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Costa G, Sposito C, Soldani C, Polidoro MA, Franceschini B, Marchesi F, Nasir FD, Virdis M, Vingiani A, Leo A, Di Tommaso L, Kotha S, Mantovani A, Mazzaferro V, Donadon M, Torzilli G. Macrophage morphology and distribution are strong predictors of prognosis in resected colorectal liver metastases: results from an external retrospective observational study. Int J Surg 2023; 109:1311-1317. [PMID: 37037585 PMCID: PMC10389408 DOI: 10.1097/js9.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Tumor-associated macrophages (TAMs) are key components of a tumoral microenvironment and have been shown to impact prognosis in different cancers. Previously reported data showed that TAM morphology correlates with prognosis in colorectal liver metastases (CLMs) after hepatectomy, with smaller TAMs (S-TAMs) conferring a more favorable prognosis than larger ones (L-TAMs). This study aims to externally validate this finding. MATERIAL AND METHODS The external cohort consisted of 84 formalin-fixed and paraffin-embedded surgical samples of CLMs and peritumoral tissue. Two-micrometer-section slides were obtained; the area and perimeter of 21 macrophages in each slide were recorded. The endpoints were TAMs morphometrics and their prognostic significance in relation to disease-free survival (DFS). RESULTS The average macrophage perimeter was 71.5±14.1 μm whilst the average area was 217.7±67.8 μm 2 . At univariate analysis, the TAM area demonstrated a statistically significant association with DFS ( P =0.0006). Optimal area cutoff value was obtained, showing a sensitivity and specificity of 92 and 56%, respectively. S-TAMs and L-TAMs were associated with 3-year DFS rates of 60 and 8.5%, respectively ( P <0.001). Multivariate analysis confirmed the predictive role of TAM area for DFS [hazard ratio (HR)=5.03; 95% CI=1.70-14.94; P =0.003]. Moreover, in a subset of patients ( n =12) characterized by unfavorable ( n =6, recurrence within 3 months) or favorable ( n =6, no recurrence after 48 months) prognosis, TAMs showed a different distribution: L-TAMs were more abundant and closer to the tumor invasive margin in patients that encountered early recurrence and tended to cluster in foci significantly larger ( P =0.02). CONCLUSIONS This external validation confirms that morphometric characterization of TAMs can serve as a simple readout of their diversity and allows to reliably stratify patient outcomes and predict disease recurrence after hepatectomy for CLMs.
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Affiliation(s)
- Guido Costa
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Department of Hepatobiliary and General Surgery
| | - Carlo Sposito
- Department of Oncology and Hemato-Oncology, University of Milan
- Department of Surgery, HPB Surgery and Liver Transplant Unit, Istituto Nazionale Tumori Fondazione IRCCS, Milan
| | | | | | | | - Federica Marchesi
- Department of Biotechnology and Translational Medicine
- Department of Immunology and Inflammation
| | | | | | | | - Ana Leo
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Division of Internal Medicine and Hepatology, Department of Gastroenterology
| | - Luca Di Tommaso
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Soumya Kotha
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Alberto Mantovani
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Department of Immunology and Inflammation
- William Harvey Research Institute, Queen Mary University, London, UK
| | - Vincenzo Mazzaferro
- Department of Oncology and Hemato-Oncology, University of Milan
- Department of Surgery, HPB Surgery and Liver Transplant Unit, Istituto Nazionale Tumori Fondazione IRCCS, Milan
| | - Matteo Donadon
- Department of Hepatobiliary and General Surgery
- Department of Surgery, University Maggiore Hospital della Carità
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Guido Torzilli
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Department of Hepatobiliary and General Surgery
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Jex N, Chowdhary A, Thirunavukarasu S, Procter H, Sengupta A, Natarajan P, Kotha S, Poenar AM, Xue H, Cubbon R, Kellman P, Greenwood JP, Plein S, Page SP, Levelt E. Coexistent diabetes is associated with the presence of adverse phenotypic features in patients with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Type 2 diabetes mellitus (DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. The reasons for this adverse prognostic association are incompletely understood. Although distinct entities both HCM and DM share common features of impaired myocardial energetics and coronary microvascular function.
Purpose
We sought to test the hypothesis that co-existent diabetes is associated with greater reductions in myocardial energetics and perfusion, and higher scar burden in HCM.
Research design and methods
Seventy-five age- and sex-matched participants with concomitant HCM and DM (HCM-DM, n=20), isolated HCM (n=20), isolated DM (n=20) and healthy volunteers (HV, n=15) underwent 31phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance imaging. The HCM groups were matched for HCM phenotype. The DM groups were matched for diabetes treatment, duration, HbA1c, body mass index and hypertension comorbidity.
