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Honeycutt D, Schmidt-Trucksäss A, Brink M, Kränkel N, Kröpfl JM. Letter to the editor: fasting decreases expression of microRNAs linked to endothelial pathophysiology in mononuclear cells of healthy subjects. Apoptosis 2024:10.1007/s10495-024-01971-4. [PMID: 38642320 DOI: 10.1007/s10495-024-01971-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
This study explores how 14-15 h fasting or acute exercise affects immune cell epigenetics, specifically focusing on miRNAs in mononuclear cells. Findings suggest fasting significantly impacts microRNAs associated with endothelial metabolism compared to exercise, but does not directly connect these changes to cell apoptosis or autophagy. This enhances comprehension of cellular self-consumption under health-promoting interventions.
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Affiliation(s)
- Denise Honeycutt
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise, and Health, Sport and Exercise Medicine, University of Basel, Grosse Allee 6, Basel, 4052, Switzerland
| | - Marijke Brink
- Department of Biomedicine, Cardiobiology, University Hospital Basel and University of Basel, Hebelstrasse 20, Basel, 4031, Switzerland
| | - Nicolle Kränkel
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
- Friede Springer - Centre of Cardiovascular Prevention @ Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Julia M Kröpfl
- Department of Sport, Exercise, and Health, Sport and Exercise Medicine, University of Basel, Grosse Allee 6, Basel, 4052, Switzerland.
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2
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Lechner K, Kia S, von Korn P, Dinges SM, Mueller S, Tjønna AE, Wisløff U, Van Craenenbroeck EM, Pieske B, Adams V, Pressler A, Landmesser U, Halle M, Kränkel N. Cardiometabolic and immune response to exercise training in patients with metabolic syndrome: retrospective analysis of two randomized clinical trials. Front Cardiovasc Med 2024; 11:1329633. [PMID: 38638882 PMCID: PMC11025358 DOI: 10.3389/fcvm.2024.1329633] [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: 10/29/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
Background Metabolic syndrome (MetS) is defined by the presence of central obesity plus ≥two metabolic/cardiovascular risk factors (RF), with inflammation being a major disease-driving mechanism. Structured endurance exercise training (ET) may positively affect these traits, as well as cardiorespiratory fitness (V̇O2peak). Aims We explore individual ET-mediated improvements of MetS-associated RF in relation to improvements in V̇O2peak and inflammatory profile. Methods MetS patients from two randomized controlled trials, ExMET (n = 24) and OptimEx (n = 34), had performed 4- or 3-months supervised ET programs according to the respective trial protocol. V̇O2peak, MetS-defining RFs (both RCTs), broad blood leukocyte profile, cytokines and plasma proteins (ExMET only) were assessed at baseline and follow-up. Intra-individual changes in RFs were analysed for both trials separately using non-parametric approaches. Associations between changes in each RF over the exercise period (n-fold of baseline values) were correlated using a non-parametrical approach (Spearman). RF clustering was explored by uniform manifold approximation and projection (UMAP) and changes in RF depending on other RF or exercise parameters were explored by recursive partitioning. Results Four months of ET reduced circulating leukocyte counts (63.5% of baseline, P = 8.0e-6), especially effector subtypes. ET response of MetS-associated RFs differed depending on patients' individual RF constellation, but was not associated with individual change in V̇O2peak. Blood pressure lowering depended on cumulative exercise duration (ExMET: ≥102 min per week; OptimEx-MetS: ≥38 min per session) and baseline triglyceride levels (ExMET: <150 mg/dl; OptimEx-MetS: <174.8 mg/dl). Neuropilin-1 plasma levels were inversely associated with fasting plasma triglycerides (R: -0.4, P = 0.004) and changes of both parameters during the ET phase were inversely correlated (R: -0.7, P = 0.0001). Conclusions ET significantly lowered effector leukocyte blood counts. The improvement of MetS-associated cardiovascular RFs depended on individual basal RF profile and exercise duration but was not associated with exercise-mediated increase in V̇O2peak. Neuropilin-1 may be linked to exercise-mediated triglyceride lowering.
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Affiliation(s)
- Katharina Lechner
- Department of Prevention and Sports Medicine, University Hospital Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sylvia Kia
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site, Berlin, Germany
| | - Pia von Korn
- Department of Prevention and Sports Medicine, University Hospital Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Sophia M. Dinges
- Department of Prevention and Sports Medicine, University Hospital Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Stephan Mueller
- Department of Prevention and Sports Medicine, University Hospital Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Arnt-Erik Tjønna
- Cardiac Exercise Research Group (CERG), Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Cardiac Exercise Research Group (CERG), Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Emeline M. Van Craenenbroeck
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Adams
- Department of Cardiology and Internal Medicine, Heart Center Dresden-University Hospital, TU Dresden, Dresden, Germany
| | - Axel Pressler
- Department of Prevention and Sports Medicine, University Hospital Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
- Private Center for Sports and Exercise Cardiology, Munich, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site, Berlin, Germany
- Friede Springer—Centre of Cardiovascular Prevention at Charité, Charité University Medicine Berlin, Berlin, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicolle Kränkel
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site, Berlin, Germany
- Friede Springer—Centre of Cardiovascular Prevention at Charité, Charité University Medicine Berlin, Berlin, Germany
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3
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Tsampasian V, Bäck M, Bernardi M, Cavarretta E, Dębski M, Gati S, Hansen D, Kränkel N, Koskinas K, Niebauer J, Spadafora L, Frias Vargas M, Biondi-Zoccai G, Vassiliou VS. Cardiovascular disease as part of Long COVID: A systematic review. Eur J Prev Cardiol 2024:zwae070. [PMID: 38381595 DOI: 10.1093/eurjpc/zwae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Long COVID syndrome has had a major impact on million patients' lives worldwide. The cardiovascular system is an important aspect of this multifaceted disease that may manifest in many ways. We have hereby performed a narrative review in order to identify the extent of the cardiovascular manifestations of the Long COVID syndrome. METHODS AND RESULTS An in-depth systematic search of the literature has been conducted for this narrative review. The systematic search of PubMed and Cochrane databases yielded 3,993, of which 629 underwent full text screening. A total of 78 studies were included in the final qualitative synthesis and data evaluation. The pathophysiology of the cardiovascular sequelae of Long COVID syndrome and the cardiac manifestations and complications of Long COVID syndrome are critically evaluated. In addition, potential cardiovascular risk factors are assessed, and preventive methods and treatment options are examined in this review. CONCLUSIONS This systematic review poignantly summarises the evidence from the available literature regarding the cardiovascular manifestations of Long COVID syndrome and reviews potential mechanistic pathways, diagnostic approaches, preventive measures and treatment options.
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Affiliation(s)
| | - Maria Bäck
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Maciej Dębski
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sabiha Gati
- Royal Brompton Hospital, UK and Imperial College London, UK
| | | | - Nicolle Kränkel
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Campus Benjamin-Franklin (CBF), Charité University Medicine Berlin, 12203 Berlin, Germany
| | - Konstantinos Koskinas
- Department of Cardiology, Bern University Hospital - INSELSPITAL, University of Bern, Switzerland
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Manuel Frias Vargas
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Spain
- San Andres Primary Care Health Centre, Madrid, Spain
| | - Giuseppe Biondi-Zoccai
- Mediterranea Cardiocentro, Naples, Italy
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Cardiology, Norfolk and Norwich University Hospital, UK
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4
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Seppelt C, Abdelwahed YS, Meteva D, Nelles G, Stähli BE, Erbay A, Kränkel N, Sieronski L, Skurk C, Haghikia A, Sinning D, Dreger H, Knebel F, Trippel TD, Krisper M, Gerhardt T, Rai H, Klotsche J, Joner M, Landmesser U, Leistner DM. Coronary microevaginations characterize culprit plaques and their inflammatory microenvironment in a subtype of acute coronary syndrome with intact fibrous cap: results from the prospective translational OPTICO-ACS study. Eur Heart J Cardiovasc Imaging 2024; 25:175-184. [PMID: 37395586 DOI: 10.1093/ehjci/jead154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023] Open
Abstract
AIMS Coronary microevaginations (CMEs) represent an outward bulge of coronary plaques and have been introduced as a sign of adverse vascular remodelling following coronary device implantation. However, their role in atherosclerosis and plaque destabilization in the absence of coronary intervention is unknown. This study aimed to investigate CME as a novel feature of plaque vulnerability and to characterize its associated inflammatory cell-vessel-wall interactions. METHODS AND RESULTS A total of 557 patients from the translational OPTICO-ACS study programme underwent optical coherence tomography imaging of the culprit vessel and simultaneous immunophenotyping of the culprit lesion (CL). Two hundred and fifty-eight CLs had a ruptured fibrous cap (RFC) and one hundred had intact fibrous cap (IFC) acute coronary syndrome (ACS) as an underlying pathophysiology. CMEs were significantly more frequent in CL when compared with non-CL (25 vs. 4%, P < 0.001) and were more frequently observed in lesions with IFC-ACS when compared with RFC-ACS (55.0 vs. 12.7%, P < 0.001). CMEs were particularly prevalent in IFC-ACS-causing CLs independent of a coronary bifurcation (IFC-ICB) when compared with IFC-ACS with an association to a coronary bifurcation (IFC-ACB, 65.4 vs. 43.7%, P = 0.030). CME emerged as the strongest independent predictor of IFC-ICB (relative risk 3.36, 95% confidence interval 1.67-6.76, P = 0.001) by multivariable regression analysis. IFC-ICB demonstrated an enrichment of monocytes in both culprit blood analysis (culprit ratio: 1.1 ± 0.2 vs. 0.9 ± 0.2, P = 0.048) and aspirated culprit thrombi (326 ± 162 vs. 96 ± 87 cells/mm2, P = 0.017), while IFC-ACB confirmed the accumulation of CD4+ T cells, as recently described. CONCLUSION This study provides novel evidence for a pathophysiological involvement of CME in the development of IFC-ACS and provides first evidence for a distinct pathophysiological pathway for IFC-ICB, driven by CME-derived flow disturbances and inflammatory activation involving the innate immune system. TRIAL REGISTRATION Registration of the study at clinicalTrials.gov (NCT03129503).
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Affiliation(s)
- Claudio Seppelt
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Denitsa Meteva
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Gregor Nelles
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
| | - Aslihan Erbay
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Lara Sieronski
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
| | - David Sinning
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Department of Cardiology Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Knebel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Department of Cardiology Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Tobias D Trippel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin 13353, Germany
| | - Maximilian Krisper
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin 13353, Germany
| | - Teresa Gerhardt
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
| | - Himanshu Rai
- Department of Cardiology and ISAR Research Centre, German Heart Centre, Technical University Munich, Munich 80636, Germany
- Cardiovascular Research Institute Dublin, Imaging Core Lab, Mater Private Network, Dublin D07 YH66, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, and Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Charité Mitte, Berlin 10117, Germany
| | - Michael Joner
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Department of Cardiology and ISAR Research Centre, German Heart Centre, Technical University Munich, Munich 80636, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
| | - David M Leistner
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
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5
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Reinshagen L, Nageswaran V, Heidecke H, Schulze-Forster K, Wilde ACB, Ramezani Rad P, Poller W, Asmus E, Simmons S, Kuebler WM, Witzenrath M, Markó L, Jakobs K, Puccini M, Leistner DM, Rauch-Kröhnert U, Kränkel N, Forslund SK, Landmesser U, Müller DN, Haghikia A. Protease-Activated Receptor-1 IgG Autoantibodies in Patients with COVID-19. Thromb Haemost 2023. [PMID: 37931906 DOI: 10.1055/a-2205-0014] [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: 11/08/2023]
Affiliation(s)
- Leander Reinshagen
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Vanasa Nageswaran
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Berlin, Germany
| | | | - Kai Schulze-Forster
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Berlin, Germany
| | | | - Pegah Ramezani Rad
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Wolfgang Poller
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Erik Asmus
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Szandor Simmons
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolfgang M Kuebler
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- The Keenan Research Centre for Biomedical Science at St. Michael's, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
- Departments of Physiology, University of Toronto, Toronto, Canada
- German Center for Lung Research (DZL), Partner site Berlin, Germany
| | - Martin Witzenrath
- German Center for Lung Research (DZL), Partner site Berlin, Germany
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lajos Markó
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Kai Jakobs
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Marianna Puccini
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Department of Medicine III, Cardiology Goethe University Frankfurt am Main, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main Frankfurt, Germany
| | - Ursula Rauch-Kröhnert
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Sofia K Forslund
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Dominik N Müller
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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6
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Nelles G, Abdelwahed YS, Alyaqoob A, Seppelt C, Stähli BE, Meteva D, Kränkel N, Haghikia A, Skurk C, Dreger H, Knebel F, Trippel TD, Krisper M, Sieronski L, Gerhardt T, Zanders L, Klotsche J, Landmesser U, Joner M, Leistner DM. Spotty calcium deposits within acute coronary syndrome (ACS)-causing culprit lesions impact inflammatory vessel-wall interactions and are associated with higher cardiovascular event rates at one year follow-up: Results from the prospective translational OPTICO-ACS study program. Atherosclerosis 2023; 385:117284. [PMID: 37871405 DOI: 10.1016/j.atherosclerosis.2023.117284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND AIMS Spotty calcium deposits (SCD) represent a vulnerable plaque feature which seems to result - as based on recent invitro studies - from inflammatory vessel-wall interactions. SCD can be reliably assessed by optical coherence tomography (OCT). Their prognostic impact is yet unknown. Therefore, the aims of this translational study were to comprehensively characterize different plaque calcification patterns, to analyze the associated inflammatory mechanisms in the microenvironment of acute coronary syndrome (ACS)-causing culprit lesions (CL) and to investigate the prognostic significance of SCD in a large cohort of ACS-patients. METHODS CL of the first 155 consecutive ACS-patients from the translational OPTICO-ACS-study program were investigated by OCT-characterization of the calcium phenotype at ACS-causing culprit lesions. Simultaneous immunophenotyping by flow-cytometric analysis and cytokine bead array technique across the CL gradient (ratio local/systemic levels) was performed and incidental major adverse cardiovascular events plus (MACE+) at 12 months after ACS were assessed. RESULTS SCD were observed within 45.2% of all analyzed ACS-causing culprit lesions (CL). Culprits containing spotty calcium were characterized by an increased culprit ratio of innate effector cytokines interleukin (IL)-8 [2.04 (1.24) vs. 1.37 (1.10) p < 0.05], as well as TNF (tumor necrosis factor)-α [1.17 (0.93) vs. 1.06 (0.89); p < 0.05)] and an increased ratio of circulating neutrophils [0.96 (0.85) vs. 0.91 (0.77); p < 0.05] as compared to culprit plaques without SCD. Total monocyte levels did not differ between the two groups (p = n.s.). However, SCD-containing CLs were characterized by an increased culprit ratio of intermediate monocytes [(1.15 (0.81) vs. 0.96 (0.84); p < 0.05)] with an enhanced surface expression of the integrin receptor CD49d as compared to intermediate monocytes derived from SCD-free CLs [(1.06 (0.94) vs. 0.97 (0.91)] p < 0.05. Finally, 12 months rates of MACE+ were higher in patients with, as compared to patients without SCD at CL (16.4% vs. 5.3%; p < 0.05). CONCLUSIONS This study for the first time identified a specific inflammatory profile of CL with SCD, with a predominance of neutrophils, intermediate monocytes and their corresponding effector molecules. Hence, this study advances our understanding of ACS-causing CL and provides the basis for future personalized anti-inflammatory, therapeutic approaches to ACS.
