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Pagonas N, Mueller R, Weiland L, Jaensch M, Dammermann W, Seibert FS, Hillmeister P, Buschmann I, Christ M, Ritter O, Westhoff TH, Sasko B, Kelesidis T. Oxidized high-density lipoprotein associates with atrial fibrillation. Heart Rhythm 2024; 21:362-369. [PMID: 38040404 PMCID: PMC11073573 DOI: 10.1016/j.hrthm.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common heart arrhythmia and considered to be a progressive chronic disease associated with increased morbidity and mortality. Recent data suggest a link between inflammation, oxidative stress, and AF, although the underlying mechanisms are not fully understood. Because oxidized lipoproteins cause structural damage and electrophysiologic changes in cardiomyocytes, it is feasible that the transformation of atheroprotective high-density lipoprotein (HDL) into dysfunctional HDL contributes to the development of AF. OBJECTIVE The purpose of this study was to determine whether a reduced antioxidant function of HDL is associated with the presence of AF. METHODS In this multicenter cross-sectional cohort study, we assessed HDL function in sera of 1206 participants. Patients were divided into groups according to the presence of AF (n = 233) or no AF (n = 973). A validated cell-free biochemical assay was used to determine reduced HDL antioxidant function as assessed by increased normalized HDL lipid peroxide content (nHDLox). RESULTS Participants with AF had a 9% higher mean relative nHDLox compared to persons without AF (P = .025). nHDLox was strongly associated with AF in all models of logistic regression, including the analysis adjusted for age, sex, and risk factors for AF (all P ≤.01). CONCLUSION Reduced antioxidant HDL function is associated with the presence of AF, which supports growing evidence that impaired lipoprotein function is linked to electrophysiological changes in cardiomyocytes. nHDLox is one of several contributors to the initiation and perpetuation of AF.
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Affiliation(s)
- Nikolaos Pagonas
- Department of Cardiology, University Hospital Ruppin-Brandenburg, Medical School Theodor Fontane, Neuruppin, Germany; Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany.
| | - Rhea Mueller
- Department of Cardiology, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Linda Weiland
- Department of Cardiology, University Hospital Ruppin-Brandenburg, Medical School Theodor Fontane, Neuruppin, Germany
| | - Monique Jaensch
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Department of Cardiology, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Werner Dammermann
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Center for Internal Medicine II, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Felix S Seibert
- Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Philipp Hillmeister
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Department of Angiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Ivo Buschmann
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Department of Angiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Martin Christ
- Department of Cardiology, Knappschaftskrankenhaus Bottrop, Academic Teaching Hospital, University Duisburg-Essen, Bottrop, Germany
| | - Oliver Ritter
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Department of Cardiology, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Benjamin Sasko
- Department of Cardiology, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany; Medical Department II, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Theodoros Kelesidis
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
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Li K, Dai M, Sacirovic M, Zemmrich C, Pagonas N, Ritter O, Grisk O, Lubomirov LT, Lauxmann MA, Bramlage P, Persson AB, Buschmann E, Buschmann I, Hillmeister P. Leukocyte telomere length and mitochondrial DNA copy number associate with endothelial function in aging-related cardiovascular disease. Front Cardiovasc Med 2023; 10:1157571. [PMID: 37342445 PMCID: PMC10277745 DOI: 10.3389/fcvm.2023.1157571] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/22/2023] [Indexed: 06/22/2023] Open
Abstract
Background We investigated the association between leukocyte telomere length, mitochondrial DNA copy number, and endothelial function in patients with aging-related cardiovascular disease (CVD). Methods In total 430 patients with CVD and healthy persons were enrolled in the current study. Peripheral blood was drawn by routine venipuncture procedure. Plasma and peripheral blood mononuclear cells (PBMCs) were collected. Cell-free genomic DNA (cfDNA) and leukocytic genomic DNA (leuDNA) were extracted from plasma and PBMCs, respectively. Relative telomere length (TL) and mitochondrial DNA copy number (mtDNA-CN) were analyzed using quantitative polymerase chain reaction. Endothelial function was evaluated by measuring flow-mediated dilation (FMD). The correlation between TL of cfDNA (cf-TL), mtDNA-CN of cfDNA (cf-mtDNA), TL of leuDNA (leu-TL), mtDNA-CN of leuDNA (leu-mtDNA), age, and FMD were analyzed based on Spearman's rank correlation. The association between cf-TL, cf-mtDNA, leu-TL, leu-mtDNA, age, gender, and FMD were explored using multiple linear regression analysis. Results cf-TL positively correlated with cf-mtDNA (r = 0.1834, P = 0.0273), and leu-TL positively correlated with leu-mtDNA (r = 0.1244, P = 0.0109). In addition, both leu-TL (r = 0.1489, P = 0.0022) and leu-mtDNA (r = 0.1929, P < 0.0001) positively correlated with FMD. In a multiple linear regression analysis model, both leu-TL (β = 0.229, P = 0.002) and leu-mtDNA (β = 0.198, P = 0.008) were positively associated with FMD. In contrast, age was inversely associated with FMD (β = -0.426, P < 0.0001). Conclusion TL positively correlates mtDNA-CN in both cfDNA and leuDNA. leu-TL and leu-mtDNA can be regarded as novel biomarkers of endothelial dysfunction.
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Affiliation(s)
- Kangbo Li
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mengjun Dai
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mesud Sacirovic
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Claudia Zemmrich
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Nikolaos Pagonas
- Department for Cardiology, Center for Internal Medicine I, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, The Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| | - Oliver Ritter
- Department for Cardiology, Center for Internal Medicine I, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, The Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| | - Olaf Grisk
- Institute of Physiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Lubomir T. Lubomirov
- Institute of Physiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Martin A. Lauxmann
- Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Anja Bondke Persson
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eva Buschmann
- Department of Cardiology, University Clinic Graz, Graz, Austria
| | - Ivo Buschmann
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, The Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| | - Philipp Hillmeister
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, The Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
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Andresen H, Pagonas N, Eisert M, Patschan D, Nordbeck P, Buschmann I, Sasko B, Ritter O. Defibrillator exchange in the elderly. Heart Rhythm O2 2023; 4:382-390. [PMID: 37361620 PMCID: PMC10288028 DOI: 10.1016/j.hroo.2023.05.001] [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] [Indexed: 06/28/2023] Open
Abstract
Background Implantable cardioverter-defibrillator (ICD) therapy in elderly patients is controversial because survival benefits might be attenuated by nonarrhythmic causes of death. Objective The purpose of this study was to investigate the outcome of septuagenarians and octogenarians after ICD generator exchange (GE). Methods A total of 506 patients undergoing elective GE were analyzed to determine the incidence of ICD shocks and/or survival after GE. Patients were divided into a septuagenarian group (age 70-79 years) and an octogenarian group (age ≥80 years). The primary endpoint was death from any cause. Secondary endpoints were survival after appropriate ICD shock and death without experiencing ICD shocks after GE ("prior death"). Results The association of the ICD with all-cause mortality and arrhythmic death was determined for septuagenarians and octogenarians. Comparing both groups, similar left ventricular ejection fraction (35.6% ± 11.2% vs 32.4% ± 8.9%) and baseline prevalence of New York Heart Association functional class III or IV heart failure (17.1% vs 14.7%) were found. During the entire follow-up period of the study, 42.5% of patients in the septuagenarian group died compared to 79% in the octogenarian group (P <.01). Prior death was significantly more frequent in both age groups than were appropriate ICD shocks. Predictors of mortality were common in both groups and included advanced heart failure, peripheral arterial disease, and renal failure. Conclusion In clinical practice, decision-making for ICD GE among the elderly should be considered carefully for individual patients.
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Affiliation(s)
- Henrike Andresen
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
| | - Nikolaos Pagonas
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Marius Eisert
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Daniel Patschan
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Ivo Buschmann
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
| | - Benjamin Sasko
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Department of Internal Medicine IV–Cardiology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
| | - Oliver Ritter
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
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Dai M, Li K, Sacirovic M, Zemmrich C, Buschmann E, Ritter O, Bramlage P, Persson AB, Buschmann I, Hillmeister P. Autophagy-related genes analysis reveals potential biomarkers for prediction of the impaired walking capacity of peripheral arterial disease. BMC Med 2023; 21:186. [PMID: 37198605 DOI: 10.1186/s12916-023-02889-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND The role of autophagy and autophagy-related genes in peripheral arterial disease (PAD) remains unknown and may be of diagnostic and prognostic value. The aim of this study is to investigate the relationship between autophagy and PAD, and identify potential diagnostic or prognostic biomarkers for medical practice. METHODS Differentially expressed autophagy-related genes in PAD were explored from GSE57691 and validated in our WalkByLab registry participants by quantitative real-time polymerase chain reaction (qRT-PCR). The level of autophagy in peripheral blood mononuclear cells (PBMCs) of WalkByLab participants was assessed by analyzing autophagic marker proteins (beclin-1, P62, LC3B). Single sample gene set enrichment analysis (ssGSEA) was used to evaluate the immune microenvironment within the artery wall of PAD patients and healthy persons. Chemokine antibody array and enzyme-linked immunosorbent assay were used to assess the chemokines in participants' plasma. Treadmill testing with Gardner protocol was used to evaluate participants' walking capacity. Pain-free walking distance, maximum walking distance, and walking time were recorded. Finally, a nomogram model based on logistic regression was built to predict impaired walking performance. RESULTS A total of 20 relevant autophagy-related genes were identified, and these genes were confirmed to be expressed at low levels in our PAD participants. Western blotting demonstrated that the expression of autophagic marker proteins beclin-1 and LC3BII were significantly reduced in PAD patients' PBMCs. ssGSEA revealed that most of the autophagy-related genes were strongly correlated with immune function, with the largest number of associated genes showing interaction between cytokine-and-cytokine receptors (CCR). In this context, the chemokines growth-related oncogene (GRO) and neutrophil activating protein2 (NAP2) are highly expressed in the plasma of WalkByLab PAD patients and were significantly negatively correlated with the walking distance assessed by Gardner treadmill testing. Finally, the plasma NAP2 level (AUC: 0.743) and derived nomogram model (AUC: 0.860) has a strong predictive potential to identify a poor walking capacity. CONCLUSIONS Overall, these data highlight both the important role of autophagy and autophagy-related genes in PAD and link them to vascular inflammation (expression of chemokines). In particular, chemokine NAP2 emerged as a novel biomarker that can be used to predict the impaired walking capacity in PAD patients.
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Affiliation(s)
- Mengjun Dai
- Center for Internal Medicine 1, Department for Angiology, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Kangbo Li
- Center for Internal Medicine 1, Department for Angiology, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Mesud Sacirovic
- Center for Internal Medicine 1, Department for Angiology, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
| | - Claudia Zemmrich
- Center for Internal Medicine 1, Department for Angiology, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Eva Buschmann
- Department of Cardiology, University Clinic Graz, Graz, Austria
| | - Oliver Ritter
- Department for Cardiology, Center for Internal Medicine I, Brandenburg Medical School Theodor Fontane, University Clinic Brandenburg, Brandenburg an der Havel, Germany
- Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Anja Bondke Persson
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Ivo Buschmann
- Center for Internal Medicine 1, Department for Angiology, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
| | - Philipp Hillmeister
- Center for Internal Medicine 1, Department for Angiology, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
- Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Brandenburg Medical School Theodor Fontane, Potsdam, Germany.
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Soubh N, Hillmeister P, Buschmann E, Klaproth C, Buschmann I. Tolerability safety and effectiveness of enhanced external counterpulsation versus individual shear rate therapy in patients with lower extremity atherosclerotic disease: A prospective pilot clinical trial. Acta Physiol (Oxf) 2023; 237:e13913. [PMID: 36599365 DOI: 10.1111/apha.13913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/10/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
AIMS We aimed to investigate the tolerability, safety, and effectiveness of enhanced external counterpulsation therapy (EECP) versus individual shear rate therapy (ISRT) in patients with lower extremity atherosclerotic disease (LEAD). METHODS Eighteen patients (age: 73.1 ± 6 years) underwent EECP and ISRT, each daily over five consecutive days in a cross-over design with a 1 week resting period in between the two regimens. A quality-of-life questionnaire was used to assess the therapy experience. Oxygen saturation (SO2 ), relative hemoglobin amount (rHb) and blood flow (Flow) in the capillary-venous-system (microcirculation) of the skin were monitored continuously during all therapy sessions using the micro-lightguide spectrophotometer, also known as oxygen to see (O2C). The effects of EECP and ISRT on the renal function and skeletal muscles were evaluated using serial blood and urine tests. RESULTS EECP therapy had to be terminated early before the end of the 5th session in 10 patients (55.6%) because of discomfort. Four patients (22.2%) experienced signs of critical limb ischaemia under EECP. The total score of the quality-of-life questionnaire was significantly higher (= better tolerated) post-ISRT compared with EECP. Microcirculation monitoring revealed that ISRT significantly increased the SO2 , blood flow and rHb during the therapy. All three parameters remained significantly increased in the observation period after ISRT. The serum levels of creatin kinase and myoglobin increased significantly under EECP. CONCLUSIONS ISRT significantly improves tolerability, safety, and effectiveness over EECP in patients with LEAD.
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Affiliation(s)
- Nibras Soubh
- Department for Angiology, Center for Internal Medicine 1, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Brandenburg/Havel, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane, the University of Potsdam, Potsdam, Germany
- Universitätsmedizin Charité, Berlin, Germany
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen (UMG), Göttingen, Germany
| | - Philipp Hillmeister
- Department for Angiology, Center for Internal Medicine 1, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Brandenburg/Havel, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane, the University of Potsdam, Potsdam, Germany
| | - Eva Buschmann
- Klinische Abteilung für Kardiologie, Universitätsklinikum Graz, Graz, Austria
| | - Christian Klaproth
- Interdisciplinary Vascular Center Nord (Gefäßzentrum Nord), Husum, Germany
| | - Ivo Buschmann
- Department for Angiology, Center for Internal Medicine 1, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Brandenburg/Havel, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane, the University of Potsdam, Potsdam, Germany
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Li K, Kratzmann V, Dai M, Gatzke N, Rocic P, Bramlage P, Grisk O, Lubomirov LT, Hoffmeister M, Lauxmann MA, Ritter O, Buschmann E, Bader M, Persson AB, Buschmann I, Hillmeister P. Angiotensin receptor-neprilysin inhibitor improves coronary collateral perfusion. Front Cardiovasc Med 2023; 9:981333. [PMID: 36818914 PMCID: PMC9936066 DOI: 10.3389/fcvm.2022.981333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/09/2022] [Indexed: 02/05/2023] Open
Abstract
Background We investigated the pleiotropic effects of an angiotensin receptor-neprilysin inhibitor (ARNi) on collateral-dependent myocardial perfusion in a rat model of coronary arteriogenesis, and performed comprehensive analyses to uncover the underlying molecular mechanisms. Methods A rat model of coronary arteriogenesis was established by implanting an inflatable occluder on the left anterior descending coronary artery followed by a 7-day repetitive occlusion procedure (ROP). Coronary collateral perfusion was measured by using a myocardial particle infusion technique. The putative ARNi-induced pro-arteriogenic effects were further investigated and compared with an angiotensin-converting enzyme inhibitor (ACEi). Expression of the membrane receptors and key enzymes in the natriuretic peptide system (NPS), renin-angiotensin-aldosterone system (RAAS) and kallikrein-kinin system (KKS) were analyzed by quantitative polymerase chain reaction (qPCR) and immunoblot assay, respectively. Protein levels of pro-arteriogenic cytokines were measured by enzyme-linked immunosorbent assay, and mitochondrial DNA copy number was assessed by qPCR due to their roles in arteriogenesis. Furthermore, murine heart endothelial cells (MHEC5-T) were treated with a neprilysin inhibitor (NEPi) alone, or in combination with bradykinin receptor antagonists. MHEC5-T proliferation was analyzed by colorimetric assay. Results The in vivo study showed that ARNis markedly improved coronary collateral perfusion, regulated the gene expression of KKS, and increased the concentrations of relevant pro-arteriogenic cytokines. The in vitro study demonstrated that NEPis significantly promoted MHEC5-T proliferation, which was diminished by bradykinin receptor antagonists. Conclusion ARNis improve coronary collateral perfusion and exert pro-arteriogenic effects via the bradykinin receptor signaling pathway.
