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Pouhin A, Coscas R, Crespy V, Poupardin O, Pais-De-Barros JP, Bouchot O, Bernard A, Steinmetz E. Comparative Evaluation of Two Paclitaxel-Coated Stents in an Experimental Setting. J Endovasc Ther 2023:15266028231198033. [PMID: 37727972 DOI: 10.1177/15266028231198033] [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] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Unlike paclitaxel-coated balloons, pre-clinical data comparing different paclitaxel-coated stents (PCSs) are weak. The study objective was to compare the features of the 2 main PCSs: Eluvia® (Boston Scientific, Marlborough, MA) versus ZilverPTX® (Cook Medical, Bloomington, IN). METHOD Analysis was carried out on 12 pigs divided into 2 groups: Eluvia® (n=6) and ZilverPTX® (n=6). The pigs received the PCS corresponding to their group in each external iliac artery and were paired one by one, to examine 6 different post-implantation timepoints: after 30 minutes, 6 hours, 24 hours, 3 days, 7 days, and 14 days. The paclitaxel concentration measurements and the histological analysis were carried out under blind testing on the plasma, arterial, lymph node, and muscle samples. A linear regression model and Wilcoxon Mann-Whitney test were used to study the variables. RESULTS The plasma paclitaxel rate decrease over 24 hours after PCS implantation was significantly different between the two groups, expressed by the correlation coefficient 0.19 (0.14-0.23; p<0.001) with an undetectable concentration at the 10th hour for Eluvia® versus 3 days for ZilverPTX®. Significantly higher paclitaxel concentrations with ZilverPTX® PCS were observed in muscle samples at each timepoint: extensor digitorum brevis 3.2 (1.17-5.23; p=0.005), biceps femoris 4.27 (2.27-6.26; p<0.001), semi-tendinosus 3.79 (1.85-5.73; p=0.001), tibialis anterior 3.0 (1.37-4.64; p=0.001), and in the femoral nodes 2.27±1.74 ng/g versus 0.14±0.13 ng/g (p<0.001). Histological analysis revealed a trend for more marked intimal inflammation in the arteries stented with ZilverPTX® (p=0.063), especially after the 7th and 14th days. CONCLUSION Such a difference in the concentration of paclitaxel in the plasma, muscles, and lymph nodes between the two stents was higher than expected based on differences in device design. The clinical consequences of these results remain to be elucidated, particularly regarding the concerning presence of paclitaxel in muscles and adjacent lymph nodes. CLINICAL IMPACT This experimental study compares 2 paclitaxel-coated stents. It demonstrates that differences in stent designs and drug features (coatings and concentrations) translate into differences in terms of concentrations of paclitaxel in the plasma, muscles, and lymph nodes. Our results favor the Eluvia® stent over the ZilverPTX® stent, although more studies are required to confirm this conclusion.
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Affiliation(s)
- Alexandre Pouhin
- Department of Vascular Surgery, Dijon University Hospital, Dijon, France
| | - Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France
- UMR 1018, Inserm-Paris11-CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paris, France
| | - Valentin Crespy
- Department of Vascular Surgery, Dijon University Hospital, Dijon, France
| | - Olivia Poupardin
- Research Society, Farming Division, Auxois-Sud, Biossan, Créancey, France
| | | | - Olivier Bouchot
- Department of Cardiac Surgery, Dijon University Hospital, Dijon, France
| | - Alain Bernard
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Eric Steinmetz
- Department of Vascular Surgery, Dijon University Hospital, Dijon, France
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Ménégaut L, Laubriet A, Crespy V, Leleu D, Pilot T, Van Dongen K, de Barros JPP, Gautier T, Petit JM, Thomas C, Nguyen M, Steinmetz E, Masson D. Inflammation and oxidative stress markers in type 2 diabetes patients with Advanced Carotid atherosclerosis. Cardiovasc Diabetol 2023; 22:248. [PMID: 37710315 PMCID: PMC10503074 DOI: 10.1186/s12933-023-01979-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major global health issue and a significant risk factor for atherosclerosis. Atherosclerosis in T2DM patients has been associated with inflammation, insulin resistance, hyperglycemia, dyslipidemia, and oxidative stress. Identifying molecular features of atherosclerotic plaques in T2DM patients could provide valuable insights into the pathogenesis of the disease. METHODS The MASCADI (Arachidonic Acid Metabolism in Carotid Stenosis Plaque in Diabetic Patients) study aimed to investigate the increase of 2-arachidonoyl-lysophatidylcholine (2-AA-LPC) in carotid plaques from T2DM and control patients and to explore its association with plaque vulnerability as well as with blood and intra-plaque biomarkers altered during diabetes. RESULTS In a population of elderly, polymedicated patients with advanced stage of atherosclerosis, we found that T2DM patients had higher systemic inflammation markers, such as high-sensitivity C-reactive protein (hsCRP) and IL-1β, higher levels of oxysterols, increased triglyceride levels, and decreased HDL levels as compared to control patients. Furthermore, 2-AA-LPC was significantly enriched in plaques from diabetic patients, suggesting its potential role in diabetic atherosclerosis. Interestingly, 2-AA-LPC was not associated with systemic markers related to diabetes, such as hsCRP, triglycerides, or HDL cholesterol. However, it was significantly correlated with the levels of inflammatory markers within the plaques such as lysophospholipids and 25-hydroxycholesterol, strengthening the link between local inflammation, arachidonic acid metabolism and diabetes. CONCLUSION Our study is in line with a key role for inflammation in the pathogenesis of diabetic atherosclerosis and highlights the involvement of 2-AA-LPC. Further research is needed to better understand the local processes involved in the alteration of plaque composition in T2DM and to identify potential therapeutic targets. TRIAL REGISTRATION The MASCADI was registered on ClinicalTrials.gov (clinical registration number: NCT03202823).
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Affiliation(s)
- Louise Ménégaut
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
- CHU Dijon, Laboratory of Clinical Chemistry, Dijon, France
| | - Aline Laubriet
- Department of Cardiovascular and Thoracic Surgery, CHU Dijon, Dijon, France
| | - Valentin Crespy
- Department of Cardiovascular and Thoracic Surgery, CHU Dijon, Dijon, France
| | - Damien Leleu
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
- CHU Dijon, Laboratory of Clinical Chemistry, Dijon, France
| | - Thomas Pilot
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Kevin Van Dongen
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Jean-Paul Pais de Barros
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
- Lipidomic Analytic Platform, Université Bourgogne Franche-Comté, Dijon, France
| | - Thomas Gautier
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Jean-Michel Petit
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
- Department of Endocrinology and metabolic diseases, CHU Dijon, Dijon, France
| | - Charles Thomas
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Maxime Nguyen
- Université Bourgogne, LNC UMR1231, Dijon, France
- INSERM, UMR1231, Dijon, France
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
- CHU Dijon Department of Anesthesiology and Intensive Care, Dijon, France
| | - Eric Steinmetz
- Department of Cardiovascular and Thoracic Surgery, CHU Dijon, Dijon, France
| | - David Masson
- Université Bourgogne, LNC UMR1231, Dijon, France.
- INSERM, UMR1231, Dijon, France.
- Université Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France.
- CHU Dijon, Laboratory of Clinical Chemistry, Dijon, France.
- UFR des sciences de santé, Bvd Jeanne d'Arc, Dijon, 21000, France.
