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Sud M, Austin P, Naimark D, Wijeysundera H, Chu A, Thanassoulis G, Ko D. IMPACT OF OUTCOME DEFINITIONS ON CARDIOVASCULAR RISK PREDICTION IN A CONTEMPORARY PRIMARY PREVENTION POPULATION. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.165] [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: 11/28/2022] Open
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Abstract
OBJECTIVES To determine the genetic correlates of physical frailty and sarcopenia, focusing on single nucleotide polymorphisms (SNPs) in genome-wide association studies (GWAS), and to explore the genetic overlap of frailty with cardiovascular disease (CVD) and its risk factors. METHODS PubMed was systematically searched for GWAS studies investigating the association between SNPs and objective measures of physical frailty or sarcopenia. SNPs were retained if they were associated with one of the phenotypes of interest by a p-value of 5.0x10-8 or less. RESULTS Ten studies were included, with a total of 237 SNPs in 181 genes being associated with physical frailty or sarcopenia; as measured by handgrip strength or lean (muscle) mass. These genes were cross-referenced in the GWAS Catalog, and many of them were found to be associated with CVD or metabolic syndrome. CONCLUSIONS Evidence from GWAS has shown that frailty is associated with common genetic polymorphisms. Many of these polymorphisms have been implicated in CVD, supporting the hypothesis of a shared pathophysiology between these entities. Future studies are eagerly anticipated to map out the mechanistic links and discover therapeutic targets and novel biomarkers for frailty.
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Affiliation(s)
- Y Ahisar
- Jonathan Afilalo, MD, MSc, FACC, FRCPC, Associate Professor, McGill University, Director, Geriatric Cardiology Fellowship Program, Jewish General Hospital, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC H3T 1E2, Phone: (514) 340-7540 | Fax: (514) 340-7534,
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Chen H, Small A, Dina C, Cairns B, Whitmer R, Lathrop M, Smith J, Holm H, Wells Q, Rader D, Soderberg S, Schott J, Engert J, Thanassoulis G. Genome-wide association meta-analysis in 652,134 participants identifies 9 novel susceptibility loci for aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1862] [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) is the most common form of incident valvular heart disease. While valve replacement is effective, the absence of an approved medical therapy provides no alternatives to patients with contraindications or mild disease. An improved understanding of the genetics of AS could identify targets for pharmacological intervention.
Methods
An inverse variance-weighted, fixed effects meta-analysis of the association of 11,591,806 variants with AS was undertaken using data from 10 European cohorts totalling 652,134 participants (13,758 cases of AS). We queried publicly available datasets to characterize the functional consequences of genome-wide significant variants, conducted a phenome-wide association study to assess their association with other outcomes, and constructed polygenic risk scores to examine their association with AS. We also performed gene- and gene-set enrichment analyses, estimated genetic correlation with cardiovascular traits, and assessed whether five lipid or immunological biomarkers were causally associated with AS using Mendelian randomization.
Results
Eighteen independent variants at 16 loci attained genome-wide significance in the meta-analysis, including variants at all seven previously reported loci. Many of the significant variants were intronic or intergenic, and the phenome-wide association study revealed extensive pleiotropy with apolipoprotein B, C-reactive protein, and other cardiovascular and immunological traits. A weighted polygenic risk score composed of the 18 variants was strongly associated with AS (adjusted OR per SD, 1.38; 95% CI, 1.33 to 1.44; p=4.6×10–57), and improved the discriminatory ability for AS when added to a model that contained clinical risk factors (difference in the area under the curve p=2.0×10–11). Gene-based approaches indicated higher IL6R expression in the blood among AS cases compared to controls (p=3.1×10–6), and the association of LDLR with AS (p=2.3×10–10). Gene set analyses revealed that genes bound by the transcription factor TCF7 or micro-RNAs miR-21, miR-219, miR-491, and miR-19 were differentially expressed in the liver depending on AS status (p≤5.7×10–4), suggesting disease development may be mediated by tissue-specific transcriptional and post-transcriptional regulation. Mendelian randomization supported a causal association of five lipid and immunological biomarkers with AS, including low-density lipoprotein cholesterol (OR per mmol/L, 1.61; 95% CI, 1.48 to 1.75; p=1.3×10–30).
