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Callon D, Glenet M, Lebreil AL, Heng L, Bouland N, Fichel C, Fornes P, Andreoletti L, Berri F. Major Group-B Enterovirus populations deleted in the noncoding 5' region of genomic RNA modulate activation of the type I interferon pathway in cardiomyocytes and induce myocarditis. PLoS Pathog 2024; 20:e1012125. [PMID: 38696536 DOI: 10.1371/journal.ppat.1012125] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 05/14/2024] [Accepted: 03/14/2024] [Indexed: 05/04/2024] Open
Abstract
Major 5'-terminally deleted (5'TD) RNA forms of group-B coxsackievirus (CVB-5'TD) has been associated with myocarditis in both mice and humans. Although it is known that interferon-β (IFN-β) signaling is critical for an efficient innate immune response against CVB-induced myocarditis, the link between CVB-5'TD RNA forms and type I IFN signaling in cardiomyocytes remains to be explored. In a mouse model of CVB3/28-induced myocarditis, major early-emerging forms of CVB-5'TD RNA have been characterized as replicative viral populations that impair IFN-β production in the heart. Synthetic CVB3/28 RNA forms mimicking each of these major 5'TD virus populations were transfected in mice and have been shown to modulate innate immune responses in the heart and to induce myocarditis in mice. Remarkably, transfection of synthetic viral RNA with deletions in the secondary structures of the 5'-terminal CVB3 RNA domain I, modifying stem-loops "b", "c" or "d", were found to impair IFN-β production in human cardiomyocytes. In addition, the activation of innate immune response by Poly(I:C), was found to restore IFN-β production and to reduce the burden of CVB-5'TD RNA-forms in cardiac tissues, thereby reducing the mortality rate of infected mice. Overall, our results indicate that major early-emerging CVB3 populations deleted in the domain I of genomic RNA, in the 5' noncoding region, modulate the activation of the type I IFN pathway in cardiomyocytes and induce myocarditis in mice. These findings shed new light on the role of replicative CVB-5'TD RNA forms as key pathophysiological factors in CVB-induced human myocarditis.
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Affiliation(s)
- Domitille Callon
- University of Reims Champagne Ardennes, Inserm, UMR-S1320 CardioVir, Reims, France
- Academic Hospital of Reims, Robert Debré, Pathology Department, Reims, France
| | - Marie Glenet
- University of Reims Champagne Ardennes, Inserm, UMR-S1320 CardioVir, Reims, France
| | - Anne-Laure Lebreil
- University of Reims Champagne Ardennes, Inserm, UMR-S1320 CardioVir, Reims, France
| | - Laetitia Heng
- University of Reims Champagne Ardennes, Inserm, UMR-S1320 CardioVir, Reims, France
| | - Nicole Bouland
- Academic Hospital of Reims, Robert Debré, Pathology Department, Reims, France
| | - Caroline Fichel
- Academic Hospital of Reims, Robert Debré, Pathology Department, Reims, France
| | - Paul Fornes
- University of Reims Champagne Ardennes, Inserm, UMR-S1320 CardioVir, Reims, France
- Academic Hospital of Reims, Robert Debré, Pathology Department, Reims, France
| | - Laurent Andreoletti
- University of Reims Champagne Ardennes, Inserm, UMR-S1320 CardioVir, Reims, France
- Academic Hospital of Reims, Robert Debré, Virology Department, Reims, France
| | - Fatma Berri
- University of Reims Champagne Ardennes, Inserm, UMR-S1320 CardioVir, Reims, France
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2
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Callon D, N'Guyen Y, Fornes P, Andreoletti L. Fatal heart arrhythmia associated with enterovirus cardiac infection and SARS-CoV-2-induced cytokine storm. Pathology 2024; 56:434-437. [PMID: 37940481 DOI: 10.1016/j.pathol.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/10/2023] [Accepted: 08/08/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Domitille Callon
- Université de Reims Champagne-Ardennes, EA 4684 Cardiovir, France; Laboratoire de Biopathologie, Hôpital Robert Debré, Reims, France
| | - Yohan N'Guyen
- Université de Reims Champagne-Ardennes, EA 4684 Cardiovir, France; Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hôpital Robert Debré, Reims, France.
| | - Paul Fornes
- Université de Reims Champagne-Ardennes, EA 4684 Cardiovir, France; Laboratoire de Biopathologie, Hôpital Robert Debré, Reims, France
| | - Laurent Andreoletti
- Université de Reims Champagne-Ardennes, EA 4684 Cardiovir, France; Laboratoire de Virologie Médicale et Moléculaire, Pole de Biologie Médicale, Hôpital Robert Debré, Reims, France
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3
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Hovhannisyan Y, Li Z, Callon D, Suspène R, Batoumeni V, Canette A, Blanc J, Hocini H, Lefebvre C, El-Jahrani N, Kitsara M, L'honoré A, Kordeli E, Fornes P, Concordet JP, Tachdjian G, Rodriguez AM, Vartanian JP, Béhin A, Wahbi K, Joanne P, Agbulut O. Critical contribution of mitochondria in the development of cardiomyopathy linked to desmin mutation. Stem Cell Res Ther 2024; 15:10. [PMID: 38167524 PMCID: PMC10763022 DOI: 10.1186/s13287-023-03619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Beyond the observed alterations in cellular structure and mitochondria, the mechanisms linking rare genetic mutations to the development of heart failure in patients affected by desmin mutations remain unclear due in part, to the lack of relevant human cardiomyocyte models. METHODS To shed light on the role of mitochondria in these mechanisms, we investigated cardiomyocytes derived from human induced pluripotent stem cells carrying the heterozygous DESE439K mutation that were either isolated from a patient or generated by gene editing. To increase physiological relevance, cardiomyocytes were either cultured on an anisotropic micropatterned surface to obtain elongated and aligned cardiomyocytes, or as a cardiac spheroid to create a micro-tissue. Moreover, when applicable, results from cardiomyocytes were confirmed with heart biopsies of suddenly died patient of the same family harboring DESE439K mutation, and post-mortem heart samples from five control healthy donors. RESULTS The heterozygous DESE439K mutation leads to dramatic changes in the overall cytoarchitecture of cardiomyocytes, including cell size and morphology. Most importantly, mutant cardiomyocytes display altered mitochondrial architecture, mitochondrial respiratory capacity and metabolic activity reminiscent of defects observed in patient's heart tissue. Finally, to challenge the pathological mechanism, we transferred normal mitochondria inside the mutant cardiomyocytes and demonstrated that this treatment was able to restore mitochondrial and contractile functions of cardiomyocytes. CONCLUSIONS This work highlights the deleterious effects of DESE439K mutation, demonstrates the crucial role of mitochondrial abnormalities in the pathophysiology of desmin-related cardiomyopathy, and opens up new potential therapeutic perspectives for this disease.
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Affiliation(s)
- Yeranuhi Hovhannisyan
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
| | - Zhenlin Li
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
| | - Domitille Callon
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
- Department of Pathology, Academic Hospital of Reims, Reims, France
| | - Rodolphe Suspène
- Virus and Cellular Stress Unit, Department of Virology, Institut Pasteur, Université Paris Cité, Paris, France
| | - Vivien Batoumeni
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
- Ksilink, Strasbourg, France
| | - Alexis Canette
- Service de Microscopie Électronique (IBPS-SME), Institut de Biologie Paris-Seine (IBPS), CNRS, Sorbonne Université, Paris, France
| | - Jocelyne Blanc
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
| | - Hakim Hocini
- INSERM U955, Equipe 16, Université Paris-Est Créteil, Créteil, France
| | - Cécile Lefebvre
- INSERM U955, Equipe 16, Université Paris-Est Créteil, Créteil, France
| | - Nora El-Jahrani
- INSERM U955, Equipe 16, Université Paris-Est Créteil, Créteil, France
| | - Maria Kitsara
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
| | - Aurore L'honoré
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
| | - Ekaterini Kordeli
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
| | - Paul Fornes
- Department of Pathology, Academic Hospital of Reims, Reims, France
| | - Jean-Paul Concordet
- INSERM U1154, CNRS UMR7196, Museum National d'Histoire Naturelle, Paris, France
| | - Gérard Tachdjian
- Laboratoire de Cytogénétique, Service d'Histologie-Embryologie-Cytogénétique, AP-HP, Hôpital Antoine Béclère, Université Paris Saclay, Clamart, France
| | - Anne-Marie Rodriguez
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France
| | - Jean-Pierre Vartanian
- Virus and Cellular Stress Unit, Department of Virology, Institut Pasteur, Université Paris Cité, Paris, France
| | - Anthony Béhin
- Reference Center for Muscle Diseases Paris-Est, Myology Institute, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Karim Wahbi
- Cardiology Department, AP-HP, Cochin Hospital, Université Paris Cité, Paris, France
| | - Pierre Joanne
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France.
| | - Onnik Agbulut
- UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Institut de Biologie Paris-Seine (IBPS), Sorbonne Université, 7, Quai St Bernard (case 256), 75005, Paris, France.
