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Margaritis M, Saini F, Baranowska-Clarke AA, Parsons S, Vink A, Budgeon C, Allcock N, Wagner BE, Samani NJ, Thüsen JVD, Robertus JL, Sheppard MN, Adlam D. Erratum to: Vascular histopathology and connective tissue ultrastructure in spontaneous coronary artery dissection: pathophysiological and clinical implications. Cardiovasc Res 2022; 119:880. [PMID: 35553642 PMCID: PMC10153413 DOI: 10.1093/cvr/cvac070] [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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2
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Faulkner N, Ng KW, Wu MY, Harvey R, Margaritis M, Paraskevopoulou S, Houlihan C, Hussain S, Greco M, Bolland W, Warchal S, Heaney J, Rickman H, Spyer M, Frampton D, Byott M, de Oliveira T, Sigal A, Kjaer S, Swanton C, Gandhi S, Beale R, Gamblin SJ, McCauley JW, Daniels RS, Howell M, Bauer D, Nastouli E, Kassiotis G. Reduced antibody cross-reactivity following infection with B.1.1.7 than with parental SARS-CoV-2 strains. eLife 2021; 10:e69317. [PMID: 34323691 PMCID: PMC8352583 DOI: 10.7554/elife.69317] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 04/11/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background The degree of heterotypic immunity induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains is a major determinant of the spread of emerging variants and the success of vaccination campaigns, but remains incompletely understood. Methods We examined the immunogenicity of SARS-CoV-2 variant B.1.1.7 (Alpha) that arose in the United Kingdom and spread globally. We determined titres of spike glycoprotein-binding antibodies and authentic virus neutralising antibodies induced by B.1.1.7 infection to infer homotypic and heterotypic immunity. Results Antibodies elicited by B.1.1.7 infection exhibited significantly reduced recognition and neutralisation of parental strains or of the South Africa variant B.1.351 (Beta) than of the infecting variant. The drop in cross-reactivity was significantly more pronounced following B.1.1.7 than parental strain infection. Conclusions The results indicate that heterotypic immunity induced by SARS-CoV-2 variants is asymmetric. Funding This work was supported by the Francis Crick Institute and the Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg.
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Affiliation(s)
- Nikhil Faulkner
- Retroviral ImmunologyLondonUnited Kingdom
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
| | - Kevin W Ng
- Retroviral ImmunologyLondonUnited Kingdom
| | - Mary Y Wu
- High Throughput Screening STPLondonUnited Kingdom
| | - Ruth Harvey
- Worldwide Influenza CentreLondonUnited Kingdom
| | - Marios Margaritis
- Advanced Pathogen Diagnostics Unit UCLH NHS TrustLondonUnited Kingdom
| | | | - Catherine Houlihan
- Advanced Pathogen Diagnostics Unit UCLH NHS TrustLondonUnited Kingdom
- Division of Infection and ImmunityLondonUnited Kingdom
| | - Saira Hussain
- Worldwide Influenza CentreLondonUnited Kingdom
- RNA Virus Replication LaboratoryLondonUnited Kingdom
| | - Maria Greco
- RNA Virus Replication LaboratoryLondonUnited Kingdom
| | | | | | - Judith Heaney
- Advanced Pathogen Diagnostics Unit UCLH NHS TrustLondonUnited Kingdom
| | - Hannah Rickman
- Advanced Pathogen Diagnostics Unit UCLH NHS TrustLondonUnited Kingdom
| | - Moria Spyer
- Advanced Pathogen Diagnostics Unit UCLH NHS TrustLondonUnited Kingdom
- Department of Population, Policy and PracticeLondonUnited Kingdom
| | | | - Matthew Byott
- Advanced Pathogen Diagnostics Unit UCLH NHS TrustLondonUnited Kingdom
| | - Tulio de Oliveira
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-NatalDurbanSouth Africa
- KwaZulu-Natal Research Innovation and Sequencing PlatformDurbanSouth Africa
- Centre for the AIDS Programme of Research in South AfricaDurbanSouth Africa
- Department of Global Health, University of WashingtonSeattleUnited States
| | - Alex Sigal
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-NatalDurbanSouth Africa
- Africa Health Research InstituteDurbanSouth Africa
- Max Planck Institute for Infection BiologyBerlinGermany
| | | | - Charles Swanton
- Cancer Evolution and Genome Instability LaboratoryLondonUnited Kingdom
| | - Sonia Gandhi
- Neurodegradation Biology LaboratoryLondonUnited Kingdom
| | - Rupert Beale
- Cell Biology of Infection LaboratoryLondonUnited Kingdom
| | - Steve J Gamblin
- Structural Biology of Disease Processes Laboratory, The Francis Crick InstituteLondonUnited Kingdom
| | | | | | | | - David Bauer
- RNA Virus Replication LaboratoryLondonUnited Kingdom
| | - Eleni Nastouli
- Retroviral ImmunologyLondonUnited Kingdom
- Advanced Pathogen Diagnostics Unit UCLH NHS TrustLondonUnited Kingdom
- Department of Population, Policy and PracticeLondonUnited Kingdom
| | - George Kassiotis
- Retroviral ImmunologyLondonUnited Kingdom
- Department of Infectious Disease, St Mary's Hospital, Imperial College LondonLondonUnited Kingdom
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3
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Akoumianakis I, Badi I, Douglas G, Chuaiphichai S, Herdman L, Akawi N, Margaritis M, Antonopoulos AS, Oikonomou EK, Psarros C, Galiatsatos N, Tousoulis D, Kardos A, Sayeed R, Krasopoulos G, Petrou M, Schwahn U, Wohlfart P, Tennagels N, Channon KM, Antoniades C. Insulin-induced vascular redox dysregulation in human atherosclerosis is ameliorated by dipeptidyl peptidase 4 inhibition. Sci Transl Med 2021; 12:12/541/eaav8824. [PMID: 32350133 DOI: 10.1126/scitranslmed.aav8824] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 10/01/2019] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
Recent clinical trials have revealed that aggressive insulin treatment has a neutral effect on cardiovascular risk in patients with diabetes despite improved glycemic control, which may suggest confounding direct effects of insulin on the human vasculature. We studied 580 patients with coronary atherosclerosis undergoing coronary artery bypass surgery (CABG), finding that high endogenous insulin was associated with reduced nitric oxide (NO) bioavailability ex vivo in vessels obtained during surgery. Ex vivo experiments with human internal mammary arteries and saphenous veins obtained from 94 patients undergoing CABG revealed that both long-acting insulin analogs and human insulin triggered abnormal responses of post-insulin receptor substrate 1 downstream signaling ex vivo, independently of systemic insulin resistance status. These abnormal responses led to reduced NO bioavailability, activation of NADPH oxidases, and uncoupling of endothelial NO synthase. Treatment with an oral dipeptidyl peptidase 4 inhibitor (DPP4i) in vivo or DPP4i administered to vessels ex vivo restored physiological insulin signaling, reversed vascular insulin responses, reduced vascular oxidative stress, and improved endothelial function in humans. The detrimental effects of insulin on vascular redox state and endothelial function as well as the insulin-sensitizing effect of DPP4i were also validated in high-fat diet-fed ApoE-/- mice treated with DPP4i. High plasma DPP4 activity and high insulin were additively related with higher cardiac mortality in patients with coronary atherosclerosis undergoing CABG. These findings may explain the inability of aggressive insulin treatment to improve cardiovascular outcomes, raising the question whether vascular insulin sensitization with DPP4i should precede initiation of insulin treatment and continue as part of a long-term combination therapy.
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Affiliation(s)
- Ioannis Akoumianakis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Ileana Badi
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Gillian Douglas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Surawee Chuaiphichai
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Laura Herdman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Nadia Akawi
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Marios Margaritis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Costas Psarros
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | | | - Dimitris Tousoulis
- First Cardiology Clinic, Athens University Medical School, Athens 115 27, Greece
| | - Attila Kardos
- Milton Keynes University Hospital NHS Foundation Trust and Faculty of Life Sciences, University of Buckingham, Buckingham MK6 5LD, UK
| | - Rana Sayeed
- Cardiothoracic Surgery Department, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - George Krasopoulos
- Cardiothoracic Surgery Department, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Mario Petrou
- Cardiothoracic Surgery Department, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Uwe Schwahn
- Sanofi Aventis Deutschland GmbH, Frankfurt D-65926, Germany
| | | | | | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK.
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4
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Margaritis M, Saini F, Baranowska-Clarke AA, Parsons S, Vink A, Budgeon C, Alcock N, Wagner BE, Samani NJ, von der Thüsen J, Robertus JL, Sheppard MN, Adlam D. Vascular histopathology and connective tissue ultrastructure in spontaneous coronary artery dissection: pathophysiological and clinical implications. Cardiovasc Res 2021; 118:1835-1848. [PMID: 34048532 PMCID: PMC9215198 DOI: 10.1093/cvr/cvab183] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 12/22/2020] [Accepted: 05/27/2021] [Indexed: 12/21/2022] Open
Abstract
Aims Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndromes
and in rare cases sudden cardiac death (SCD). Connective tissue abnormalities, coronary
inflammation, increased coronary vasa vasorum (VV) density, and
coronary fibromuscular dysplasia have all been implicated in the pathophysiology of SCAD
but have not previously been systematically assessed. We designed a study to investigate
the coronary histological and dermal collagen ultrastructural findings in SCAD. Methods and results Thirty-six autopsy SCAD cases were compared with 359 SCAD survivors. Coronary and
myocardial histology and immunohistochemistry were undertaken. Transmission electron
microscopy (TEM) of dermal extracellular matrix (ECM) components of
n = 31 SCAD survivors and n = 16 healthy volunteers
were compared. Autopsy cases were more likely male (19% vs. 5%;
P = 0.0004) with greater proximal left coronary involvement (56% vs.