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Affiliation(s)
- Gregor Nelles
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Aseel Alyaqoob
- Department of Cardiology and ISAR Research Centre, German Heart Centre, 80636, Munich, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Munch, 80636, Munich, Germany
| | - Claudio Seppelt
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany
| | - Barbara E Stähli
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Cardiology, Universitäres Herzzentrum, Universitätsspital Zürich, Zurich, Switzerland
| | - Denitsa Meteva
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Cardiology Charité University Medicine Berlin, Campus Mitte, 10117, Germany
| | - Fabian Knebel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Cardiology Charité University Medicine Berlin, Campus Mitte, 10117, Germany; Department of Cardiology, Sana Clinic Lichtenberg, 10365, Berlin, Germany
| | - Tobias D Trippel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Cardiology, Charité University Medicine, Campus Virchow, 13353, Berlin, Germany
| | - Maximilian Krisper
- Department of Cardiology, Charité University Medicine, Campus Virchow, 13353, Berlin, Germany
| | - Lara Sieronski
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Teresa Gerhardt
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Berlin Institute of Health (BIH), 10117, Berlin, Germany; Cardiovascular Research Institute and the Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, USA
| | - Lukas Zanders
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, Institute for Social Medicine, Epidemiology und Heath Economy, Charité University Medicine Berlin, Campus Mitte, 10117, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Berlin Institute of Health (BIH), 10117, Berlin, Germany
| | - Michael Joner
- Department of Cardiology and ISAR Research Centre, German Heart Centre, 80636, Munich, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Munch, 80636, Munich, Germany
| | - David M Leistner
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany; Berlin Institute of Health (BIH), 10117, Berlin, Germany.
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7
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Meteva D, Vinci R, Seppelt C, Abdelwahed YS, Pedicino D, Nelles G, Skurk C, Haghikia A, Rauch-Kröhnert U, Gerhardt T, Straessler E, Zhao Y, Golla F, Joner M, Rai H, Kratzer A, Arnal HG, Liuzzo G, Klotsche J, Crea F, Landmesser U, Leistner DM, Kränkel N. Toll-like receptor 2, hyaluronan, and neutrophils play a key role in plaque erosion: the OPTICO-ACS study. Eur Heart J 2023; 44:3892-3907. [PMID: 37381760 DOI: 10.1093/eurheartj/ehad379] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND AND AIMS In one-third of patients with acute coronary syndrome (ACS), thrombosis occurs despite an intact fibrous cap (IFC) (IFC-ACS, 'plaque erosion'). Recent studies emphasize neutrophils as the immediate inflammatory response in this pathology, but their exact molecular activation patterns are still poorly understood and may represent future therapeutic targets. METHODS AND RESULTS Thirty-two patients with IFC-ACS and matched patients with ACS with ruptured fibrous cap (RFC) (RFC-ACS) from the OPTICO-ACS study were included, and blood samples were collected from the local site of the culprit lesion and the systemic circulation. Neutrophil surface marker expression was quantified by flow cytometry. Neutrophil cytotoxicity towards endothelial cells was examined in an ex vivo co-culture assay. Secretion of active matrix metalloproteinase 9 (MMP9) by neutrophils was evaluated using zymography in supernatants and in plasma samples. Optical coherence tomography (OCT)-embedded thrombi were used for immunofluorescence analysis. Toll-like receptor 2 (TLR2) expression was higher on neutrophils from IFC-ACS than RFC-ACS patients. TLR2 stimulation increased the release of active MMP9 from local IFC-ACS-derived neutrophils, which also aggravated endothelial cell death independently of TLR2. Thrombi of IFC-ACS patients exhibited more hyaluronidase 2 with concomitant increase in local plasma levels of the TLR2 ligand: hyaluronic acid. CONCLUSION The current study provides first in-human evidence for distinct TLR2-mediated neutrophil activation in IFC-ACS, presumably triggered by elevated soluble hyaluronic acid. Together with disturbed flow conditions, neutrophil-released MMP9 might be promoting endothelial cell loss-triggered thrombosis and therefore providing a potential future target for a phenotype-specific secondary therapeutic approach in IFC-ACS.
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Affiliation(s)
- Denitsa Meteva
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
| | - Ramona Vinci
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome 00168, Italy
- Department of Cardiovascular Sciences, IRCCS Fondazione Policlinico Universitario A. Gemelli, Largo Francesco Vito 1, Rome 00168, Italy
| | - Claudio Seppelt
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
- Department of Cardiology and Angiology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60598, Germany
| | - Youssef S Abdelwahed
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
| | - Daniela Pedicino
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome 00168, Italy
- Department of Cardiovascular Sciences, IRCCS Fondazione Policlinico Universitario A. Gemelli, Largo Francesco Vito 1, Rome 00168, Italy
| | - Gregor Nelles
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Carsten Skurk
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
| | - Arash Haghikia
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, Berlin 10178, Germany
| | - Ursula Rauch-Kröhnert
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
| | - Teresa Gerhardt
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, Berlin 10178, Germany
| | - Elisabeth Straessler
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
| | - Yingjie Zhao
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Felix Golla
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Michael Joner
- Department of Cardiology and ISAR Research Centre, German Heart Centre Munich, Lazarettstrasse 36, Munich 80636, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Munich, Munich 80636, Germany
| | - Himanshu Rai
- Cardiovascular Research Institute Dublin, Mater Private Network, 73 Eccles Street, Dublin D07 YH66, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St. Stephan's Green, Dublin D02 YN77, Ireland
| | - Adelheid Kratzer
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
| | - Hector Giral Arnal
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
| | - Giovanna Liuzzo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome 00168, Italy
- Department of Cardiovascular Sciences, IRCCS Fondazione Policlinico Universitario A. Gemelli, Largo Francesco Vito 1, Rome 00168, Italy
| | - Jens Klotsche
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- German Rheumatism Research Centre (DRFZ) and Institute for Social Medicine, Epidemiology and Health Economy, Charitė University Medicine Berlin, Campus Charite Mitte, Charitėplatz 1, Berlin 10117, Germany
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome 00168, Italy
- Department of Cardiovascular Sciences, IRCCS Fondazione Policlinico Universitario A. Gemelli, Largo Francesco Vito 1, Rome 00168, Italy
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, Berlin 10178, Germany
| | - David M Leistner
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, Berlin 10178, Germany
- Department of Cardiology and Angiology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60598, Germany
| | - Nicolle Kränkel
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Berlin, Berlin 12203, Germany
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8
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Gerhardt T, Seppelt C, Abdelwahed YS, Meteva D, Wolfram C, Stapmanns P, Erbay A, Zanders L, Nelles G, Musfeld J, Sieronski L, Stähli BE, Montone RA, Vergallo R, Haghikia A, Skurk C, Knebel F, Dreger H, Trippel TD, Rai H, Joner M, Klotsche J, Libby P, Crea F, Kränkel N, Landmesser U, Leistner DM. Culprit plaque morphology determines inflammatory risk and clinical outcomes in acute coronary syndrome. Eur Heart J 2023; 44:3911-3925. [PMID: 37381774 DOI: 10.1093/eurheartj/ehad334] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 06/30/2023] Open
Abstract
AIMS Rupture of the fibrous cap (RFC) and erosion of an intact fibrous cap (IFC) are the two predominant mechanisms causing acute coronary syndromes (ACS). It is uncertain whether clinical outcomes are different following RFC-ACS vs. IFC-ACS and whether this is affected by a specific inflammatory response. The prospective, translational OPTIcal-COherence Tomography in Acute Coronary Syndrome study programme investigates the impact of the culprit lesion phenotype on inflammatory profiles and prognosis in ACS patients. METHODS AND RESULTS This analysis included 398 consecutive ACS patients, of which 62% had RFC-ACS and 25% had IFC-ACS. The primary endpoint was a composite of cardiac death, recurrent ACS, hospitalization for unstable angina, and target vessel revascularization at 2 years [major adverse cardiovascular events (MACE+)]. Inflammatory profiling was performed at baseline and after 90 days. Patients with IFC-ACS had lower rates of MACE+ than those with RFC-ACS (14.3% vs. 26.7%, P = 0.02). In 368-plex proteomic analyses, patients with IFC-ACS showed lower inflammatory proteome expression compared with those with RFC-ACS, including interleukin-6 and proteins associated with the response to interleukin-1β. Circulating plasma levels of interleukin-1β decreased from baseline to 3 months following IFC-ACS (P < 0.001) but remained stable following RFC-ACS (P = 0.25). Interleukin-6 levels decreased in patients with RFC-ACS free of MACE+ (P = 0.01) but persisted high in those with MACE+. CONCLUSION This study demonstrates a distinct inflammatory response and a lower risk of MACE+ following IFC-ACS. These findings advance our understanding of inflammatory cascades associated with different mechanisms of plaque disruption and provide hypothesis generating data for personalized anti-inflammatory therapeutic allocation to ACS patients, a strategy that merits evaluation in future clinical trials.
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Affiliation(s)
- Teresa Gerhardt
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Cardiovascular Research Institute and the Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, USA
| | - Claudio Seppelt
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Denitsa Meteva
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Christopher Wolfram
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
| | - Philip Stapmanns
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
| | - Aslihan Erbay
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany
| | - Lukas Zanders
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Gregor Nelles
- Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany
| | - Johanna Musfeld
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
| | - Lara Sieronski
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Barbara E Stähli
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Zurich, Switzerland
| | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arash Haghikia
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Fabian Knebel
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, Campus Charité Mitte (CCM), Berlin 10117, Germany
- Sana Klinikum Lichtenberg, Innere Medizin II: Schwerpunkt Kardiologie, Berlin, Germany
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, Campus Charité Mitte (CCM), Berlin 10117, Germany
| | - Tobias D Trippel
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Clinic (CVK), Berlin 13353, Germany
| | - Himanshu Rai
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, 80636 Munich, Germany
- Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research) partner Site Munich, Munich 80636, Germany
| | - Jens Klotsche
- German Rheumatism Research Center Berlin, and Institute for Social Medicine, Epidemiology und Health Economy, Charité University Medicine Berlin, Campus Charité Mitte, Berlin 10117, Germany
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Nicolle Kränkel
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Germany and Berlin Institute of Health (BIH), Hindenburgdamm 30, Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany
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9
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Kränkel N, Rauch-Kroehnert U. Artificial sweetener sucralose: a possible modulator of autoimmune diseases. Signal Transduct Target Ther 2023; 8:377. [PMID: 37779177 PMCID: PMC10543406 DOI: 10.1038/s41392-023-01607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- Nicolle Kränkel
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Campus Benjamin-Franklin (CBF), 12203, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
- Friede Springer-Centre of Cardiovascular Prevention @ Charité, Charité-University Medicine Berlin, Berlin, Germany
| | - Ursula Rauch-Kroehnert
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Campus Benjamin-Franklin (CBF), 12203, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.
- Friede Springer-Centre of Cardiovascular Prevention @ Charité, Charité-University Medicine Berlin, Berlin, Germany.
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10
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Kränkel N, Scherrenberg M, Abela M, Shemesh E, Kopylova O, Babu AS, Gaber MH, Śliż D, Salzwedel A. Do we practice what we preach? Implementation of cardiovascular prevention strategies in 13 European countries between 2011 and 2021. A statement of the European Association of Preventive Cardiology of the ESC. Eur J Prev Cardiol 2023:zwad312. [PMID: 37769237 DOI: 10.1093/eurjpc/zwad312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 09/30/2023]
Affiliation(s)
- Nicolle Kränkel
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Campus Benjamin-Franklin (CBF), 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany
- Friede Springer - Centre of Cardiovascular Prevention @ Charité, Charité University Medicine Berlin, Berlin, Germany
| | - Martijn Scherrenberg
- University of Hasselt, Faculty of Medicine and Life Sciences, Agoralaan, 3590 Diepenbeek, Belgium
| | - Mark Abela
- Department of Cardiac Rehabilitation, Mater Dei Hospital, Malta, MSD2090/Department of Cardiology, University of Malta, Malta, MSD2080
| | - Elad Shemesh
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center
| | - Oksana Kopylova
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Daniel Śliż
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Poland
- Centre of Postgraduate Medical Education, Warsaw, Poland (School of Public Health)
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences, University of Potsdam, Germany
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11
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Ghanbari EP, Jakobs K, Puccini M, Reinshagen L, Friebel J, Haghikia A, Kränkel N, Landmesser U, Rauch-Kröhnert U. The Role of NETosis and Complement Activation in COVID-19-Associated Coagulopathies. Biomedicines 2023; 11:biomedicines11051371. [PMID: 37239041 DOI: 10.3390/biomedicines11051371] [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: 04/05/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Inflammation-induced coagulopathy is a common complication associated with coronavirus disease 2019 (COVID-19). We aim to evaluate the association of NETosis and complement markers with each other as well as their association with thrombogenicity and disease severity in COVID-19. The study included hospitalized patients with an acute respiratory infection: patients with SARS-CoV2 infection (COVpos, n = 47) or either pneumonia or infection-triggered acute exacerbated COPD (COVneg, n = 36). Our results show that NETosis, coagulation, and platelets, as well as complement markers, were significantly increased in COVpos patients, especially in severely ill COVpos patients. NETosis marker MPO/DNA complexes correlated with coagulation, platelet, and complement markers only in COVpos. Severely ill COVpos patients showed an association between complement C3 and SOFA (R = 0.48; p ≤ 0.028), C5 and SOFA (R = 0.46; p ≤ 0.038), and C5b-9 and SOFA (R = 0.44; p ≤ 0.046). This study provides further evidence that NETosis and the complement system are key players in COVID-19 inflammation and clinical severity. Unlike previous studies that found NETosis and complement markers to be elevated in COVID-19 patients compared to healthy controls, our findings show that this characteristic distinguishes COVID-19 from other pulmonary infectious diseases. Based on our results, we propose that COVID-19 patients at high risk for immunothrombosis could be identified via elevated complement markers such as C5.
