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Kong XY, Lauritzen KH, Dahl TB, Holm S, Olsen MB, Skjelland M, Nielsen C, Michelsen AE, Ueland T, Aukrust P, Halvorsen B, Sandanger Ø. CD38 deficient mice are not protected from atherosclerosis. Biochem Biophys Res Commun 2024; 705:149734. [PMID: 38430607 DOI: 10.1016/j.bbrc.2024.149734] [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: 02/18/2024] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
CD38 is a multifunctional enzyme implicated in chemotaxis of myeloid cells and lymphocyte activation, but also expressed by resident cells such as endothelial and smooth muscle cells. CD38 is important for host defense against microbes. However, CD38's role in the pathogenesis of atherosclerosis is controversial with seemingly conflicting results reported so far. To clarify the discrepancy of current literature on the effect of CD38 ablation on atherosclerosis development, we implanted a shear stress modifier around the right carotid artery in CD38-/- and WT mice. Hypercholesterolemia was induced by human gain-of-function PCSK9 (D374Y), introduced using AAV vector (serotype 9), combined with an atherogenic diet for a total of 9 weeks. Atherosclerosis was assessed at the aortic root, aortic arch and the right carotid artery. The findings can be summarized as follows: i) CD38-/- and WT mice had a similar atherosclerotic burden in all three locations, ii) No significant differences in monocyte infiltration or macrophage content could be seen in the plaques, and iii) The amount of collagen deposition in the plaques were also similar between CD38-/- and WT mice. In conclusion, our data suggest that CD38-/- mice are neither protected against nor prone to atherosclerosis compared to WT mice.
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Affiliation(s)
- Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Knut H Lauritzen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tuva Børresdatter Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Maria Belland Olsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mona Skjelland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Christopher Nielsen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway; Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Annika E Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Sandanger
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Weller J, Krzywicka K, van de Munckhof A, Dorn F, Althaus K, Bode FJ, Bandettini di Poggio M, Buck B, Kleinig T, Cordonnier C, Dizonno V, Duan J, Elkady A, Chew BLA, Garcia-Esperon C, Field TS, Legault C, Morin Martin M, Michalski D, Pelz J, Schoenenberger S, Nagel S, Petruzzellis M, Raposo N, Skjelland M, Zimatore DS, Aaron S, Sanchez van Kammen M, Aguiar de Sousa D, Lindgren E, Jood K, Scutelnic A, Heldner MR, Poli S, Arauz A, Conforto AB, Putaala J, Tatlisumak T, Arnold M, Coutinho JM, Günther A, Zimmermann J, Ferro JM. Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. Eur Stroke J 2024; 9:105-113. [PMID: 37771138 PMCID: PMC10916823 DOI: 10.1177/23969873231202363] [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: 07/06/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION There is little data on the role of endovascular treatment (EVT) of cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT). Here, we describe clinical characteristics and outcomes of CVST-VITT patients who were treated with EVT. PATIENTS AND METHODS We report data from an international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 6 March 2023. VITT was defined according to the Pavord criteria. RESULTS EVT was performed in 18/136 (13%) patients with CVST-VITT (92% aspiration and/or stent retrieval, 8% local thrombolysis). Most common indications were extensive thrombosis and clinical or radiological deterioration. Compared to non-EVT patients, those receiving EVT had a higher median thrombus load (4.5 vs 3). Following EVT, local blood flow was improved in 83% (10/12, 95% confidence interval [CI] 54-96). One (6%) asymptomatic sinus perforation occurred. Eight (44%) patients treated with EVT also underwent decompressive surgery. Mortality was 50% (9/18, 95% CI 29-71) and 88% (8/9, 95% CI 25-66) of surviving EVT patients achieved functional independence with a modified Rankin Scale score of 0-2 at follow-up. In multivariable analysis, EVT was not associated with increased mortality (adjusted odds ratio, 0.66, 95% CI 0.16-2.58). DISCUSSION AND CONCLUSION We describe the largest cohort of CVST-VITT patients receiving EVT. Half of the patients receiving EVT died during hospital admission, but most survivors achieved functional independence.
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Affiliation(s)
- Johannes Weller
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Felix J Bode
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, AB, Canada
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, Lille, France
| | - Vanessa Dizonno
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Jiangang Duan
- Department of Neurology and Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | | | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Legault
- Division of Neurology, McGill University Health Centre, Montreal, QC, Canada
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | | | - Johann Pelz
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Marco Petruzzellis
- Neuroradiology Unit, Azienda Ospedaliera Consorziale Policlinico di Bari, Italy
| | - Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France and Inserm, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mayte Sanchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Stroke Centre, Lisbon Central University Hospital, Lisbon, Portugal
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany and Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
| | - Adriana B Conforto
- Hospital das Clinicas/São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - José M Ferro
- Centro de Estudas Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Nome T, Enriquez B, Nome CG, Tennøe B, Lund CG, Skjelland M, Aamodt AH, Beyer M. Clinical outcome after thrombectomy in patients with MeVO stroke: importance of clinical and technical factors. J Neurol 2024; 271:877-886. [PMID: 37847291 PMCID: PMC10827971 DOI: 10.1007/s00415-023-12025-1] [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: 06/29/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Whereas high-level evidence has been proven for safety and efficacy of endovascular treatment (EVT) in large vessel occlusion (LVO) stroke, the evidence for EVT in medium vessel occlusion (MeVO) in both sexes and different age groupremains to be answered. The aim of this study was to evaluate the importance of clinical and technical parameters, focusing on sex, age and EVT procedural factors, on functional outcome in primary MeVO (pMeVO) strokes. METHODS 144 patients with pMeVO in the MCA territory from the Oslo Acute Reperfusion Stroke Study (OSCAR) were included. Clinical and radiological data were collected including 90-day mRS follow-up. RESULTS Successful reperfusion with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 123 patients (84%). Good functional outcome (mRS ≤ 2) at 90-day follow-up was achieved in 84 patients (61.8%). Two or more passes with stent retriever was associated with increased risk of SAH, poor mTICI and poor functional outcome. In average, women had 62 min longer ictus to recanalization time compared to men. Age over 80 years was significantly associated with poor outcome and death. CONCLUSION In pMeVO patients, TICI score and number of passes with stent retriever were the main technical factors predicting mRS ≤ 2. Good clinical outcome occurred almost twice as often in patients under 80 years of age compared to patients over 80 years. Women with MeVO strokes had significant longer time from ictus to recanalization; however, this did not affect the clinical outcome.
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Affiliation(s)
- Terje Nome
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Brian Enriquez
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cecilie G Nome
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, GliaLab and Letten Centre, University of Oslo, Oslo, Norway
| | - Bjørn Tennøe
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway.
| | - Mona Beyer
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Stø K, Skagen KR, Valeur J, Yang K, Bjerkeli V, Aukrust P, Skjelland M, Halvorsen B. Increased plasma levels of non-sugar sweeteners in patients with symptomatic carotid atherosclerosis. SCAND CARDIOVASC J 2023; 57:2205068. [PMID: 37102258 DOI: 10.1080/14017431.2023.2205068] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Purpose. The non-sugar sweeteners acesulfame K and saccharin are considered safe, but there is conflicting evidence on their effects on cardiovascular health. Materials and methods. In this explorative pilot study, we measured plasma levels of acesulfame K and saccharin in 15 patients with symptomatic carotid atherosclerosis, 18 asymptomatic patients and 15 control subjects. Fecal microbiota and short-chain fatty acids were analyzed. Dietary and medical history was assessed. Results. Symptomatic patients had higher levels of acesulfame K and saccharin compared to controls. Acesulfame K was associated with increased leukocyte count. Saccharin was associated with more severe carotid stenosis, as well as lower fecal butyric acid.
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Affiliation(s)
- Kristine Stø
- Institute of Clinical Medicine, University of Oslo, Norway
- Department of Neurology, Oslo University Hospital, Norway
| | | | - Jørgen Valeur
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Kuan Yang
- Institute of Clinical Medicine, University of Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Norway
| | | | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Norway
| | - Mona Skjelland
- Institute of Clinical Medicine, University of Oslo, Norway
- Department of Neurology, Oslo University Hospital, Norway
| | - Bente Halvorsen
- Institute of Clinical Medicine, University of Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Norway
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5
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Enriquez BAB, Nome T, Nome CG, Tennøe B, Lund CG, Beyer MK, Skjelland M, Aamodt AH. Predictors of outcome after endovascular treatment for tandem occlusions: a single center retrospective analysis. BMC Neurol 2023; 23:82. [PMID: 36849925 PMCID: PMC9969668 DOI: 10.1186/s12883-023-03127-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The endovascular treatment procedure in tandem occlusions (TO) is complex compared to single occlusion (SO) and optimal management remains uncertain. The aim of this study was to identify clinical and procedural factors that may be associated to efficacy and safety in the management of TO and compare functional outcome in TO and SO stroke patients. METHODS This is a retrospective single center study of medium (MeVO) and large vessel occlusion (LVO) of the anterior circulation. Clinical, imaging, and interventional data were analyzed to identify predictive factors for symptomatic intracranial hemorrhage (sICH) and functional outcome after endovascular treatment (EVT) in TO. Functional outcome in TO and SO patients was compared. RESULTS Of 662 anterior circulation stroke patients with MeVO and LVO stroke, 90 (14%) had TO. Stenting was performed in 73 (81%) of TO patients. Stent thromboses occurred in 8 (11%) patients. Successful reperfusion with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 82 (91%). SICH occurred in seven (8%). The strongest predictors for sICH were diabetes mellitus and number of stent retriever passes. Good functional clinical outcome (mRS ≤ 2) at 90-day follow up was similar in TO and SO patients (58% vs 59% respectively). General anesthesia (GA) was associated with good functional outcome whereas hemorrhage in the infarcted tissue, lower mTICI score and history of smoking were associated with poor outcome. CONCLUSIONS The risk of sICH was increased in patients with diabetes mellitus and those with extra stent-retriever attempts. Functional clinical outcomes in patients with TO were comparable to patients with SO.
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Affiliation(s)
| | - Terje Nome
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
| | - Cecilie G. Nome
- grid.55325.340000 0004 0389 8485Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Tennøe
- grid.55325.340000 0004 0389 8485Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Christian G. Lund
- grid.55325.340000 0004 0389 8485Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona K. Beyer
- grid.55325.340000 0004 0389 8485Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mona Skjelland
- grid.55325.340000 0004 0389 8485Department of Neurology, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Hege Aamodt
- grid.55325.340000 0004 0389 8485Department of Neurology, Oslo University Hospital, Oslo, Norway
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6
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Krzywicka K, Aguiar de Sousa D, Cordonnier C, Bode FJ, Field TS, Michalski D, Pelz J, Skjelland M, Wiedmann M, Zimmermann J, Wittstock M, Zanotti B, Ciccone A, Bandettini di Poggio M, Borhani-Haghighi A, Chatterton S, Aujayeb A, Devroye A, Dizonno V, Geeraerts T, Giammello F, Günther A, Ichaporia NR, Kleinig T, Kristoffersen ES, Lemmens R, De Maistre E, Mirzaasgari Z, Payen JF, Putaala J, Petruzzellis M, Raposo N, Sadeghi-Hokmabadi E, Schoenenberger S, Umaiorubahan M, Sylaja PN, van de Munckhof A, Sánchez van Kammen M, Lindgren E, Jood K, Scutelnic A, Heldner MR, Poli S, Kruip MJHA, Arauz A, Conforto AB, Aaron S, Middeldorp S, Tatlisumak T, Arnold M, Coutinho JM, Ferro JM. Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. Eur J Neurol 2023; 30:1335-1345. [PMID: 36773014 DOI: 10.1111/ene.15735] [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: 11/22/2022] [Revised: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in-hospital mortality in these patients are explored. METHODS Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680-1689), were included. RESULTS Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p < 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p < 0.001) and bilaterally absent pupillary reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p = 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent. CONCLUSIONS Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.
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Affiliation(s)
- Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- Stroke Centre, Lisbon Central University Hospital Center, Lisbon, Portugal.,CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Charlotte Cordonnier
- INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, University of Lille, Lille, France
| | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Markus Wiedmann
- Department of Surgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Bruno Zanotti
- Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy
| | - Alfonso Ciccone
- Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy
| | | | | | - Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Vanessa Dizonno
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, University Toulouse 3-Paul-Sabatier, University Hospital of Toulouse, Hôpital Pierre-Paul Riquet, CHU Toulouse-Purpan, Toulouse, France
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXVI Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Stroke Unit, Department of Clinical and Experimental Medicine, Polyclinic Hospital G. Martino, Messina, Italy
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Espen S Kristoffersen
- Department of Neurology, Akershus University Hospital, Oslo, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Emmanuel De Maistre
- Laboratoire d'Hématologie-Hémostase, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Jean-Francois Payen
- Department of Anaesthesia and Intensive Care, Grenoble Alpes University Hospital, and Grenoble Alpes University, Grenoble Institut des Neurosciences, INSERM U1216, Grenoble, France
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Inserm, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Elyar Sadeghi-Hokmabadi
- Department of Neurology, Imam-Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Padmavathy N Sylaja
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany.,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Antonio Arauz
- National Institute of Neurology and Surgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Adriana B Conforto
- Hospital das Clinicas/São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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7
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van de Munckhof A, Borhani-Haghighi A, Aaron S, Krzywicka K, Poli S, Cordonnier C, Kleinig TJ, Lemmens R, Sanchez van Kammen M, Scutelnic A, Lindgren E, Mbroh J, Ciccone A, Wittstock M, Zimmermann J, Bode FJ, Skjelland M, Devroye A, Duan J, Hiltunen S, Petruzzellis M, Kremer Hovinga JA, Günther A, Jood K, Tatlisumak T, Putaala J, Heldner M, Arnold M, Aguiar De Sousa D, Wasay M, Arauz A, Conforto AB, Ferro JM, Coutinho JM. Abstract 112: Cerebral Venous Sinus Thrombosis Due To Vaccine-induced Immune Thrombotic Thrombocytopenia In Middle-Income Countries. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.112] [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] [Indexed: 02/05/2023]
Abstract
Introduction:
Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). In India alone, 1.67 billion ChAdOx1 nCoV-19 vaccines have been administered by August 23, 2022. Surprisingly however, there are only few reports of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) from LMICs. We aimed to gain insight into the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs.
Methods:
We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared characteristics of CVST-VITT cases from LMICs to cases from high-income countries (HICs).
Results:
By August 15, 2022, 228 CVST cases after vaccination were reported, of which 63 cases from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, and Turkiye). Of these, 32/63 (51%) met the criteria for definite, probable or possible VITT. Only 5/32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-PF4 antibodies were not tested in 21/32 (66%) cases. Patients from MICs were diagnosed in a later time period than patients from HICs (1/32 [3%] vs 65/103 [63%] cases diagnosed before May 2021, respectively). Median age was 26 (IQR 20-37) vs 47 (IQR 32-58) years, and proportion of women was 25/32 (78%) vs 77/103 (75%) in MICs vs HICs, respectively. Clinical manifestations, such as focal neurologic deficits, coma, seizures, and intracranial hemorrhages, were similar. Concomitant venous thromboembolism was less frequent in MICs (3/31 [10%] vs 26/97 [27%]). Median platelet count nadir was higher in the MICs than the HICs group (65 x10
9
/L [IQR 36-115] vs 33 x10
9
/L [IQR 18-55],
p
=0.001). Intravenous immunoglobulin use was similar (19/30 [63%] vs 63/99 [64%]). In-hospital mortality was lower in the MICs than the HICs group (7/32 [22%, 95%CI 11-39] vs 44/102 [43%, 95%CI 34-53],
p
=0.031).
