Proteomic Profiling of Dilated Cardiomyopathy Plasma Samples ─ Searching for Biomarkers with Potential to Predict the Outcome of Therapy

Determination of the prognosis and treatment outcomes of dilated cardiomyopathy is a serious problem due to the lack of valid specific protein markers. Using in-depth proteome discovery analysis, we compared 49 plasma samples from patients suffering from dilated cardiomyopathy with plasma samples from their healthy counterparts. In total, we identified 97 proteins exhibiting statistically significant dysregulation in diseased plasma samples. The functional enrichment analysis of differentially expressed proteins uncovered dysregulation in biological processes like inflammatory response, wound healing, complement cascade, blood coagulation, and lipid metabolism in dilated cardiomyopathy patients. The same proteome approach was employed in order to find protein markers whose expression differs between the patients well-responding to therapy and nonresponders. In this case, 45 plasma proteins revealed statistically significant different expression between these two groups. Of them, fructose-1,6-bisphosphate aldolase seems to be a promising biomarker candidate because it accumulates in plasma samples obtained from patients with insufficient treatment response and with worse or fatal outcome. Data are available via ProteomeXchange with the identifier PXD046288.

Angiotensin-converting enzyme inhibitors, angiotensin-II-receptor antagonists and angiotensin-receptor blocker/neprilysin inhibitor utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic

AIMS

Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at angiotensin-converting enzyme inhibitors (ACEI), angiotensin-II-receptor antagonists (ARB) and angiotensin receptor blocker/neprilysin inhibitor (ARNI) use.

METHODS AND RESULTS

ACEi and ARBs were generally used in 87.6% of all HF patients in 2012 (n=154 627); 84.5% in 2013 (n=170 861); 83.5% in 2014 (n=186 963); 81.6% in 2015 (n=198 844); 80.1% in 2016 (n=205 793); 78.0% in 2017 (n=212 152) and in 76.7% in 2018 (n=219 235). In a sub-analysis of patients with a medical procedure and/or examination using an I50.x ICD code accounted for in the given year, ACEi and ARBs were generally used in 99.3% in 2012 (n=63 250); 96% in 2013 (n=62 241); 95.2% in 2014 (n=64 414); 93.3% in 2015 (n=65 217); 91.8% in 2016 (n=65 236); 90.1% in 2017 (n=65 761) and in 88.6% in 2018 (n=66 332). In 2018, the majority of patients with HF were prescribed ramipril (n=49 909; 17.5%) and perindopril (n=44 332; 15.5%). The mostly prescribed ARBs in 2018 were telmisartan (n=18 669; 6.5%); losartan (n=13 935; 4.9%) and valsartan (n=4 849; 1.7%). In 24.5% of cases, ACEIs and ARBs were prescribed in a fixed combination with another drug. ARNI became gradually more prescribed from 2018 (n=9 659 in November 2020).

CONCLUSION

In an analysis of ACEIs, ARBs and ARNIs utilization in all patients treated for heart failure in the given year in the whole country, we found a comparable rate of drug prescription in comparison with specific heart failure registries. This indicates a good translation of current standard of care into common clinical practice. Ramipril and perindopril remained the mostly prescribed ACEIs and telmisartan became the mostly prescribed ARB. Since 2018, ARNIs began to be widely prescribed.

Beta-blockers utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic

AIMS

Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at beta-blockers (BBs) utilization.

METHODS AND RESULTS

The beta-blockers were generally used in 81.8% of all patients treated for HF in 2012 (n=52 140); 81.8% in 2013 (n=53 058); 83.1% in 2014 (n=56 221); 82.1% in 2015 (n=57 421); 83.3% in 2016 (n=59 187); 82.2% in 2017 (60 058) and in 81.4% in 2018 (n=60 966). In 2018, the majority of patients treated for HF were prescribed metoprolol (22 974; 30.7%) and bisoprolol (21 001; 28%). Carvedilol was prescribed in 7 331 patients treated for HF (9.8%), nebivolol in 5 392 HF patients. Despite its primary indication, betaxolol was used in 2 341 patients treated for HF (3.1%). All other beta-blockers were used in less than 1% of HF patients. In some of the mostly used BBs, their prescription in patients treated for HF changed in the last years (metoprolol 32.4% in 2012, 30.7% in 2018; bisoprolol 20.3% in 2012, 28% in 2018; carvedilol 18.3% in 2012, 9.8% in 2018; nebivolol 2.5% in 2012, 7.2% in 2018; betaxolol 4.2% in 2012, 3.1% in 2018).