Conclusions
Evidence from large-scale genetic analyses indicate that lipid metabolism, inflammation, and calcification are key contributors to AS.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Canadian Institutes of Health Research, National Institutes of Health
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Affiliation(s)
- H.Y Chen
- McGill University, Department of Medicine, Montreal, Canada
| | - A.M Small
- University of Pennsylvania, Department of Medicine, Philadelphia, United States of America
| | - C Dina
- Institut du Thorax, Nantes, France
| | - B.J Cairns
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R.A Whitmer
- University of California Davis, Department of Public Health Sciences, Davis, United States of America
| | - M Lathrop
- McGill University and Genome Quebec Innovation Centre, Montreal, Canada
| | - J.G Smith
- Lund University, Department of Cardiology, Lund, Sweden
| | - H Holm
- deCODE genetics/Amgen Inc, Reykjavik, Iceland
| | - Q.S Wells
- Vanderbilt University Medical Center, Vanderbilt Translational and Clinical Cardiovascular Research Center, Nashville, United States of America
| | - D.J Rader
- University of Pennsylvania, Departments of Genetics and Medicine, Philadelphia, United States of America
| | - S Soderberg
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | | | - J.C Engert
- McGill University, Department of Medicine, Montreal, Canada
| | - G Thanassoulis
- McGill University, Department of Medicine, Montreal, Canada
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Bakhsh A, Thanassoulis G, Engert JC, Elstein E, Huynh T, Giannetti N. P253 Withdrawal of beta- blockers and ACE inhibitors after left ventricular systolic function recovery in patient with dilated cardiomyopathy randomized control trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.081] [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
Funding Acknowledgements
The Rosenfeld Heart Fund
Introduction
recovery of left ventricle (LV) systolic function with normalization of ejection fraction (LVEF) occurs in 10 - 27% of patients with 80% maintaining recovery. However, the need for medical therapy after recovery is often questioned. Previous randomized studies of treatment withdrawal were small, not selected for non-ischemic dilated cardiomyopathy (DCM) and had a reference of improved or recovered EF to > 40% or > 10% change from LVEF at time of diagnosis. Hypothesis: In patients with DCM with recovery of the LV systolic function to an EF (>50%), medical therapy withdrawal is possible without rebound LV systolic dysfunction. Method: This was a pilot randomized control open-label trial with 2:1 randomization for withdrawal of b-blockers and ACE inhibitors in patients with recovered LV systolic function. Patients’ medication discontinuation occurred in 2 phases with a six-month interval and patients were followed for one year. The primary endpoint was LVEF reduction (< 40%). Results: There were 22 patients (10 females) enrolled. The mean age was 60 ± 12y. The mean LVEF at enrollment was 58 ± 5% with no significant difference in the mean LVEF in both groups. Sixteen patients were assigned to the withdrawal group and 6 assigned to the control group. The primary endpoint occurred in 31% of the withdrawal group compared to none of the control. The rate of 1ry outcome after withdrawal of medical therapy was 19%, p-value 0.15. The mean LVEF at 1 year for the treatment withdrawal group was 46.8 ± 12% and control 55 ± 6%, p-value 0.15. In the medication withdrawal group, the mean LVEF reduction was 10.6 ± 11% and the difference between the mean LVEF at enrollment and at 1 year was 10.6 ± 11% with 95% CI (4.6,16.49), p-value 0.0017. Conclusion: In DCM patients with recovery of LV systolic function, we observed worsening of LVEF after withdrawal of b-blockers and ACE inhibitors.
Abstract P253 Figure.
