Plasma PCSK9 levels increase following percutaneous coronary interventions

Background

Beside its role in cholesterol homeostasis, Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) has been associated with the processes of vascular inflammation and atherosclerosis. The protein is expressed in endothelial cells, smooth muscle cells and macrophages and it is detected inside the human atherosclerotic plaque.

Purpose

We aimed to investigate the effect of acute inflammation associated with plaque rupture and vascular injury during elective percutaneous coronary intervention (PCI) on plasma levels of PCSK9 in patients with coronary artery disease (CAD).

Methods

We measured PCSK9, C-reactive protein (CRP), Interleukin-6 (IL-6) and high-sensitivity cardiac Troponin T (hs-cTnT) plasma levels immediately before and 18–24 hours after PCI via the radial approach, in 68 consecutive patients with stable CAD referred for elective PCI of a de novo lesion in a native coronary artery. Patients with unstable coronary syndrome <3 months old, baseline inflammatory condition, malignancy, auto-immune disease or intervention via the femoral access, were excluded.

Results

All patients were treated with balloon angioplasty and implantation of a second-generation drug eluting stent (DES). Baseline plasma levels of PCSK9 were higher in women and in patients treated with statins. At 18–24 hours after the procedure, plasma levels of PCSK9, CRP, IL-6 and hs-cTnT increased significantly compared to baseline (table). The change (elevation) in CRP plasma levels was statistically correlated with that of IL-6 (r=0.33; p=0.006) and with that of hs-cTnT (r=0.28; p=0.023). However, there was no correlation between the change (elevation) in plasma PCSK9 levels and those of IL-6 (r=−0.09; p=0.47), CRP (r=0.01; p=0.9), and hs-cTnT (r=0.1; p=0.41).

Conclusions

Plasma levels of PCSK9 increased by 26% following PCI with DES. That elevation was however, not correlated with the degree of myocardial injury (hs-cTnT) or of inflammation (IL-6 and CRP). The mechanism underlying PCK9 elevation post PCI requires further investigation.

Funding Acknowledgement

Type of funding sources: None.

Prediction of preterm delivery by second trimester inflammatory biomarkers in the amniotic fluid

OBJECTIVE

To search for a correlation between mid-pregnancy altered levels of inflammatory markers and preterm delivery.

METHODS

A prospective cohort series included 39 patients undergoing amniocentesis one additional milliliter of amniotic fluid (AF) was stored for later dosage of interleukin-6 (Il-6), matrix metalloproteinase-9 (MMP-9), glucose and C-reactive protein (CRP). Maternal serum CRP and glucose levels were also obtained. Exclusion criteria were multiple pregnancies, chorioamnionitis, group B streptococcus colonization, bacterial vaginosis and cases with proven aneuploidy. We searched for correlation between AF and plasmatic markers and also for a difference between patients with term and preterm delivery.

RESULTS

33 participants were eligible and one third had preterm delivery. Levels of the plasmatic biomarkers did not correlate with the AF biomarkers except for plasmatic glucose and AF IL-6 levels (r=0.350; p=0.016). The levels of all AF biomarkers did not differ significantly between the pre-term and the term groups (p>0.05). The optimal screening cutoffs for identifying pregnancies at risk were different than the ones initially indicated.

CONCLUSION

Mid-pregnancy amniotic fluid biomarker levels do not correlate with preterm delivery. Plasma CRP is not correlated with these markers. Cutoff levels suggested are sparse and heterogeneous. Larger studies are needed before advising routine measurement of these markers.

Effect of high bolus dose tirofiban on the inflammatory response following percutaneous coronary intervention

BACKGROUND

Tirofiban at the bolus dose of 10 microg/kg does not suppress the inflammatory response following percutaneous coronary intervention (PCI). This may be due to less than optimal inhibition of platelet aggregation. High bolus dose tirofiban (25 microg/kg) allows better inhibition of platelet aggregation but its anti-inflammatory effect remains unknown.

HYPOTHESIS

High bolus dose tirofiban exhibits anti-inflammatory activity.

METHODS

A total of 100 patients referred for PCI were randomized to receive high bolus dose tirofiban followed by a 24-h infusion or a bolus and an infusion of saline. Patients with elevated troponin or with thrombus in the culprit lesion were excluded. Inflammatory markers were measured at baseline and at 24 h.