CONCLUSION

In an analysis of beta-blockers utilization in all patients treated for heart failure in the given year in the whole country, we have found only slightly lower amount of drug prescription in comparison with specific heart failure registries. This indicates a good translation of current standard of care into common clinical practice. Metoprolol remained the mostly prescribed drug. The prescription of bisoprolol and nebivolol has increased at the expense of carvedilol.

Heart failure disease management program, its contribution to established pharmacotherapy and long-term prognosis in real clinical practice - retrospective data analysis

BACKGROUND AND AIMS

The prognosis of patients with heart failure (HF) is still generally unfavorable. HF with reduced ejection fraction (HFrEF) patients reach target medication doses in very low percentages in daily clinical practice. HF disease management programs (DMP), including nurse and telemedicine support that facilitate achieving target medication doses, may improve the unfavorable prognosis.

METHODS

We retrospectively analyzed the data of 738 patients with HFrEF who were followed in a single HF center during the years 1975-2011, for 6.4 (median) years. DMP, nurse and telemedicine support is established at this center.

RESULTS

The group achieved left ventricle (LV) recovery after the HF treatment. The median LV ejection fraction improved from 25.0% at baseline to 50.0% at the time of the latest data collection. The proportion of NYHA II, III and IV classes decreased from 27.6%, 30.2% and 29.7% to 26.6%, 7.2% and 0.1%, respectively while the proportion of NYHA class I increased from 12.5% to 66.1%. Median NT-proBNP decreased from 975.0 to 324.0 pg/mL. The survival of the patient group was favorable; 79.7% survived 18.1 years after diagnosis of HF. A high percentage of the patients received recommended target or higher than target doses of angiotensin-converting enzyme inhibitors (82.0%) and beta-blockers (78.1%).

CONCLUSION

The established pharmacotherapy resulted from an effective DMP and this contributed to the favorable prognosis.

Development of a hybrid ozonation biofilm-membrane filatration process for the production of drinking water

Drinking water sources in Norway are characterized by high concentrations of natural organic matter (NOM), low alkalinity and low turbidity. The removal of NOM is therefore a general requirement in producing potable water. Drinking water treatment plants are commonly designed with coagulation direct filtration or NF spiral wound membrane processes. This study has investigated the feasibility and potential of a hybrid process combining ozonation and biofiltration with a rotating disk membrane for treating drinking water with high NOM concentrations. Ozonation will oxidize the NOM content removing colour and form biodegradable organic compounds, which can be removed in biological filters. A constructed water was used in this study which is representative of ozonated NOM-containing water. A rotating membrane disk bioreactor downstream the ozonation process was used to carry out both the biodegradation as well as biomass separation in the same reactor. Maintenance of biodegradation of the organic matter while controlling biofouling of the membrane and acceptable water production rates was the focus in the study. Three operating modes were investigated. Removal of the biodegradable organics was consistent throughout the study indicating that sufficient biomass was maintained in the reactor for all operating conditions tested. Biofouling control was not achieved through shear-induced cleaning by periodically rotating the membrane disks at high speed. By adding a small amount of sponges in the membrane chamber the biofouling could be controlled by mechanical cleaning of the membrane surface during disk rotation. The overall results indicate that the system can favorably be used in an ozonation/biofiltration process by carrying out both biodegradation as well as biomass separation in the same reactor.

Sibutramine in the treatment of obesity in type 2 diabetic patients and in nondiabetic subjects

Obesity is considered a chronic disease requiring treatment. The effect of sibutramine combined with hypocaloric diet and exercise on body weight, body fat mass, lipids, glycemic control, insulin secretion and insulin resistance was evaluated in a randomized, controlled, open-label study. A total of 44 obese type 2 diabetic patients (aged 45.2+/-5.2 years, BMI 33.62+/-2.2 kg/m(2)) and 49 obese nondiabetic subjects (aged 41.9+/-5.7 years, BMI 34.3+/-2.6 kg/m(2)) were treated with sibutramine for 3 months. Moreover, 39 age-matched obese type 2 diabetic patients and 41 obese nondiabetic subjects only on hypocaloric diet and exercise served as control groups. Insulin secretion was estimated during intravenous glucose tolerance test; insulin resistance was assessed by the HOMA index. There was a significant reduction in body weight in both sibutramine-treated diabetic patients (7.1%) and nondiabetic subjects (9.1%), accompanied by a significant reduction in body fat mass. HbA1c decreased significantly in the diabetic patients after sibutramine treatment. There was a significant improvement of lipid parameters in the two groups. Insulin resistance decreased by 21.9% in the sibutramine-treated diabetic patients and by 38.5% in the nondiabetic group. Weight loss was accompanied by an increase of 43.8% in first phase insulin secretion in the sibutramine-treated diabetic group; in the treated nondiabetic subjects there was a decrease in first and second phase insulin secretion and the area under the curve for total insulin secretion. In conclusion, sibutramine leads to a significant reduction in body weight, body fat mass and waist and hip circumferences; it improves insulin sensitivity, insulin secretion, glycaemic control and lipid parameters in both diabetic and nondiabetic obese subjects.

