Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 54
Filtrar
Más filtros












Base de datos
Intervalo de año de publicación
1.
Int J Mol Sci ; 24(22)2023 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-38003354

RESUMEN

Surface-enhanced Raman scattering (SERS) is of growing interest for a wide range of applications, especially for biomedical analysis, thanks to its sensitivity, specificity, and multiplexing capabilities. A crucial role for successful applications of SERS is played by the development of reproducible, efficient, and facile procedures for the fabrication of metal nanostructures (SERS substrates). Even more challenging is to extend the fabrication techniques of plasmonic nano-textures to atomic force microscope (AFM) probes to carry out tip-enhanced Raman spectroscopy (TERS) experiments, in which spatial resolution below the diffraction limit is added to the peculiarities of SERS. In this short review, we describe recent studies performed by our group during the last ten years in which novel nanofabrication techniques have been successfully applied to SERS and TERS experiments for studying bio-systems and molecular species of environmental interest.


Asunto(s)
Nanoestructuras , Espectrometría Raman , Espectrometría Raman/métodos , Nanoestructuras/química , Metales
2.
Int J Mol Sci ; 24(15)2023 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-37569474

RESUMEN

The development of sensitive methods for the detection of endotoxin molecules, such as lipopolysaccharides (LPS), is essential for food safety and health control. Conventional analytical methods used for LPS detection are based on the pyrogen test, plating and culture-based methods, and the limulus amoebocyte lysate method (LAL). Alternatively, the development of reliable biosensors for LPS detection would be highly desirable to solve some critical issues, such as high cost and a long turnaround time. In this work, we present a label-free Surface-Enhanced Raman Spectroscopy (SERS)-based method for LPS detection in its free form. The proposed method combines the benefits of plasmonic enhancement with the selectivity provided by a specific anti-lipid A antibody (Ab). A high-enhancing nanostructured silver substrate was coated with Ab. The presence of LPS was quantitatively monitored by analyzing the changes in the Ab spectra obtained in the absence and presence of LPS. A limit of detection (LOD) and quantification (LOQ) of 12 ng/mL and 41 ng/mL were estimated, respectively. Importantly, the proposed technology could be easily expanded for the determination of other biological macromolecules.


Asunto(s)
Técnicas Biosensibles , Nanopartículas del Metal , Animales , Endotoxinas , Lipopolisacáridos , Espectrometría Raman , Cangrejos Herradura , Nanopartículas del Metal/química
3.
Environ Toxicol Pharmacol ; 102: 104235, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37481049

RESUMEN

Benzodiazepines, psychotropic drugs, are among the most frequently found pharmaceuticals in aquatic matrices. An increasing number of studies are reporting their harmful effects on adults' behaviour and physiology, while little information is available regarding developing organisms exposed since early stages. Improper activation of GABA receptors during embryonic development is likely to induce relevant consequences on the morphogenesis and, at later stages, on behaviour. This study investigated the negative effects of three increasing concentrations of delorazepam on Xenopus laevis retinal and skeletal muscle morphogenesis. Morphological and ultrastructural investigations were correlated with gene expression, while Raman spectroscopy highlighted the main biochemical components affected. Conventional phototactic response and orientation in the magnetic field were assessed as indicators of proper interaction between sensory organs and the nervous system. Results confirm the profound impact of delorazepam on development and return an alarming picture of the amphibians' survival potentialities in a benzodiazepine-contaminated environment.


Asunto(s)
Benzodiazepinas , Músculo Esquelético , Femenino , Animales , Xenopus laevis , Benzodiazepinas/toxicidad , Psicotrópicos/toxicidad , Retina
4.
Int J Mol Sci ; 24(13)2023 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-37445624