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Affiliation(s)
- Emily Parissa Ghanbari
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Kai Jakobs
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Marianna Puccini
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Leander Reinshagen
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Julian Friebel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ursula Rauch-Kröhnert
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
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12
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Puccini M, Jakobs K, Reinshagen L, Friebel J, Schencke PA, Ghanbari E, Landmesser U, Haghikia A, Kränkel N, Rauch U. Galectin-3 as a Marker for Increased Thrombogenicity in COVID-19. Int J Mol Sci 2023; 24:ijms24097683. [PMID: 37175392 PMCID: PMC10178107 DOI: 10.3390/ijms24097683] [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: 03/23/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
Galectin-3 is a beta-galactoside-binding lectin involved in inflammation and lung fibrosis and postulated to enhance thrombosis. In COVID-19, it is considered to be a prognostic marker of severity. The aim of this study was to evaluate whether galectin-3 is associated with thrombogenicity in COVID-19. Patients with moderate-to-severe COVID-19 (COVpos; n = 55) and patients with acute respiratory diseases, but without COVID-19 (COVneg; n = 35), were included in the study. We measured the amount of galectin-3, as well as other platelet and coagulation markers, and correlated galectin-3 levels with these markers of thrombogenicity and with the SOFA Score values. We found that galectin-3 levels, as well as von Willebrand Factor (vWF), antithrombin and tissue plasminogen activator levels, were higher in the COVpos than they were in the COVneg cohort. Galectin-3 correlated positively with vWF, antithrombin and D-dimer in the COVpos cohort, but not in the COVneg cohort. Moreover, galactin-3 correlated also with clinical disease severity, as measured by the SOFA Score. In patients with acute respiratory diseases, galectin-3 can be considered as a marker not only for disease severity, but also for increased hypercoagulability. Whether galectin-3 might be a useful therapeutic target in COVID-19 needs to be assessed in future studies.
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Affiliation(s)
- Marianna Puccini
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 10178 Berlin, Germany
| | - Kai Jakobs
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 10178 Berlin, Germany
| | - Leander Reinshagen
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 10178 Berlin, Germany
| | - Julian Friebel
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 10178 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10178 Berlin, Germany
| | - Philipp-Alexander Schencke
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
| | - Emily Ghanbari
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 10178 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10178 Berlin, Germany
| | - Arash Haghikia
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 10178 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10178 Berlin, Germany
| | - Nicolle Kränkel
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 10178 Berlin, Germany
| | - Ursula Rauch
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, 12203 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 10178 Berlin, Germany
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13
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Valenzuela PL, Ruilope LM, Santos-Lozano A, Wilhelm M, Kränkel N, Fiuza-Luces C, Lucia A. Exercise benefits in cardiovascular diseases: from mechanisms to clinical implementation. Eur Heart J 2023:7099688. [PMID: 37005351 DOI: 10.1093/eurheartj/ehad170] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/11/2023] [Accepted: 03/07/2023] [Indexed: 04/04/2023] Open
Abstract
There is a pandemic of physical inactivity that appears to parallel the widespread prevalence of cardiovascular disease (CVD). Yet, regular physical activity (PA) and exercise can play an important role not only in primary cardiovascular prevention but also in secondary prevention. This review discusses some of the main cardiovascular effects of PA/exercise and the mechanisms involved, including a healthier metabolic milieu with attenuation of systemic chronic inflammation, as well as adaptations at the vascular (antiatherogenic effects) and heart tissue (myocardial regeneration and cardioprotection) levels. The current evidence for safe implementation of PA and exercise in patients with CVD is also summarized.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), 7 Planta, Bloque D., Av. de Córdoba s/n, Madrid 28041, Spain
- Department of Systems Biology, University of Alcala, Madrid 28871, Spain
| | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid 28041, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), 7 Planta, Bloque D., Av. de Córdoba s/n, Madrid 28041, Spain
- i+HeALTH Research Group, Department of Health Sciences, European University Miguel de Cervantes, Valladolid 47012, Spain
| | - Matthias Wilhelm
- Medical Division Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Nicolle Kränkel
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- Friede Springer-Centre of Cardiovascular Prevention @ Charité, Charité University Medicine Berlin, Berlin 10117, Germany
| | - Carmen Fiuza-Luces
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), 7 Planta, Bloque D., Av. de Córdoba s/n, Madrid 28041, Spain
| | - Alejandro Lucia
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid 28007, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid 28670, Spain
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14
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Giral H, Franke V, Moobed M, Müller MF, Lübking L, James DM, Hartung J, Kuschnerus K, Meteva D, Seppelt C, Jakob P, Klingenberg R, Kränkel N, Leistner D, Zeller T, Blankenberg S, Zimmermann F, Haghikia A, Lüscher TF, Akalin A, Landmesser U, Kratzer A. Rapid Inflammasome Activation Is Attenuated in Post-Myocardial Infarction Monocytes. Front Immunol 2022; 13:857455. [PMID: 35558073 PMCID: PMC9090500 DOI: 10.3389/fimmu.2022.857455] [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: 01/19/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
Inflammasomes are crucial gatekeepers of the immune response, but their maladaptive activation associates with inflammatory pathologies. Besides canonical activation, monocytes can trigger non-transcriptional or rapid inflammasome activation that has not been well defined in the context of acute myocardial infarction (AMI). Rapid transcription-independent inflammasome activation induced by simultaneous TLR priming and triggering stimulus was measured by caspase-1 (CASP1) activity and interleukin release. Both classical and intermediate monocytes from healthy donors exhibited robust CASP1 activation, but only classical monocytes produced high mature interleukin-18 (IL18) release. We also recruited a limited number of coronary artery disease (CAD, n=31) and AMI (n=29) patients to evaluate their inflammasome function and expression profiles. Surprisingly, monocyte subpopulations isolated from blood collected during percutaneous coronary intervention (PCI) from AMI patients presented diminished CASP1 activity and abrogated IL18 release despite increased NLRP3 gene expression. This unexpected attenuated rapid inflammasome activation was accompanied by a significant increase of TNFAIP3 and IRAKM expression. Moreover, TNFAIP3 protein levels of circulating monocytes showed positive correlation with high sensitive troponin T (hsTnT), implying an association between TNFAIP3 upregulation and the severity of tissue injury. We suggest this monocyte attenuation to be a protective phenotype aftermath following a very early inflammatory wave in the ischemic area. Damage-associated molecular patterns (DAMPs) or other signals trigger a transitory negative feedback loop within newly recruited circulating monocytes as a mechanism to reduce post-injury tissue damage.
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Affiliation(s)
- Hector Giral
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Vedran Franke
- Max Delbrück Center, The Berlin Institute for Medical Systems Biology, Berlin, Germany
| | - Minoo Moobed
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja F Müller
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Laura Lübking
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Divya Maria James
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johannes Hartung
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kira Kuschnerus
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Denitsa Meteva
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Claudio Seppelt
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Philipp Jakob
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Klingenberg
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolle Kränkel
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - David Leistner
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Friederike Zimmermann
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Altuna Akalin
- Max Delbrück Center, The Berlin Institute for Medical Systems Biology, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adelheid Kratzer
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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15
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Kränkel N. Increased cardiovascular risk in boys born with hypospadias: intriguing observations and remaining questions. Eur Heart J 2022; 43:1846-1848. [PMID: 35567565 DOI: 10.1093/eurheartj/ehac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicolle Kränkel
- Charité-Universitätsmedizin Berlin, Department of Cardiology, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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16
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Jakobs K, Reinshagen L, Puccini M, Friebel J, Wilde ACB, Alsheik A, Rroku A, Landmesser U, Haghikia A, Kränkel N, Rauch-Kröhnert U. Disease Severity in Moderate-to-Severe COVID-19 Is Associated With Platelet Hyperreactivity and Innate Immune Activation. Front Immunol 2022; 13:844701. [PMID: 35359931 PMCID: PMC8963244 DOI: 10.3389/fimmu.2022.844701] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/28/2021] [Accepted: 02/11/2022] [Indexed: 01/14/2023] Open
Abstract
BackgroundHemostasis and inflammation are both dysregulated in patients with moderate-to-severe coronavirus disease 2019 (COVID-19). Yet, both processes can also be disturbed in patients with other respiratory diseases, and the interactions between coagulation, inflammation, and disease severity specific to COVID-19 are still vague.MethodsHospitalized patients with acute respiratory symptoms and with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-positive (COVpos) and SARS-CoV2-negative (COVneg) status were included. We assessed adenosine diphosphate (ADP)-, thrombin receptor activator peptide 6 (TRAP)-, and arachidonic acid (AA)-induced platelet reactivity by impedance aggregometry, as well as leukocyte subtype spectrum and platelet-leukocyte aggregates by flow cytometry and inflammatory cytokines by cytometric bead array.ResultsADP-, TRAP-, and AA-induced platelet reactivity was significantly higher in COVpos than in COVneg patients. Disease severity, assessed by sequential organ failure assessment (SOFA) score, was higher in COVpos than in COVneg patients and again higher in deceased COVpos patients than in surviving COVpos. The SOFA score correlated significantly with the mean platelet volume and TRAP-induced platelet aggregability. A larger percentage of classical and intermediate monocytes, and of CD4pos T cells (TH) aggregated with platelets in COVpos than in COVneg patients. Interleukin (IL)-1 receptor antagonist (RA) and IL-6 levels were higher in COVpos than in COVneg patients and again higher in deceased COVpos patients than in surviving COVpos. IL-1RA and IL-6 levels correlated with the SOFA score in COVpos but not in COVneg patients. In both respiratory disease groups, absolute levels of B-cell-platelet aggregates and NK-cell-platelet aggregates were correlated with ex vivo platelet aggegation upon stimulation with AA and ADP, respectively, indicating a universal, but not a COVID-19-specific mechanism.ConclusionIn moderate-to-severe COVID-19, but not in other respiratory diseases, disease severity was associated with platelet hyperreactivity and a typical inflammatory signature. In addition to a severe inflammatory response, platelet hyperreactivity associated to a worse clinical outcome in patients with COVID-19, pointing to the importance of antithrombotic therapy for reducing disease severity.
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Affiliation(s)
- Kai Jakobs
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Leander Reinshagen
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Marianna Puccini
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Julian Friebel
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Anne-Christin Beatrice Wilde
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Ayman Alsheik
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andi Rroku
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- *Correspondence: Ursula Rauch-Kröhnert, ; Nicolle Kränkel,
| | - Ursula Rauch-Kröhnert
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- *Correspondence: Ursula Rauch-Kröhnert, ; Nicolle Kränkel,
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17
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [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: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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18
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Kränkel N. The "real world" is relative-and biased. Eur J Prev Cardiol 2021; 29:1331-1333. [PMID: 34940857 DOI: 10.1093/eurjpc/zwab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nicolle Kränkel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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19
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Friebel J, Moritz E, Witkowski M, Jakobs K, Strässler E, Dörner A, Steffens D, Puccini M, Lammel S, Glauben R, Nowak F, Kränkel N, Haghikia A, Moos V, Schutheiss HP, Felix SB, Landmesser U, Rauch BH, Rauch U. Pleiotropic Effects of the Protease-Activated Receptor 1 (PAR1) Inhibitor, Vorapaxar, on Atherosclerosis and Vascular Inflammation. Cells 2021; 10:cells10123517. [PMID: 34944024 PMCID: PMC8700178 DOI: 10.3390/cells10123517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Protease-activated receptor 1 (PAR1) and toll-like receptors (TLRs) are inflammatory mediators contributing to atherogenesis and atherothrombosis. Vorapaxar, which selectively antagonizes PAR1-signaling, is an approved, add-on antiplatelet therapy for secondary prevention. The non-hemostatic, platelet-independent, pleiotropic effects of vorapaxar have not yet been studied. METHODS AND RESULTS Cellular targets of PAR1 signaling in the vasculature were identified in three patient cohorts with atherosclerotic disease. Evaluation of plasma biomarkers (n = 190) and gene expression in endomyocardial biopsies (EMBs) (n = 12) revealed that PAR1 expression correlated with endothelial activation and vascular inflammation. PAR1 colocalized with TLR2/4 in human carotid plaques and was associated with TLR2/4 gene transcription in EMBs. In addition, vorapaxar reduced atherosclerotic lesion size in apolipoprotein E-knock out (ApoEko) mice. This reduction was associated with reduced expression of vascular adhesion molecules and TLR2/4 presence, both in isolated murine endothelial cells and the aorta. Thrombin-induced uptake of oxLDL was augmented by additional TLR2/4 stimulation and abrogated by vorapaxar. Plaque-infiltrating pro-inflammatory cells were reduced in vorapaxar-treated ApoEko mice. A shift toward M2 macrophages paralleled a decreased transcription of pro-inflammatory cytokines and chemokines. CONCLUSIONS PAR1 inhibition with vorapaxar may be effective in reducing residual thrombo-inflammatory event risk in patients with atherosclerosis independent of its effect on platelets.