18%; P < 0.0001) compared to SCAD survivors. N = 24
(66%) of cases showed no myocardial infarction on macro- or microscopic examination
consistent with arrhythmogenic death. There was significantly
(P < 0.001) higher inflammation in cases with delayed-onset death
vs. sudden death and significantly more inflammation surrounding the dissected vs.
non-dissected vessel segments. N = 17 (47%) cases showed limited
intimal fibro-elastic thickening but no features of fibromuscular dysplasia and no
endothelial or internal elastic lamina abnormalities. There were no differences in VV
density between SCAD and control cases. TEM revealed no general ultrastructural
differences in ECM components or markers of fibroblast metabolic activity. Conclusions Assessment of SCD requires careful exclusion of SCAD, particularly in cases without
myocardial necrosis. Peri-coronary inflammation in SCAD is distinct from vasculitides
and likely a reaction to, rather than a cause for SCAD. Coronary fibromuscular dysplasia
or increased VV density does not appear pathophysiologically important. Dermal
connective tissue changes are not common in SCAD survivors.
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Affiliation(s)
- Marios Margaritis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Francesca Saini
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Ania A Baranowska-Clarke
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University, Melbourne Victoria
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Charley Budgeon
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.,Australia & School of Population and Global Health, University of Western Australia, Perth, Western Australia
| | - Natalie Alcock
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Bart E Wagner
- Electron Microscopy, Histopathology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Jan von der Thüsen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Lukas Robertus
- Department of Pathology, Royal Brompton Hospital, London, United Kingdom
| | - Mary N Sheppard
- CRY Department of Cardiovascular Pathology, Molecular and Clinical Sciences Research Institute, St Georges Medical School, London, United Kingdom
| | - David Adlam
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
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Frampton D, Rampling T, Cross A, Bailey H, Heaney J, Byott M, Scott R, Sconza R, Price J, Margaritis M, Bergstrom M, Spyer MJ, Miralhes PB, Grant P, Kirk S, Valerio C, Mangera Z, Prabhahar T, Moreno-Cuesta J, Arulkumaran N, Singer M, Shin GY, Sanchez E, Paraskevopoulou SM, Pillay D, McKendry RA, Mirfenderesky M, Houlihan CF, Nastouli E. Genomic characteristics and clinical effect of the emergent SARS-CoV-2 B.1.1.7 lineage in London, UK: a whole-genome sequencing and hospital-based cohort study. Lancet Infect Dis 2021; 21:1246-1256. [PMID: 33857406 PMCID: PMC8041359 DOI: 10.1016/s1473-3099(21)00170-5] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/14/2023]
Abstract
Background Emergence of variants with specific mutations in key epitopes in the spike protein of SARS-CoV-2 raises concerns pertinent to mass vaccination campaigns and use of monoclonal antibodies. We aimed to describe the emergence of the B.1.1.7 variant of concern (VOC), including virological characteristics and clinical severity in contemporaneous patients with and without the variant. Methods In this cohort study, samples positive for SARS-CoV-2 on PCR that were collected from Nov 9, 2020, for patients acutely admitted to one of two hospitals on or before Dec 20, 2020, in London, UK, were sequenced and analysed for the presence of VOC-defining mutations. We fitted Poisson regression models to investigate the association between B.1.1.7 infection and severe disease (defined as point 6 or higher on the WHO ordinal scale within 14 days of symptoms or positive test) and death within 28 days of a positive test and did supplementary genomic analyses in a cohort of chronically shedding patients and in a cohort of remdesivir-treated patients. Viral load was compared by proxy, using PCR cycle threshold values and sequencing read depths. Findings Of 496 patients with samples positive for SARS-CoV-2 on PCR and who met inclusion criteria, 341 had samples that could be sequenced. 198 (58%) of 341 had B.1.1.7 infection and 143 (42%) had non-B.1.1.7 infection. We found no evidence of an association between severe disease and death and lineage (B.1.1.7 vs non-B.1.1.7) in unadjusted analyses (prevalence ratio [PR] 0·97 [95% CI 0·72–1·31]), or in analyses adjusted for hospital, sex, age, comorbidities, and ethnicity (adjusted PR 1·02 [0·76–1·38]). We detected no B.1.1.7 VOC-defining mutations in 123 chronically shedding immunocompromised patients or in 32 remdesivir-treated patients. Viral load by proxy was higher in B.1.1.7 samples than in non-B.1.1.7 samples, as measured by cycle threshold value (mean 28·8 [SD 4·7] vs 32·0 [4·8]; p=0·0085) and genomic read depth (1280 [1004] vs 831 [682]; p=0·0011). Interpretation Emerging evidence exists of increased transmissibility of B.1.1.7, and we found increased virus load by proxy for B.1.1.7 in our data. We did not identify an association of the variant with severe disease in this hospitalised cohort. Funding University College London Hospitals NHS Trust, University College London/University College London Hospitals NIHR Biomedical Research Centre, Engineering and Physical Sciences Research Council.
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Affiliation(s)
- Dan Frampton
- Division of Infection and Immunity, University College London, London, UK; Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, UK; The Francis Crick Institute, London, UK
| | - Tommy Rampling
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aidan Cross
- North Middlesex University Hospital NHS Trust, London, UK
| | - Heather Bailey
- Institute for Global Health, University College London, London, UK
| | - Judith Heaney
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, UK; The Francis Crick Institute, London, UK
| | - Matthew Byott
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, UK; The Francis Crick Institute, London, UK
| | - Rebecca Scott
- North Middlesex University Hospital NHS Trust, London, UK
| | - Rebecca Sconza
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joseph Price
- North Middlesex University Hospital NHS Trust, London, UK
| | - Marios Margaritis
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Malin Bergstrom
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Moira J Spyer
- Great Ormond Street Institute of Child Health, University College London, London, UK; Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, UK; The Francis Crick Institute, London, UK
| | - Patricia B Miralhes
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Grant
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, UK; North Middlesex University Hospital NHS Trust, London, UK
| | | | - Chris Valerio
- North Middlesex University Hospital NHS Trust, London, UK
| | - Zaheer Mangera
- Division of Infection and Immunity, University College London, London, UK
| | | | | | - Nish Arulkumaran
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Gee Yen Shin
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emilie Sanchez
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, UK
| | - Rachel A McKendry
- London Centre for Nanotechnology, University College London, London, UK; Division of Medicine, University College London, London, UK
| | | | - Catherine F Houlihan
- Division of Infection and Immunity, University College London, London, UK; Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eleni Nastouli
- Great Ormond Street Institute of Child Health, University College London, London, UK; Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, UK; Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK; The Francis Crick Institute, London, UK.
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6
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Margaritis M, Saini F, Baranowska A, Parsons S, Vink A, Budgeon C, Alcock N, Wagner B, Samani N, Robertus J, Von Der Thusen J, Sheppard M, Adlam D. Spontaneous coronary artery dissection: novel pathophysiological insights from histological and ultrastructural tissue analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndromes and rarely sudden cardiac death (SCD). SCAD is characterised by medial false lumen haematoma formation and periadventitial inflammatory cell infiltrate. Although SCAD has been linked to connective tissue disorders, its pathophysiology remains poorly understood and the role of inflammation unknown.
Purpose
We sought to establish the definitive histopathological features of SCAD and explore pathophysiological mechanisms through assessment of dermal connective tissue ultrastructure.
Methods
N=36 SCD cases diagnosed as SCAD on autopsy were identified in pathology archives at four international centres. Their demographic and clinical characteristics were compared with n=359 survivors recruited in a SCAD survivors cohort. Haematoxylin & eosin sections were examined under light microscope. Immunohistochemistry (IHC) was employed for quantification of inflammatory cell infiltrate (CD68, CD3) and vasa vasorum density (CD31) of SCAD cases (n=20) compared to age- and sex-matched controls (n=10). Dermal extracellular matrix components (EMC) of n=32 SCAD survivors and n=16 healthy volunteers (HV) were compared using electron microscopy (EM).
Results
The autopsy series cases were more likely to be male (p=0.0256) and had higher incidence of left main stem (p=0.0475) and proximal left anterior descending (p<0.001) disease compared to SCAD survivors. N=24 (66%) of SCAD autopsy case showed no evidence of myocardial necrosis. N=17 (47%) showed mild-moderate atherosclerotic changes but no features of fibromuscular dysplasia. There were no differences in vasa vasorum density between SCAD and control cases (A). The degree of inflammatory cell infiltrate varied greatly but significantly higher than controls (B), comprising CD68+ macrophages, eosinophils and CD3+ positive T-cells. There was a statistically significant association (p=0.006) between the degree of inflammatory cell infiltrate and the length of time from onset of symptoms to death (Panel C), as well as significantly (p<0.001) denser inflammatory cell infiltrate adjacent to the dissection plane (D, exemplary sections E&F). EM revealed no differences between SCAD and HV in dermal fibroblast size & activity or elastin size & damage indicators, but possible changes in subgroups with more extreme clinical phenotype or pregnancy-related SCAD (G).