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Affiliation(s)
- Kangbo Li
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Victoria Kratzmann
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Mengjun Dai
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nora Gatzke
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Petra Rocic
- Department of Physiology and Pharmacology, College of Osteopathic Medicine, Sam Houston State University, Huntsville, TX, United States
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Olaf Grisk
- Institute of Physiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Lubomir T. Lubomirov
- Institute of Physiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Meike Hoffmeister
- Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, The Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| | - Martin A. Lauxmann
- Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Oliver Ritter
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, The Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
- Department for Cardiology, Center for Internal Medicine I, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Eva Buschmann
- Department of Cardiology, University Clinic Graz, Graz, Austria
| | - Michael Bader
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
- Institute for Biology, University of Lübeck, Lübeck, Germany
| | - Anja Bondke Persson
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ivo Buschmann
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, The Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| | - Philipp Hillmeister
- Department for Angiology, Center for Internal Medicine I, Deutsches Angiologie Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, The Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
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Wautrecht JC, Olinic DM, Catalano M, Baines C, Belch J, Blinc A, Buschmann I, Celovska D, Colgan MP, Dimakakos E, Heiss C, Kolossvary E, Kozak M, Kroon B, Mazzolai L, Marakomichelakis G, Pecsvarady Z, Pias Canedo MA, Quere I, Roztocil K, Schernthaner GH, Sieron A, Spaak J, Sprynger M, Stanek A, Staub D, Vasic D, Visona A, Willfort-Ehringer A. UEMS training requirements for angiology/vascular medicine. European standards of postgraduate medical specialist training. 2022 up-dated version. INT ANGIOL 2022; 41:258-274. [PMID: 35373943 DOI: 10.23736/s0392-9590.22.04893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jean-Claude Wautrecht
- Department of Vascular Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium -
| | - Dan-Mircea Olinic
- Medical Clinic no. 1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mariella Catalano
- Interuniversity Research Center on Vascular Disease-Biomedical and Clinical Science, H. Sacco Department, University of Milan, Milan, Italy
| | - Colin Baines
- Department of Vascular Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Jill Belch
- Department of Vascular Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Ales Blinc
- Department of Vascular Diseases, University Medical Center of Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivo Buschmann
- Center for Internal Medicine/Angiology, University Clinic Brandenburg, Theodor Fontane (MHB), Brandenburg, Germany
| | - Denisa Celovska
- First Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Mary-Paula Colgan
- Department of Vascular Diseases, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Evangelos Dimakakos
- Vascular Unit, Third Department of Internal Medicine, Sotira Public Hospital, University of Athens, Athens, Greece
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.,Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Endre Kolossvary
- Department of Angiology, St Imre University Teaching Hospital, Budapest, Hungary
| | - Matija Kozak
- Department of Vascular Diseases, University Medical Center of Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bram Kroon
- Section of Vascular Medicine, Department of Internal Medicine, Maastricht University Medical Center and School for Cardiovascular Research (CARIM), Maastricht, The Netherlands
| | - Lucia Mazzolai
- Heart and Vessel Department, Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland
| | - George Marakomichelakis
- Fourth Department of Internal Medicine and Unit for Medical Angiology, Evangelismos State General Hospital, Athens, Greece
| | - Zsolt Pecsvarady
- Second Department of Internal Medicine (Vascular Center), Flor Ferenc Teaching Hospital, Budapest, Hungary
| | - Maria A Pias Canedo
- Angiology and Vascular Surgery, Hospital da Luz Arrabida, Vila Nova de Gaia, Portugal
| | - Isabelle Quere
- Service of Vascular Medicine, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
| | - Karel Roztocil
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Gerit H Schernthaner
- Division of Angiology, Second Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Aleksander Sieron
- Faculty of Health Sciences, Jan Dlugosz University in Czestochowa, Czestochowa, Poland
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Katowice, Poland
| | - Daniel Staub
- Angiology Clinic, University Hospital of Basel, Basel, Switzerland
| | - Dragan Vasic
- Clinic of Vascular and Endovascular Surgery, Department of Internal Medicine and Angiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Adriana Visona
- Angiology Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso, Italy
| | - Andrea Willfort-Ehringer
- Division of Internal Medicine, Department of Angiology, Medical University of Vienna, Vienna, Austria
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8
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Hillmeister P, Nagorka S, Gatzke N, Dülsner A, Li K, Dai M, Bondke Persson A, Lauxmann MA, Jaurigue J, Ritter O, Bramlage P, Buschmann E, Buschmann I. Angiotensin-converting enzyme inhibitors stimulate cerebral arteriogenesis. Acta Physiol (Oxf) 2022; 234:e13732. [PMID: 34555240 DOI: 10.1111/apha.13732] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 12/20/2022]
Abstract
AIM Arteriogenesis constitutes the most efficient endogenous rescue mechanism in cases of cerebral ischaemia. The aim of this work was to investigate whether angiotensin-converting enzyme inhibitors (ACEi) stimulates, and angiotensin II receptor type 1 blockers (ARB) inhibits cerebral collateral growth by applying a three-vessel occlusion (3-VO) model in rat. METHODS Cerebral collateral growth was measured post 3-VO (1) by assessing blood flow using the cerebrovascular reserve capacity (CVRC) technique, and (2) by assessing vessel diameters in the posterior cerebral artery (PCA) via the evaluation of latex angiographies. A stimulatory effect on arteriogenesis was investigated for ACEi administration ± bradykinin receptor 1 (B1R) and 2 (B2R) blockers, and an inhibitory effect was analysed for ARB administration. Results were validated by immunohistochemical analysis and mechanistic data were collected by human umbilical vein endothelial cell (HUVEC) viability or scratch assay and monocyte (THP-1) migration assay. RESULTS An inhibitory effect of ARB on arteriogenesis could not be demonstrated. However, collateral growth measurements demonstrated a significantly increased CVRC and PCA diameters in the ACEi group. ACEi stimulates cell viability and migration, which could be partially reduced by additional administration of bradykinin receptor 1 inhibitor (B1Ri). ACEi inhibits the degradation of pro-arteriogenic bradykinin derivatives, but combined ACEi + B1Ri + B1Ri (BRB) treatment did not reverse the stimulatory effect. Yet, co-administration of ACEi + BRB enhances arteriogenesis and cell migration. CONCLUSION We demonstrate a potent stimulatory effect of ACEi on cerebral arteriogenesis in rats, presumable via B1R. However, results imply a pleiotropic and compensatory effect of ACEi on bradykinin receptor-stimulated arteriogenesis.
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Affiliation(s)
- Philipp Hillmeister
- Brandenburg Medical School Theodor Fontane (MHB) Deutsche Angiologie Zentrum Brandenburg‐Berlin (DAZB) Department for Angiology Center for Internal Medicine I Campus University Clinic Brandenburg Brandenburg an der Havel Germany
- Faculty of Health Sciences (FGW) Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg the Brandenburg Medical School Theodor Fontane (MHB) University of Potsdam Brandenburg an der Havel Germany
| | | | - Nora Gatzke
- Brandenburg Medical School Theodor Fontane (MHB) Deutsche Angiologie Zentrum Brandenburg‐Berlin (DAZB) Department for Angiology Center for Internal Medicine I Campus University Clinic Brandenburg Brandenburg an der Havel Germany
| | | | - Kangbo Li
- Brandenburg Medical School Theodor Fontane (MHB) Deutsche Angiologie Zentrum Brandenburg‐Berlin (DAZB) Department for Angiology Center for Internal Medicine I Campus University Clinic Brandenburg Brandenburg an der Havel Germany
- Charité Universitätsmedizin Berlin Berlin Germany
| | - Mengjun Dai
- Brandenburg Medical School Theodor Fontane (MHB) Deutsche Angiologie Zentrum Brandenburg‐Berlin (DAZB) Department for Angiology Center for Internal Medicine I Campus University Clinic Brandenburg Brandenburg an der Havel Germany
- Charité Universitätsmedizin Berlin Berlin Germany
| | | | - Martin A. Lauxmann
- Brandenburg Medical School Theodor Fontane (MHB) Deutsche Angiologie Zentrum Brandenburg‐Berlin (DAZB) Department for Angiology Center for Internal Medicine I Campus University Clinic Brandenburg Brandenburg an der Havel Germany
- Brandenburg Medical School Theodor Fontane (MHB) Brandenburg Medical School (MHB) Theodor Fontane Institute for Biochemistry & Clinic for Nephrology Brandenburg an der Havel Germany
| | - Jonnel Jaurigue
- Brandenburg Medical School Theodor Fontane (MHB) Deutsche Angiologie Zentrum Brandenburg‐Berlin (DAZB) Department for Angiology Center for Internal Medicine I Campus University Clinic Brandenburg Brandenburg an der Havel Germany
| | - Oliver Ritter
- Brandenburg Medical School Theodor Fontane (MHB) Brandenburg Medical School (MHB) Theodor Fontane Institute for Biochemistry & Clinic for Nephrology Brandenburg an der Havel Germany
- Brandenburg Medical School Theodor Fontane (MHB) Department for Cardiology Center for Internal Medicine I Campus University Clinic Brandenburg Brandenburg an der Havel Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine Cloppenburg Germany
| | - Eva Buschmann
- Department of Cardiology University Clinic Graz Graz Austria
| | - Ivo Buschmann
- Brandenburg Medical School Theodor Fontane (MHB) Deutsche Angiologie Zentrum Brandenburg‐Berlin (DAZB) Department for Angiology Center for Internal Medicine I Campus University Clinic Brandenburg Brandenburg an der Havel Germany
- Faculty of Health Sciences (FGW) Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg the Brandenburg Medical School Theodor Fontane (MHB) University of Potsdam Brandenburg an der Havel Germany
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9
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Ritter O, Pagonas N, Eisert M, Patschan D, Nordbeck P, Buschmann I, Sasko B, Andresen H. ICD exchange in the elderly. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
ICD therapy in elderly patients is controversially discussed, since survival benefits might be attenuated by non-arrhythmic causes of death.
Purpose
This study aimed to investigate the outcome of septua- and octogenarians after ICD generator exchange (GE).
Methods
506 patients undergoing elective GE were analysed to determine the incidence of ICD shocks and survival after GE. For further analysis, patients were divided according to age (70 – 79 or ≥80 years) and previous ICD therapy: patients that did not experience a shock and patients that received at least one shock from prior ICDs.
Results
The effect of the ICD on all-cause mortality and arrhythmic death was determined for two groups (patients with 70 – 79 and ≥80 years). Comparing septua- with octogenarians, similar left ventricular ejection fraction (35.6±11.2% vs. 32.4±8.9%) and baseline prevalence of NYHA class 3 or 4 heart failure (17.1% vs. 14.7%) was found. Older patients were more likely to die of non-arrhythmic death (22% per year vs. 8% per year, p<0.001). We also investigated the necessity of ICD therapy dependent on whether ICD therapy occurred during the previous battery live. Septuagenarians and octogenarians with previous shocks had a higher incidence of further ICD therapy in the following battery life period (41% vs. 19%, p<0.001, and 22% vs. 17%, p<0.001).
Conclusion
Decision making for ICD generator exchange among elderly patients should be considered carefully for an individual patient during clinical practice.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- O Ritter
- University Hospital Brandenburg, Department of Internal Medicine I, Brandenburg an der Havel, Germany
| | - N Pagonas
- University Hospital Brandenburg, Department of Internal Medicine I, Brandenburg an der Havel, Germany
| | - M Eisert
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - D Patschan
- University Hospital Brandenburg, Department of Internal Medicine I, Brandenburg an der Havel, Germany
| | - P Nordbeck
- Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
| | - I Buschmann
- University Hospital Brandenburg, Department of Internal Medicine I, Brandenburg an der Havel, Germany
| | - B Sasko
- Department of Internal Medicine IV - Cardiology, Bottrop, Germany
| | - H Andresen
- University Hospital Brandenburg, Department of Internal Medicine I, Brandenburg an der Havel, Germany
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10
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Pagonas N, Sasko B, Mueller R, Jaensch M, Dammermann W, Hillmeister P, Buschmann I, Ritter O, Westhoff TH, Kelesidis T. High-density lipoprotein lipid peroxidation in association with presence of coronary artery disease and atrial fibrillation in a large cross-sectional study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The function of high-density lipoprotein (HDL) cholesterol may play a more important role in the prevention of cardiovascular disease compared to the concentration of the HDL. Cardiovascular diseases such as coronary artery disease (CAD) and atrial fibrillation (AF) have been linked to impaired HDL function.
Purpose
The aim of the present study is to assess a biochemical measure of the antioxidant function of HDL and its association with presence of CAD and AF.
Methods
Patients admitted for elective cardiac catheterization were recruited in this cross-sectional study. Out of 1231 participants that were included in the analyses, 727 patients had confirmed CAD (CAD group), 369 patients had no CAD (no CAD group) and 129 persons were included as a control group. HDL function was measured in sera by determination of HDL-lipid peroxidation content (HDLox) assessed by a validated fluorometric cell-free biochemical assay and was normalized for the levels of HDL cholesterol (normalized HDLox/HDL-C ratio or nHDLox; no units). Results are expressed as median with interquartile range. Associations of nHDLox with presence of CAD and AF were assessed by univariate and multivariate analyses.
Results
Participants in the CAD group had higher levels of nHDLox (0.80, 0.61–1.03) compared to the no CAD (0.70, 0.55–0.93) and control (0.66, 0.55–1.03, no units, p<0.001) group. Out of 1206 participants, 233 (19%) had AF and 973 (81%) had no AF. Patients with AF have also higher nHDLox (0.82, 0.60–10.03) compared to persons without AF (0.73, 0.58–0.98, p=0.03). In univariate analysis nHDLox was associated with CAD (p<0.001). In multivariate analysis adjusted for age, gender, CAD, BMI and hypertension, nHDLox was a strong independent predictor of atrial fibrillation (p=0.015) but was not an independent predictor of CAD (p>0.05)
Conclusions
Reduced antioxidant function of HDL (increased HDLox measured by a biochemical assay), a metric of HDL function, is increased in patients with atherosclerosis and manifested CAD and is also associated with the presence of atrial fibrillation independent of the presence of CAD.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Medical School of Brandenburg-MHB Fontane
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Affiliation(s)
- N Pagonas
- University Hospital Brandenburg, Brandenburg, Germany
| | - B Sasko
- University Hospital Brandenburg, Brandenburg, Germany
| | - R Mueller
- University Hospital Brandenburg, Brandenburg, Germany
| | - M Jaensch
- University Hospital Brandenburg, Brandenburg, Germany
| | - W Dammermann
- University Hospital Brandenburg, Brandenburg, Germany
| | - P Hillmeister
- University Hospital Brandenburg, Brandenburg, Germany
| | - I Buschmann
- University Hospital Brandenburg, Brandenburg, Germany
| | - O Ritter
- University Hospital Brandenburg, Brandenburg, Germany
| | - T H Westhoff
- Ruhr University Bochum (RUB), Marien Hospital Herne, Bochum, Germany
| | - T Kelesidis
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, United States of America
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11
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Li K, Zemmrich C, Bramlage P, Persson AB, Sacirovic M, Ritter O, Buschmann E, Buschmann I, Hillmeister P. Effect of ACEI and ARB treatment on nitric oxide-dependent endothelial function. VASA 2021; 50:413-422. [PMID: 34428929 DOI: 10.1024/0301-1526/a000971] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/24/2022]
Abstract
Background: Angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are widely used as a first-line therapy for the treatment of cardiovascular disease. Here, ACEI modulate the bradykinin receptor (BDKRB1 and BDKRB2) system and NO-dependent endothelial function, thus determining cardiovascular health and regenerative arteriogenesis. The current study aims at evaluating nitric oxide-dependent endothelial function, and gene expression of bradykinin receptors in peripheral blood mononuclear cells (PBMC) from patients with ACEI or ARB treatment. Patients and methods: The WalkByLab has been established to screen cardiovascular patients for peripheral artery disease and coronary artery disease. In total 177 patients from WalkByLab with heterogenous disease and risk status were randomly selected, divided according to their medication history into the following groups: 1. ACEI group, 2. ARB group or 3. non-ACE/ARB group. Total plasma nitrite/nitrate (NO) levels were measured, endothelial function was evaluated by assessing flow meditated dilation (FMD). PBMC were isolated from peripheral whole blood, and gene expression (qRT-PCR) of bradykinin receptors and angiotensin converting enzyme were assessed. Results: Plasma total NO concentration in the ACEI group (24.66±16.28, µmol/l) was increased as compared to the ARB group (18.57±11.58, µmol/l, P=0.0046) and non-ACE/ARB group (16.83±8.64, µmol/l, P=0.0127) in patients between 40 to 90 years of age. However, FMD values (%) in the ACEI group (7.07±2.40, %) were similar as compared to the ARB (6.35±2.13, %) and non-ACE/ARB group (6.51±2.15, %), but significantly negatively correlated with age. Interestingly, BDKRB1 mRNA level was significantly higher and BDKRB2 mRNA level lower in the ACEI group (BDKRB1 3.88-fold±1.05, BDKRB2 0.22-fold±0.04) as compared to the non-ACE/ARB group (BDKRB1 1.00-fold±0.39, P<0.0001, BDKRB2 1.00-fold±0.45, P=0.0136). Conclusions: ACEI treatment enhances total nitrite/nitrate concentration, furthermore, upregulates BDKRB1 in PBMC, but downregulates BDKRB2 mRNA expression. FMD is a strong determinant of vascular aging and is sensitive to underlying heterogenous cardiovascular diseases.