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Pinguet V, Duloquin G, Thibault T, Devilliers H, Comby PO, Crespy V, Ricolfi F, Vergely C, Giroud M, Béjot Y. Pre-existing brain damage and association between severity and prior cognitive impairment in ischemic stroke patients. J Neuroradiol 2023; 50:16-21. [PMID: 35289302 DOI: 10.1016/j.neurad.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/10/2022] [Accepted: 03/03/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND We evaluated whether pre-existing brain damage may explain greater severity in cognitively-impaired patients with ischemic stroke (IS). METHODS IS patients were retrieved from the population-based registry of Dijon, France. Pre-existing damage (leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy) was assessed on initial CT-scan. Association between prestroke cognitive status defined as no impairment, mild cognitive impairment (MCI), or dementia, and clinical severity at IS onset assessed with the NIHSS score was evaluated using ordinal regression analysis. Mediation analysis was performed to assess pre-existing brain lesions as mediators of the relationship between cognitive status and severity. RESULTS Among the 916 included patients (mean age 76.8 ± 15.0 years, 54.3% women), those with pre-existing MCI (n = 115, median NIHSS [IQR]: 6 [2-15]) or dementia (n = 147, median NIHSS: 6 [3-15]) had a greater severity than patients without (n = 654, median NIHSS: 3 [1-9]) in univariate analysis (OR=1.69; 95% CI: 1.18-2.42, p = 0.004, and OR=2.06; 95% CI: 1.49-2.84, p < 0.001, respectively). Old cortical lesion (OR=1.53, p = 0.002), central atrophy (OR=1.41, p = 0.005), cortical atrophy (OR=1.90, p < 0.001) and moderate (OR=1.41, p = 0.005) or severe (OR=1.84, p = 0.002) leukoaraiosis were also associated with greater severity. After adjustments, pre-existing MCI (OR=1.52; 95% CI: 1.03-2.26, p = 0.037) or dementia (OR=1.94; 95% CI: 1.32-2.86, p = 0.001) remained associated with higher severity at IS onset, independently of confounding factors including imaging variables. Association between cognitive impairment and severity was not mediated by pre-existing visible brain damages. CONCLUSION Impaired brain ischemic tolerance in IS patients with prior cognitive impairment could involve other mechanisms than pre-existing visible brain damage.
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Affiliation(s)
- Valentin Pinguet
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France; Department of Neuroimaging, University Hospital of Dijon, France
| | - Gauthier Duloquin
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France; Department of Neurology, University Hospital of Dijon, France
| | - Thomas Thibault
- INSERM CIC-1432 Clinical Investigation Center, Clinical Epidemiology, University Hospital of Dijon, France; Internal Medicine and Systemic Diseases unit, University Hospital of Dijon, France
| | - Hervé Devilliers
- INSERM CIC-1432 Clinical Investigation Center, Clinical Epidemiology, University Hospital of Dijon, France; Internal Medicine and Systemic Diseases unit, University Hospital of Dijon, France
| | - Pierre-Olivier Comby
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France; Department of Neuroimaging, University Hospital of Dijon, France
| | - Valentin Crespy
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France; Department of Vascular Surgery, University Hospital of Dijon, France
| | - Frédéric Ricolfi
- Department of Neuroimaging, University Hospital of Dijon, France
| | - Catherine Vergely
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France
| | - Maurice Giroud
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France; Department of Neurology, University Hospital of Dijon, France
| | - Yannick Béjot
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France; Department of Neurology, University Hospital of Dijon, France.
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Ménégaut L, Laubriet A, Crespy V, Nguyen M, Petit JM, Tarris G, Pilot T, Varin A, Choubley H, Bergas V, de Barros JPP, Thomas C, Steinmetz E, Masson D. Profiling of lipid mediators in atherosclerotic carotid plaques from type 2 diabetic and non-diabetic patients. Prostaglandins Leukot Essent Fatty Acids 2022; 184:102477. [PMID: 35952424 DOI: 10.1016/j.plefa.2022.102477] [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: 12/24/2021] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Diabetes is associated with an accelerated development of atherosclerosis. Specific mechanisms related to diabetes and hyperglycemia may play a role in this process. In particular, alterations of arachidonic acid (AA) metabolism have been reported. Our main goal was to investigate for differences in the concentration of LTB4 and RvD1 as well as selected cyclooxygenase-derived mediators in carotid plaques from diabetic and non-diabetic patients. We also aimed to analyze the relationship between omega 6 and omega 3 Poly-Unsaturated Fatty acids (PUFAs) content in the plaques and the concentrations of these lipid mediators. METHODS 29 type 2 diabetic patients and 30 control patients admitted for surgical treatment of carotid stenosis were enrolled in the present study. Carotid plaques were harvested for in-depth lipidomic profiling. RESULTS No differences for LTB4 or other lipid mediators were observed between diabetic and non-diabetic patients. RvD1 levels were below the threshold of quantification in most of the samples. A significant correlation was found between LTB4 and 5(S)-HETE levels. Omega 3 enrichment was not significantly different between control and diabetic plaques. There was a negative correlation between DHA/AA ratio and the level of 5(S)-HETE while there was a positive association with TXB2 and PGD2 concentrations. CONCLUSION-PERSPECTIVES Our results does not support the hypothesis of a specific involvement of LTB4 or COX-derived mediators in diabetic atherosclerosis. The relationship between DHA enrichment and the concentrations of specific inflammatory mediators within the plaque is of interest and will need to be confirmed in larger studies.
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Affiliation(s)
- Louise Ménégaut
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France; CHU Dijon, Laboratory of Clinical Chemistry, Dijon, France
| | - Aline Laubriet
- CHU Dijon, Department of Cardiovascular Surgery, Dijon, France
| | - Valentin Crespy
- CHU Dijon, Department of Cardiovascular Surgery, Dijon, France
| | - Maxime Nguyen
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France; CHU Dijon Department of Anesthesiology and Intensive Care, Dijon, France
| | - Jean-Michel Petit
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France; CHU Dijon, Department of Endocrinology and metabolic diseases, Dijon, France
| | | | - Thomas Pilot
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Alexis Varin
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France; Lipidomic Analytic Platform, Université Bourgogne Franche-Comté, Dijon, France
| | - Hélène Choubley
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France; Lipidomic Analytic Platform, Université Bourgogne Franche-Comté, Dijon, France
| | - Victoria Bergas
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France; Lipidomic Analytic Platform, Université Bourgogne Franche-Comté, Dijon, France
| | - Jean-Paul Pais de Barros
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France; Lipidomic Analytic Platform, Université Bourgogne Franche-Comté, Dijon, France
| | - Charles Thomas
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Eric Steinmetz
- CHU Dijon, Department of Cardiovascular Surgery, Dijon, France
| | - David Masson
- Université Bourgogne Franche-Comté, LNC UMR1231, Dijon, France; INSERM, UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France; CHU Dijon, Laboratory of Clinical Chemistry, Dijon, France.