Conclusions
To our knowledge this is the largest SCAD pathology case series so far. We show for the first time that periadvential inflammation in SCAD appears to be time-dependent and localising to the dissected coronary segment, suggesting healing response to injury rather than causal contribution. We found no evidence to suggest increased vasa vasorum density is pathophysiologically important. Connective tissue changes were only linked to a small proportion of cases. These novel findings may have important implications for the management of SCAD patients.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation, Leicester NIHR Biomedical Research Centre
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Affiliation(s)
- M Margaritis
- University of Leicester, Leicester, United Kingdom
| | - F Saini
- University of Leicester, Leicester, United Kingdom
| | - A Baranowska
- University of Leicester, Leicester, United Kingdom
| | - S Parsons
- Monash University, Melbourne, Australia
| | - A Vink
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - C Budgeon
- University of Leicester, Leicester, United Kingdom
| | - N Alcock
- University of Leicester, Leicester, United Kingdom
| | - B Wagner
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - N Samani
- University of Leicester, Leicester, United Kingdom
| | - J.L Robertus
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | | - M Sheppard
- St George's Healthcare NHS Trust, London, United Kingdom
| | - D Adlam
- University of Leicester, Leicester, United Kingdom
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7
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Akoumianakis I, Sanna F, Margaritis M, Badi I, Akawi N, Herdman L, Coutinho P, Fagan H, Antonopoulos AS, Oikonomou EK, Thomas S, Chiu AP, Chuaiphichai S, Kotanidis CP, Christodoulides C, Petrou M, Krasopoulos G, Sayeed R, Lv L, Hale A, Naeimi Kararoudi M, McNeill E, Douglas G, George S, Tousoulis D, Channon KM, Antoniades C. Adipose tissue-derived WNT5A regulates vascular redox signaling in obesity via USP17/RAC1-mediated activation of NADPH oxidases. Sci Transl Med 2020; 11:11/510/eaav5055. [PMID: 31534019 DOI: 10.1126/scitranslmed.aav5055] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 08/09/2019] [Indexed: 12/19/2022]
Abstract
Obesity is associated with changes in the secretome of adipose tissue (AT), which affects the vasculature through endocrine and paracrine mechanisms. Wingless-related integration site 5A (WNT5A) and secreted frizzled-related protein 5 (SFRP5), adipokines that regulate noncanonical Wnt signaling, are dysregulated in obesity. We hypothesized that WNT5A released from AT exerts endocrine and paracrine effects on the arterial wall through noncanonical RAC1-mediated Wnt signaling. In a cohort of 1004 humans with atherosclerosis, obesity was associated with increased WNT5A bioavailability in the circulation and the AT, higher expression of WNT5A receptors Frizzled 2 and Frizzled 5 in the human arterial wall, and increased vascular oxidative stress due to activation of NADPH oxidases. Plasma concentration of WNT5A was elevated in patients with coronary artery disease compared to matched controls and was independently associated with calcified coronary plaque progression. We further demonstrated that WNT5A induces arterial oxidative stress and redox-sensitive migration of vascular smooth muscle cells via Frizzled 2-mediated activation of a previously uncharacterized pathway involving the deubiquitinating enzyme ubiquitin-specific protease 17 (USP17) and the GTPase RAC1. Our study identifies WNT5A and its downstream vascular signaling as a link between obesity and vascular disease pathogenesis, with translational implications in humans.
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Affiliation(s)
- Ioannis Akoumianakis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Fabio Sanna
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Marios Margaritis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Ileana Badi
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Nadia Akawi
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Laura Herdman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Patricia Coutinho
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Harry Fagan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Amy P Chiu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Surawee Chuaiphichai
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Christos P Kotanidis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | | | - Mario Petrou
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - Lei Lv
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Ashley Hale
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Meisam Naeimi Kararoudi
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Eileen McNeill
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Gillian Douglas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Sarah George
- Bristol Medical School, University of Bristol, Research Floor Level 7, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Dimitris Tousoulis
- Cardiology Department, Athens University Medical School, Athens 115 27, Greece
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.
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8
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De Wilton A, Margaritis M, Mills H, Logan S, Hatcher J, Morris-Jones S. Proteus mirabilis - a rare cause of non-HACEK Gram-negative infective endocarditis. Acute Med 2020; 19:149-153. [PMID: 33020759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Infective endocarditis caused by Proteus mirabilis is strikingly rare. Here, we describe the case of an 86-year old man with five recurrent septic episodes over a period of three months associated with Proteus mirabilis bacteraemia secondary to underlying Proteus endocarditis. The final diagnosis was made based on clinical findings, blood culture results and transoesophageal echocardiogram. The patient was treated medically with 6 weeks of ceftriaxone and long-term oral ciprofloxacin. On completion of intravenous therapy the patient remained well. We performed a literature review and found this to be only the fourth confirmed case of Proteus mirabilis endocarditis successfully treated with antibiotic therapy alone. This case highlights an important but rare cause of endocarditis, reinforcing the need to consider this diagnosis in recurrent Gram-negative bacteraemia even if by an atypical organism.
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Affiliation(s)
- A De Wilton
- Hospital for Tropical diseases, University College London Hospital, London, UK
| | - M Margaritis
- Hospital for Tropical diseases, University College London Hospital, London, UK
| | - H Mills
- Hospital for Tropical diseases, University College London Hospital, London, UK
| | - S Logan
- Hospital for Tropical diseases, University College London Hospital, London, UK
| | - J Hatcher
- London School of Hygiene and Tropical Medicine, London, UK
| | - S Morris-Jones
- Department of Clinical Microbiology, University College London Hospital, London, UK
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9
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Adlam D, Olson TM, Combaret N, Kovacic JC, Iismaa SE, Al-Hussaini A, O'Byrne MM, Bouajila S, Georges A, Mishra K, Braund PS, d'Escamard V, Huang S, Margaritis M, Nelson CP, de Andrade M, Kadian-Dodov D, Welch CA, Mazurkiewicz S, Jeunemaitre X, Wong CMY, Giannoulatou E, Sweeting M, Muller D, Wood A, McGrath-Cadell L, Fatkin D, Dunwoodie SL, Harvey R, Holloway C, Empana JP, Jouven X, Olin JW, Gulati R, Tweet MS, Hayes SN, Samani NJ, Graham RM, Motreff P, Bouatia-Naji N. Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection. J Am Coll Cardiol 2019; 73:58-66. [PMID: 30621952 PMCID: PMC10403154 DOI: 10.1016/j.jacc.2018.09.085] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [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: 08/24/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene. OBJECTIVES This study sought to test the association between the rs9349379 genotype and SCAD. METHODS Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD. RESULTS The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence. CONCLUSIONS The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD.
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Affiliation(s)
- David Adlam
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
| | - Timothy M Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nicolas Combaret
- Department of Cardiology, University Hospital of Clermont-Ferrand, Auvergne University, Clermont-Ferrand, France
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, Marie-Josée and Henry R. Kravis Cardiovascular Health Center at Mount Sinai, New York, New York
| | - Siiri E Iismaa
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Abtehale Al-Hussaini
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Megan M O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Sara Bouajila
- Department of Cardiology, University Hospital of Clermont-Ferrand, Auvergne University, Clermont-Ferrand, France
| | - Adrien Georges
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Ketan Mishra
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Peter S Braund
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Valentina d'Escamard
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, Marie-Josée and Henry R. Kravis Cardiovascular Health Center at Mount Sinai, New York, New York
| | - Siying Huang
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Marios Margaritis
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Mariza de Andrade
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Daniella Kadian-Dodov
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, Marie-Josée and Henry R. Kravis Cardiovascular Health Center at Mount Sinai, New York, New York
| | - Catherine A Welch
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Stephani Mazurkiewicz
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Xavier Jeunemaitre
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France; Department of Genetics, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Claire Mei Yi Wong
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Eleni Giannoulatou
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Sweeting
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - David Muller
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Alice Wood
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Lucy McGrath-Cadell
- St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Diane Fatkin
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Sally L Dunwoodie
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Richard Harvey
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Cameron Holloway
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Jean-Philippe Empana
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Xavier Jouven
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Jeffrey W Olin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, Marie-Josée and Henry R. Kravis Cardiovascular Health Center at Mount Sinai, New York, New York
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Robert M Graham
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Pascal Motreff
- Department of Cardiology, University Hospital of Clermont-Ferrand, Auvergne University, Clermont-Ferrand, France
| | - Nabila Bouatia-Naji
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France.