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Marey I, Fressart V, Rambaud C, Fornes P, Martin L, Grotto S, Alembik Y, Gorka H, Millat G, Gandjbakhch E, Bordet C, de la Grandmaison GL, Richard P, Charron P. Clinical impact of post-mortem genetic testing in cardiac death and cardiomyopathy. Open Med (Wars) 2020; 15:435-446. [PMID: 33336002 PMCID: PMC7711964 DOI: 10.1515/med-2020-0150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/13/2022] Open
Abstract
Post-mortem genetic analyses may help to elucidate the cause of cardiac death. The added value is however unclear when a cardiac disease is already suspected or affirmed. Our aim was to study the feasibility and medical impact of post-mortem genetic analyses in suspected cardiomyopathy. We studied 35 patients with cardiac death and suspected cardiomyopathy based on autopsy or clinical data. After targeted sequencing, we identified 15 causal variants in 15 patients (yield 43%) in sarcomeric (n = 8), desmosomal (n = 3), lamin A/C (n = 3) and transthyretin (n = 1) genes. The results had various impacts on families, i.e. allowed predictive genetic testing in relatives (15 families), planned early therapeutics based on the specific underlying gene (5 families), rectified the suspected cardiomyopathy subtype (2 families), assessed the genetic origin of cardiomyopathy that usually has an acquired cause (1 family), assessed the diagnosis in a patient with uncertain borderline cardiomyopathy (1 family), reassured the siblings because of a de novo mutation (2 families) and allowed prenatal testing (1 family). Our findings suggest that post-mortem molecular testing should be included in the strategy of family care after cardiac death and suspected cardiomyopathy, since genetic findings provide additional information useful for relatives, which are beyond conventional autopsy.
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Affiliation(s)
- Isabelle Marey
- APHP, Reference Center for Hereditary Heart Diseases, Department of Genetics, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Véronique Fressart
- APHP, Cardiogenetics and Myogenetics Unit, Metabolic Biochemistry Department, Pitié-Salpêtrière Hospital Group, 75013 Paris, France
| | - Caroline Rambaud
- Department of Pathology and Legal Medicine, Raymond Poincaré Hospital, APHP, UVSQ, 92380 Garches, France
| | - Paul Fornes
- Department of Pathology and Legal Medicine, Reims Hospital, 51100 Reims, France
| | - Laurent Martin
- Department of Pathology and Legal Medicine, Dijon Hospital, 21000 Dijon, France
| | - Sarah Grotto
- Department of Medical Genetics, Robert Debré Hospital, 75019 Paris, France
| | - Yves Alembik
- Department of Medical Genetics, Strasbourg-Hautepierre Hospital, 67000 Strasbourg, France
| | - Hervé Gorka
- Department of Cardiology, Chartres Hospital, 28000 Chartres, France
| | - Gilles Millat
- Molecular Cardiogenetics Laboratory, Center for Biology and Pathology East, Hospices Civils de Lyon, 69500 Bron, France
| | - Estelle Gandjbakhch
- APHP, Reference Center for Hereditary Heart Diseases, Department of Genetics, Pitié-Salpêtrière Hospital, 75013 Paris, France.,Sorbonne Université, INSERM, UMR_S 1166, ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
| | - Céline Bordet
- APHP, Reference Center for Hereditary Heart Diseases, Department of Genetics, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | | | - Pascale Richard
- APHP, Cardiogenetics and Myogenetics Unit, Metabolic Biochemistry Department, Pitié-Salpêtrière Hospital Group, 75013 Paris, France
| | - Philippe Charron
- APHP, Reference Center for Hereditary Heart Diseases, Department of Genetics, Pitié-Salpêtrière Hospital, 75013 Paris, France.,Sorbonne Université, INSERM, UMR_S 1166, ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
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5
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Bouin A, Gretteau PA, Wehbe M, Renois F, N'Guyen Y, Lévêque N, Vu MN, Tracy S, Chapman NM, Bruneval P, Fornes P, Semler BL, Andreoletti L. Enterovirus Persistence in Cardiac Cells of Patients With Idiopathic Dilated Cardiomyopathy Is Linked to 5' Terminal Genomic RNA-Deleted Viral Populations With Viral-Encoded Proteinase Activities. Circulation 2020; 139:2326-2338. [PMID: 30755025 DOI: 10.1161/circulationaha.118.035966] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Group B enteroviruses are common causes of acute myocarditis, which can be a precursor of chronic myocarditis and dilated cardiomyopathy, leading causes of heart transplantation. To date, the specific viral functions involved in the development of dilated cardiomyopathy remain unclear. METHODS Total RNA from cardiac tissue of patients with dilated cardiomyopathy was extracted, and sequences corresponding to the 5' termini of enterovirus RNAs were identified. After next-generation RNA sequencing, viral cDNA clones mimicking the enterovirus RNA sequences found in patient tissues were generated in vitro, and their replication and impact on host cell functions were assessed on primary human cardiac cells in culture. RESULTS Major enterovirus B populations characterized by 5' terminal genomic RNA deletions ranging from 17 to 50 nucleotides were identified either alone or associated with low proportions of intact 5' genomic termini. In situ hybridization and immunohistological assays detected these persistent genomes in clusters of cardiomyocytes. Transfection of viral RNA into primary human cardiomyocytes demonstrated that deleted forms of genomic RNAs displayed early replication activities in the absence of detectable viral plaque formation, whereas mixed deleted and complete forms generated particles capable of inducing cytopathic effects at levels distinct from those observed with full-length forms alone. Moreover, deleted or full-length and mixed forms of viral RNA were capable of directing translation and production of proteolytically active viral proteinase 2A in human cardiomyocytes. CONCLUSIONS We demonstrate that persistent viral forms are composed of B-type enteroviruses harboring a 5' terminal deletion in their genomic RNAs and that these viruses alone or associated with full-length populations of helper RNAs could impair cardiomyocyte functions by the proteolytic activity of viral proteinase 2A in cases of unexplained dilated cardiomyopathy. These results provide a better understanding of the molecular mechanisms that underlie the persistence of EV forms in human cardiac tissues and should stimulate the development of new therapeutic strategies based on specific inhibitors of the coxsackievirus B proteinase 2A activity for acute and chronic cardiac infections.
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Affiliation(s)
- Alexis Bouin
- EA-4684 Cardiovir, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France (A.B., P.-A.G., M.W., F.R., Y.N., A.R., P.F., L.A.).,Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine (A.B., M.N.V., B.L.S.)
| | - Paul-Antoine Gretteau
- EA-4684 Cardiovir, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France (A.B., P.-A.G., M.W., F.R., Y.N., A.R., P.F., L.A.)
| | - Michel Wehbe
- EA-4684 Cardiovir, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France (A.B., P.-A.G., M.W., F.R., Y.N., A.R., P.F., L.A.).,Centre AZM pour la recherche en biotechnologie et ses applications, Université Libanaise, Tripoli, Lebanon (M.W.)
| | - Fanny Renois
- EA-4684 Cardiovir, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France (A.B., P.-A.G., M.W., F.R., Y.N., A.R., P.F., L.A.).,LUNAM University, Oniris, LABERCA, UMR INRA 1329, Nantes, France (F.R.).,CHU Robert Debré, Laboratoire de Virologie Médicale et Moléculaire, Reims, France (F.R., Y.N., N.L., P.F., L.A.)
| | - Yohan N'Guyen
- EA-4684 Cardiovir, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France (A.B., P.-A.G., M.W., F.R., Y.N., A.R., P.F., L.A.).,CHU Robert Debré, Laboratoire de Virologie Médicale et Moléculaire, Reims, France (F.R., Y.N., N.L., P.F., L.A.)
| | - Nicolas Lévêque
- CHU Robert Debré, Laboratoire de Virologie Médicale et Moléculaire, Reims, France (F.R., Y.N., N.L., P.F., L.A.).,EA-4331 LITEC, Faculty of Medicine and Pharmacy, University Hospital of Poitiers, France (N.L.)
| | - Michelle N Vu
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine (A.B., M.N.V., B.L.S.)
| | - Steven Tracy
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha (S.T., N.M.C.)
| | - Nora M Chapman
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha (S.T., N.M.C.)
| | - Patrick Bruneval
- Service d'Anatomie Pathologique, Hôpital Européen Georges Pompidou, Paris, France (P.B.)
| | - Paul Fornes
- EA-4684 Cardiovir, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France (A.B., P.-A.G., M.W., F.R., Y.N., A.R., P.F., L.A.)
| | - Bert L Semler
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine (A.B., M.N.V., B.L.S.)
| | - Laurent Andreoletti
- EA-4684 Cardiovir, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France (A.B., P.-A.G., M.W., F.R., Y.N., A.R., P.F., L.A.)