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Affiliation(s)
- Julian Friebel
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
- Berlin Institute of Health, 10178 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Eileen Moritz
- Center of Drug Absorption and Transport, Institute of Pharmacology, University Medicine Greifswald, 17489 Greifswald, Germany; (E.M.); (B.H.R.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, 17475 Greifswald, Germany;
| | - Marco Witkowski
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Kai Jakobs
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
| | - Elisabeth Strässler
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Andrea Dörner
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
- Berlin Institute of Health, 10178 Berlin, Germany
| | - Daniel Steffens
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
| | - Marianna Puccini
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
| | - Stella Lammel
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
| | - Rainer Glauben
- Medical Department I, Gastroenterology, Infectious Diseases and Rheumatology, Charité—University Medicine, 12203 Berlin, Germany; (R.G.); (F.N.); (V.M.)
| | - Franziska Nowak
- Medical Department I, Gastroenterology, Infectious Diseases and Rheumatology, Charité—University Medicine, 12203 Berlin, Germany; (R.G.); (F.N.); (V.M.)
| | - Nicolle Kränkel
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Arash Haghikia
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
- Berlin Institute of Health, 10178 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Verena Moos
- Medical Department I, Gastroenterology, Infectious Diseases and Rheumatology, Charité—University Medicine, 12203 Berlin, Germany; (R.G.); (F.N.); (V.M.)
| | | | - Stephan B. Felix
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, 17475 Greifswald, Germany;
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Ulf Landmesser
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
- Berlin Institute of Health, 10178 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Bernhard H. Rauch
- Center of Drug Absorption and Transport, Institute of Pharmacology, University Medicine Greifswald, 17489 Greifswald, Germany; (E.M.); (B.H.R.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, 17475 Greifswald, Germany;
- Department of Human Medicine, Section of Pharmacology and Toxicology, Carl von Ossietzky Universität, 26129 Oldenburg, Germany
| | - Ursula Rauch
- Charité Center 11—Department of Cardiology, Charité—University Medicine, 12203 Berlin, Germany; (J.F.); (M.W.); (K.J.); (E.S.); (A.D.); (D.S.); (M.P.); (S.L.); (N.K.); (A.H.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-513794
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20
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Jödicke RA, Huo S, Kränkel N, Piper SK, Ebinger M, Landmesser U, Flöel A, Endres M, Nave AH. The Dynamic of Extracellular Vesicles in Patients With Subacute Stroke: Results of the "Biomarkers and Perfusion-Training-Induced Changes After Stroke" ( BAPTISe) Study. Front Neurol 2021; 12:731013. [PMID: 34819906 PMCID: PMC8606784 DOI: 10.3389/fneur.2021.731013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Extracellular vesicles (EV) are sub-1 μm bilayer lipid coated particles and have been shown play a role in long-term cardiovascular outcome after ischemic stroke. However, the dynamic change of EV after stroke and their implications for functional outcome have not yet been elucidated. Methods: Serial blood samples from 110 subacute ischemic stroke patients enrolled in the prospective BAPTISe study were analyzed. All patients participated in the PHYS-STROKE trial and received 4-week aerobic training or relaxation sessions. Levels of endothelial-derived (EnV: Annexin V+, CD45-, CD41-, CD31+/CD144+/CD146+), leukocyte-derived (LV: Annexin V+, CD45+, CD41-), monocytic-derived (MoV: Annexin V+, CD41-, CD14+), neuronal-derived (NV: Annexin V+, CD41-, CD45-, CD31-, CD144-, CD146-, CD56+/CD171+/CD271+), and platelet-derived (PV: Annexin V+, CD41+) EV were assessed via fluorescence-activated cell sorting before and after the trial intervention. The levels of EV at baseline were dichotomized at the 75th percentile, with the EV levels at baseline above the 75th percentile classified as "high" otherwise as "low." The dynamic of EV was classified based on the difference between baseline and post intervention, defining increases above the 75th percentile as "high increase" otherwise as "low increase." Associations of baseline levels and change in EV concentrations with Barthel Index (BI) and cardiovascular events in the first 6 months post-stroke were analyzed using mixed model regression analyses and cox regression. Results: Both before and after intervention PV formed the largest population of vesicles followed by NV and EnV. In mixed-model regression analyses, low NV [-8.57 (95% CI -15.53 to -1.57)] and low PV [-6.97 (95% CI -13.92 to -0.01)] at baseline were associated with lower BI in the first 6 months post-stroke. Patients with low increase in NV [8.69 (95% CI 2.08-15.34)] and LV [6.82 (95% CI 0.25-13.4)] were associated with reduced BI in the first 6 months post-stroke. Neither baseline vesicles nor their dynamic were associated with recurrent cardiovascular events. Conclusion: This is the first report analyzing the concentration and the dynamic of EV regarding associations with functional outcome in patients with subacute stroke. Lower levels of PV and NV at baseline were associated with a worse functional outcome in the first 6 months post-stroke. Furthermore, an increase in NV and LV over time was associated with worse BI in the first 6 months post-stroke. Further investigation of the relationship between EV and their dynamic with functional outcome post-stroke are warranted. Clinical Trial Registration: clinicaltrials.gov/, identifier: NCT01954797.
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Affiliation(s)
- Ruben A Jödicke
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Shufan Huo
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Disease, Partner Site Berlin, Berlin, Germany
| | - Nicolle Kränkel
- Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie K Piper
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Ulf Landmesser
- Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Agnes Flöel
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases, Rostock/Greifswald, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Center for Neurodegenerative Disease, Partner Site Berlin, Berlin, Germany
| | - Alexander H Nave
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Disease, Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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21
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Haghikia A, Zimmermann F, Schumann P, Jasina A, Roessler J, Schmidt D, Heinze P, Kaisler J, Nageswaran V, Aigner A, Ceglarek U, Cineus R, Hegazy AN, van der Vorst EPC, Döring Y, Strauch CM, Nemet I, Tremaroli V, Dwibedi C, Kränkel N, Leistner DM, Heimesaat MM, Bereswill S, Rauch G, Seeland U, Soehnlein O, Müller DN, Gold R, Bäckhed F, Hazen SL, Haghikia A, Landmesser U. Propionate attenuates atherosclerosis by immune-dependent regulation of intestinal cholesterol metabolism. Eur Heart J 2021; 43:518-533. [PMID: 34597388 DOI: 10.1093/eurheartj/ehab644] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [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: 01/29/2021] [Revised: 06/30/2021] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Atherosclerotic cardiovascular disease (ACVD) is a major cause of mortality and morbidity worldwide, and increased low-density lipoproteins (LDLs) play a critical role in development and progression of atherosclerosis. Here, we examined for the first time gut immunomodulatory effects of the microbiota-derived metabolite propionic acid (PA) on intestinal cholesterol metabolism. METHODS AND RESULTS Using both human and animal model studies, we demonstrate that treatment with PA reduces blood total and LDL cholesterol levels. In apolipoprotein E-/- (Apoe-/-) mice fed a high-fat diet (HFD), PA reduced intestinal cholesterol absorption and aortic atherosclerotic lesion area. Further, PA increased regulatory T-cell numbers and interleukin (IL)-10 levels in the intestinal microenvironment, which in turn suppressed the expression of Niemann-Pick C1-like 1 (Npc1l1), a major intestinal cholesterol transporter. Blockade of IL-10 receptor signalling attenuated the PA-related reduction in total and LDL cholesterol and augmented atherosclerotic lesion severity in the HFD-fed Apoe-/- mice. To translate these preclinical findings to humans, we conducted a randomized, double-blinded, placebo-controlled human study (clinical trial no. NCT03590496). Oral supplementation with 500 mg of PA twice daily over the course of 8 weeks significantly reduced LDL [-15.9 mg/dL (-8.1%) vs. -1.6 mg/dL (-0.5%), P = 0.016], total [-19.6 mg/dL (-7.3%) vs. -5.3 mg/dL (-1.7%), P = 0.014] and non-high-density lipoprotein cholesterol levels [PA vs. placebo: -18.9 mg/dL (-9.1%) vs. -0.6 mg/dL (-0.5%), P = 0.002] in subjects with elevated baseline LDL cholesterol levels. CONCLUSION Our findings reveal a novel immune-mediated pathway linking the gut microbiota-derived metabolite PA with intestinal Npc1l1 expression and cholesterol homeostasis. The results highlight the gut immune system as a potential therapeutic target to control dyslipidaemia that may introduce a new avenue for prevention of ACVDs.
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Affiliation(s)
- Arash Haghikia
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straβe 2, Berlin 10178, Germany
| | - Friederike Zimmermann
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Paul Schumann
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andrzej Jasina
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Johann Roessler
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - David Schmidt
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Philipp Heinze
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Johannes Kaisler
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Vanasa Nageswaran
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Annette Aigner
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straβe 2, Berlin 10178, Germany.,Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Paul-List-Str. 13-15, Leipzig 04103, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Roodline Cineus
- Department of Gastroenterology, Infectiology, and Rheumatology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,Deutsches Rheumaforschungszentrum Berlin (DRFZ), An Institute of the Leibniz Association, Berlin, Germany
| | - Ahmed N Hegazy
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straβe 2, Berlin 10178, Germany.,Department of Gastroenterology, Infectiology, and Rheumatology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,Deutsches Rheumaforschungszentrum Berlin (DRFZ), An Institute of the Leibniz Association, Berlin, Germany
| | - Emiel P C van der Vorst
- Institute for Cardiovascular Prevention (IPEK), LMU München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich, Heart Alliance Munich, Munich, Germany.,Interdisciplinary Center for Clinical Research (IZKF), Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Pauwelsstraße 30, Aachen 52074, Germany.,Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht 6200 MD, the Netherlands
| | - Yvonne Döring
- Institute for Cardiovascular Prevention (IPEK), LMU München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich, Heart Alliance Munich, Munich, Germany.,Departement of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Murtenstrasse 35, Bern CH-3008, Switzerland
| | - Christopher M Strauch
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Ina Nemet
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Valentina Tremaroli
- The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 16, Gothenburg SE-413 45, Sweden
| | - Chinmay Dwibedi
- The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 16, Gothenburg SE-413 45, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Box 430, Gothenburg 405 30, Sweden
| | - Nicolle Kränkel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straβe 2, Berlin 10178, Germany
| | - Markus M Heimesaat
- Insitute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin 12203, Germany
| | - Stefan Bereswill
- Insitute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin 12203, Germany
| | - Geraldine Rauch
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straβe 2, Berlin 10178, Germany.,Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ute Seeland
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Campus Charité Mitte Luisenstraße 57, Berlin 10117, Germany
| | - Oliver Soehnlein
- Institute for Cardiovascular Prevention (IPEK), LMU München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich, Heart Alliance Munich, Munich, Germany.,Institute for Experimental Pathology (ExPat), Center for Molecular Biology of Inflammation (ZMBE), Von-Esmarch-Straße 56, WWU Münster 48149, Germany
| | - Dominik N Müller
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straβe 2, Berlin 10178, Germany.,Experimental and Clinical Research Center, a joint cooperation of Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert-Rössle-Str. 10, Berlin 13092, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Fredrik Bäckhed
- The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 16, Gothenburg SE-413 45, Sweden.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen DK-2200, Denmark.,Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Box 430, Gothenburg 405 30, Sweden
| | - Stanley L Hazen
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave., NC-10 Cleveland 44195, OH, USA
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, Magdeburg 39120, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straβe 2, Berlin 10178, Germany
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22
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Yergöz F, Friebel J, Kränkel N, Rauch-Kroehnert U, Schultheiss HP, Landmesser U, Dörner A. Adenine Nucleotide Translocase 1 Expression Modulates the Immune Response in Ischemic Hearts. Cells 2021; 10:cells10082130. [PMID: 34440901 PMCID: PMC8393693 DOI: 10.3390/cells10082130] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Adenine nucleotide translocase 1 (ANT1) transfers ATP and ADP over the mitochondrial inner membrane and thus supplies the cell with energy. This study analyzed the role of ANT1 in the immune response of ischemic heart tissue. Ischemic ANT1 overexpressing hearts experienced a shift toward an anti-inflammatory immune response. The shift was characterized by low interleukin (IL)-1β expression and M1 macrophage infiltration, whereas M2 macrophage infiltration and levels of IL-10, IL-4, and transforming growth factor (TGFβ) were increased. The modulated immune response correlated with high mitochondrial integrity, reduced oxidative stress, low left ventricular end-diastolic heart pressure, and a high survival rate. Isolated ANT1-transgenic (ANT1-TG) cardiomyocytes expressed low levels of pro-inflammatory cytokines such as IL-1α, tumor necrosis factor α, and TGFβ. However, they showed increased expression and cellular release of anti-inflammatory immunomodulators such as vascular endothelial growth factor. The secretome from ANT1-TG cardiomyocytes initiated stress resistance when applied to ischemic wild-type cardiomyocytes and endothelial cells. It additionally prevented macrophages from expressing pro-inflammatory cytokines. Additionally, ANT1 expression correlated with genes that are related to cytokine and growth factor pathways in hearts of patients with ischemic cardiomyopathy. In conclusion, ANT1-TG cardiomyocytes secrete soluble factors that influence ischemic cardiac cells and initiate an anti-inflammatory immune response in ischemic hearts.
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Affiliation(s)
- Fatih Yergöz
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- Institute of Health Center for Regenerative Therapies (BCRT), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Julian Friebel
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Ursula Rauch-Kroehnert
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | | | - Ulf Landmesser
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- Institute of Health Center for Regenerative Therapies (BCRT), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Andrea Dörner
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-513-727
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23
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Leistner DM, Kränkel N, Meteva D, Abdelwahed YS, Seppelt C, Stähli BE, Rai H, Skurk C, Lauten A, Mochmann HC, Fröhlich G, Rauch-Kröhnert U, Flores E, Riedel M, Sieronski L, Kia S, Strässler E, Haghikia A, Dirks F, Steiner JK, Mueller DN, Volk HD, Klotsche J, Joner M, Libby P, Landmesser U. Differential immunological signature at the culprit site distinguishes acute coronary syndrome with intact from acute coronary syndrome with ruptured fibrous cap: results from the prospective translational OPTICO-ACS study. Eur Heart J 2021; 41:3549-3560. [PMID: 33080003 DOI: 10.1093/eurheartj/ehaa703] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/15/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Acute coronary syndromes with intact fibrous cap (IFC-ACS), i.e. caused by coronary plaque erosion, account for approximately one-third of ACS. However, the underlying pathophysiological mechanisms as compared with ACS caused by plaque rupture (RFC-ACS) remain largely undefined. The prospective translational OPTICO-ACS study programme investigates for the first time the microenvironment of ACS-causing culprit lesions (CL) with intact fibrous cap by molecular high-resolution intracoronary imaging and simultaneous local immunological phenotyping. METHODS AND RESULTS The CL of 170 consecutive ACS patients were investigated by optical coherence tomography (OCT) and simultaneous immunophenotyping by flow cytometric analysis as well as by effector molecule concentration measurements across the culprit lesion gradient (ratio local/systemic levels). Within the study cohort, IFC caused 24.6% of ACS while RFC-ACS caused 75.4% as determined and validated by two independent OCT core laboratories. The IFC-CL were characterized by lower lipid content, less calcification, a thicker overlying fibrous cap, and largely localized near a coronary bifurcation as compared with RFC-CL. The microenvironment of IFC-ACS lesions demonstrated selective enrichment in both CD4+ and CD8+ T-lymphocytes (+8.1% and +11.2%, respectively, both P < 0.05) as compared with RFC-ACS lesions. T-cell-associated extracellular circulating microvesicles (MV) were more pronounced in IFC-ACS lesions and a significantly higher amount of CD8+ T-lymphocytes was detectable in thrombi aspirated from IFC-culprit sites. Furthermore, IFC-ACS lesions showed increased levels of the T-cell effector molecules granzyme A (+22.4%), perforin (+58.8%), and granulysin (+75.4%) as compared with RFC plaques (P < 0.005). Endothelial cells subjected to culture in disturbed laminar flow conditions, i.e. to simulate coronary flow near a bifurcation, demonstrated an enhanced adhesion of CD8+T cells. Finally, both CD8+T cells and their cytotoxic effector molecules caused endothelial cell death, a key potential pathophysiological mechanism in IFC-ACS. CONCLUSIONS The OPTICO-ACS study emphasizes a novel mechanism in the pathogenesis of IFC-ACS, favouring participation of the adaptive immune system, particularly CD4+ and CD8+ T-cells and their effector molecules. The different immune signatures identified in this study advance the understanding of coronary plaque progression and may provide a basis for future development of personalized therapeutic approaches to ACS with IFC. TRIAL REGISTRATION The study was registered at clinicalTrials.gov (NCT03129503).