Conclusions:
The absolute number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines in these countries. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
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Affiliation(s)
| | | | | | | | - Sven Poli
- Dept of Neurology & Stroke, Hertie Institute for Clinical Brain Rsch, Tuebingen, Germany
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | | | | | | | | | | | - Joshua Mbroh
- Dept of Neurology & Stroke, Eberhard-Karls Univ, Tuebingen, Germany
| | - Alfonso Ciccone
- Carlo Poma Hosp, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | | | | | - Felix J Bode
- Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | | | | | - Jiangang Duan
- Neurology, Xuanwu Hosp, Capital Med Univ, Beijing, China
| | | | | | | | | | | | | | - Jukka Putaala
- Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
| | - Mirjam Heldner
- Inselspital, Bern Univ Hosp, Univ of Bern, Bern, Switzerland
| | - Marcel Arnold
- Inselspital, Bern Univ Hosp, Univ of Bern, Bern, Switzerland
| | | | | | - Antonio Arauz
- Instituto Nacional de Neurologia, Mexico City, Mexico
| | | | - Jose M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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8
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Fontaine MAC, Jin H, Gagliardi M, Rousch M, Wijnands E, Stoll M, Li X, Schurgers L, Reutelingsperger C, Schalkwijk C, van den Akker NMS, Molin DG, Gullestad L, Eritsland J, Hoffman P, Skjelland M, Andersen GØ, Aukrust P, Karel J, Smirnov E, Halvorsen B, Temmerman L, Biessen EA. Blood Milieu in Acute Myocardial Infarction Reprograms Human Macrophages for Trauma Repair. Adv Sci (Weinh) 2023; 10:e2203053. [PMID: 36526599 PMCID: PMC9929255 DOI: 10.1002/advs.202203053] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/06/2022] [Indexed: 06/17/2023]
Abstract
Acute myocardial infarction (AMI) is accompanied by a systemic trauma response that impacts the whole body, including blood. This study addresses whether macrophages, key players in trauma repair, sense and respond to these changes. For this, healthy human monocyte-derived macrophages are exposed to 20% human AMI (n = 50) or control (n = 20) serum and analyzed by transcriptional and multiparameter functional screening followed by network-guided data interpretation and drug repurposing. Results are validated in an independent cohort at functional level (n = 47 AMI, n = 25 control) and in a public dataset. AMI serum exposure results in an overt AMI signature, enriched in debris cleaning, mitosis, and immune pathways. Moreover, gene networks associated with AMI and with poor clinical prognosis in AMI are identified. Network-guided drug screening on the latter unveils prostaglandin E2 (PGE2) signaling as target for clinical intervention in detrimental macrophage imprinting during AMI trauma healing. The results demonstrate pronounced context-induced macrophage reprogramming by the AMI systemic environment, to a degree decisive for patient prognosis. This offers new opportunities for targeted intervention and optimized cardiovascular disease risk management.
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9
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Seim BE, Holt MF, Ratajska A, Michelsen A, Ringseth MM, Halvorsen BE, Skjelland M, Kvitting JPE, Lundblad R, Krohg-Sørensen K, Osnes LTN, Aukrust P, Paus B, Ueland T. Markers of extracellular matrix remodeling and systemic inflammation in patients with heritable thoracic aortic diseases. Front Cardiovasc Med 2022; 9:1073069. [PMID: 36606286 PMCID: PMC9808784 DOI: 10.3389/fcvm.2022.1073069] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/29/2022] [Indexed: 01/07/2023] Open
Abstract
Background In approximately 20% of patients with thoracic aortic aneurysms or dissections a heritable thoracic aortic disease (HTAD) is suspected. Several monogenic connective tissue diseases imply high risk of aortic disease, including both non-syndromic and syndromic forms. There are some studies assessing inflammation and extracellular matrix remodeling in patients with non-hereditary aortic disease, but such studies in patients with hereditary diseases are scarce. Aims To quantify markers of extracellular matrix (ECM) and inflammation in patients with vascular connective tissue diseases versus healthy controls. Methods Patients with Loeys-Dietz syndrome (LDS, n = 12), Marfan syndrome (MFS, n = 11), and familial thoracic aortic aneurysm 6 (FTAA6, n = 9), i.e., actin alpha 2 (ACTA2) pathogenic variants, were recruited. Exome or genome sequencing was performed for genetic diagnosis. Several markers of inflammation and ECM remodeling were measured in plasma by enzyme immunoassays. Flow cytometry of T-cell subpopulations was performed on a subgroup of patients. For comparison, blood samples were drawn from 14 healthy controls. Results (i) All groups of HTAD patients had increased levels matrix metalloproteinase-9 (MMP-9) as compared with healthy controls, also in adjusted analyses, reflecting altered ECM remodeling. (ii) LDS patients had increased levels of pentraxin 3 (PTX3), reflecting systemic inflammation. (iii) LDS patients have increased levels of soluble CD25, a marker of T-cell activation. Conclusion Our data suggest that upregulated MMP-9, a matrix degrading enzyme, is a common feature of several subgroups of HTAD. In addition, LDS patients have increased levels of PTX3 reflecting systemic and in particular vascular inflammation.
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Affiliation(s)
- Bjørn Edvard Seim
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Margrethe Flesvig Holt
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway,*Correspondence: Margrethe Flesvig Holt,
| | | | - Annika Michelsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Bente Evy Halvorsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - John-Peder Escobar Kvitting
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Runar Lundblad
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Liv T. N. Osnes
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Faculty of Health Sciences, K. G. Jebsen Thrombosis Research Center, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
| | - Benedicte Paus
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway,Faculty of Health Sciences, K. G. Jebsen Thrombosis Research Center, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
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10
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van de Munckhof A, Lindgren E, Kleinig TJ, Field TS, Cordonnier C, Krzywicka K, Poli S, Sánchez van Kammen M, Borhani-Haghighi A, Lemmens R, Scutelnic A, Ciccone A, Gattringer T, Wittstock M, Dizonno V, Devroye A, Elkady A, Günther A, Cervera A, Mengel A, Chew BLA, Buck B, Zanferrari C, Garcia-Esperon C, Jacobi C, Soriano C, Michalski D, Zamani Z, Blacquiere D, Johansson E, Cuadrado-Godia E, Vuillier F, Bode FJ, Caparros F, Maier F, Tsivgoulis G, Katzberg HD, Duan J, Burrow J, Pelz J, Mbroh J, Oen J, Schouten J, Zimmermann J, Ng K, Garambois K, Petruzzellis M, Carvalho Dias M, Ghiasian M, Romoli M, Miranda M, Wronski M, Skjelland M, Almasi-Dooghaee M, Cuisenier P, Murphy S, Timsit S, Coutts SB, Schönenberger S, Nagel S, Hiltunen S, Chatterton S, Cox T, Bartsch T, Shaygannejad V, Mirzaasgari Z, Middeldorp S, Levi MM, Kremer Hovinga JA, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, Aguiar de Sousa D, Ferro JM, Coutinho JM. Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase. Stroke 2022; 53:3206-3210. [PMID: 36082668 PMCID: PMC9508952 DOI: 10.1161/strokeaha.122.039575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization. METHODS We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization). RESULTS Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed). CONCLUSIONS In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
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Affiliation(s)
- Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.)
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia (T.J.K.)
| | - Thalia S Field
- Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (T.S.F., V.D.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (C.C., F.C.)
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.).,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Germany. (S.P., J.M.)
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | | | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (R.L., A.D.)
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy (A. Ciccone)
| | | | - Matthias Wittstock
- Department of Neurology, University Hospital Rostock, Germany (M. Wittstock)
| | - Vanessa Dizonno
- Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (T.S.F., V.D.)
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Belgium (R.L., A.D.)
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia (A.E.)
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Germany (A.G.)
| | - Alvaro Cervera
- Royal Darwin Hospital, Darwin, Northern Territory, Australia (A. Cervera)
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.)
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, Australia (B.L.A.C., C.G.-E.)
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Canada (B.B.)
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Italy (C.Z.)
| | - Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, Australia (B.L.A.C., C.G.-E.)
| | - Christian Jacobi
- Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany (C.J.)
| | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain (C.S.)
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Germany (D.M., J. Pelz)
| | - Zohreh Zamani
- Department of Neurology, Firoozabadi Hospital, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran. (Z.Z.)
| | | | - Elias Johansson
- Department Clinical Science, Wallenberg Center for Molecular Medicine (WCMM), Umeå University, Sweden (E.J.)
| | - Elisa Cuadrado-Godia
- Department of Neurology, University Hospital del Mar, Barcelona, Spain (E.C.-G.)
| | | | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Germany (F.J.B., J.Z.)
| | - François Caparros
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (C.C., F.C.)
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Germany (F.M.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T.)
| | - Hans D Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Canada (H.D.K.)
| | - Jiangang Duan
- Department of Neurology and Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China (J.D.)
| | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Australia (J.B.)
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Germany (D.M., J. Pelz)
| | - Joshua Mbroh
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.).,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Germany. (S.P., J.M.)
| | - Joyce Oen
- Department of Neurology, Antonius Ziekenhuis, Sneek, the Netherlands (J.O.)
| | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, the Netherlands (J.S.)
| | - Julian Zimmermann
- Department of Neurology, Universitätsklinikum Bonn, Germany (F.J.B., J.Z.)
| | - Karl Ng
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Katia Garambois
- Department of Neurology, CHU Grenoble Alpes, France (K.G., P.C.)
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Italy (M.P.)
| | - Mariana Carvalho Dias
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Portugal (M.C.D.)
| | - Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Iran (M.G.)
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M.R.)
| | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal (M.M.)
| | - Miriam Wronski
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Norway (M.S.)
| | | | | | - Seán Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, UCD School of Medicine and RCSI Medical School, Dublin, Ireland (S. Murphy)
| | - Serge Timsit
- Department of Neurology, Stroke Unit, Hôpital de la Cavale Blanche, CHRU de Brest (University Hospital), Université de Bretagne Occidentale, Inserm 1078, Brest, France (S.T.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Canada (S.B.C.)
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Germany (S.S., S.N.)
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, United Kingdom (T.C.)
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany (T.B.)
| | - Vahid Shaygannejad
- Isfahan University of Medical Sciences (IUMS), Isfahan Neurosciences Research Center (INRC), Iran (V.S.).,Department of Internal (INRC), Iran (V.S.)
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran. (M.A.-D., Z.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (S. Middeldorp)
| | - Marcel M Levi
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (M.M.L.).,National Institute for Health Research, University College London Hospitals (UCLH), Biomedical Research Centre, London, United Kingdom (M.M.L.)
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (J.A.K.H.)
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.)
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Diana Aguiar de Sousa
- Stroke Centre, Lisbon Central University Hospital Centre, Portugal (D.A.d.S.).,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.)
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.)
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
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11
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Lund C, Skjelland M, Brækken SK, Dietrichs E. David Russell. Tidsskriftet 2022. [DOI: 10.4045/tidsskr.22.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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12
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Scutelnic A, Krzywicka K, Mbroh J, van de Munckhof A, van Kammen MS, de Sousa DA, Lindgren E, Jood K, Günther A, Hiltunen S, Putaala J, Tiede A, Maier F, Kern R, Bartsch T, Althaus K, Ciccone A, Wiedmann M, Skjelland M, Medina A, Cuadrado-Godia E, Cox T, Aujayeb A, Raposo N, Garambois K, Payen JF, Vuillier F, Franchineau G, Timsit S, Bougon D, Dubois MC, Tawa A, Tracol C, De Maistre E, Bonneville F, Vayne C, Mengel A, Michalski D, Pelz J, Wittstock M, Bode F, Zimmermann J, Schouten J, Buture A, Murphy S, Palma V, Negro A, Gutschalk A, Nagel S, Schoenenberger S, Frisullo G, Zanferrari C, Grillo F, Giammello F, Martin MM, Cervera A, Burrow J, Esperon CG, Chew BLA, Kleinig TJ, Soriano C, Zimatore DS, Petruzzellis M, Elkady A, Miranda MS, Fernandes J, Vogel ÅH, Johansson E, Philip AP, Coutts SB, Bal S, Buck B, Legault C, Blacquiere D, Katzberg HD, Field TS, Dizonno V, Gattringer T, Jacobi C, Devroye A, Lemmens R, Kristoffersen ES, di Poggio MB, Ghiasian M, Karapanayiotides T, Chatterton S, Wronski M, Ng K, Kahnis R, Geeraerts T, Reiner P, Cordonnier C, Middeldorp S, Levi M, van Gorp ECM, van de Beek D, Brodard J, Kremer Hovinga JA, Kruip MJHA, Tatlisumak T, Ferro JM, Coutinho JM, Arnold M, Poli S, Heldner MR. Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination. Ann Neurol 2022; 92:562-573. [PMID: 35689346 PMCID: PMC9349982 DOI: 10.1002/ana.26431] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 01/01/2023]
Abstract
Objective Cerebral venous thrombosis (CVT) caused by vaccine‐induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus‐based severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non‐heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. Methods We used data from an international prospective registry of patients with CVT after the adenovirus‐based SARS‐CoV‐2 vaccination. We analyzed possible, probable, or definite VITT‐CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. Results Ninety‐nine patients with VITT‐CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in‐line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16–1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06–0.58). Treatment with non‐heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24–2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74–6.54). Conclusions In patients with VITT‐CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT‐CVT. ANN NEUROL 2022;92:562–573
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Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joshua Mbroh
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany.,Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andreas Tiede
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Saarbrücken, Germany
| | - Rolf Kern
- Department of Neurology, Kempten Hospital, Kempten, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Markus Wiedmann
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Antonio Medina
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Katia Garambois
- Stroke Unit, University Hospital of Grenoble, Grenoble, France
| | | | | | - Guillaume Franchineau
- Department of Intensive Care, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France
| | - Serge Timsit
- Neurology and Stroke Unit, Centre Hospitalier Universitaire de Brest, CHU Brest, Brest, France
| | - David Bougon
- Department of Critical Care, Annecy Genevois Hospital, Annecy, France
| | - Marie-Cécile Dubois
- Department of Anesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - Audrey Tawa
- Department of Anesthesia and Intensive Care, University Hospital of Rennes, Rennes, France
| | | | | | - Fabrice Bonneville
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Caroline Vayne
- Department of Hematology and Hemostasis, Tours University Hospital, Tours, France
| | - Annerose Mengel
- Department of Neurology and Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | | | - Felix Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - Alina Buture
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Vincenzo Palma
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Alberto Negro
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Alexander Gutschalk
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Giovanni Frisullo
- Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Melegnano, Italy
| | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXV Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | - Alvaro Cervera
- Department of Neurology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Carlos Garcia Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain
| | | | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Miguel S Miranda
- Department of Neurology, Hospital de Cascais Dr José de Almeida, Cascais, Portugal
| | - João Fernandes
- Department of Neurology, Norra Älvsborgs Länssjukhus, Trollhattan, Sweden
| | | | - Elias Johansson
- Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå, Sweden
| | | | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Simerpreet Bal
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Catherine Legault
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dylan Blacquiere
- Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hans D Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Vanessa Dizonno
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | | | - Christian Jacobi
- Department of Neurology, Nordwest Hospital, Frankfurt am Main, Germany
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | | | - Sophie Chatterton
- Department of Neurology, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Miriam Wronski
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Karl Ng
- Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Kahnis
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Thomas Geeraerts
- Department of Anaesthesiology and Critical Care, University Toulouse 3-Paul-Sabatier, University Hospital of Toulouse, Hôpital Pierre-Paul Riquet, CHU Toulouse-Purpan, Toulouse, France
| | - Peggy Reiner
- Service de neurologie, hôpital Lariboisière Université Paris-7, AP-HP, Paris Cedex 10, France
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Saskia Middeldorp
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Levi
- National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Justine Brodard
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Turgut Tatlisumak
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany.,Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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13
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Enriquez BA, Tennøe B, Nome T, Gjertsen Ø, Nedregaard B, Sletteberg R, Skattør T, Sökjer M, Johansen H, Skagen KR, Skjelland M, Aamodt AH, Lund CG. Mekanisk trombektomi ved akutt hjerneinfarkt. Tidsskr Nor Laegeforen 2022; 142:21-0577. [PMID: 35510464 DOI: 10.4045/tidsskr.21.0577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Mechanical thrombectomy is now the standard treatment for acute ischaemic stroke with occlusion of a carotid or intercranial artery. With occlusions of this type, thrombolytic treatment often has limited effect. The therapeutic outcome with the use of thrombectomy is time-dependent, and a personalised approach to indication is always necessary. To achieve the best possible results, the main prerequisites are good clinical procedures, an optimal patient pathway, high neuroradiological competence and coordinated, interdisciplinary teams.