RESULTS

Levels of soluble CD40 ligand (sCD40L) were not affected by PCI while those of interleukin-6 (IL-6) and of high sensitivity C-reactive protein (hs-CRP) significantly increased. Despite inhibiting platelet's aggregation by > 90%, tirofiban did not suppress the rise of IL-6 and hs-CRP. Median (interquartile range) elevation of IL-6 was 0.6 pg/mL (-1.5-3.6) versus 0.4 pg/mL (-0.7-1.8) and that of hs-CRP was 2.1 mg/L (0.7-5.2) versus 2.4 mg/L (1-4.7) in the tirofiban and the control groups, respectively (p = ns). However, in patients with diabetes mellitus, tirofiban significantly suppressed the rise of hs-CRP by 65% (p = 0.01), but did not significantly affect the rise of IL-6.

CONCLUSION

In low-risk patients undergoing PCI, tirofiban did not attenuate the rise of inflammatory markers. However, the significant effect in diabetics suggests that tirofiban may have anti-inflammatory activity in higher risk patients.

Food allergy in Lebanon: is sesame seed the "middle eastern" peanut

A randomly sampled, cross-sectional serology test-based survey was conducted in Lebanon to describe the pattern of food allergy among Lebanese population. The prevalence of specific Immunoglobulin E (IgE) to food allergens was investigated in 20 laboratories in different regions of Lebanon by an immunoblot assay over a 1 year period. Clinical correlation was determined in two university hospitals. There were 1842 patients with suspected IgE-mediated food allergic reactions tested for specific IgE upon their physician's request. Clinical correlation was done in 93 patients. We identified 386 out of 1842 (20.95%) patients with positive specific IgE to food allergens. The clinical presentations were cutaneous, digestive, and anaphylaxis. The major cause of allergy was cow's milk in infants and young children, hazelnut and wheat flour in adults. Although specific IgE to peanut in infants, children, and adults were higher than for sesame, peanut-induced allergic reactions were mild, in contrary to sesame where anaphylaxis was the only clinical manifestation. Recently, sesame has been recognized as an increasingly frequent and potentially severe allergen. Further studies with double-blind, placebo-controlled food challenge are needed to establish the real prevalence of food allergy in Lebanon, and to determine the most common allergens taking in consideration the nutritional habits of our population.

[Acute respiratory distress syndrome complicating Ebstein-Barr virus pneumonia]

Introduction

Chez l’adulte immunocompétent, l’Epstein Barr (EBV) entraîne une maladie autolimitée spontanément résolutive.

Observation

Un syndrome de détresse respiratoire aigu (SDRA) compliquant une pneumonie grave à EBV est rapporté avec le recours à une ventilation artificielle prolongée. Le diagnostic était confirmé par l’usage des sérologies spécifiques et la recherche de la charge d’ADN virale par PCR. À part la stratégie protectrice de la ventilation mécanique, le traitement médical a compris l’utilisation de l’Acyclovir et les immunoglobulines polyclonales dans la phase précoce ainsi que des corticoïdes systémiques dans la phase tardive. La guérison était progressive et complète.

Conclusion

La pneumonie à EBV compliquée d’un SDRA chez les immunocompétents existe. Sa prise en charge est un défi diagnostique et thérapeutique.

Percutaneous coronary intervention increases leptin and decreases adiponectin levels

OBJECTIVE

The study was designed to examine the effect of percutaneous coronary intervention (PCI) on adiponectin and leptin levels. We have previously demonstrated that PCI triggers a systemic inflammatory response. We hypothesized that inflammation participates in the pathogenesis of diabetes mellitus and the metabolic syndrome by modulating levels of adiponectin and leptin.

DESIGN

Prospective study in which inflammation was induced by PCI.

PATIENTS

Forty-eight patients with stable coronary artery disease and without diabetes mellitus.

MEASUREMENTS

High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), leptin and adiponectin were measured at baseline and 48 h after the procedure.