Involvement of nitric oxide in the nociception of kyotorphin, TYR-CAV and MIF-s analogues in the rat spinal cord

The spinal analgesic effects of Kyotorphin (Kyo) and Melanocyte-inhibiting factor (MIF-l) were studied during acute pain in rats chronically implanted with intrathecal (i.t.) cannulas. Kyo (5 micrograms), t-Cav (5 micrograms), Tyr-Cav (5 micrograms), L-NAME (1500 micrograms), MIF-Cav (200-400 micrograms) and MIF-sLeu (200 micrograms) exerted antinociceptive effects in both tests. The coadministration of Kyo + L-NAME enhanced the nociceptive effect compared with L-NAME (PP) or Kyo alone (PP, TF). The combination of Tyr-Cav + L-NAME enhanced the antinociceptive effect compared with L-NAME (PP) or Tyr-Cav alone (TF, PP). MIF-l (200 micrograms) had a weak antinociceptive effect in both tests. The coadministration of MIF-Cav + L-NAME enhanced the nociceptive effect compared with L-NAME (TF) or MIF-Cav alone (TF). The combination of MIF-sLeu + L-NAME enhanced the antinociceptive effect compared with L-NAME (TF) or MIF-sLeu alone (TF, PP). The results suggest that nitric oxide (NO) is involved in the antinociceptive effects of neuropeptides in the rat spinal cord.

Effects of the calcium antagonists verapamil and nitrendipine on carbamazepine withdrawal

This study was aimed at examining the effects of two frequently used Ca2+ antagonists, nitrendipine and verapamil, on withdrawal after cessation of long-term treatment with the anticonvulsant drug carbamazepine in rats. The 48-h interruption of long-term (21 days) carbamazepine treatment led to the appearance of withdrawal characterized by increases in seizure intensity, the percentage of rats with tonic seizures and mortality. Oral treatment with the two calcium antagonists in combination with carbamazepine abolished the signs of carbamazepine withdrawal. Seizure intensity, the percentage of rats with tonic seizures and mortality in the groups treated with the combinations of carbamazepine + verapamil and carbamazepine + nitrendipine were significantly lower than those of the group of rats treated with carbamazepine alone. In conclusion, some Ca2+ antagonists could attenuate the manifestations of anticonvulsant withdrawal and thus could be used as adjuvants in long-term anticonvulsant therapy.

Effect of dotarizine on electroconvulsive shock or pentylenetetrazol-induced amnesia and on seizure reactivity in rats

Dotarizine (DOT), a compound performing both as calcium antagonist and as 5-HT2 receptor antagonist, was evaluated for its ability to protect against electroconvulsive shock (ECS)- and pentylenetetrazol (PTZ)-induced performance deficit in a passive avoidance "step-down" task in rats. Its effect on electric and PTZ seizure models was also studied. DOT administered orally at a dose of 50 mg/kg for 5 days before learning had no significant effect on retention tests given 3 h, 24 h and 7 days after the training session. It should be noted, however, that DOT completely prevented ECS- and PTZ-induced amnesia in passive avoidance situation. DOT had a pronounced protective effect against electric seizures but did not affect PTZ seizures. The present results provide additional evidence for the role of serotonergic neurotransmitter system and calcium homeostasis for memory and seizure reactivity and may be important in the development of effective treatment strategies for memory dysfunction.

Stimulation of 5-HT1A receptors in the dorsal hippocampus impairs acquisition and performance of a spatial task in a water maze

8-Hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), a potent 5-HT1A receptor agonist, was infused in the dorsal hippocampus of rats and its effect on acquisition and performance of a 2-platform spatial discrimination task was studied using a water maze. The infusion (0.5 microliter/min) of 2 but not 0.4 microgram 8-OH-DPAT in the CA1 region of the dorsal hippocampus impaired rats' accuracy with no effect on latency (except day 3). At 5 micrograms 8-OH-DPAT impaired rats' accuracy and significantly increased choice latencies from day 2 to day 5 of the training period. The dose of 2 micrograms significantly increased the errors of omissions on the first day of training and animals which had received 5 micrograms 8-OH-DPAT made significantly more errors of omission on the first and second days of training. Intrahippocampal administration of 1 microgram spiroxatrine, a 5-HT1A receptor antagonist, antagonized the effect of 5 micrograms 8-OH-DPAT on accuracy and choice latency with no significant effect on the errors of omission on days 1 and 2 of training. Infusion of 2 and 5 micrograms 8-OH-DPAT in the dorsal hippocampus also impaired accuracy in well-trained rats. The results suggest that stimulation of 5-HT1A receptors in the CA1 region of the dorsal hippocampus causes an impairment of spatial discrimination in rats.