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6
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Fernández-Rodríguez A, Burton JL, Andreoletti L, Alberola J, Fornes P, Merino I, Martínez MJ, Castillo P, Sampaio-Maia B, Caldas IM, Saegeman V, Cohen MC. Post-mortem microbiology in sudden death: sampling protocols proposed in different clinical settings. Clin Microbiol Infect 2018; 25:570-579. [PMID: 30145399 DOI: 10.1016/j.cmi.2018.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/10/2018] [Accepted: 08/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autopsies, including minimally invasive autopsies, are a powerful tool for determination of the cause of death. When a patient dies from an infection, microbiology is crucial to identify the causative organism. Post-mortem microbiology (PMM) aims to detect unexpected infections causing sudden deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical errors. Additionally, the analysis of the thanatomicrobiome may help to estimate the post-mortem interval. AIMS The aim was to provide advice in the collection of PMM samples and to propose sampling guidelines for microbiologists advising autopsy pathologists facing different sudden death scenarios. SOURCES A multidisciplinary team with experts in various fields of microbiology and autopsies on behalf of the ESGFOR (ESCMID - European Society of Clinical Microbiology and Infectious Diseases - study group of forensic and post-mortem microbiology and in collaboration with the European Society of Pathology) developed this narrative review based on a literature search using MedLine and Scopus electronic databases supplemented with their own expertise. CONTENT These guidelines address measures to prevent sample contamination in autopsy microbiology; general PMM sampling technique; protocols for PMM sampling in different scenarios and using minimally invasive autopsy; and potential use of the evolving post-mortem microbiome to estimate the post-mortem interval. IMPLICATIONS Adequate sampling is paramount to identify the causative organism. Meaningful interpretation of PMM results requires careful evaluation in the context of clinical history, macroscopic and histological findings. Networking and closer collaboration among microbiologists and autopsy pathologists is vital to maximize the yield of PMM.
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Affiliation(s)
- A Fernández-Rodríguez
- Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas de Madrid, Madrid, Spain.
| | | | - L Andreoletti
- Molecular and Clinical Virology Department, EA-4684 CardioVir, Faculty of Medicine and University Hospital Centre, University of Reims Champagne-Ardenne, Reims, France
| | - J Alberola
- Microbiology Service, University Hospital Dr. Peset Valencia, School of Medicine, University of Valencia, Valencia, Spain
| | - P Fornes
- Pathology Department and Forensic Institute, Academic Hospital, Champagne-Ardenne, Reims, France
| | - I Merino
- Microbiology Department, Hospital Universitario Ramón y Cajal-Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - M J Martínez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - P Castillo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - B Sampaio-Maia
- Faculdade de Medicina Dentária, i3S - Instituto de Investigação e Inovação em Saúde, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - I M Caldas
- Faculdade de Medicina Dentária da Universidade do Porto, CFE - Centre os Functional Ecology, University of Coimbra, IINFACTS - Institute of Research and Advanced Training in Health Sciences, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal
| | - V Saegeman
- Clinical Laboratory, AZ Nikolaas, Sint-Niklaas, Belgium
| | - M C Cohen
- Sheffield Children's Hospital NHS FT, Histopathology Department, Sheffield UK
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7
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Bouin A, Nguyen Y, Wehbe M, Renois F, Fornes P, Bani-Sadr F, Metz D, Andreoletti L. Major Persistent 5' Terminally Deleted Coxsackievirus B3 Populations in Human Endomyocardial Tissues. Emerg Infect Dis 2018; 22:1488-90. [PMID: 27434549 PMCID: PMC4982168 DOI: 10.3201/eid2208.160186] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We performed deep sequencing analysis of the enterovirus 5′ noncoding region in cardiac biopsies from a patient with dilated cardiomyopathy. Results displayed a mix of deleted and full-length coxsackievirus B3, characterized by a low viral RNA load (8.102 copies/μg of nucleic acids) and a low viral RNA positive-sense to RNA negative-sense ratio of 4.8.
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8
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N'Guyen Y, Lesaffre F, Metz D, Tassan S, Saade Y, Boulagnon C, Fornes P, Renois F, Andreoletti L. Enterovirus but not Parvovirus B19 is associated with idiopathic dilated cardiomyopathy and endomyocardial CD3, CD68, or HLA-DR expression. J Med Virol 2016; 89:55-63. [PMID: 27301802 DOI: 10.1002/jmv.24600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 01/23/2023]
Abstract
We assessed Enterovirus (EV) &Parvovirus B19 (PVB19) genomes and CD3, CD68&HLA-DR detection in dilated cardiomyopathies (DCM). EV&PVB19 genomes and CD3, CD68&HLA-DR were detected by PCR and immunohistochemistry assays in 115 endomyocardial biopsies obtained in 13 idiopathic DCM (iDCM) and 10 explained DCM (eDCM) patients. Results were compared with those of 47 atrial surgical samples (47 surgery controls) and 22 autoptic cardiac samples (11 healthy heart controls) (2008-2014, Reims, France). EV was detected in 23.1% of iDCM patients but not in eDCM and controls (P = 0.003) (viral load 803 copies/μg). PVB19 was detected in 76.9%, 80.0%, 63.6% and 78.2% of iDCM, eDCM, healthy heart and surgery controls (P = 0.99) with a mean viral load of 413, 346, 1,428, and 71 copies/μg. CD3, CD68 or HLA-DR were detected in 100 and 50% of EV and PVB19 "mono-infected" iDCM patients. EV was exclusively detected in iDCM cases in association with CD3, CD68, or HLA-DR indicating that EV could be an etiological cause in a subset of iDCM cases. By contrast the equal frequent detection of PVB19 in iDCM cases and controls without association with CD3, CD68, or HLA-DR suggested that PVB19 could be a bystander in many DCM cases. J. Med. Virol. 89:55-63, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yohan N'Guyen
- Laboratoirede Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, France. .,EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France.
| | - François Lesaffre
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France.,Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Damien Metz
- Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Sophie Tassan
- Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Yves Saade
- Service de Chirurgie Thoracique, Centre hospitalier universitaire de Reims, France
| | - Camille Boulagnon
- Laboratoire d'Anatomie Pathologique, Faculté de médecine, Université de Reims Champagne Ardennes, Reims, France.,Laboratoire d'Anatomie Pathologique, Centre hospitalier universitaire de Reims, France
| | - Paul Fornes
- Laboratoire d'Anatomie Pathologique, Faculté de médecine, Université de Reims Champagne Ardennes, Reims, France.,Laboratoire d'Anatomie Pathologique, Centre hospitalier universitaire de Reims, France
| | - Fanny Renois
- Laboratoirede Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, France.,EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
| | - Laurent Andreoletti
- Laboratoirede Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, France.,EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
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9
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Andréoletti L, Metz D, Fornes P. Letter by Andreoletti et al regarding article, "contribution and risks of left ventricular endomyocardial biopsy in patients with cardiomyopathies: a retrospective study over a 28-year period". Circulation 2014; 130:e30. [PMID: 25047590 DOI: 10.1161/circulationaha.113.006846] [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: 11/16/2022]
Affiliation(s)
- Laurent Andréoletti
- Laboratoire de Virologie Médicale et Moléculaire, et EA-4684 (CardioVir), Centre Hospitalier Universitaire de Reims, Reims, France
| | - Damien Metz
- Service de Cardiologie, Pôle de medecine du Centre Hospitalier Universitaire de Reims, Reims, France
| | - Paul Fornes
- Laboratoire d'anatomopathologie et EA-4684 (CardioVir) Centre Hospitalier Universitaire de Reims, Reims, France
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10
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Juthier F, Ennezat PV, Fornes P, Hachulla E, Hatron PY, Robin E, Prat A, Bouchindhomme B, Banfi C, Fouquet O, Vincentelli A. Myocardial involvement in systemic capillary leak syndrome: first demonstration by pathologic findings. Eur Heart J Acute Cardiovasc Care 2013; 1:248-52. [PMID: 24062914 DOI: 10.1177/2048872612455142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/25/2012] [Indexed: 11/16/2022]
Abstract
This case vignette relates the unknown association between systemic capillary leak syndrome, namely Clarkson's syndrome, and acute cardiac dysfunction. 'Central extra-corporeal life support (ECLS)' was needed for the management of an intractable cardiogenic shock. The acute cardiac condition completely resolved within few days. Pathology showed diffuse interstitial edema within the myocardium suggestive of cardiac involvement of the disease.
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Affiliation(s)
- Francis Juthier
- Centre Hospitalier et Régional Universitaire de Lille, Department of Cardiovascular Surgery, Lille, France ; Université Lille Nord de France, Lille, France
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11
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Vite A, Gandjbakhch E, Prost C, Fressart V, Fouret P, Neyroud N, Gary F, Donal E, Varnous S, Fontaine G, Fornes P, Hidden-Lucet F, Komajda M, Charron P, Villard E. Desmosomal cadherins are decreased in explanted arrhythmogenic right ventricular dysplasia/cardiomyopathy patient hearts. PLoS One 2013; 8:e75082. [PMID: 24086444 PMCID: PMC3781033 DOI: 10.1371/journal.pone.0075082] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022] Open
Abstract
Aims Arrhythmogenic right ventricular Dysplasia/cardiomyopathy (ARVD/C) is an autosomal dominant inherited cardiomyopathy associated with ventricular arrhythmia, heart failure and sudden death. Genetic studies have demonstrated the central role of desmosomal proteins in this disease, where 50% of patients harbor a mutation in a desmosmal gene. However, clinical diagnosis of the disease remains difficult and molecular mechanisms appears heterogeneous and poorly understood. The aim of this study was to characterize the expression profile of desmosomal proteins in explanted ARVD/C heart samples, in order to identify common features of the disease. Methods and Results We examined plakophilin-2, desmoglein-2, desmocollin-2, plakoglobin and β-catenin protein expression levels from seven independent ARVD/C heart samples compared to two ischemic, five dilated cardiomyopathy and one healthy heart sample as controls. Ventricular and septum sections were examined by immunoblot analysis of total heart protein extracts and by immunostaining. Immunoblots indicated significant decreases in desmoglein-2 and desmocollin-2, independent of any known underlying mutations, whereas immune-histochemical analysis showed normal localization of all desmosomal proteins. Quantitative RT-PCR revealed normal DSG2 and DSC2 mRNA transcript levels, suggesting increased protein turn-over rather than transcriptional down regulation. Conclusion Reduced cardiac desmoglein-2 and desmocollin-2 levels appear to be specifically associated with ARVD/C, independent of underlying mutations. These findings highlight a key role of desmosomal cadherins in the pathophysiology of ARVD/C. Whether these reductions could be considered as specific markers for ARVD/C requires replication analysis.