Results
ESC sudden cardiac death risk scores were comparable between the HCM groups (HCM: 2.2±1.5%, HCM-DM: 1.9±1.2%; p=NS) and sarcomeric mutations were equally common. HCM-DM had the highest NT-proBNP levels (HV: 42 ng/L [IQR: 35–66], DM: 118 ng/L [IQR: 53–187], HCM: 298 ng/L [IQR: 157–837], HCM-DM: 726 ng/L [IQR: 213–8695]; p<0.0001). Left-ventricular ejection fraction, mass and wall thickness were similar between the HCM groups. HCM-DM displayed a greater degree of fibrosis burden with higher scar percentage, and lower global longitudinal strain compared to the isolated HCM. PCr/ATP was similarly decreased in the HCM-DM and DM (HV: 2.17±0.49, DM: 1.61±0.23, HCM: 1.93±0.38, HCM-DM: 1.54±0.27; p=0.0003). HCM-DM had the lowest stress myocardial blood flow (HV: 2.06±0.42 ml/min/g, DM: 1.78±0.45 ml/min/g, HCM: 1.74±0.44 ml/min/g, HCM-DM: 1.39±0.42 ml/min/g; p=0.004).
Conclusions
We show for the first time that HCM patients with DM comorbidity display greater reductions in myocardial energetics, perfusion, contractile function and higher myocardial scar burden and serum NT-proBNP levels compared to patients with isolated HCM despite similar LV mass and wall thickness and presence of sarcomeric mutations. These adverse phenotypic features may be important components of the adverse clinical manifestation attributable to a combined presence of HCM and DM.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Diabetes UK
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Affiliation(s)
- N Jex
- University of Leeds , Leeds , United Kingdom
| | - A Chowdhary
- University of Leeds , Leeds , United Kingdom
| | | | - H Procter
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - A Sengupta
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - P Natarajan
- University of Leeds , Leeds , United Kingdom
| | - S Kotha
- University of Leeds , Leeds , United Kingdom
| | - A M Poenar
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - R Cubbon
- University of Leeds , Leeds , United Kingdom
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | | | - S Plein
- University of Leeds , Leeds , United Kingdom
| | - S P Page
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - E Levelt
- University of Leeds , Leeds , United Kingdom
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3
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Gorecka M, Nejadhamzeeigilani H, Craven TP, Chew PG, Dobson LE, Brown LAE, Chowdhary A, Jex N, Thirunavukarasu S, Sharrack N, Javed W, Kotha S, Levelt E, Goddard AJP, Greenwood JP. Perioperative cerebral microinfarction and quality of life following mitral valve surgery. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Mitral regurgitation (MR) is the second most common valvular pathology worldwide. When untreated, severe MR is associated with significant morbidity and mortality. Mitral valve surgery is recommended in symptomatic patients and those with evidence of adverse left atrial or left ventricular remodelling. Although uncommon, stroke is a recognised complication of mitral valve surgery and is associated with unfavourable outcomes. While silent cerebral microinfarction has been described following cardiac surgery, its incidence in mitral valve surgery and its impact on quality of life is presently unknown. The main aim of this study was to assess the incidence of perioperative cerebral microinfarction following mitral valve surgery and its impact on medium-term health-related quality of life (HRQoL).
Methods
Cerebral diffusion-weighted magnetic resonance imaging (DWI-MRI) was conducted pre-operatively and prior to discharge in 31 patients undergoing mitral valve surgery for mitral regurgitation. Blinded analysis was conducted by a neuro-radiologist. HRQoL assessment was undertaken at baseline and at a 6-month follow up with EuroQoL-5 dimensions (EQ-5D-5L) and Hospital Anxiety and Depression Scale (HADS) questionnaires.
Results
Thirty-one patients underwent paired cerebral DWI-MRI (mitral valve replacement (MVR) n=16 [52%] and mitral valve repair (MVr) n=15 [48%]). Prevalence of atrial fibrillation was similar in both groups (MVR n=9 [56%] vs. MVr n=7 [47%], p=0.59). Peri-operative cerebral microinfarction occurred in 9 patients (29%). Embolic events were numerically higher in the MVR group versus MVr group, but not statistically significant (n=7 [44%] vs. n=2 [13%], p=0.06). Presence of multiple lesions, large lesions >5mm, small lesions <5mm and the total number of lesions did not differ significantly between the two groups. Median volume of lesions was higher in the MVR group versus MVr (0 [0–0.4] vs 0 [0–0], p=0.04) (Table 1).
There was no difference in the mean change in HRQoL during 6m follow up between patients with peri-operative cerebral microinfarction and those with no detectable embolic events (Table 2). Within group comparison (MVR group and MVr group) also did not demonstrate any significant difference.