Doppler two-dimensional echocardiographic determinations of right ventricular output and diastolic filling

Two methods of measuring right ventricular cardiac output with pulsed Doppler two-dimensional echocardiography were developed in 29 patients who underwent cardiac catheterization and angiography. Using tricuspid inflow and main pulmonary artery outflow methods we determined cardiac output, and good correlations were observed between thermodilution and Doppler measurements (r = 0.93 and 0.89, respectively). Results by the two methods correlated closely in patients without regurgitant lesions. In patients with tricuspid regurgitation, right ventricular inflow was always greater than right ventricular outflow volume while the reverse was true in those with pulmonary insufficiency. Furthermore, we investigated the right ventricular peak filling rate as the Doppler peak diastolic velocity X cross-sectional area of the tricuspid annulus and half filling right ventricular fraction derived from the time velocity integral of the Doppler-determined velocity curve. For the tricuspid valve morphologically, the Doppler-derived velocity profile in diastole resembled the first derivative of the angiographic right ventricular volume curve. A significant correlation was observed between the Doppler echocardiographic and angiographic peak filling rate (r = 0.84). The results of the present study validate the use of Doppler two-dimensional quantitative measurements of the right ventricular output, regurgitant fraction and indexes of diastolic function.

Evidence that the dorsal raphe area is involved in the effect of clonidine against pentylenetetrazole-induced seizures in rats

Injections of 5,7-dihydroxytryptamine (5,7-DHT) in the rat ventromedial tegmentum, which depleted forebrain serotonin, and of 6-hydroxydopamine in the dorsal noradrenergic bundle, which caused a marked reduction of forebrain noradrenaline, intensified pentylenetetrazol (PTZ)-induced seizures. Neither condition significantly modified the inhibitory effect of 0.5 mg/kg clonidine on PTZ-induced seizures, with the exception of the effect on mortality which was reduced in 5,7-DHT treated animals. Electrolytic lesions in the nucleus raphe medianus or dorsalis potentiated PTZ-induced seizures but only lesions in the nucleus raphe dorsalis significantly attenuated the effect of clonidine on tonic seizures and mortality. Both lesions reduced clonidine's effect on latency to the first convulsion. The results indicate that the dorsal raphe area plays a role in the inhibitory effect of 0.5 mg/kg clonidine on PTZ-induced seizures. Serotonin neurons other than those innervating diencephalic and telencephalic structures may also contribute, particularly to the effect of clonidine on tonic seizures.

Serotonin mediation of the protective effect of clonidine against pentylenetetrazol-induced seizures in rats

An intraperitoneal injection of 0.5 mg/kg clonidine significantly increased the latency to the first convulsion and reduced tonic seizures and mortality caused by pentylenetetrazol (PTZ), 90 mg/kg, administered subcutaneously to rats. 1 mg/kg clonidine produced similar effects except that tonic seizures were not significantly affected. No effect was observed with 0.01 or 0.1 mg/kg clonidine. Metergoline (1 mg/kg) and methysergide (10 mg/kg), administered intraperitoneally, completely prevented the effect of 0.5 mg/kg clonidine on PTZ-induced seizures. An intraperitoneal injection of 5 mg/kg of d-fenfluramine, a releaser of 5HT from nerve terminals, significantly reduced tonic seizures and completely blocked mortality caused by PTZ but did not significantly modify the latency to the first convulsion. The results suggest that serotonin plays an important role in the protective effect of 0.5 mg/kg clonidine against PTZ-induced seizures. Possible reasons for the different effects of clonidine on different experimental seizures are discussed.

Potentiation by yohimbine of pentylenetetrazol-induced seizures in rats: role of alpha 2 adrenergic receptors

10 mg/kg yohimbine significantly reduced the latency to the first convulsion of rats treated with 90 mg/kg pentylenetetrazol (PTZ) and markedly increased the number of animals showing generalized strong clonic seizures and dying within 1 h. All the animals treated with 20 mg/kg yohimbine and PTZ died with 1 h after repeated episodes of strong generalized clonic seizures. Yohimbine's ability to cause tonic seizures and mortality in rats given 70 mg/kg s.c. PTZ was reduced by pretreatment with clonidine (0.5 mg/kg i.p.). Strong clonic seizures of animals treated with yohimbine + PTZ were less affected by clonidine treatment. It thus appears that yohimbine potentiates PTZ-induced seizures through an action on alpha 2 adrenoreceptors, although other mechanisms, e.g. serotonergic ones, seem to contribute to yohimbine's effect.