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Affiliation(s)
| | - Bjørn Tennøe
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Terje Nome
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Øyvind Gjertsen
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Bård Nedregaard
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Ruth Sletteberg
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Thor Skattør
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Martin Sökjer
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | | | | | - Mona Skjelland
- Nevrologisk avdeling, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
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14
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Niyonzima N, Rahman J, Kunz N, West EE, Freiwald T, Desai JV, Merle NS, Gidon A, Sporsheim B, Lionakis MS, Evensen K, Lindberg B, Skagen K, Skjelland M, Singh P, Haug M, Ruseva MM, Kolev M, Bibby J, Marshall O, O’Brien B, Deeks N, Afzali B, Clark RJ, Woodruff TM, Pryor M, Yang ZH, Remaley AT, Mollnes TE, Hewitt SM, Yan B, Kazemian M, Kiss MG, Binder CJ, Halvorsen B, Espevik T, Kemper C. Mitochondrial C5aR1 activity in macrophages controls IL-1β production underlying sterile inflammation. Sci Immunol 2021; 6:eabf2489. [PMID: 34932384 PMCID: PMC8902698 DOI: 10.1126/sciimmunol.abf2489] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While serum-circulating complement destroys invading pathogens, intracellularly active complement, termed the “complosome,” functions as a vital orchestrator of cell-metabolic events underlying T cell effector responses. Whether intracellular complement is also nonredundant for the activity of myeloid immune cells is currently unknown. Here, we show that monocytes and macrophages constitutively express complement component (C) 5 and generate autocrine C5a via formation of an intracellular C5 convertase. Cholesterol crystal sensing by macrophages induced C5aR1 signaling on mitochondrial membranes, which shifted ATP production via reverse electron chain flux toward reactive oxygen species generation and anaerobic glycolysis to favor IL-1β production, both at the transcriptional level and processing of pro–IL-1β. Consequently, atherosclerosis-prone mice lacking macrophage-specific C5ar1 had ameliorated cardiovascular disease on a high-cholesterol diet. Conversely, inflammatory gene signatures and IL-1β produced by cells in unstable atherosclerotic plaques of patients were normalized by a specific cell-permeable C5aR1 antagonist. Deficiency of the macrophage cell-autonomous C5 system also protected mice from crystal nephropathy mediated by folic acid. These data demonstrate the unexpected intracellular formation of a C5 convertase and identify C5aR1 as a direct modulator of mitochondrial function and inflammatory output from myeloid cells. Together, these findings suggest that the complosome is a contributor to the biologic processes underlying sterile inflammation and indicate that targeting this system could be beneficial in macrophage-dependent diseases, such as atherosclerosis.
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Affiliation(s)
- Nathalie Niyonzima
- Center of Molecular Inflammation Research (CEMIR), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jubayer Rahman
- Complement and Inflammation Research Section (CIRS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Natalia Kunz
- Complement and Inflammation Research Section (CIRS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Erin E. West
- Complement and Inflammation Research Section (CIRS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Tilo Freiwald
- Immunoregulation Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, MD 20892, USA
| | - Jigar V. Desai
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nicolas S. Merle
- Complement and Inflammation Research Section (CIRS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Alexandre Gidon
- Center of Molecular Inflammation Research (CEMIR), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Bjørnar Sporsheim
- Center of Molecular Inflammation Research (CEMIR), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Administration, St. Olavs Hospital, University Hospital in Trondheim, Trondheim, Norway
| | - Michail S. Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kristin Evensen
- Department of Neurology, Vestre Viken, Drammen Hospital, Drammen, Norway
| | - Beate Lindberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Parul Singh
- Complement and Inflammation Research Section (CIRS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Markus Haug
- Center of Molecular Inflammation Research (CEMIR), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Norway Regional Health Authority, St. Olavs Hospital HF, Trondheim, Norway
| | - Marieta M. Ruseva
- BG2, Adaptive Immunity Research Unit, GlaxoSmithKline, Stevenage, UK
| | - Martin Kolev
- BG2, Adaptive Immunity Research Unit, GlaxoSmithKline, Stevenage, UK
| | - Jack Bibby
- Complement and Inflammation Research Section (CIRS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Olivia Marshall
- Discovery DMPK Bioanalysis Unit, GlaxoSmithKline, Stevenage, UK
| | - Brett O’Brien
- Discovery DMPK Bioanalysis Unit, GlaxoSmithKline, Stevenage, UK
| | - Nigel Deeks
- Discovery DMPK Bioanalysis Unit, GlaxoSmithKline, Stevenage, UK
| | - Behdad Afzali
- Immunoregulation Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, MD 20892, USA
| | - Richard J. Clark
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Trent M. Woodruff
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Milton Pryor
- Lipoprotein Metabolism Section, Cardiopulmonary Branch, NHLBI, NIH, Bethesda, MD 20892, USA
| | - Zhi-Hong Yang
- Lipoprotein Metabolism Section, Cardiopulmonary Branch, NHLBI, NIH, Bethesda, MD 20892, USA
| | - Alan T. Remaley
- Lipoprotein Metabolism Section, Cardiopulmonary Branch, NHLBI, NIH, Bethesda, MD 20892, USA
| | - Tom E. Mollnes
- Center of Molecular Inflammation Research (CEMIR), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Immunology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
- Research Laboratory, Nordland Hospital, Bodø, Norway
- K.G. Jebsen TREC, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Stephen M. Hewitt
- Laboratory of Pathology, National Cancer Institute (NCI), NIH, Bethesda, MD 20892, USA
| | - Bingyu Yan
- Departments of Biochemistry and Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Majid Kazemian
- Departments of Biochemistry and Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Máté G. Kiss
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Christoph J. Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Bente Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Terje Espevik
- Center of Molecular Inflammation Research (CEMIR), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Norway Regional Health Authority, St. Olavs Hospital HF, Trondheim, Norway
| | - Claudia Kemper
- Complement and Inflammation Research Section (CIRS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
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15
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Grøan M, Ospel J, Ajmi S, Sandset EC, Kurz MW, Skjelland M, Advani R. Time-Based Decision Making for Reperfusion in Acute Ischemic Stroke. Front Neurol 2021; 12:728012. [PMID: 34790159 PMCID: PMC8591257 DOI: 10.3389/fneur.2021.728012] [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: 06/20/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Decision making in the extended time windows for acute ischemic stroke can be a complex and time-consuming process. The process of making the clinical decision to treat has been compounded by the availability of different imaging modalities. In the setting of acute ischemic stroke, time is of the essence and chances of a good outcome diminish by each passing minute. Navigating the plethora of advanced imaging modalities means that treatment in some cases can be inefficaciously delayed. Time delays and individually based non-programmed decision making can prove challenging for clinicians. Visual aids can assist such decision making aimed at simplifying the use of advanced imaging. Flow charts are one such visual tool that can expedite treatment in this setting. A systematic review of existing literature around imaging modalities based on site of occlusion and time from onset can be used to aid decision making; a more program-based thought process. The use of an acute reperfusion flow chart helping navigate the myriad of imaging modalities can aid the effective treatment of patients.
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Affiliation(s)
- Mathias Grøan
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johanna Ospel
- Department of Radiology, Basel University Hospital, Basel, Switzerland.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Soffien Ajmi
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,University of Stavanger, Stavanger, Norway
| | - Else Charlotte Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Martin W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Mona Skjelland
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rajiv Advani
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
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16
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Sánchez van Kammen M, Aguiar de Sousa D, Poli S, Cordonnier C, Heldner MR, van de Munckhof A, Krzywicka K, van Haaps T, Ciccone A, Middeldorp S, Levi MM, Kremer Hovinga JA, Silvis S, Hiltunen S, Mansour M, Arauz A, Barboza MA, Field TS, Tsivgoulis G, Nagel S, Lindgren E, Tatlisumak T, Jood K, Putaala J, Ferro JM, Arnold M, Coutinho JM, Sharma AR, Elkady A, Negro A, Günther A, Gutschalk A, Schönenberger S, Buture A, Murphy S, Paiva Nunes A, Tiede A, Puthuppallil Philip A, Mengel A, Medina A, Hellström Vogel Å, Tawa A, Aujayeb A, Casolla B, Buck B, Zanferrari C, Garcia-Esperon C, Vayne C, Legault C, Pfrepper C, Tracol C, Soriano C, Guisado-Alonso D, Bougon D, Zimatore DS, Michalski D, Blacquiere D, Johansson E, Cuadrado-Godia E, De Maistre E, Carrera E, Vuillier F, Bonneville F, Giammello F, Bode FJ, Zimmerman J, d'Onofrio F, Grillo F, Cotton F, Caparros F, Puy L, Maier F, Gulli G, Frisullo G, Polkinghorne G, Franchineau G, Cangür H, Katzberg H, Sibon I, Baharoglu I, Brar J, Payen JF, Burrow J, Fernandes J, Schouten J, Althaus K, Garambois K, Derex L, Humbertjean L, Lebrato Hernandez L, Kellermair L, Morin Martin M, Petruzzellis M, Cotelli M, Dubois MC, Carvalho M, Wittstock M, Miranda M, Skjelland M, Bandettini di Poggio M, Scholz MJ, Raposo N, Kahnis R, Kruyt N, Huet O, Sharma P, Candelaresi P, Reiner P, Vieira R, Acampora R, Kern R, Leker R, Coutts S, Bal S, Sharma SS, Susen S, Cox T, Geeraerts T, Gattringer T, Bartsch T, Kleinig TJ, Dizonno V, Arslan Y. Characteristics and Outcomes of Patients With Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia. JAMA Neurol 2021; 78:1314-1323. [PMID: 34581763 DOI: 10.1001/jamaneurol.2021.3619] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson). Objective To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS. Design, Setting, and Participants This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination. Exposures Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria. Main Outcomes and Measures Clinical characteristics and mortality rate. Results Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later. Conclusions and Relevance In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.
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Affiliation(s)
- Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal
| | - Sven Poli
- Department of Neurology and Stroke, Eberhard-Karls University, Tuebingen, Germany.,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Charlotte Cordonnier
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs van Haaps
- Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel M Levi
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Suzanne Silvis
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maryam Mansour
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - Antonio Arauz
- National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr R.A. Calderón Guardia, San José, Costa Rica
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Georgios Tsivgoulis
- Second Department of Neurology in National, Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jose M Ferro
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Aarti R Sharma
- Imperial College London School of Medicine, Imperial College London, London, United Kingdom
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Alberto Negro
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Gutschalk
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Alina Buture
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland.,School of Medicine, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ana Paiva Nunes
- Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Andreas Tiede
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Tuebingen, Germany
| | - Antonio Medina
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Audrey Tawa
- Department of Anesthesia and Intensive Care, University Hospital of Rennes, Rennes, France
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom
| | - Barbara Casolla
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom.,Stroke Unit, Hôpital Pasteur 2, URRIS - UR2CA, Unité de Recherche Clinique Cote d'Azur, Cote d'Azur University, Nice, France
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Melegnano, Italy
| | | | - Caroline Vayne
- Department of Hematology and Hemostasis, Tours University Hospital, Tours, France
| | - Catherine Legault
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christian Pfrepper
- Division of Hemostaseology, Leipzig University Hospital, Leipzig, Germany
| | | | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain
| | | | - David Bougon
- Department of Critical Care, Annecy Genevois Hospital, Annecy, France
| | | | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Dylan Blacquiere
- Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Elias Johansson
- Department Clinical Science, Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden
| | | | | | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Fabrice Bonneville
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXV Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | - Julian Zimmerman
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Francois Cotton
- Department of Radiology, Lyon University Hospital, Lyon, France
| | - François Caparros
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Laurent Puy
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Saarbrücken, Germany
| | - Giosue Gulli
- Department of Medicine, Ashford and St Peters Hospital NHS Foundation Trust, Surrey, United Kingdom
| | - Giovanni Frisullo
- Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Guillaume Franchineau
- Department of Intensive Care, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France
| | - Hakan Cangür
- Department of Neurology, Hospital of the City of Wolfsburg, Wolfsburg, Germany
| | - Hans Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Igor Sibon
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Irem Baharoglu
- Department of Neurology, Haga Hospital, The Hague, the Netherlands
| | - Jaskiran Brar
- Department of Neurology, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | | | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Australia
| | - João Fernandes
- Department of Neurology, Norra Älvsborgs Länssjukhus, Trollhattan, Sweden
| | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands
| | | | - Katia Garambois
- Stroke Unit, University Hospital of Grenoble, Grenoble, France
| | - Laurent Derex
- Department of Neurology, Hospices Civils de Lyon, Lyon, France
| | | | | | - Lukas Kellermair
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Maria Cotelli
- Department of Neurology, ASL Vallecamonica-Sebino, Breno, Italy
| | - Marie-Cécile Dubois
- Department of Anesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - Marta Carvalho
- Department of Neurology, Centro Hospitalar Universitário de São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr José de Almeida, Cascais, Portugal
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Moritz J Scholz
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Robert Kahnis
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Nyika Kruyt
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Olivier Huet
- UFR de Bio-médecine, Hospital de la Cavale Blanche, CHRU de Brest, Brest, France
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, London, United Kingdom
| | - Paolo Candelaresi
- Department of Neurology and Stroke, Cardarelli Hospital, Naples, Italy
| | - Peggy Reiner
- Department of Neurology, Lariboisière Hospital, Paris, France
| | - Ricardo Vieira
- Department of Hematology, Universidade Federal do Cariri, Juazeiro do Norte, Brazil
| | | | - Rolf Kern
- Department of Neurology, Kempten Hospital, Kempten, Germany
| | - Ronen Leker
- Department of Neurology, Hadassah University Medical Center, Jerusalem, Israel
| | - Shelagh Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Simerpreet Bal
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Shyam S Sharma
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Sophie Susen
- Department of Hematology and Transfusion, Lille University Hospital, Lille, France
| | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France
| | | | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Vanessa Dizonno
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Yildiz Arslan
- Neurology Clinic, Medicana İzmir International Hospital, Izmir, Turkey
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17
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Holm S, Kared H, Michelsen AE, Kong XY, Dahl TB, Schultz NH, Nyman TA, Fladeby C, Seljeflot I, Ueland T, Stensland M, Mjaaland S, Goll GL, Nissen-Meyer LS, Aukrust P, Skagen K, Gregersen I, Skjelland M, Holme PA, Munthe LA, Halvorsen B. Immune complexes, innate immunity, and NETosis in ChAdOx1 vaccine-induced thrombocytopenia. Eur Heart J 2021; 42:4064-4072. [PMID: 34405870 PMCID: PMC8385969 DOI: 10.1093/eurheartj/ehab506] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 06/09/2021] [Revised: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 01/04/2023] Open
Abstract
Aims We recently reported five cases of vaccine-induced immune thrombotic thrombocytopenia (VITT) 7–10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against corona virus disease 2019 (COVID-19). We aimed to investigate the pathogenic immunological responses operating in these patients. Methods and results We assessed circulating inflammatory markers by immune assays and immune cell phenotyping by flow cytometry analyses and performed immunoprecipitation with anti-platelet factor (PF)4 antibody in plasma samples followed by mass spectrometry from all five patients. A thrombus was retrieved from the sinus sagittal superior of one patient and analysed by immunohistochemistry and flow cytometry. Precipitated immune complexes revealed multiple innate immune pathway triggers for platelet and leucocyte activation. Plasma contained increased levels of innate immune response cytokines and markers of systemic inflammation, extensive degranulation of neutrophils, and tissue and endothelial damage. Blood analyses showed activation of neutrophils and increased levels of circulating H3Cit, dsDNA, and myeloperoxidase–DNA complex. The thrombus had extensive infiltration of neutrophils, formation of neutrophil extracellular traps (NETs), and IgG deposits. Conclusions The results show that anti-PF4/polyanion IgG-mediated thrombus formation in VITT patients is accompanied by a massive innate immune activation and particularly the fulminant activation of neutrophils including NETosis. These results provide novel data on the immune response in this rare adenoviral vector-induced VITT.