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Affiliation(s)
- Alexia Vite
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
| | - Estelle Gandjbakhch
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Catherine Prost
- Laboratoire d’histologie et de thérapie génique, University Paris XIII, Bobigny, France
- Département de Pathologie, University Paris V, Hôpital Necker enfants malades, Paris, France
| | - Veronique Fressart
- Service de Biochimie Métabolique, Unité de Cardiogénétique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pierre Fouret
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- Service d’Anatomie Pathologique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nathalie Neyroud
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
| | - Françoise Gary
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
| | - Erwan Donal
- Département de Cardiologie, Hôpital Pontchaillou, Rennes, France
| | - Shaida Varnous
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Guy Fontaine
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Paul Fornes
- Département de Pathologie, Hôpital universitaire, Reims
| | | | - Michel Komajda
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Philippe Charron
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Villard
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
- * E-mail:
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12
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Desmons A, Terrade C, Boulagnon C, Giusti D, Nguyen Y, Andreoletti L, Fornes P, Digeon B, Leveque N. Post-mortem diagnosis, of cytomegalovirus and varicella zoster virus co-infection by combined histology and tissue molecular biology, in a sudden unexplained infant death. J Clin Virol 2013; 58:486-9. [PMID: 24001883 PMCID: PMC7128706 DOI: 10.1016/j.jcv.2013.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/23/2013] [Accepted: 08/05/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND An autopsy case of a two-month-old male infant who suddenly and unexpectedly died during his sleep, eight days after the onset of benign varicella. OBJECTIVES To describe post-mortem combined histological and tissue molecular biological techniques for the diagnosis of cytomegalovirus and varicella zoster virus co-infection as a cause of death. STUDY DESIGN Real-time quantitative PCR and RT-PCR assays for Herpesviruses, respiratory viruses, Adenovirus, Enterovirus and Parvovirus B19 were performed on multi-organ frozen samples and paraffin-embedded tissues in combination with histology. RESULTS Cytomegalovirus and varicella zoster virus were detected by molecular biology with highest viral loads detected in the lungs (4.6×10(7) and 1.9×10(5) genome copies per million of cells, respectively). Pulmonary extensive necrotizing inflammation and immunohistochemistry correlated to virological data. Virological molecular biology was negative on paraffin-embedded tissues. CONCLUSIONS This case shows that thorough quantitative virological investigations on frozen tissues must be performed in combination with histology and immunohistochemistry for the determination of the cause of a sudden unexplained infant death.
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Affiliation(s)
- Aurore Desmons
- Clinical and Molecular Virology Unit, University Hospital, Reims, France; EA-4684 Cardiovir SFR-CAP Sante, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
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13
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Abstract
Abstract: In March 2009, a new strain of influenza A/H1N1 virus was identified in Mexico, responsible for a pandemic. Worldwide, more than 13,500 patients died, most often from acute respiratory distress syndrome. Because sudden death cases were rare, involving mostly young apparently healthy persons, influenza A/H1N1 (2009)‐related deaths may be misdiagnosed, which can raise medico‐legal issues. Case history: we report on an unexpected out‐of‐hospital death involving a young male with no past medical history and no vaccination. Fever was his only symptom. Laboratory tests: histology showed patchy necrotic foci with mononuclear inflammation in the lungs. The heart was histologically normal, but virological analyses using molecular biology on frozen myocardial samples showed high virus load. In conclusion, this case report shows that influenza A/H1N1 (2009) virus can be a cause of sudden cardiac death in the young and demonstrates the importance of quantitative virological analyses for the diagnosis of myocarditis.
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14
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Leveque N, Boulagnon C, Brasselet C, Lesaffre F, Boutolleau D, Metz D, Fornes P, Andreoletti L. A fatal case of Human Herpesvirus 6 chronic myocarditis in an immunocompetent adult. J Clin Virol 2011; 52:142-5. [DOI: 10.1016/j.jcv.2011.06.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/27/2011] [Accepted: 06/29/2011] [Indexed: 01/15/2023]
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15
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Boulagnon C, Garnotel R, Fornes P, Gillery P. Post-mortem biochemistry of vitreous humor and glucose metabolism: an update. Clin Chem Lab Med 2011; 49:1265-1270. [DOI: 10.1515/cclm.2011.638] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractPost-mortem biochemistry, also called thanatochemistry, has proved useful in forensics for estimating the time since death and assessing the cause of death. Ketoacidosis is a frequent complication of diabetes mellitus which can be lethal, with possible medicolegal implications. However, interpretation of biochemical analyses is difficult because of post-mortem blood alterations involving glucose metabolic pathways. Vitreous humor is better preserved than blood after death, and therefore is preferentially used in thanatochemistry. However, both the lack of experience of most biochemists with this matrix in clinical practice, and the paucity of post-mortem studies make interpretation of post-mortem analyses difficult. This review examines the recent advances in the knowledge of glucose metabolism in vitreous humor, and the methods used for the post-mortem diagnosis of diabetic complications.
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16
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Basso C, Burke M, Fornes P, Gallagher PJ, De Gouveia RH, Sheppard M, Thiene G, Van Der Wal A. Guidelines for autopsy investigation of sudden cardiac death. Pathologica 2010; 102:391-404. [PMID: 21361120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of sudden cardiac death is now of particular importance. Pathologists are responsible for determining the precise cause of sudden death but there is considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology developed these Guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate assessment of sudden cardiac death, including not only a protocol for heart examination and histological sampling, but also for toxicology and molecular investigation. Our recommendations apply to University Medical Centres, Regional and District Hospitals and all types of Forensic Medicine Institutes. If a uniform method of investigation is adopted throughout the European Union, this will lead to improvements in standards of practice, allow meaningful comparisons between different communities and regions and, most importantly, permit future trends in the patterns of disease causing sudden death to be monitored.
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Affiliation(s)
- C Basso
- Department of Medical Diagnostic Sciences and Special Therapies, University of Padua, Italy
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17
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Basso C, Burke M, Fornes P, Gallagher PJ, de Gouveia RH, Sheppard M, Thiene G, van der Wal A. Guidelines for autopsy investigation of sudden cardiac death. Cesk Patol 2010; 46:43-48. [PMID: 21275225] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed, and the accurate diagnosis of the causes of sudden cardiac death is now of particular importance. Pathologists are responsible for determining the precise cause of sudden death but there is considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology developed guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate assessment of sudden cardiac death, including not only a protocol for heart examination and histological sampling, but also for toxicology and molecular investigation. Our recommendations apply to university medical centres, regional and district hospitals and all types of forensic medicine institutes. If a uniform method of investigation is adopted throughout the European Union, this will lead to improvements in standards of practice, allow meaningful comparisons between different communities and regions and, most importantly, permit future trends in the patterns of disease causing sudden death to be monitored.
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Affiliation(s)
- Cristina Basso
- Department of Medical Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy.
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18
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Martrille L, Irinopoulou T, Bruneval P, Baccino E, Fornes P. Age at death estimation in adults by computer-assisted histomorphometry of decalcified femur cortex. J Forensic Sci 2009; 54:1231-7. [PMID: 19818112 DOI: 10.1111/j.1556-4029.2009.01178.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 1965, Kerley pioneered histomorphometry of bone as an aging method. The technique has been modified by several authors, and some have used computer-assisted image analysis. Undecalcified bone sections used in these methods are obtained with a diamond wafer saw or by grinding the sections manually or automatically with abrasive paper. In the present study, we examined the application of histomorphometry to decalcified bone sections, routinely obtained in every pathology lab, from paraffin blocks cut with a standard microtome. This study was divided into two parts: in the first, we tested different decalcifying methods to determine the most appropriate for femoral bone; in the second part, we used computer-assisted histomorphometry to estimate age at death in 29 samples of femoral bone. We measured intact osteon density (N.On), fragmented osteon density (N.On.Fg) and percentage of lamellar bone surface per unit area (Lm.B.Ar) in the cortex of the femoral midshaft, on four or 20 fields per section. We found that 20% nitric acid solution at room temperature proved to be the best decalcifying method, with a mean decalcification duration of 1 week. Fragmented osteon density was found to be the morphometric feature most closely correlated with age, followed by intact osteon density; Lm.B.Ar. did not increase accuracy. The best accuracy (4.1 +/- 3.5 years) was obtained for individuals under the age of 70 when measurements of 20 fields were used for the analysis. For all individuals, the inaccuracy was 6.1 +/- 6.2 years and 8.1 +/- 8 years, with 20 and four fields respectively. The present study shows that decalcification of bone sections can be used for age estimation at death. This procedure is particularly useful in case of mass disaster as it is easily done in any pathology department.