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Affiliation(s)
- David M Leistner
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Nicolle Kränkel
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Denitsa Meteva
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Claudio Seppelt
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Himanshu Rai
- DZHK (German Centre for Cardiovascular Research) Partner Site Munch, Munich, 80636, Germany
| | - Carsten Skurk
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Alexander Lauten
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Hans-Christian Mochmann
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany
| | - Georg Fröhlich
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Ursula Rauch-Kröhnert
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Eduardo Flores
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany
| | - Matthias Riedel
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Lara Sieronski
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Sylvia Kia
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Elisabeth Strässler
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Arash Haghikia
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Fabian Dirks
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Julia K Steiner
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Dominik N Mueller
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany.,Experimental and Clinical Research Centre (ECRC), a cooperation of Charité University Medicine Berlin and Max Delbruck Centre for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany.,Max Delbruck Centre for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
| | - Hans-Dieter Volk
- Berlin Institute of Health (BIH), Berlin 10117, Germany.,Institute for Medical Immunology and BIH Centre for Regenerative Therapies (BCRT), and Berlin Centre for Advanced Therapies (BeCAT), Charité University Medicine Berlin, Berlin 13353, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, and Institute for Social Medicine, Epidemiology und Heath Economy, Charité University Medicine Berlin, Campus Charité Mitte, Berlin 10117, Germany
| | - Michael Joner
- Department of Cardiology and ISAR Research Centre, German Heart Centre, Munich, 80636, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Munch, Munich, 80636, Germany
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 77 Ave Louis Pasteur, Boston, MA 02115, USA
| | - Ulf Landmesser
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
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24
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Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Kränkel N, Niebauer J, Tiberi M, Abreu A, Solberg EE, Pescatello L, Brguljan J, Coca A, Leeson P. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol 2021; 29:205-215. [PMID: 33758927 DOI: 10.1093/eurjpc/zwaa141] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
Treatment of hypertension and its complications remains a major ongoing health care challenge. Around 25% of heart attacks in Europe are already attributed to hypertension and by 2025 up to 60% of the population will have hypertension. Physical inactivity has contributed to the rising prevalence of hypertension, but patients who exercise or engage in physical activity reduce their risk of stroke, myocardial infarction, and cardiovascular mortality. Hence, current international guidelines on cardiovascular disease prevention provide generic advice to increase aerobic activity, but physiological responses differ with blood pressure (BP) level, and greater reductions in BP across a population may be achievable with more personalized advice. We performed a systematic review of meta-analyses to determine whether there was sufficient evidence for a scientific Consensus Document reporting how exercise prescription could be personalized for BP control. The document discusses the findings of 34 meta-analyses on BP-lowering effects of aerobic endurance training, dynamic resistance training as well as isometric resistance training in patients with hypertension, high-normal, and individuals with normal BP. As a main finding, there was sufficient evidence from the meta-review, based on the estimated range of exercise-induced BP reduction, the number of randomized controlled trials, and the quality score, to propose that type of exercise can be prescribed according to initial BP level, although considerable research gaps remain. Therefore, this evidence-based Consensus Document proposes further work to encourage and develop more frequent use of personalized exercise prescription to optimize lifestyle interventions for the prevention and treatment of hypertension.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Arne Deiseroth
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Nicolle Kränkel
- Charité, University Medicine Berlin, Department of Cardiology, Campus Benjamin-Franklin (CBF), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Austria.,Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1 Pesaro, Italy
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Portugal.,Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa, Portugal
| | | | - Linda Pescatello
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, USA
| | - Jana Brguljan
- Universitiy Medical Centre Ljubljana, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic, University of Barcelona, Spain
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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25
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Halle M, Davos CH, Dendale P, Papadakis M, Pfaff C, Kränkel N. Future of preventive cardiology: EAPC vision 2020-22. Eur J Prev Cardiol 2021; 28:356-358. [PMID: 33966077 DOI: 10.1093/eurjpc/zwaa116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/15/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Martin Halle
- Department of Prevention and Sports Medicine, Center for Sports Cardiology/EAPC, School of Medicine, University Hospital 'Klinikum rechts der Isar', Technical University of Munich, Georg-Brauchle-Ring 56, D-80992 Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Paul Dendale
- Heart Centre Hasselt and Hasselt University, Hasselt, Belgium
| | - Michael Papadakis
- Cardiovascular clinical academic group, St George's, University of London, UK
| | - Camille Pfaff
- European Society of Cardiology, Sophia Antipolis, France
| | - Nicolle Kränkel
- Depatment of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Berlin, Germany
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26
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Huo S, Kränkel N, Nave AH, Sperber PS, Rohmann JL, Piper SK, Heuschmann PU, Landmesser U, Endres M, Siegerink B, Liman TG. Endothelial and Leukocyte-Derived Microvesicles and Cardiovascular Risk After Stroke: PROSCIS-B. Neurology 2020; 96:e937-e946. [PMID: 33184230 DOI: 10.1212/wnl.0000000000011223] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 10/05/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the role of circulating microvesicles (MV) on long-term cardiovascular outcomes after stroke, we measured them in patients with first-ever stroke with a 3-year follow-up. METHODS In the Prospective Cohort With Incident Stroke Berlin (PROSCIS-B), patients with first-ever ischemic stroke were followed up for 3 years. The primary combined endpoint consisted of recurrent stroke, myocardial infarction, and all-cause mortality. Citrate-blood levels of endothelial MV (EMV), leukocyte-derived MV (LMV), monocytic MV (MMV), and platelet-derived MV (PMV) were measured with flow cytometry. Kaplan-Meier curves and adjusted Cox proportional hazards models were used to estimate the effect of MV levels on the combined endpoint. RESULTS Five hundred seventy-one patients were recruited (median age 69 years, 39% female, median NIH Stroke Scale score 2, interquartile range 1-4), and 95 endpoints occurred. Patients with levels of EMV (adjusted hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.2-4.9) or LMV (HR 3.1, 95% CI 1.4-6.8) in the highest quartile were more likely to experience an event than participants with lower levels with the lowest quartile used as the reference category. The association was less pronounced for PMV (HR 1.7, 95% CI 0.9-3.2) and absent for MMV (HR 1.1, 95% CI 0.6-1.8). CONCLUSION High levels of EMV and LMV after stroke were associated with worse cardiovascular outcome within 3 years. These results reinforce that endothelial dysfunction and vascular inflammation affect the long-term prognosis after stroke. EMV and LMV might play a role in risk prediction for stroke patients. CLINICALTRIALSGOV IDENTIFIER NCT01363856. CLASSIFICATION OF EVIDENCE This study provides Class II evidence of the effect of MV levels on subsequent stroke, myocardial infarction, or all-cause mortality in survivors of mild stroke.
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Affiliation(s)
- Shufan Huo
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany.
| | - Nicolle Kränkel
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Alexander Heinrich Nave
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Pia Sophie Sperber
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Jessica Lee Rohmann
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Sophie Käthe Piper
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Peter Ulrich Heuschmann
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Ulf Landmesser
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Matthias Endres
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Bob Siegerink
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Thomas Günter Liman
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
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27
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Kuhring M, Eisenberger A, Schmidt V, Kränkel N, Leistner DM, Kirwan J, Beule D. Concepts and Software Package for Efficient Quality Control in Targeted Metabolomics Studies: MeTaQuaC. Anal Chem 2020; 92:10241-10245. [PMID: 32603093 DOI: 10.1021/acs.analchem.0c00136] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Targeted quantitative mass spectrometry metabolite profiling is the workhorse of metabolomics research. Robust and reproducible data are essential for confidence in analytical results and are particularly important with large-scale studies. Commercial kits are now available which use carefully calibrated and validated internal and external standards to provide such reliability. However, they are still subject to processing and technical errors in their use and should be subject to a laboratory's routine quality assurance and quality control measures to maintain confidence in the results. We discuss important systematic and random measurement errors when using these kits and suggest measures to detect and quantify them. We demonstrate how wider analysis of the entire data set alongside standard analyses of quality control samples can be used to identify outliers and quantify systematic trends to improve downstream analysis. Finally, we present the MeTaQuaC software which implements the above concepts and methods for Biocrates kits and other target data sets and creates a comprehensive quality control report containing rich visualization and informative scores and summary statistics. Preliminary unsupervised multivariate analysis methods are also included to provide rapid insight into study variables and groups. MeTaQuaC is provided as an open source R package under a permissive MIT license and includes detailed user documentation.
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Affiliation(s)
- Mathias Kuhring
- Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany.,Max Delbrück Center (MDC) for Molecular Medicine, Robert-Rössle-Strasse 10, 13125 Berlin, Germany
| | - Alina Eisenberger
- Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany.,Max Delbrück Center (MDC) for Molecular Medicine, Robert-Rössle-Strasse 10, 13125 Berlin, Germany
| | - Vanessa Schmidt
- Max Delbrück Center (MDC) for Molecular Medicine, Robert-Rössle-Strasse 10, 13125 Berlin, Germany
| | - Nicolle Kränkel
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - David M Leistner
- Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany.,Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Jennifer Kirwan
- Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany.,Max Delbrück Center (MDC) for Molecular Medicine, Robert-Rössle-Strasse 10, 13125 Berlin, Germany
| | - Dieter Beule
- Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany.,Max Delbrück Center (MDC) for Molecular Medicine, Robert-Rössle-Strasse 10, 13125 Berlin, Germany.,Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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28
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Bahls M, Koc A, Kaczmarek S, Lehnert K, Urbaneck I, Landmesser U, Felix SB, Dörr M, Kränkel N. The Immune Response To Cardiorespiratory Exercise Testing In Heart Failure Patients With Reduced Ejection Fraction. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000670132.85218.d6] [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: 11/21/2022]
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29
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Kränkel N, Strässler E, Uhlemann M, Müller M, Briand-Schumacher S, Klingenberg R, Schulze PC, Adams V, Schuler G, Lüscher TF, Möbius-Winkler S, Landmesser U. Extracellular vesicle species differentially affect endothelial cell functions and differentially respond to exercise training in patients with chronic coronary syndromes. Eur J Prev Cardiol 2020; 28:1467-1474. [PMID: 32380860 DOI: 10.1177/2047487320919894] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Extracellular vesicles are released upon cellular activation and mediate inter-cellular communication. Individual species of extracellular vesicles might have divergent roles in vascular homeostasis and may show different responses to therapies such as exercise training. AIMS We examine endothelial effects of medium-size and small extracellular vesicles from the same individual with or without chronic coronary syndrome, and in chronic coronary syndrome patients participating in a four-week high-intensity interval training intervention. METHODS Human aortic endothelial cells were exposed to medium-size extracellular vesicles and small extracellular vesicles isolated from plasma samples of study participants. Endothelial cell survival, activation and re-endothelialisation capacity were assessed by respective staining protocols. Extracellular vesicles were quantified by nanoparticle tracking analysis and flow cytometry. Extracellular vesicle microRNA expression was quantified by realtime-quantitative polymerase chain reaction. RESULTS In patients with chronic coronary syndrome (n = 25), plasma counts of leukocyte-derived medium-size extracellular vesicles were higher than in age-matched healthy controls (n = 25; p = 0.04) and were reduced by high-intensity interval training (n = 15; p = 0.01 vs baseline). Re-endothelialisation capacity was promoted by medium-size extracellular vesicles from controls, but not by medium-size extracellular vesicles from chronic coronary syndrome patients. High-intensity interval training for 4 weeks enhanced medium-size extracellular vesicle-mediated support of in vitro re-endothelialisation. Small extracellular vesicles from controls or chronic coronary syndrome patients increased endothelial cell death and reduced repair functions and were not affected by high-intensity interval training. CONCLUSION The present study demonstrates that medium-size extracellular vesicles and small extracellular vesicles differentially affect endothelial cell survival and repair responses. This equilibrium is unbalanced in patients with chronic coronary syndrome where leukocyte-derived medium-size extracellular vesicles are increased leading to a loss of medium-size extracellular vesicle-mediated endothelial repair. High-intensity interval training partially restored medium-size extracellular vesicle-mediated endothelial repair, underlining its use in cardiovascular prevention and therapy to improve endothelial function.