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Duloquin G, Crespy V, Jakubina P, Giroud M, Vergely C, Béjot Y. Large Vessel Occlusion in Patients With Minor Ischemic Stroke in a Population-Based Study. The Dijon Stroke Registry. Front Neurol 2022; 12:796046. [PMID: 35095739 PMCID: PMC8795366 DOI: 10.3389/fneur.2021.796046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Strategy for the acute management of minor ischemic stroke (IS) with large vessel occlusion (LVO) is under debate, especially the benefits of mechanical thrombectomy. The frequency of minor IS with LVO among overall patients is not well established. This study aimed to assess the proportion of minor IS and to depict characteristics of patients according to the presence of LVO in a comprehensive population-based setting. Methods: Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). All arterial imaging exams were reviewed to assess arterial occlusion. Minor stroke was defined as that with a National Institutes of Health Stroke Scale (NIHSS) score of <6. Proportion of patients with LVO was estimated in the minor IS population. The clinical presentation of patients was compared according to the presence of an LVO. Results: Nine hundred seventy-one patients were registered, including 582 (59.9%) patients with a minor IS. Of these patients, 23 (4.0%) had a LVO. Patients with minor IS and LVO had more severe presentation [median 3 (IQR 2–5) vs. 2 (IQR 1–3), p = 0.001] with decreased consciousness (13.0 vs. 1.6%, p<0.001) and cortical signs (56.5 vs. 30.8%, p = 0.009), especially aphasia (34.8 vs. 15.4%, p = 0.013) and altered item level of consciousness (LOC) questions (26.1 vs. 11.6%, p = 0.037). In multivariable analyses, only NIHSS score (OR = 1.45 per point; 95% CI: 1.11–1.91, p = 0.007) was associated with proximal LVO in patients with minor IS. Conclusion: Large vessel occlusion (LVO) in minor stroke is non-exceptional, and our findings highlight the need for emergency arterial imaging in any patients suspected of acute stroke, including those with minor symptoms because of the absence of obvious predictors of proximal LVO.
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Nasr B, Crespy V, Penasse E, Gaudry M, Rosset E, Feugier P, Gouëffic Y, Maurel B, Hostalrich A, Alric P, Sadaghianloo N, Settembre N, Chevallier J, Ben Ahmed S, Gouny P, Steinmetz E. Late Outcomes of Carotid Artery Stenting for Radiation Therapy-Induced Carotid Stenosis. J Endovasc Ther 2022; 29:921-928. [PMID: 35012391 DOI: 10.1177/15266028211068757] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Carotid artery stenting (CAS) appears as a promising alternative treatment to carotid endarterectomy for radiation therapy (RT)-induced carotid stenosis. However, this is based on a poor level of evidence studies (small sample size, primarily single institution reports, few long-term data). The purpose of this study was to report the long-term outcomes of a multicentric series of CAS for RT-induced stenosis. METHODS All CAS for RT-induced stenosis performed in 11 French academic institutions from 2005 to 2017 were collected in this retrospective study. Patient demographics, clinical risk factors, elapsed time from RT, clinical presentation and imaging parameters of carotid stenosis were preoperatively gathered. Long-term outcomes were determined by clinical follow-up and duplex ultrasound. The primary endpoint was the occurrence of cerebrovascular events during follow-up. Secondary endpoints included perioperative morbidity and mortality rate, long-term mortality rate, primary patency, and target lesion revascularization. RESULTS One hundred and twenty-one CAS procedures were performed in 112 patients. The mean interval between irradiation and CAS was 15 ± 12 years. In 31.4% of cases, the lesion was symptomatic. Mean follow-up was 42.5 ± 32.6 months (range 1-141 months). The mortality rate at 5 years was 23%. The neurologic event-free survival and the in-stent restenosis rates at 5 years were 87.8% and 38.9%, respectively. Diabetes mellitus (p=0.02) and single postoperative antiplatelet therapy (p=0.001) were found to be significant predictors of in-stent restenosis. Freedom from target lesion revascularization was 91.9% at 5 years. CONCLUSION This study showed that CAS is an effective option for RT-induced stenosis in patients not favorable to carotid endarterectomy. The CAS was associated with a low rate of neurological events and reinterventions at long-term follow-up.
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Affiliation(s)
- Bahaa Nasr
- CHU Brest, Hôpital Cavale Blanche, Brest, France
| | | | | | | | - Eugenio Rosset
- CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Yann Gouëffic
- Centre Casculaire, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | - Pierre Alric
- CHU Montpellier, Hôpital Lapeyronie, Montpellier, France
| | | | | | | | | | - Pierre Gouny
- CHU Brest, Hôpital Cavale Blanche, Brest, France
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Baudry A, Mariet AS, Benzenine E, Crespy V, Bernard C, Morgant MC, Bejot Y, Giroud M, Bouchot O, Steinmetz E, Quantin C. Cardiovascular Surgical Emergencies in France, before, during and after the First Lockdown for COVID-19 in 2020: A Comparative Nationwide Retrospective Cohort Study. Life (Basel) 2021; 11:life11111245. [PMID: 34833121 PMCID: PMC8620591 DOI: 10.3390/life11111245] [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: 10/07/2021] [Revised: 11/02/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There are still gaps regarding the impact of the nationwide lockdown on non-COVID-19 emergency hospitalizations. This study aims to describe the trends in hospitalizations for cardiovascular surgical emergencies in France, before, during and after the first lockdown. Materials and Methods: All adults admitted for mechanical complications of myocardial infarction (MI), aortic dissection, aortic aneurysm rupture, acute and critical limb ischemia, circulatory assistance, heart transplantation and major amputation were included. This retrospective cohort study used the French National Hospital Discharge database. The numbers of hospitalizations per month in 2020 were compared to the previous three years. Results: From January to September 2020, 94,408 cases of the studied conditions were reported versus 103,126 in the same period in 2019 (−8.5%). There was a deep drop in most conditions during the lockdown, except for circulatory assistance, which increased. After the lockdown, mechanical complications of MI and aortic aneurysm rupture increased, and cardiac transplantations declined compared with previous years. Conclusion: We confirmed a deep drop in most cardiovascular surgical emergencies during the lockdown. The post-lockdown period was characterized by a small over-recovery for mechanical complications of MI and aortic aneurysm rupture, suggesting that many patients were able to access surgery after the lockdown.
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Affiliation(s)
- Anna Baudry
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Anne-Sophie Mariet
- Biostatistics and Bioinformatics (DIM), University Hospital of Dijon, 21000 Dijon, France; (A.-S.M.); (E.B.)
- CIC1432, University Hospital of Dijon, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, 21000 Dijon, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital of Dijon, 21000 Dijon, France; (A.-S.M.); (E.B.)
| | - Valentin Crespy
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Chloé Bernard
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Marie-Catherine Morgant
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Yannick Bejot
- Neurology Department, University Hospital of Dijon, 21000 Dijon, France; (Y.B.); (M.G.)
- Dijon Stroke Registry (Santé Publique France–Inserm)-EA 7460 (Pathophysiology and Epidemiology of Cerebro-CardioVascular Diseases), University of Burgundy, UFBC, 21000 Dijon, France
| | - Maurice Giroud
- Neurology Department, University Hospital of Dijon, 21000 Dijon, France; (Y.B.); (M.G.)
- Dijon Stroke Registry (Santé Publique France–Inserm)-EA 7460 (Pathophysiology and Epidemiology of Cerebro-CardioVascular Diseases), University of Burgundy, UFBC, 21000 Dijon, France
| | - Olivier Bouchot
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Eric Steinmetz
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital of Dijon, 21000 Dijon, France; (A.-S.M.); (E.B.)