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10
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Margaritis M. Endothelial dysfunction in HIV infection: experimental and clinical evidence on the role of oxidative stress. ACTA ACUST UNITED AC 2019. [DOI: 10.21037/arh.2019.02.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Akoumianakis I, Herdman L, Margaritis M, Sayeed R, Krasopoulos G, Petrou M, Tennagels N, Wohlfart P, Channon KM, Antoniades C. 2437Insulin triggers oxidative stress in the vascular wall of patients with atherosclerosis, independently of systemic insulin resistance: the beneficial role of DPP-IV inhibition. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I Akoumianakis
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - L Herdman
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - M Margaritis
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - R Sayeed
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - G Krasopoulos
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - M Petrou
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - N Tennagels
- Sanofi-Aventis Deutschland GmbH, R&D Diabetes Division, Research & Translational Medicine, Frankfurt, Germany
| | - P Wohlfart
- Sanofi-Aventis Deutschland GmbH, R&D Diabetes Division, Research & Translational Medicine, Frankfurt, Germany
| | - K M Channon
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - C Antoniades
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
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12
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Akoumianakis I, Antonopoulos AS, Herdman L, Margaritis M, Oikonomou EK, Krasopoulos G, Petrou M, Sayeed R, Channon KM, Antoniades C. 3398NADPH oxidase activity in internal mammary arteries predicts mortality in patients undergoing coronary bypass surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I Akoumianakis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A S Antonopoulos
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - L Herdman
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M Margaritis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - E K Oikonomou
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - G Krasopoulos
- John Radcliffe Hospital, Cardiothoracic Surgery Department, Oxford, United Kingdom
| | - M Petrou
- John Radcliffe Hospital, Cardiothoracic Surgery Department, Oxford, United Kingdom
| | - R Sayeed
- John Radcliffe Hospital, Cardiothoracic Surgery Department, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - C Antoniades
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
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13
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Akoumianakis I, Sanna F, Margaritis M, Herdman L, Antonopoulos AS, Sayeed R, Krasopoulos G, Petrou M, Channon KM, Antoniades C. P592Perivascular adipose tissue-derived Wnt5a as a regulator of human vascular disease pathogenesis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I Akoumianakis
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - F Sanna
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - M Margaritis
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - L Herdman
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - A S Antonopoulos
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - R Sayeed
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - G Krasopoulos
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - M Petrou
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - C Antoniades
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
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14
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Margaritis M, Sanna F, Lazaros G, Akoumianakis I, Patel S, Antonopoulos AS, Duke C, Herdman L, Psarros C, Oikonomou EK, Shirodaria C, Petrou M, Sayeed R, Krasopoulos G, Lee R, Tousoulis D, Channon KM, Antoniades C. Predictive value of telomere length on outcome following acute myocardial infarction: evidence for contrasting effects of vascular vs. blood oxidative stress. Eur Heart J 2018; 38:3094-3104. [PMID: 28444175 PMCID: PMC5837455 DOI: 10.1093/eurheartj/ehx177] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 04/21/2016] [Accepted: 03/22/2017] [Indexed: 12/16/2022] Open
Abstract
Aims Experimental evidence suggests that telomere length (TL) is shortened by oxidative DNA damage, reflecting biological aging. We explore the value of blood (BTL) and vascular TL (VTL) as biomarkers of systemic/vascular oxidative stress in humans and test the clinical predictive value of BTL in acute myocardial infarction (AMI). Methods and results In a prospective cohort of 290 patients surviving recent AMI, BTL measured on admission was a strong predictor of all-cause [hazard ratio (HR) [95% confidence interval (CI)]: 3.21 [1.46–7.06], P = 0.004] and cardiovascular mortality (HR [95% CI]: 3.96 [1.65–9.53], P = 0.002) 1 year after AMI (for comparisons of short vs. long BTL, as defined by a T/S ratio cut-off of 0.916, calculated using receiver operating characteristic analysis; P adjusted for age and other predictors). To explore the biological meaning of these findings, BTL was quantified in 727 consecutive patients undergoing coronary artery bypass grafting (CABG), and superoxide (O2.-) was measured in peripheral blood mononuclear cells (PBMNC). VTL/vascular O2.- were quantified in saphenous vein (SV) and mammary artery (IMA) segments. Patients were genotyped for functional genetic polymorphisms in P22ph°x (activating NADPH-oxidases) and vascular smooth muscle cells (VSMC) selected by genotype were cultured from vascular tissue. Short BTL was associated with high O2.- in PBMNC (P = 0.04) but not in vessels, whereas VTL was related to O2.- in IMA (ρ = −0.49, P = 0.004) and SV (ρ = −0.52, P = 0.01). Angiotensin II (AngII) incubation of VSMC (30 days), as a means of stimulating NADPH-oxidases, increased O2.- and reduced TL in carriers of the high-responsiveness P22ph°x alleles (P = 0.007). Conclusion BTL predicts cardiovascular outcomes post-AMI, independently of age, whereas VTL is a tissue-specific (rather than a global) biomarker of vascular oxidative stress. The lack of a strong association between BTL and VTL reveals the importance of systemic vs. vascular factors in determining clinical outcomes after AMI.
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Affiliation(s)
- Marios Margaritis
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Fabio Sanna
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - George Lazaros
- 1st Department of Cardiology, Hippokrateion Hospital, University of Athens, Vas Sofias 114, 11527, Athens, Greece
| | - Ioannis Akoumianakis
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Sheena Patel
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Alexios S Antonopoulos
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Chloe Duke
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Laura Herdman
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Costas Psarros
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Evangelos K Oikonomou
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Cheerag Shirodaria
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Mario Petrou
- Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Rana Sayeed
- Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - George Krasopoulos
- Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Regent Lee
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokrateion Hospital, University of Athens, Vas Sofias 114, 11527, Athens, Greece
| | - Keith M Channon
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
| | - Charalambos Antoniades
- Cardiovascular Medicine Division, University of Oxford, John Radcliffe Hospital, West Wing L6, Headley Way, Oxford OX3 9DU, UK
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15
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Antonopoulos AS, Sanna F, Sabharwal N, Thomas S, Oikonomou EK, Herdman L, Margaritis M, Shirodaria C, Kampoli AM, Akoumianakis I, Petrou M, Sayeed R, Krasopoulos G, Psarros C, Ciccone P, Brophy CM, Digby J, Kelion A, Uberoi R, Anthony S, Alexopoulos N, Tousoulis D, Achenbach S, Neubauer S, Channon KM, Antoniades C. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med 2018; 9:9/398/eaal2658. [PMID: 28701474 DOI: 10.1126/scitranslmed.aal2658] [Citation(s) in RCA: 511] [Impact Index Per Article: 85.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/30/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
Early detection of vascular inflammation would allow deployment of targeted strategies for the prevention or treatment of multiple disease states. Because vascular inflammation is not detectable with commonly used imaging modalities, we hypothesized that phenotypic changes in perivascular adipose tissue (PVAT) induced by vascular inflammation could be quantified using a new computerized tomography (CT) angiography methodology. We show that inflamed human vessels release cytokines that prevent lipid accumulation in PVAT-derived preadipocytes in vitro, ex vivo, and in vivo. We developed a three-dimensional PVAT analysis method and studied CT images of human adipose tissue explants from 453 patients undergoing cardiac surgery, relating the ex vivo images with in vivo CT scan information on the biology of the explants. We developed an imaging metric, the CT fat attenuation index (FAI), that describes adipocyte lipid content and size. The FAI has excellent sensitivity and specificity for detecting tissue inflammation as assessed by tissue uptake of 18F-fluorodeoxyglucose in positron emission tomography. In a validation cohort of 273 subjects, the FAI gradient around human coronary arteries identified early subclinical coronary artery disease in vivo, as well as detected dynamic changes of PVAT in response to variations of vascular inflammation, and inflamed, vulnerable atherosclerotic plaques during acute coronary syndromes. Our study revealed that human vessels exert paracrine effects on the surrounding PVAT, affecting local intracellular lipid accumulation in preadipocytes, which can be monitored using a CT imaging approach. This methodology can be implemented in clinical practice to noninvasively detect plaque instability in the human coronary vasculature.
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Affiliation(s)
- Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Fabio Sanna
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nikant Sabharwal
- Cardiothoracic Directorate, Oxford University Hospitals National Health System (NHS) Foundation Trust, Oxford, UK
| | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Laura Herdman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Marios Margaritis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK
| | - Cheerag Shirodaria
- Cardiothoracic Directorate, Oxford University Hospitals National Health System (NHS) Foundation Trust, Oxford, UK
| | - Anna-Maria Kampoli
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ioannis Akoumianakis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mario Petrou
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Constantinos Psarros
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Patricia Ciccone
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Carl M Brophy
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Janet Digby
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew Kelion
- Cardiothoracic Directorate, Oxford University Hospitals National Health System (NHS) Foundation Trust, Oxford, UK
| | - Raman Uberoi
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Suzan Anthony
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Dimitris Tousoulis
- 1st Department of Cardiology, Athens University Medical School, Athens, Greece
| | - Stephan Achenbach
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK.,Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK.,Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. .,Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK.,Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
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Margaritis M, Psarras K, Panaretou V, Thanos AG, Malamis D, Sotiropoulos A. Improvement of home composting process of food waste using different minerals. Waste Manag 2018; 73:87-100. [PMID: 29248370 DOI: 10.1016/j.wasman.2017.12.009] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 12/05/2017] [Accepted: 12/09/2017] [Indexed: 06/07/2023]
Abstract
This article presents the experimental study of the process of composting in a prototype home-scale system with a special focus on process improvement by using different additives (i.e. woodchips, perlite, vermiculite and zeolite). The interventions with different bulking agents were realized through composting cycles using substrates with 10% additives in specific mixtures of kitchen waste materials. The pre-selected proportion of the mixtures examined was 3:1:1 in cellulosic:proteins:carbohydrates, in order to achieve an initial C/N ratio equal to 30. The control of the initial properties of the examined substrates aimed at the consequent improvement of the properties of the final product (compost). The results indicated that composting process was enhanced with the use of additives and especially the case of zeolite and perlite provided the best results, in terms of efficient temperature evolution (>55 °C for 4 consecutive days). Carbon to nitrogen ratios decreased by 40% from the initial values for the reactors were minerals were added, while for the bioreactor tested with woodchips the reduction was slight, showing slowest degradation rate. Moisture content of produced compost varied within the range of 55-64% d.m., while nutrient content (K, Na, Ca, Mg) was in accordance with the limit values reported in literature. Finally, the composts obtained, exhibited a satisfactory degree of maturity, fulfilling the criterion related to the absence of phytotoxic compounds.