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Affiliation(s)
- Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway
| | - Hassen Kared
- KG Jebsen Centre for B Cell Malignancies, University of Oslo, Postbox 4950, 0424 Oslo, Norway.,Department of Immunology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Annika E Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Nina H Schultz
- Department of Haematology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway.,Department of Haematology, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Tuula A Nyman
- Department of Immunology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Cathrine Fladeby
- Department of Microbiology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Ingebjørg Seljeflot
- Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Postbox 6050, Langnes 9037 Tromsø, Norway
| | - Maria Stensland
- Department of Immunology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Siri Mjaaland
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Postbox 222, Skøyen, 0213 Oslo, Norway
| | - Guro Løvik Goll
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Postbox 23 Vindern, 0319 Oslo, Norway
| | | | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway
| | - Mona Skjelland
- Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Department of Neurology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Pål A Holme
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Department of Haematology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Ludvig A Munthe
- KG Jebsen Centre for B Cell Malignancies, University of Oslo, Postbox 4950, 0424 Oslo, Norway.,Department of Immunology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
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18
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Wiedmann M, Skattør T, Stray-Pedersen A, Romundstad L, Antal EA, Marthinsen PB, Sørvoll IH, Leiknes Ernstsen S, Lund CG, Holme PA, Johansen TO, Brunborg C, Aamodt AH, Schultz NH, Skagen K, Skjelland M. Vaccine Induced Immune Thrombotic Thrombocytopenia Causing a Severe Form of Cerebral Venous Thrombosis With High Fatality Rate: A Case Series. Front Neurol 2021; 12:721146. [PMID: 34393988 PMCID: PMC8363077 DOI: 10.3389/fneur.2021.721146] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 06/06/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
During a 2-week period, we have encountered five cases presenting with the combination of cerebral venous thrombosis (CVT), intracerebral hemorrhage and thrombocytopenia. A clinical hallmark was the rapid and severe progression of disease in spite of maximum treatment efforts, resulting in fatal outcome in for 4 out of 5 patients. All cases had received ChAdOx1 nCov-19 vaccine 1–2 weeks earlier and developed a characteristic syndrome thereafter. The rapid progressive clinical course and high fatality rate of CVT in combination with thrombocytopenia in such a cluster and in otherwise healthy adults is a recent phenomenon. Cerebral autopsy findings were those of venous hemorrhagic infarctions and thrombi in dural venous sinuses, including thrombus material apparently rich in thrombocytes, leukocytes and fibrin. Vessel walls were free of inflammation. Extra-cerebral manifestations included leech-like thrombi in large veins, fibrin clots in small venules and scattered hemorrhages on skin and membranes. CVT with thrombocytopenia after adenovirus vectored COVID-19 vaccination is a new clinical syndrome that needs to be recognized by clinicians, is challenging to treat and seems associated with a high mortality rate.
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Affiliation(s)
- Markus Wiedmann
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Thor Skattør
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Arne Stray-Pedersen
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University in Oslo, Oslo, Norway
| | - Luis Romundstad
- Department of Anesthesiology and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
| | - Ellen-Ann Antal
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Pål Bache Marthinsen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Hausberg Sørvoll
- Norwegian National Unit for Platelet Immunology at University Hospital of North Norway, Tromsø, Norway
| | - Siw Leiknes Ernstsen
- Norwegian National Unit for Platelet Immunology at University Hospital of North Norway, Tromsø, Norway
| | | | - Pål Andre Holme
- Faculty of Medicine, Institute of Clinical Medicine, University in Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | | | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | | | - Nina Haagenrud Schultz
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Department of Haematology, Akershus University Hospital, Lillestrøm, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Faculty of Medicine, Institute of Clinical Medicine, University in Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
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19
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Kong XY, Huse C, Yang K, Øgaard J, Berges N, Vik ES, Nawaz MS, Quiles-Jiménez A, Abbas A, Gregersen I, Holm S, Bjerkli V, Rashidi A, Fladeby C, Suganthan R, Sagen EL, Skjelland M, Lång A, Bøe SO, Bjørås M, Aukrust P, Alseth I, Halvorsen B, Dahl TB. Endonuclease V Regulates Atherosclerosis Through C-C Motif Chemokine Ligand 2-Mediated Monocyte Infiltration. J Am Heart Assoc 2021; 10:e020656. [PMID: 34259011 PMCID: PMC8483470 DOI: 10.1161/jaha.120.020656] [Citation(s) in RCA: 7] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background In cardiovascular diseases, atherosclerotic disorder are the most frequent and important with respect to morbidity and mortality. Inflammation mediated by immune cells is central in all parts of the atherosclerotic progress, and further understanding of the underlying mechanisms is needed. Growing evidence suggests that deamination of adenosine‐to‐inosine in RNA is crucial for a correct immune response; nevertheless, the role of adenosine‐to‐inosine RNA editing in atherogenesis has barely been studied. Several proteins have affinity for inosines in RNA, one being ENDOV (endonuclease V), which binds and cleaves RNA at inosines. Data on ENDOV in atherosclerosis are lacking. Methods and Results Quantitative polymerase chain reaction on ENDOV mRNA showed an increased level in human carotid atherosclerotic plaques compared with control veins. Inosine‐ribonuclease activity as measured by an enzyme activity assay is detected in immune cells relevant for the atherosclerotic process. Abolishing EndoV in atherogenic apolipoprotein E‐deficient (ApoE−/−) mice reduces the atherosclerotic plaque burden, both in size and lipid content. In addition, in a brain stroke model, mice without ENDOV suffer less damage than control mice. Finally, lack of EndoV reduces the recruitment of monocytes to atherosclerotic lesions in atherogenic ApoE−/− mice. Conclusions ENDOV is upregulated in human atherosclerotic lesions, and data from mice suggest that ENDOV promotes atherogenesis by enhancing the monocyte recruitment into the atherosclerotic lesion, potentially by increasing the effect of CCL2 activation on these cells.
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Affiliation(s)
- Xiang Yi Kong
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Camilla Huse
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - Kuan Yang
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Jonas Øgaard
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Natalia Berges
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway.,Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Erik Sebastian Vik
- Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Meh Sameen Nawaz
- Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Ana Quiles-Jiménez
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | | | - Ida Gregersen
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - Sverre Holm
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Vigdis Bjerkli
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - Azita Rashidi
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Cathrine Fladeby
- Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Rajikala Suganthan
- Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Ellen Lund Sagen
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Mona Skjelland
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway.,Department of Neurology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Anna Lång
- Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Stig Ove Bøe
- Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Magnar Bjørås
- Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway.,Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Pål Aukrust
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway.,Section of Clinical Immunology and Infectious Diseases Oslo University Hospital, Rikshospitalet Oslo Norway.,K.G. Jebsen, The Faculty of Health Sciences The Arctic University of Tromsø Tromsø Norway
| | - Ingrun Alseth
- Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Bente Halvorsen
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - Tuva Børresdatter Dahl
- Research Institute for Internal Medicine Oslo University Hospital, Rikshospitalet Oslo Norway.,Department of Microbiology Oslo University Hospital, Rikshospitalet Oslo Norway
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20
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Quiles-Jiménez A, Gregersen I, Mittelstedt Leal de Sousa M, Abbas A, Kong XY, Alseth I, Holm S, Dahl TB, Skagen K, Skjelland M, Aukrust P, Bjørås M, Halvorsen B. N6-methyladenosine in RNA of atherosclerotic plaques: An epitranscriptomic signature of human carotid atherosclerosis. Biochem Biophys Res Commun 2020; 533:631-637. [PMID: 33004177 DOI: 10.1016/j.bbrc.2020.09.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND More than 170 post-transcriptional RNA modifications regulate the localization, processing and function of cellular RNAs, and aberrant RNA modifications have been linked to a range of human diseases. The RNA modification landscape in atherosclerosis, the main underlying cause of cardiovascular diseases, is still largely unknown. METHODS We used mass spectrometry to analyse a selection of RNA-modifying enzymes and the N6-methyladenosine (m6A) in carotid atherosclerotic lesion samples representing early and advanced stages of atherosclerosis as compared to non-atherosclerotic arteries from healthy controls. FINDINGS (i) the detection of different levels of several enzymes involved in methylations occurring in rRNA and mRNA; (ii) these findings included changes in the levels of methyltransferases ('writers'), binding proteins ('readers') and demethylases ('erasers') during atherosclerosis as compared to non-atherosclerotic control arteries, with generally the most prominent differences in samples from early atherosclerotic lesions; and (iii) these changes were accompanied by a marked downregulation of m6A in rRNA, the most abundant and well-studied modification in mRNA with a wide range of effects on cell biology. INTERPRETATION We show for the first time that RNA-modifying enzymes and the well-studied RNA modification m6A are differentially regulated in atherosclerotic lesions, which potentially could help creating new prognostic and treatment strategies.
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Affiliation(s)
- Ana Quiles-Jiménez
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway
| | - Mirta Mittelstedt Leal de Sousa
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway; PROMEC Core Facility for Proteomics and Metabolomics, NTNU and the Central Norway Regional Health Authority, Trondheim, Norway
| | - Azhar Abbas
- Department of Neurology, Østfold Hospital Trust Kalnes, Grålum, Norway
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Ingrun Alseth
- Department of Microbiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | - Magnar Bjørås
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway; PROMEC Core Facility for Proteomics and Metabolomics, NTNU and the Central Norway Regional Health Authority, Trondheim, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway.
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21
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Niyonzima N, Bakke SS, Gregersen I, Holm S, Sandanger Ø, Orrem HL, Sporsheim B, Ryan L, Kong XY, Dahl TB, Skjelland M, Sørensen KK, Rokstad AM, Yndestad A, Latz E, Gullestad L, Andersen GØ, Damås JK, Aukrust P, Mollnes TE, Halvorsen B, Espevik T. Cholesterol crystals use complement to increase NLRP3 signaling pathways in coronary and carotid atherosclerosis. EBioMedicine 2020; 60:102985. [PMID: 32927275 PMCID: PMC7494683 DOI: 10.1016/j.ebiom.2020.102985] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 02/27/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND During atherogenesis, cholesterol precipitates into cholesterol crystals (CC) in the vessel wall, which trigger plaque inflammation by activating the NACHT, LRR and PYD domains-containing protein 3 (NLRP3) inflammasome. We investigated the relationship between CC, complement and NLRP3 in patients with cardiovascular disease. METHODS We analysed plasma, peripheral blood mononuclear cells (PBMC) and carotid plaques from patients with advanced atherosclerosis applying ELISAs, multiplex cytokine assay, qPCR, immunohistochemistry, and gene profiling. FINDINGS Transcripts of interleukin (IL)-1beta(β) and NLRP3 were increased and correlated in PBMC from patients with acute coronary syndrome (ACS). Priming of these cells with complement factor 5a (C5a) and tumour necrosis factor (TNF) before incubation with CC resulted in increased IL-1β protein when compared to healthy controls. As opposed to healthy controls, systemic complement was significantly increased in patients with stable angina pectoris or ACS. In carotid plaques, complement C1q and C5b-9 complex accumulated around CC-clefts, and complement receptors C5aR1, C5aR2 and C3aR1 were higher in carotid plaques compared to control arteries. Priming human carotid plaques with C5a followed by CC incubation resulted in pronounced release of IL-1β, IL-18 and IL-1α. Additionally, mRNA profiling demonstrated that C5a and TNF priming followed by CC incubation upregulated plaque expression of NLRP3 inflammasome components. INTERPRETATION We demonstrate that CC are important local- and systemic complement activators, and we reveal that the interaction between CC and complement could exert its effect by activating the NLRP3 inflammasome, thus promoting the progression of atherosclerosis.
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Affiliation(s)
- Nathalie Niyonzima
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Siril S Bakke
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital, Norway
| | - Øystein Sandanger
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Hilde L Orrem
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Bjørnar Sporsheim
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Liv Ryan
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital, Norway
| | | | - Mona Skjelland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Neurology, Oslo University Hospital, Norway
| | - Kirsten Krohg Sørensen
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Anne Mari Rokstad
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Eicke Latz
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway; Institute of Innate Immunity, Biomedical Center, University of Bonn, Germany
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Norway; KG Jebsen Center for Cardiac Research, and Center for Heart Failure Research, Oslo University Hospital, Norway
| | | | - Jan Kristian Damås
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Norway
| | - Tom E Mollnes
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway; Department of Immunology, Oslo University Hospital, Norway; KG Jebsen TREC, Department of Clinical Medicine, University of Tromsø, Norway; Research Laboratory, Norland Hospital, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 17, Trondheim 7030, Norway; The Central Norway Regional Health Authority, St. Olavs Hospital HF, Norway.