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Affiliation(s)
- Laurent Martrille
- Department of Forensic Medicine, Lapeyronie Hospital, Montpellier, France.
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Hoizey G, Gozalo C, Canas F, Fornes P, Binet L, Thomas A, Oget O, Millart H, Lamiable D. Distribution tissulairepost-mortemdu méprobamate: à propos de 8 cas. ACTA ACUST UNITED AC 2008. [DOI: 10.1051/ata:2008006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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20
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Maréchaux S, Fornes P, Petit S, Poisson C, Thevenin D, Le Tourneau T, Asseman P, Bruneval P, Ennezat PV. Pathology of inverted Takotsubo cardiomyopathy. Cardiovasc Pathol 2007; 17:241-3. [PMID: 18402803 DOI: 10.1016/j.carpath.2007.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 07/25/2007] [Accepted: 08/15/2007] [Indexed: 12/17/2022] Open
Abstract
Myocardial dysfunction without coronary involvement may occur in acute cerebral diseases. The inverted Takotsubo pattern has been recently recognized as a novel heart neurologic stress-related syndrome. We report on the case of a 40-year-old woman presenting with massive subarachnoid hemorrhage and brain death. Echocardiography revealed an extensive left ventricular circumferential akinesis except at the apex. Histologic analysis of the heart confirmed the absence of myocardial infarction and revealed only sparse foci of myocyte necrosis with contraction bands in the akinetic areas.
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Affiliation(s)
- Sylvestre Maréchaux
- Echocardiography and Physiology Laboratories, Lille Medical University Center, Lille, France.
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Basso C, Burke M, Fornes P, Gallagher PJ, de Gouveia RH, Sheppard M, Thiene G, van der Wal A. Guidelines for autopsy investigation of sudden cardiac death. Virchows Arch 2007; 452:11-8. [PMID: 17952460 DOI: 10.1007/s00428-007-0505-5] [Citation(s) in RCA: 288] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 08/08/2007] [Accepted: 08/21/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Cristina Basso
- Pathological Anatomy, Department of Medical Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy.
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22
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Boutros C, Zegdi R, Lila N, Cambillau M, Fornes P, Carpentier A, Fabini JN. Carbon monoxide can prevent acute lung injury observed after ischemia reperfusion of the lower extremities. J Surg Res 2007; 143:437-42. [PMID: 17825843 DOI: 10.1016/j.jss.2007.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Revised: 01/31/2007] [Accepted: 02/03/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary expression of heme oxygenase has been observed in multiple studies. This expression has been found beneficial in decreasing the severity of acute lung injury (ALI) post ischemia-reperfusion (I/R). The aim of this study was to assess the role of exogenous administration of the end-products of heme oxygenase reaction, carbon monoxide, and bilirubin, in the severity of ALI. STUDY DESIGN We compared five groups of rats (n = 7/group) including a sham group and four I/R of the lower extremities by clamping the abdominal aorta for 2 h followed by reperfusion for 2 h. The four I/R groups included a control group, one pretreated with bilirubin (50 micromol/kg IV), another with inhaled carbon monoxide (CO) (250 ppm), and the last pretreated with both. The severity of ALI has been evaluated by a histological assay grading neutrophilic infiltration, as well as a study of the microvascular permeability using the Evans blue. RESULTS The administration of CO prevented pulmonary microvascular permeability alteration noted after I/R of the lower limbs (pulmonary content of Evans blue: 141 +/- 23 microg/g of tissue in the isolated I/R group versus 68 +/- 34 microg/g of tissue in CO group; P < 0.001). Histologically CO administration inhibited neutrophilic sequestration observed after I/R. On the other hand, treatment by bilirubin alone (50 micromol/kg IV) did not modify the extent of pulmonary injury. CONCLUSION Exogenous administration of carbon monoxide by inhalation at low doses prevented ALI post-I/R in this model.
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Affiliation(s)
- Cherif Boutros
- Laboratory of the Study of Cardiac Grafts and Protheses, Broussias Hospital, Paris, France.
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Abstract
Diagnosis of incidental adrenal masses is a real challenge to radiologists. The most common incidental tumors of the adrenal gland are adenomas and metastases. This article presents our experience with uncommon adrenal incidentalomas. Most of the magnetic resonance imaging characteristic features are demonstrated. When possible, they are correlated with the findings at gross and microscopic analysis, to help in understanding the mechanisms by which magnetic resonance imaging may aid in the characterization of the incidental adrenal mass.
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Affiliation(s)
- Christine Hoeffel
- Université Paris - Descartes Faculté Cochin-Port-Royal, Paris, France.
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Wassef M, Mallat Z, Duong Van Huyen JP, Lelievre-Pegorier M, Wernert N, Cazes A, Fornes P. [New biological concepts in cardiovascular pathology]. Ann Pathol 2006; 26 Spec No 1:1S66-72. [PMID: 17149183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- M Wassef
- Service d'anatomie Pathologique, Hôpital Lariboisière, Paris, France
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25
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Fontaine G, Fornes P, Frank R. Letter regarding article by Coronel et al, "right ventricular fibrosis and conduction delay in a patient with clinical signs of Brugada syndrome: a combined electrophysiological, genetic, histopathologic, and computational study". Circulation 2006; 113:e726; author reply e726-7. [PMID: 16639785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Boutros CN, Zegdi R, Lila N, Combillau M, Fornes P, Carpentier A, Noel Fabiani J. Pulmonary expression of inducible heme-oxygenase after ischemia/reperfusion of the lower extremities in rats. J Surg Res 2005; 129:306-12. [PMID: 16140332 DOI: 10.1016/j.jss.2005.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Revised: 06/24/2005] [Accepted: 06/25/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Expression of inducible heme-oxygenase (HO-1) has been shown to be increased in various inflammatory disorders, which may confer a protective role. The aim of our study was to assess pulmonary expression of HO-1 after ischemia/reperfusion (I/R) of the lower limbs in rats. MATERIALS AND METHODS We compared three groups of rats (n = 5/group): one Sham group, and two I/R groups (aorta cross-clamped for 2 h followed by 2 h of reperfusion), one of which pre-treated with Zn-protoporphyrin (Zn-PP), a competitive inhibitor of HO (50 micromol/kg, i.p.). At the end of experiment, lungs were harvested for determination of HO activity and HO-1 expression by Western blot and immunohistochemistry. Lung injury was assessed by bronchoalveolar lavage, histological study, and determination of the lung Evans Blue dye content, an index of microvascular permeability. RESULTS I/R of the lower limbs was responsible for acute lung injury (ALI), characterized by neutrophilic infiltration (87 +/- 20 x 10(3) neutrophils/mm(3), Sham group versus 191 +/- 38 x 10(3) neutrophils/mm(3), I/R group; P < 0.002) and an increase in lung Evans blue dye content: (74 +/- 6 microg/g, Sham group versus 122 +/- 48 microg/g, I/R group; P < 0.05). Pre-treatment with Zn-PP further increases the Evans Blue content (122 +/- 48 microg/g, I/R group versus 179 +/- 23 microg/g Zn-PP group P < 0.05) and the neutrophilic infiltration. Pulmonary heme-oxygenase activity, and HO-1 content were increased after I/R. (10.5 +/- 12 pmol bilirubin/mg protein/h, Sham group versus 101.2 +/- 66 pmol bilirubin/mg protein/h, I/R group; P < 0.02). Immunohistochemistry revealed that the expression of HO-1 was mainly localized to inflammatory cells. CONCLUSIONS ALI following I/R of the lower limbs in rats is associated with an increase of pulmonary expression of HO-1, inhibition of this expression increase the severity of ALI.
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Affiliation(s)
- Cherif N Boutros
- Laboratory of the Study of Cardiac Grafts and Prostheses, Broussais Hospital, Paris, France.
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Boutros CN, Zegdi R, Lila N, Combillau M, Fornes P, Carpentier A, Fabiani JN. Carbon monoxide can prevent acute lung injury observed after ischemia reperfusion of the lower extremities. J Am Coll Surg 2005. [DOI: 10.1016/j.jamcollsurg.2005.06.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Boddaert J, Mallat Z, Fornes P, Esposito B, Lecomte D, Verny M, Tedgui A, Belmin J. Age and gender effects on apoptosis in the human coronary arterial wall. Mech Ageing Dev 2005; 126:678-84. [PMID: 15888322 DOI: 10.1016/j.mad.2005.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Revised: 01/03/2005] [Accepted: 01/04/2005] [Indexed: 02/04/2023]
Abstract
The relationship between aging and apoptosis remains unclear. We wondered whether apoptosis could be enhanced in arterial aging in the absence of overt or advanced arterial disease. Apoptosis-related proteins were investigated using three methods: TdT-mediated dUTP digoxigenin nick end labeling (TUNEL) technique, active cysteine-dependant aspartate specific proteases (caspase)-3 and poly ADP-ribose polymerase (PARP) in coronary arteries of human subjects ranging from 25 to 92 years. We found no significant correlation between age and the apoptotic index using the three methods. The percentage of active caspase-3 positive cells was found to be significantly higher in men than in women (9.11 +/- 12.3 cells/mm(2) versus 2.01 +/- 4.55 cells/mm(2), respectively, p = 0.017). These sex-related differences did not reach statistical significance using TUNEL (9.93 +/- 17 and 2.61 +/- 4.58 cells/mm(2), p = 0.32) and PARP methods (3.42 +/- 7.74 and 0.86 +/- 0.95 cells/mm(2), p < 0.49). This is the first report of detection of apoptotic cells in the human arterial wall in adult subjects free from arterial diseases. Apoptosis is an attractive hypothesis to account for organ aging, but our study suggests that apoptosis is not a key factor in aging of the arterial wall.