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Affiliation(s)
- Kangbo Li
- Department for Angiology, Center for Internal Medicine I, Brandenburg Medical School Theodor Fontane, Campus University Clinic Brandenburg, Deutsches Angiologie Zentrum Brandenburg-Berlin (DAZB), Brandenburg an der Havel, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Claudia Zemmrich
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Anja Bondke Persson
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Mesud Sacirovic
- Department for Angiology, Center for Internal Medicine I, Brandenburg Medical School Theodor Fontane, Campus University Clinic Brandenburg, Deutsches Angiologie Zentrum Brandenburg-Berlin (DAZB), Brandenburg an der Havel, Germany
| | - Oliver Ritter
- Department for Cardiology, Center for Internal Medicine I, Brandenburg Medical School Theodor Fontane, Campus University Clinic Brandenburg, Brandenburg an der Havel, Germany.,Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Brandenburg Medical School Theodor Fontane, Germany
| | - Eva Buschmann
- Department of Cardiology, University Clinic Graz, Austria
| | - Ivo Buschmann
- Department for Angiology, Center for Internal Medicine I, Brandenburg Medical School Theodor Fontane, Campus University Clinic Brandenburg, Deutsches Angiologie Zentrum Brandenburg-Berlin (DAZB), Brandenburg an der Havel, Germany.,Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Brandenburg Medical School Theodor Fontane, Germany
| | - Philipp Hillmeister
- Department for Angiology, Center for Internal Medicine I, Brandenburg Medical School Theodor Fontane, Campus University Clinic Brandenburg, Deutsches Angiologie Zentrum Brandenburg-Berlin (DAZB), Brandenburg an der Havel, Germany.,Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Brandenburg Medical School Theodor Fontane, Germany
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12
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Zemmrich C, Bramlage P, Hillmeister P, Sacirovic M, Buschmann I. Risk Factor Management in Non-Metropolitan Patients with Coronary and Peripheral Artery Disease - A Protocol of a Prospective, Multi-Center, Quality Improvement Strategy. Vasc Health Risk Manag 2021; 17:267-272. [PMID: 34079274 PMCID: PMC8166327 DOI: 10.2147/vhrm.s307014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) and peripheral arterial disease (PAD) account for significant morbidity and mortality in Germany and are more prevalent in rural, non-metropolitan areas. The goal of this study is to screen patients for their current atherosclerotic status, initiate treatment according to the latest scientific findings using a standardised multimodal approach and track their atherosclerotic status over one year. METHODS AND ANALYSIS This manuscript describes the study protocol of a prospective, multicentre registry of 500 sequential patients with CAD and/or PAD in rural, non-metropolitan regions of Germany. Patients, who visit the "WalkByLab" at the Brandenburg Medical School, Brandenburg, Germany, will be assessed by using our structured, multimodal risk factor management (SMART) tool to evaluate cardiovascular morbidity data, collect information on care and deliver multimodal therapy. The study's primary objective is a cross-sectional examination of the risk profile, diagnostic and therapeutic status in this patient group. Secondary objectives include the assessment of risk factor correlations as well as changes in risk-factor profile and therapy adherence. Patients will be examined at baseline and followed up at three-monthly intervals for one year. Over this time, atherosclerotic risk factors and patient adherence to defined therapeutic strategies will be evaluated. Study completion is estimated to be December 2021. An expansion of this concept into other rural, non-metropolitan neighbouring regions is planned. ETHICS AND DISSEMINATION This registry was assessed and approved by the ethics committee of the Brandenburg State Medical Association, Brandenburg, Germany, and conducted in accordance with the Declaration of Helsinki. The study findings will be disseminated through usual academic channels including meeting presentations and peer-reviewed publications. PROTOCOL VERSION 1.0.
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Affiliation(s)
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Philipp Hillmeister
- Department of Angiology, Medical University Brandenburg, Brandenburg, Germany
| | - Mesud Sacirovic
- Department of Angiology, Medical University Brandenburg, Brandenburg, Germany
| | - Ivo Buschmann
- Department of Angiology, Medical University Brandenburg, Brandenburg, Germany
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13
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Udelnow A, Hawemann M, Buschmann I, Meyer F, Halloul Z. Post-exercise pulsatility index indicates treatment effects in peripheral arterial occlusive disease (PAOD). Wien Klin Wochenschr 2021; 134:148-155. [PMID: 33709183 PMCID: PMC8857004 DOI: 10.1007/s00508-021-01818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/16/2021] [Indexed: 11/05/2022]
Abstract
Background Hypothesis: Post-exercise measurements better discriminate PAOD-patients from healthy persons and they more sensitively detect hemodynamic improvements after treatment procedures than resting measurements. Methods A total of 19 healthy volunteers and 23 consecutive PAOD-patients underwent measurements of peak systolic velocity (PSV), end-diastolic velocity (EDV), minimal diastolic velocity (MDV), time-averaged maximum velocities (TAMAX), resistance index (RI) and pulsatility index (PI) before and after a standard exercise test (at 1, 2, 3, 4 and 5 min) before and after treatment (incl. epidemiological data, PAOD risk factors and comorbidities). Results In resting values, healthy persons and PAOD-patients did not differ significantly in any of the hemodynamic parameters. PSV increased after treatment in PAOD-patients by 5 cm/s (paired t‑test, p: 0.025); however, when the amplitude of autoregulatory changes related to the resting values were calculated, PAOD-patients showed clearly less hemodynamic changes after exercise than healthy persons (p: 0.04; 0.002; <0.001 for PSV, TAMAX and PI, resp.). The time course after exercise was compared by repeated measures of ANOVA. Healthy persons differed significantly in PI, RI and PSV from PAOD patients before and after treatment (p<0.001 each). The PAOD-patients revealed a significantly improved PI after treatment (p: 0.042). The only factor contributing significantly to PI independently from grouping was direct arterial vascularization as compared to discontinuous effects by an obstructed arterial tree. Conclusion Healthy persons cannot be well differentiated from PAOD-patients solely by hemodynamics at rest but by characteristic changes after standard exercise. Treatment effects are reflected by higher PI-values after exercise.
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Affiliation(s)
- Andrej Udelnow
- Dept. of Endovascular and Vascular Surgery/Phlebology, Brandenburg Medical School Theodor Fontane, Dessau Municipal Hospital, Dessau, Germany.
| | - Maria Hawemann
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Ivo Buschmann
- Dept. of Angiology, Brandenburg Medical School Theodor Fontane, Brandenburg Municipal Hospital, Brandenburg, Germany
| | - Frank Meyer
- Dept. of General, Abdominal, Vascular and Transplant Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Zuhir Halloul
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, Magdeburg University Hospital, Magdeburg, Germany
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14
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Lange C, Ngare N, Hillmeister P, Bramlage P, Langhoff R, Buschmann I. Impact of chemotherapeutic effects on the pathophysiology of the arterial wall - insights from peripheral arterial disease. VASA 2020; 50:265-269. [PMID: 33140700 DOI: 10.1024/0301-1526/a000923] [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: 11/19/2022]
Abstract
Systemic antineoplastic treatment agents represent one of the fastest developing medical fields. Oncological treatment is becoming increasingly individualized and new targets with corresponding agents, are constantly being developed. In tandem with this progress, new combinations and algorithms have evolved and patient's outcome have improved. Expanding tumors rely on a growing neovascular network to maintain their increased metabolism, which is caused by an accelerated reproduction rate. Accordingly, interrupting this supply mechanism is a major component of antineoplastic pharmaceutics and is a hallmark of cancer treatment. With advances in cancer treatment, long-term side effects have become an important consideration, especially in cases of neoplasia in young patients. While neuropathy and cardiotoxicity are well documented, vascular adverse events remain poorly understood. The mutual risk factors, like smoking and increased age, complicate the association between the vascular pathology and the earlier antineoplastic therapy. A deeper understanding of the effects of chemotherapy on peripheral arterial disease could lead to more detailed pathophysiological insight into both maladies and to new treatment options.
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Affiliation(s)
- Christoph Lange
- Center for Anesthesiology, Brandenburg Medical School, Brandenburg, Germany
| | - Njeri Ngare
- European Foundation for Vascular & Preventive Medicine, Brandenburg, Germany
| | - Philipp Hillmeister
- Department for Angiology, Center for Internal Medicine I, Brandenburg Medical School, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Ralf Langhoff
- Department Angiology/Vascular Centre, Sankt Gertrauden Hospital, Berlin, Germany
| | - Ivo Buschmann
- Department for Angiology, Center for Internal Medicine I, Brandenburg Medical School, Germany
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15
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Bramlage P, Lanzinger S, Hess E, Fahrner S, Heyer CHJ, Friebe M, Buschmann I, Danne T, Holl RW, Seufert J. Renal function deterioration in adult patients with type-2 diabetes. BMC Nephrol 2020; 21:312. [PMID: 32727401 PMCID: PMC7391505 DOI: 10.1186/s12882-020-01952-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore, in a large group of patients with type-2 diabetes (T2DM), renal function decline in terms of the slope of the estimated glomerular filtration rate (eGFR) over time, and to find out how classical risk factors, such as the presence of hypertension, dyslipidemia and microalbuminuria, affect the renal function. METHODS The analysis included 32,492 adult T2DM patients from the DIVE/DPV registries who had serial eGFR determinations and information on the presence of microalbuminuria, hypertension and dyslipidemia available. RESULTS Patients had a mean age of 66.3 years, 52.6% were male with a mean BMI of 31.7 kg/m2. The mean eGFR was 78.4 ± 21.4 mL/min/1.73m2. The results showed that the prevalence of renal function impairment understood as chronic kidney disease (CKD) is considerable (53.0%) in a population of patients with T2DM and has a high incidence rate of 6.6% within a year. Serial determinations of the eGFR are, however, infrequent (7.8% of all patients) and these patients are characterised by the presence of a high-risk profile for CKD, such as hypertension (88.1%) and dyslipidemia (66.1%). Over a three-year time period, 30.9% of the patients had an eGFR slope of -12 mL/min/1.73m2 or more; and more than a doubled proportion of patients with an eGFR < 30 mL/min/1.73 m2 (3.8% vs. 1.8%; p < 0.001). Hypertension and albuminuria contributed to renal function decline while dyslipidemia did not negatively affect the slope. CONCLUSION CKD is highly prevalent in patients with T2DM. Serial surveillance of the glomerular filtration rate is, however, not established in clinical practice, which would be necessary as indicated by a doubling of patients with an eGFR < 30 mL/min/1.73 m2 within 3 years. Moreover, the use of renin-angiotensin blocking agents was low, pointing at considerable room for improvement. Taken together we conclude that a closer surveillance of patients with diabetes based on the presence of further risk factors is mandatory combined with a mandatory prescription of RAS blocking agents once microalbuminuria and / or renal function deterioration develops.
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Affiliation(s)
- Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661 Cloppenburg, Germany
| | - Stefanie Lanzinger
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V, München-Neuherberg, Germany
| | - Eva Hess
- Diabetologische Schwerpunktpraxis Dres, Hess, Worms, Germany
| | - Simon Fahrner
- Medizinische Klinik, SRH Klinik Sigmaringen, Pfullendorf, Germany
| | | | | | - Ivo Buschmann
- Department of Angiology, Medical University of Brandenburg, Brandenburg, Germany
| | - Thomas Danne
- Kinderkrankenhaus auf der Bult, Diabeteszentrum für Kinder und Jugendliche, Hannover, Germany
| | - Reinhard W. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V, München-Neuherberg, Germany
| | - Jochen Seufert
- Universitätsklinikum Freiburg, Medizinische Fakultät, Freiburg, Germany
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Hillmeister P, Tadic M, Ngare N, Pagonas N, Buschmann I. Exercise and cardiovascular diseases. Acta Physiol (Oxf) 2020; 229:e13476. [PMID: 32311828 DOI: 10.1111/apha.13476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Philipp Hillmeister
- Department for Angiology Center for Internal Medicine I Clinic Brandenburg Brandenburg Medical School (MHB) & Faculty of Health Sciences Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg the Brandenburg Medical School Theodor Fontane and the University of Potsdam Brandenburg an der Havel Germany
| | - Marijana Tadic
- Department for Angiology Center for Internal Medicine I Clinic Brandenburg Brandenburg Medical School (MHB) & Faculty of Health Sciences Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg the Brandenburg Medical School Theodor Fontane and the University of Potsdam Brandenburg an der Havel Germany
| | - Njeri Ngare
- Department for Angiology Center for Internal Medicine I Clinic Brandenburg Brandenburg Medical School (MHB) & Faculty of Health Sciences Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg the Brandenburg Medical School Theodor Fontane and the University of Potsdam Brandenburg an der Havel Germany
| | - Nikolaos Pagonas
- Department for Angiology Center for Internal Medicine I Clinic Brandenburg Brandenburg Medical School (MHB) & Faculty of Health Sciences Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg the Brandenburg Medical School Theodor Fontane and the University of Potsdam Brandenburg an der Havel Germany
- Department for Cardiology Center for Internal Medicine I Clinic Brandenburg Brandenburg Medical School (MHB) Brandenburg an der Havel Germany
| | - Ivo Buschmann
- Department for Angiology Center for Internal Medicine I Clinic Brandenburg Brandenburg Medical School (MHB) & Faculty of Health Sciences Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg the Brandenburg Medical School Theodor Fontane and the University of Potsdam Brandenburg an der Havel Germany
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17
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van Mark G, Tittel SR, Sziegoleit S, Putz FJ, Durmaz M, Bortscheller M, Buschmann I, Seufert J, Holl RW, Bramlage P. Type 2 diabetes in older patients: an analysis of the DPV and DIVE databases. Ther Adv Endocrinol Metab 2020; 11:2042018820958296. [PMID: 33014328 PMCID: PMC7509713 DOI: 10.1177/2042018820958296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The clinical profile differs between old and young patients with type 2 diabetes mellitus (T2DM). We explored, based on a large real-world database, patient and disease characteristics and actual treatment patterns by age. METHODS The analysis was based on the DIVE and DPV registries of patients with T2DM. Patients were analyzed by age groups 50-59 (middle-young), 60-69 (young-old), 70-79 (middle-old), 80-89 (old), and 90 years or more (oldest-old). RESULTS A total of 396,719 patients were analyzed, of which 17.7% were 50-59 years, 27.7% 60-69 years, 34.3% 70-79 years, 18.3% 80-89 years and 2.0% at least 90 years. We found that (a) T2DM in old and oldest-old patients was characterized much less by the presence of metabolic risk factors such as hypertension, obesity, dyslipidemia and smoking than in younger patients; (b) the HbA1c was much lower in oldest-old than in middle-young patients (7.2 ± 1.6% versus 8.0 ± 2.2%; p < 0.001), but it was associated with higher proportions of patients with severe hypoglycemia (7.0 versus 1.6%; p < 0.001); (c) this was potentially associated with the higher and increasing rates of insulin use in older patients (from 17.6% to 37.6%, p < 0.001) and the particular comorbidity profile of these patients, for example, chronic kidney disease (CKD); (d) patients with late diabetes onset had lower HbA1c values, lower bodyweight and less cardiovascular risk factors; (e) patients with a longer diabetes duration had a considerable increase in macrovascular and even more microvascular complications. CONCLUSION In very old patients there is a need for frequent careful routine assessment and a tailored pharmacotherapy in which patient safety is much more important than blood-glucose-lowering efficacy.
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Affiliation(s)
- Gesine van Mark
- Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany
| | - Sascha R. Tittel
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT; Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V., München-Neuherberg, Germany
| | | | | | - Mesut Durmaz
- Praxis für Innere Medizin, Endokrinologie & Diabetologie, Hof, Germany
| | | | - Ivo Buschmann
- Department of Angiology, Medical School Brandenburg (MHB) & Deutsches Angiologie Zentrum Brandenburg Berlin (DAZB), Brandenburg, Germany
| | - Jochen Seufert
- Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Germany
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Patschan D, Patschan S, Buschmann I, Ritter O. Loop Diuretics in Acute Kidney Injury Prevention, Therapy, and Risk Stratification. Kidney Blood Press Res 2019; 44:457-464. [PMID: 31362295 DOI: 10.1159/000501315] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Loop diuretics (LD) are widely used in emergency and intensive care medicine. SUMMARY The substances increase the clearance of electrolytes and water; thus, they allow us to control hypervolemia and to prevent patients from pulmonary edema. LD are also frequently applied to patients with an acute decrease in glomerular filtration rate, namely, acute kidney injury (AKI). Nevertheless, volume depletion may be associated with reduced renal perfusion and possibly slower restitution or even aggravation of kidney dysfunction. Several trials on the preventive or therapeutic efficacy of LD have been published since the early 1970s. Our review article is intended to summarize the most important references related to this topic. In addition, we discuss the diagnostic value of the so-called furosemide stress test. The currently available data indicate that LD may act in a beneficial manner as long as euvolemia is maintained (matched hydration). Key Massages: LD are not beneficial for AKI treatment if kidney-related endpoints are considered. In certain situations, AKI prevention with LD can be associated with favorable outcomes as long as euvolemia is maintained. LD can help to identify AKI subjects at a higher risk of AKI progression, but the exact clinical consequences need to be determined.