- CIC1432, University Hospital of Dijon, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, 21000 Dijon, France
- Université Paris-Saclay, UVSQ, University of Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, 94800 Villejuif, France
- Correspondence: ; Tel.: +33-38029-3629; Fax: +33-38029-3973
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8
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Mechtouff L, Rascle L, Crespy V, Canet-Soulas E, Nighoghossian N, Millon A. A narrative review of the pathophysiology of ischemic stroke in carotid plaques: a distinction versus a compromise between hemodynamic and embolic mechanism. Ann Transl Med 2021; 9:1208. [PMID: 34430649 PMCID: PMC8350662 DOI: 10.21037/atm-20-7490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/31/2021] [Indexed: 12/13/2022]
Abstract
Atherosclerotic carotid artery stenosis causes about 10–20% of all ischemic strokes through two main mechanisms: hemodynamic impairment in case of significant stenosis and thromboembolism from an atherosclerotic plaque regardless of the degree of stenosis. The latter is the most frequent mechanism and appear to result from embolization from a vulnerable atherosclerotic plaque or acute occlusion of the carotid artery and propagation of thrombus distally. Downstream infarcts may occur in a territory of major cerebral artery or at the most distal areas between two territories of major cerebral arteries, the so-called watershed (WS), or border zone area. Although WS infarcts, especially deep WS infarct, were historically thought to be due to hemodynamic compromise, the role of microembolism has also been documented, both mechanisms may act synergistically to promote WS infarcts. Routine and more advanced imaging techniques may provide information on the underlying mechanism involved in ipsilateral ischemic stroke. A better understanding of ischemic stroke pathogenesis in carotid stenosis may limit the use of routine non-selective shunt, whose benefit-risk balance is debated, to patients with hemodynamic impairment. After reviewing existing evidence underpinning the contribution of the two mechanisms in downstream ischemic stroke and the various imaging techniques available to investigate them, we will focus on the pathogenesis of WS infarcts that remains debated.
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Affiliation(s)
- Laura Mechtouff
- Stroke Center, Hospices Civils de Lyon, Lyon, France.,INSERM U1060, CarMeN Laboratory, University Claude Bernard Lyon 1, Lyon, France
| | - Lucie Rascle
- Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Valentin Crespy
- Vascular Surgery Department, Hospices Civils de Lyon, Lyon, France
| | | | - Norbert Nighoghossian
- Stroke Center, Hospices Civils de Lyon, Lyon, France.,INSERM U1060, CarMeN Laboratory, University Claude Bernard Lyon 1, Lyon, France
| | - Antoine Millon
- Vascular Surgery Department, Hospices Civils de Lyon, Lyon, France.,LIBM EA7424, Team Atherosclerosis, Thrombosis and Physical Activity, University Claude Bernard Lyon 1, Lyon, France
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9
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Thomas Q, Crespy V, Duloquin G, Ndiaye M, Sauvant M, Béjot Y, Giroud M. Stroke in women: When gender matters. Rev Neurol (Paris) 2021; 177:881-889. [PMID: 34172293 DOI: 10.1016/j.neurol.2021.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022]
Abstract
Stroke in women may be considered as a distinct entity due to numerous differences compared with men, including specific epidemiological, etiological, and outcome features along with unique pathophysiological mechanisms. Stroke is the second cause of death in women worldwide with sex-specific causes of stroke in youger women such as pregnancy, post-partum period, oral contraception and migraine. Substitutive hormone treatment in older women is no more recommended in regard of the increased thromboembolic risk it generates. Venous thrombolysis with rtPA and mechanical thrombectomy are now proven to be as efficacious in women as in men. After a stroke, women present poorer quality of life than men attributable to age, more severe stroke, pre-stroke dependency and depression. Recent data concerning the latest epidemiological surveys reveal a shift in trends with the rise of incidence of strokes in young women (≤55 years and 64 years) contrasting with the stability of incidence rates in older women. As science is unvealing sex-related differences in cardiovascular disorders, health policies need to be adapted accordingly to improve stroke prevention and pre-stroke health in women. In the meantime, therapeutical trials should include more women in order to be able to formulate adequate management.
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Affiliation(s)
- Q Thomas
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France.
| | - V Crespy
- Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - G Duloquin
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - M Ndiaye
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France
| | - M Sauvant
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France
| | - Y Béjot
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - M Giroud
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
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10
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Ménégaut L, Jalil A, Pilot T, van Dongen K, Crespy V, Steinmetz E, Pais de Barros JP, Geissler A, Le Goff W, Venteclef N, Lagrost L, Gautier T, Thomas C, Masson D. Regulation of glycolytic genes in human macrophages by oxysterols: a potential role for liver X receptors. Br J Pharmacol 2021; 178:3124-3139. [PMID: 33377180 DOI: 10.1111/bph.15358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Subset of macrophages within the atheroma plaque displays a high glucose uptake activity. Nevertheless, the molecular mechanisms and the pathophysiological significance of this high glucose need remain unclear. While the role for hypoxia and hypoxia inducible factor 1α has been demonstrated, the contribution of lipid micro-environment and more specifically oxysterols is yet to be explored. EXPERIMENTAL APPROACH Human macrophages were conditioned in the presence of homogenates from human carotid plaques, and expression of genes involved in glucose metabolism was quantified. Correlative analyses between gene expression and the oxysterol composition of plaques were performed. KEY RESULTS Conditioning of human macrophages by plaque homogenates induces expression of several genes involved in glucose uptake and glycolysis including glucose transporter 1 (SLC2A1) and hexokinases 2 and 3 (HK2 and HK3). This activation is significantly correlated to the oxysterol content of the plaque samples and is associated with a significant increase in the glycolytic activity of the cells. Pharmacological inverse agonist of the oxysterol receptor liver X receptor (LXR) partially reverses the induction of glycolysis genes without affecting macrophage glycolytic activity. Chromatin immunoprecipitation analysis confirms the implication of LXR in the regulation of SLC2A1 and HK2 genes. CONCLUSION AND IMPLICATIONS While our work supports the role of oxysterols and the LXR in the modulation of macrophage metabolism in atheroma plaques, it also highlights some LXR-independent effects of plaques samples. Finally, this study identifies hexokinase 3 as a promising target in the context of atherosclerosis. LINKED ARTICLES This article is part of a themed issue on Oxysterols, Lifelong Health and Therapeutics. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.16/issuetoc.
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Affiliation(s)
- Louise Ménégaut
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France.,Laboratory of Clinical Chemistry, CHU Dijon, Dijon, France
| | - Antoine Jalil
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Thomas Pilot
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Kevin van Dongen
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France.,Laboratory of Clinical Chemistry, CHU Dijon, Dijon, France
| | - Valentin Crespy
- Department of Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Eric Steinmetz
- Department of Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Jean Paul Pais de Barros
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,Lipidomic Analytic Platform, UBFC, Dijon, France
| | | | - Wilfried Le Goff
- Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), UMR_S1166, Hôpital de la Pitié, Paris, France
| | - Nicolas Venteclef
- Cordeliers Research Centre, INSERM, IMMEDIAB, Université de Paris, Université Paris, Paris, France
| | - Laurent Lagrost
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Thomas Gautier
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Charles Thomas
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - David Masson
- Univ. Bourgogne Franche-Comté, LNC UMR1231, Dijon, France.,INSERM, LNC UMR1231, Dijon, France.,FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France.,Laboratory of Clinical Chemistry, CHU Dijon, Dijon, France
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11
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Crespy V, Blitti C, Pouhin A, Favier C, Ghassani A, Penillon S, Steinmetz É. Advantages of the retroperitoneal pararectal in the ex situ surgery of renal arterial lesions. Ann Vasc Surg 2020. [DOI: 10.1016/j.avsg.2020.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Duloquin G, Graber M, Garnier L, Crespy V, Comby PO, Baptiste L, Mohr S, Delpont B, Guéniat J, Blanc-Labarre C, Hervieu-Bègue M, Osseby GV, Giroud M, Béjot Y. Incidence of Acute Ischemic Stroke With Visible Arterial Occlusion. Stroke 2020; 51:2122-2130. [DOI: 10.1161/strokeaha.120.029949] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Because of several methodological limitations, previous studies focusing on the prevalence of large vessel occlusion in ischemic stroke (IS) patients provided conflicting results. We evaluated the incidence of IS with a visible arterial occlusion using a comprehensive population-based registry.