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Affiliation(s)
- A Bakhsh
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - G Thanassoulis
- McGill University Health Centre, Cardiology , Montreal, Canada
| | - J C Engert
- McGill University Health Centre, Cardiology , Montreal, Canada
| | - E Elstein
- McGill University Health Centre, Cardiology , Montreal, Canada
| | - T Huynh
- McGill University Health Centre, Cardiology , Montreal, Canada
| | - N Giannetti
- McGill University Health Centre, Cardiology , Montreal, Canada
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Després A, Perrot N, Tastet L, Pouliot A, Shen M, Chen H, Bourgeois R, Trottier M, Guimond J, Tessier M, Nadeau M, Sebastien T, Couture P, Dweck M, Tsimikas S, Thanassoulis G, Pibarot P, Marie-Annick Clavel M, Arsenault B. Lipoprotein(A), Oxidized Phospholipids, And Aortic Valve Microcalcification Assessed By 18f-Naf Pet/Ct. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.322] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lepage-Mireault G, Nguyen A, Gregoire J, Thanassoulis G, Tardif JC, Huynh T. P5350Potential utility of the SCORE risk estimator to predict fatal cardiovascular events in a North American population: CARTaGENE cohort. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Nguyen
- McGill University Health Centre, medicine, Montreal, Canada
| | - J Gregoire
- Montreal Heart Institute, Montreal, Canada
| | - G Thanassoulis
- McGill University Health Centre, medicine, Montreal, Canada
| | - J C Tardif
- Montreal Heart Institute, Montreal, Canada
| | - T Huynh
- McGill University Health Centre, medicine, Montreal, Canada
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AlTurki A, Marafi M, Alturki H, Thanassoulis G, Tardif J, Huynh T. THE EFFECT OF PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 ANTIBODIES ON MORTALITY AND CARDIOVASCULAR OUTCOMES: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.234] [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: 10/18/2022] Open
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Choi J, Winters N, Pelletier R, Eisenberg M, Bacon S, Cox J, Daskalopoulou S, Lavoie K, Karp I, Shimony A, So D, Thanassoulis G, Pilote L. SEX DIFFERENCES IN CLINICAL OUTCOMES AFTER PREMATURE ACUTE CORONARY SYNDROME. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.042] [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: 10/22/2022] Open
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Luk K, Thanassoulis G, Desbiens K, Wang L, Giannetti N, Engert J. EXOME SEQUENCING IDENTIFIES NOVEL TITIN TRUNCATING MUTATIONS IN DILATED CARDIOMYOPATHY PATIENTS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.147] [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: 10/22/2022] Open
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Geagea A, Pilote L, Dufresne L, Engert J, Thanassoulis G. LIPOPROTEIN(A) AND RECURRENT CARDIOVASCULAR EVENTS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.547] [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: 11/27/2022] Open
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Kamel S, Richards B, Dufresne L, Engert J, Thanassoulis G. TOTAL CHOLESTEROL, LOW-DENSITY LIPOPROTEIN CHOLESTEROL, OR HIGH DENSITY LIPOPROTEIN AND BONE HEALTH: SYSTEMATIC REVIEW AND MENDELIAN RANDOMIZATION. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Afshar M, Pilote L, Dufresne L, Engert J, Thanassoulis G. LIPOPROTEIN(A) INTERACTIONS WITH LOW-DENSITY LIPOPROTEIN CHOLESTEROL AND OTHER CARDIOVASCULAR RISK FACTORS: A CASE-ONLY STUDY OF PREMATURE ACS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.730] [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: 10/22/2022] Open
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Leung Yinko SSL, Thanassoulis G, Stark KD, Avgil Tsadok M, Engert JC, Pilote L. Omega-3 fatty acids and the genetic risk of early onset acute coronary syndrome. Nutr Metab Cardiovasc Dis 2014; 24:1234-1239. [PMID: 24998078 DOI: 10.1016/j.numecd.2014.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 02/12/2014] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Recent gene-environment interaction studies suggest that diet may influence an individual's genetic predisposition to cardiovascular risk. We evaluated whether omega-3 fatty acid intake may influence the risk for acute coronary syndrome (ACS) conferred by genetic polymorphisms among patients with early onset ACS. METHODS AND RESULTS Our population consisted of 705 patients of white European descent enrolled in GENESIS-PRAXY, a multicenter cohort study of patients aged 18-55 years and hospitalized with ACS. We used a case-only design to investigate interactions between the omega-3 index (a validated biomarker of omega-3 fatty acid intake) and 30 single nucleotide polymorphisms (SNPs) robustly associated with ACS. We used logistic regression to assess the interaction between each SNP and the omega-3 index. Interaction was also assessed between the omega-3 index and a genetic risk score generated from the 30 SNPs. All models were adjusted for age and sex. An interaction for increased ACS risk was found between carriers of the chromosome 9p21 variant rs4977574 and low omega-3 index (OR 1.57, 95% CI 1.07-2.32, p = 0.02), but this was not significant after correction for multiple testing. Similar results were obtained in the adjusted model (OR 1.55, 95% CI 1.05-2.29, p = 0.03). We did not observe any interaction between the genetic risk score or any of the other SNPs and the omega-3 index. CONCLUSION Our results suggest that omega-3 fatty acid intake may modify the genetic risk conferred by chromosome 9p21 variation in the development of early onset ACS and requires independent replication.