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Affiliation(s)
- Daniel Patschan
- Zentrum für Innere Medizin 1 - Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Germany,
| | - Susann Patschan
- Zentrum für Innere Medizin 1 - Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Germany
| | - Ivo Buschmann
- Zentrum für Innere Medizin 1 - Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Germany
| | - Oliver Ritter
- Zentrum für Innere Medizin 1 - Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Germany
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Schwahn-Schreiber C, Breu FX, Rabe E, Buschmann I, Döller W, Lulay GR, Miller A, Valesky E, Reich-Schupke S. [S1 guideline on intermittent pneumatic compression (IPC)]. Hautarzt 2019; 69:662-673. [PMID: 29951853 DOI: 10.1007/s00105-018-4219-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Under the direction of the German Society of Phlebology (Deutsche Gesellschaft für Phlebologie) and in cooperation with other specialist associations, the S1 guideline on intermittent pneumatic compression (IPC) was adopted in January 2018. It replaces the previous guideline from March 2005. The aim of the guideline is to optimize the indication and therapeutic use of IPC in vascular diseases and edema. An extensive literature search of MEDLINE, existing guidelines, and work relevant to the topic was performed. In view of the often methodologically weak study quality with often small numbers of cases and heterogeneous treatment protocols, recommendations can often only be derived from the available data using good clinical practice/expert consensus. Intermittent pneumatic compression is used for thromboembolism prophylaxis, decongestive therapy for edema, and to positively influence arterial and venous circulation to improve clinical symptoms and accelerate ulcer healing in both the outpatient and inpatient care setting. The therapy regimens and devices used depend on the indication and target location. They can be used as outpatient and inpatient devices as well as at home for long-term indications. A target indication is thrombosis prophylaxis. IPC should be used in severe chronic venous insufficiency (stages C4b to C6), in extremity lymphedema as an add-on therapy and in peripheral arterial occlusive disease (PAOD) with stable intermittent claudication or critical ischemia. IPC can be used in post-traumatic edema, therapy-resistant venous edema, lipedema and hemiplegia with sensory deficits and edema. Absolute and relative contraindications to IPC must be taken into account and risks considered and avoided as far as possible. Adverse events are extremely rare if IPC is used correctly. If the indication and application are correct-also as an add-on therapy-it is a safe and effective treatment method, especially for the treatment of the described vascular diseases and edema as well as thrombosis prophylaxis.
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Affiliation(s)
| | - F X Breu
- Venenzentrum am Tegernsee, Tegernseerstr.3, 83703, Gmund am Tegernsee, Deutschland
| | - E Rabe
- Klinik und Poliklinik für Dermatologie, Sigmund Freud Str. 25, 53105, Bonn, Deutschland
| | - I Buschmann
- Klinik für Innere Medizin I - Kardiologie, Pulmologie, Angiologie, Städtisches Klinikum Brandenburg GmbH, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland
| | - W Döller
- , Ingeborg Bachmann-Weg 11, 9400, Wolfsberg, Österreich
| | - G R Lulay
- Klinik für Gefäß- und Endovaskularchirurgie - Phlebologie - Lymphologie - Gefäß- und Lymphzentrum Nord-West, Klinikum Rheine/Mathias-Spital, Frankenburgstr. 31, 48341, Rheine, Deutschland
| | - A Miller
- die hautexperten, Praxis, Wilmersdorfer Str. 62, 10627, Berlin, Deutschland
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - S Reich-Schupke
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Ruhr-Universität Bochum, Hiltroper Landwehr 11-13, 44805, Bochum, Deutschland
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20
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Pagonas N, Vlatsas S, Bauer F, Seibert FS, Sasko B, Buschmann I, Ritter O, Kelesidis T, Westhoff TH. The impact of aerobic and isometric exercise on different measures of dysfunctional high-density lipoprotein in patients with hypertension. Eur J Prev Cardiol 2019; 26:1301-1309. [PMID: 31067131 DOI: 10.1177/2047487319848199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Exercise training increases high-density lipoprotein (HDL) cholesterol, but its effect on HDL function is unclear. In hypertensives, exercise improves endothelial dysfunction, which is related to HDL function. In the present study, we assess for the first time the effects of different exercise modalities on two cell-free assays of HDL function. DESIGN The study was conducted as a prospective randomized controlled trial in 75 hypertensive patients. METHODS Patients were randomized in three groups: (a) handgrip isometric training five times weekly; (b) placebo-handgrip; and (c) aerobic exercise training at least three times per week. HDL function was assessed in serum samples at baseline and after 12 weeks of training by two independent assays that determine the proinflammatory phenotype (haptoglobin content) of a specific amount of HDL (Haptoglobin-HDL [HPHDL]) and oxidized HDL (HDLox) as a measure of reduced antioxidant function of HDL. HDL function measures were normalized by the measures of a pooled control of sera from healthy participants and by HDL-C levels (normalized ratio, no units). RESULTS Aerobic exercise led to significant reduction of the HDLox from 0.99 ± 0.27 to 0.90 ± 0.29 (no units, p = 0.03). The HPHDL did not change in any training group. Changes of HDLox correlated with reduction of the systolic blood pressure only after aerobic exercise (R = 0.64, p = 0.03). CONCLUSIONS Aerobic but not isometric exercise improves the antioxidant function of HDL in patients with hypertension. This improvement correlates positively with reductions of blood pressure.
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Affiliation(s)
- Nikolaos Pagonas
- 1 Department of Cardiology, Medical University of Brandenburg, Germany.,2 Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Germany
| | - Stergios Vlatsas
- 3 Department of Nephrology, Charité - Campus Benjamin Franklin, Berlin, Germany
| | - Frederic Bauer
- 2 Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Germany
| | - Felix S Seibert
- 2 Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Germany
| | - B Sasko
- 1 Department of Cardiology, Medical University of Brandenburg, Germany
| | - I Buschmann
- 4 Department of Angiology, Medical University of Brandenburg, Germany
| | - O Ritter
- 1 Department of Cardiology, Medical University of Brandenburg, Germany
| | - Theodoros Kelesidis
- 5 Department of Medicine, David Geffen School of Medicine, University of California, LA, USA
| | - Timm H Westhoff
- 2 Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Germany
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21
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Hillmeister P, Buschmann I, Bondke Persson A. Listen to your physiologist! Acta Physiol (Oxf) 2019; 225:e13265. [PMID: 30762943 DOI: 10.1111/apha.13265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/09/2019] [Accepted: 02/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Philipp Hillmeister
- Department for Angiology Brandenburg Medical School, Campus Clinic Brandenburg, DAZB Deutsches Angiologie Zentrum Brandenburg-Berlin Brandenburg an der Havel Germany
| | - Ivo Buschmann
- Department for Angiology Brandenburg Medical School, Campus Clinic Brandenburg, DAZB Deutsches Angiologie Zentrum Brandenburg-Berlin Brandenburg an der Havel Germany
| | - Anja Bondke Persson
- Charité– Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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22
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Leigh MB, Kor S, Czantrak P, Sacirovic M, Pagonas N, Hillmeister P, Zeidler G, Bramlage P, Buschmann I. Recanalization of bilateral axillaris/brachialis artery occlusion in a patient with Takayashu arteritis: First case report on using a novel drug-coated nitinol "chocolate" balloon catheter. Clin Case Rep 2018; 6:2490-2494. [PMID: 30564355 PMCID: PMC6293143 DOI: 10.1002/ccr3.1884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/23/2018] [Accepted: 10/02/2018] [Indexed: 11/22/2022] Open
Abstract
When fibrosis develops in Takayasu arteritis (TA), endovascular treatment may become necessary. A 63-year-old woman with TA underwent PTA with a nitinol-structured (chocolate-like) drug-coated balloon (C-DEB PTA). She remained in remission for >1 year. The case may foster research into the use of C-DEB PTA in TA.
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Affiliation(s)
- Mariatu Binta Leigh
- Department of Obstetrics and GynecologyVivantes Hospital NeukoellnBerlinGermany
- European Foundation for Vascular and Preventive Medicine (EFVM)BerlinGermany
| | - Samad Kor
- Department for Angiology, Center for Internal Medicine IBrandenburg Medical School Theodor FontaneBrandenburgGermany
| | - Petar Czantrak
- Department for Angiology, Center for Internal Medicine IBrandenburg Medical School Theodor FontaneBrandenburgGermany
| | - Mesud Sacirovic
- Department for Angiology, Center for Internal Medicine IBrandenburg Medical School Theodor FontaneBrandenburgGermany
| | - Nikolaos Pagonas
- Department for Angiology, Center for Internal Medicine IBrandenburg Medical School Theodor FontaneBrandenburgGermany
| | - Philipp Hillmeister
- Department for Angiology, Center for Internal Medicine IBrandenburg Medical School Theodor FontaneBrandenburgGermany
| | | | - Peter Bramlage
- Department for Angiology, Center for Internal Medicine IBrandenburg Medical School Theodor FontaneBrandenburgGermany
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | - Ivo Buschmann
- European Foundation for Vascular and Preventive Medicine (EFVM)BerlinGermany
- Department for Angiology, Center for Internal Medicine IBrandenburg Medical School Theodor FontaneBrandenburgGermany
- DAZB (Deutsches Angiologie Zentrum Brandenburg‐ Berlin)German Center for Vascular Medicine Brandenburg‐ BerlinGermany
- Charité, Universitätsmedizin BerlinBerlinGermany
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23
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Cantrak P, Sacirovic M, Hillmeister P, Buschmann E, Buschmann I. P1638Establishment of the pilot interdisciplinary LimbPainUnit in the non-metropolitan region of Brandenburg for improving the medical care for Peripheral Arterial Occlusive Disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Cantrak
- MHB - Brandenburg Medical School, Campus Clinic Brandenburg, Brandenburg an der Havel, Germany
| | - M Sacirovic
- MHB - Brandenburg Medical School, Campus Clinic Brandenburg, Brandenburg an der Havel, Germany
| | - P Hillmeister
- MHB - Brandenburg Medical School, Campus Clinic Brandenburg, Brandenburg an der Havel, Germany
| | - E Buschmann
- MHB - Brandenburg Medical School, Campus Clinic Brandenburg, Brandenburg an der Havel, Germany
| | - I Buschmann
- MHB - Brandenburg Medical School, Campus Clinic Brandenburg, Brandenburg an der Havel, Germany
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Buschmann EE, Li L, Brix M, Zietzer A, Hillmeister P, Busjahn A, Bramlage P, Buschmann I. A novel computer-aided diagnostic approach for detecting peripheral arterial disease in patients with diabetes. PLoS One 2018; 13:e0199374. [PMID: 29928037 PMCID: PMC6013098 DOI: 10.1371/journal.pone.0199374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/06/2018] [Indexed: 12/19/2022] Open
Abstract
Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis, with diabetes being one of its most significant risk factors. Owing to medial arterial calcification (MAC), the ankle–brachial index (ABI) is not always a reliable tool for detecting PAD. Arterial Doppler flow parameters, such as systolic maximal acceleration (ACCmax) and relative pulse slope index (RPSI), may serve as effective surrogates to detect stenosis-induced flow alteration. In the present study, ACCmax and RPSI were prospectively evaluated in 166 patients (304 arteries) with clinical suspicion of PAD, including 76 patients with and 90 patients without diabetes. In the overall sample, the sensitivity of ACCmax (69%) was superior to that of ABI (58%) and RPSI (56%). In patients with diabetes, the sensitivity of ACCmax (57%), ABI (56%) and RPSI (57%) were similar, though a parallel test taking both ACCmax and RPSI into account further increased sensitivity to 68%. The specificity (98%) and accuracy (78%) of ACCmax were superior to those of ABI (83% and 70%, respectively), as were the specificity (95%) and accuracy (77%) of RPSI in patients with diabetes. The diagnostic properties of ACCmax and RPSI were superior to those of ABI for detecting PAD in patients with diabetes. Our acceleration algorithm (Gefäßtachometer®) provides a rapid, safe, noninvasive tool for identifying PAD in patients with diabetes.
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Affiliation(s)
- Eva Elina Buschmann
- Dept. for Cardiology, Center of Internal Medicine, Medical University Graz, Graz, Austria
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- * E-mail:
| | - Lulu Li
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Michèle Brix
- Department of Physiology Charité Benjamin Franklin, Berlin, Germany
| | - Andreas Zietzer
- Richard-Thoma Laboratories for Arteriogenesis, Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Berlin, Germany
- Medizinische Klinik II, Universität Bonn, Bonn, Germany
| | - Philipp Hillmeister
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Peter Bramlage
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Ivo Buschmann
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Physiology Charité Benjamin Franklin, Berlin, Germany
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25
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Patschan D, Buschmann I, Ritter O, Kribben A. Cell-Based Therapies in Acute Kidney Injury (AKI). Kidney Blood Press Res 2018; 43:673-681. [PMID: 29734169 DOI: 10.1159/000489624] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/26/2018] [Indexed: 11/19/2022] Open
Abstract
Acute kidney injury frequently occurs in hospitalized patients all over the world. The prognosis remains poor since specific therapies for promoting kidney regeneration/repair are still missing. In recent years cell-based strategies have improved AKI outcomes under experimental circumstances. Four groups of cells, each of them displaying certain biological and functional characteristics have been evaluated in AKI, induced Pluripotent Stem Cells (iPSCs), Spermatagonial Stem Cells (SSCs), Proangiogenic Cells (PACs) and Endothelial Colony Forming Cells (ECFCs), and Mesenchymal Stem Cells (MSCs). All of these have been documented to stabilize either parameters of kidney excretory dysfunction and/or certain morphological parameters. The mechanisms responsible for AKI protection include direct (cell incorporation) and indirect processes, the latter being mediated by humoral factors and particularly by the production of so-called extracellular vesicles. Cell-derived vesicular organelles have been shown to carry pro-regenerative micro-RNA molecules which stabilize the vascular and tubular function. The first trials in humans have been initiated, the majority of such trials employs MSCs. However, any transfer of cell-based strategies in the clinical practice is potentially associated with significant difficulties. These include cell availability, tolerance and competence. The article intends to summarize essential informations about all of the four populations mentioned above and to discuss implications for the management of human AKI.
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Affiliation(s)
- Daniel Patschan
- Innere Medizin I, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hoch-schule Brandenburg, Brandenburg, Germany,
| | - Ivo Buschmann
- Innere Medizin I, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hoch-schule Brandenburg, Brandenburg, Germany
| | - Oliver Ritter
- Innere Medizin I, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hoch-schule Brandenburg, Brandenburg, Germany
| | - Andreas Kribben
- Klinik für Nephrologie, Universitätsklinikum Essen, Essen, Germany
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Picard F, Panagiotidou P, Wolf-Pütz A, Buschmann I, Buschmann E, Steffen M, Klein RM. Usefulness of Individual Shear Rate Therapy, New Treatment Option for Patients With Symptomatic Coronary Artery Disease. Am J Cardiol 2018; 121:416-422. [PMID: 29274808 DOI: 10.1016/j.amjcard.2017.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 01/12/2023]
Abstract
The aim of this study was to elucidate if patients with coronary artery disease (CAD), who fail to respond to revascularization procedures, can improve from individual shear rate therapy (ISRT). The ISRT is an adaptation of the external counterpulsation with lower individual treatment pressures based on Doppler-ultrasound measurements during counterpulsation. In contrast to the external counterpulsation therapy, the ISRT is based on the detection of the individual intra-arterial shear rate. Here we report about the first clinical trial of 31 patients with CAD who were enrolled for 30 sessions of ISRT. To determine the therapeutic effect of ISRT we measured the exercise capacity, the arterial stiffness, the aortic wave reflection, and the 24-hour blood pressure before and after 30 treatment sessions. After 6 weeks of accomplished ISRT the walking distance during the 6-minute walking test extended by 78 m (p = 0.007). The total exercise duration in the exercise stress electrocardiogram increased by 84 seconds (p = 0.012) but not the stress intensity (p = 0.086). The pulse wave velocity decreased by 1.2 m/s (p = 0.004) and demonstrated a decrease in arterial stiffness. Pulse wave analysis results demonstrated a progressive decrease in central blood pressure by 12 mmHg (p = 0.008), in pulse pressure by 9 mmHg (p = 0.005), and in augmentation pressure by 5.3 mmHg (p = 0.004). The 24-hour blood pressure decreased systolic by 15 mmHg (p <0.001) and diastolic by 8 mmHg (p = 0.033). The patients also benefited subjectively followed by New York Heart Association and Canadian Cardiovascular Society classifications. In conclusion, the ISRT is an effective treatment for patients with CAD to improve cardiac fitness, arterial stiffness, and to reduce blood pressure.