Methods:
Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). All arterial imaging exams were reviewed to assess arterial occlusion. Annual incidence rates of IS (first-ever and recurrent events) and IS with a visible occlusion were calculated.
Results:
One thousand sixty cases of IS were recorded (mean age: 76.0±15.8 years, 53.9% women). Information about arterial imaging was available in 971 (91.6%) of them, and only preexisting dementia was independently associated with having missing information (odds ratio=0.34 [95% CI, 0.18–0.65],
P
=0.001). Among these patients, 284 (29.2%) had a visible arterial occlusion. Occlusion site was the anterior circulation in 226 patients (23.3% of overall patients with available data) and the posterior circulation in 58 patients (6.0%). A proximal occlusion of the anterior circulation was observed in 167 patients (17.2%). The crude annual incidence rate of total IS per 100 000 was 138 (95% CI, 129–146). Corresponding standardized rates were 66 (95% CI, 50–82) to the World Health Organization and 141 (95% CI, 118–164) to the 2013 European populations. The crude annual incidence rate of IS with a visible arterial occlusion per 100 000 was 37 (95% CI, 33–41) and that of IS with a proximal occlusion of the anterior circulation was 22 (95% CI, 18–25). Corresponding standardized rates were 18 (95% CI, 10–26) and 10 (95% CI, 8–13) to the World Health Organization population, and 38 (95% CI, 26–50) and 23 (95% CI, 19–26) to the 2013 European population, respectively.
Conclusions:
These results will be helpful to plan the need for thrombectomy-capable stroke center resources.
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Affiliation(s)
- Gauthier Duloquin
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Mathilde Graber
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Lucie Garnier
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Valentin Crespy
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Pierre-Olivier Comby
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Laura Baptiste
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Sophie Mohr
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Benoit Delpont
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Julien Guéniat
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Christelle Blanc-Labarre
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Marie Hervieu-Bègue
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Guy-Victor Osseby
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Maurice Giroud
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
| | - Yannick Béjot
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France
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13
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Béjot Y, Duloquin G, Crespy V, Durier J, Garnier L, Graber M, Giroud M. Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke. Stroke 2020; 51:1667-1673. [DOI: 10.1161/strokeaha.119.028845] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status.
Methods—
Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013–2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and severity was evaluated using ordinal regression analysis models in which the NIHSS score was considered as a categorical variable.
Results—
Among the 1048 patients (mean age, 76.3±15.2 years; 54.0% women), a greater severity was observed in those with MCI (n=132; median NIHSS: 6; interquartile range, 2–15), and those with dementia (n=164; median NIHSS: 7; interquartile range, 3–16), than in patients without cognitive impairment (n=752; median NIHSS: 3; interquartile range, 1–9). MCI (odds ratio [OR], 1.70 [95% CI, 1.21–2.38];
P
=0.002) and dementia (OR, 2.24 [95% CI, 1.65–3.04];
P
<0.001) were both associated with a greater severity at onset. The association was still observed after adjustment for clinical variables and proximal arterial occlusion (OR, 1.52 [95% CI, 1.02–2.28];
P
=0.04 for MCI; OR, 2.16 [95% CI, 1.45–3.22];
P
<0.001 dementia). Further adjustment for prestroke handicap slightly reduced the magnitude of the association (OR, 1.49 [95% CI, 0.98–2.25];
P
=0.06 for MCI, and OR, 1.98 [95% CI, 1.26–3.12];
P
=0.02 for dementia). The greater severity in patients with prestroke cognitive impairment was not specifically driven by a more severe impairment of either motor or language function.
Conclusions—
Patients with preexisting cognitive impairment suffered more severe ischemic stroke. This result could reflect a lower brain tolerance of acute ischemia. Further studies are needed to explore the underlying mechanisms that could be targeted from therapeutic perspectives focusing on neuroprotection.
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Affiliation(s)
- Yannick Béjot
- From the Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, France
| | - Gauthier Duloquin
- From the Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, France
| | - Valentin Crespy
- From the Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, France
| | - Jérôme Durier
- From the Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, France
| | - Lucie Garnier
- From the Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, France
| | - Mathilde Graber
- From the Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, France
| | - Maurice Giroud
- From the Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, France
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14
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Ménégaut L, Thomas C, Jalil A, Julla JB, Magnani C, Ceroi A, Basmaciyan L, Dumont A, Le Goff W, Mathew MJ, Rébé C, Dérangère V, Laubriet A, Crespy V, Pais de Barros JP, Steinmetz E, Venteclef N, Saas P, Lagrost L, Masson D. Interplay between Liver X Receptor and Hypoxia Inducible Factor 1α Potentiates Interleukin-1β Production in Human Macrophages. Cell Rep 2020; 31:107665. [DOI: 10.1016/j.celrep.2020.107665] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/09/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022] Open
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15
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Delpy JP, Blitti CM, Crespy V, Chretien N, Jaillant N, Kazandjian C, Steinmetz E. The Banana Technique in the Management of Complex Aorto-Iliac Aneuryms is Reliable in the Short and Long Run. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Delpy JP, Die-Loucou J, Crespy V, Blitti C, Favier C, Steinmetz E. IF08. Results of a New Retroperitoneal Approach for Abdominal Aortic Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.009] [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: 11/25/2022]
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17
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Crespy V, Salomon du Mont L, Kaladji A, Bartoli M, Gouëffic Y, Abello N, Magnan PE, Cardon A, Chaillou P, Steinmetz E. Endovascular Treatment of Asymptomatic Abdominal Aortic Aneurysms in Octogenarians: Factors Influencing Long-term Survival. Ann Vasc Surg 2017; 45:199-205. [PMID: 28651997 DOI: 10.1016/j.avsg.2017.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Beyond the age of 80 years, the preventive treatment of an asymptomatic abdominal aortic aneurysm (AAA) has to be decided in light of the life expectancy which it is difficult to evaluate, but it is important to determine who in this population will benefit from it. The objective of our study was to determine the factors influencing short-term mortality and long-term survival in patients aged 80 years and older after the endovascular treatment of AAAs (EVAR). MATERIAL AND METHODS We present a retrospective analysis of the prospective databases of 4 French academic departments of vascular surgery, bringing together the data of all the patients presenting an AAA who were treated by EVAR between 1998 and 2011. Logistic regression and multivariate analysis with a Cox survival model were used to determine the factors influencing perioperative and long-term mortality. The cumulative rate of events for the measurement of survival was calculated with the technique of Kaplan-Meier. RESULTS We treated 345 octogenarians and 339 younger patients. The average follow-up was 40 months. Average survival was 75% at 36 months and 49% at 60 months. There was no evidence of any risk factor influencing mortality at 30 days in the octogenarians. However, chronic kidney disease (odds ratio [OR] = 3.95, P <0.001) and chronic respiratory failure (OR = 2.62, P <0.001) proved to be independent factors of a poor long-term prognosis. CONCLUSIONS The treatment by stent graft in octogenarians is effective in the long term. The presence of an impaired renal function or respiratory failure in this population could put into question the operative indication.