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Affiliation(s)
- S S L Leung Yinko
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - G Thanassoulis
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - K D Stark
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - M Avgil Tsadok
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - J C Engert
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - L Pilote
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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Thanassoulis G, Luk K, Schulz C, Engert J, Do R, Hindy G, Rukh G, Dufresne L, Almgren P, Owens D, Harris T, Peloso G, Kerr K, Wong Q, Smith A, Budoff M, Rotter J, Cupples L, Rich S, Kathiresan S, Orho-Melander M, Gudnason V, O'Donnell C, Post W, Smith J. GENETICALLY ELEVATED LOW-DENSITY LIPOPROTEIN CHOLESTEROL IS ASSOCIATED WITH AORTIC VALVE CALCIFICATION AND INCIDENT AORTIC STENOSIS: A MENDELIAN RANDOMIZATION STUDY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.448] [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: 10/24/2022] Open
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Hindieh W, Pilote L, Cheema A, Labos C, Dufresne L, Engert J, Thanassoulis G. ASSOCIATION BETWEEN FAMILY HISTORY AND SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS WITH PREMATURE ACUTE CORONARY SYNDROMES. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.535] [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: 11/16/2022] Open
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Yinko SSL, Pelletier R, Behlouli H, Lavoie K, Bacon S, Daskalopoulou S, Thanassoulis G, Karp I, Eisenberg M, Pilote L, Investigators GP. BARRIERS TO IMPROVEMENTS IN FRUIT AND VEGETABLE INTAKE AFTER PREMATURE ACUTE CORONARY SYNDROME: WHAT IS THE ROLE OF DIETARY COUNSELLING AND PATIENT CHARACTERISTICS? Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.218] [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: 10/24/2022] Open
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Labos C, Wang R, Pilote L, Bogaty P, Brophy J, Engert J, Thanassoulis G. UTILITY OF A LDL CHOLESTEROL GENETIC RISK SCORE TO PREDICT RECURRENT CARDIOVASCULAR EVENTS AFTER ACUTE CORONARY SYNDROME. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.152] [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] Open
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Labos C, Engert J, Wang R, Bogaty P, Brophy J, Thanassoulis G. Development of a Genetic Risk Score to Predict Adverse Outcomes After ACS. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.488] [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: 11/30/2022] Open
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Khan N, Avgil M, Norris C, Pelletier R, Bacon S, Thanassoulis G, Daskalopoulou S, Behlouli H, Karp I, Pilote L. Sex Differences in Prodromal Symptoms and Health Seeking Behaviors for Acute Coronary Syndrome. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.491] [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: 11/27/2022] Open
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Sajjan U, Thanassoulis G, Cherapanov V, Lu A, Sjolin C, Steer B, Wu YJ, Rotstein OD, Kent G, McKerlie C, Forstner J, Downey GP. Enhanced susceptibility to pulmonary infection with Burkholderia cepacia in Cftr(-/-) mice. Infect Immun 2001; 69:5138-50. [PMID: 11447196 PMCID: PMC98610 DOI: 10.1128/iai.69.8.5138-5150.2001] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Progressive pulmonary infection is the dominant clinical feature of cystic fibrosis (CF), but the molecular basis for this susceptibility remains incompletely understood. To study this problem, we developed a model of chronic pneumonia by repeated instillation of a clinical isolate of Burkholderia cepacia (genomovar III, ET12 strain), an opportunistic gram-negative bacterium, from a case of CF into the lungs of Cftr (m1unc-/-) (Cftr(-/-)) and congenic Cftr(+/+) controls. Nine days after the last instillation, the CF transmembrane regulator knockout mice showed persistence of viable bacteria with chronic severe bronchopneumonia while wild-type mice remained healthy. The histopathological changes in the lungs of the susceptible Cftr(-/-) mice were characterized by infiltration of a mixed inflammatory-cell population into the peribronchiolar and perivascular spaces, Clara cell hyperplasia, mucus hypersecretion in airways, and exudation into alveolar airspaces by a mixed population of macrophages and neutrophils. An increased proportion of neutrophils was observed in bronchoalveolar lavage fluid from the Cftr(-/-) mice, which, despite an increased bacterial load, demonstrated minimal evidence of activation. Alveolar macrophages from Cftr(-/-) mice also demonstrated suboptimal activation. These observations suggest that the pulmonary host defenses are compromised in lungs from animals with CF, as manifested by increased susceptibility to bacterial infection and lung injury. This murine model of chronic pneumonia thus reflects, in part, the situation in human patients and may help elucidate the mechanisms leading to defective host defense in CF.
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Affiliation(s)
- U Sajjan
- Research Institute, The Hospital for Sick Children, Toronto, Ontario M5G 1X8
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