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22
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Gregersen I, Michelsen AE, Lunde NN, Åkerblom A, Lakic TG, Skjelland M, Ryeng Skagen K, Becker RC, Lindbäck J, Himmelmann A, Solberg R, Johansen HT, James SK, Siegbahn A, Storey RF, Kontny F, Aukrust P, Ueland T, Wallentin L, Halvorsen B. Legumain in Acute Coronary Syndromes: A Substudy of the PLATO (Platelet Inhibition and Patient Outcomes) Trial. J Am Heart Assoc 2020; 9:e016360. [PMID: 32809893 PMCID: PMC7660754 DOI: 10.1161/jaha.120.016360] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The cysteine protease legumain is increased in patients with atherosclerosis, but its causal role in atherogenesis and cardiovascular disease is still unclear. The aim of the study was to investigate the association of legumain with clinical outcome in a large cohort of patients with acute coronary syndrome. Methods and Results Serum levels of legumain were analyzed in 4883 patients with acute coronary syndrome from a substudy of the PLATO (Platelet Inhibition and Patient Outcomes) trial. Levels were analyzed at admission and after 1 month follow-up. Associations between legumain and a composite of cardiovascular death, spontaneous myocardial infarction or stroke, and its individual components were assessed by multivariable Cox regression analyses. At baseline, a 50% increase in legumain level was associated with a hazard ratio (HR) of 1.13 (95% CI, 1.04-1.21), P=0.0018, for the primary composite end point, adjusted for randomized treatment. The association remained significant after adjustment for important clinical and demographic variables (HR, 1.10; 95% CI, 1.02-1.19; P=0.013) but not in the fully adjusted model. Legumain levels at 1 month were not associated with the composite end point but were negatively associated with stroke (HR, 0.62; 95% CI, 0.44-0.88; P=0.0069), including in the fully adjusted model (HR, 0.57; 95% CI, 0.37-0.88; P=0.0114). Conclusions Baseline legumain was associated with the primary outcome in patients with acute coronary syndrome, but not in the fully adjusted model. The association between high levels of legumain at 1 month and decreased occurrence of stroke could be of interest from a mechanistic point of view, illustrating the potential dual role of legumain during atherogenesis and acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00391872.
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Affiliation(s)
- Ida Gregersen
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - Annika E Michelsen
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - Ngoc Nguyen Lunde
- Section of Pharmacology and Pharmaceutical Biosciences Department of Pharmacy University of Oslo Norway
| | - Axel Åkerblom
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Tatevik G Lakic
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Mona Skjelland
- Department of Neurology Oslo University Hospital Rikshospitalet Oslo Norway
| | | | - Richard C Becker
- Division of Cardiovascular Health and Disease Heart, Lung and Vascular Institute Academic Health Center Cincinnati OH
| | - Johan Lindbäck
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | | | - Rigmor Solberg
- Section of Pharmacology and Pharmaceutical Biosciences Department of Pharmacy University of Oslo Norway
| | - Harald T Johansen
- Section of Pharmacology and Pharmaceutical Biosciences Department of Pharmacy University of Oslo Norway
| | - Stefan K James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Agneta Siegbahn
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease University of Sheffield Sheffield United Kingdom
| | - Frederic Kontny
- Department of Cardiology Stavanger University Hospital Stavanger Norway.,Drammen Heart Center Drammen Norway
| | - Pål Aukrust
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway.,Section of Clinical Immunology and Infectious Diseases Oslo University Hospital Rikshospitalet Oslo Norway.,K.G. Jebsen TREC The Faculty of Health Sciences The Arctic University of Tromsø Tromsø Norway
| | - Thor Ueland
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway.,K.G. Jebsen TREC The Faculty of Health Sciences The Arctic University of Tromsø Tromsø Norway
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Bente Halvorsen
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
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23
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Skagen K, Aamodt AH, Enriquez B, Skjelland M. Too little knowledge about blood pressure in cases of ischaemic stroke. Tidsskr Nor Laegeforen 2020; 140:20-0323. [PMID: 32549003 DOI: 10.4045/tidsskr.20.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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24
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Tancin Lambert A, Kong XY, Ratajczak-Tretel B, Atar D, Russell D, Skjelland M, Bjerkeli V, Skagen K, Coq M, Schordan E, Firat H, Halvorsen B, Aamodt AH. Biomarkers Associated with Atrial Fibrillation in Patients with Ischemic Stroke: A Pilot Study from the NOR-FIB Study. Cerebrovasc Dis Extra 2020; 10:11-20. [PMID: 32028277 PMCID: PMC7036587 DOI: 10.1159/000504529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/10/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Cardioembolic stroke due to paroxysmal atrial fibrillation (AF) may account for 1 out of 4 cryptogenic strokes (CS) and transient ischemic attacks (TIAs). The purpose of this pilot study was to search for biomarkers potentially predicting incident AF in patients with ischemic stroke or TIA. Methods Plasma samples were collected from patients aged 18 years and older with ischemic stroke or TIA due to AF (n = 9) and large artery atherosclerosis (LAA) with ipsilateral carotid stenosis (n = 8) and age- and sex-matched controls (n = 10). Analyses were performed with the Olink technology simultaneously measuring 184 biomarkers of cardiovascular disease. For bioinformatics, acquired data were analyzed using gene set enrichment analysis (GSEA). Selected proteins were validated using ELISA. Individual receiver operating characteristic (ROC) curves and odds ratios from logistic regression were calculated. A randomForest (RF) model with out-of-bag estimate was applied for predictive modeling. Results GSEA indicated enrichment of proteins related to inflammatory response in the AF group. Interleukin (IL)-6, growth differentiation factor (GDF)-15, and pentraxin-related protein PTX3 were the top biomarkers on the ranked list for the AF group compared to the LAA group and the control group. ELISA validated increased expression of all tested proteins (GDF-15, PTX3, and urokinase plasminogen activator surface receptor [U-PAR]), except for IL-6. 19 proteins had the area under the ROC curve (AUC) over 0.85 including all of the proteins with significant evolution in the logistic regression. AUCs were very discriminant in distinguishing patients with and without AF (LAA and control group together). GDF-15 alone reached AUC of 0.95. Based on RF model, all selected participants in the tested group were classified correctly, and the most important protein in the model was GDF-15. Conclusions Our results demonstrate an association between inflammation and AF and that multiple proteins alone and in combination may potentially be used as indicators of AF in CS and TIA patients. However, further studies including larger samples sizes are needed to support these findings. In the ongoing NOR-FIB study, we plan further biomarker assessments in patients with CS and TIA undergoing long-term cardiac rhythm monitoring with insertable cardiac monitors.
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Affiliation(s)
- Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway, .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,
| | - Xiang Y Kong
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology B, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - David Russell
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Vigdis Bjerkeli
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Bente Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne H Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway
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25
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Zamani M, Skagen K, Scott H, Russell D, Skjelland M. Advanced ultrasound methods in assessment of carotid plaque instability: a prospective multimodal study. BMC Neurol 2020; 20:39. [PMID: 31996153 PMCID: PMC6990506 DOI: 10.1186/s12883-020-1620-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 01/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background A significant proportion of ischemic strokes are caused by emboli from atherosclerotic, unstable carotid artery plaques. The selection of patients for endarterectomy in current clinical practice is primarily based on the degree of carotid artery stenosis and clinical symptoms. However, the content of the plaque is known to be more important for stroke risk. Intraplaque neovascularization (IPN) has recently emerged as a possible surrogate marker for plaque instability. Neo-microvessels from the adventitial vasa vasorum grow into the full thickness of the vessel wall in an adaptive response to hypoxia, causing subsequent intraplaque haemorrhage and plaque rupture. Conventional ultrasound cannot detect IPN. Contrast-enhanced ultrasound and Superb Microvascular Imaging (SMI), have, however, shown promise in IPN assessment. Recent research using Shear Wave Elastography (SWE) has also reported reduced tissue stiffness in the artery wall (reduced mean Young’s modulus) in unstable compared to stable plaques. The purpose of this study is to identify unstable carotid artery plaques at risk of rupture and future ischemic stroke risk using multimodal assessments. Methods Forty five symptomatic and 45 asymptomatic patients > 18 years, with > 50% carotid stenosis referred to Oslo University Hospital ultrasound lab will be included in this on-going project. Patients will undergo contrast enhanced ultrasound, SMI, carotid-MRI and PET-(18F-FDG). Contrast enhanced ultrasound will be analyzed semi-quantitatively (5-levels visual classification) and quantitatively by plotting time-intensity curve analyses to obtain plaque peak contrast enhancement intensity. Plaques removed at carotid endarterectomy will be assessed histologically and the number of microvessels, areas of inflammation, granulation, calcification, lipid and fibrosis will be measured. Discussion This multimodality study will primarily provide information on the clinical value of advanced ultrasound methods (SMI, SWE) for the detection of unstable carotid artery plaque in comparison with other methods including contrast-enhanced ultrasound, carotid-MRI and PET-(18F-FDG) using histology as the gold standard. Secondly, findings from the methods mentioned above will be related to cerebrovascular symptoms, blood tests (leukocytes, CRP, ESR, lipoproteins and inflammatory markers) and cardiovascular risk factors at inclusion and at 1-year follow-up. The overall aim is to optimize detection of plaque instability which can lead to better preventive decisions and reduced stroke rate.
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Affiliation(s)
- M Zamani
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway. .,Department of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - K Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H Scott
- Department of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pathology, Oslo University Hospital, Rikshospitalet, Norway
| | - D Russell
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
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26
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Zamani M, Skagen K, Russell D, Skjelland M. Response by Zamani et al to Letter Regarding Article, “Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media”. Stroke 2020; 51:e12. [DOI: 10.1161/strokeaha.119.027944] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mahtab Zamani
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - David Russell
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet
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Lunde NN, Gregersen I, Ueland T, Shetelig C, Holm S, Kong XY, Michelsen AE, Otterdal K, Yndestad A, Broch K, Gullestad L, Nyman TA, Bendz B, Eritsland J, Hoffmann P, Skagen K, Gonçalves I, Nilsson J, Grenegård M, Poreba M, Drag M, Seljeflot I, Sporsheim B, Espevik T, Skjelland M, Johansen HT, Solberg R, Aukrust P, Björkbacka H, Andersen GØ, Halvorsen B. Legumain is upregulated in acute cardiovascular events and associated with improved outcome - potentially related to anti-inflammatory effects on macrophages. Atherosclerosis 2019; 296:74-82. [PMID: 31870625 DOI: 10.1016/j.atherosclerosis.2019.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/20/2019] [Accepted: 12/12/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS We have previously found increased levels of the cysteine protease legumain in plasma and plaques from patients with carotid atherosclerosis. This study further investigated legumain during acute cardiovascular events. METHODS Circulating levels of legumain from patients and legumain released from platelets were assessed by enzyme-linked-immunosorbent assay. Quantitative PCR and immunoblotting were used to study expression, while localization was visualized by immunohistochemistry. RESULTS In the SUMMIT Malmö cohort (n = 339 with or without type 2 diabetes and/or cardiovascular disease [CVD], and 64 healthy controls), the levels of circulating legumain were associated with the presence of CVD in non-diabetics, with no relation to outcome. In symptomatic carotid plaques and in samples from both coronary and intracerebral thrombi obtained during acute cardiovascular events, legumain was co-localized with macrophages in the same regions as platelets. In vitro, legumain was shown to be present in and released from platelets upon activation. In addition, THP-1 macrophages exposed to releasate from activated platelets showed increased legumain expression. Interestingly, primary peripheral blood mononuclear cells stimulated with recombinant legumain promoted anti-inflammatory responses. Finally, in a STEMI population (POSTEMI; n = 272), patients had significantly higher circulating legumain before and immediately after percutaneous coronary intervention compared with healthy controls (n = 67), and high levels were associated with improved outcome. CONCLUSIONS Our data demonstrate for the first time that legumain is upregulated during acute cardiovascular events and is associated with improved outcome.
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Affiliation(s)
- Ngoc Nguyen Lunde
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway.
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Christian Shetelig
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Annika E Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Otterdal
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Lars Gullestad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Tuula A Nyman
- Proteomics Core Facility, Department of Immunology, Institute of Clinical Medicine, University of Oslo and Rikshospitalet Oslo, Oslo, Norway
| | - Bjørn Bendz
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Pavel Hoffmann
- Section of Interventional Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Isabel Gonçalves
- Experimental Cardiovascular Research Unit, Dept. of Clinical Sciences, Malmö Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Sweden
| | - Jan Nilsson
- Experimental Cardiovascular Research Unit, Dept. of Clinical Sciences, Malmö Lund University, Malmö, Sweden
| | | | - Marcin Poreba
- Department of Bioorganic Chemistry, Faculty of Chemistry, Wroclaw University of Technology, Wroclaw, Poland
| | - Marcin Drag
- Department of Bioorganic Chemistry, Faculty of Chemistry, Wroclaw University of Technology, Wroclaw, Poland
| | - Ingebjørg Seljeflot
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Bjørnar Sporsheim
- Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona Skjelland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Harald Thidemann Johansen
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Rigmor Solberg
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Harry Björkbacka
- Experimental Cardiovascular Research Unit, Dept. of Clinical Sciences, Malmö Lund University, Malmö, Sweden
| | - Geir Øystein Andersen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Zamani M, Skagen K, Scott H, Lindberg B, Russell D, Skjelland M. Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media. Stroke 2019; 50:3121-3127. [PMID: 31510899 DOI: 10.1161/strokeaha.119.025496] [Citation(s) in RCA: 40] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background and Purpose- A significant proportion of ischemic strokes are caused by emboli from unstable carotid artery plaques with intraplaque neovascularization (IPN) as a key feature of plaque instability. IPN is not detectable with conventional Doppler ultrasound. Contrast-enhanced ultrasound (CEUS) can visualize IPN, but its use is limited in clinical practice because it requires an intravenous injection of contrast. Superb microvascular imaging (SMI) without contrast uses an algorithm to remove clutter and motion wall artifacts while preserving low-velocity blood flow signals, enabling visualization of IPN. Our aim was to assess the feasibility of SMI for the detection of IPN. Methods- Thirty-one patients with >50% carotid stenosis were included: 22 patients were symptomatic and 9 asymptomatic. All patients underwent conventional carotid ultrasound, CEUS, SMI, and blood tests. CEUS and SMI findings were compared and correlated to histological plaque assessments after endarterectomy. Results- There was significant positive correlation between an IPN visual 5-level classification of SMI and a semiquantitative analysis of CEUS (P<0.001, r=0.911). Plaques with higher SMI grades had higher numbers of neovessels quantified at histology (P=0.041, r=0.460). Hypoechoic plaques had higher grades of IPN on both CEUS and SMI (P<0.001). Higher visual IPN counts on SMI were associated with (1) increased areas of inflammation (P=0.043, r=0.457), (2) combined rank scores of granulation tissue, inflammation and lipids (P=0.02, r=0.494) at histology, and (3) higher peak-intensity values on quantitative CEUS (P=0.042, r=0.514). Conclusions- SMI ultrasound can detect neovascularization with accuracy comparable to CEUS, suggesting SMI to be a promising noninvasive alternative to CEUS for the assessment of carotid plaque stability.