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Affiliation(s)
- Valentin Crespy
- Service de chirurgie cardiovasculaire et thoracique, Cardiovascular and Thoracique Surgery Department, CHU Francois Mitterrand, Dijon, France.
| | - Lucie Salomon du Mont
- Service de chirurgie cardiovasculaire et thoracique, Cardiovascular and Thoracique Surgery Department, CHU Francois Mitterrand, Dijon, France
| | - Adrien Kaladji
- Unité de chirurgie vasculaire, Vascular Surgery Department, CHU Rennes, Rennes, France
| | - Michel Bartoli
- Service de chirurgie vasculaire, Vascular Surgery Department, Hôpital de la Timone, Marseille, France
| | - Yann Gouëffic
- Service de chirurgie vasculaire, Vascular Surgery Department, Institut du Thorax, CHU Nantes, Nantes, France
| | - Nicolas Abello
- Service de chirurgie cardiovasculaire et thoracique, Cardiovascular and Thoracique Surgery Department, CHU Francois Mitterrand, Dijon, France
| | - Pierre-Edouard Magnan
- Service de chirurgie vasculaire, Vascular Surgery Department, Hôpital de la Timone, Marseille, France
| | - Alain Cardon
- Unité de chirurgie vasculaire, Vascular Surgery Department, CHU Rennes, Rennes, France
| | - Philippe Chaillou
- Service de chirurgie vasculaire, Vascular Surgery Department, Institut du Thorax, CHU Nantes, Nantes, France
| | - Eric Steinmetz
- Service de chirurgie cardiovasculaire et thoracique, Cardiovascular and Thoracique Surgery Department, CHU Francois Mitterrand, Dijon, France
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Crespy V, Chevallier O, Dominguez J, Kazadjian C, Steinmetz E, Pottecher P, Loffroy R. Endovascular management of a giant symptomatic gluteal artery aneurysm with selective arterial embolization. Quant Imaging Med Surg 2017; 7:163-165. [PMID: 28275573 DOI: 10.21037/qims.2016.11.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Valentin Crespy
- Department of Vascular Surgery, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon Cedex, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon Cedex, France
| | - Joaquim Dominguez
- Department of Vascular Surgery, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon Cedex, France
| | - Caroline Kazadjian
- Department of Vascular Surgery, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon Cedex, France
| | - Eric Steinmetz
- Department of Vascular Surgery, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon Cedex, France
| | - Pierre Pottecher
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon Cedex, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon Cedex, France
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Salomon du Mont L, Mauny F, Chrétien N, Kazandjan C, Bourgeot C, Crespy V, Abello N, Rinckenbach S, Steinmetz E. Obesity is Not an Independent Factor for Adverse Outcome after Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2016; 33:67-74. [DOI: 10.1016/j.avsg.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/11/2015] [Accepted: 12/25/2015] [Indexed: 12/20/2022]
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Abello N, Chretien N, Bourgeot C, Crespy V, Favier C, Dominguez J, Steinmetz E. Medico-economic Analysis of the Treatment of Abdominal Aortic Aneurysms. Ann Vasc Surg 2015. [DOI: 10.1016/j.avsg.2015.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Neveu V, Perez-Jiménez J, Vos F, Crespy V, du Chaffaut L, Mennen L, Knox C, Eisner R, Cruz J, Wishart D, Scalbert A. Phenol-Explorer: an online comprehensive database on polyphenol contents in foods. Database (Oxford) 2010; 2010:bap024. [PMID: 20428313 PMCID: PMC2860900 DOI: 10.1093/database/bap024] [Citation(s) in RCA: 795] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 11/16/2009] [Accepted: 12/07/2009] [Indexed: 11/20/2022]
Abstract
A number of databases on the plant metabolome describe the chemistry and biosynthesis of plant chemicals. However, no such database is specifically focused on foods and more precisely on polyphenols, one of the major classes of phytochemicals. As antoxidants, polyphenols influence human health and may play a role in the prevention of a number of chronic diseases such as cardiovascular diseases, some cancers or type 2 diabetes. To determine polyphenol intake in populations and study their association with health, it is essential to have detailed information on their content in foods. However this information is not easily collected due to the variety of their chemical structures and the variability of their content in a given food. Phenol-Explorer is the first comprehensive web-based database on polyphenol content in foods. It contains more than 37 000 original data points collected from 638 scientific articles published in peer-reviewed journals. The quality of these data has been evaluated before they were aggregated to produce final representative mean content values for 502 polyphenols in 452 foods. The web interface allows making various queries on the aggregated data to identify foods containing a given polyphenol or polyphenols present in a given food. For each mean content value, it is possible to trace all original content values and their literature sources. Phenol-Explorer is a major step forward in the development of databases on food constituents and the food metabolome. It should help researchers to better understand the role of phytochemicals in the technical and nutritional quality of food, and food manufacturers to develop tailor-made healthy foods. Database URL: http://www.phenol-explorer.eu
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Affiliation(s)
- V Neveu
- UMR 1019 - Unité de Nutrition Humaine, INRA, Centre de Recherche de Clermont-Ferrand-Theix, 63122 Saint-Genès-Champanelle, France
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Abstract
Phloretin is a flavonoid found exclusively in apples and in apple-derived products where it is present as the glucosidic form, namely, phloridzin (phloretin 2'-O-glucose). In the present study, we compared the changes in plasma and urine concentrations of these two compounds in rats fed a single meal containing 0.25% phloridzin or 0.157% phloretin (corresponding to the ingestion of 22 mg of phloretin equivalents). In plasma, phloretin was recovered mainly as the conjugated forms (glucuronided and/or sulfated) but some unconjugated phloretin was also detected. By contrast, no trace of intact phloridzin was detected in plasma of rats fed a phloridzin meal. These compounds presented different kinetics of absorption; phloretin appeared more rapidly in plasma when rats were fed the aglycone than when fed the glucoside. However, whatever compound was administered, no significant difference in the plasma concentrations of total phloretin were observed 10 h after food intake. At 24 h after the beginning of the meal, the plasma concentrations of phloretin were almost back to the baseline, indicating that this compound was excreted rapidly in urine. The total urinary excretion rate of phloretin was not affected by the forms administered, and was estimated to be 8.5 micromol/24 h in rats fed phloretin or phloridzin. Thus, 10.4% of the ingested dose was recovered in urine after 24 h.
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Affiliation(s)
- V Crespy
- Laboratoire des Maladies Métaboliques et des Micronutriments, I.N.R.A. de Clermont-Ferrand/Theix, 63122 Saint Genès Champanelle, France.