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Affiliation(s)
- M Margaritis
- Unit of Environmental Science and Technology, School of Chemical Engineering, National Technical University of Athens, Greece
| | - K Psarras
- Unit of Environmental Science and Technology, School of Chemical Engineering, National Technical University of Athens, Greece
| | - V Panaretou
- Unit of Environmental Science and Technology, School of Chemical Engineering, National Technical University of Athens, Greece
| | - A G Thanos
- Unit of Environmental Science and Technology, School of Chemical Engineering, National Technical University of Athens, Greece
| | - D Malamis
- Unit of Environmental Science and Technology, School of Chemical Engineering, National Technical University of Athens, Greece
| | - A Sotiropoulos
- Unit of Environmental Science and Technology, School of Chemical Engineering, National Technical University of Athens, Greece.
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17
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Antonopoulos AS, Margaritis M, Shirodaria C, Antoniades C. Translating the effects of statins: from redox regulation to suppression of vascular wall inflammation. Thromb Haemost 2017; 108:840-8. [PMID: 22872079 DOI: 10.1160/th12-05-0337] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/24/2012] [Indexed: 12/21/2022]
Abstract
Vascular oxidative stress is a key feature of atherogenesis, and targeting vascular redox signalling is a rational therapeutic goal in vascular disease pathogenesis. 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors or statins are potent lipid-lowering drugs that improve cardiovascular outcomes. It is now widely accepted that cardiovascular disease prevention by statins is dependent not only on their lipid lowering effects, but also on their beneficial effects on vascular redox signalling. Cell culture and animal models have provided important findings on the effects of statins on vascular redox and nitric oxide bioavailability. Recent evidence from studies on human vessels has further enhanced our understanding of the "pleiotropic" effects of statins on vascular wall. Reversal of endothelial dysfunction in human vessels by statins is dependent on the mevalonate pathway and Rac1 inhibition. These critical steps are responsible for reducing NADPH-oxidase activity and improving tetrahydrobiopterin bioavailability and nitric oxide synthase (NOS) coupling in human vessels. However, mevalonate pathway inhibition has been also held responsible for some of the side effects observed after statin treatment. In this review we summarise the existing knowledge on the effects of statins on vascular biology by discussing key findings from basic science as well as recent evidence from translational studies in humans. Finally, we discuss emerging aspects of statin pleiotropy, such as their effects on adipose tissue biology and adipokine synthesis that may light additional mechanistic links between statin treatment and improvement of clinical outcome in primary and secondary prevention.
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Margaritis M, Sanna F, Antoniades C. Statins and oxidative stress in the cardiovascular system. Curr Pharm Des 2017; 23:CPD-EPUB-85994. [PMID: 28950822 DOI: 10.2174/1381612823666170926130338] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 11/22/2022]
Abstract
Statins are widely established as an important class of medications for primary and secondary prevention of cardiovascular disease. In addition to their lipid-lowering effects, mounting evidence suggests that statins exhibit non-lipid-lowering mediated effects in the cardiovascular system. These so called "pleiotropic" effects are partly due to antioxidant properties of statins. These are mediated by inhibition of the mevalonate pathway, which interferes with small GTP-ase protein prenylation. This, in turn, leads to anti-oxidant effects of statins via a plethora of mechanisms. Statins prevent the activation of the pro-oxidant enzyme NADPH-oxidase by interfering with Rac1 activation and translocation to the membrane, as well as reducing expression of crucial subunits of NADPH-oxidase. Statins also enhance the expression, enzymatic activity and coupling of endothelial nitric oxide synthase (eNOS), through mevalonate-dependent effects. The net result is a restoration of the redox balance in the cardiovascular system, with subsequent anti-atherosclerotic and cardioprotective effects. While the evidence from basic science studies and animal models is strong, more clinical trials are required to establish the relevance of these pleiotropic effects to human cardiovascular disease and potentially lead to expanded indications for statin treatment or alternative therapeutic strategies.
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Affiliation(s)
- Marios Margaritis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford. United Kingdom
| | - Fabio Sanna
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford. United Kingdom
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford. United Kingdom
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19
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Sanna F, Margaritis M, Antoniades C. Perivascular adipose tissue as an endocrine organ: the role of statins. Curr Pharm Des 2017; 23:CPD-EPUB-85996. [PMID: 28950824 DOI: 10.2174/1381612823666170926133843] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022]
Abstract
Adipose tissue (AT), aside from being an energy storage site, functions as a source of cytokines, adipokines and other vasoactive molecules. Dysfunctional AT contributes to the development of cardiovascular disease by shifting to a pro-oxidant, pro-inflammatory phenotype. Perivascular AT (PVAT) is of particular importance to the development of vascular disease, due to its close proximity to the vascular wall. Molecules released from PVAT can exert both pro- and anti-contractile effects, the balance of which plays a role in controlling vascular tone. Recent evidence supports the existence of reciprocal, two-way interactions between PVAT and the vascular wall. Statins, with their pivotal role in cardiovascular disease prevention, have been shown to exert lipid-lowering independent, pleiotropic effects on the vascular wall, some of which may be mediated by modulatory effects on PVAT inflammation and secretome. These effects of statins provide a paradigm for the development of new therapeutic agents aimed at modulating PVAT function, as a novel treatment strategy against cardiovascular disease.
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Affiliation(s)
- Fabio Sanna
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford . United Kingdom
| | - Marios Margaritis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford . United Kingdom
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford . United Kingdom
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20
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Antonopoulos AS, Margaritis M, Verheule S, Recalde A, Sanna F, Herdman L, Psarros C, Nasrallah H, Coutinho P, Akoumianakis I, Brewer AC, Sayeed R, Krasopoulos G, Petrou M, Tarun A, Tousoulis D, Shah AM, Casadei B, Channon KM, Antoniades C. Mutual Regulation of Epicardial Adipose Tissue and Myocardial Redox State by PPAR-γ/Adiponectin Signalling. Circ Res 2016; 118:842-55. [PMID: 26838789 PMCID: PMC4772814 DOI: 10.1161/circresaha.115.307856] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [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: 10/23/2015] [Accepted: 01/21/2016] [Indexed: 01/09/2023]
Abstract
RATIONALE Adiponectin has anti-inflammatory effects in experimental models, but its role in the regulation of myocardial redox state in humans is unknown. Although adiponectin is released from epicardial adipose tissue (EpAT), it is unclear whether it exerts any paracrine effects on the human myocardium. OBJECTIVE To explore the cross talk between EpAT-derived adiponectin and myocardial redox state in the human heart. METHODS AND RESULTS EpAT and atrial myocardium were obtained from 306 patients undergoing coronary artery bypass grafting. Functional genetic polymorphisms that increase ADIPOQ expression (encoding adiponectin) led to reduced myocardial nicotinamide adenine dinucleotide phosphate oxidase-derived O2 (-), whereas circulating adiponectin and ADIPOQ expression in EpAT were associated with elevated myocardial O2 (-). In human atrial tissue, we demonstrated that adiponectin suppresses myocardial nicotinamide adenine dinucleotide phosphate oxidase activity, by preventing AMP kinase-mediated translocation of Rac1 and p47(phox) from the cytosol to the membranes. Induction of O2 (-) production in H9C2 cardiac myocytes led to the release of a transferable factor able to induce peroxisome proliferator-activated receptor-γ-mediated upregulation of ADIPOQ expression in cocultured EpAT. Using a NOX2 transgenic mouse and a pig model of rapid atrial pacing, we found that oxidation products (such as 4-hydroxynonenal) released from the heart trigger peroxisome proliferator-activated receptor-γ-mediated upregulation of ADIPOQ in EpAT. CONCLUSIONS We demonstrate for the first time in humans that adiponectin directly decreases myocardial nicotinamide adenine dinucleotide phosphate oxidase activity via endocrine or paracrine effects. Adiponectin expression in EpAT is controlled by paracrine effects of oxidation products released from the heart. These effects constitute a novel defense mechanism of the heart against myocardial oxidative stress.
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Affiliation(s)
- Alexios S Antonopoulos
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Marios Margaritis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Sander Verheule
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Alice Recalde
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Fabio Sanna
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Laura Herdman
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Costas Psarros
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Hussein Nasrallah
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Patricia Coutinho
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Ioannis Akoumianakis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Alison C Brewer
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Rana Sayeed
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - George Krasopoulos
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Mario Petrou
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Akansha Tarun
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Dimitris Tousoulis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Ajay M Shah
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Barbara Casadei
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Keith M Channon
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.)
| | - Charalambos Antoniades
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., A.R., F.S., L.H., C.P., P.C., I.A., A.T., B.C., K.M.C., C.A.); Cardiac Electrophysiology Group, Department of Physiology, Maastricht University, Maastricht, The Netherlands (S.V., H.N.); Department of Cardiology, Athens University Medical School, Athens, Greece (D.T.); Cardiovascular Division, King's College London BHF Centre, London, United Kingdom (A.C.B., A.M.S.); and Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.S., G.K., M.P.).