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Affiliation(s)
- Mahtab Zamani
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Karolina Skagen
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Helge Scott
- Department of Pathology (H.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Beate Lindberg
- Department of Cardiothoracic Surgery (B.L.), Oslo University Hospital, Rikshospitalet, Norway
| | - David Russell
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Mona Skjelland
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
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29
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Gravastrand CS, Steinkjer B, Halvorsen B, Landsem A, Skjelland M, Jacobsen EA, Woodruff TM, Lambris JD, Mollnes TE, Brekke OL, Espevik T, Rokstad AMA. Cholesterol Crystals Induce Coagulation Activation through Complement-Dependent Expression of Monocytic Tissue Factor. J Immunol 2019; 203:853-863. [PMID: 31270150 DOI: 10.4049/jimmunol.1900503] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/13/2019] [Indexed: 01/24/2023]
Abstract
Cholesterol crystals (CC) are strong activators of complement and could potentially be involved in thromboinflammation through complement-coagulation cross-talk. To explore the coagulation-inducing potential of CC, we performed studies in lepirudin-based human whole blood and plasma models. In addition, immunohistological examinations of brain thrombi and vulnerable plaque material from patients with advanced carotid atherosclerosis were performed using polarization filter reflected light microscopy to identify CC. In whole blood, CC exposure induced a time- and concentration-dependent generation of prothrombin fragment 1+2 (PTF1.2), tissue factor (TF) mRNA synthesis, and monocyte TF expression. Blocking Abs against TF abolished CC-mediated coagulation, thus indicating involvement of the TF-dependent pathway. Blockade of FXII by corn trypsin inhibitor had a significant inhibitory effect on CC-induced PTF1.2 in platelet-free plasma, although the overall activation potential was low. CC exposure did not induce platelet aggregation, TF microparticle induction, or TF on granulocytes or eosinophils. Inhibition of complement C3 by CP40 (compstatin), C5 by eculizumab, or C5aR1 by PMX53 blocked CC-induced PTF1.2 by 90% and reduced TF+ monocytes from 18-20 to 1-2%. The physiologic relevance was supported by birefringent CC structures adjacent to monocytes (CD14), TF, and activated complement iC3b and C5b-9 in a human brain thrombus. Furthermore, monocyte influx and TF induction in close proximity to CC-rich regions with activated complement were found in a vulnerable plaque. In conclusion, CC could be active, releasable contributors to thrombosis by inducing monocyte TF secondary to complement C5aR1 signaling.
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Affiliation(s)
- Caroline S Gravastrand
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Bjørg Steinkjer
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, 0424 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0424 Oslo, Norway.,K.G. Jebsen Inflammation Research Centre, University of Oslo, 0318 Oslo, Norway
| | - Anne Landsem
- Research Laboratory, Nordland Hospital, 8092 Bodo, Norway.,Faculty of Health Sciences, K.G. Jebsen Thrombosis Research and Expertise Center, The Arctic University of Norway, 9037 Tromso, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Trent M Woodruff
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - John D Lambris
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Tom E Mollnes
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,Research Laboratory, Nordland Hospital, 8092 Bodo, Norway.,Faculty of Health Sciences, K.G. Jebsen Thrombosis Research and Expertise Center, The Arctic University of Norway, 9037 Tromso, Norway.,Department of Immunology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; and
| | - Ole-Lars Brekke
- Research Laboratory, Nordland Hospital, 8092 Bodo, Norway.,Faculty of Health Sciences, K.G. Jebsen Thrombosis Research and Expertise Center, The Arctic University of Norway, 9037 Tromso, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Anne Mari A Rokstad
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway; .,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,Centre for Obesity, Clinic of Surgery, St. Olav's University Hospital, 7006 Trondheim, Norway
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30
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Johnsrud K, Skagen K, Seierstad T, Skjelland M, Russell D, Revheim ME. 18F-FDG PET/CT for the quantification of inflammation in large carotid artery plaques. J Nucl Cardiol 2019; 26:883-893. [PMID: 29209949 PMCID: PMC6517604 DOI: 10.1007/s12350-017-1121-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/19/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is currently no consensus on the methodology for quantification of 18F-FDG uptake in inflammation in atherosclerosis. In this study, we explore different methods for quantification of 18F-FDG uptake in carotid atherosclerotic plaques and correlate the uptake values to histological assessments of inflammation. METHODS AND RESULTS Forty-four patients with atherosclerotic stenosis ≥70% of the internal carotid artery underwent 18F-FDG PET/CT. Maximum standardized uptake values (SUVmax) from all plaque-containing slices were collected. SUVmax for the single highest and the mean of multiple slices with and without blood background correction (by subtraction (cSUV) or by division (target-to-background ratio (TBR)) were calculated. Following endarterectomy 30 plaques were assessed histologically. The length of the plaques at CT was 6-32 mm. The 18F-FDG uptake in the plaques was 1.15-2.66 for uncorrected SUVs, 1.16-3.19 for TBRs, and 0.20-1.79 for cSUVs. There were significant correlations between the different uptake values (r = 0.57-0.99, P < 0.001). Methods with and without blood background correction showed similar, moderate correlations to the amount of inflammation assessed at histology (r = 0.44-0.59, P < 0.02). CONCLUSIONS In large stenotic carotid plaques, 18F-FDG uptake reflects the inflammatory status as assessed at histology. Increasing number of PET slices or background correction did not change the correlation.
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Affiliation(s)
- Kjersti Johnsrud
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Postbox 4950, Nydalen, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern, 0318, Oslo, Norway.
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Postbox 4950, Nydalen, 0424, Oslo, Norway
| | - Therese Seierstad
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Postbox 4950, Nydalen, 0424, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Postbox 4950, Nydalen, 0424, Oslo, Norway
| | - David Russell
- Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern, 0318, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Postbox 4950, Nydalen, 0424, Oslo, Norway
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Postbox 4950, Nydalen, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern, 0318, Oslo, Norway
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31
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Skagen K, Hetlevik SO, Zamani M, Lilleby V, Skjelland M. Preclinical Carotid Atherosclerosis in Patients With Juvenile-Onset Mixed Connective Tissue Disease. J Stroke Cerebrovasc Dis 2019; 28:1295-1301. [PMID: 30772156 DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/25/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study investigated preclinical atherosclerosis in patients with juvenile mixed connective tissue disease (JMCTD), which is a chronic inflammatory disease with a varied phenotype. Mixed connective tissue disease (MCTD) has well known associations with other autoimmune diseases known to have increased risk of cardiovascular disease. However, the cardiovascular risk for patients with the juvenile form remains unclear. MATERIALS AND METHODS Forty-nine patients with JMCTD and 45 age-and sex-matched controls took part in this study. They underwent blood tests, clinical examination, and ultrasound measurement of the carotid arteries. RESULTS We found that patients had significantly higher average carotid intima-media thickness (IMT) as compared to controls (mean 0.57 ± 0.09 versus 0.53 ± 0.06, P = .03). IMT also increased with both increasing disease duration (years from diagnosis), and severity as assessed by the physicians global assessment score, after adjustment for age. CONCLUSIONS This is the first study to demonstrate increased preclinical atherosclerosis in juvenile MCTD. Our findings suggest that the atherosclerotic burden in this patient group, which was independent of traditional cardiovascular risk factors, might be secondary to the underlying connective tissue disease.
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Affiliation(s)
- Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Siri Opsahl Hetlevik
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Mahtab Zamani
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Vibke Lilleby
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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32
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Jusufovic M, Skagen K, Krohg-Sørensen K, Skjelland M. Current Medical and Surgical Stroke Prevention Therapies for Patients with Carotid Artery Stenosis. Curr Neurovasc Res 2019; 16:96-103. [PMID: 30706783 DOI: 10.2174/1567202616666190131162811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 01/22/2023]
Abstract
Carotid Artery Stenosis (CAS) is a marker of systemic atherosclerosis and patients with CAS are at high risk of vascular events in multiple vascular locations, including ipsilateral ischemic stroke. Both medical and surgical therapies have been demonstrated effective in reducing this risk. The optimal management for patients with asymptomatic carotid artery stenosis remains controversial. In patients with symptomatic CAS ≥70%, CEA has been demonstrated to reduce the risk of stroke. With the risk of recurrent stroke being particularly high in the first 2 weeks after the first event, Carotid Endarterectomy (CEA) or carotid angioplasty with stenting provides maximal benefits to patients with symptomatic CAS ≥70% if performed within this «2-week» target. Several large ongoing trials are currently comparing the risks and benefits of carotid revascularization versus medical therapy alone.
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Affiliation(s)
- Mirza Jusufovic
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine University of Oslo, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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33
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Bjerknes S, Toft M, Konglund AE, Pham U, Waage TR, Pedersen L, Skjelland M, Haraldsen I, Andersson S, Dietrichs E, Skogseid IM. Multiple Microelectrode Recordings in STN-DBS Surgery for Parkinson's Disease: A Randomized Study. Mov Disord Clin Pract 2018; 5:296-305. [PMID: 30009214 PMCID: PMC6033169 DOI: 10.1002/mdc3.12621] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 09/07/2017] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/15/2022] Open
Abstract
Background Subthalamic nucleus deep brain stimulation improves motor symptoms and fluctuations in advanced Parkinson's disease, but the degree of clinical improvement depends on accurate anatomical electrode placement. Methods used to localize the sensory‐motor part of the nucleus vary substantially. Using microelectrode recordings, at least three inserted microelectrodes are needed to obtain a three‐dimensional map. Therefore, multiple simultaneously inserted microelectrodes should provide better guidance than single sequential microelectrodes. We aimed to compare the use of multiple simultaneous versus single sequential microelectrode recordings on efficacy and safety of subthalamic nucleus stimulation. Methods Sixty patients were included in this double‐blind, randomized study, 30 in each group. Primary outcome measures were the difference from baseline to 12 months in the MDS‐UPDRS motor score (part III) in the off‐medication state and quality of life using the Parkinson's Disease Questionnaire‐39 (PDQ‐39) scores. Results The mean reduction of the MDS‐UPDRS III off score was 35 (SD 12) in the group investigated with multiple simultaneous microelectrodes compared to 26 (SD 10) in the single sequential microelectrode group (p = 0.004). The PDQ‐39 Summary Index did not differ between the groups, but the domain scores activities of daily living and bodily discomfort improved significantly more in the multiple microelectrodes group. The frequency of serious adverse events did not differ significantly. Conclusions After 12 months of subthalamic nucleus stimulation, the multiple microelectrodes group had a significantly greater improvement both in MDS‐UPDRS III off score and in two PDQ‐39 domains. Our results may support the use of multiple simultaneous microelectrode recordings. Trial registration http://ClinicalTrials.gov Identifier: NCT00855621 (first received March 3, 2009).
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Affiliation(s)
- Silje Bjerknes
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Mathias Toft
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Ane E Konglund
- Department of Neurosurgery Oslo University Hospital Oslo Norway
| | - Uyen Pham
- Department of Neuropsychiatry and Psychosomatic Medicine Oslo University Hospital Oslo Norway
| | | | - Lena Pedersen
- Department of Neurology Oslo University Hospital Oslo Norway
| | - Mona Skjelland
- Department of Neurology Oslo University Hospital Oslo Norway
| | - Ira Haraldsen
- Department of Neuropsychiatry and Psychosomatic Medicine Oslo University Hospital Oslo Norway
| | | | - Espen Dietrichs
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
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34
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Skarpengland T, Skjelland M, Kong XY, Skagen K, Holm S, Otterdal K, Dahl CP, Krohg-Sørensen K, Sagen EL, Bjerkeli V, Aamodt AH, Abbas A, Gregersen I, Aukrust P, Halvorsen B, Dahl TB. Increased Levels of Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 in Ischemic Stroke and Transient Ischemic Attack. J Am Heart Assoc 2018; 7:JAHA.117.006479. [PMID: 29330254 PMCID: PMC5850141 DOI: 10.1161/jaha.117.006479] [Citation(s) in RCA: 29] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Soluble lectin‐like oxidized low‐density lipoprotein receptor‐1 (sLOX‐1) has been shown to be increased in patients with acute ischemic stroke. Here, we evaluated plasma sLOX‐1 levels and vascular carotid plaque LOX‐1 (ie, OLR1) gene expression in patients with ischemic stroke and transient ischemic attack (TIA) with particular focus on their relation to time since symptom onset. Methods and Results Plasma sLOX‐1 (n=232) and carotid plaque OLR1 gene expression (n=146) were evaluated in patients who were referred to evaluation for carotid endarterectomy, as well as in healthy control plasma (n=81). Patients were categorized according to presence of acute ischemic stroke or transient ischemic attack (n=35) ≤7 days, >7 days ≤3 months (n=90), >3 months (n=40), or no reported symptoms before study inclusion (n=67). Our major findings were the following: (1) Patients with carotid atherosclerosis had increased plasma sLOX‐1 levels as compared with controls. (2) Plaque OLR1 mRNA levels were increased in carotid plaques (n=146) compared with nonatherosclerotic vessels (ie, common iliac arteries of organ donors, n=10). (3) There were no differences in sLOX plasma levels or OLR1 gene expression when analyzed according to the time since relevant cerebral ischemic symptoms. (4) Also patients with severe carotid atherosclerosis without any previous ischemic events had raised sLOX‐1 levels. (5) Immunostaining showed colocalization between LOX‐1 and macrophages within the carotid plaques. (6) Also patients with acute stroke (within 7 days) caused by atrial fibrillation (n=22) had comparable raised sLOX‐1 levels. Conclusions sLOX‐1 levels are elevated in patients with ischemic stroke and transient ischemic attack independent of cause and time since the ischemic event.
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Affiliation(s)
- Tonje Skarpengland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kari Otterdal
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Christen P Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway
| | - Ellen L Sagen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway .,Department of Microbiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
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Jusufovic M, Sandset EC, Skagen K, Skjelland M. Blood Pressure Lowering Treatment in Patients with Carotid Artery Stenosis. Curr Hypertens Rev 2017; 12:148-55. [PMID: 27292176 DOI: 10.2174/157340211202160525010133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/22/2022]
Abstract
Stroke is the second most common cause of death and the most common cause of disability worldwide. Up to 30% of ischaemic strokes are caused by carotid atherosclerosis, usually due to thromboemboli from an atherosclerotic plaque at the carotid bifurcation. High blood pressure is an important risk factor for atherosclerosis, the development of unstable carotid plaques, and ischaemic strokes. Differentiation between asymptomatic and symptomatic carotid atherosclerosis is critical to treatment management because of the difference in natural history. Intensive medical treatment including blood pressure lowering medication reduces the risk of both primary and secondary vascular events in patients at risk. This review summarises recent data on blood pressure management in patients with carotid artery stenosis.
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Affiliation(s)
- Mirza Jusufovic
- Department of Neurology, P.O. Box 4950 Nydalen, NO-0424, Oslo, Norway.
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Gregersen I, Sandanger Ø, Askevold ET, Sagen EL, Yang K, Holm S, Pedersen TM, Skjelland M, Krohg-Sørensen K, Hansen TV, Dahl TB, Otterdal K, Espevik T, Aukrust P, Yndestad A, Halvorsen B. Interleukin 27 is increased in carotid atherosclerosis and promotes NLRP3 inflammasome activation. PLoS One 2017; 12:e0188387. [PMID: 29176764 PMCID: PMC5703457 DOI: 10.1371/journal.pone.0188387] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022] Open
Abstract
Aim Interleukin-27 (IL-27) is involved in different inflammatory diseases; however, its role in atherosclerosis is unclear. In this study we investigated the expression of IL-27 and its receptor in patients with carotid atherosclerosis and if IL-27 could modulate the inflammatory effects of the NLRP3 inflammasome in vitro. Methods Plasma IL-27 was measured by enzyme immunoassay in patients with carotid stenosis (n = 140) and in healthy controls (n = 19). Expression of IL-27 and IL-27R was analyzed by quantitative PCR and immunohistochemistry in plaques from patients and in non-atherosclerotic vessels. THP-1 monocytes, primary monocytes and peripheral blood mononuclear cells (PBMCs) were used to study effects of IL-27 in vitro. Results Our main findings were: (i) Plasma levels of IL-27 were significantly elevated in patients with carotid atherosclerotic disease compared to healthy controls. (ii) Gene expression of IL-27 and IL-27R was significantly elevated in plaques compared to control vessels, and co-localized to macrophages. (iii) In vitro, IL-27 increased NLRP3 inflammasome activation in monocytes with enhanced release of IL-1 β. Conclusions We demonstrate increased levels of IL-27 and IL-27R in patients with carotid atherosclerosis. Our in vitro findings suggest an inflammatory role for IL-27, which can possibly be linked to atherosclerotic disease development.