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Affiliation(s)
- Frauke Picard
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany.
| | - Petroula Panagiotidou
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Ana Wolf-Pütz
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Ivo Buschmann
- Department for Cardiology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany; Medical University Brandenburg (MHB), Center for Internal Medicine, Department for Angiology, Campus Brandenburg Germany, Germany
| | - Eva Buschmann
- Department for Cardiology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany; Medical University Brandenburg (MHB), Center for Internal Medicine, Department for Angiology, Campus Brandenburg Germany, Germany
| | - Maximilian Steffen
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Rolf Michael Klein
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany; Department of Cardiology, University Hospital Witten/Herdecke, Germany
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Leigh MB, John-Cole V, Kamara M, Koroma AP, Koroma MM, Emuveyan EE, Bramlage P, Buschmann I. A Triple Obstetric Challenge of Thoracopagus-Type Conjoined Twins, Eclampsia, and Obstructed Labor: A Case Report from Sub-Saharan Africa. Case Rep Obstet Gynecol 2017; 2017:6815748. [PMID: 29359057 PMCID: PMC5735603 DOI: 10.1155/2017/6815748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022] Open
Abstract
Conjoined twins are very rarely seen. We present a case of thoracopagus that was undiagnosed prior to delivery and combined with eclampsia and obstructed labor in a low-resource setting in sub-Saharan Africa. A 27-year-old pregnant woman was presented to the maternity emergency unit of Princess Christian Maternity Hospital (PCMH) in Freetown at term in labor. Upon admission, the patient was awake and orientated and presented a blood pressure of 180/120 mmHg and a protein value of 3+ on urine dipstick test. Clinical examination-ultrasound was not available-led to the admission diagnosis: obstructed labor with intrauterine fetal death and preeclampsia. Application of Hydralazine 5 mg (i.v.) under close blood pressure monitoring was performed. Under spontaneous progression of labor, one head of the yet unknown conjoined twin was born. The patient developed eclamptic fits. Ceasing of seizures was achieved after implementing the loading dose of the MgSO4 protocol. A vaginal examination led to the unexpected diagnosis of conjoined twins. An emergency cesarean section under general anesthesia via a longitudinal midline incision was performed immediately. The born head was repositioned vaginally. The stillborn conjoined twins presented a female thoracopagus type that seemed to involve the heart. After 8 weeks, the woman was clinically fully recovered.
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Affiliation(s)
- Mariatu Binta Leigh
- Department of Obstetrics and Gynecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
- Center for Internal Medicine I, Department for Angiology, Medical School Brandenburg Theodor Fontane (MHB), Campus Brandenburg, Brandenburg, Germany
| | - Valerie John-Cole
- Department of Obstetrics and Gynecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Mike Kamara
- Department of Obstetrics and Gynecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Alimamy Philip Koroma
- Department of Obstetrics and Gynecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Michael Momoh Koroma
- Department of Anesthesia, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Edward Ejiro Emuveyan
- Department of Obstetrics and Gynecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Akoka, Lagos, Nigeria
| | - Peter Bramlage
- Center for Internal Medicine I, Department for Angiology, Medical School Brandenburg Theodor Fontane (MHB), Campus Brandenburg, Brandenburg, Germany
| | - Ivo Buschmann
- Center for Internal Medicine I, Department for Angiology, Medical School Brandenburg Theodor Fontane (MHB), Campus Brandenburg, Brandenburg, Germany
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Li L, Hillmeister P, Buschmann E, Brix M, Zietzer A, Buschmann I. P1409A novel computer-aided diagnostic approach to detect peripheral arterial disease in diabetic populations. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1409] [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: 11/14/2022] Open
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Hillmeister P, Liebeskind D, Ritter O, Buschmann I, Hetzel A, Reinhard M, Buschmann E. P4305Short-term external counterpulsation augments cerebral blood flow and tissue oxygenation in chronic cerebrovascular occlusive disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4305] [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: 11/14/2022] Open
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Zietzer A, Buschmann EE, Janke D, Li L, Brix M, Meyborg H, Stawowy P, Jungk C, Buschmann I, Hillmeister P. Acute physical exercise and long-term individual shear rate therapy increase telomerase activity in human peripheral blood mononuclear cells. Acta Physiol (Oxf) 2017; 220:251-262. [PMID: 27770498 DOI: 10.1111/apha.12820] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/28/2016] [Accepted: 10/17/2016] [Indexed: 01/03/2023]
Abstract
AIM Physical activity is a potent way to impede vascular ageing. However, patients who suffer from peripheral artery disease (PAD) are often unable to exercise adequately. For those patients, we have developed individual shear rate therapy (ISRT), which is an adaptation of external counterpulsation and enhances endovascular fluid shear stress to increase collateral growth (arteriogenesis). To evaluate the effects of physical exercise and ISRT on the telomere biology of peripheral blood mononuclear cells (PBMCs), we conducted two clinical trials. METHODS In the ISRT-1 study, we assessed PBMC telomerase activity in 26 young healthy volunteers upon a single (short-term) ISRT session and a single treadmill running session. In the ISRT-2 study, we investigated PBMC telomere biology of 14 elderly patients with PAD, who underwent 30 h of (long-term) ISRT within a 5-week period. RESULTS We demonstrate that telomerase activity significantly increased from 39.84 Total Product Generated (TPG) Units ± 6.15 to 58.10 TPG ± 10.46 upon a single treadmill running session in healthy volunteers. In the ISRT-2 trial, PBMC telomerase activity and the mRNA expression of the telomere-protective factor TRF2 increased from 40.87 TPG ± 4.45 to 60.98 TPG ± 6.83 and 2.10-fold ± 0.40, respectively, upon long-term ISRT in elderly patients with PAD. CONCLUSION In summary, we show that acute exercise and long-term ISRT positively affect PBMC telomerase activity, which is indicative for an improved regenerative potential of immune cells and vascular tissues. Long-term ISRT also enhances the gene expression of the telomere-protective factor TRF2.
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Affiliation(s)
- A. Zietzer
- Experimental and Clinical Research Center (ECRC); Richard-Thoma-Laboratories for Arteriogenesis; Center for Cardiovascular Research; Charité - Universitätsmedizin Berlin; Campus Mitte (CCM); Berlin Germany
| | - E. E. Buschmann
- Department for Angiology; Center for Internal Medicine I; Medical University of Brandenburg (MHB); Brandenburg an der Havel Brandenburg Germany
- Institute of Physiology; Charité - Universitätsmedizin Berlin; Campus Mitte (CCM); Berlin Germany
| | - D. Janke
- Berlin-Brandenburg School for Regenerative Therapies (BSRT); Charité - Universitaetsmedizin Berlin; Campus Virchow Klinikum (CVK) and Institute of Chemistry and Biochemistry; Freie Universität Berlin; Berlin Germany
| | - L. Li
- Experimental and Clinical Research Center (ECRC); Richard-Thoma-Laboratories for Arteriogenesis; Center for Cardiovascular Research; Charité - Universitätsmedizin Berlin; Campus Mitte (CCM); Berlin Germany
- Department for Angiology; Center for Internal Medicine I; Medical University of Brandenburg (MHB); Brandenburg an der Havel Brandenburg Germany
| | - M. Brix
- Experimental and Clinical Research Center (ECRC); Richard-Thoma-Laboratories for Arteriogenesis; Center for Cardiovascular Research; Charité - Universitätsmedizin Berlin; Campus Mitte (CCM); Berlin Germany
| | - H. Meyborg
- Department of Medicine/Cardiology; Deutsches Herzzentrum Berlin; Berlin Germany
| | - P. Stawowy
- Department of Medicine/Cardiology; Deutsches Herzzentrum Berlin; Berlin Germany
| | - C. Jungk
- Experimental and Clinical Research Center (ECRC); Richard-Thoma-Laboratories for Arteriogenesis; Center for Cardiovascular Research; Charité - Universitätsmedizin Berlin; Campus Mitte (CCM); Berlin Germany
| | - I. Buschmann
- Experimental and Clinical Research Center (ECRC); Richard-Thoma-Laboratories for Arteriogenesis; Center for Cardiovascular Research; Charité - Universitätsmedizin Berlin; Campus Mitte (CCM); Berlin Germany
- Department for Angiology; Center for Internal Medicine I; Medical University of Brandenburg (MHB); Brandenburg an der Havel Brandenburg Germany
| | - P. Hillmeister
- Experimental and Clinical Research Center (ECRC); Richard-Thoma-Laboratories for Arteriogenesis; Center for Cardiovascular Research; Charité - Universitätsmedizin Berlin; Campus Mitte (CCM); Berlin Germany
- Department for Angiology; Center for Internal Medicine I; Medical University of Brandenburg (MHB); Brandenburg an der Havel Brandenburg Germany
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Brix M, Buschmann EE, Zietzer A, Jaurigue JA, Li L, Jungk C, Buschmann I, Janke D, Hillmeister P. Long-term individual shear rate therapy counterpulsation enhances plasma nitrite release in patients with PAD. VASA 2016; 46:37-45. [PMID: 27960614 DOI: 10.1024/0301-1526/a000600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Individual shear rate therapy (ISRT) has been designed as a novel non-invasive treatment option for peripheral artery disease (PAD) patients and has been shown to improve endothelial function and walking distance. The aim of this study was to elucidate the impact of ISRT on the level of nitric oxide in patient blood plasma and the expression of related molecular markers in peripheral blood mononuclear cells (PBMCs). Molecular diagnostic tests were performed for two ISRT trials. PATIENTS AND METHODS In ISRT-1 26 healthy subjects underwent one session of treadmill training and one session of ISRT respectively in a cross-over design. In ISRT-2 14 PAD patients with a stable intermittent claudication underwent a 30 hours long-term treatment. Plasma nitrite release as well as the mRNA expression of NOS2 and key regulators of the kallikrein-kinin system were measured in PBMCs at different time points. RESULTS Short-term ISRT revealed significantly decreased NOS2 expression in PBMCs of healthy volunteers and PAD patients. Long-term ISRT, in turn, demonstrated a significant plasma nitrite increase in PAD patients. CONCLUSIONS We verified that long-term ISRT stimulates the vascular system and exerts a comparable effect to physical exercise in regards to NO release, which coincide with recent findings regarding an improvement of endothelial function. However, further studies are necessary to investigate the role for circulating leukocytes.
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Affiliation(s)
- Michèle Brix
- a These authors contributed equally.,2 Charité-Universitaetsmedizin Berlin (CCM), Center for Cardiovascular Research, Richard-Thoma-Laboratories for Arteriogenesis Berlin, Berlin, Germany
| | - Eva-Elina Buschmann
- a These authors contributed equally.,1 Medical University of Brandenburg (MHB), Center for Internal Medicine I, Dept. for Angiology, Brandenburg an der Havel, Germany.,2 Charité-Universitaetsmedizin Berlin (CCM), Center for Cardiovascular Research, Richard-Thoma-Laboratories for Arteriogenesis Berlin, Berlin, Germany.,3 Charité-Universitaetsmedizin Berlin (CCM), Institute of Physiology, Berlin, Germany
| | - Andreas Zietzer
- 2 Charité-Universitaetsmedizin Berlin (CCM), Center for Cardiovascular Research, Richard-Thoma-Laboratories for Arteriogenesis Berlin, Berlin, Germany
| | - Jonnel Anthony Jaurigue
- 2 Charité-Universitaetsmedizin Berlin (CCM), Center for Cardiovascular Research, Richard-Thoma-Laboratories for Arteriogenesis Berlin, Berlin, Germany
| | - Lulu Li
- 1 Medical University of Brandenburg (MHB), Center for Internal Medicine I, Dept. for Angiology, Brandenburg an der Havel, Germany.,2 Charité-Universitaetsmedizin Berlin (CCM), Center for Cardiovascular Research, Richard-Thoma-Laboratories for Arteriogenesis Berlin, Berlin, Germany
| | - Constantin Jungk
- 2 Charité-Universitaetsmedizin Berlin (CCM), Center for Cardiovascular Research, Richard-Thoma-Laboratories for Arteriogenesis Berlin, Berlin, Germany
| | - Ivo Buschmann
- 1 Medical University of Brandenburg (MHB), Center for Internal Medicine I, Dept. for Angiology, Brandenburg an der Havel, Germany.,2 Charité-Universitaetsmedizin Berlin (CCM), Center for Cardiovascular Research, Richard-Thoma-Laboratories for Arteriogenesis Berlin, Berlin, Germany.,3 Charité-Universitaetsmedizin Berlin (CCM), Institute of Physiology, Berlin, Germany
| | - Doreen Janke
- a These authors contributed equally.,4 Charité-Universitaetsmedizin Berlin (CVK), Berlin-Brandenburg School for Regenerative Therapies Berlin, Berlin, Germany.,5 FU Berlin, Institute for Chemistry and Biochemistry, Berlin, Germany
| | - Philipp Hillmeister
- a These authors contributed equally.,1 Medical University of Brandenburg (MHB), Center for Internal Medicine I, Dept. for Angiology, Brandenburg an der Havel, Germany.,2 Charité-Universitaetsmedizin Berlin (CCM), Center for Cardiovascular Research, Richard-Thoma-Laboratories for Arteriogenesis Berlin, Berlin, Germany.,3 Charité-Universitaetsmedizin Berlin (CCM), Institute of Physiology, Berlin, Germany
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van Royen N, Piek JJ, Legemate DA, Schaper W, Oskam J, Atasever B, Voskuil M, Ubbink D, Schirmer SH, Buschmann I, Bode C, Buschmann EE. Design of the START-trial: STimulation of ARTeriogenesis using subcutaneous application of GM-CSF as a new treatment for peripheral vascular disease. A randomized, double-blind, placebo-controlled trial. Vasc Med 2016; 8:191-6. [PMID: 14989560 DOI: 10.1191/1358863x03vm496oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/21/2023]
Abstract
Peripheral arterial disease (PAD) affects a large percentage of the elderly population. Standard invasive treatment, apart from risk factor modulation, consists of bypass surgery or percutaneous transluminal angioplasty. However, symptomatic recurrence rates are high for both procedures and a substantial part of the patient population with PAD is not a candidate for invasive revascularization due to complexity of the lesion and/or co-morbidity. Therapeutic arteriogenesis has been proposed as an alternative treatment option. The present paper describes the design of the START-trial. This trial aims to determine the potential of the proarteriogenic substance granulocyte/macrophage colony stimulating factor (GM-CSF) to increase maximal walking distance in patients with intermittent claudication. A double-blinded, randomized, placebo-controlled study will be performed in 40 patients with peripheral obstructive arterial disease Rutherford grade I, category 2 or 3, that are candidates for bypass surgery or percutaneous transluminal angioplasty. Based on pharmacokinetic and toxicologic studies, a dose of 10 mg/kg will be used. Patients will be treated for a period of 14 days on each consecutive day, with the last injection applied on day 12. The primary endpoint will be the change in walking distance from day 0 to day 14 as assessed by an exercise treadmill test. Secondary endpoints will be the ankle-brachial index at rest and after exercise, the pain-free walking distance and cutaneous microcirculatory alterations as assessed by laser Doppler fluxmetry. Iliac flow reserve and conductance will be measured by magnetic resonance imaging.
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Affiliation(s)
- Niels van Royen
- Department of Cardiology, University of Amsterdam, The Netherlands.
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Buschmann* EE, Brix* M, Li L, Doreen J, Zietzer A, Li M, Buschmann I, Hillmeister P. Adaptation of external counterpulsation based on individual shear rate therapy improves endothelial function and claudication distance in peripheral artery disease. VASA 2016; 45:317-24. [DOI: 10.1024/0301-1526/a000544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: External counterpulsation therapy enhances blood flow and was shown to improve endothelial function and quality of life in coronary artery disease patients. However, high pressures of up to 300 mmHg may lead to malperfusion of the ischaemic limb. To improve the clinical outcome of patients with peripheral artery disease (PAD), we adjusted external counterpulsation and developed a novel non-invasive approach termed individual shear rate therapy (ISRT). Patients and methods: In the present study, 14 patients with a Fontaine stage IIb and femoral-popliteal PAD underwent 30 hours of ISRT over 5 weeks. For ISRT, individual treatment pressures that do not exceed 160 mmHg were assessed by Doppler flow parameters during counterpulsation (individual shear rate diagnosis) in order to enhance and maximise peripheral perfusion. The study aimed to enhance peripheral perfusion and evaluate the primary clinical endpoint endothelial function, as well as to perform preliminary analysis of the ankle brachial index (ABI) and walking distance. Results: Doppler flow measurements in the lower limb (ankle) validated that maximum blood flow velocity during systole and acceleration doubled during ISRT. Study results demonstrated that long-term ISRT significantly increased flow-mediated dilation (FMD) in the brachial artery (0.13+/- 0.09 mm to 0.38+/- 0.05 mm; p < 0.05), while nitromediated dilation (0.36+/- 0.10 mm to 0.45+/- 0.08 mm) remained and common femoral artery FMD did not reach statistical significance (0.38+/- 0.08 mm to 0.67+/- 0.19 mm; p<0.05). Initial claudication distance considerably improved for all patients after 30 hours of ISRT (92.6 +/- 8.2 metres to 280+/- 101.3 metres, p<0.05), just like the absolute claudication distance, which showed a more than 2.5-fold increase (167.8+/- 18.1 metres to 446.7+/- 133.3 metres; p<0.05). The ABI did not improve (0.58+/- 0.03 to 0.65+/- 0.04). Conclusions: Our data demonstrate that long-term ISRT is a potential novel non-invasive treatment to improve endothelial function and absolute pain-free walking distance for PAD patients.