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21
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Antonopoulos AS, Margaritis M, Coutinho P, Shirodaria C, Psarros C, Herdman L, Sanna F, De Silva R, Petrou M, Sayeed R, Krasopoulos G, Lee R, Digby J, Reilly S, Bakogiannis C, Tousoulis D, Kessler B, Casadei B, Channon KM, Antoniades C. Adiponectin as a link between type 2 diabetes and vascular NADPH oxidase activity in the human arterial wall: the regulatory role of perivascular adipose tissue. Diabetes 2015; 64:2207-19. [PMID: 25552596 DOI: 10.2337/db14-1011] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [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] [Received: 07/03/2014] [Accepted: 12/20/2014] [Indexed: 12/25/2022]
Abstract
Oxidative stress plays a critical role in the vascular complications of type 2 diabetes. We examined the effect of type 2 diabetes on NADPH oxidase in human vessels and explored the mechanisms of this interaction. Segments of internal mammary arteries (IMAs) with their perivascular adipose tissue (PVAT) and thoracic adipose tissue were obtained from 386 patients undergoing coronary bypass surgery (127 with type 2 diabetes). Type 2 diabetes was strongly correlated with hypoadiponectinemia and increased vascular NADPH oxidase-derived superoxide anions (O2˙(-)). The genetic variability of the ADIPOQ gene and circulating adiponectin (but not interleukin-6) were independent predictors of NADPH oxidase-derived O2˙(-). However, adiponectin expression in PVAT was positively correlated with vascular NADPH oxidase-derived O2˙(-). Recombinant adiponectin directly inhibited NADPH oxidase in human arteries ex vivo by preventing the activation/membrane translocation of Rac1 and downregulating p22(phox) through a phosphoinositide 3-kinase/Akt-mediated mechanism. In ex vivo coincubation models of IMA/PVAT, the activation of arterial NADPH oxidase triggered a peroxisome proliferator-activated receptor-γ-mediated upregulation of the adiponectin gene in the neighboring PVAT via the release of vascular oxidation products. We demonstrate for the first time in humans that reduced adiponectin levels in individuals with type 2 diabetes stimulates vascular NADPH oxidase, while PVAT "senses" the increased NADPH oxidase activity in the underlying vessel and responds by upregulating adiponectin gene expression. This PVAT-vessel interaction is identified as a novel therapeutic target for the prevention of vascular complications of type 2 diabetes.
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Affiliation(s)
| | | | | | | | - Costas Psarros
- 1st Department of Cardiology, Athens University Medical School, Athens, Greece
| | - Laura Herdman
- Cardiovascular Medicine Division, University of Oxford, Oxford, U.K
| | - Fabio Sanna
- Cardiovascular Medicine Division, University of Oxford, Oxford, U.K
| | - Ravi De Silva
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, U.K
| | - Mario Petrou
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, U.K
| | - Rana Sayeed
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, U.K
| | | | - Regent Lee
- Cardiovascular Medicine Division, University of Oxford, Oxford, U.K
| | - Janet Digby
- Cardiovascular Medicine Division, University of Oxford, Oxford, U.K
| | - Svetlana Reilly
- Cardiovascular Medicine Division, University of Oxford, Oxford, U.K
| | | | - Dimitris Tousoulis
- 1st Department of Cardiology, Athens University Medical School, Athens, Greece
| | - Benedikt Kessler
- Nuffield Department of Medicine, University of Oxford, Oxford, U.K
| | - Barbara Casadei
- Cardiovascular Medicine Division, University of Oxford, Oxford, U.K
| | - Keith M Channon
- Cardiovascular Medicine Division, University of Oxford, Oxford, U.K
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Antonopoulos AS, Margaritis M, Coutinho P, Digby J, Patel R, Psarros C, Ntusi N, Karamitsos TD, Lee R, De Silva R, Petrou M, Sayeed R, Demosthenous M, Bakogiannis C, Wordsworth PB, Tousoulis D, Neubauer S, Channon KM, Antoniades C. Reciprocal Effects of Systemic Inflammation and Brain Natriuretic Peptide on Adiponectin Biosynthesis in Adipose Tissue of Patients With Ischemic Heart Disease. Arterioscler Thromb Vasc Biol 2014; 34:2151-9. [DOI: 10.1161/atvbaha.114.303828] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [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—
To explore the role of systemic inflammation in the regulation of adiponectin levels in patients with ischemic heart disease.
Approach and Results—
In a cross-sectional study of 575 subjects, serum adiponectin was compared between healthy subjects, patients with coronary artery disease with no/mild/severe heart failure (HF), and patients with nonischemic HF. Adiponectin expression and release from femoral, subcutaneous and thoracic adipose tissue was determined in 258 additional patients with coronary artery bypass grafting. Responsiveness of the various human adipose tissue depots to interleukin-6, tumor necrosis factor-α, and brain natriuretic peptide (BNP) was examined by using ex vivo models of human fat. The effects of inducible low-grade inflammation were tested by using the model of
Salmonella typhi
vaccine-induced inflammation in healthy individuals. In the cross-sectional study, HF strikingly increased adiponectin levels. Plasma BNP was the strongest predictor of circulating adiponectin and its release from all adipose tissue depots in patients with coronary artery bypass grafting, even in the absence of HF. Femoral AT was the depot with the least macrophages infiltration and the largest adipocyte cell size and the only responsive to systemic and ex vivo proinflammatory stimulation (effect reversible by BNP). Low-grade inflammation reduced circulating adiponectin levels, while circulating BNP remained unchanged.
Conclusions—
This study demonstrates the regional variability in the responsiveness of human adipose tissue to systemic inflammation and suggests that BNP (not systemic inflammation) is the main driver of circulating adiponectin in patients with advanced atherosclerosis even in the absence of HF. Any interpretation of circulating adiponectin as a biomarker should take into account the underlying disease state, background inflammation, and BNP levels.
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Affiliation(s)
- Alexios S. Antonopoulos
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Marios Margaritis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Patricia Coutinho
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Janet Digby
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Rikhil Patel
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Constantinos Psarros
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Ntobeko Ntusi
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Theodoros D. Karamitsos
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Regent Lee
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Ravi De Silva
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Mario Petrou
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Rana Sayeed
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Michael Demosthenous
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Constantinos Bakogiannis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Paul B. Wordsworth
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Dimitris Tousoulis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Stefan Neubauer
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Keith M. Channon
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
| | - Charalambos Antoniades
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.S.A., M.M., P.C., J.D., R.P., N.N., T.D.K., R.L., S.N., K.M.C., C.A.); 1st Cardiology Department, Athens University Medical School, Athens, Greece (C.P., M.D., C.B., D.T.); Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom (R.D.S., M.P., R.S.); and NIHR Oxford Musculoskeletal Biomedical Research Unit & Nuffield Department of Orthopaedics,
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Abstract
SIGNIFICANCE Endothelial dysfunction and the imbalance between nitric oxide (NO) and reactive oxygen species production in the vascular endothelium are important early steps in atherogenesis, a major socioeconomic health problem. Statins have well-established roles in primary and secondary prevention of cardiovascular disease (CVD), due to both their lipid-lowering capacity and their pleiotropic properties. It is therefore important to understand the mechanisms by which statins can modify endothelial function and affect atherogenesis. RECENT ADVANCES In the last decade, the concept of statin pleiotropy has been reinforced by a large number of cell culture, animal, and translational studies. Statins have been shown to suppress the activity of pro-oxidant enzymes (such as NADPH oxidase) and pro-inflammatory transcriptional pathways in the endothelium. At the same time, they enhance endothelial NO synthase expression and activity while they also improve its enzymatic coupling. This leads to increased NO bioavailability and improved endothelial function. CRITICAL ISSUES Despite significant recent advances, the exact mechanisms of statin pleitropy are still only partially understood. The vast majority of the published literature relies on animal studies, while the actual mechanistic studies in humans are limited. FUTURE DIRECTIONS The success of statins as endothelium redox-modifying agents with a direct impact on clinical outcome highlights the importance of the endothelium as a therapeutic target in CVD. Better understanding of the mechanisms that underlie endothelial dysfunction could lead to the design of novel therapeutic strategies that target the vascular endothelium for the prevention and treatment of CVD.