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Crespy V, Morand C, Besson C, Manach C, Démigné C, Rémésy C. Comparison of the intestinal absorption of quercetin, phloretin and their glucosides in rats. J Nutr 2001; 131:2109-14. [PMID: 11481403 DOI: 10.1093/jn/131.8.2109] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Absorption and metabolism of quercetin and isoquercitrin (quercetin 3-O-glucose) were investigated in rats after in situ perfusion of jejunum plus ileum (15 nmol/min) for 30 min and compared with those of phloretin and phloridzin (phloretin 2'-O-glucose). After perfusion of the glucosides, the corresponding aglycone forms and conjugated derivatives appeared in the lumen. The conjugated metabolites were similar to those recovered after intestinal perfusion of the aglycone forms. Regardless of the aglycone or glucoside perfused, only conjugated forms were present in the mesenteric vein blood draining the perfused segment showing the importance of intestinal conjugation. The hydrolysis of glucosides was a prerequisite step before their conjugation by intestinal enzymes and their transport towards the mucosal and serosal sides. In contrast to phloridzin, lactase phloridzin hydrolase activity did not seem to be an essential pathway for isoquercitrin hydrolysis. The 3-O-glucosylation of quercetin improved the net absorption of the aglycone (P < 0.05), whereas phloretin absorption decreased when present as 2'-O-glucoside (P < 0.05). Whatever the perfused compound, the efficiency of the absorption seemed to be linked to the intestinal conjugation process and to the luminal secretion of metabolites.
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Affiliation(s)
- V Crespy
- Laboratoire des Maladies Métaboliques et des Micronutriments, Institut National de la Recherche Agronomique, de Clermont-Ferrand/Theix, 63122 Saint Genès Champanelle, France.
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Abstract
Flavan-3-ols are the most abundant flavonoids in the human diet, but little is known about their absorption and metabolism. In this study, the absorption and metabolism of the monomeric flavan-3-ol, catechin, was investigated after the in situ perfusion of the jejunum + ileum in rats. Five concentrations of catechin were studied, ranging from 1 to 100 micromol/L. The absorption of catechin was directly proportional to the concentration, and 35 +/- 2% of the perfused catechin was absorbed during the 30-min period. Effluent samples contained only native catechin, indicating that intestinal excretion of metabolites is not a mechanism of catechin elimination. Catechin was absorbed into intestinal cells and metabolized extensively because no native catechin could be detected in plasma from the mesenteric vein. Mesenteric plasma contained glucuronide conjugates of catechin and 3'-O-methyl catechin (3'OMC), indicating the intestinal origin of these conjugates. Additional methylation and sulfation occurred in the liver, and glucuronide + sulfate conjugates of 3'OMC were excreted extensively in bile. Circulating forms were mainly glucuronide conjugates of catechin and 3'OMC. The data further demonstrate the role of the rat small intestine in the glucuronidation and methylation of flavonoids as well as the role of the liver in sulfation, methylation and biliary excretion.
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Affiliation(s)
- J L Donovan
- Laboratoire des Maladies Métaboliques et Micronutriments, INRA, 63122 Saint-Genès Champanelle, France
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Morand C, Manach C, Crespy V, Remesy C. Quercetin 3-O-beta-glucoside is better absorbed than other quercetin forms and is not present in rat plasma. Free Radic Res 2000; 33:667-76. [PMID: 11200097 DOI: 10.1080/10715760000301181] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [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: 10/24/2022]
Abstract
The effect of the nature of the sugar moiety on quercetin absorption has been investigated in rats. Four groups of rats received an experimental meal containing 20 mg of quercetin equivalents, supplied as quercetin, quercetin 3-O-beta-glucoside, quercetin 3-O-beta-rhamnoside or rutin. Four hours after the meal, the metabolites identified in hydrolysed plasma were identical in all groups (3'- and 4'-methylquercetin). However, the total concentration of metabolites was markedly different: 11.2+/-1.8, 2.5+/-2.0 and 33.2+/-3.5 microM for the quercetin, rutin, and quercetin 3-glucoside meals respectively. After quercetin 3-rhamnoside consumption, we failed to detect any metabolites in the plasma. These data suggest that the 3-O-glucosylation improves the absorption of quercetin in the small intestine, whereas the binding of a rhamnose to the aglycone markedly depresses it. Additional experiments have shown that the higher plasma levels measured after quercetin 3-glucoside meal compared to the quercetin meal were maintained throughout the 24-hour period following the meal. Using a multi-electrode coulometric detection, together with suitable chromatographic conditions, we were able to distinguish between the conjugated and the glycosylated forms. Thus, we clearly showed the absence of quercetin 3-O-beta-glucoside in the plasma from rats fed a diet containing this glucoside. This result suggests that quercetin 3-O-beta-glucoside is hydrolysed before or during its intestinal absorption.
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Affiliation(s)
- C Morand
- Unité des Maladies Métaboliques et des Micronutriments, INRA de Clermont-Ferrand/Theix, St Genès Champanelle, France.
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Abstract
Several studies suggest that polyphenols might exert a protective effect against osteopenia. The present experiment was conducted to observe the effects of rutin (quercetin-3-O-glucose rhamnose) on bone metabolism in ovariectomized (OVX) rats. Thirty 3-month-old Wistar rats were used. Twenty were OVX while the 10 controls were sham-operated (SH). Among the 20 OVX, for 90 days after surgery 10 were fed the same synthetic diet as the SH or OVX ones, but 0. 25% rutin (OVX + R) was added. At necropsy, the decrease in uterine weight was not different in OVX and OVX + R rats. Ovariectomy also induced a significant decrease in both total and distal metaphyseal femoral mineral density, which was prevented by rutin consumption. Moreover, femoral failure load, which was not different in OVX and SH rats, was even higher in OVX + R rats than in OVX or SH rats. In the same way, on day 90, both urinary deoxypyridinoline (DPD) excretion (a marker for bone resorption) and calciuria were higher in OVX rats than in OVX + R or SH rats. Simultaneously, plasma osteocalcin (OC) concentration (a marker for osteoblastic activity) was higher in OVX + R rats than in SH rats. High-performance liquid chromatography (HPLC) profiles of plasma samples from OVX + R rats revealed that mean plasma concentration of active metabolites (quercetin and isorhamnetin) from rutin was 9.46+/-1 microM, whereas it was undetectable in SH and OVX rats. These results indicate that rutin (and/or its metabolites), which appeared devoid of any uterotrophic activity, inhibits ovariectomy-induced trabecular bone loss in rats, both by slowing down resorption and increasing osteoblastic activity.
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Affiliation(s)
- M N Horcajada-Molteni
- Unité Maladies Métaboliques et Micronutriments, Institut National de la Recherche Agronomique, Clermont-Theix, France
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Abstract
A large number of flavonoids, mostly O-glycosides, are found in foods of plant origin. The bound sugar moiety is known to influence their bioavailability. We examined here the effect of the nature of the sugar on the absorption of the glycosides. Four groups of rats (n = 6) received a meal containing 20 mg of quercetin equivalents supplied as aglycone, quercetin 3-glucoside, quercetin 3-rhamnoside or rutin. Plasma were hydrolysed by a beta-glucuronidase/sulfatase and analyzed by HPLC coupled to UV detection at 370 nm. Four hours after the beginning of the meal, the quercetin metabolites present in plasma were identical in all groups but their total concentrations were quite different. With pure quercetin the circulating levels were 1.7 +/- 1.8 microM, but this level was three fold higher when quercetin was supplied as quercetin 3-glucoside (33.2 +/- 3.5 microM). By contrast, the plasma concentrations of quercetin metabolites was quite low with the rutin meal (about 3 microM) and undetectable after the quercetin 3-rhamnoside meal. These data suggest that the 3-O-glucosylation improves the absorption of quercetin in the small intestine, whereas the binding of a rhamnose or of a glucose-rhamnose moiety to the aglycone markedly depressed its absorption. Additionnal experiments have shown that the higher plasma levels measured after the meal containing quercetin 3-glucoside compared to quercetin were maintained throughout a 24 hour period following the meal. In conclusion, the nature of the glycosylation markedly influences the efficiency of quercetin absorption in rats. Quercetin 3-glucose can be absorbed in the small intestine and is better absorbed than quercetin itself. By contrast, glycosides containing a rhamnose moiety could not be absorbed in the small intestine.