RESUMEN

The pursuit of environmentally friendly solvents has become an essential research topic in sustainable chemistry and nanomaterial science. With the need to substitute toxic solvents in nanofabrication processes becoming more pressing, the search for alternative solvents has taken on a crucial role in this field. Additionally, the use of toxic, non-economical organic solvents, such as N-methyl-2 pyrrolidone and dimethylformamide, is not suitable for all biomedical applications, even though these solvents are often considered as the best exfoliating agents for nanomaterial fabrication. In this context, the success of producing two-dimensional transition metal dichalcogenides (2D TMDs), such as MoS2 and WS2, with excellent captivating properties is due to the ease of synthesis based on environment-friendly, benign methods with fewer toxic chemicals involved. Herein, we report for the first time on the use of cyrene as an exfoliating agent to fabricate monolayer and few-layered 2D TMDs with a versatile, less time-consuming liquid-phase exfoliation technique. This bio-derived, aprotic, green and eco-friendly solvent produced a stable, surfactant-free, concentrated 2D TMD dispersion with very interesting features, as characterized by UV-visible and Raman spectroscopies. The surface charge and morphology of the fabricated nanoflakes were analyzed using ς-potential and scanning electron microscopy. The study demonstrates that cyrene is a promising green solvent for the exfoliation of 2D TMD nanosheets with potential advantages over traditional organic solvents. The ability to produce smaller-sized-especially in the case of WS2 as compared to MoS2-and mono/few-layered nanostructures with higher negative surface charge values makes cyrene a promising candidate for various biomedical and electronic applications. Overall, the study contributes to the development of sustainable and environmentally friendly methods for the production of 2D nanomaterials for various applications.


Asunto(s)
Nanoestructuras , Elementos de Transición , Solventes , Molibdeno/química , Elementos de Transición/química , Nanoestructuras/química
5.
Sci Rep ; 13(1): 7408, 2023 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-37149715

RESUMEN

We investigate a quasi-2D suspension of Brownian particles in an optical speckle field produced by holographic manipulation of a laser wavefront. This system was developed to study, in a systematic and controllable way, a distinctive instance of diffusion, called Fickian yet Non Gaussian diffusion (FnGD), observed, during the last decade, for colloidal particles in a variety of complex and biological fluids. Our setup generates an optical speckle field that behaves like a disordered set of optical traps. First, we describe the experimental setup and the dynamics of the particles, focusing on mean square displacements, displacement distributions and kurtosis. Then, we present Brownian Dynamics simulations of point-like particles in a complex energy landscape, mimicking that generated by the optical speckle field. We show that our simulations can capture the salient features of the experimental results, including the emergence of FnGD, also covering times longer than the ones so far achieved in experiments. Some deviations are observed at long time only, with the Gaussian restoring being slower in simulations than in experiments. Overall, the introduced numerical model might be exploited to guide the design of upcoming experiments targeted, for example, to fully monitor the recovery of Gaussianity.

6.
Biomed Opt Express ; 14(12): 6442-6469, 2023 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-38420310

RESUMEN

Optical tweezers (OT) have become an essential technique in several fields of physics, chemistry, and biology as precise micromanipulation tools and microscopic force transducers. Quantitative measurements require the accurate calibration of the trap stiffness of the optical trap and the diffusion constant of the optically trapped particle. This is typically done by statistical estimators constructed from the position signal of the particle, which is recorded by a digital camera or a quadrant photodiode. The finite integration time and sampling frequency of the detector need to be properly taken into account. Here, we present a general approach based on the joint probability density function of the sampled trajectory that corrects exactly the biases due to the detector's finite integration time and limited sampling frequency, providing theoretical formulas for the most widely employed calibration methods: equipartition, mean squared displacement, autocorrelation, power spectral density, and force reconstruction via maximum-likelihood-estimator analysis (FORMA). Our results, tested with experiments and Monte Carlo simulations, will permit users of OT to confidently estimate the trap stiffness and diffusion constant, extending their use to a broader set of experimental conditions.

7.
Front Bioeng Biotechnol ; 10: 844011, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35360403

RESUMEN

Two-dimensional nanomaterials, such as MoS2 nanosheets, have been attracting increasing attention in cancer diagnosis and treatment, thanks to their peculiar physical and chemical properties. Although the mechanisms which regulate the interaction between these nanomaterials and cells are not yet completely understood, many studies have proved their efficient use in the photothermal treatment of cancer, and the response to MoS2 nanosheets at the single-cell level is less investigated. Clearly, this information can help in shedding light on the subtle cellular mechanisms ruling the interaction of this 2D material with cells and, eventually, to its cytotoxicity. In this study, we use confocal micro-Raman spectroscopy to reconstruct the thermal map of single cells targeted with MoS2 under continuous laser irradiation. The experiment is performed by analyzing the water O-H stretching band around 3,400 cm-1 whose tetrahedral structure is sensitive to the molecular environment and temperature. Compared to fluorescence-based approaches, this Raman-based strategy for temperature measurement does not suffer fluorophore instability, which can be significant under continuous laser irradiation. We demonstrate that irradiation of human breast cancer MCF7 cells targeted with MoS2 nanosheets causes a relevant photothermal effect, which is particularly high in the presence of MoS2 nanosheet aggregates. Laser-induced heating is strongly localized near such particles which, in turn, tend to accumulate near the cytoplasmic membrane. Globally, our experimental outcomes are expected to be important for tuning the nanosheet fabrication process.