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Affiliation(s)
- Eva-Elina Buschmann*
- , Department for Angiology, Brandenburg/ Havel, Germany
- Department of Physiology, Charité Benjamin Franklin Berlin, Germany
| | - Michele Brix*
- Richard-Thoma Laboratories for Arteriogenesis, Experimental and Clinical Research Center (ECRC), Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Germany
| | - Lulu Li
- , Department for Angiology, Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Experimental and Clinical Research Center (ECRC), Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Germany
| | - Janke Doreen
- Richard-Thoma Laboratories for Arteriogenesis, Experimental and Clinical Research Center (ECRC), Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies (BSRT), Charité Universitaetsmedizin Berlin, Germany and Institute of Chemistry and Biochemistry, FU Berlin, Germany
| | - Andreas Zietzer
- Richard-Thoma Laboratories for Arteriogenesis, Experimental and Clinical Research Center (ECRC), Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Germany
| | - Meijing Li
- Richard-Thoma Laboratories for Arteriogenesis, Experimental and Clinical Research Center (ECRC), Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Germany
| | - Ivo Buschmann
- , Department for Angiology, Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Experimental and Clinical Research Center (ECRC), Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Germany
| | - Philipp Hillmeister
- , Department for Angiology, Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Experimental and Clinical Research Center (ECRC), Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Germany
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Schulte KL, Kralj I, Gissler HM, Bagnaschino LA, Buschmann I, Pernès JM, Haage P, Goverde P, Beregi JP, Válka M, Boudny J, Geibel T, Velkoborsky M, Zähringer M, Paetzel C, Fanelli F, Müller-Hülsbeck S, Zeller T, Langhoff R. MISAGO 2: One-Year Outcomes After Implantation of the Misago Self-Expanding Nitinol Stent in the Superficial Femoral and Popliteal Arteries of 744 Patients. J Endovasc Ther 2012; 19:774-84. [DOI: 10.1583/jevt-12-3861mr.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Singer E, Imfeld S, Staub D, Hoffmann U, Buschmann I, Labs KH, Jaeger KA. Effect of aspirin versus clopidogrel on walking exercise performance in intermittent claudication-a double-blind randomized multicenter trial. J Am Heart Assoc 2012; 1:51-6. [PMID: 23130118 PMCID: PMC3487315 DOI: 10.1161/jaha.111.000067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 12/16/2011] [Indexed: 11/16/2022]
Abstract
Background This study sought to determine possible effects of different antiplatelet therapies on walking exercise performance in intermittent claudication. Aspirin, in contrast to clopidogrel, interferes with processes that increase collateral conductance in an ischemic animal model. Methods and Results Patients with stable intermittent claudication were recruited from 21 centers in Switzerland and Germany and randomized to either aspirin or clopidogrel treatment. They participated in a 3-month rehabilitation program (electronically monitored, home-based, 1-hour daily walking sessions at a speed of approximately 120 steps/min). Walking distance was assessed by treadmill tests (3.2 km/h; 12% grade) at baseline and after 12 weeks. A total of 229 of 259 patients with a mean age of 66.2±7.7 years completed the study according to the protocol. A total of 24.5% were females, 20.1% diabetics, and 85.6% were active/ex-smokers. The baseline characteristics were a median (interquartile range) ankle/brachial index of 0.69 (0.57±0.8), an initial claudication distance (ICD) of 98 m (70 to 151 m), and an absolute claudication distance (ACD) of 162 m (113 to 302 m). Training resulted in a median increase of initial claudication distance by 33.5 m (33.3%) in the clopidogrel group and 29 m (33.9%) in the aspirin group. The values for absolute claudication distance were 60.5 m (34.9%) and 75 m (35.3%), respectively (pICD=0.42 and pACD=0.66). Conclusions Treatment with aspirin did not show a difference in initial claudication distance or absolute claudication distance improvements compared with clopidogrel after a 3-month walking rehabilitation program. (J Am Heart Assoc. 2012;1:51-56.) Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00189618, URL: https://EudraCT.ema.europa.eu, Unique identifier: 2004-005041-35
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Affiliation(s)
- Elisabeth Singer
- Department of Angiology, University Hospital, University of Basel, Switzerland (E.S., S.I., D.S., K.-H.L., K.A.J.)
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Singer E, Imfeld S, Staub D, Hoffmann U, Buschmann I, Labs KH, Jaeger KA. Effect of Aspirin Versus Clopidogrel on Walking Exercise Performance in Intermittent Claudication: A Double-Blind Randomized Multicenter Trial. J Am Heart Assoc 2012. [DOI: 10.1161/xjaha.111.000067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hillmeister P, Gatzke N, Dülsner A, Bader M, Schadock I, Hoefer I, Hamann I, Infante-Duarte C, Jung G, Troidl K, Urban D, Stawowy P, Frentsch M, Li M, Nagorka S, Wang H, Shi Y, le Noble F, Buschmann I. Arteriogenesis Is Modulated By Bradykinin Receptor Signaling. Circ Res 2011; 109:524-33. [DOI: 10.1161/circresaha.111.240986] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [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: 11/16/2022]
Abstract
Rationale:
Positive outward remodeling of pre-existing collateral arteries into functional conductance arteries, arteriogenesis, is a major endogenous rescue mechanism to prevent cardiovascular ischemia. Collateral arterial growth is accompanied by expression of kinin precursor. However, the role of kinin signaling via the kinin receptors (B1R and B2R) in arteriogenesis is unclear.
Objective:
The purpose of this study was to elucidate the functional role and mechanism of bradykinin receptor signaling in arteriogenesis.
Methods and Results:
Bradykinin receptors positively affected arteriogenesis, with the contribution of B1R being more pronounced than B2R. In mice, arteriogenesis upon femoral artery occlusion was significantly reduced in B1R mutant mice as evidenced by reduced microspheres and laser Doppler flow perfusion measurements. Transplantation of wild-type bone marrow cells into irradiated B1R mutant mice restored arteriogenesis, whereas bone marrow chimeric mice generated by reconstituting wild-type mice with B1R mutant bone marrow showed reduced arteriogenesis after femoral artery occlusion. In the rat brain 3-vessel occlusion arteriogenesis model, pharmacological blockade of B1R inhibited arteriogenesis and stimulation of B1R enhanced arteriogenesis. In the rat, femoral artery ligation combined with arterial venous shunt model resulted in flow-driven arteriogenesis, and treatment with B1R antagonist R715 decreased vascular remodeling and leukocyte invasion (monocytes) into the perivascular tissue. In monocyte migration assays, in vitro B1R agonists enhanced migration of monocytes.
Conclusions:
Kinin receptors act as positive modulators of arteriogenesis in mice and rats. B1R can be blocked or therapeutically stimulated by B1R antagonists or agonists, respectively, involving a contribution of peripheral immune cells (monocytes) linking hemodynamic conditions with inflammatory pathways.
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Affiliation(s)
- Philipp Hillmeister
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Nora Gatzke
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - André Dülsner
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Michael Bader
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Ines Schadock
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Imo Hoefer
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Isabell Hamann
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Carmen Infante-Duarte
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Georg Jung
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Kerstin Troidl
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Daniel Urban
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Philipp Stawowy
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Marco Frentsch
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Meijing Li
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Stephanie Nagorka
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Haitao Wang
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Yu Shi
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Ferdinand le Noble
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
| | - Ivo Buschmann
- From the Experimental and Clinical Research Center of the Charite and the Max Delbrueck Center for Molecular Medicine (P.H., A.D., M.L., H.W., Y.S., F.l.N., I.B.), Berlin, Germany; Center for Cardiovascular Research (P.H., N.G., A.D., M.L., S.N., I.B.), Charité, Berlin, Germany; Center for Stroke Research Berlin (P.H., F.l.N., I.B.), Charité, Berlin, Germany; Experimental Neuroimmunology (I.H., C.I.D.), Max Delbrueck Center (M.B., I.S.), Berlin, Germany; Department of Experimental Cardiology (I.H.),
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Bondke Persson A, Buschmann EE, Lindhorst R, Troidl K, Langhoff R, Schulte KL, Buschmann I. Therapeutic arteriogenesis in peripheral arterial disease: combining intervention and passive training. VASA 2011; 40:177-87. [PMID: 21638246 DOI: 10.1024/0301-1526/a000092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The prevalence of peripheral arterial disease (PAD) is on the rise in an aging population, significantly affecting quality of life, morbidity and mortality. Besides medical treatment and surgical or interventional revascularization, supervised exercise programs are a primary treatment modality for PAD. Training may significantly increase pain-free walking time (+ 180 %) while avoiding the associated complications of (repeated) invasive revascularization. Training effects rely on an improvement of risk factor management, muscle function, economy of movement, hemorheology, vascular growth and collateral vessel growth. Exercise training upregulates pulsatile fluid shear stress on the vascular endothelium, prompting an improvement of endothelial function (eNOS, NO) and an outgrowth of preexistent collaterals (arteriogenesis) to functional conductance arteries outside the ischemic area at risk. However, the necessary intense minimum training intervals compromise patient compliance, and the impaired functional status of many PAD patients limits active exercise training. Strategies are necessary to a) increase training compliance, b) make the benefits of exercise training available to patients unable to exercise actively and c) therapeutically enhance the adaptive growth of biological bypasses (arteriogenesis). A modified form of passive exercise training derived from enhanced external counterpulsation (low-pressure ECP) which was originally developed for the therapy of heart failure, may prove to be an option for this group of patients. Therefore, this review article suggests a tailored combination therapy, consisting of a facilitating revascularization procedure to restore arterial inflow, succeeded by supervised exercise training, which has yielded promising therapeutic results in clinical trials. Further studies, using appropriate imaging methods and controls, are under way to (a) establish the efficacy of low-pressure EECP in PAD patients and (b) to directly correlate training-induced improvements of collateral flow to the functional improvements seen with exercise training.
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Affiliation(s)
- A Bondke Persson
- Institut für Vegetative Physiologie, Charité Universitaetsmedizin Berlin, Germany.
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Hillmeister P, Noble F, Gatzke N, Dülsner A, Bader M, Schadock I, Troidl K, Jung G, Bondke A, Höfer I, Buschmann I. The Role of Bradykinin Receptors in Arteriogenesis: from molecular concepts to therapeutic modulation. FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.1092.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Philipp Hillmeister
- Experimental and Clinical Research CenterCharite Berlin & Max‐Delbrueck Center for Molecular MedicineBerlinGermany
- Center for Stroke Research Berlin
| | - Ferdinand Noble
- Experimental and Clinical Research CenterCharite Berlin & Max‐Delbrueck Center for Molecular MedicineBerlinGermany
- Center for Stroke Research Berlin
| | | | | | - Michael Bader
- Max‐Delbrueck Center for Molecular MedicineBerlinGermany
| | - Ines Schadock
- Max‐Delbrueck Center for Molecular MedicineBerlinGermany
| | - Kerstin Troidl
- Max‐Planck‐Institute for Heart and Lung ResearchBad NauheimGermany
| | - Georg Jung
- Max‐Planck‐Institute for Heart and Lung ResearchBad NauheimGermany
| | | | - Imo Höfer
- University of UtrechtUtrechtNetherlands
| | - Ivo Buschmann
- Department of Internal Medicine/CardiologyCharite‐MitteBerlinGermany
- Experimental and Clinical Research CenterCharite Berlin & Max‐Delbrueck Center for Molecular MedicineBerlinGermany
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Jungehuelsing G, Liman T, Brunecker P, Ebel A, Endres M, Buschmann I, Pagonas N, Buschmann E. Does External Counterpulsation Augment Mean Cerebral Blood Flow in the Healthy Brain? Effects of External Counterpulsation on Middle Cerebral Artery Flow Velocity and Cerebrovascular Regulatory Response in Healthy Subjects. Cerebrovasc Dis 2010; 30:612-7. [DOI: 10.1159/000319891] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 07/27/2010] [Indexed: 11/19/2022] Open
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Buschmann I, Pries A, Styp-Rekowska B, Hillmeister P, Loufrani L, Henrion D, Shi Y, Duelsner A, Hoefer I, Gatzke N, Wang H, Lehmann K, Ulm L, Ritter Z, Hauff P, Hlushchuk R, Djonov V, van Veen T, le Noble F. Pulsatile shear and Gja5 modulate arterial identity and remodeling events during flow-driven arteriogenesis. Development 2010; 137:2187-96. [PMID: 20530546 DOI: 10.1242/dev.045351] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [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: 12/21/2022]
Abstract
In the developing chicken embryo yolk sac vasculature, the expression of arterial identity genes requires arterial hemodynamic conditions. We hypothesize that arterial flow must provide a unique signal that is relevant for supporting arterial identity gene expression and is absent in veins. We analyzed factors related to flow, pressure and oxygenation in the chicken embryo vitelline vasculature in vivo. The best discrimination between arteries and veins was obtained by calculating the maximal pulsatile increase in shear rate relative to the time-averaged shear rate in the same vessel: the relative pulse slope index (RPSI). RPSI was significantly higher in arteries than veins. Arterial endothelial cells exposed to pulsatile shear in vitro augmented arterial marker expression as compared with exposure to constant shear. The expression of Gja5 correlated with arterial flow patterns: the redistribution of arterial flow provoked by vitelline artery ligation resulted in flow-driven collateral arterial network formation and was associated with increased expression of Gja5. In situ hybridization in normal and ligation embryos confirmed that Gja5 expression is confined to arteries and regulated by flow. In mice, Gja5 (connexin 40) was also expressed in arteries. In the adult, increased flow drives arteriogenesis and the formation of collateral arterial networks in peripheral occlusive diseases. Genetic ablation of Gja5 function in mice resulted in reduced arteriogenesis in two occlusion models. We conclude that pulsatile shear patterns may be central for supporting arterial identity, and that arterial Gja5 expression plays a functional role in flow-driven arteriogenesis.
