate and sulfate are metabolites of hydrogen sulfide (H2S), a gaseous signaling molecule with cardiovascular (CV) protective properties. Urinary thiosulfate excretion and sulfate excretion are associated with favorable disease outcome in high-risk patient groups. We investigated the relationship between urinary excretion of sulfur metabolites, and risk of CV events and all-cause mortality in the general population. Results: Subjects (n = 6839) of the Prevention of Renal and Vascular End-stage Disease (PREVEND) study were followed prospectively. At baseline, 24-h urinary excretion of thiosulfate and sulfate was determined. Median urinary thiosulfate and sulfate excretion values were 1.27 (interquartile range [IQR] 0.89-2.37) μmol/24 h and 15.7 (IQR 12.0-20.3) mmol/24 h, respectively. Neither thiosulfate nor sulfate excretion showed an independent association with risk of CV events. Sulfate, but not thiosulfate, was inversely associated with risk of all-cause mortality, independent of potential confounders (hazard ratio 0.73 [95% confidence interval 0.63-0.84], p < 0.001). This association appeared most pronounced for normolipidemic subjects (pinteraction = 0.019). Innovation: The strong association between sulfate excretion and mortality in the general population emphasizes the (patho)physiological importance of sulfate or its precursor H2S. Conclusion: We hypothesize that urinary sulfate excretion, which is inversely associated with all-cause mortality in the general population, holds clinical relevance as a beneficial modulator in health and disease. Antioxid. Redox Signal. 30, 1999-2010.
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Affiliation(s)
- Joost C van den Born
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Anne-Roos S Frenay
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Anne M Koning
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands.,2 Department of Surgery, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Matthias Bachtler
- 3 Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Ineke J Riphagen
- 4 Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands.,5 Top Institute Food and Nutrition, Wageningen, The Netherlands
| | - Isidor Minovíc
- 4 Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Martin Feelisch
- 6 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,7 NIHR Biomedical Research Centre, University of Southampton, Southampton, United Kingdom.,8 University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Marinda M Dekker
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Marian L C Bulthuis
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Ron T Gansevoort
- 4 Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Andreas Pasch
- 3 Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Stephan J L Bakker
- 4 Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands.,5 Top Institute Food and Nutrition, Wageningen, The Netherlands
| | - Harry van Goor
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
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Affiliation(s)
- Harald H H W Schmidt
- Department of Pharmacology & Personalised Medicine, Faculty of Health, Medicine & Life Science, Maastricht University, The Netherlands (H.H.H.W.S.)
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, UK (M.F.)
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50
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Curtis PJ, van der Velpen V, Berends L, Jennings A, Feelisch M, Umpleby AM, Evans M, Fernandez BO, Meiss MS, Minnion M, Potter J, Minihane AM, Kay CD, Rimm EB, Cassidy A. Blueberries improve biomarkers of cardiometabolic function in participants with metabolic syndrome-results from a 6-month, double-blind, randomized controlled trial. Am J Clin Nutr 2019; 109:1535-1545. [PMID: 31136659 PMCID: PMC6537945 DOI: 10.1093/ajcn/nqy380] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/10/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anthocyanin-rich blueberry intake is associated with reduced type 2 diabetes and cardiovascular disease (CVD) risk in prospective studies, although long-term randomized controlled trials (RCTs) have not been conducted in at-risk populations. OBJECTIVE In the longest-duration RCT to date, we examined the effect of 6-mo blueberry intake on insulin resistance and cardiometabolic function in metabolic syndrome. METHODS A double-blind, parallel RCT (n = 115; age 63 ± 7 y; 68% male; body mass index 31.2 ± 3.0 kg/m2) was conducted, which fed 2 dietarily achievable blueberry intakes [equivalent to 1/2 and 1 cup/d (75/150 g)] compared with matched placebo. Insulin resistance was assessed via the homeostasis model assessment of insulin resistance (primary endpoint) and confirmed by [6-6-2H2]-glucose-labeled, 2-step hyperinsulinemic clamp (n = 20). Clinically relevant cardiometabolic endpoints [including flow-mediated dilatation, augmentation index, lipoprotein status (by nuclear magnetic resonance spectroscopy), and nitric oxide (NO)-related metabolite assay] and anthocyanin metabolism were assessed. RESULTS A daily intake of 1 cup of blueberries improved endothelial function (flow-mediated dilatation: +1.45%; 95% CI: 0.83%, 2.1%; P = 0.003), systemic arterial stiffness (augmentation index: -2.24%; 95% CI: -3.97%, -0.61%; P = 0.04) and attenuated cyclic guanosine monophosphate concentrations. In statin nonusers (n = 71), elevated high-density lipoprotein cholesterol (+0.08 mmol/L; P = 0.03), high-density lipoprotein particle density (+0.48n, ×10-6; P = 0.002) and apolipoprotein A-I (+0.05 g/L; P = 0.01) concentrations were observed following the 1-cup/d intervention. Treatment compliance was 94.1% (wrapper returns) and total concentrations of anthocyanin-derived phenolic acid metabolites significantly increased, dose-dependently, in serum and 24-h urine (P < 0.01 and P < 0.001, respectively). Insulin resistance, pulse wave velocity, blood pressure, NO, and overall plasma thiol status were unaffected. Likewise, a half cup per day had no effect on any biomarkers. CONCLUSIONS Despite insulin resistance remaining unchanged we show, to our knowledge, the first sustained improvements in vascular function, lipid status, and underlying NO bioactivity following 1 cup blueberries/d. With effect sizes predictive of 12-15% reductions in CVD risk, blueberries should be included in dietary strategies to reduce individual and population CVD risk. This study was registered at clinicaltrials.gov as NCT02035592.
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Affiliation(s)
- Peter J Curtis
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Vera van der Velpen
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Lindsey Berends
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Amy Jennings
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - A Margot Umpleby
- Department of Nutritional Sciences, University of Surrey, Guildford, United Kingdom
| | - Mark Evans
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Bernadette O Fernandez
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mia S Meiss
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - John Potter
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Anne-Marie Minihane
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Colin D Kay
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Eric B Rimm
- Departments of Epidemiology & Nutrition, Harvard TH Chan School of Public Health, and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Aedín Cassidy
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom,Address correspondence to AC (e-mail: )
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