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Affiliation(s)
- Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- Faculty of Medicine, University of Oslo Oslo, Norway
- * E-mail:
| | - Øystein Sandanger
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Erik T. Askevold
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Ellen Lund Sagen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
| | - Kuan Yang
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- Faculty of Medicine, University of Oslo Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
| | - Turid M. Pedersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- Faculty of Medicine, University of Oslo Oslo, Norway
| | - Mona Skjelland
- Department of Neurology Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Faculty of Medicine, University of Oslo Oslo, Norway
- Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Trond Vidar Hansen
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Tuva Børresdatter Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- Faculty of Medicine, University of Oslo Oslo, Norway
| | - Kari Otterdal
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- Faculty of Medicine, University of Oslo Oslo, Norway
- K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- Faculty of Medicine, University of Oslo Oslo, Norway
- K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,Oslo, Norway
- Faculty of Medicine, University of Oslo Oslo, Norway
- K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
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Bakke SS, Aune MH, Niyonzima N, Pilely K, Ryan L, Skjelland M, Garred P, Halvorsen B, Latz E, Damås JK, Mollnes TE, Espevik T. Cyclodextrin inhibits CC-induced complement activation. Mol Immunol 2017. [DOI: 10.1016/j.molimm.2017.06.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Espevik T, Niyonzima N, Bakke S, Halvorsen B, Gregersen I, Skjelland M, Yndestad A, Sandanger Ø, Andersen GØ, Gullestad L, Latz E, Aukrust P, Mollnes TE. Systemic- and local complement activation controls the NLRP3 inflammasome pathway in patients with atherosclerosis. Mol Immunol 2017. [DOI: 10.1016/j.molimm.2017.06.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bakke SS, Aune MH, Niyonzima N, Pilely K, Ryan L, Skjelland M, Garred P, Aukrust P, Halvorsen B, Latz E, Damås JK, Mollnes TE, Espevik T. Cyclodextrin Reduces Cholesterol Crystal–Induced Inflammation by Modulating Complement Activation. J I 2017; 199:2910-2920. [DOI: 10.4049/jimmunol.1700302] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/09/2017] [Indexed: 11/19/2022]
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Espada S, Stavik B, Holm S, Sagen EL, Bjerkeli V, Skjelland M, Dahl TB, Espevik T, Kanse S, Sandset PM, Skretting G, Halvorsen B. Tissue factor pathway inhibitor attenuates ER stress-induced inflammation in human M2-polarized macrophages. Biochem Biophys Res Commun 2017; 491:442-448. [PMID: 28712870 DOI: 10.1016/j.bbrc.2017.07.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/12/2017] [Indexed: 01/08/2023]
Abstract
Endoplasmic reticulum (ER) stress has been shown to play a key role during the initiation and clinical progression of the cardiovascular diseases, such as atherosclerosis. We have recently shown that expression of tissue factor pathway inhibitor (TFPI) in human monocyte-derived macrophages (MDMs) was induced by cholesterol crystals (CC). In the present study we aimed to determine the role of TFPI under ER stress conditions using human MDMs. qRT-PCR and immunohistochemistry analysis were performed to determine the presence of the ER stress marker CCAAT/enhancer binding protein homologous protein (CHOP) and TFPI in human carotid plaque material and also in human MDMs polarized into pro-inflammatory M1 or anti-inflammatory M2 populations. CHOP mRNA levels were upregulated in the plaques compared to healthy vessels, and CHOP protein was localized in the same area as TFPI in the plaques. Both CHOP and TFPI mRNA levels were upregulated after CC treatment, especially in the M2 phenotype, and the ER stress inhibitor 4-phenylbutyric acid (PBA) reversed this effect. Furthermore, CC treatment increased the levels of the pro-inflammatory cytokines TNF-α, IL-6, and IL-8, which for TNF-α and IL-8 was inhibited by PBA, and reduced the levels of the anti-inflammatory cytokine IL-10 in M2-polarized macrophages. Knockdown of TFPI prior to CC treatment exacerbated TNF-α and IL-6 levels, but reduced IL-8 and IL-10 levels. Our results show that CC induce TFPI and cytokine expression in M2-polarized macrophages through activation of the ER stress pathway and that TFPI has a protective effect against TNF-α and IL-6 mediated inflammation. These mechanisms may have implications for the pathogenesis of atherosclerosis.
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Affiliation(s)
- Sandra Espada
- Department of Haematology, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Box 1072 Blindern, 0316 Oslo, Norway
| | - Benedicte Stavik
- Department of Haematology, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway.
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway
| | - Ellen Lund Sagen
- Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Box 1072 Blindern, 0316 Oslo, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Box 1072 Blindern, 0316 Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Department of Microbiology, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Sandip Kanse
- Department of Haematology, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Box 1072 Blindern, 0316 Oslo, Norway
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Box 1072 Blindern, 0316 Oslo, Norway
| | - Grethe Skretting
- Department of Haematology, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, BOX 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Box 1072 Blindern, 0316 Oslo, Norway
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Stavik B, Holm S, Espada S, Iversen N, Sporsheim B, Bjerkeli V, Dahl TB, Sandset PM, Skjelland M, Espevik T, Skretting G, Halvorsen B. Increased expression of TFPI in human carotid stenosis. Thromb Res 2017; 155:31-37. [PMID: 28482260 DOI: 10.1016/j.thromres.2017.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/04/2017] [Accepted: 04/25/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Tissue factor (TF) pathway inhibitor (TFPI) is the physiological inhibitor of TF induced blood coagulation and two isoforms exists, TFPIα and TFPIβ. In atherosclerotic plaques, TFPI may inhibit TF activity and thrombus formation, which is the main cause of ischemic stroke in carotid artery disease. We aimed to identify the isoforms of TFPI present in human carotid plaques and potential sources of TFPI. MATERIALS AND METHODS Human atherosclerotic plaques from carotid endarterectomies were used for mRNA and immunohistochemistry analyses. hPBMCs isolated from buffy coats and THP-1 cells were differentiated and polarized into M1 or M2 macrophages, and subsequently cultured with or without cholesterol crystals (CC). mRNA and protein expression were measured with qRT-PCR and ELISA, respectively, and procoagulant activity was assessed using a two-stage chromogenic assay. RESULTS TFPIα and TFPIβ mRNA levels were significantly increased in carotid plaques, whereas TF levels were unchanged as compared to healthy arteries. Antibodies against total TFPI showed elevated levels compared to antibodies against free TFPIα, both by immunohistochemical and ELISA detection in plaques. The antibody against total TFPI also co-localized with CD68 and the M1 and M2 markers CD80 and CD163, respectively. The TFPI mRNA expression was elevated and the procoagulant activity was decreased in M2 compared to M1 polarized human macrophages. TFPI was present in early foam cell formation and CC treatment increased the TFPI mRNA expression even further in M2 macrophages. CONCLUSIONS Our data indicate that both isoforms of TFPI are present in advanced plaques and that anti-inflammatory M2 macrophages may be a potential source of TFPI.
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Affiliation(s)
- Benedicte Stavik
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Department of Haematology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Sandra Espada
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Department of Haematology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Nina Iversen
- Department of Medical Genetics, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Bjørnar Sporsheim
- Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tuva Børresdatter Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Per Morten Sandset
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Department of Haematology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Grethe Skretting
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Department of Haematology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Centre, University of Oslo, Oslo, Norway
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Abstract
Cardiovascular disease is estimated to be the leading cause of death, globally causing 14 million deaths each year. Stroke remains a massive public health problem and there is an increasing need for better strategies for the prevention and treatment of this disease. At least 20% of ischemic strokes are thromboembolic in nature, caused by a thromboembolism from an atherosclerotic plaque at the carotid bifurcation or the internal carotid artery. Current clinical guidelines for both primary and secondary prevention of stroke in patients with carotid stenosis caused by atherosclerotic plaques remain reliant on general patient characteristics (traditional risk factors for stroke) and static measures of the degree of artery stenosis. Patients with similar traditional risk factors, however, have been found to have different risk of stroke, and it has in recent years become increasingly clear that the degree of artery stenosis alone is not the best estimation of stroke risk. There is a need for new methods for the assessment of stroke risk to improve risk prediction for the individual patient. This review aims to give an overview of new methods available for the identification of carotid plaque instability and the assessment of stroke risk.
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Affiliation(s)
- Karolina Skagen
- Karolina Skagen, Oslo University Hospital, Rikshospitalet, Nevrologisk poliklinikk, Postbox 4950 Nydalen, 0424 Oslo, Norway,
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Zimmer S, Grebe A, Bakke SS, Bode N, Halvorsen B, Ulas T, Skjelland M, De Nardo D, Labzin LI, Kerksiek A, Hempel C, Heneka MT, Hawxhurst V, Fitzgerald ML, Trebicka J, Björkhem I, Gustafsson JÅ, Westerterp M, Tall AR, Wright SD, Espevik T, Schultze JL, Nickenig G, Lütjohann D, Latz E. Cyclodextrin promotes atherosclerosis regression via macrophage reprogramming. Sci Transl Med 2016; 8:333ra50. [PMID: 27053774 DOI: 10.1126/scitranslmed.aad6100] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/18/2016] [Indexed: 12/12/2022]
Abstract
Atherosclerosis is an inflammatory disease linked to elevated blood cholesterol concentrations. Despite ongoing advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains the leading cause of death worldwide. Continuous retention of apolipoprotein B-containing lipoproteins in the subendothelial space causes a local overabundance of free cholesterol. Because cholesterol accumulation and deposition of cholesterol crystals (CCs) trigger a complex inflammatory response, we tested the efficacy of the cyclic oligosaccharide 2-hydroxypropyl-β-cyclodextrin (CD), a compound that increases cholesterol solubility in preventing and reversing atherosclerosis. We showed that CD treatment of murine atherosclerosis reduced atherosclerotic plaque size and CC load and promoted plaque regression even with a continued cholesterol-rich diet. Mechanistically, CD increased oxysterol production in both macrophages and human atherosclerotic plaques and promoted liver X receptor (LXR)-mediated transcriptional reprogramming to improve cholesterol efflux and exert anti-inflammatory effects. In vivo, this CD-mediated LXR agonism was required for the antiatherosclerotic and anti-inflammatory effects of CD as well as for augmented reverse cholesterol transport. Because CD treatment in humans is safe and CD beneficially affects key mechanisms of atherogenesis, it may therefore be used clinically to prevent or treat human atherosclerosis.
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Affiliation(s)
- Sebastian Zimmer
- Medizinische Klinik und Poliklinik II, University Hospital Bonn, 53105 Bonn, Germany
| | - Alena Grebe
- Institute of Innate Immunity, University Hospital Bonn, 53127 Bonn, Germany
| | - Siril S Bakke
- Institute of Innate Immunity, University Hospital Bonn, 53127 Bonn, Germany. German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany. Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7489 Trondheim, Norway
| | - Niklas Bode
- Medizinische Klinik und Poliklinik II, University Hospital Bonn, 53105 Bonn, Germany
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, 0424 Oslo, Norway
| | - Thomas Ulas
- Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, 0424 Oslo, Norway
| | - Dominic De Nardo
- Institute of Innate Immunity, University Hospital Bonn, 53127 Bonn, Germany. Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia. Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Larisa I Labzin
- Institute of Innate Immunity, University Hospital Bonn, 53127 Bonn, Germany
| | - Anja Kerksiek
- Institute of Clinical Chemistry und Clinical Pharmacology, University Hospital Bonn, 53105 Bonn, Germany
| | | | - Michael T Heneka
- Clinic and Polyclinic for Neurology, University Hospital Bonn, 53105 Bonn, Germany
| | - Victoria Hawxhurst
- Lipid Metabolism Unit, Center for Computational and Integrative Biology, Boston, MA 02114, USA
| | - Michael L Fitzgerald
- Lipid Metabolism Unit, Center for Computational and Integrative Biology, Boston, MA 02114, USA
| | - Jonel Trebicka
- Medizinische Klinik und Poliklinik I, University Hospital Bonn, 53105 Bonn, Germany. Faculty of Health Sciences, University of Southern Denmark Campusvej 55, DK-5230 Odense M, Denmark
| | - Ingemar Björkhem
- Division of Clinical Chemistry, Karolinska Institutet, Huddinge University Hospital, 141 86 Huddinge, Sweden
| | - Jan-Åke Gustafsson
- Center for Nuclear Receptors and Cell Signaling, University of Houston, Houston, TX 77004, USA
| | - Marit Westerterp
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Alan R Tall
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | | | - Terje Espevik
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7489 Trondheim, Norway
| | - Joachim L Schultze
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany. Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, University Hospital Bonn, 53105 Bonn, Germany
| | - Dieter Lütjohann
- Institute of Clinical Chemistry und Clinical Pharmacology, University Hospital Bonn, 53105 Bonn, Germany
| | - Eicke Latz
- Institute of Innate Immunity, University Hospital Bonn, 53127 Bonn, Germany. German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany. Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7489 Trondheim, Norway. Department of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA 01605, USA.
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Lunde NN, Holm S, Dahl TB, Elyouncha I, Sporsheim B, Gregersen I, Abbas A, Skjelland M, Espevik T, Solberg R, Johansen HT, Halvorsen B. Increased levels of legumain in plasma and plaques from patients with carotid atherosclerosis. Atherosclerosis 2016; 257:216-223. [PMID: 27940038 DOI: 10.1016/j.atherosclerosis.2016.11.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS The cysteine protease legumain has been shown to be up-regulated in unstable atherosclerotic plaques. This study aims to further elucidate legumain in atherosclerosis, by examining legumain in plasma and carotid plaques from patients with carotid stenosis. Furthermore, legumain secretion from monocyte-derived macrophages treated with atherogenic lipids during macrophage polarization was studied. METHODS Plasma levels of legumain from patients with carotid stenosis (n = 254), healthy controls (n = 91), and secreted from monocyte-derived macrophages were assessed by enzyme-linked-immunosorbent assay. Quantitative PCR and immunoblotting of legumain were performed on isolated plaques and legumain localization was visualized by immunohistochemistry and fluorescence microscopy. Monocyte-derived macrophages polarized to M1 or M2 macrophages were treated with VLDL, oxLDL or cholesterol crystals (CC) and the level of legumain analysed. RESULTS Patients with carotid stenosis had significantly higher levels of plasma legumain compared with healthy controls (median 2.0 versus 1.5 ng/ml, respectively; p = 0.003), although there was no correlation between the level of legumain and the degree of stenosis, and legumain was not an independent factor to identify patients with carotid plaques. Moreover, patients with symptoms the last 2 months had higher expressions of mature legumain, cystatin C and E/M, and the macrophage markers CD80 (M1) and CD163 (M2). Legumain co-localized with both M1 and M2 macrophages within plaques, whereas legumain mRNA expression was significantly higher (p < 0.0001) in plaques compared to non-atherosclerotic arteries (controls). Furthermore, in vitro studies showed significantly increased secretion of legumain from pro-inflammatory M1 compared to pro-resolving M2 macrophages (p = 0.014), and particularly in M1 treated with CC. In plaques, legumain was localized to structures resembling foam cells. CONCLUSIONS Legumain is increased in both plasma and plaques of patients with carotid stenosis and might be a new and early biomarker of atherosclerosis.