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Affiliation(s)
- Jacques Boddaert
- INSERM U-541, IFR Circulation, Hôpital Lariboisière, Paris, France.
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Poirier-Quinot M, Ginefri JC, Ledru F, Fornes P, Darrasse L. Preliminary ex vivo 3D microscopy of coronary arteries using a standard 1.5 T MRI scanner and a superconducting RF coil. MAGMA 2005; 18:89-95. [PMID: 15711851 DOI: 10.1007/s10334-004-0097-x] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Revised: 12/01/2004] [Accepted: 12/01/2004] [Indexed: 11/28/2022]
Abstract
This paper presents the feasibility of three-dimensional (3D) magnetic resonance (MR) histology of atheromatous coronary lesions in the entire human heart ex vivo using a standard 1.5 T scanner and a 12 mm high-temperature superconducting (HTS) surface coil. The HTS coil was a five-turn transmission-line resonator operated at 77 K, affording a signal-to-noise ratio (SNR) gain of about ninefold as compared to a similar, room-temperature copper coil. Local microscopy at the surface of an explanted, entire heart was achieved by a 3D spoiled gradient echo sequence and assessed by comparison with conventional histology. One hundred and twenty four adjacent cross sections of the coronary artery, with voxels of 59 x 59 x 100 microm3 and an SNR of about 20, were obtained in 25 min. Consecutive data sets were combined to reconstruct extended views along the artery. Compared to histology, MR microscopy allowed precise nondestructive 3D depiction of the architecture of the atheromatous plaques. This is the first report of microscopic details (less than 10(-3) mm3 voxels) of diseased arteries obtained in an entire human heart preserving the arterial integrity and the spatial geometry of atheroma. This noninvasive microscopy approach using a HTS surface coil might be applied in vivo to study the architecture and components of superficial human structures, using routine MR scanners.
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Fontaine G, Hebert JL, Prost-Squarcioni C, Fornes P, Frank R, Thomas D. [Arrhythmogenic right ventricular dysplasia]. Arch Mal Coeur Vaiss 2004; 97:1155-9. [PMID: 15609920] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Congestive cardiac failure could be as important as cardiac arrhythmias in the natural history of arrhythmogenic right ventricular dysplasia. This can be related to the progressive replacement of myocardium by fat and fibrosis of the right ventricle. The left ventricle may also be involved by the same disease process. Moreover, inflammation can be superimposed on ARVD, resulting in a wide spectrum of clinical presentation which can mimick idiopathic dilated cardiomyopathy. Right ventricular cardiac failure has been controlled by anterior dynamic cardiomyoplasty.
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Affiliation(s)
- G Fontaine
- Service de rythmologie, Institut de cardiologie, hôpital La Pitié-Salpêtrière, Paris
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Duong Van Huyen JP, Fornes P, Guillemain R, Amrein C, Chevalier P, Latremouille C, Creput C, Glotz D, Nochy D, Bruneval P. Acute vascular humoral rejection in a sensitized cardiac graft recipient: diagnostic value of C4d immunofluorescence. Hum Pathol 2004; 35:385-8. [PMID: 15017599 DOI: 10.1016/j.humpath.2003.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 37-year-old female patient had a cardiac transplantation for dilated cardiomyopathy. She was sensitized by two pregnancies showing anti-human leukocyte antigen I and II antibodies. The pretransplantation crossmatch was negative, but she developed acute humoral rejection characterized by vascular C4d deposits, arteriolitis, and intravascular leukocyte accumulation and adhesion in venules. Although C4d deposits disappeared in 4 weeks, she had persistent endothelial cell activation (endothelial expression of ELAM-1, VCAM-1, or human leukocyte antigen class II) throughout the 6 months of follow-up. Although she received intensive immunosuppression, she presented three episodes of acute cellular rejection during that period of time. This case shows that C4d deposits represent a sensitive marker of acute humoral rejection in cardiac transplantation. Therefore, C4d immunofluorescence should be more frequently assessed in endomyocardial biopsies.
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Affiliation(s)
- Jean-Paul Duong Van Huyen
- Department of Pathology, Unit of Cardiac Transplantation, Hôpital Européen Georges Pompidou, Paris, France
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Cornet M, Mallat H, Somme D, Guérot E, Kac G, Mainardi JL, Fornes P, Gutmann L, Lavarde V. Fulminant invasive pulmonary aspergillosis in immunocompetent patients--a two-case report. Clin Microbiol Infect 2004; 9:1224-7. [PMID: 14686988 DOI: 10.1111/j.1469-0691.2003.00792.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Two cases of invasive aspergillosis (IA) in immunocompetent patients with a fulminant fatal outcome are reported. Both patients were elderly and had a history of chronic lung disease treated with prolonged inhaled corticosteroids and a short course of systemic corticosteroids. They presented with dyspnea and fever, their respiratory function deteriorated rapidly, and they died 7 days after admission. Aspergillus fumigatus was cultured from respiratory samples. IA was confirmed in one case by necropsy that showed diffuse bilateral necrotizing pneumonitis and myocarditis. In the other case, IA diagnosis was established by thoracic CT scan plus detection of Aspergillus antigen in two blood samples. These two cases demonstrate that short-term corticosteroid therapy in immunocompetent patients with underlying chronic lung conditions is a risk factor for IA, and that its evolution can be fulminant.
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Affiliation(s)
- M Cornet
- Microbiologie, Hôpital Européen Georges Pompidou, 20-40 rue Leblanc, 75908 Paris Cedex 15, France.
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Lorin De La Grandmaison G, Izembart M, Fornes P, Paraire F. Myocarditis associated with Hashimoto’s disease: a case report. Int J Legal Med 2003; 117:361-4. [PMID: 14520579 DOI: 10.1007/s00414-003-0392-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2001] [Accepted: 06/24/2003] [Indexed: 10/26/2022]
Abstract
We report on a sudden cardiac death case involving a 40-year-old man with no known medical history. Forensic autopsy showed lymphocytic myocarditis associated with lymphocytic thyroiditis. In both the heart and the thyroid gland, the inflammatory foci often had a nodular pattern with a germinal centre. Virological and toxicological analyses were negative. Postmortem biochemistry showed a slight increase in TSH in combination with normal T3 and T4 blood levels suggesting hypothyroidism. High titres of antiperoxidase and antithyroglobulin antibodies with normal levels of TSH receptor antibodies, in addition to biological hypothyroidism and lymphocytic inflammation were consistent with the diagnosis of Hashimoto's thyroiditis. Immunohistochemical studies excluded a lymphoma and showed no evidence of viral myocarditis. In contrast to Grave's disease, Hashimoto's thyroiditis has never been reported in association with myocarditis as a cause of sudden death. We conclude that the cardiac immunological and histological pattern, similar to that found in the thyroid gland suggests an autoimmune myocarditis.
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Affiliation(s)
- G Lorin De La Grandmaison
- Department of Pathology and Forensic Medicine, Raymond Poincaré Hospital, 104 Boulevard Raymond Poincaré, 92380, Garches, France.
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Pons S, Hagège A, Fornes P, Gervais M, Giudicelli JF, Richer C. Effects of angiotensin II type 1 receptor blockade in ApoE-deficient mice with post-ischemic heart failure. J Cardiovasc Pharmacol 2003; 42:17-23. [PMID: 12827021 DOI: 10.1097/00005344-200307000-00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We investigated in mice whether atherosclerosis exacerbates the development of post-ischemic heart failure and alters the beneficial effects of long-term angiotensin II type 1 receptor blockade in this model. ApoE-deficient (ApoE(-/-)) and C57BL/6J (C57) mice with myocardial infarction (coronary ligation) received vehicle (C57 and ApoE(-/-)) or irbesartan (Ir, 50mg/kg/d orally, C57-Ir and ApoE(-/-)-Ir). Ten months post myocardial infarction, survival rates were similar in C57 (58%) and ApoE(62%). Atherosclerosis induced no significant alteration in blood pressure, cardiac output (fluospheres), total peripheral resistance, or shortening fraction (echocardiography) but increased renal resistance (+50%, P<0.05). Chronic Ir treatment significantly improved survival to a similar extent in both C57-Ir (85%) and ApoE(-/-)-Ir (86%). It also decreased blood pressure to a similar extent in both strains (-16% and -18%, both P<0.05). In C57-Ir mice, Ir did not modify cardiac output or total peripheral resistance, but it decreased renal resistance (-28%, P<0.001) and left-ventricular weight (-28%, P<0.05). In ApoE(-/-)-Ir mice, Ir limited atherosclerotic lesions (-13%, P<0.05), increased cardiac output (+28%, P<0.05) and shortening fraction (+24%, P<0.05), and decreased total peripheral resistance (-33%, P<0.01), renal resistance (-61%, P<0.001), and left-ventricular weight (-27%, P<0.001). In conclusion, atherosclerosis does not worsen heart failure development in mice and, although the beneficial cardiovascular effects of AT1 receptor blockade are greater in ApoE(-/-) than in C57, reduction in mortality is similar in both strains.