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Affiliation(s)
- Nicolle Kränkel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Germany.,Berlin Institute of Health, Germany.,Center of Molecular Cardiology, University of Zurich, Switzerland
| | - Elisabeth Strässler
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Germany.,Berlin Institute of Health, Germany.,Center of Molecular Cardiology, University of Zurich, Switzerland
| | | | - Maja Müller
- Department of Cardiology, University Hospital Zurich, Switzerland
| | | | | | | | - Volker Adams
- Heart Center, University of Leipzig, Germany.,Heart Center Dresden, TU Dresden, Germany
| | | | - Thomas F Lüscher
- Center of Molecular Cardiology, University of Zurich, Switzerland.,Heart Division, Royal Brompton and Harefield Hospitals, UK
| | - Sven Möbius-Winkler
- Heart Center, University of Leipzig, Germany.,Department of Internal Medicine I, University Hospital Jena, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Germany.,Berlin Institute of Health, Germany.,Center of Molecular Cardiology, University of Zurich, Switzerland.,Department of Cardiology, University Hospital Zurich, Switzerland
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30
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Lechner K, McKenzie AL, Kränkel N, Von Schacky C, Worm N, Nixdorff U, Lechner B, Scherr J, Weingärtner O, Krauss RM. High-Risk Atherosclerosis and Metabolic Phenotype: The Roles of Ectopic Adiposity, Atherogenic Dyslipidemia, and Inflammation. Metab Syndr Relat Disord 2020; 18:176-185. [PMID: 32119801 PMCID: PMC7196362 DOI: 10.1089/met.2019.0115] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Current algorithms for assessing risk of atherosclerotic cardiovascular disease (ASCVD) and, in particular, the reliance on low-density lipoprotein (LDL) cholesterol in conditions where this measurement is discordant with apoB and LDL-particle concentrations fail to identify a sizeable part of the population at high risk for adverse cardiovascular events. This results in missed opportunities for ASCVD prevention, most notably in those with metabolic syndrome, prediabetes, and diabetes. There is substantial evidence that accumulation of ectopic fat and associated metabolic traits are markers for and pathogenic components of high-risk atherosclerosis. Conceptually, the subset of advanced lesions in high-risk atherosclerosis that triggers vascular complications is closely related to a set of coordinated high-risk traits clustering around a distinct metabolic phenotype. A key feature of this phenotype is accumulation of ectopic fat, which, coupled with age-related muscle loss, creates a milieu conducive for the development of ASCVD: atherogenic dyslipidemia, nonresolving inflammation, endothelial dysfunction, hyperinsulinemia, and impaired fibrinolysis. Sustained vascular inflammation, a hallmark of high-risk atherosclerosis, impairs plaque stabilization in this phenotype. This review describes how metabolic and inflammatory processes that are promoted in large measure by ectopic adiposity, as opposed to subcutaneous adipose tissue, relate to the pathogenesis of high-risk atherosclerosis. Clinical biomarkers indicative of these processes provide incremental information to standard risk factor algorithms and advanced lipid testing identifies atherogenic lipoprotein patterns that are below the discrimination level of standard lipid testing. This has the potential to enable improved identification of high-risk patients who are candidates for therapeutic interventions aimed at prevention of ASCVD.
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Affiliation(s)
- Katharina Lechner
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Nicolle Kränkel
- Klinik Für Kardiologie, Campus Benjamin Steglitz, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Clemens Von Schacky
- Preventive Cardiology, Ludwig-Maximilians University, Munich, Germany
- Omegametrix, Martinsried, Germany
| | - Nicolai Worm
- German University for Prevention and Health Care Management, Saarbrücken, Germany
| | | | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - Johannes Scherr
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- University Center for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Ronald M. Krauss
- University of California, San Francisco, San Francisco, California, USA
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31
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Cardner M, Yalcinkaya M, Goetze S, Luca E, Balaz M, Hunjadi M, Hartung J, Shemet A, Kränkel N, Radosavljevic S, Keel M, Othman A, Karsai G, Hornemann T, Claassen M, Liebisch G, Carreira E, Ritsch A, Landmesser U, Krützfeldt J, Wolfrum C, Wollscheid B, Beerenwinkel N, Rohrer L, von Eckardstein A. Structure-function relationships of HDL in diabetes and coronary heart disease. JCI Insight 2020; 5:131491. [PMID: 31830004 PMCID: PMC7030825 DOI: 10.1172/jci.insight.131491] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 07/01/2019] [Accepted: 12/04/2019] [Indexed: 12/24/2022] Open
Abstract
High-density lipoproteins (HDL) contain hundreds of lipid species and proteins and exert many potentially vasoprotective and antidiabetogenic activities on cells. To resolve structure-function-disease relationships of HDL, we characterized HDL of 51 healthy subjects and 98 patients with diabetes (T2DM), coronary heart disease (CHD), or both for protein and lipid composition, as well as functionality in 5 cell types. The integration of 40 clinical characteristics, 34 nuclear magnetic resonance (NMR) features, 182 proteins, 227 lipid species, and 12 functional read-outs by high-dimensional statistical modeling revealed, first, that CHD and T2DM are associated with different changes of HDL in size distribution, protein and lipid composition, and function. Second, different cellular functions of HDL are weakly correlated with each other and determined by different structural components. Cholesterol efflux capacity (CEC) was no proxy of other functions. Third, 3 potentially novel determinants of HDL function were identified and validated by the use of artificially reconstituted HDL, namely the sphingadienine-based sphingomyelin SM 42:3 and glycosylphosphatidylinositol-phospholipase D1 for the ability of HDL to inhibit starvation-induced apoptosis of human aortic endothelial cells and apolipoprotein F for the ability of HDL to promote maximal respiration of brown adipocytes.
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Affiliation(s)
- Mathias Cardner
- Department of Biosystems Science and Engineering, Swiss Federal Institute of Technology in Zurich (ETH Zurich), Basel, Switzerland
- Swiss Institute of Bioinformatics (SIB), Basel, Switzerland
| | - Mustafa Yalcinkaya
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Sandra Goetze
- Department of Health Sciences and Technology and
- Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Edlira Luca
- Department of Diabetology and Endocrinology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | | | - Monika Hunjadi
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Hartung
- Department of Cardiology, University Medicine Charité Berlin, Berlin, Germany
| | | | - Nicolle Kränkel
- Department of Cardiology, University Medicine Charité Berlin, Berlin, Germany
| | - Silvija Radosavljevic
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Michaela Keel
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Alaa Othman
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Gergely Karsai
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Thorsten Hornemann
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Manfred Claassen
- Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
- Department of Biology, ETH Zurich, Zurich, Switzerland
| | - Gerhard Liebisch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | | | - Andreas Ritsch
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Ulf Landmesser
- Department of Cardiology, University Medicine Charité Berlin, Berlin, Germany
| | - Jan Krützfeldt
- Department of Diabetology and Endocrinology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | | | - Bernd Wollscheid
- Department of Health Sciences and Technology and
- Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Niko Beerenwinkel
- Department of Biosystems Science and Engineering, Swiss Federal Institute of Technology in Zurich (ETH Zurich), Basel, Switzerland
- Swiss Institute of Bioinformatics (SIB), Basel, Switzerland
| | - Lucia Rohrer
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
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Gevaert AB, Adams V, Bahls M, Bowen TS, Cornelissen V, Dörr M, Hansen D, Kemps HM, Leeson P, Van Craenenbroeck EM, Kränkel N. Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A 'call to action' from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2019; 27:1369-1385. [PMID: 31581819 DOI: 10.1177/2047487319877716] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The benefit of regular physical activity and exercise training for the prevention of cardiovascular and metabolic diseases is undisputed. Many molecular mechanisms mediating exercise effects have been deciphered. Personalised exercise prescription can help patients in achieving their individual greatest benefit from an exercise-based cardiovascular rehabilitation programme. Yet, we still struggle to provide truly personalised exercise prescriptions to our patients. In this position paper, we address novel basic and translational research concepts that can help us understand the principles underlying the inter-individual differences in the response to exercise, and identify early on who would most likely benefit from which exercise intervention. This includes hereditary, non-hereditary and sex-specific concepts. Recent insights have helped us to take on a more holistic view, integrating exercise-mediated molecular mechanisms with those influenced by metabolism and immunity. Unfortunately, while the outline is recognisable, many details are still lacking to turn the understanding of a concept into a roadmap ready to be used in clinical routine. This position paper therefore also investigates perspectives on how the advent of 'big data' and the use of animal models could help unravel inter-individual responses to exercise parameters and thus influence hypothesis-building for translational research in exercise-based cardiovascular rehabilitation.
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Affiliation(s)
- Andreas B Gevaert
- GENCOR Department, University of Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Belgium.,Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Volker Adams
- Department of Molecular and Experimental Cardiology, TU Dresden, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University of Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - T Scott Bowen
- School of Biomedical Sciences, University of Leeds, UK
| | | | - Marcus Dörr
- Department of Internal Medicine B, University of Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Belgium.,Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Hareld Mc Kemps
- Fitheid, Leefstijl, Ontwikkeling en Wetenschap (FLOW), Máxima Medical Centre, The Netherlands
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, UK
| | - Emeline M Van Craenenbroeck
- GENCOR Department, University of Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Nicolle Kränkel
- Department of Cardiology, Charité Universitätsmedizin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
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33
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Lechner K, von Schacky C, McKenzie AL, Worm N, Nixdorff U, Lechner B, Kränkel N, Halle M, Krauss RM, Scherr J. Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors. Eur J Prev Cardiol 2019; 27:394-406. [PMID: 31408370 PMCID: PMC7065445 DOI: 10.1177/2047487319869400] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [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: 12/21/2022]
Abstract
Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle–disease interactions. Chronic exposure to environmental stressors like poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation and psychosocial stress affect numerous traditional and non-traditional intermediary pathways related to ASCVD. These include body composition, cardiorespiratory fitness, muscle strength and functionality and the intestinal microbiome, which are increasingly recognized as major determinants of cardiovascular health. Evidence points to partially overlapping mechanisms, including effects on inflammatory and nutrient sensing pathways, endocrine signalling, autonomic function and autophagy. Of particular relevance is the potential of low-risk lifestyle factors to impact on plaque vulnerability through altered adipose tissue and skeletal muscle phenotype and secretome. Collectively, low-risk lifestyle factors cause a set of phenotypic adaptations shifting tissue cross-talk from a proinflammatory milieu conducive for high-risk atherosclerosis to an anti-atherogenic milieu. The ketone body ß-hydroxybutyrate, through inhibition of the NLRP-3 inflammasome, is likely to be an intermediary for many of these observed benefits. Adhering to low-risk lifestyle factors adds to the prognostic value of optimal risk factor management, and benefit occurs even when the impact on conventional risk markers is discouragingly minimal or not present. The aims of this review are (a) to discuss novel lifestyle risk factors and their underlying biochemical principles and (b) to provide new perspectives on potentially more feasible recommendations to improve long-term adherence to low-risk lifestyle factors.
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Affiliation(s)
- Katharina Lechner
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany
| | - Clemens von Schacky
- Preventive Cardiology, Ludwig-Maximilians University, Munich, Germany.,Omegametrix, Martinsried, Germany
| | | | - Nicolai Worm
- German University for Prevention and Health Care Management, Saarbrücken, Germany
| | - Uwe Nixdorff
- European Prevention Centre, Medical Centre Düsseldorf (Grand Arc), Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - Nicolle Kränkel
- Charité - Universitätsmedizin Berlin, Klinik für Kardiologie, Campus Benjamin Steglitz, Berlin, Germany
| | - Martin Halle
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany
| | | | - Johannes Scherr
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Switzerland
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Haghikia A, Li XS, Liman TG, Bledau N, Schmidt D, Zimmermann F, Kränkel N, Widera C, Sonnenschein K, Haghikia A, Weissenborn K, Fraccarollo D, Heimesaat MM, Bauersachs J, Wang Z, Zhu W, Bavendiek U, Hazen SL, Endres M, Landmesser U. Gut Microbiota-Dependent Trimethylamine N-Oxide Predicts Risk of Cardiovascular Events in Patients With Stroke and Is Related to Proinflammatory Monocytes. Arterioscler Thromb Vasc Biol 2019; 38:2225-2235. [PMID: 29976769 DOI: 10.1161/atvbaha.118.311023] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [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] [Indexed: 12/13/2022]
Abstract
Objective- Gut microbiota-dependent metabolites, in particular trimethylamine N-oxide (TMAO), have recently been reported to promote atherosclerosis and thrombosis. Here, we examined for the first time the relation of TMAO and the risk of incident cardiovascular events in patients with recent first-ever ischemic stroke in 2 independent prospective cohorts. Moreover, the link between TMAO and proinflammatory monocytes as a potential contributing factor for cardiovascular risk in stroke patients was studied. Approach and Results- In a first study (n=78), higher TMAO plasma levels were linked with an increased risk of incident cardiovascular events including myocardial infarction, recurrent stroke, and cardiovascular death (fourth quartile versus first quartile; hazard ratio, 2.31; 95% CI, 1.25-4.23; P<0.01). In the second independent validation cohort (n=593), high TMAO levels again heralded marked increased risk of adverse cardiovascular events (fourth quartile versus first quartile; hazard ratio, 5.0; 95% CI, 1.7-14.8; P<0.01), and also after adjustments for cardiovascular risk factors including hypertension, diabetes mellitus, LDL (low-density lipoprotein) cholesterol, and estimated glomerular filtration rate (hazard ratio, 3.3; 95% CI, 1.2-10.9; P=0.04). A significant correlation was also found between TMAO levels and percentage of proinflammatory intermediate CD14++CD16+ monocytes ( r=0.70; P<0.01). Moreover, in mice fed a diet enriched with choline to increase TMAO synthesis, levels of proinflammatory murine Ly6Chigh monocytes were higher than in the chow-fed control group (choline: 9.2±0.5×103 per mL versus control: 6.5±0.5×103 per mL; P<0.01). This increase was abolished in mice with depleted gut microbiota (choline+antibiotics: 5.4±0.7×103 per mL; P<0.001 versus choline). Conclusions- The present study demonstrates for the first time a graded relation between TMAO levels and the risk of subsequent cardiovascular events in patients with recent prior ischemic stroke. Our data support the notion that TMAO-related increase of proinflammatory monocytes may add to elevated cardiovascular risk of patients with increased TMAO levels.
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Affiliation(s)
- Arash Haghikia
- From the Department of Cardiology (A.H., D.S., F.Z., N.K., U.L.)
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (A.H., N.K., M.E., U.L.)
| | - Xinmin S Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (X.S.L., Z.W., W.Z., S.L.H.)
| | | | - Nils Bledau
- Cardiology and Angiology (N.B., K.S., D.F., J.B., U.B.)
| | - David Schmidt
- From the Department of Cardiology (A.H., D.S., F.Z., N.K., U.L.)
| | | | - Nicolle Kränkel
- From the Department of Cardiology (A.H., D.S., F.Z., N.K., U.L.)
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (A.H., N.K., M.E., U.L.)
| | - Christian Widera
- Department of Cardiology, Heart Center Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Germany (C.W.)
| | | | - Aiden Haghikia
- Department of Neurology, Ruhr-University Bochum, Germany (A.H.)
| | | | | | - Markus M Heimesaat
- Institute of Microbiology and Infection Immunology (M.M.H.)