Conclusions
Peri-operative cerebral microinfarction occurred in almost a third of patients undergoing mitral valve surgery, with higher volume of lesions following MVR. These lesions however, did not exhibit significant impact on medium term health-related quality of life.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Gorecka
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | | | - T P Craven
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - P G Chew
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - L E Dobson
- Manchester University NHS Foundation Trust , Manchester , United Kingdom
| | - L A E Brown
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - A Chowdhary
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - N Jex
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - S Thirunavukarasu
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - N Sharrack
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - W Javed
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - S Kotha
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - E Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - A J P Goddard
- Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - J P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
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Jex N, Cubbon R, Chowdhary A, Thirunavukarasu S, Kotha S, Procter H, Xue H, Swoboda P, Kellman P, Greenwood JP, Plein S, Levelt E. Clinical outcomes and myocardial recovery in energetics, perfusion and contractile function after valve replacement surgery in severe aortic stenosis patients with diabetes comorbidity. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and type 2 diabetes mellitus (DM) are increasingly frequent comorbidities in aging populations, and diabetes is associated with increased morbidity and mortality after aortic valve replacement (AVR). Although distinct pathological entities, AS and DM share common features of impaired myocardial energetics and coronary microvascular dysfunction (CMD). The mechanisms for the adverse prognostic association between AS and DM are incompletely understood.
Purpose
Utilising 31phosphorus magnetic resonance spectroscopy (31P-MRS) and CMR, we tested the hypotheses that the collective impact of severe AS and DM on the myocardium aggravates the impairment in energetics, function and perfusion.
Methods
Eighty-eight severe AS patients with (AS-DM) and without DM (Iso-AS) undergoing AVR and 15 healthy volunteers were recruited. Patients with coronary artery disease were excluded. Participants with AS underwent 31P-MRS and comprehensive CMR imaging 1 month prior to and 6 months after AVR.
Results
Demographic, biochemical and CMR/31P-MRS data are shown in Table-1. All groups were matched for age and sex distribution, with AS groups matched for surgical scores and frailty scores. NTproBNP levels were similarly elevated in AS groups. Left ventricular (LV) volumes and ejection fraction (EF) were similar between the groups, with no significant difference in LV mass or wall thickness between the AS groups. The baseline differences in myocardial energetics, stress myocardial blood flow (MBF) and global longitudinal strain (GLS) are shown in the Figure. AS-DM patients showed greater reductions in myocardial energetics (p<0.0001), global stress MBF (p<0.0001) and more significant reductions in GLS (p=0.001) than the Iso-AS patients. At 6 month post AVR both AS groups showed significant improvements in stress MBF and GLS. However, only the Iso-AS patients showed significant improvement in myocardial energetics.
AS patients were followed up for a median of 12 months. Cumulative incidence of the clinical events post AVR (composite of cardiovascular death, stroke, heart failure admission, infective endocarditis) were significantly higher in the AS-DM group than the Iso-AS group (Hazard Ratio: 3.35; 95% CI: 0.97–11.6; p=0.02).
Conclusion
Diabetes was associated with increased morbidity and mortality after AVR. We showed for the first time that the collective impact of T2DM and AS on the myocardium aggravates energetic impairment, CMD and contractile dysfunction. While myocardial recovery following AVR was associated with similar improvements in perfusion and contractile function in severe AS patients with and without T2DM, improvements in energetics were only detected in isolated AS patients. However, despite the significant improvements in contractile function and perfusion following AVR in diabetes patients, these parameters remained lower in the group with diabetes comorbidity compared to isolated AS patients.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust
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Affiliation(s)
- N Jex
- University of Leeds , Leeds , United Kingdom
| | - R Cubbon
- University of Leeds , Leeds , United Kingdom
| | - A Chowdhary
- University of Leeds , Leeds , United Kingdom
| | | | - S Kotha
- University of Leeds , Leeds , United Kingdom
| | - H Procter
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - P Swoboda
- University of Leeds , Leeds , United Kingdom
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | | | - S Plein
- University of Leeds , Leeds , United Kingdom
| | - E Levelt
- University of Leeds , Leeds , United Kingdom
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5
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Chowdhary A, Cubbon R, Thirunavukarasu S, Jex N, Kotha S, Xue H, Kellman P, Greenwood J, Plein S, Levelt E. Body mass index associated differences in cardiac stress energetics in type 2 diabetes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with T2D and heart disease have normal body mass index (BMI), suggesting that diabetes and obesity mediate cardiovascular change by different mechanisms. Changes in cardiac energy metabolism in lean diabetic patients during exercise stress have not been previously reported.
Objectives
We aimed to assess if there are BMI-associated differences in cardiac stress metabolism in patients with T2D.