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Affiliation(s)
- Marios Margaritis
- Division of Cardiovascular Medicine, University of Oxford , Oxford, United Kingdom
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Margaritis M, Antonopoulos A, Reilly S, Sayeed R, Desilva R, Petrou M, Tousoulis D, Stefanadis C, Channon KM, Antoniades C. Perivascular adipose tissue supresses superoxide production in internal mammary artery grafts by regulating Rac1-mediated activation of vascular NADPH-oxidase. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p366] [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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Margaritis M, Antonopoulos A, Coutinho P, Lee R, Desilva R, Sayeed R, Petrou M, Tousoulis D, Channon KM, Antoniades C. A novel cross-talk between perivascular adipose tissue and the arterial wall controls redox state in human atherosclerosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1617] [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: 11/15/2022] Open
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Antonopoulos A, Patel R, Demosthenous M, Margaritis M, Digby J, Sayeed R, Tousoulis D, Stefanadis C, Channon KM, Antoniades C. Differential responses of distinct adipose tissue depots to acute and chronic inflammation: novel insights into the complex mechanisms regulating adiponectin biosynthesis in humans. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p725] [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: 11/12/2022] Open
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Margaritis M, Antonopoulos A, Coutinho P, Petrou M, DeSilva R, Sayeed R, Channon K, Antoniades C. YIA2: A NOVEL CROSS-TALK BETWEEN PERIVASCULAR ADIPOSE TISSUE AND THE ARTERIAL WALL CONTROLS REDOX STATE IN HUMAN ATHEROSCLEROSIS. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Margaritis M, Antonopoulos AS, Digby J, Lee R, Reilly S, Coutinho P, Shirodaria C, Sayeed R, Petrou M, De Silva R, Jalilzadeh S, Demosthenous M, Bakogiannis C, Tousoulis D, Stefanadis C, Choudhury RP, Casadei B, Channon KM, Antoniades C. Interactions between vascular wall and perivascular adipose tissue reveal novel roles for adiponectin in the regulation of endothelial nitric oxide synthase function in human vessels. Circulation 2013; 127:2209-21. [PMID: 23625959 DOI: 10.1161/circulationaha.112.001133] [Citation(s) in RCA: 236] [Impact Index Per Article: 21.5] [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: 02/07/2023]
Abstract
BACKGROUND Adiponectin is an adipokine with potentially important roles in human cardiovascular disease states. We studied the role of adiponectin in the cross-talk between adipose tissue and vascular redox state in patients with atherosclerosis. METHODS AND RESULTS The study included 677 patients undergoing coronary artery bypass graft surgery. Endothelial function was evaluated by flow-mediated dilation of the brachial artery in vivo and by vasomotor studies in saphenous vein segments ex vivo. Vascular superoxide (O2(-)) and endothelial nitric oxide synthase (eNOS) uncoupling were quantified in saphenous vein and internal mammary artery segments. Local adiponectin gene expression and ex vivo release were quantified in perivascular (saphenous vein and internal mammary artery) subcutaneous and mesothoracic adipose tissue from 248 patients. Circulating adiponectin was independently associated with nitric oxide bioavailability and O2(-) production/eNOS uncoupling in both arteries and veins. These findings were supported by a similar association between functional polymorphisms in the adiponectin gene and vascular redox state. In contrast, local adiponectin gene expression/release in perivascular adipose tissue was positively correlated with O2(-) and eNOS uncoupling in the underlying vessels. In ex vivo experiments with human saphenous veins and internal mammary arteries, adiponectin induced Akt-mediated eNOS phosphorylation and increased tetrahydrobiopterin bioavailability, improving eNOS coupling. In ex vivo experiments with human saphenous veins/internal mammary arteries and adipose tissue, we demonstrated that peroxidation products produced in the vascular wall (ie, 4-hydroxynonenal) upregulate adiponectin gene expression in perivascular adipose tissue via a peroxisome proliferator-activated receptor-γ-dependent mechanism. CONCLUSIONS We demonstrate for the first time that adiponectin improves the redox state in human vessels by restoring eNOS coupling, and we identify a novel role of vascular oxidative stress in the regulation of adiponectin expression in human perivascular adipose tissue.
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Affiliation(s)
- Marios Margaritis
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Lee R, Antonopoulos AS, Alexopoulou Z, Margaritis M, Kharbanda RK, Choudhury RP, Antoniades C, Channon KM. Artifactual elevation of plasma sCD40L by residual platelets in patients with coronary artery disease. Int J Cardiol 2013; 168:1648-50. [PMID: 23578897 DOI: 10.1016/j.ijcard.2013.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 03/09/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Regent Lee
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Antonopoulos AS, Margaritis M, Lee R, Channon K, Antoniades C. Statins as anti-inflammatory agents in atherogenesis: molecular mechanisms and lessons from the recent clinical trials. Curr Pharm Des 2012; 18:1519-30. [PMID: 22364136 PMCID: PMC3394171 DOI: 10.2174/138161212799504803] [Citation(s) in RCA: 308] [Impact Index Per Article: 25.7] [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: 12/16/2011] [Accepted: 01/10/2012] [Indexed: 12/18/2022]
Abstract
Ample evidence exists in support of the potent anti-inflammatory properties of statins. In cell studies and animal models statins exert beneficial cardiovascular effects. By inhibiting intracellular isoprenoids formation, statins suppress vascular and myocardial inflammation, favorably modulate vascular and myocardial redox state and improve nitric oxide bioavailability. Randomized clinical trials have demonstrated that further to their lipid lowering effects, statins are useful in the primary and secondary prevention of coronary heart disease (CHD) due to their anti-inflammatory potential. The landmark JUPITER trial suggested that in subjects without CHD, suppression of low-grade inflammation by statins improves clinical outcome. However, recent trials have failed to document any clinical benefit with statins in high risk groups, such in heart failure or chronic kidney disease patients. In this review, we aim to summarize the existing evidence on statins as an anti-inflammatory agent in atherogenesis. We describe the molecular mechanisms responsible for the anti-inflammatory effects of statins, as well as clinical data on the non lipid-lowering, anti-inflammatory effects of statins on cardiovascular outcomes. Lastly, the controversy of the recent large randomized clinical trials and the issue of statin withdrawal are also discussed.
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Affiliation(s)
- Alexios S Antonopoulos
- Department of Cardiovascular Medicine, University of Oxford, West Wing Level 6, John Radcliffe Hospital, Headley Way, OX3 9DU, Oxford UK
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Cunnington C, Van Assche T, Shirodaria C, Kylintireas I, Lindsay AC, Lee JM, Antoniades C, Margaritis M, Lee R, Cerrato R, Crabtree MJ, Francis JM, Sayeed R, Ratnatunga C, Pillai R, Choudhury RP, Neubauer S, Channon KM. Systemic and vascular oxidation limits the efficacy of oral tetrahydrobiopterin treatment in patients with coronary artery disease. Circulation 2012; 125:1356-66. [PMID: 22315282 PMCID: PMC5238935 DOI: 10.1161/circulationaha.111.038919] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND The endothelial nitric oxide synthase cofactor tetrahydrobiopterin (BH4) plays a pivotal role in maintaining endothelial function in experimental vascular disease models and in humans. Augmentation of endogenous BH4 levels by oral BH4 treatment has been proposed as a potential therapeutic strategy in vascular disease states. We sought to determine the mechanisms relating exogenous BH4 to human vascular function and to determine oral BH4 pharmacokinetics in both plasma and vascular tissue in patients with coronary artery disease. METHODS AND RESULTS Forty-nine patients with coronary artery disease were randomized to receive low-dose (400 mg/d) or high-dose (700 mg/d) BH4 or placebo for 2 to 6 weeks before coronary artery bypass surgery. Vascular function was quantified by magnetic resonance imaging before and after treatment, along with plasma BH4 levels. Vascular superoxide, endothelial function, and BH4 levels were determined in segments of saphenous vein and internal mammary artery. Oral BH4 treatment significantly augmented BH4 levels in plasma and in saphenous vein (but not internal mammary artery) but also increased levels of the oxidation product dihydrobiopterin (BH2), which lacks endothelial nitric oxide synthase cofactor activity. There was no effect of BH4 treatment on vascular function or superoxide production. Supplementation of human vessels and blood with BH4 ex vivo revealed rapid oxidation of BH4 to BH2 with predominant BH2 uptake by vascular tissue. CONCLUSIONS Oral BH4 treatment augments total biopterin levels in patients with established coronary artery disease but has no net effect on vascular redox state or endothelial function owing to systemic and vascular oxidation of BH4. Alternative strategies are required to target BH4-dependent endothelial function in established vascular disease states.
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Affiliation(s)
- Colin Cunnington
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Antonopoulos AS, Antoniades C, Margaritis M, Tousoulis D, Demosthenous M, Miliou A, Psarros C, Koumallos N, Bakogiannis C, Stefanadis C. ADIPONECTIN THROUGHOUT THE CARDIOVASCULAR DISEASE CONTINUUM: REDOX STATE IN THE FAILING MYOCARDIUM AS A REGULATOR OF CIRCULATING ADIPONECTIN LEVELS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61051-1] [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: 11/25/2022]
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Antoniades C, Demosthenous M, Reilly S, Margaritis M, Zhang MH, Antonopoulos A, Marinou K, Nahar K, Jayaram R, Tousoulis D, Bakogiannis C, Sayeed R, Triantafyllou C, Koumallos N, Psarros C, Miliou A, Stefanadis C, Channon KM, Casadei B. Myocardial Redox State Predicts In-Hospital Clinical Outcome After Cardiac Surgery. J Am Coll Cardiol 2012; 59:60-70. [DOI: 10.1016/j.jacc.2011.08.062] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/05/2011] [Accepted: 08/08/2011] [Indexed: 10/14/2022]
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Lee R, Margaritis M, Channon KM, Antoniades C. Evaluating oxidative stress in human cardiovascular disease: methodological aspects and considerations. Curr Med Chem 2012; 19:2504-20. [PMID: 22489713 PMCID: PMC3412204 DOI: 10.2174/092986712800493057] [Citation(s) in RCA: 341] [Impact Index Per Article: 28.4] [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: 08/26/2011] [Revised: 11/01/2011] [Accepted: 11/25/2011] [Indexed: 11/22/2022]
Abstract
Oxidative stress is a key feature in atherogenesis, since reactive oxygen species (ROS) are involved in all stages of the disease, from endothelial dysfunction to atheromatic plaque formation and rupture. It is therefore important to identify reliable biomarkers allowing us to monitor vascular oxidative stress status. These may lead to improved understanding of disease pathogenesis and development of new therapeutic strategies. Measurement of circulating biomarkers of oxidative stress is challenging, since circulation usually behaves as a separate compartment to the individual structures of the vascular wall. However, measurement of stable products released by the reaction of ROS and vascular/circulating molecular structures is a particularly popular approach. Serum lipid hydroperoxides, plasma malondialdehyde or urine F2-isoprostanes are widely used and have a prognostic value in cardiovascular disease. Quantification of oxidative stress at a tissue level is much more accurate. Various chemiluminescence and high performance liquid chromatography assays have been developed over the last few years, and some of them are extremely accurate and specific. Electron spin resonance spectroscopy and micro-electrode assays able to detect ROS directly are also widely used. In conclusion, measurement of circulating biomarkers of oxidative stress is valuable, and some of them appear to have predictive value in cardiovascular disease. However, these biomarkers do not necessarily reflect intravascular oxidative stress and therefore cannot be used as therapeutic targets or markers to monitor pharmacological treatments in clinical settings. Measurement of vascular oxidative stress status is still the only reliable way to evaluate the involvement of oxidative stress in atherogenesis.