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Affiliation(s)
- Ngoc Nguyen Lunde
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway
| | - Inass Elyouncha
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Bjørnar Sporsheim
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Azhar Abbas
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Østfold Hospital Trust, Kalnes, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rigmor Solberg
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway.
| | | | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway
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45
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Skarpengland T, Dahl TB, Skjelland M, Scheffler K, de Sousa MML, Gregersen I, Kuśnierczyk A, Sharma A, Slupphaug G, Eide L, Segers FM, Skagen KR, Dahl CP, Russell D, Folkersen L, Krohg-Sørensen K, Holm S, Bjørås M, Aukrust P, Halvorsen B. Enhanced base excision repair capacity in carotid atherosclerosis may protect nuclear DNA but not mitochondrial DNA. Free Radic Biol Med 2016; 97:386-397. [PMID: 27381496 DOI: 10.1016/j.freeradbiomed.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/13/2016] [Accepted: 07/01/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Lesional and systemic oxidative stress has been implicated in the pathogenesis of atherosclerosis, potentially leading to accumulation of DNA base lesions within atherosclerotic plaques. Although base excision repair (BER) is a major pathway counteracting oxidative DNA damage, our knowledge on BER and accumulation of DNA base lesions in clinical atherosclerosis is scarce. Here, we evaluated the transcriptional profile of a wide spectrum of BER components as well as DNA damage accumulation in atherosclerotic and non-atherosclerotic arteries. METHODS BER gene expression levels were analyzed in 162 carotid plaques, 8 disease-free carotid specimens from patients with carotid plaques and 10 non-atherosclerotic control arteries. Genomic integrity, mitochondrial (mt) DNA copy number, oxidative DNA damage and BER proteins were evaluated in a subgroup of plaques and controls. RESULTS Our major findings were: (i) The BER pathway showed a global increased transcriptional response in plaques as compared to control arteries, accompanied by increased expression of several BER proteins. (ii) Whereas nuclear DNA stability was maintained within carotid plaques, mtDNA integrity and copy number were decreased. (iii) Within carotid plaques, mRNA levels of several BER genes correlated with macrophage markers. (iv) In vitro, some of the BER genes were highly expressed in the anti-inflammatory and pro-resolving M2 macrophages, showing increased expression upon exposure to modified lipids. CONCLUSIONS The increased transcriptional response of BER genes in atherosclerosis may contribute to lesional nuclear DNA stability but appears insufficient to maintain mtDNA integrity, potentially influencing mitochondrial function in cells within the atherosclerotic lesion.
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Affiliation(s)
- Tonje Skarpengland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mona Skjelland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Department of Neurology, Oslo University Hospital Rikshospitalet, Norway
| | - Katja Scheffler
- Department of Medical Biochemistry, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirta Mittelsted Leal de Sousa
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna Kuśnierczyk
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Animesh Sharma
- PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Slupphaug
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Eide
- Department of Medical Biochemistry, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Filip M Segers
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | | | - Christen P Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway; Center of Heart Failure Research, University of Oslo, Oslo, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lasse Folkersen
- Center for Biological Sequence Analysis, Technical University of Denmark, Copenhagen, Denmark
| | - Kirsten Krohg-Sørensen
- Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Magnar Bjørås
- Department of Microbiology, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
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46
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Skarpengland T, Holm S, Scheffler K, Gregersen I, Dahl TB, Suganthan R, Segers FM, Østlie I, Otten JJT, Luna L, Ketelhuth DFJ, Lundberg AM, Neurauter CG, Hildrestrand G, Skjelland M, Bjørndal B, Svardal AM, Iversen PO, Hedin U, Nygård S, Olstad OK, Krohg-Sørensen K, Slupphaug G, Eide L, Kuśnierczyk A, Folkersen L, Ueland T, Berge RK, Hansson GK, Biessen EAL, Halvorsen B, Bjørås M, Aukrust P. Neil3-dependent base excision repair regulates lipid metabolism and prevents atherosclerosis in Apoe-deficient mice. Sci Rep 2016; 6:28337. [PMID: 27328939 PMCID: PMC4916448 DOI: 10.1038/srep28337] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/08/2016] [Accepted: 06/01/2016] [Indexed: 12/23/2022] Open
Abstract
Increasing evidence suggests that oxidative DNA damage accumulates in atherosclerosis. Recently, we showed that a genetic variant in the human DNA repair enzyme NEIL3 was associated with increased risk of myocardial infarction. Here, we explored the role of Neil3/NEIL3 in atherogenesis by both clinical and experimental approaches. Human carotid plaques revealed increased NEIL3 mRNA expression which significantly correlated with mRNA levels of the macrophage marker CD68. Apoe−/−Neil3−/− mice on high-fat diet showed accelerated plaque formation as compared to Apoe−/− mice, reflecting an atherogenic lipid profile, increased hepatic triglyceride levels and attenuated macrophage cholesterol efflux capacity. Apoe−/−Neil3−/− mice showed marked alterations in several pathways affecting hepatic lipid metabolism, but no genotypic alterations in genome integrity or genome-wide accumulation of oxidative DNA damage. These results suggest a novel role for the DNA glycosylase Neil3 in atherogenesis in balancing lipid metabolism and macrophage function, potentially independently of genome-wide canonical base excision repair of oxidative DNA damage.
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Affiliation(s)
- Tonje Skarpengland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Katja Scheffler
- Department of Medical Biochemistry, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Basic Medical Research, University of Oslo, Oslo, Norway.,Department of Informatics, University of Oslo, Oslo, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Rajikala Suganthan
- Department of Microbiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Filip M Segers
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ingunn Østlie
- Department of Pathology,Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - Jeroen J T Otten
- Department of Experimental Vascular Pathology, University of Maastricht, Maastricht, The Netherlands
| | - Luisa Luna
- Department of Microbiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Daniel F J Ketelhuth
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anna M Lundberg
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gunn Hildrestrand
- Department of Microbiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Asbjørn M Svardal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Per O Iversen
- Institute of Basic Medical Research, University of Oslo, Oslo, Norway.,Department of Hematology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Department of Nutrition, University of Oslo, Oslo, Norway
| | - Ulf Hedin
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ståle Nygård
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Ole K Olstad
- Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Geir Slupphaug
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Eide
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Anna Kuśnierczyk
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lasse Folkersen
- Center for Biological Sequence Analysis, Technical University of Denmark, Copenhagen, Denmark
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Rolf K Berge
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Göran K Hansson
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Erik A L Biessen
- Department of Experimental Vascular Pathology, University of Maastricht, Maastricht, The Netherlands
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Magnar Bjørås
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Microbiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
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47
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Skagen K, Evensen K, Scott H, Krohg-Sørensen K, Vatnehol SA, Hol PK, Skjelland M, Russell D. Semiautomated Magnetic Resonance Imaging Assessment of Carotid Plaque Lipid Content. J Stroke Cerebrovasc Dis 2016; 25:2004-10. [PMID: 27234919 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/16/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The composition of a carotid plaque is important for plaque vulnerability and stroke risk. The main aim of this study was to assess the potential of semiautomated segmentation of carotid plaque magnetic resonance imaging (MRI) in the assessment of the size of the lipid-rich necrotic core (LRNC). METHODS Thirty-four consecutive patients with carotid stenosis of 70% or higher, who were scheduled for carotid endarterectomy, underwent a clinical neurological examination, Color duplex ultrasound, 3-T MRI with an 8-channel carotid coil, and blood tests. All examinations were performed less than 24 hours prior to surgery and plaques were assessed histologically immediately following endarterectomy. Plaques were defined as symptomatic when associated with ipsilateral cerebral ischemic symptoms within 30 days prior to inclusion. The level of agreement between the size of the LRNC and calcification on MRI to the histological estimation of the same tissue components, plaque echolucency on ultrasound, and symptoms was assessed. RESULTS The size of the LRNC on MRI was significantly correlated to the percentage amount of lipid per plaque on histological assessment (P = .010, r = .5), and to echogenicity on ultrasound with echolucent plaques having larger LRNC than echogenic plaques (P = .001, r = -.7). CONCLUSIONS In this study, we found that semiautomated MRI assessments of the percentage LRNC in carotid plaques were significantly correlated to the percentage LRNC per plaque on histological assessment, and to echogenicity on ultrasound with echolucent plaques having larger LRNC than echogenic plaques.
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Affiliation(s)
- Karolina Skagen
- Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Kristin Evensen
- Department of Neurology, Oslo University Hospital, Norway; Vestre Viken, Drammen Hospital, Norway
| | - Helge Scott
- Department of Pathology, Oslo University Hospital, Norway
| | | | | | - Per Kristian Hol
- Institute of Clinical Medicine, University of Oslo, Norway; The Intervention Centre, Oslo University Hospital, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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48
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Paramel Varghese G, Folkersen L, Strawbridge RJ, Halvorsen B, Yndestad A, Ranheim T, Krohg-Sørensen K, Skjelland M, Espevik T, Aukrust P, Lengquist M, Hedin U, Jansson JH, Fransén K, Hansson GK, Eriksson P, Sirsjö A. NLRP3 Inflammasome Expression and Activation in Human Atherosclerosis. J Am Heart Assoc 2016; 5:JAHA.115.003031. [PMID: 27207962 PMCID: PMC4889178 DOI: 10.1161/jaha.115.003031] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [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: 12/19/2022]
Abstract
Background The NLR family, pyrin domain containing 3 (NLRP3) inflammasome is an interleukin (IL)‐1β and IL‐18 cytokine processing complex that is activated in inflammatory conditions. The role of the NLRP3 inflammasome in the pathogenesis of atherosclerosis and myocardial infarction is not fully understood. Methods and Results Atherosclerotic plaques were analyzed for transcripts of the NLRP3 inflammasome, and for IL‐1β release. The Swedish First‐ever myocardial Infarction study in Ac‐county (FIA) cohort consisting of DNA from 555 myocardial infarction patients and 1016 healthy individuals was used to determine the frequency of 4 single nucleotide polymorphisms (SNPs) from the downstream regulatory region of NLRP3. Expression of NLRP3, Apoptosis‐associated speck‐like protein containing a CARD (ASC), caspase‐1 (CASP1), IL1B, and IL18 mRNA was significantly increased in atherosclerotic plaques compared to normal arteries. The expression of NLRP3 mRNA was significantly higher in plaques of symptomatic patients when compared to asymptomatic ones. CD68‐positive macrophages were observed in the same areas of atherosclerotic lesions as NLRP3 and ASC expression. Occasionally, expression of NLRP3 and ASC was also present in smooth muscle cells. Cholesterol crystals and ATP induced IL‐1β release from lipopolysaccharide‐primed human atherosclerotic lesion plaques. The minor alleles of the variants rs4266924, rs6672995, and rs10733113 were associated with NLRP3 mRNA levels in peripheral blood mononuclear cells but not with the risk of myocardial infarction. Conclusions Our results indicate a possible role of the NLRP3 inflammasome and its genetic variants in the pathogenesis of atherosclerosis.
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Affiliation(s)
- Geena Paramel Varghese
- Cardiovascular Research Centre, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Lasse Folkersen
- Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rona J Strawbridge
- Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Trine Ranheim
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Terje Espevik
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Norway K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Mariette Lengquist
- Department of Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Hedin
- Department of Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jan-Håkan Jansson
- Department of Internal Medicine, Skellefteå Hospital and Umeå University Hospital, Umeå, Sweden
| | - Karin Fransén
- Cardiovascular Research Centre, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Göran K Hansson
- Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Eriksson
- Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Allan Sirsjö
- Cardiovascular Research Centre, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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49
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Skagen K, Trøseid M, Ueland T, Holm S, Abbas A, Gregersen I, Kummen M, Bjerkeli V, Reier-Nilsen F, Russell D, Svardal A, Karlsen TH, Aukrust P, Berge RK, Hov JER, Halvorsen B, Skjelland M. The Carnitine-butyrobetaine-trimethylamine-N-oxide pathway and its association with cardiovascular mortality in patients with carotid atherosclerosis. Atherosclerosis 2016; 247:64-9. [PMID: 26868510 DOI: 10.1016/j.atherosclerosis.2016.01.033] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/12/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE γ-butyrobetaine (γBB) is a metabolite from dietary Carnitine, involved in the gut microbiota-dependent conversion from Carnitine to the pro-atherogenic metabolite trimethylamine-N-oxide (TMAO). Orally ingested γBB has a pro-atherogenic effect in experimental studies, but γBB has not been studied in relation to atherosclerosis in humans. The aim of this study was to evaluate associations between serum levels of γBB, TMAO and their common precursors Carnitine and trimethyllysine (TML) and carotid atherosclerosis and adverse outcome. METHODS Serum γBB, Carnitine, TML and TMAO were quantified by high performance liquid chromatography in patients with carotid artery atherosclerosis (n = 264) and healthy controls (n = 62). RESULTS Serum γBB (p = 0.024) and Carnitine (p = 0.001), but not TMAO or TML, were increased in patients with carotid atherosclerosis. Higher levels of γBB and TML, but not TMAO or Carnitine were independently associated with cardiovascular death also after adjustment for age and eGFR (adjusted HR [95%] 3.3 [1.9-9.1], p = 0.047 and 6.0 [1.8-20.34], p = 0.026, respectively). CONCLUSIONS Patients with carotid atherosclerosis had increased serum levels of γBB, and elevated levels of γBB and its precursor TML were associated with cardiovascular mortality. Long-term clinical studies of γBB, as a cardiovascular risk marker, and safety studies regarding dietary supplementation of γBB, are warranted.
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Affiliation(s)
- Karolina Skagen
- Department of Neurology, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Marius Trøseid
- Institute of Clinical Medicine, University of Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; K.G.Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Azhar Abbas
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Neurology, Østfold Hospital, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Martin Kummen
- Institute of Clinical Medicine, University of Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; K.G. Jebsen Inflammatory Research Center, Norway; Norwegian PSC Research Center, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Frode Reier-Nilsen
- Dept of Vascular and Thoracic Surgery, Akershus University Hospital, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Asbjørn Svardal
- Department of Clinical Science, University of Bergen, Norway
| | - Tom Hemming Karlsen
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Transplantation Medicine, Section for Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Norway; K.G. Jebsen Inflammatory Research Center, Norway; K.G.Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Rolf K Berge
- Department of Clinical Science, University of Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Johannes E R Hov
- Institute of Clinical Medicine, University of Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Norwegian PSC Research Center, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Norway; Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Norway; K.G.Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Bente Halvorsen
- Institute of Clinical Medicine, University of Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; K.G. Jebsen Inflammatory Research Center, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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50
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Jusufovic M, Gjertsen Ø, Khalid F, Tennøe B, Skjelland M. Cerebral venous thrombectomy. Tidsskr Nor Laegeforen 2015; 135:1752. [PMID: 26486670 DOI: 10.4045/tidsskr.15.0538] [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: 11/02/2022] Open
Affiliation(s)
| | - Øivind Gjertsen
- Avdeling for radiologi og nukleærmedisin/nevroradiologisk enhet Klinikk for diagnostikk og intervensjon
| | | | - Bjørn Tennøe
- Avdeling for radiologi og nukleærmedisin/nevroradiologisk enhet Klinikk for diagnostikk og intervensjon
| | - Mona Skjelland
- Nevrologisk avdeling Klinikk for kirurgi og nevrofag Oslo universitetssykehus, Rikshospitalet
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