Methods
Twenty-five overweight T2D patients (O-T2D) and eleven lean T2D patients (LnT2D), age- and ethnicity-matched and with no other comorbidities were studied. Patients were on oral hypoglycaemics only and were free of diabetes complications. Participants underwent rest and dobutamine stress phosphorus magnetic resonance spectroscopy (31P-MRS) and cardiovascular magnetic resonance (CMR) at 3T for the assessment of myocardial phosphocreatine to ATP ratio (PCr/ATP) as a measure of myocardial energetics, biventricular volumes, rest and stress left ventricular (LV) ejection fraction, global longitudinal shortening, and mitral in-flow E/A ratio for assessment of diastolic function and perfusion.
Intravenous Dobutamine was administered at a dose of 10μg/kg/min, increasing at 90 second intervals up to a maximum of 40 μg/kg/min to achieve a target heart rate of 65% of the age-predicted maximal heart rate. Mean rate pressure product (RPP) was recorded at rest and stress. Heart rate was maintained at target for the duration of the 31P-MRS and stress CMR cine, mitral in-flow and perfusion acquisitions.
Results
The cardiac volumes, systolic or diastolic function and LV mass were similar between LnT2D and O-T2D. Although the O-T2D patients had a numerically lower rest and stress PCr/ATP ratio, this did not reach statistical significance. Resting PCr/ATP was reduced in LnT2D and O-T2D patients similarly. However, LnT2D showed a greater reduction in PCr/ATP (stress PCr/ATP LnT2D 1.51±0.2 vs O-T2D 1.41±0.25, p=0.02) despite similar increases in RPP. Stress myocardial blood flow (MBF) was also significantly lower in the O-T2D patients. There were significant correlations of BMI with LV mass (r=0.35, p=0.03); stress LVEF (r=−0.34, p=0.04); stress MBF stress (r=−0.53, p=0.001) and stress E/A (r=0.46, p=0.01) (figure 1).
Conclusions
Despite their better stress perfusion and similar glycaemic control, LnT2D show worse metabolic reserve characterised by more significant decrements in energetics in response to hemodynamic stress compared to overweight patients with T2D. Higher BMI correlates inversely with stress myocardial blood flow and with stress left ventricular ejection fraction. The presence of these subtle alterations in measures of stress metabolism and perfusion might signify a distinct metabolic phenotype of “lean diabetic cardiomyopathy”. Future studies are needed to further delineate alterations in cardiac energy metabolism in lean and overweight/obese type 2 diabetes patients, and their role in the development of cardiac dysfunction.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome TrustBHF
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Affiliation(s)
- A Chowdhary
- University of Leeds , Leeds , United Kingdom
| | - R Cubbon
- University of Leeds , Leeds , United Kingdom
| | | | - N Jex
- University of Leeds , Leeds , United Kingdom
| | - S Kotha
- University of Leeds , Leeds , United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - J Greenwood
- University of Leeds , Leeds , United Kingdom
| | - S Plein
- University of Leeds , Leeds , United Kingdom
| | - E Levelt
- University of Leeds , Leeds , United Kingdom
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Thiru S, Ansari F, Cubbon R, Forbes K, Chowdhary A, Jex N, Kotha S, Morley L, Xue H, Kellman P, Greenwood JP, Plein S, Everett T, Scott E, Levelt E. Gestational diabetes, preeclampsia and the maternal heart. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Gestational diabetes mellitus (GDM) and preeclampsia (pE) are both associated with an increased risk of cardiovascular mortality and morbidity, including an increased risk of developing heart failure in later life. Both conditions are increasing in prevalence; GDM affects up to 12% and pE affects 3–5% of pregnancies worldwide. Compromised cardiac energy production is an important contributor to most forms of heart disease. The changes in myocardial energetics in GDM and pE have not been characterised previously.
Purpose
We sought to assess if women with GDM and women with pE in the third trimester of pregnancy exhibit adverse cardiac alterations in myocardial energetics, function or tissue characteristics.
Methods
Thirty-eight healthy pregnant (HP) women, thirty women with GDM and fifteen women with pE were recruited, matched for age and ethnicity. Participants underwent phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance for assessment of myocardial energetics (phosphocreatine to ATP ratio (PCr/ATP)), tissue characteristics, biventricular volumes and ejection fractions, left ventricular (LV) mass, global longitudinal strain (GLS) and mitral in-flow E/A ratio.
Results
The biochemical characteristics and multiparametric MR results are given in Table 1.
The women in the GDM and the pE groups had higher body-mass index. There was a stepwise increase in the systolic and diastolic BP from the HP to the GDM to the pE group. There was no difference in NTproBNP concentrations between the groups. The gestational weight gain was higher in women with GDM and pE compared to the HP group.