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Affiliation(s)
| | | | | | - C Antoniades
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Antoniades C, Cunnington C, Antonopoulos A, Neville M, Margaritis M, Demosthenous M, Bendall J, Hale A, Cerrato R, Tousoulis D, Bakogiannis C, Marinou K, Toutouza M, Vlachopoulos C, Leeson P, Stefanadis C, Karpe F, Channon KM. Induction of vascular GTP-cyclohydrolase I and endogenous tetrahydrobiopterin synthesis protect against inflammation-induced endothelial dysfunction in human atherosclerosis. Circulation 2011; 124:1860-70. [PMID: 21969008 PMCID: PMC5238937 DOI: 10.1161/circulationaha.111.029272] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The endothelial nitric oxide synthase cofactor tetrahydrobiopterin (BH4) is essential for maintenance of enzymatic function. We hypothesized that induction of BH4 synthesis might be an endothelial defense mechanism against inflammation in vascular disease states. METHODS AND RESULTS In Study 1, 20 healthy individuals were randomized to receive Salmonella typhi vaccine (a model of acute inflammation) or placebo in a double-blind study. Vaccination increased circulating BH4 and interleukin 6 and induced endothelial dysfunction (as evaluated by brachial artery flow-mediated dilation) after 8 hours. In Study 2, a functional haplotype (X haplotype) in the GCH1 gene, encoding GTP-cyclohydrolase I, the rate-limiting enzyme in biopterin biosynthesis, was associated with endothelial dysfunction in the presence of high-sensitivity C-reactive protein in 440 coronary artery disease patients. In Study 3, 10 patients with coronary artery disease homozygotes for the GCH1 X haplotype (XX) and 40 without the haplotype (OO) underwent S Typhi vaccination. XX patients were unable to increase plasma BH4 and had a greater reduction of flow-mediated dilation than OO patients. In Study 4, vessel segments from 19 patients undergoing coronary bypass surgery were incubated with or without cytokines (interleukin-6/tumor necrosis factor-α/lipopolysaccharide) for 24 hours. Cytokine stimulation upregulated GCH1 expression, increased vascular BH4, and improved vasorelaxation in response to acetylcholine, which was inhibited by the GTP-cyclohydrolase inhibitor 2,4-diamino-6-hydroxypyrimidine. CONCLUSIONS The ability to increase vascular GCH1 expression and BH4 synthesis in response to inflammation preserves endothelial function in inflammatory states. These novel findings identify BH4 as a vascular defense mechanism against inflammation-induced endothelial dysfunction.
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Affiliation(s)
- Charalambos Antoniades
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Hedley Way, OX3 9DU, Oxford, UK
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Antonopoulos AS, Lee R, Margaritis M, Antoniades C. Adiponectin as a regulator of vascular redox state: therapeutic implications. Recent Pat Cardiovasc Drug Discov 2011; 6:78-88. [PMID: 21453253 DOI: 10.2174/157489011795933837] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 03/13/2011] [Indexed: 02/07/2023]
Abstract
Recently, adipose tissue has been implicated in the regulation of vascular function in humans. This regulatory function is mediated via the release of vasoactive cytokines called adipokines. Adiponectin is an adipokine with powerful anti-inflammatory and antioxidant properties being dysregulated in obesity and in insulin resistance states. In both in vitro and in vivo models adiponectin has been shown to increase nitric oxide bioavailability, improve endothelial function, and exert beneficial effects on vascular smooth muscle cell function. Strategies to upregulate adiponectin expression or to potentiate adiponectin signalling may favourably modulate vascular redox state and therefore reduce cardiovascular risk. Various drug classes such as glitazones, newer sulfonylureas, angiotensin receptor blockers, ACE inhibitors and nicotinic acid exert beneficial effects on insulin resistance partly by increasing plasma adiponectin levels. Others such as tetrahydrobiopterin or certain antioxidants are also promising in normalizing plasma adiponectin levels. Given the central role of adiponectin in vascular disease states and obesity-related metabolic disorders, improving adiponectin vascular or systemic bioavailability via existing drugs or novel therapeutic strategies may be valuable in the prevention of cardiovascular disease in humans. The discussion of recent patents for the adiponectin as a regulator of vascular redox state also included in this review article.
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Margaritis M, Antoniades C, Demosthenous M, Antonopoulos AS, Tousoulis D, Bakogiannis C, Lymperiadis D, Reilly S, Casadei B, Stefanadis C. MYOCARDIAL O2- AND ONOO-GENERATION IN CHRONIC ATRIAL FIBRILLATION. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60089-2] [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: 11/28/2022]
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Liapi C, Kyriakaki A, Zarros A, Al-Humadi H, Stolakis V, Gkrouzman E, Anifantaki F, Skandali N, Margaritis M, Tsakiris S. Effects of adult-onset choline deprivation on the activities of acetylcholinesterase, (Na+,K+)- and Mg2+-ATPase in crucial rat brain regions. Food Chem Toxicol 2008; 47:82-5. [PMID: 18992298 DOI: 10.1016/j.fct.2008.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 09/09/2008] [Accepted: 10/10/2008] [Indexed: 11/25/2022]
Abstract
Choline (Ch) plays an important role in brain neurotransmission, while Ch-deprivation (CD) has been linked to various pathophysiological states. Prolonged ingestion of Ch-deficient diet (CDD) is known to produce CD causing a reduction of rat brain acetylcholine (ACh) levels, as well as memory and growth disorders. The aim of this study was to investigate the effect of a 2-month adult-onset CD on the activities of acetylcholinesterase (AChE), (Na+,K+)- and Mg2+-ATPase in crucial brain regions of male rats. Adult rats were divided into two groups (control and CD). The CD group was fed with CDD for 2-months. At the end of the second month, rats were sacrificed by decapitation and the brain regions were rapidly removed. Enzyme activities were measured spectrophotometrically in the homogenated frontal cortex, hippocampus, hypothalamus, cerebellum, and pons. In CD rats, AChE activity was found statistically significantly increased in the hippocampus and the cerebellum (+28%, P<0.001 and +46%, P<0.001, respectively, as compared to control), while it was found unaltered in the other three regions (frontal cortex, hypothalamus and pons). (Na+,K+)-ATPase activity was found increased by CD in the frontal cortex (+30%, P<0.001), decreased in both hippocampus and hypothalamus (-68%, P<0.001 and -51%, P<0.001, respectively), and unaltered in both cerebellum and pons. No statistically significant changes were observed in the activities of Mg2+-ATPase in the frontal cortex and the hypothalamus, while statistically significant increases were recorded in the hippocampus (+21%, P<0.01), the cerebellum (+85%, P<0.001) and the pons (+19%, P<0.05), as compared to control levels. Our data suggest that adult-onset CD can have significant effects on the examined brain parameters in the examined crucial brain regions, as well as that CD is a metabolic disorder towards which different and brain region specific neurophysiological responses seem to occur. Following a 2-month adult-onset CD, the activity of AChE was found to be increased in the hippocampus and the cerebellum and unaltered in the other three regions (frontal cortex, hypothalamus and pons), while Na+,K+-ATPase activity was found to be increased in the frontal cortex, decreased in both hippocampus and hypothalamus, and unaltered in both cerebellum and pons. Moreover, Mg2+-ATPase activity was found to be unaltered in the frontal cortex and the hypothalamus, and increased in the hippocampus, the cerebellum and the pons. The observed differentially affected activities of AChE, (Na+,K+)-ATPase and Mg2+-ATPase (induced by CD) could result in modulations of cholinergic neurotransmission, neural excitability, metabolic energy production, Mg2+ homeostasis and protein synthesis (that might have a variety of neurophysiological consequences depending on the brain region in which they seem to occur).
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Affiliation(s)
- Charis Liapi
- Department of Pharmacology, Medical School, University of Athens, Athens, Greece
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