Studies on the role of serotonin in different regions of the rat central nervous system on pentylenetetrazol-induced seizures and the effect of di-n-propylacetate

5,7-Dihydroxytryptamine (5,7-DHT) injections which caused selective depletion of serotonin in the forebrain enhanced the seizures caused by pentylenetetrazol (PTZ 90 mg/kg s.c.) in rats. No effect was observed in rats with 5,7-DHT-induced depletion of spinal serotonin or treated with metergoline (1 mg/kg i.p.) or methysergide (10 mg/kg i.p.). The various procedures aimed at decreasing serotonin transmission did not significantly modify the effect of di-n-propylacetate (DPA) on tonic seizures and mortality caused by PTZ but significantly reduced the DPA-induced increase in the latency to the first convulsion. More animals with clonic seizures were seen in the DPA-treated group which had been subjected to selective depletion of spinal serotonin or treated with methysergide than in DPA-treated controls. Combined treatment with d-fenfluramine (1.25 mg/kg i.p.) and DPA (75 mg/kg i.p.), doses which by themselves had no significant effect, reduced tonic seizures and mortality caused by PTZ. The results show that a diffuse deficit in forebrain serotonin enhances PTZ-induced seizures. Serotonin does not play an important role in the effect of DPA against PTZ-DPA on clonic convulsions. Agents increasing serotonin transmission may enhance the anticonvulsant activity of DPA.

The role of different types of adrenergic receptors in pentylenetetrazol-induced seizures and the effect of di-n-propylacetate in the rat

Selective depletion of forebrain noradrenaline has been shown to potentiate various types of experimentally induced seizures. This study was aimed at exploring the role of different types of adrenergic receptors in pentylenetetrazol (PTZ)-induced seizures in rats and the anticonvulsive effect of di-n-propylacetate (DPA). Piperoxane (10 and 20 mg/kg, IP) significantly potentiated PTZ-induced tonic seizures and mortality. Similar effects were observed after 6-hydroxydopamine (6-OHDA)-induced depletion of forebrain noradrenaline, whereas no effects were found in animals with depletion of spinal noradrenaline. Neither phenoxybenzamine (20 mg/kg, IP) nor prazosin (1 and 10 mg/kg, IP) nor propranolol (2 and 5 mg/kg, IP) modified tonic seizures and mortality caused by PTZ. Combined treatment with propranolol (5 mg/kg, IP) and prazosin (10 mg/kg, IP) had no effect either. Various agents used to increase central serotonin transmission (d-fenfluramine, 5 mg/kg, IP; quipazine, 10 mg/kg, IP; m-chlorophenylpiperazine, 3 mg/kg, IP) did not alter the effect of piperoxane on PTZ-induced seizures. None of the conditions used to diminish central adrenergic function significantly affected the inhibitory effect of DPA on tonic seizures and mortality caused by PTZ. Combined treatment with subthreshold doses of clonidine (0.1 mg/kg, IP) and DPA (75 mg/kg, IP) significantly reduced tonic seizures and mortality caused by PTZ. The data suggest that alpha 2 type adrenoceptors are involved in the control of PTZ-induced seizures in rats. The peculiarity of the role of these receptors in the effect of PTZ is discussed.

The effect of L-DOPA and L-5-hydroxytryptophan on the pentetrazole seizures in rats after lesions of the median raphe nucleus and substantia nigra

Electrolytic lesions of the median raphe nucleus and substantia nigra markedly increased susceptibility to pentetrazole seizures in rats. L-5-hydroxytryptophan, considerably increasing the serotonin (5-HT) level in the brain, markedly inhibited the seizures and abolished the seizure-enhanced effect of lesion of the substantia nigra. L-DOPA tended to potentiate the seizures-enhancing effect produced by lesions of the median raphe nucleus. The changes in the brain 5-HT level and the intensity of pentetrazole seizures were correlated. The results indicate that the balance between neurotransmitter systems in the brain is of importance to the susceptibility to pentetrazole convulsions.

The influence of methionine on rats and mice behaviour

Methionine given ivc or ip to rats and ic to mice acts only slightly on the central nervous system of these animals; it has either stimulating or inhibiting action, depending on the test applied.