The women in the GDM and the pE groups showed similar reductions in myocardial PCr/ATP ratios compared to HP group (Figure 1a), accompanied by lower LV end-diastolic volumes and higher LV mass (Figure 1b) and enhanced LV concentricity in both groups (Figure 1c). While LV ejection fractions were similar across the groups, the GLS was reduced in women with GDM and in women with pE (Figure 1d).
Conclusions
We show here for the first time that despite no prior diagnosis of diabetes or hypertension, women with GDM or pE manifest impaired myocardial contractility and higher LV mass, associated with reductions in myocardial energetics. These findings may aid our understanding of the long-term cardiovascular risks associated with these conditions.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust
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Affiliation(s)
- S Thiru
- Leeds General Infirmary , Leeds , United Kingdom
| | - F Ansari
- Leeds General Infirmary , Leeds , United Kingdom
| | - R Cubbon
- Leeds General Infirmary , Leeds , United Kingdom
| | - K Forbes
- Leeds General Infirmary , Leeds , United Kingdom
| | - A Chowdhary
- Leeds General Infirmary , Leeds , United Kingdom
| | - N Jex
- Leeds General Infirmary , Leeds , United Kingdom
| | - S Kotha
- Leeds General Infirmary , Leeds , United Kingdom
| | - L Morley
- Leeds General Infirmary , Leeds , United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | | | - S Plein
- Leeds General Infirmary , Leeds , United Kingdom
| | - T Everett
- Leeds General Infirmary , Leeds , United Kingdom
| | - E Scott
- Leeds General Infirmary , Leeds , United Kingdom
| | - E Levelt
- Leeds General Infirmary , Leeds , United Kingdom
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Abstract
Glomerulonephritis (GN) refers to a group of renal diseases affecting the glomeruli due to the damage mediated by immunological mechanisms. A large proportion of the disease manifestations are caused by disturbances in the complement system. They can be due to genetic errors, autoimmunity, microbes or abnormal immunoglobulins, like modified IgA or paraproteins. The common denominator in most of the problems is an overactive or misdirected alternative pathway complement activation. An assessment of kidney function, amount of proteinuria and hematuria are crucial elements to evaluate, when glomerulonephritis is suspected. However, the cornerstones of the diagnoses are renal biopsy and careful examination of the complement abnormality. Differential diagnostics between the various forms of GN is not possible based on clinical features, as they may vary greatly. This review describes the known mechanisms of complement dysfunction leading to different forms of primary GN (like IgA glomerulonephritis, dense deposit disease, C3 glomerulonephritis, post-infectious GN, membranous GN) and differences to atypical hemolytic uremic syndrome. It also covers the basic elements of etiology-directed therapy and prognosis of the most common forms of GN. Common principles in the management of GN include treatment of hypertension and reduction of proteinuria, some require immunomodulating treatment. Complement inhibition is an emerging treatment option. A thorough understanding of the basic disease mechanism and a careful follow-up are needed for optimal therapy.
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Affiliation(s)
- Kati Kaartinen
- Department of Nephrology, Abdominal Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Adrian Safa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Bacteriology and Immunology, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Soumya Kotha
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Bacteriology and Immunology, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Giorgio Ratti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Bacteriology and Immunology, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Seppo Meri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Bacteriology and Immunology, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland; HUSLAB, Helsinki University Central Hospital, Helsinki, Finland.
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8
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Dharmastuti D, Agni A, Widyaputri F, Pawiroranu S, Sofro Z, Wardhana F, Haryanto S, Widayanti T, Kotha S, Gupta P, Sasongko M. Associations of Physical Activity and Sedentary Behaviour with Vision-Threatening Diabetic Retinopathy in Indonesian Population with Type 2 Diabetes Mellitus: Jogjakarta Eye Diabetic Study in the Community (JOGED.COM). Ophthalmic Epidemiol 2017; 25:113-119. [DOI: 10.1080/09286586.2017.1367410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- D.P Dharmastuti
- Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - A.N Agni
- Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - F Widyaputri
- Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - S Pawiroranu
- Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Z.M Sofro
- Department of Physiology, Faculty of Medicine, Universitas Gadjah Mada
| | - F.S Wardhana
- Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - S Haryanto
- Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - T.W Widayanti
- Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - S Kotha
- Hellen Keller International, Yogyakarta, Indonesia
| | - P Gupta
- Hellen Keller International, Yogyakarta, Indonesia
| | - M.B Sasongko
- Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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9
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Affiliation(s)
- S Meade