- Berlin Institute of Health (BIH), Germany (M.M.H., M.E., U.L.)
| | | | - Zeneng Wang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (X.S.L., Z.W., W.Z., S.L.H.)
| | - Weifei Zhu
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (X.S.L., Z.W., W.Z., S.L.H.)
| | - Udo Bavendiek
- Cardiology and Angiology (N.B., K.S., D.F., J.B., U.B.)
| | - Stanley L Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (X.S.L., Z.W., W.Z., S.L.H.)
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (S.L.H.)
| | - Matthias Endres
- Department of Neurology (T.G.L., M.E.)
- Center for Stroke Research Berlin (M.E.), Charité-Universitätsmedizin Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (A.H., N.K., M.E., U.L.)
- Berlin Institute of Health (BIH), Germany (M.M.H., M.E., U.L.)
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany (M.E.)
| | - Ulf Landmesser
- From the Department of Cardiology (A.H., D.S., F.Z., N.K., U.L.)
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (A.H., N.K., M.E., U.L.)
- Berlin Institute of Health (BIH), Germany (M.M.H., M.E., U.L.)
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Witvrouwen I, Van Craenenbroeck EM, Abreu A, Moholdt T, Kränkel N. Exercise training in women with cardiovascular disease: Differential response and barriers - review and perspective. Eur J Prev Cardiol 2019; 28:779-790. [PMID: 30889981 DOI: 10.1177/2047487319838221] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation has a class 1A recommendation in coronary artery disease and heart failure based on its beneficial effects on mortality, morbidity and quality of life. However, the inter-individual response to exercise training is highly variable and influenced by both training and patient characteristics. Notably, men and women display a different training response, even when accounting for age, height and lean muscle mass. Most studies investigating exercise effects on various physiological outcomes focus on male patients. Because women are understudied, the scientific evidence for tailored exercise prescription in women is still limited. METHODS This narrative review summarises: (a) the underlying physiological determinants of the response to exercise training in women with cardiovascular disease, in which women rely more on fat than on carbohydrate oxidation during exercise, have lower aerobic capacities and smaller increases in cardiac function during exercise; (b) the benefits and barriers of exercise in women, in whom improving cardiometabolic risk and quality of life is weighed against socioeconomic and psychological needs; and (c) the relevance of different clinical endpoints in exercise trials such as maximum oxygen uptake, morbidity, mortality, training characteristics, quality of life and metabolic or vascular endpoints. RESULTS Finally, we provide a perspective on how to improve referral, enrolment and adherence to exercise training in women, with structured approaches to inform the referring physician as well as the patient, and offering more flexible, gender-tailored or tele/smartphone-based programmes while addressing the socioeconomic and psychological needs of the patients. This may ultimately improve the admission, adherence and outcome of exercise-based cardiac rehabilitation in women.
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Affiliation(s)
- Isabel Witvrouwen
- 1 Laboratory of Cellular and Molecular Cardiology, University of Antwerp, Belgium.,2 Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Emeline M Van Craenenbroeck
- 1 Laboratory of Cellular and Molecular Cardiology, University of Antwerp, Belgium.,2 Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Ana Abreu
- 3 Serviço de Cardiologia, Hospital Santa Maria/HPV, CHLN, Lisboa, Portugal
| | - Trine Moholdt
- 4 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Norway
| | - Nicolle Kränkel
- 5 Department of Cardiology, Charité Universitätsmedizin, Germany.,6 German Center for Cardiovascular Research, partner site Berlin, Germany
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Kuschnerus K, Straessler ET, Müller MF, Lüscher TF, Landmesser U, Kränkel N. Increased Expression of miR-483-3p Impairs the Vascular Response to Injury in Type 2 Diabetes. Diabetes 2019; 68:349-360. [PMID: 30257976 DOI: 10.2337/db18-0084] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 09/13/2018] [Indexed: 11/13/2022]
Abstract
Aggravated endothelial injury and impaired endothelial repair capacity contribute to the high cardiovascular risk in patients with type 2 diabetes (T2D), but the underlying mechanisms are still incompletely understood. Here we describe the functional role of a mature form of miRNA (miR) 483-3p, which limits endothelial repair capacity in patients with T2D. Expression of human (hsa)-miR-483-3p was higher in endothelial-supportive M2-type macrophages (M2MΦs) and in the aortic wall of patients with T2D than in control subjects without diabetes. Likewise, the murine (mmu)-miR-483* was higher in T2D than in nondiabetic murine carotid samples. Overexpression of miR-483-3p increased endothelial and macrophage apoptosis and impaired reendothelialization in vitro. The inhibition of hsa-miR-483-3p in human T2D M2MΦs transplanted to athymic nude mice (NMRI-Foxn1ν/Foxn1ν ) or systemic inhibition of mmu-miR-483* in B6.BKS(D)-Leprdb /J diabetic mice rescued diabetes-associated impairment of reendothelialization in the murine carotid-injury model. We identified the endothelial transcription factor vascular endothelial zinc finger 1 (VEZF1) as a direct target of miR-483-3p. VEZF1 expression was reduced in aortae of diabetic mice and upregulated in diabetic murine aortae upon systemic inhibition of mmu-483*. The miRNA miR-483-3p is a critical regulator of endothelial integrity in patients with T2D and may represent a therapeutic target to rescue endothelial regeneration after injury in patients with T2D.
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Affiliation(s)
- Kira Kuschnerus
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Elisabeth T Straessler
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Maja F Müller
- University Hospital Zurich, Department of Cardiology, Zürich, Switzerland
| | - Thomas F Lüscher
- University Hospital Zurich, Department of Cardiology, Zürich, Switzerland
- Center of Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Ulf Landmesser
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- University Hospital Zurich, Department of Cardiology, Zürich, Switzerland
- Center of Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Nicolle Kränkel
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Center of Molecular Cardiology, University of Zurich, Zurich, Switzerland
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Kemps H, Kränkel N, Dörr M, Moholdt T, Wilhelm M, Paneni F, Serratosa L, Ekker Solberg E, Hansen D, Halle M, Guazzi M. Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2019; 26:709-727. [PMID: 30642190 DOI: 10.1177/2047487318820420] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.
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Affiliation(s)
- Hareld Kemps
- 1 Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Nicolle Kränkel
- 2 Charité - Universitätsmedizin Berlin, Klinik für Kardiologie, Campus Benjamin Steglitz, Germany.,3 DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Marcus Dörr
- 4 University Medicine Greifswald, Department of Internal Medicine B, Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Trine Moholdt
- 6 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Trondheim, Norway.,7 St Olav's Hospital, Trondheim, Norway
| | - Matthias Wilhelm
- 8 Department of Cardiology, Bern University Hospital and University of Bern, Switzerland
| | - Francesco Paneni
- 9 Centre for Molecular Cardiology and Cardiology, Zurich University Hospital, University of Zurich, Switzerland
| | - Luis Serratosa
- 10 Hospital Universitario Quironsalud, Madrid, Spain.,11 Ripoll & De Prado Sport Clinic, FIFA Medical Centre of Excellence, Murcia, Spain
| | | | - Dominique Hansen
- 13 Hasselt University, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium.,14 Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Martin Halle
- 15 Technical University Munich, Department of Prevention, Rehabilitation and Sports Medicine, Germany.,16 DZHK (German Centre for Cardiovascular Research), partner site Munich, Germany
| | - Marco Guazzi
- 17 University Cardiology Department and Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology, I.R.C.C.S., Milan, Italy.,18 Policlinico San Donato University Hospital, Milan, Italy
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Kränkel N. You don't know them until you challenge them - micro ribonucleic acid changes in response to acute exercise in patients with coronary artery disease. Eur J Prev Cardiol 2018; 26:343-345. [PMID: 30526024 DOI: 10.1177/2047487318816419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicolle Kränkel
- 1 Charité - Universitätsmedizin Berlin, Department of Cardiology, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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39
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Kränkel N, Bahls M, Van Craenenbroeck EM, Adams V, Serratosa L, Solberg EE, Hansen D, Dörr M, Kemps H. Exercise training to reduce cardiovascular risk in patients with metabolic syndrome and type 2 diabetes mellitus: How does it work? Eur J Prev Cardiol 2018; 26:701-708. [PMID: 30317879 DOI: 10.1177/2047487318805158] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Metabolic syndrome (MetS) - a clustering of pathological conditions, including abdominal obesity, hypertension, dyslipidemia and hyperglycaemia - is closely associated with the development of type 2 diabetes mellitus (T2DM) and a high risk of cardiovascular disease. A combination of multigenetic predisposition and lifestyle choices accounts for the varying inter-individual risk to develop MetS and T2DM, as well as for the individual amount of the increase in cardiovascular risk in those patients. A physically active lifestyle can offset about half of the genetically mediated cardiovascular risk. Yet, the extent to which standardized exercise programmes can reduce cardiovascular risk differs between patients. Exercise parameters, such as frequency, intensity, type and duration or number of repetitions, differentially target metabolic function, vascular health and physical fitness. In addition, exercise-induced molecular mechanisms are modulated by other patient-specific variables, such as age, diet and medication. This review discusses the molecular and cellular mechanisms underlying the effects of exercise training on cardiovascular risk specifically in patients with MetS and T2DM.
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Affiliation(s)
- Nicolle Kränkel
- 1 Charité - Universitätsmedizin Berlin, Klinik für Kardiologie, Campus Benjamin Steglitz, Berlin, Germany.,2 DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Martin Bahls
- 3 University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany.,4 DZHK (German Centre for Cardiovascular Research), Partner Site, Greifswald, Germany
| | | | - Volker Adams
- 6 Department of Molecular and Experimental Cardiology, TU Dresden, Heart Centre Dresden, Dresden, Germany
| | - Luis Serratosa
- 7 Hospital Universitario Quironsalud, Madrid, Spain.,8 Ripoll & De Prado Sport Clinic, FIFA Medical Centre of Excellence, Madrid, Spain
| | | | - Dominique Hansen
- 10 Hasselt University, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium.,11 Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marcus Dörr
- 3 University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany.,4 DZHK (German Centre for Cardiovascular Research), Partner Site, Greifswald, Germany
| | - Hareld Kemps
- 12 Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
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Remm F, Kränkel N, Lener D, Drucker DJ, Sopper S, Brenner C. Sitagliptin Accelerates Endothelial Regeneration after Vascular Injury Independent from GLP1 Receptor Signaling. Stem Cells Int 2018; 2018:5284963. [PMID: 29531541 PMCID: PMC5822806 DOI: 10.1155/2018/5284963] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/23/2017] [Accepted: 12/02/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION DPP4 inhibitors (gliptins) are commonly used antidiabetic drugs for the treatment of type 2 diabetes. Gliptins also act in a glucose-independent manner and show vasoregenerative effects. We have shown that gliptins can remarkably accelerate vascular healing after vascular injury. However, the underlying mechanisms remain unclear. Here, we examined potential signaling pathways linking gliptins to enhanced endothelial regeneration. METHODS AND RESULTS We used wild-type and GLP1 receptor knockout (Glp1r-/-) mice to investigate the underlying mechanisms of gliptin-induced reendothelialization. The prototype DPP4 inhibitor sitagliptin accelerated endothelial healing in both animal models. Improved endothelial growth was associated with gliptin-mediated progenitor cell recruitment into the diseased vascular wall via the SDF1-CXCR4 axis independent of GLP1R-dependent signaling pathways. Furthermore, SDF1 showed direct proproliferative effects on endothelial cells. Excessive neointimal formation was not observed in gliptin- or placebo-treated Glp1r-/- mice. CONCLUSION We identified the SDF1-CXCR4 axis as a crucial signaling pathway for endothelial regeneration after acute vascular injury. Furthermore, SDF1 can directly increase endothelial cell proliferation. Gliptin-mediated potentiation of endothelial regeneration was preserved in Glp1r-/- animals. Thus, gliptin-mediated endothelial regeneration proceeds through SDF-1/CXCR4 in a GLP1R-independent manner after acute vascular injury.
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Affiliation(s)
- Friederike Remm
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nicolle Kränkel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Daniela Lener
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel J. Drucker
- Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Sieghart Sopper
- Department of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Brenner
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Cardiology, Reha Zentrum Muenster, Münster, Tirol, Austria
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Strässler ET, Aalto-Setälä K, Kiamehr M, Landmesser U, Kränkel N. Age Is Relative-Impact of Donor Age on Induced Pluripotent Stem Cell-Derived Cell Functionality. Front Cardiovasc Med 2018; 5:4. [PMID: 29423397 PMCID: PMC5790033 DOI: 10.3389/fcvm.2018.00004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/09/2018] [Indexed: 01/20/2023] Open
Abstract
Induced pluripotent stem cells (iPSCs) avoid many of the restrictions that hamper the application of human embryonic stem cells: limited availability of source material due to legal restrictions in some countries, immunogenic rejection and ethical concerns. Also, the donor’s clinical phenotype is often known when working with iPSCs. Therefore, iPSCs seem ideal to tackle the two biggest tasks of regenerative medicine: degenerative diseases with genetic cause (e.g., Duchenne’s muscular dystrophy) and organ replacement in age-related diseases (e.g., end-stage heart or renal failure), especially in combination with recently developed gene-editing tools. In the setting of autologous transplantation in elderly patients, donor age becomes a potentially relevant factor that needs to be assessed. Here, we review and critically discuss available data pertinent to the questions: How does donor age influence the reprogramming process and iPSC functionality? Would it even be possible to reprogram senescent somatic cells? How does donor age affect iPSC differentiation into specialised cells and their functionality? We also identify research needs, which might help resolve current unknowns. Until recently, most hallmarks of ageing were attributed to an accumulation of DNA damage over time, and it was thus expected that DNA damage from a somatic cell would accumulate in iPSCs and the cells derived from them. In line with this, a decreased lifespan of cloned organisms compared with the donor was also observed in early cloning experiments. Therefore, it was questioned for a time whether iPSC derived from an old individual’s somatic cells would suffer from early senescence and, thus, may not be a viable option either for disease modelling nor future clinical applications. Instead, typical signs of cellular ageing are reverted in the process of iPSC reprogramming, and iPSCs from older donors do not show diminished differentiation potential nor do iPSC-derived cells from older donors suffer early senescence or show functional impairments when compared with those from younger donors. Thus, the data would suggest that donor age does not limit iPSC application for modelling genetic diseases nor regenerative therapies. However, open questions remain, e.g., regarding the potential tumourigenicity of iPSC-derived cells and the impact of epigenetic pattern retention.