RESULTS

Following PCI, hs-CRP increased by 211%, IL-6 by 87% and leptin by 19%, while adiponectin decreased by 14% (P < 0.001 for all). The change in IL-6 correlated with that in hs-CRP (rho = 0.32; P = 0.027), as did the changes in IL-6 and leptin (rho = 0.31; P = 0.03). The change in adiponectin, however, did not correlate with the change in any of the other markers.

CONCLUSION

This study demonstrates that PCI affects the levels of adiponectin and leptin within 48 h. These effects may be secondary to the inflammatory response triggered by PCI.

Effects of clopidogrel on soluble CD40 ligand and on high-sensitivity C-reactive protein in patients with stable coronary artery disease

BACKGROUND

Antiplatelet therapy with clopidogrel decreases ischemic complication especially in patients with acute coronary syndromes or after percutaneous coronary interventions. Our study was designed to test the effects of clopidogrel on soluble CD40 ligand (sCD40l) and on high-sensitivity C-reactive protein (hs-CRP) in patients with stable coronary artery disease (CAD).

METHODS

This is a randomized, double-blind, placebo-controlled study. A total of 73 patients with stable CAD for > 6 months were randomized to receive either clopidogrel (loading dose 300 mg followed by 75 mg/d) for 8 weeks or placebo. Soluble CD40 ligand and hs-CRP were measured at baseline and at completion of the study.

RESULTS

All patients were on aspirin therapy, and 74% were on statins. Median and interquartile ranges (IQR) of sCD40l decreased from 64 pg/mL (43-99) at baseline to 53 pg/mL (35-77) at 8 weeks (P = .03) in the clopidogrel group and remained unchanged in the placebo group (59 pg/mL, IQR 35-77 vs 55 pg/mL, IQR 35-78) (P = non significant). Levels of hs-CRP were not affected by therapy and remained unchanged in both groups.

CONCLUSIONS

In patients with stable CAD, clopidogrel inhibits the release of sCD40l by platelets, which may contribute to the clinical benefit provided by this drug. This, however, does not translate in a reduction of subclinical inflammation, as measured by hs-CRP.

Effects of tirofiban and statins on high-sensitivity C-reactive protein, interleukin-6, and soluble CD40 ligand following percutaneous coronary interventions in patients with stable coronary artery disease

This study assessed the effects of tirofiban and statins on high-sensitivity C-reactive protein, interleukin-6, and soluble CD40 ligand after percutaneous coronary intervention in patients who had stable coronary artery disease. Tirofiban insignificantly limited the increase of soluble CD40 ligand after revascularization, especially in patients who had high levels of this marker at baseline (p = 0.06), whereas statins significantly inhibited increases in interleukin-6 and, to a lesser extent, high-sensitivity C-reactive protein without affecting the soluble CD40 ligand.

Hepatitis B and C seroprevalence in the Lebanese population

We aimed to evaluate exposure to hepatitis B and C viruses [HBV and HBC] and candidate risk factors among the Lebanese population. All individuals presenting to all laboratory units in the country over a 2-week period were asked for a 5-mL whole blood sample and answered a questionnaire addressing risk factors. For individuals under 15 years of age the mother was interviewed. In all, 2893 blood samples were examined. Refusal rate was 2.9%. Exposure to HBV antigen was 18.9%; 1.9% were carriers and acute hepatitis B point prevalence was 0.1%. Exposure to HCV antigen was 0.7%. Exposure to both HBc and HCV antibodies was 0.2%. HBc prevalence increased with age and was higher among men. Significant risk factors included blood transfusion, haemodialysis and gastrointestinal endoscopy.

Hepatitis B and C seroprevalence in the Lebanese population

We aimed to evaluate exposure to hepatitis B and C viruses (HBV and HBC) and candidate risk factors among the Lebanese population. All individuals presenting to all laboratory units in the country over a 2-week period were asked for a 5-mL whole blood sample and answered a questionnaire addressing risk factors. For individuals under 15 years of age the mother was interviewed. In all, 2893 blood samples were examined. Refusal rate was 2.9%. Exposure to HBV antigen was 18.9%; 1.9% were carriers and acute hepatitis B point prevalence was 0.1%. Exposure to HCV antigen was 0.7%. Exposure to both HBc and HCV antibodies was 0.2%. HBc prevalence increased with age and was higher among men. Significant risk factors included blood transfusion, haemodialysis and gastrointestinal endoscopy.