- Core Medical Trainee in the Department of Gastroenterology, Queen Elizabeth Hospital, London SE18 4QH
| | - S Kotha
- Gastroenterology Registrar in the Department of Gastroenterology, Queen Elizabeth Hospital, London
| | - A Gera
- Gastroenterology Consultant in the Department of Gastroenterology, Queen Elizabeth Hospital, London
| | - A Loganayagam
- Gastroenterology Consultant in the Department of Gastroenterology, Queen Elizabeth Hospital, London
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10
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Harvey BM, Eschbach M, Glynn EA, Kotha S, Darre M, Adams DJ, Ramanathan R, Mancini R, Govoni KE. Effect of daily lithium chloride administration on bone mass and strength in growing broiler chickens. Poult Sci 2015; 94:296-301. [PMID: 25609690 DOI: 10.3382/ps/peu079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objective was to determine the effects of oral lithium chloride supplementation on bone strength and mass in broiler chickens. Ninety-six broilers were assigned to 1 of 2 treatment groups (lithium chloride or control; n=48/treatment). Beginning at 1 or 3 wk of age, chickens were administered lithium chloride (20 mg/kg body weight) or water daily by oral gavage. At 6 wk of age, chickens were euthanized and bone and muscle samples were collected. A 24 h lithium chloride (20 mg/kg body weight) challenge determined that serum lithium chloride increased within 2 h and cleared the system within 24 h, demonstrating the effective delivery of lithium chloride. Treatment did not influence body weight (P≥0.20) or feed intake (P≥0.81), demonstrating that lithium chloride did not negatively affect broiler growth. To determine bone strength, 3-point bending was performed on the femora and tibiae obtained from control and lithium chloride-treated birds in the 1 wk group. Lithium chloride-treated birds had a 22% reduction in stiffness compared with control in the femora (P=0.02) without a corresponding reduction in elastic modulus. No differences were observed in yield or ultimate load and in the corresponding calculations of stresses (P≥0.26). The toughness of tibiae was not altered in lithium chloride compared with control (P=0.11). Bone length and micro-CT imaging were performed on the tibiae of control and lithium chloride groups. No differences (P≥0.52) in bone length, cortical or trabecular bone volume, trabecular thickness, number, or spacing were observed. Lithium chloride treatment did not affect pectoralis muscle color or lipid oxidation (P>0.05). In conclusion, lithium chloride treatment in broilers did not negatively affect growth or meat quality. A reduction in bone stiffness of the femur with lithium chloride treatment was observed, however unlike the mouse model, the dosages of lithium chloride used in the current study did not result in anabolic effects on broiler long bones.
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Affiliation(s)
- B M Harvey
- Department of Animal Science, University of Connecticut, Storrs, CT
| | - M Eschbach
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT
| | - E A Glynn
- Department of Animal Science, University of Connecticut, Storrs, CT
| | - S Kotha
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT
| | - M Darre
- Department of Animal Science, University of Connecticut, Storrs, CT
| | - D J Adams
- Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - R Ramanathan
- Department of Animal Science, University of Connecticut, Storrs, CT
| | - R Mancini
- Department of Animal Science, University of Connecticut, Storrs, CT
| | - K E Govoni
- Department of Animal Science, University of Connecticut, Storrs, CT
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11
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Kotha S, Goyal D, Bitra A, Thota N, Kruger G, Anand R. Diversity oriented approach to triazole based peptidomimetics as mammalian sterile 20 kinase inhibitors. RSC Adv 2013. [DOI: 10.1039/c3ra44318c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Kotha S, Shah VR, Mishra PP, Datta A. Design and synthesis of a novel anthracene-based fluorescent probe through the application of the Suzuki–Miyaura cross-coupling reaction. Amino Acids 2007; 35:169-73. [PMID: 17914601 DOI: 10.1007/s00726-007-0592-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 07/13/2007] [Indexed: 10/22/2022]
Abstract
We report on a simple synthetic route to a novel anthracene-based bis-armed amino acid derivative as a useful fluorescent probe. Various photophysical studies of this amino acid derivative are also described. Here, Suzuki-Miyaura cross-coupling reaction has been used as a key step for carbon-carbon bond formation.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology-Bombay, Powai, Mumbai, India.
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13
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Kotha S, Shah VR, Halder S, Vinodkumar R, Lahiri K. Synthesis of bis-armed amino acid derivatives via the alkylation of ethyl isocyanoacetate and the Suzuki–Miyaura cross-coupling reaction. Amino Acids 2006; 32:387-94. [PMID: 17031480 DOI: 10.1007/s00726-006-0402-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 07/17/2006] [Indexed: 10/24/2022]
Abstract
Two synthetic routes to bis-armed-alpha-amino acid derivatives are described. The first route involves alkylation of dibromo derivatives with ethyl isocyanoacetate under phase-transfer catalysis (PTC) conditions. The second route uses a palladium-mediated Suzuki-Miyaura cross-coupling reaction between a DL-4-boronophenylalanine derivative and aromatic diiodo (or dibromo) compounds.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology-Bombay, Powai, Mumbai, India.