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Affiliation(s)
- Sandrine Pons
- Département de Pharmacologie, INSERM E 00-01, Faculté de Médecine, La Kremlin-Bicêtre, France
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Martinod E, Seguin A, Pfeuty K, Fornes P, Kambouchner M, Azorin JF, Carpentier AF. Long-term evaluation of the replacement of the trachea with an autologous aortic graft. Ann Thorac Surg 2003; 75:1572-8; discussion 1578. [PMID: 12735581 DOI: 10.1016/s0003-4975(03)00120-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tracheal reconstruction after extensive resection remains a challenge in thoracic surgery. The goal of this experimental study was to analyze the long-term evolution of tracheal replacement using an autologous aortic graft. METHODS In 21 sheep, a 5-cm segment of the cervical trachea was replaced by a segment of the descending thoracic aorta that was reconstructed to a prosthetic graft. Because of the airway collapse reported in a previous series, a permanent (n = 13) or temporary (n = 8) stent was systematically placed in the lumen of the graft. Clinical, bronchoscopic, and histologic examinations were performed up to 3 years after implantation. RESULTS All animals survived the operation with no paraplegia. In the group with a permanent stent, three complications occurred: one stent displacement, one laryngeal edema, and one infection. Stent removal was tolerated after 6 months in the group with a temporary stent. Histologic examination showed a progressive transformation of the arterial segment into first extensive inflammatory tissue with a squamous epithelium, and after 6 to 36 months well-differentiated tracheal tissue including a continuous mucociliary epithelium and regular rings of newly formed cartilage. CONCLUSIONS An autologous aortic graft used as a substitute for extensive tracheal replacement in sheep remained functional for periods up to 3 years. The progressive transformation of the graft into a structure resembling tracheal tissue seems to be a key factor in long-term patency. The mechanism of this regenerative process and the possibility of using arterial homografts, which would make clinical application easier, remain to be evaluated.
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Affiliation(s)
- Emmanuel Martinod
- Laboratoire d'Etude des Greffes et Prothèses Cardiaques, Hôpital Broussais, Upres 264, Université Paris 6, France.
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Abstract
A growing number of people are involved in recreational physical activity. It is therefore not uncommon for a medical examiner to encounter sports-related sudden deaths and to be faced with the legal implications. The authors examined the clinical and cardiac pathologic patterns in 31 persons who died suddenly during sports activities and underwent autopsy at the Institute of Forensic Medicine of Paris between 1991 and 2001. Twenty-nine male subjects, ranging in age from 7 to 57 years (mean 30 years) and two female subjects, 8 and 60 years old, died suddenly during sports activities. The sports involved were various, with running the most frequent: 13 cases. Cardiomyopathies (10 cases) and coronary artery disease (9 cases) were the most frequent causes of deaths. Despite the severity of lesions, only 4 subjects had a known cardiovascular disease. In conclusion, with regard to prevention, efforts should be continued to improve the sensitivity and specificity of diagnostic tools and screening strategies. In this regard, medicolegal autopsies should be systematically performed in cases of sudden death during sports activities, because they provide accurate and useful information for a better knowledge of sports-related mortality.
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Affiliation(s)
- Paul Fornes
- Institute of Forensic Medicine of Paris, and Department of Forensic Sciences, Medical School Cochin Port-Royal, University of Paris, Paris, France.
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Zakine G, Martinod E, Fornes P, Sapoval M, Barritault D, Carpentier AF, Chachques JC. Growth factors improve latissimus dorsi muscle vascularization and trophicity after cardiomyoplasty. Ann Thorac Surg 2003; 75:549-54. [PMID: 12607671 DOI: 10.1016/s0003-4975(02)04332-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Dynamic cardiomyoplasty consists of wrapping the electrostimulated latissimus dorsi muscle (LDM) around the failed heart. Partial ischemia followed by atrophy of the middle and distal part of the LDM were observed in 30% of clinical cases after LDM flap elevation from its origin. In the current study, we hypothesized that local administration of growth factors at the LDM/epicardial interface could improve muscle vascularization and trophicity. METHODS In 24 sheep, dynamic cardiomyoplasty was performed using the left LDM. A multiperforated catheter was positioned at the LDM/epicardial interface for a weekly administration, during a 1-month period, of the following factors: basic fibroblast growth factor (bFGF, n = 6), vascular endothelial growth factor (VEGF, n = 6), and regenerating agent (RGTA, n = 6). Six sheep injected with phosphate-buffered saline (used for dilution of the growth factors) were used as a control group. At 3 months, angiographic, histologic, and histomorphometric studies were performed. RESULTS Angiographic studies of the animals treated with growth factors demonstrated hypervascularization due to the development of new vessels. Histomorphometric and histologic studies showed a significant increase in the number of capillaries and arterioles (100 fields/muscle) in the groups treated with bFGF (443.0 +/- 101.2, p < 0.01), RGTA (293.2 +/- 29.3, p < 0.05), and VEGF (246.5 +/- 45.9, p < 0.05), as compared with the control group (81.5 +/- 11.4). A significantly lower atrophy score was observed in the groups treated with bFGF (1.4 +/- 0.18, p < 0.05), RGTA (1.59 +/- 0.17, p < 0.05), and VEGF (1.96 +/- 0.14, NS), as compared with the control group (2.48 +/- 0.16). CONCLUSIONS Local administration at the heart/muscle interface of growth factors increases muscle vascularization and avoids muscle atrophy in an experimental cardiomyoplasty model, both of which are advantageous to the contracting LDM. The local growth factors delivery system used in this study appears efficient, easy to implant, and manipulate and safe.
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Affiliation(s)
- Gilbert Zakine
- Department of Cardiovascular Surgery, Broussais Hospital, Paris, France
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Pons S, Fornes P, Hagege AA, Heudes D, Giudicelli JF, Richer C. Survival, haemodynamics and cardiac remodelling follow up in mice after myocardial infarction. Clin Exp Pharmacol Physiol 2003; 30:25-31. [PMID: 12542449 DOI: 10.1046/j.1440-1681.2003.03784.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. In the present study, the time-course, over a 1 year period, of postischaemic dilated cardiomyopathy and/or development of congestive heart failure was investigated in mice in terms of survival and cardiac functional and structural characteristics. 2. C57BL/6 mice with myocardial infarction (MI mice; coronary ligation n = 78) or sham-operated animals (n = 45) were used and echocardiographic, haemodynamic and histomorphometric parameters were assessed at 3, 6 and 12 months post-MI. 3. At 12 months, the survival rate was 70% in MI mice. Left ventricular dysfunction was evidenced by a strong decrease in ejection fraction (EF; -48 and -53% at 6 and 12 months, respectively; both P < 0.05) and an increase in left ventricular end-diastolic pressure (+100% at both 6 and 12 months; both P < 0.05). There was no major worsening in cardiac function between 6 and 12 months, suggesting strong compensatory mechanisms. Cardiac remodelling was observed, characterized by strong left ventricular hypertrophy (+38 and +62% at 6 and 12 months, respectively; both P < 0.05) and dilatation (+53% at 6 months; P < 0.05), but collagen was not significantly increased. Significant correlations were found between EF (echocardiography) and dP/dtmax, between end-diastolic volume (echocardiography) and left ventricular internal perimeter (histomorphometry) and between left ventricular mass (echocardiography) and weight. 4. In conclusion, despite a high survival rate, the MI mouse model displays most of the hallmarks of postischaemic dilated cardiomyopathy and/or congestive heart failure, thus affording the necessary background for the subsequent evaluation of gene manipulation and/or drug effects. In addition, two-dimensional echocardiography appears to be a suitable tool for the long-term follow up of cardiac function and remodelling in this model.