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Affiliation(s)
- Ivo Buschmann
- Experimental and Clinical Research Center (ECRC) of the Charite and the Max-Delbrueck Center for Molecular Medicine (MDC), D13125 Berlin-Buch, Germany
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Schuchardt M, Toelle M, Huang T, Wiedon A, Van Der Giet M, Mill C, George S, Jeremy J, Santulli G, Illario M, Cipolletta E, Sorriento D, Del Giudice C, Anastasio A, Trimarco B, Iaccarino G, Jobs A, Wagner C, Kurtz A, De Wit C, Koller A, Suvorava T, Weber M, Dao V, Kojda G, Tsaousi A, Lyon C, Williams H, George S, Barth N, Loot A, Fleming I, Keul P, Lucke S, Graeler M, Heusch G, Levkau B, Biessen E, De Jager S, Bermudez-Pulgarin B, Bot I, Abia R, Van Berkel T, Renger A, Noack C, Zafiriou M, Dietz R, Bergmann M, Zelarayan L, Hammond J, Hamelet J, Van Assche T, Belge C, Vanderper A, Langin D, Herijgers P, Balligand J, Perrot A, Neubert M, Dietz R, Posch M, Oezcelik C, Posch M, Waldmuller S, Perrot A, Berger F, Scheffold T, Bouvagnet P, Ozcelik C, Lebreiro A, Martins E, Lourenco P, Cruz C, Martins M, Bettencourt P, Maciel M, Abreu-Lima C, Pilichou K, Bauce B, Rampazzo A, Carturan E, Corrado D, Thiene G, Basso C, Piccini I, Fortmueller L, Kuhlmann M, Schaefers M, Carmeliet P, Kirchhof P, Fabritz L, Sanchez J, Rodriguez-Sinovas A, Agullo E, Garcia-Dorado D, Lymperopoulos A, Rengo G, Gao E, Zincarelli C, Koch W, Fontes-Sousa A, Silva S, Gomes M, Ferreira P, Leite-Moreira A, Capuano V, Ferron L, Ruchon Y, Ben Mohamed F, Renaud JF, Morgan P, Falcao-Pires I, Goncalves N, Gavina C, Pinho S, Moura C, Amorim M, Pinho P, Leite-Moreira A, Christ T, Molenaar P, Diez A, Ravens U, Kaumann A, Kletsiou E, Giannakopoulou M, Bozas E, Iliodromitis E, Anastasiou-Nana M, Papathanassoglou E, Chottova Dvorakova M, Mistrova E, Perez N, Slavikova J, Hynie S, Sida P, Klenerova V, Massaro M, Scoditti E, Carluccio M, Storelli C, Distante A, De Caterina R, Cingolani H, Zakrzewicz A, Hoffmann C, Hohberg M, Chlench S, Maroski J, Drab M, Siegel G, Pries A, Farrell K, Holt C, Zahradnikova A, Schrot G, Ibatov A, Wilck N, Fechner M, Arias A, Meiners S, Baumann G, Stangl V, Stangl K, Ludwig A, Polakova E, Christ A, Eijgelaar W, Daemen M, Li X, Penfold M, Schall T, Weber C, Schober A, Hintenberger R, Kaun C, Zahradnik I, Pfaffenberger S, Maurer G, Huber K, Wojta J, Demyanets S, Titov V, Nazari-Jahantigh M, Weber C, Schober A, Chin-Dusting J, Zahradnikova A, Vaisman B, Khong S, Remaley A, Andrews K, Hoeper A, Khalid A, Fuglested B, Aasum E, Larsen T, Titov V, Fluschnik N, Carluccio M, Scoditti E, Massaro M, Storelli C, Distante A, De Caterina R, Diebold I, Petry A, Djordjevic T, Belaiba R, Sossalla S, Fratz S, Hess J, Kietzmann T, Goerlach A, O'shea K, Chess D, Khairallah R, Walsh K, Stanley W, Falcao-Pires I, Ort K, Goncalves N, Van Der Velden J, Moreira-Goncalves D, Paulus W, Niessen H, Perlini S, Leite-Moreira A, Azibani F, Tournoux F, Fazal L, Neef S, Polidano E, Merval R, Chatziantoniou C, Samuel J, Delcayre C, Azibani F, Tournoux F, Fazal L, Polidano E, Merval R, Hasenfuss G, Chatziantoniou C, Samuel J, Delcayre C, Mgandela P, Brooksbank R, Maswanganyi T, Woodiwiss A, Norton G, Makaula S, Sartiani L, Maier L, Bucciantini M, Spinelli V, Coppini R, Russo E, Mugelli A, Cerbai E, Stefani M, Sukumaran V, Watanabe K, Ma M, Weinert S, Thandavarayan R, Azrozal W, Sari F, Shimazaki H, Kobayashi Y, Roleder T, Golba K, Deja M, Malinowski M, Wos S, Poitz D, Stieger P, Grebe M, Tillmanns H, Preissner K, Sedding D, Ercan E, Guven A, Asgun F, Ickin M, Ercan F, Herold J, Kaplan A, Yavuz O, Bagla S, Yang Y, Ma Y, Liu F, Li X, Huang Y, Kuka J, Vilskersts R, Schmeisser A, Vavers E, Liepins E, Dambrova M, Mariero L, Rutkovskiy A, Stenslokken K, Vaage J, Duerr G, Suchan G, Heuft T, Strasser J, Klaas T, Zimmer A, Welz A, Fleischmann B, Dewald O, Voelkl J, Haubner B, Kremser C, Mayr A, Klug G, Braun-Dullaeus R, Reiner M, Pachinger O, Metzler B, Pisarenko O, Shulzhenko V, Pelogeykina Y, Khatri D, Studneva I, Barnucz E, Loganathan S, Nazari-Jahantigh M, Hirschberg K, Korkmaz S, Merkely B, Karck M, Szabo G, Bencsik P, Gorbe A, Kocsis G, Csonka C, Csont T, Weber C, Shamloo M, Woodburn K, Ferdinandy P, Szucs G, Kupai K, Csonka C, Csont C, Ferdinandy P, Kocsisne Fodor G, Bencsik P, Schober A, Fekete V, Varga Z, Monostori P, Turi S, Ferdinandy P, Csont T, Leuner A, Eichhorn B, Ravens U, Morawietz H, Babes E, Babes V, Popescu M, Ardelean A, Rus M, Bustea C, Gwozdz P, Csanyi G, Luzak B, Gajda M, Mateuszuk L, Chmura-Skirlinska A, Watala C, Chlopicki S, Kierzkowska I, Sulicka J, Kwater A, Strach M, Surdacki A, Siedlar M, Grodzicki T, Olieslagers S, Pardali L, Tchaikovski V, Ten Dijke P, Waltenberger J, Renner M, Redwan B, Winter M, Panzenboeck A, Jakowitsch J, Sadushi-Kolici R, Bonderman D, Lang I, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Oliviero C, Bellandi F, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Casprini P, Bellandi F, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Amato M, Bellandi F, Molins B, Pena E, Badimon L, Ferreiro Gutierrez J, Ueno M, Alissa R, Dharmashankar K, Capodanno D, Desai B, Bass T, Angiolillo D, Chabielska E, Gromotowicz A, Szemraj J, Stankiewicz A, Zakrzeska A, Mohammed S, Molla F, Soldo A, Russo I, Germano G, Balconi G, Staszewsky L, Latini R, Lynch F, Austin C, Prendergast B, Keenan D, Malik R, Izzard A, Heagerty A, Czikora A, Lizanecz E, Rutkai I, Boczan J, Porszasz R, Papp Z, Edes I, Toth A, Colantuoni A, Vagnani S, Lapi D, Maroz-Vadalazhskaya N, Koslov I, Shumavetz V, Glibovskaya T, Ostrovskiy Y, Koutsiaris A, Tachmitzi S, Kotoula M, Giannoukas A, Tsironi E, Rutkai I, Czikora A, Darago A, Orosz P, Megyesi Z, Edes I, Papp Z, Toth A, Eichhorn B, Schudeja S, Matschke K, Deussen A, Ravens U, Castro M, Cena J, Walsh M, Schulz R, Poddar K, Rha S, Ramasamy S, Park J, Choi C, Seo H, Park C, Oh D, Lebreiro A, Martins E, Almeida J, Pimenta S, Bernardes J, Machado J, Abreu-Lima C, Sabatasso S, Laissue J, Hlushchuk R, Brauer-Krisch E, Bravin A, Blattmann H, Michaud K, Djonov V, Hirschberg K, Tarcea V, Pali S, Korkmaz S, Loganathan S, Merkely B, Karck M, Szabo G, Pagliani L, Faggin E, Rattazzi M, Puato M, Presta M, Grego F, Deriu G, Pauletto P, Kaiser R, Albrecht K, Schgoer W, Theurl M, Beer A, Wiedemann D, Steger C, Bonaros N, Kirchmair R, Kharlamov A, Cabaravdic M, Breuss J, Uhrin P, Binder B, Fiordaliso F, Balconi G, Mohammed S, Maggioni M, Biondi A, Masson S, Cervo L, Latini R, Francke A, Herold J, Soenke W, Strasser R, Braun-Dullaeus R, Hecht N, Vajkoczy P, Woitzik J, Hackbusch D, Gatzke N, Duelsner A, Tsuprykov O, Slavic S, Buschmann I, Kappert K, Massaro M, Scoditti E, Carluccio M, Storelli C, Distante A, De Caterina R, Barandi L, Harmati G, Simko J, Horvath B, Szentandrassy N, Banyasz T, Magyar J, Nanasi P, Kaya A, Uzunhasan I, Yildiz A, Yigit Z, Turkoglu C, Doisne N, Zannad N, Hivert B, Cosnay P, Maupoil V, Findlay I, Virag L, Kristof A, Koncz I, Szel T, Jost N, Biliczki P, Papp J, Varro A, Bukowska A, Skopp K, Hammwoehner M, Huth C, Bode-Boeger S, Goette A, Workman A, Dempster J, Marshall G, Rankin A, Revnic C, Ginghina C, Revnic F, Yakushev S, Petrushanko I, Makhro A, Segato Komniski M, Mitkevich V, Makarov A, Gassmann M, Bogdanova A, Rutkovskiy A, Mariero L, Stenslokken K, Valen G, Vaage J, Dizayee S, Kaestner S, Kuck F, Piekorz R, Hein P, Matthes J, Nurnberg B, Herzig S, Hertel F, Switalski A, Bender K, Kienitz MC, Pott L, Fornai L, Angelini A, Erika Amstalden Van Hove E, Fedrigo M, Thiene G, Heeren R, Kruse M, Pongs O, Lehmann H, Martens-Lobenhoffer J, Hammwoehner M, Roehl F, Bukowska A, Bode-Boeger S, Goette A, Radicke S, Cotella C, Sblattero D, Schaefer M, Ravens U, Wettwer E, Santoro C, Seyler C, Kulzer M, Zitron E, Scholz E, Welke F, Thomas D, Karle C, Schmidt K, Radicke S, Dobrev D, Ravens U, Wettwer E, Houshmand N, Menesi D, Ravens U, Wettwer E, Cotella D, Papp J, Varro A, Szuts V, Szuts V, Houshmand N, Puskas L, Jost N, Virag L, Kiss I, Deak F, Varro A, Tereshchenko S, Gladyshev M, Kalachova G, Syshchik N, Gogolashvili N, Dedok E, Evert L, Wenzel J, Brandenburger M, Bogdan R, Richardt D, Reppel M, Hescheler J, Dendorfer A, Terlau H, Wiegerinck R, Galvez-Monton C, Jorge E, Martinez R, Ricart E, Cinca J, Bagavananthem Andavan G, Lemmens Gruber R, Brack K, Coote J, Ng G, Daimi H, Haj Khelil A, Neji A, Ben Hamda K, Maaoui S, Aranega A, Chibani J, Franco Jaime D, Tanko AS, Brack K, Coote J, Ng G, Doisne N, Hivert B, Cosnay P, Findlay I, Maupoil V, Daniel JM, Bielenberg W, Stieger P, Tillmanns H, Sedding D, Fortini C, Toffoletto B, Fucili A, Beltrami A, Fiorelli V, Francolini G, Ferrari R, Beltrami C, Castellani C, Ravara B, Tavano R, Thiene G, Vettor R, De Coppi P, Papini E, Angelini A, Molla F, Soldo A, Biondi A, Staszewsky L, Russo I, Gunetti M, Fagioli F, Latini R, Suffredini S, Sartiani L, Stillitano F, Mugelli A, Cerbai E, Krausgrill B, Halbach M, Soemantri S, Schenk K, Lange N, Hescheler J, Saric T, Muller-Ehmsen J, Kavanagh D, Zhao Y, Yemm A, Kalia N, Wright E, Farrell K, Wallrapp C, Geigle P, Lewis A, Stratford P, Malik N, Holt C, Krausgrill B, Raths M, Halbach M, Schenk K, Hescheler J, Muller-Ehmsen J, Zagallo M, Luni C, Serena E, Cimetta E, Zatti S, Giobbe G, Elvassore N, Serena E, Cimetta E, Zaglia T, Zatti S, Zambon A, Gordon K, Elvassore N, Mioulane M, Foldes G, Ali N, Harding S, Gorbe A, Szunyog A, Varga Z, Pirity M, Rungaruniert S, Dinnyes A, Csont T, Ferdinandy P, Foldes G, Mioulane M, Iqbal A, Schneider MD, Ali N, Harding S, Babes E, Babes V, Khodjaeva E, Ibadov R, Khalikulov K, Mansurov A, Astvatsatryan A, Senan M, Astvatsatryan A, Senan M, Nemeth A, Lenkey Z, Ajtay Z, Cziraki A, Sulyok E, Horvath I, Lobenhoffer J, Bode-Boger S, Li J, He Y, Yang X, Wang F, Xu H, Li X, Zhao X, Lin Y, Juszynski M, Ciszek B, Jablonska A, Stachurska E, Ratajska A, Atkinson A, Inada S, Li J, Sleiman R, Zhang H, Boyett M, Dobrzynski H, Fedorenko O, Hao G, Atkinson A, Yanni J, Buckley D, Anderson R, Boyett M, Dobrzynski H, Ma Y, Ma X, Hu Y, Yang Y, Huang D, Liu F, Huang Y, Liu C, Jedrzejczyk T, Balwicki L, Wierucki L, Zdrojewski T, Makhro A, Agarkova I, Vogel J, Gassmann M, Bogdanova A, Korybalska K, Pyda M, Witowski J, Ibatov A, Sozmen N, Seymen A, Tuncay E, Turan B, Huang Y, Ma Y, Yang Y, Liu F, Chen B, Li X, Houston-Feenstra L, Chiong JR, Jutzy K, Furundzija V, Kaufmann J, Kappert K, Meyborg H, Fleck E, Stawowy P, Ksiezycka-Majczynska E, Lubiszewska B, Kruk M, Kurjata P, Ruzyllo W, Ibatov A, Driesen R, Coenen T, Fagard R, Sipido K, Petrov V, Aksentijevic D, Lygate C, Makinen K, Sebag-Montefiore L, Medway D, Schneider J, Neubauer S, Gasser R, Holzwart E, Rainer P, Von Lewinski D, Maechler H, Gasser S, Roessl U, Pieske B, Krueger J, Kintscher U, Kappert K, Podramagi T, Paju K, Piirsoo A, Roosimaa M, Kadaja L, Orlova E, Ruusalepp A, Seppet E, Auquier J, Ginion A, Hue L, Horman S, Beauloye C, Vanoverschelde J, Bertrand L, Fekete V, Zvara A, Pipis J, Konya C, Csonka C, Puskas L, Csont T, Ferdinandy P, Gasser S, Rainer P, Holzwart E, Roessl U, Kraigher-Krainer E, Von Lewinksi D, Pieske B, Gasser R, Gonzalez-Loyola A, Barba I, Rodriguez-Sinovas A, Fernandez-Sanz C, Agullo E, Ruiz-Meana M, Garcia-Dorado D, Forteza M, Bodi Peris V, Monleon D, Mainar L, Morales J, Moratal D, Trapero I, Chorro F, Leszek P, Sochanowicz B, Szperl M, Kolsut P, Piotrowski W, Rywik T, Danko B, Kruszewski M, Stanley W, Khairallah R, Khanna N, O'shea K, Kristian T, Hecker P, Des Rosiers R, Fiskum G, Fernandez-Alfonso M, Guzman-Ruiz R, Somoza B, Gil-Ortega M, Attane C, Castan-Laurell I, Valet P, Ruiz-Gayo M, Maroz-Vadalazhskaya N, Denissevich T, Shumavetz V, Ostrovskiy Y, Schrepper A, Schwarzer M, Amorim P, Schoepe M, Mohr F, Doenst T, Chiellini G, Ghelardoni S, Saba A, Marchini M, Frascarelli S, Raffaelli A, Scanlan T, Zucchi R, Van Den Akker N, Molin D, Kolk F, Jeukens F, Olde Engberink R, Waltenberger J, Post M, Van Den Akker N, Molin D, Verbruggen S, Schulten H, Post M, Waltenberger J, Rochais F, Kelly R, Aberg M, Johnell M, Wickstrom M, Siegbahn A, Dimitrakis P, Groppalli V, Ott D, Seifriz F, Suter T, Zuppinger C, Kashcheyeu Y, Mueller R, Wiesen M, Saric T, Gruendemann D, Hescheler J, Herzig S, Falcao-Pires I, Fontes-Sousa A, Lopes-Conceicao L, Bras-Silva C, Leite-Moreira A, Bukauskas F, Palacios-Prado N, Norheim F, Raastad T, Thiede B, Drevon C, Haugen F, Lindner D, Westermann D, Zietsch C, Schultheiss HP, Tschoepe C, Horn M, Graham H, Hall M, Richards M, Clarke J, Dibb K, Trafford A, Cheng CF, Lin H, Eigeldiger-Berthou S, Buntschu P, Frobert A, Flueck M, Tevaearai H, Kadner A, Mikhailov A, Torrado M, Centeno A, Lopez E, Lourido L, Castro Beiras A, Popov T, Srdanovic I, Petrovic M, Canji T, Kovacevic M, Jovelic A, Sladojevic M, Panic G, Kararigas G, Fliegner D, Regitz-Zagrosek V, De La Rosa Sanchez A, Dominguez J, Sedmera D, Franco D, Aranega A, Medunjanin S, Burgbacher F, Schmeisser A, Strasser R, Braun-Dullaeus R, Li X, Ma Y, Yang Y, Liu F, Han W, Chen B, Zhang J, Gao X, Bayliss C, Song W, Stuckey D, Dyer E, Leung MC, Monserrat L, Marston S, Sorriento D, Santulli G, Fusco A, Trimarco B, Iaccarino G, Revnic C, Ginghina C, Revnic F, Paillard M, Liang J, Strub G, Gomez L, Hait N, Allegood J, Lesnefsky E, Spiegel S, Zuchi C, Coiro S, Bettini M, Ciliberti G, Mancini I, Tritto I, Becker L, Ambrosio G, Adam T, Sharp S, Opie L, Lecour S, Khaliulin I, Parker J, Halestrap A, Kandasamy A, Schulz R, Schoepe M, Schwarzer M, Schrepper A, Osterholt M, Amorim P, Mohr F, Doenst T, Fernandez-Sanz C, Ruiz-Meana M, Miro-Casas E, Agullo E, Boengler K, Schulz R, Garcia-Dorado D, Menazza S, Canton M, Sheeran F, Di Lisa F, Pepe S, Borchi E, Manni M, Bargelli V, Giordano C, D'amati G, Cerbai E, Nediani C, Raimondi L, Micova P, Balkova P, Kolar F, Neckar J, Novak F, Novakova O, Schuchardt M, Toelle M, Pruefer N, Pruefer J, Jankowski V, Jankowski J, Van Der Giet M, Han W, Su Y, Zervou S, Aksentijevic D, Lygate C, Neubauer S, Seidel B, Korkmaz S, Radovits T, Hirschberg K, Loganathan S, Barnucz E, Karck M, Szabo G, Aggeli I, Kefaloyianni E, Beis I, Gaitanaki C, Lacerda L, Somers S, Opie L, Lecour S, Brack K, Coote J, Ng G, Paur H, Nikolaev V, Lyon A, Harding S, Bras-Silva C. Sunday, 18 July 2010. Cardiovasc Res 2010. [DOI: 10.1093/cvr/cvq176] [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: 11/13/2022] Open
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Carrão ACR, Chilian WM, Yun J, Kolz C, Rocic P, Lehmann K, van den Wijngaard JPHM, van Horssen P, Spaan JAE, Ohanyan V, Pung YF, Buschmann I. Stimulation of coronary collateral growth by granulocyte stimulating factor: role of reactive oxygen species. Arterioscler Thromb Vasc Biol 2009; 29:1817-22. [PMID: 19542022 DOI: 10.1161/atvbaha.109.186445] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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
OBJECTIVE The purpose of this study was to determine whether G-CSF promotes coronary collateral growth (CCG) and decipher the mechanism for this stimulation. METHODS AND RESULTS In a rat model of repetitive episodic myocardial ischemia (RI, 40 seconds LAD occlusion every 20 minutes for 2 hours and 20 minutes, 3 times/d for 5 days) CCG was deduced from collateral-dependent flow (flow to LAD region during occlusion). After RI, G-CSF (100 microg/kg/d) increased CCG (P<0.01) (0.47+/-0.15) versus vehicle (0.14+/-0.06). Surprisingly, G-CSF treatment without RI increased CCG (0.57+/-0.18) equal to G-CSF+RI. We evaluated ROS by dihydroethidine (DHE) fluorescence (LV injection, 60 microg/kg, during two episodes of ischemia). DHE fluorescence was double in G-CSF+RI versus vehicle+RI (P<0.01), and even higher in G-CSF without RI (P<0.01). Interestingly, the DHE signal did not colocalize with myeloperoxidase (immunostaining, neutrophil marker) but appeared in cardiac myocytes. The study of isolated cardiac myocytes revealed the cytokine stimulates ROS which elicit production of angiogenic factors. Apocynin inhibited G-CSF effects both in vivo and in vitro. CONCLUSIONS G-CSF stimulates ROS production directly in cardiomyocytes, which plays a pivotal role in triggering adaptations of the heart to ischemia including growth of the coronary collaterals.