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14
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Abstract
The objective of this paper is to describe in details of various available methods to prepare C(alpha,alpha)-dibenzylglycine (Dbzg) and then include our work involving the synthesis of side chain Dbzg derivatives. alpha,alpha-Disubstituted amino acids (alpha,alphaAAs) are important members in the family of modified amino acids. Replacement of the alpha-hydrogens of glycine 1 by alkyl groups leads to alpha,alphaAAs. The steric hindrance of the quaternary centre of Aib 2 combined with the helix-forming capacity has attracted the attention of structural biologists and protein crystallographers. Dbzg 3 is a special structural variant of Aib. The presence of two benzyl groups at C(alpha)-position not only impart rigidity to the peptide backbone in which it is incorporated, but also acts as a useful vehicle for studying pi-pi interactions. Although several C(alpha,alpha)-disubstituted glycines such as C(alpha,alpha)-diethyl glycine (Deg), C(alpha,alpha)-dipropyl glycine (Dpg) etc. have been studied in detail, not much has been known about Dbzg because of limited availability of synthetic procedures. Various Dbzg derivatives 19a-f have been prepared using ethyl isocyanoacetate 14 as a glycine equivalent (eq.). A useful and simple methodology has been developed using the Suzuki-Miyaura cross-coupling reaction for the modification of Dbzg derivatives 17d, 19d, 22. Using this 'Building Block Approach' (Accounts of Chemical Research 36, 2003, 342) one can generate a variety of Dbzg derivatives 20a-f and 23a-e, which may find useful applications in combinatorial synthesis and QSAR studies.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology-Bombay, Powai, Mumbai 400076, India.
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15
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Poddar P, Wilson JL, Srikanth H, Yoo JH, Wereley NM, Kotha S, Barghouty L, Radhakrishnan R. Nanocomposite magneto-rheological fluids with uniformly dispersed Fe nanoparticles. J Nanosci Nanotechnol 2004; 4:192-196. [PMID: 15112566 DOI: 10.1166/jnn.2004.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A systematic study of the magnetic and rheological properties of magneto-rheological (MR) fluids containing micron-size and nano-size iron particles is presented. The MR fluids were prepared with hydraulic oil as the carrier liquid and lecithin as an effective surfactant medium that promotes uniform particle dispersion. Magnetic measurements on micron-, hybrid-(nano + micron), and nano-MR fluids clearly indicate that the partial replacement of the micro-size particles by nanoparticles results in a better suspension and robust chain formation under applied external magnetic fields. For nano-MR fluids, the measured yield stress was found to be lower than micron-MR fluids. However, better flow properties and sharper magnetic switching make nanoparticle-based MR fluids appealing for microfluidics device applications where higher yield stress is not required.
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Affiliation(s)
- P Poddar
- Materials Physics Laboratory, Department of Physics, University of South Florida, Tampa, Florida 33620, USA
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16
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Abstract
For the first time, we have modified phenylalanine peptides by the Suzuki-Miyaura coupling reaction which may be useful in developing combinatorial libraries of peptidomimetics.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology-Bombay, Powai, Mumbai 400 076, India.
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17
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Abstract
A useful synthon to approach artificial phenylalanyl peptides in a [2 + 2 + 2] cycloaddition reaction, C(alpha,alpha)-dipropargylglycine (Dprg) is examined for its conformational preferences as a constrained residue. Crystal structure analysis and preliminary NMR results establish possible preference of the residue for folded (alpha) rather than extended (beta) region of the straight phi,psi conformational space. Boc-Dprg-L-Leu-OMe (1) displays two molecular conformations within the same crystallographic asymmetric unit, with Dprg in the alpha(R) or alpha(L) conformation, participating in a type I beta-turn or an alpha(L)-alpha(R)-type fold, in which Leu(2) assumes the alpha(R) conformation stereochemically favored for an L-chiral residue. Boc-Dprg-D-Val-L-Leu-OMe (2) displays a type I' beta-turn conformation in crystal, with both Dprg(1) and D-Val(2) assuming the alpha(L) conformation stereochemically favored for a D-chiral residue, with 4 --> 1 type hydrogen bond linking L-Leu(3) NH with Boc CO. NMR analysis using temperature variation, solvent titration, and a spin probe study suggests a fully solvent-exposed nature of Dprg NH, ruling out a fully extended C(5)-type conformation for this residue, and solvent sequestered nature of L-Leu(3) NH, suggesting possibility of a beta-turn due to Dprg assuming a folded conformation.
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Affiliation(s)
- L Damodharan
- Department of Crystallography and Biophysics, University of Madras, Chennai-600 025, India
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18
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Abstract
Ring-closing metathesis (RCM) with alpha,alpha-diallylglycyl peptides is shown to furnish alpha,alpha-cyclopentenylglycyl peptides as conformationally restrained analogues in the form of post-translational type peptide modification suitable for both peptidomimetic and combinatorial chemistry applications.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology-Bombay, 400 076, Mumbai, India.