8.
Sensors (Basel) ; 22(7)2022 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-35408378

RESUMEN

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous pollutants that are typically released into the environment during the incomplete combustion of fossil fuels. Due to their relevant carcinogenicity, mutagenicity, and teratogenicity, it is urgent to develop sensitive and cost-effective strategies for monitoring them, especially in aqueous environments. Surface-enhanced Raman spectroscopy (SERS) can potentially be used as a reliable approach for this purpose, as it constitutes a valid alternative to traditional techniques, such as liquid and gas chromatography. Nevertheless, the development of an SERS-based platform for detection PAHs has so far been hindered by the poor adsorption of PAHs onto silver- and gold-based SERS-active substrates. To overcome this limitation, several research efforts have been directed towards the development of functionalized SERS substrates for the improvement of PAH adsorption. However, these strategies suffer from the interference that functionalizing molecules can produce in SERS detection. Herein, we demonstrate the feasibility of label-free detection of pyrene by using a highly porous 3D-SERS substrate produced by an inductively coupled plasma (ICP). Thanks to the coral-like nanopattern exhibited by our substrate, clear signals ascribable to pyrene molecules can be observed with a limit of detection of 23 nM. The observed performance can be attributed to the nanoporous character of our substrate, which combines a high density of hotspots and a certain capability of trapping molecules and favoring their adhesion to the Ag nanopattern. The obtained results demonstrate the potential of our substrates as a large-area, label-free SERS-based platform for chemical sensing and environmental control applications.


Asunto(s)
Nanopartículas del Metal , Hidrocarburos Policíclicos Aromáticos , Estudios de Factibilidad , Nanopartículas del Metal/química , Hidrocarburos Policíclicos Aromáticos/análisis , Porosidad , Pirenos , Plata/química , Espectrometría Raman/métodos , Agua
9.
Soft Matter ; 18(2): 351-364, 2022 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-34888591

RESUMEN

Fickian yet non-Gaussian Diffusion (FnGD), widely observed for colloidal particles in a variety of complex and biological fluids, emerges as a most intriguing open issue in Soft Matter. To fully monitor FnGD and advance its understanding, recording many trajectories over a large time range is crucial, which makes experiments challenging. Here we exploit a recently introduced experimental model of finely tunable FnGD: a quasi-2d system of Brownian beads in water moving in a heterogeneous energy landscape generated by a static and spatially random optical force field (speckle pattern). By performing experiments at different optical power, we succeed in monitoring the evolution as well as the precursors of FnGD. Fickian scaling of the mean square displacement is always attained after a subdiffusive regime while the displacement distributions keep on being non-Gaussian, which allows for measuring a characteristic length- and time-scale for the onset of FnGD, ξf and tf. We find that ξf stays constant, whereas tf grows as the inverse of the long-time diffusion coefficient tf ∝ D-1 for increasing the optical power. Deviations from the standard Gaussian shape of the displacement distribution are neatly characterized on a broad range of times, focusing on the excess probability at small displacements and on the decay-length of the distinctive exponential tails. Such deviations are fully built in the subdiffusive regime and, at the FnGD onset, grow with the optical power. As time goes on, the small-displacement probability narrows and the exponential tails progressively break up, with a tendency to recover the Gaussian behaviour. Overall, both subdiffusion and FnGD become more marked and persistent on increasing the optical power, suggesting a strict relation between these two regimes. As clearly demonstrated by our results, the adopted model-system represents a privileged stage for in-depth study of FnGD and opens the way to unveil the nature of this phenomenon through finely tuned and well-controlled experiments.

10.
Int J Mol Sci ; 24(1)2022 Dec 29.
Artículo en Inglés | MEDLINE | ID: mdl-36614044

RESUMEN

Nanoparticles (NPs) coated with hyaluronic acid (HA) seem to be increasingly promising for targeted therapy due to HA chemical versatility, which allows them to bind drugs of different natures, and their affinity with the transmembrane receptor CD-44, overexpressed in tumor cells. However, an essential aspect for clinical use of NPs is formulation stability over time. For these reasons, analytical techniques capable of characterizing their physico-chemical properties are needed. In this work, poly(lactide-co-glycolide) (PLGA) NPs with an average diameter of 100-150 nm, coated with a few 10 s of nm of HA, were synthesized. For stability characterization, two complementary investigative techniques were used: Dynamic Light Scattering (DLS) and Surface-Enhanced Raman Scattering (SERS) spectroscopy. The first technique provided information on size, polidispersity index, and zeta-potential, and the second provided a deeper insight on the NP surface chemicals, allowing distinguishing of HA-coated NPs from uncoated ones. Furthermore, in order to estimate formulation stability over time, NPs were measured and monitored for two weeks. SERS results showed a progressive decrease in the signal associated with HA, which, however, is not detectable by the DLS measurements.