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Abstract
The vascular system is generated and maintained by reactions of blood vessels to stimuli of several types. The basic outline of the vascular system is determined during development by genetic programming, guided by the unique temporal and spatial patterns of structural and molecular features available in the embryo. With establishment of blood flow, control of vascular development is increasingly taken over by feedback signals derived from vascular function, including blood flow and pressure, in addition to those derived from the metabolic state of the tissue. Mechanical and molecular signals also govern the post-natal structural adaptation of vascular beds in response to functional requirements, both during normal, physiological conditions (growth, exercise) and during pathophysiological conditions including ischaemic diseases and tumour growth. The orderly structure of vascular beds emerges as each vessel segment reacts to the local conditions and stimuli that it experiences, according to a common set of genetically determined responses. In this process of angioadaptation, the properties and architecture of vascular beds are determined by the continuous interplay between vascular and cellular reactions to haemodynamic and molecular signals and the functional implications of these reactions, constituting a complex feedback system. Here, studies on vascular development and adaptation in response to haemodynamic and molecular factors are integrated, with emphasis on arterial-venous network development and structural adaptation of vessels.
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Affiliation(s)
- Ferdinand le Noble
- Department of Angiogenesis and Cardiovascular Pathology, Max Delbrueck Center for Molecular Medicine , Robert Roessle Strasse 10, 13125 Berlin, Germany.
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Jankowski V, Patzak A, Herget-Rosenthal S, Tran TNA, Lai EY, Günthner T, Buschmann I, Zidek W, Jankowski J. Uridine adenosine tetraphosphate acts as an autocrine hormone affecting glomerular filtration rate. J Mol Med (Berl) 2008; 86:333-40. [PMID: 18250997 DOI: 10.1007/s00109-008-0306-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 12/04/2007] [Accepted: 12/11/2007] [Indexed: 10/22/2022]
Abstract
Recently, uridine adenosine tetraphosphate (Up(4)A) was described as a strong vasoconstrictor released from endothelial cells after stimulation with mechanical stress. In this study, we isolated and identified Up(4)A from kidney tissue, and we characterized the essential varying effects of Up(4)A on the afferent and efferent arterioles. Porcine and human kidney tissue was fractionated by size exclusion chromatography, affinity chromatography, anion exchange chromatography and reverse phase chromatography. In fractions purified to homogeneity, Up(4)A was identified by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS), MALDI-LIFT fragment mass spectrometry (MALDI-TOF/TOF MS), retention-time comparison and enzymatic cleavage analysis. We analysed the release of Up(4)A from cultivated renal proximal tubule cells after stimulation of protein kinase C with oleoyl-2-acetyl-sn-glycerol (OAG). Up(4)A was identified in renal tissue, and the effect of Up(4)A on the vascular tone of isolated perfused afferent and efferent arterioles was tested. Stimulation of tubule cells with OAG increased the release rate of Up(4)A from tubule cells about tenfold. Up(4)A acts as a strong vasoconstrictive mediator on afferent arterioles, but has no significant effect on the tone of efferent arterioles, suggesting a functional role of Up(4)A as an autocrine hormone for glomerular perfusion. Because of the predominant effect of the Up(4)A on afferent arterioles, we assume that Up(4)A may decrease glomerular perfusion, intra-glomerular pressure and, hence, glomerular filtration rate. The release of Up(4)A from renal tubular cells may be an additional mechanism whereby tubular cells could affect renal perfusion. Up(4)A release may further contribute to renal vascular autoregulation mechanisms. In conclusion, as Up(4)A occurs in renal tissue and has marked effects on afferent but not efferent arterioles, Up(4)A may play a role in renal hemodynamics and possibly blood pressure regulation.
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Affiliation(s)
- V Jankowski
- Campus Benjamin Franklin, Medizinische Klinik IV, Charité-Universitaetsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany
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Abstract
Background: This paper introduces a proof-of-concept trial in progress, supposedly providing new important information on anti-platelet drugs used in patients with peripheral arterial disease (PAD). The Arteriogenesis Competence Network (Art.Net.) of the Universities of Basel, Berlin, and Freiburg could show in animal models that Aspirin (ASA), in contrast to Clopidogrel, inhibits the formation of an appropriate collateral network (arteriogenesis). This trial is supposed to reproduce the animal data in man. Materials and methods: In a prospective, double-blind, parallel-group, bi-national (D, CH), multicentre trial, 250 patients will be randomised to either 100 mg ASA or 75 mg Clopidogrel once daily. Patients will then enter a three months structured rehabilitation programme with daily physical training supposed to induce arteriogenesis. The claudication distances will be tested as the primary endpoint at baseline, 6 weeks, and at 3 months. Also, the 24h physical activity profile of all patients will be electronically documented. Conclusions: This trial will provide information on potential disadvantages when using ASA in PAD patients. If data emerging from animal pharmacology can be reproduced in man, the present standard scheme of anti-aggregant treatment in PAD patients has to be reconsidered.
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Affiliation(s)
- E Singer
- Department of Angiology, University of Basel Medical School, Petersgraben 4, CH-4031 Basel, Switzerland.
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Grundmann S, Hoefer I, Ulusans S, Bode C, Oesterle S, Tijssen JG, Piek JJ, Buschmann I, van Royen N. Granulocyte-macrophage colony-stimulating factor stimulates arteriogenesis in a pig model of peripheral artery disease using clinically applicable infusion pumps. J Vasc Surg 2006; 43:1263-9. [PMID: 16765251 DOI: 10.1016/j.jvs.2006.02.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 02/26/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND A growing number of patients suffer from peripheral artery disease (PAD). Current therapies are often limited by the extent of vascular pathology and the occurrence of restenosis after angioplasty. The stimulatory effect of growth factor administration on collateral vessel formation (arteriogenesis) has evolved as a potential new treatment for this patient group. Granulocyte-macrophage colony-stimulating factor (GM-CSF) was shown to stimulate arteriogenesis in small-animal models and in a pilot study in patients with coronary artery disease. Although a recent clinical study demonstrated disappointing results after subcutaneous GM-CSF application in patients with PAD, we hypothesized that intra-arterial cytokine application using implantable infusion pumps might well stimulate arteriogenesis in a large-species model of peripheral vascular disease. We also aimed to compare continuous and intermittent infusion regimens and to validate experimental and clinically available measurements of collateral artery growth. METHODS Twenty-four pigs underwent unilateral occlusion of the right femoral artery and received either GM-CSF continuously, GM-CSF intermittently, or phosphate-buffered saline (PBS). After 1 week, collateral conductance was determined under maximal vasodilatation with adenosine and by using a pump-driven extracorporal shunt system. RESULTS Conductance showed a significant stimulatory effect of GM-CSF on arteriogenesis (collateral conductance [mL/min/mm Hg]: PBS, 37.7 +/- 5.4; GM-CSF continuous, 69.2 +/- 12.5; GM-CSF intermittent, 71.5 +/- 11.1). Flow measurements under reactive hyperemia were consistent with these results (flow occluded/non-occluded hind limb: PBS, 40.5% +/- 9.1%; GM-CSF continuous, 48.9% +/- 3.9%; GM-CSF intermittent, 48.7% +/- 4.4%). Measurements of ankle/brachial indices were not sensitive enough to detect the differences in collateral growth between the three groups. CONCLUSION These results demonstrate the proarteriogenic properties of GM-CSF in larger animal species, revealing comparable efficacy of continuous and intermittent intra-arterial infusion. Furthermore, we provide evidence that implantable pumps offer a possible means for the intra-arterial application of growth factors. Intra-arterial application of GM-CSF might be a future treatment option for vascular occlusive disease. Finally, we show that in the peripheral circulation, pressure measurements alone have a low sensitivity to determine the effects of proarteriogenic therapy compared with flow or combined flow-pressure measurements.
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Affiliation(s)
- Sebastian Grundmann
- Department of Cardiology and Angiology, University Hospital Freiburg, Freiburg, Germany.
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48
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Abstract
Stroke is the leading cause of disability and a major cause of death in Germany and the western world. Ischemic stroke involves different pathophysiologic mechanisms such as thromboembolic vascular occlusion, cerebral micro- or macroangiopathy, extracranial arterial stenosis, and cardiac embolism. Experimental and clinical studies have shown that arteriogenesis, the adaptive growth of pre-existing collateral arteries, can be therapeutically enhanced in peripheral circulation and the heart. We examined the consequences to time course and hemodynamics of brain arteriogenesis in a chronic hypoperfusion model following systemic administration of the hemopoietic growth factor called granulocyte macrophage colony stimulating factor (GM-CSF). Treatment with GM-CSF led to the growth of intracranial collateral arteries, which improved the cerebral hemodynamic reserve and significantly reduced energy failure when brains were additionally challenged by hypotension. Therapeutically induced arteriogenesis may be of considerable interest for preventing infarction in patients with uncompensated cerebrovascular disease.
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Affiliation(s)
- H-J Busch
- Abteilung Kardiologie und Angiologie, Innere Medizin III, Forschergruppe für experimentelle und klinische Arteriogenese, Universitätsklinikum Freiburg.
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49
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van Royen N, Schirmer SH, Atasever B, Behrens CYH, Ubbink D, Buschmann EE, Voskuil M, Bot P, Hoefer I, Schlingemann RO, Biemond BJ, Tijssen JG, Bode C, Schaper W, Oskam J, Legemate DA, Piek JJ, Buschmann I. START Trial: a pilot study on STimulation of ARTeriogenesis using subcutaneous application of granulocyte-macrophage colony-stimulating factor as a new treatment for peripheral vascular disease. Circulation 2005; 112:1040-6. [PMID: 16087795 DOI: 10.1161/circulationaha.104.529552] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Granulocyte-macrophage colony-stimulating factor (GM-CSF) was recently shown to increase collateral flow index in patients with coronary artery disease. Experimental models showed beneficial effects of GM-CSF on collateral artery growth in the peripheral circulation. Thus, in the present study, we evaluated the effects of GM-CSF in patients with peripheral artery disease. METHODS AND RESULTS A double-blinded, randomized, placebo-controlled study was performed in 40 patients with moderate or severe intermittent claudication. Patients were treated with placebo or subcutaneously applied GM-CSF (10 microg/kg) for a period of 14 days (total of 7 injections). GM-CSF treatment led to a strong increase in total white blood cell count and C-reactive protein. Monocyte fraction initially increased but thereafter decreased significantly as compared with baseline. Both the placebo group and the treatment group showed a significant increase in walking distance at day 14 (placebo: 127+/-67 versus 184+/-87 meters, P=0.03, GM-CSF: 126+/-66 versus 189+/-141 meters, P=0.04) and at day 90. Change in walking time, the primary end point of the study, was not different between groups. No change in ankle-brachial index was found on GM-CSF treatment at day 14 or at day 90. Laser Doppler flowmetry measurements showed a significant decrease in microcirculatory flow reserve in the control group (P=0.03) and no change in the GM-CSF group. CONCLUSIONS The present study does not support the use of GM-CSF for treatment of patients with moderate or severe intermittent claudication. Issues that need to be addressed are dosing, the selection of patients, and potential differences between GM-CSF effects in the coronary and the peripheral circulation.
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Affiliation(s)
- Niels van Royen
- Department of Cardiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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50
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Hua J, Dobrucki LW, Sadeghi MM, Zhang J, Bourke BN, Cavaliere P, Song J, Chow C, Jahanshad N, van Royen N, Buschmann I, Madri JA, Mendizabal M, Sinusas AJ. Noninvasive Imaging of Angiogenesis With a
99m
Tc-Labeled Peptide Targeted at α
v
β
3
Integrin After Murine Hindlimb Ischemia. Circulation 2005; 111:3255-60. [PMID: 15956134 DOI: 10.1161/circulationaha.104.485029] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Noninvasive imaging strategies play a critical role in assessment of the efficacy of angiogenesis therapies. The α
v
β
3
integrin is activated in angiogenic vessels and represents a potential target for noninvasive imaging of angiogenesis.
Methods and Results—
We evaluated a
99m
Tc-labeled peptide (NC100692) targeted at α
v
β
3
integrin for imaging in an established murine model of angiogenesis induced by hindlimb ischemia. Control mice (n=9) or mice with surgical right femoral artery occlusion (n=29) were injected with NC100692 (1.5±0.2 mCi IV) at different times after femoral occlusion (1, 3, 7, and 14 days) for in vivo pinhole planar gamma camera imaging. Tissue from hindlimb proximal and distal to occlusion was excised for gamma well counting and for immunostaining. On in vivo pinhole images, increased focal NC100692 activity was seen distal to the occlusion at days 3 and 7. This increase in relative NC100692 activity was confirmed by gamma well counting. Lectin staining confirmed increased angiogenesis in the ischemic hindlimb at these time points. A fluorescent analogue of NC100692 was used to confirm specificity and localization of the targeted tracer in cultured endothelial cells. In addition, endothelial cell specificity was confirmed on tissue sections with the use of dual immunofluorescent staining of endothelium and the fluorescent analogue targeted at the α
v
β
3
integrin.
Conclusions—
A
99m
Tc-labeled peptide (NC100692) targeted at α
v
β
3
integrin selectively localized to endothelial cells in regions of increased angiogenesis and could be used for noninvasive serial “hot spot” imaging of angiogenesis. This targeted radiotracer imaging approach is a major advance in tracking therapeutic myocardial angiogenesis and has an important clinical potential.
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Affiliation(s)
- Jing Hua
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn 06520-8017, USA
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