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19
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Foulger SH, Kotha S, Sweryda-Krawiec B, Baughman TW, Ballato JM, Jiang P, Smith DW. Robust polymer colloidal crystal photonic bandgap structures. Opt Lett 2000; 25:1300-1302. [PMID: 18066199 DOI: 10.1364/ol.25.001300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
New polymeric matrices are presented that embed organic colloidal crystalline arrays (CCA's) into mechanically stable photonic bandgap structures. We achieved these new matrices either by dispersing polystyrene CCA's with high molecular weight hydrophilic polymer [poly(ethylene glycol); (PEG)] or through in situ polymerization of hydrophilic monomers (acrylamide and acrylate functional PEG variants) about the CCA. CCA-dispersed PEG matrices exhibited strong red opalescence with a narrow peak at 614 nm and were sufficiently rigid to withstand repeated mechanical deformation. Visible photonic bandgaps also were observed from free-standing CCA composites with cross-linked poly(N, N-dimethylacrylamide) matrices. The results demonstrate the technological potential for robust organic photonic crystals.
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20
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Abstract
Tetralin-based constrained alpha-amino acid derivatives were prepared via [4 + 2]-cycloaddition reaction as a key step. Here sultine is used as a latent diene and 2-acetamidoacrylate serves as a dienophile component.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology-Bombay, Mumbai.
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21
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Kotha S, Sreenivasachary N. A new synthetic approach to 1,2,3,4-tetrahydroisoquinoline-3-carboxylic acid (Tic) derivatives via a [2 + 2 + 2] cycloaddition reaction. Bioorg Med Chem Lett 2000; 10:1413-5. [PMID: 10888321 DOI: 10.1016/s0960-894x(00)00259-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Tetrahydroisoquinoline-3-carboxylic acid derivatives are prepared via a [2 + 2 + 2] cycloaddition reaction as a key step using Wilkinson's and CpCo(CO)2 catalysts.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology-Bombay, Mumbai, India.
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22
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Abstract
Conformationally constrained cyclic alpha-amino acid derivatives were synthesized under solid-liquid phase-transfer catalysis conditions. This methodology involves the bis-alkylation of ethyl isocyanoacetate with various alpha,alpha'-dibromo-o-xylene derivatives [alpha,alpha'-dibromo-o-xylene 5, 2,3-bis(bromomethyl)-1, 4-dimethoxybenzene 6, 1,2-bis(bromomethyl)-4,5-dibromobenzene 7, 2, 3-bis(bromomethyl)naphthalene 8, 1,8-bis(bromomethyl)-naphthalene 9, 6,7-bis(bromomethyl)-2,2-dimethyl-1H-phenalene-1,3(2H)-dione 10, 2, 3-bis(bromomethyl)-1,4-anthraquinone 11, 6, 7-bis(bromomethyl)quinoxaline 12, 3,4-bis(bromomethyl)furan 13, 1,2, 4,5-tetrakis(bromomethyl)benzene 28, and hexakis(bromomethyl)benzene 30] using potassium carbonate as a base and tetrabutylammonium hydrogensulfate as a phase-transfer catalyst to give corresponding isonitrile derivatives, which upon hydrolysis with HCl in ethanol gave amino esters. Using this method electron-deficient as well as electron-rich and halogen-substituted indan-based alpha-amino acids were prepared. The preparation of bis-indan as well as tris-indan alpha-amino esters is also described.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology, Powai, Mumbai 400 076, India
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23
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Kotha S, Screenivasachary N, Halder S. First synthesis of optically active benzocyclobutene and biphenylene-based unusual alpha-amino acid derivatives. Bioorg Med Chem Lett 1999; 9:2565-8. [PMID: 10498209 DOI: 10.1016/s0960-894x(99)00437-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Various optically pure benzocyclobutene and biphenylene-based alpha-amino acid derivatives are prepared in a very high diastereoselective manner via a six step sequence using Schöllkopfchiral auxiliary.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology, Mumbai
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24
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Abstract
Five and seven membered constrained alpha-amino acid derivatives were synthesized using ring-closing metathesis reaction as a key step.
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Affiliation(s)
- S Kotha
- Department of Chemistry, Indian Institute of Technology, Powai, Mumbai, India
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25
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Hu H, Kotha S, Brennan T. The role of nutrition in mitigating environmental insults: policy and ethical issues. Environ Health Perspect 1995; 103 Suppl 6:185-190. [PMID: 8549471 PMCID: PMC1518915 DOI: 10.1289/ehp.95103s6185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- H Hu
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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