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Affiliation(s)
- S Pons
- Département de Pharmacologie, INSERM E00-01, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France
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Hoeffel JC, Hoeffel CC, Fornes P. RE: Awasthi M, Narlawar R, Hira P, Shah P. Fetus in fetu. Rare cause of a lump in an adult's abdomen. Australas Radiol 2001;45: 354-56. Australas Radiol 2002; 46:345-6. [PMID: 12196253 DOI: 10.1046/j.1440-1673.2002.01079.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Aupècle B, Serraf A, Belli E, Mohammadi S, Lacour-Gayet F, Fornes P, Planché C. Intermediate follow-up of a composite stentless porcine valved conduit of bovine pericardium in the pulmonary circulation. Ann Thorac Surg 2002; 74:127-32. [PMID: 12118743 DOI: 10.1016/s0003-4975(02)03639-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the pediatric population, glutaraldehyde-preserved bovine pericardium conduit containing a stentless porcine valve has been proposed as an alternative to homografts for right ventricular outflow tract reconstruction. METHODS Between June 1996 and March 2000, a total of 55 patients, 20 with truncus arteriosus, 21 with pulmonary atresia with ventricular septal defect, and 14 with miscellaneous defects, received this conduit. Median age at implantation was 3.4 months (range, 3 days to 19 years), and 27 patients (50%) were less than 3 months old. Clinical outcome, echocardiographic data, and pathologic analysis were recorded. End points for conduit failure were conduit replacement or dilation. A mean follow-up of 27 months (range, 2 to 46 months) was available for 47 survivors. RESULTS Procedure for conduit obstruction was required in 13 patients. The most common procedure was operation, and all but 3 patients had an unsuccessful balloon angioplasty before reoperation. Actuarial freedom from conduit dilation or reoperation was 93.6% (95% confidence limits, 82% to 99%), 81.9% (95% confidence limits, 64% to 91%), 77.8% (95% confidence limits, 39% to 78%), and 64.3% (95% confidence limits, 26% to 73%) at 1, 2, 3, and 4 postoperative years, respectively. Univariate analysis identified small conduit size as a risk factor for conduit obstruction. CONCLUSIONS Although this new conduit was not free from progressive obstruction, our clinical results (easy to work and good valvular function) and the availability in small sizes encouraged us to use it as an alternative to small-size homografts when those were not available.
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Affiliation(s)
- Bertrand Aupècle
- Department of Pediatric Cardiac Surgery, Hospital Marie-Lannelongue, Paris Sud University, Le Plessis Robinson, France
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Héron E, Hernigou A, Fornes P, Chatellier G, Emmerich J, Fiessinger JN. [Central nervous system involvement in scleroderma]. Ann Med Interne (Paris) 2002; 153:179-82. [PMID: 12218900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Emmanuel Héron
- Service de Médecine Vasculaire, Hospital des Quinze-Vingts, 28, rue de Charenton 75012 Paris, France
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Chachques JC, Argyriadis PG, Latremouille C, D'Attellis N, Fornes P, Bruneval P, Couetil JP, Carpentier AF. Cardiomyoplasty: ventricular reconstruction after tumor resection. J Thorac Cardiovasc Surg 2002; 123:889-94. [PMID: 12019373 DOI: 10.1067/mtc.2002.121493] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although cardiac transplantation has been performed for complete removal of ventricular tumors, complete surgical resection with ventricular reconstruction is desirable. Thus patients with benign tumors would probably be cured, and those with malignant tumors would have a better prognosis. In this study extensive and complete surgical resection of ventricular tumors is followed by anatomic and functional ventricular reconstruction with a dynamic cardiomyoplasty procedure. METHODS Seven patients (mean age, 32.7 years) underwent complete resection of ventricular tumors. Histologic types were distributed as follows: fibroma in 2 patients and sarcoma, lymphosarcoma, hemangioma, lipoma, and metastatic angiosarcoma, respectively, in the remaining 5 patients. Six of the patients were considered candidates for heart transplantation because of the extent of tumor invasion. Surgery consisted of 4 steps: (1) tumor resection; (2) coronary artery resection (when invaded by the tumor) and coronary artery bypass grafting; (3) valvular reconstruction (when possible) or replacement; and (4) ventricular wall reconstruction with a pericardial patch for closure of the ventricular defect (neoendocardium) covered by the electrostimulated latissimus dorsi muscle flap (neomyocardium). RESULTS All patients survived surgical intervention, but 2 late postoperative deaths are reported. Among the surviving patients, early complications played a major role in their postoperative course and consisted of arrhythmias, atrioventricular block necessitating a dual-chamber pulse generator, respiratory insufficiency, and heart failure. Two patients were assisted postoperatively with an intra-aortic balloon pump. On postoperative follow-up (mean, 72.4 +/- 8.5 months), an improvement in the patients' functional status was observed. Patients moved from a mean New York Heart Association functional class of 2.8 to a mean functional class of 1.2. CONCLUSIONS The excellent long-term evolution without recurrence, ventricular dysfunction, and/or thromboembolic complications implies that cardiomyoplasty could be recommended as an alternative to heart transplantation for the therapy of large ventricular tumors.
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Affiliation(s)
- Juan-Carlos Chachques
- Department of Cardiovascular Surgery, Broussais and Pompidou Hospitals, Paris, France.
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Hoeffel JC, Fornes P. Esophageal carcinoma in a 15-year-old girl: a case report and a review of the literature. Ann Saudi Med 2002; 22:272; author reply 272-3. [PMID: 17159425 DOI: 10.5144/0256-4947.2002.272] [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: 11/22/2022] Open
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Hoeffel JC, Galloy MA, Mainard L, Fornes P, Hoeffel CC. Thoracic calcifications in childhood. Crit Rev Comput Tomogr 2002; 43:9-37. [PMID: 11990653] [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] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Thoracic calcifications are found in the following locations: mediastinum, lung, pleura, cardiovascular system, and thoracic wall. The calcifications of the mediastinum include mostly inflammatory lesions and malignant neoplasms. Pulmonary calcifications are mainly inflammatory lesions and metastases of osteosarcomas. Where the cardiovascular system is concerned, the most common calcifications are those of the heart relating to tumors or surgery. Calcifications of the aortic wall and valve calcifications can be found. In the thoracic wall there are calcifications of the bone and of soft tissues. The knowledge of shape and location is very useful for the diagnosis of the underlying disease. Calcifications in the thorax are frequently manifestations of previous infectious processes. Less often, they may be due to neoplasms, metabolic disorders, or previous medical therapy.
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Richer C, Domergue V, Gervais M, Fornes P, Trabold F, Giudicelli JF. Coronary dilatation reserve in experimental hypertension and chronic heart failure: effects of blockade of the renin-angiotensin system. Clin Exp Pharmacol Physiol 2001; 28:997-1001. [PMID: 11903302 DOI: 10.1046/j.1440-1681.2001.03573.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. The aim of the present study was to investigate left and right ventricular (LV and RV, respectively) coronary vasodilatation reserve (CVR; fluorescent microsphere technique) in rats with hypertension (spontaneously hypertensive rats (SHR)) or congestive heart failure (CHF) and the effects of early and chronic renin-angiotensin system (RAS) blockade thereupon. 2. In adult SHR, both LV and RV CVR were impaired, especially in the non-hypertrophied RV, the main factor involved being coronary vascular remodelling. Blockade of the RAS normalized both LV and RV CVR, mainly through the prevention of hypertension and suppression of the resulting pericoronary fibrosis. 3. In postischaemic CHF rats, there was an early and severe degradation of LV and RV CVR that developed before any significant vascular remodelling and appeared to be linked to the deterioration of cardiac hypertrophy and haemodynamics. This degradation in CVR further worsened over the longer term due to late-developing pericoronary fibrosis and endothelial dysfunction. Blockade of the RAS had no early effects on LV and RV CVR, but improved RV CVR over the long term, mainly by limiting RV hypertrophy and by preventing the development of pericoronary fibrosis and coronary endothelial dysfunction. 4. In kallikrein-kinin system-deficient mice, CVR was not different from that of wild-type mice, suggesting that this system is not implicated in normal CVR regulation.
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Affiliation(s)
- C Richer
- Département de Pharmacologie et INSERM 00-01, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France.
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Hoeffel JC, Hoeffel CC, Fornes P. Re: Ciftci et al "Pheochromocytoma in Children" (J Pediatr Surg 36:447-452, 2001). J Pediatr Surg 2001; 36:1874. [PMID: 11733930 DOI: 10.1053/jpsu.2001.28879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mallat Z, Fornes P, Costagliola R, Esposito B, Belmin J, Lecomte D, Tedgui A. Age and gender effects on cardiomyocyte apoptosis in the normal human heart. J Gerontol A Biol Sci Med Sci 2001; 56:M719-23. [PMID: 11682581 DOI: 10.1093/gerona/56.11.m719] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Animal studies have suggested that apoptosis could play a significant role in the myocardial aging process. Although no information is available in humans, the paradigm that cardiomyocyte apoptosis is increased in the aged human heart has been widely propagated. Moreover, it is unknown whether gender differences may influence cardiomyocyte apoptosis. METHODS Cardiomyocyte apoptosis was compared between subjects ranging in age from 21 to 93 years (22 men and 19 women), free of any cardiovascular disease, who died of either violent or natural causes. Strict inclusion and exclusion criteria were used to ensure that the selected hearts accurately represented normal aging. RESULTS Apoptosis was detected using the TdT-mediated dUTP digoxigenin nick end labeling (TUNEL) technique (controls for TUNEL included negative staining for splicing factor SC-35 and for Ki-67 antigen). The percentage of cardiomyocyte death ranged from 0% to 0.0437%, with no correlation with the age of the subject (p =.85). However, the percentage of apoptosis was threefold higher in men than in women (0.0133% +/- 0.0030% vs 0.0042% +/- 0.0008%, respectively; p <.01). CONCLUSIONS Our results in humans do not support the hypothesis that aging influences the percentage of cardiomyocyte apoptosis. However, gender appears to be an important determinant of the occurrence of apoptosis.
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Affiliation(s)
- Z Mallat
- Institut National de la Santé et de la Recherche Médicale, Institut Fédératif de Recherche Circulation Lariboisière, Paris, France
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