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Affiliation(s)
- C Morand
- Unité des Maladies Métaboliques et des Micronutriments, INRA Theix, Ceyrat, France.
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Abstract
Quercetin and catechin are present in noticeable amounts in human diet and these polyphenolic compounds are supposed to exert beneficial effects on human health. However, their metabolic fates in the organism have never been compared. In the present study, rats were fed a 0.25% quercetin or a 0.25% catechin diet. Quercetin and catechin metabolites were analyzed in plasma and liver samples by high-performance liquid chromatography coupled to an ultraviolet or a multielectrode coulometric detection. All plasma metabolites were present as conjugated forms, but catechin metabolites were mainly constituted by glucuronidated derivatives, whereas quercetin metabolites were sulfo- and glucurono-sulfo conjugates. Quercetin was more intensively methylated than catechin in plasma. The plasma quercetin metabolites are well maintained during the postabsorptive period (approximately 50 microM), whereas the concentration of catechin metabolites dropped dramatically between 12- and 24-h after an experimental meal (from 38.0 to 4.5 microM). In the liver, the concentrations of quercetin and catechin derivatives were lower than in plasma, and no accumulation was observed when the rats were adapted for 14 d to the supplemented diets. The hepatic metabolites were intensively methylated (90-95%), but in contrast to plasma, some free aglycones could be detected. Thus, it clearly appears that studies dealing with the biological impact of these polyphenols should take into account the feature of their bioavailability, particularly the fact that their circulating metabolites are conjugated derivatives.
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Affiliation(s)
- C Manach
- Unité des Maladies Métaboliques et Micronutriments, I.N.R.A. de Clermont-Ferrand/Theix, St. Genès-Champanelle, France.
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Crespy V, Morand C, Manach C, Besson C, Demigne C, Remesy C. Part of quercetin absorbed in the small intestine is conjugated and further secreted in the intestinal lumen. Am J Physiol 1999; 277:G120-6. [PMID: 10409158 DOI: 10.1152/ajpgi.1999.277.1.g120] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Rutin and quercetin absorption and metabolism were investigated in rats after in situ perfusion of jejunum plus ileum (15 nmol/min). In contrast to rutin, a high proportion of quercetin (two-thirds) disappeared during perfusion, reflecting extensive transfer into the intestinal wall. Net quercetin absorption was not complete (2.1 nmol/min), inasmuch as 52% were reexcreted in the lumen as conjugated derivatives (7.7 nmol/min). Enterohepatic recycling contribution of flavonoids was excluded by catheterization of the biliary duct before perfusion. After a 30-min perfusion period, 0.71 microM of quercetin equivalents were detected in plasma, reflecting a significant absorption from the small intestine. The differential hydrolysis of effluent samples by glucuronidase and/or sulfatase indicates that the conjugated forms released in the lumen were 1) glucuronidated derivatives of quercetin and of its methoxylated forms (64%) and 2) sulfated form of quercetin (36%). In vitro quercetin glucuronides synthetized using jejunal and ileal microsomal fractions were similar to those recovered in the effluent of perfusion. These data suggest that glucuronidation and sulfatation take place in intestinal cells, whereas no glucurono-sulfoconjugates could be detected in the effluent. The present work shows that a rapid quercetin absorption in the small intestine is very effective together with its active conjugation in intestinal cells.
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Affiliation(s)
- V Crespy
- Laboratoire des Maladies Métaboliques et des Micronutriments, Institut National de la Recherche Agronomique de Clermont-Ferrand/Theix, 63122 Saint Genès Champanelle, France.
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Abstract
Quercetin is one of the most widely distributed flavonoids present in fruits and vegetables. The present experiments were performed on rats adapted for 3 wk to a semipurified diet supplemented with 0.2% quercetin. The major part of the circulating metabolites of quercetin (91.5%) are glucurono-sulfo conjugates of isorhamnetin (3'-O-methyl quercetin; 89.1 +/- 2.1 microM) and of quercetin (14.7 +/- 1.7 microM); the minor part (8.5%) is constituted by glucuronides of quercetin and its methoxylated forms (9.6 +/- 2.3 microM). Conjugated dienes formation, resulting from Cu2+-catalyzed oxidation of rat very low density lipoproteins + low density lipoproteins (LDL), was effectively inhibited in vitro by conjugated metabolites of quercetin. These metabolites appeared to be four times more potent than trolox in inhibiting LDL oxidation. Moreover, the plasma from rats adapted to a diet containing 0.2% quercetin exhibited a total antioxidant status markedly higher than that of control rats (+60%). This study shows that ubiquitous quercetin is conjugated in vivo, yielding metabolites that exhibit antioxidant properties. Thus the health benefits of flavonoids in foods can be due to the antioxidant properties of their metabolites.
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Affiliation(s)
- C Morand
- Laboratoire des Maladies Métaboliques et des Micronutriments, Institut National de la Recherche Agronomique de Clermont-Ferrand/Theix, 63122 Saint-Genès-Champanelle, France
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Manach C, Morand C, Crespy V, Demigné C, Texier O, Régérat F, Rémésy C. Quercetin is recovered in human plasma as conjugated derivatives which retain antioxidant properties. FEBS Lett 1998; 426:331-6. [PMID: 9600261 DOI: 10.1016/s0014-5793(98)00367-6] [Citation(s) in RCA: 441] [Impact Index Per Article: 17.0] [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: 02/07/2023]
Abstract
Quercetin is one of the most abundant flavonoids in the human diet. This study aimed to determine the plasma concentrations of quercetin in 10 healthy volunteers after the consumption of a complex meal rich in plant products. Quercetin was determined in plasma (2 h before, and 3, 7 and 20 h after the meal), and in a duplicated portion of the meal by HPLC analysis with an electrochemical detection. The amount of ingested quercetin was estimated to be 87 mg. Before the meal, quercetin concentration in hydrolyzed plasmas ranged from 28 to 142 nM. A marked increase was observed 3 h after the meal in all subjects, with a mean concentration of 373 nM (S.E.M. = 61). After 7 h, quercetin concentration in hydrolyzed plasmas decreased and after 20 h basal levels were found again. The antioxidant capacities of quercetin, 3'-O-methylquercetin, and of some of their conjugated derivatives were compared by the measurement of the conjugated dienes resulting from the Cu2+-induced oxidation of human LDL. 3'-O-Methylquercetin and conjugated derivatives of quercetin significantly prolonged the lag phase, but the magnitude of their effect was about half that of the aglycone.
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Affiliation(s)
- C Manach
- Unité des Maladies Métaboliques et Micronutriments, I.N.R.A. de Clermont-Ferrand/Theix, St Genès-Champanelle, France.
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