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Affiliation(s)
- Elisabeth Tamara Strässler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Katriina Aalto-Setälä
- University of Tampere, Department of Medicine and Life Sciences, Tampere, Finland.,Heart Center, Tampere University Hospital, Tampere, Finland
| | - Mostafa Kiamehr
- University of Tampere, Department of Medicine and Life Sciences, Tampere, Finland.,Heart Center, Tampere University Hospital, Tampere, Finland
| | - Ulf Landmesser
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Nicolle Kränkel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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Witkowski M, Steffens D, Hassanein A, Witkowski M, Kränkel N, Doerner A, Friebel J, Landmesser U, Rauch U. Dabigatran-related platelet thrombin response during triple anti-thrombotic therapy: A matter of time? Thromb Res 2016; 149:62-63. [PMID: 27907813 DOI: 10.1016/j.thromres.2016.11.013] [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] [Received: 10/16/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Witkowski
- Department of Cardiology, Charité Universitätsmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Daniel Steffens
- Department of Cardiology, Charité Universitätsmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Adel Hassanein
- Department of Cardiology, Charité Universitätsmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Mario Witkowski
- Medical Microbiology and Hygiene, Obere Zahlbacher str. 67, 55131 Mainz, Germany
| | - Nicolle Kränkel
- Department of Cardiology, Charité Universitätsmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Andrea Doerner
- Department of Cardiology, Charité Universitätsmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Julian Friebel
- Department of Cardiology, Charité Universitätsmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ursula Rauch
- Department of Cardiology, Charité Universitätsmedizin, Hindenburgdamm 30, 12203 Berlin, Germany.
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43
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Affiliation(s)
- Nicolle Kränkel
- Department of Cardiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany; ; German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany
| | - Stefan Blankenberg
- Univeristy Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; ; German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Tanja Zeller
- Univeristy Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; ; German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
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Witkowski M, Weithauser A, Tabaraie T, Steffens D, Kränkel N, Witkowski M, Stratmann B, Tschoepe D, Landmesser U, Rauch-Kroehnert U. Micro-RNA-126 Reduces the Blood Thrombogenicity in Diabetes Mellitus via Targeting of Tissue Factor. Arterioscler Thromb Vasc Biol 2016; 36:1263-71. [PMID: 27127202 PMCID: PMC4894779 DOI: 10.1161/atvbaha.115.306094] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Objective— Diabetes mellitus involves vascular inflammatory processes and is a main contributor to cardiovascular mortality. Notably, heightened levels of circulating tissue factor (TF) account for the increased thrombogenicity and put those patients at risk for thromboembolic events. Here, we sought to investigate the role of micro-RNA (miR)–driven TF expression and thrombogenicity in diabetes mellitus. Approach and Results— Plasma samples of patients with diabetes mellitus were analyzed for TF protein and activity as well as miR-126 expression before and after optimization of the antidiabetic treatment. We found low miR-126 levels to be associated with markedly increased TF protein and TF-mediated thrombogenicity. Reduced miR-126 expression was accompanied by increased vascular inflammation as evident from the levels of vascular adhesion molecule-1 and fibrinogen, as well as leukocyte counts. With optimization of the antidiabetic treatment miR-126 levels increased and thrombogenicity was reduced. Using a luciferase reporter system, we demonstrated miR-126 to directly bind to the F3-3′-untranslated region, thereby reducing TF expression both on mRNA and on protein levels in human microvascular endothelial cells as well as TF mRNA and activity in monocytes. Conclusions— Circulating miR-126 exhibits antithrombotic properties via regulating post-transcriptional TF expression, thereby impacting the hemostatic balance of the vasculature in diabetes mellitus.
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Affiliation(s)
- Marco Witkowski
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Alice Weithauser
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Termeh Tabaraie
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Daniel Steffens
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Nicolle Kränkel
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Mario Witkowski
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Bernd Stratmann
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Diethelm Tschoepe
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Ulf Landmesser
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Ursula Rauch-Kroehnert
- From the Charité Centrum 11, Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany; Research Centre Immunology and Institute of Medical Microbiology and Hygiene, University of Mainz Medical Centre, Mainz, Germany; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany.
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Kränkel N. How to keep on going: Editorial comment on The long-term effects of a randomized trial comparing aerobic interval versus continuous training in coronary artery disease patients: one-year data from the SAINTEX-CAD study. Eur J Prev Cardiol 2016; 23:1151-3. [PMID: 27081165 DOI: 10.1177/2047487316642368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nicolle Kränkel
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany German Centre for Cardiovascular Research, Berlin, Germany Berlin Institute of Health, Berlin, Germany
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Paneni F, Costantino S, Kränkel N, Cosentino F, Lüscher TF. Reprogramming ageing and longevity genes restores paracrine angiogenic properties of early outgrowth cells. Eur Heart J 2016; 37:1733-7. [DOI: 10.1093/eurheartj/ehw073] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/01/2016] [Indexed: 01/20/2023] Open
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Abstract
Impaired functions of vascular cells are responsible for the majority of complications in patients with type 2 diabetes (T2D). Recently a better understanding of mechanisms contributing to development of vascular dysfunction and the role of systemic inflammatory activation and functional alterations of several secretory organs, of which adipose tissue has more recently been investigated, has been achieved. Notably, the progression of vascular disease within the context of T2D appears to be driven by a multitude of incremental signaling shifts. Hence, successful therapies need to target several mechanisms in parallel, and over a long time period. This review will summarize the latest molecular strategies and translational developments of cardiovascular therapy in patients with T2D.
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Affiliation(s)
- Kira Kuschnerus
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Medizinische Klinik für Kardiologie, Berlin, Germany
| | - Ulf Landmesser
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Medizinische Klinik für Kardiologie, Berlin, Germany
| | - Nicolle Kränkel
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Medizinische Klinik für Kardiologie, Berlin, Germany
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Brenner C, Franz WM, Kühlenthal S, Kuschnerus K, Remm F, Gross L, Theiss HD, Landmesser U, Kränkel N. DPP-4 inhibition ameliorates atherosclerosis by priming monocytes into M2 macrophages. Int J Cardiol 2015. [PMID: 26197403 DOI: 10.1016/j.ijcard.2015.07.044] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Glipitins are widely used for the treatment of type 2 diabetic patients. In addition to their improvement of glycemic control, animal studies have suggested an independent anti-atherosclerotic effect of gliptins. Nevertheless, recent clinical trials regarding long-term effects of gliptin therapy on vascular events have been disappointing. This discrepancy led us to better dissect the functional role of SDF-1/CXCR4 signaling as a potential mechanism underlying gliptin action. The study should give improved understanding of the potential of gliptin therapy in the prevention and treatment of atherosclerosis. METHODS AND RESULTS In an ApoE-/- mouse model on high cholesterol diet, long-term treatment with the DPP-4 inhibitor Sitagliptin significantly reduced atherosclerosic plaque load in the aorta. Flow cytometry analyses showed an enrichment of M2 macrophages in the aortic wall under gliptin therapy. Importantly, the number of recruited CD206+ macrophages was inversely correlated with total plaque area while no correlation was found for the overall macrophage population or M1 macrophages. Blockade of CXCR4/SDF-1 signaling by AMD3100 inhibited aortic M2 accumulation and the therapeutic effect of Sitagliptin. Correspondingly, Sitagliptin shifted the polarization profile of macrophages towards a M2-like phenotype. CONCLUSION Sitagliptin-mediated inhibition of early atherosclerosis is based on M2-polarization during monocyte differentiation via the SDF-1/CXCR4 signaling. In contrast to earlier assumptions gliptin treatment might be especially effective in prevention of atherosclerosis.
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Affiliation(s)
- C Brenner
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria; Department of Internal Medicine I, University of Munich, Munich, Germany.
| | - W M Franz
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - S Kühlenthal
- Department of Internal Medicine I, University of Munich, Munich, Germany
| | - K Kuschnerus
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F Remm
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria; Department of Internal Medicine I, University of Munich, Munich, Germany
| | - L Gross
- Department of Internal Medicine I, University of Munich, Munich, Germany
| | - H D Theiss
- Department of Internal Medicine I, University of Munich, Munich, Germany
| | - U Landmesser
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - N Kränkel
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Spescha RD, Klohs J, Semerano A, Giacalone G, Derungs RS, Reiner MF, Rodriguez Gutierrez D, Mendez-Carmona N, Glanzmann M, Savarese G, Kränkel N, Akhmedov A, Keller S, Mocharla P, Kaufmann MR, Wenger RH, Vogel J, Kulic L, Nitsch RM, Beer JH, Peruzzotti-Jametti L, Sessa M, Lüscher TF, Camici GG. Post-ischaemic silencing of p66Shc reduces ischaemia/reperfusion brain injury and its expression correlates to clinical outcome in stroke. Eur Heart J 2015; 36:1590-600. [PMID: 25904764 DOI: 10.1093/eurheartj/ehv140] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 02/16/2015] [Accepted: 04/06/2015] [Indexed: 12/25/2022] Open
Abstract
AIM Constitutive genetic deletion of the adaptor protein p66(Shc) was shown to protect from ischaemia/reperfusion injury. Here, we aimed at understanding the molecular mechanisms underlying this effect in stroke and studied p66(Shc) gene regulation in human ischaemic stroke. METHODS AND RESULTS Ischaemia/reperfusion brain injury was induced by performing a transient middle cerebral artery occlusion surgery on wild-type mice. After the ischaemic episode and upon reperfusion, small interfering RNA targeting p66(Shc) was injected intravenously. We observed that post-ischaemic p66(Shc) knockdown preserved blood-brain barrier integrity that resulted in improved stroke outcome, as identified by smaller lesion volumes, decreased neurological deficits, and increased survival. Experiments on primary human brain microvascular endothelial cells demonstrated that silencing of the adaptor protein p66(Shc) preserves claudin-5 protein levels during hypoxia/reoxygenation by reducing nicotinamide adenine dinucleotide phosphate oxidase activity and reactive oxygen species production. Further, we found that in peripheral blood monocytes of acute ischaemic stroke patients p66(Shc) gene expression is transiently increased and that this increase correlates with short-term neurological outcome. CONCLUSION Post-ischaemic silencing of p66(Shc) upon reperfusion improves stroke outcome in mice while the expression of p66(Shc) gene correlates with short-term outcome in patients with ischaemic stroke.
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Affiliation(s)
- R D Spescha
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - J Klohs
- Institute for Biomedical Engineering, Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, Switzerland
| | - A Semerano
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - G Giacalone
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - R S Derungs
- Division of Psychiatry Research, University of Zurich, Schlieren, Switzerland
| | - M F Reiner
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - D Rodriguez Gutierrez
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland
| | - N Mendez-Carmona
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland
| | - M Glanzmann
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - G Savarese
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - N Kränkel
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - A Akhmedov
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - S Keller
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - P Mocharla
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - M R Kaufmann
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - R H Wenger
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - J Vogel
- Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - L Kulic
- Division of Psychiatry Research, University of Zurich, Schlieren, Switzerland
| | - R M Nitsch
- Division of Psychiatry Research, University of Zurich, Schlieren, Switzerland
| | - J H Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | | | - M Sessa
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - T F Lüscher
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland Cardiology, University Heart Center, University Hospital, Zurich, Switzerland
| | - G G Camici
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, Schlieren CH-8952, Switzerland Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
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Ascione R, Rowlinson J, Avolio E, Katare R, Meloni M, Spencer HL, Mangialardi G, Norris C, Kränkel N, Spinetti G, Emanueli C, Madeddu P. Migration towards SDF-1 selects angiogenin-expressing bone marrow monocytes endowed with cardiac reparative activity in patients with previous myocardial infarction. Stem Cell Res Ther 2015; 6:53. [PMID: 25889213 PMCID: PMC4440500 DOI: 10.1186/s13287-015-0028-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 06/19/2014] [Revised: 07/04/2014] [Accepted: 02/27/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction Chemokine-directed migration is crucial for homing of regenerative cells to the infarcted heart and correlates with outcomes of cell therapy trials. Hence, transplantation of chemokine-responsive bone marrow cells may be ideal for treatment of myocardial ischemia. To verify the therapeutic activity of bone marrow mononuclear cells (BM-MNCs) selected by in vitro migration towards the chemokine stromal cell-derived factor-1 (SDF-1) in a mouse model of myocardial infarction (MI), we used BM-MNCs from patients with previous large MI recruited in the TransACT-1&2 cell therapy trials. Methods Unfractioned BM-MNCs, SDF-1-responsive, and SDF-1-nonresponsive BM-MNCs isolated by patients recruited in the TransACT-1&2 cell therapy trials were tested in Matrigel assay to evaluate angiogenic potential. Secretome and antigenic profile were characterized by flow cytometry. Angiogenin expression was measured by RT-PCR. Cells groups were also intramyocardially injected in an in vivo model of MI (8-week-old immune deficient CD1-FOXN1nu/nu mice). Echocardiography and hemodynamic measurements were performed before and at 14 days post-MI. Arterioles and capillaries density, infiltration of inflammatory cells, interstitial fibrosis, and cardiomyocyte proliferation and apoptosis were assessed by immunohistochemistry. Results In vitro migration enriched for monocytes, while CD34+ and CD133+ cells and T lymphocytes remained mainly confined in the non-migrated fraction. Unfractioned total BM-MNCs promoted angiogenesis on Matrigel more efficiently than migrated or non-migrated cells. In mice with induced MI, intramyocardial injection of unfractionated or migrated BM-MNCs was more effective in preserving cardiac contractility and pressure indexes than vehicle or non-migrated BM-MNCs. Moreover, unfractioned BM-MNCs enhanced neovascularization, whereas the migrated fraction was unique in reducing the infarct size and interstitial fibrosis. In vitro studies on isolated cardiomyocytes suggest participation of angiogenin, a secreted ribonuclease that inhibits protein translation under stress conditions, in promotion of cardiomyocyte survival by migrated BM-MNCs. Conclusions Transplantation of bone marrow cells helps post-MI healing through distinct actions on vascular cells and cardiomyocytes. In addition, the SDF-1-responsive fraction is enriched with angiogenin-expressing monocytes, which may improve cardiac recovery through activation of cardiomyocyte response to stress. Identification of factors linking migratory and therapeutic outcomes could help refine regenerative approaches. Electronic supplementary material The online version of this article (doi:10.1186/s13287-015-0028-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raimondo Ascione
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | - Jonathan Rowlinson
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | - Elisa Avolio
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | - Rajesh Katare
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | - Marco Meloni
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | - Helen L Spencer
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | - Giuseppe Mangialardi
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | - Caroline Norris
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | | | | | - Costanza Emanueli
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
| | - Paolo Madeddu
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Road, Bristol, BS2 8HW, UK.
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