Asunto(s)
Nanopartículas , Espectrometría Raman , Ácido Hialurónico/química , Nanopartículas/química , Portadores de Fármacos
11.
Sci Rep ; 11(1): 22295, 2021 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-34785690

RESUMEN

The fabrication of plasmonic nanostructures with a reliable, low cost and easy approach has become a crucial and urgent challenge in many fields, including surface-enhanced Raman spectroscopy (SERS) based applications. In this frame, nanoporous metal films are quite attractive, due to their intrinsic large surface area and high density of metal nanogaps, acting as hot-spots for Raman signal enhancement. In this paper, we report a detailed study on the fabrication of nanoporous silver-based SERS substrates, obtained by the application of two successive treatments with an Inductively Coupled Plasma (ICP) system, using synthetic air and Ar as feeding gases. The obtained substrates exhibit a quite broad plasmonic response, covering the Vis-NIR range, and an enhancement factor reaching 6.5 [Formula: see text], estimated by using 4-mercaptobenzoic acid (4-MBA) as probe molecule at 532 nm. Moreover, the substrates exhibit a quite good spatial reproducibility on a centimeter scale, which assures a good signal stability for analytical measurements. Globally, the developed protocol is easy and cost effective, potentially usable also for mass production thanks to the remarkable inter-batches reproducibility. As such, it holds promise for its use in SERS-based sensing platforms for sensitive detection of targets molecules.

12.
Phys Rev Lett ; 126(15): 158003, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33929249

RESUMEN

The recently discovered Fickian yet non-Gaussian diffusion (FnGD) is here finely tuned and investigated over a wide range of probabilities and timescales using a quasi-2D suspension of colloidal beads under the action of a static and spatially random optical force field. This experimental model allows one to demonstrate that a "rapid" FnGD regime with a diffusivity close to that of free suspension can originate from earlier subdiffusion. We show that these two regimes are strictly tangled: as subdiffusion deepens upon increasing the optical force, deviations from Gaussianity in the FnGD regime become larger and more persistent in time. In addition, the distinctive exponential tails of FnGD are quickly built up in the subdiffusive regime. Our results shed new light on previous experimental observations and suggest that FnGD may generally be a memory effect of earlier subdiffusive processes.

13.
Nanoscale ; 12(48): 24376-24384, 2020 Dec 23.
Artículo en Inglés | MEDLINE | ID: mdl-33179660

RESUMEN

Tip-enhanced Raman spectroscopy is a powerful tool for the analysis of system interfaces, enabling access to chemical information with nanometric spatial resolution and sensitivity up to the single molecule level. Such features are due to the presence of proper metallic nanostructures at the TERS probe apex, which, via the excitation of a plasmonic field, confine light to a nanometric region. The nano-sized characteristic of such metallic structures intrinsically renders the fabrication of high performing and reproducible TERS probes still a challenge. In this paper, we present a facile, rapid and effective approach to prepare Ag-based TERS probes. The fabrication process proposed herein is based on spinodal dewetting of Ag-coated AFM-probes through a RF plasma treatment. The obtained probes appear covered with a coral-like silver nanotexture, endowed with an excellent plasmonic activity. Intriguingly, such a texture can be easily tuned by changing some process parameters, such as Ag film thickness and exposure time to the plasma. The as-prepared TERS probes show a high TERS enhancement, reaching 107, and allow a good spatial resolution, down to 10 nm. Finally, we suggest an easy and effective procedure to restore oxidized TERS tips following exposure to ambient air, which can be applied to all types of Ag-based TERS tips.

14.
J Colloid Interface Sci ; 561: 136-146, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-31812860

RESUMEN

HYPOTHESIS: While the phase behavior of aqueous surfactant solutions is usually described in term of the equilibrium microstructures of lyotropic liquid crystals, the transformations which take place when a phase turns into another one, either by changing the concentration or the temperature, are still to be elucidated. A simultaneous determination of concentration and microstructure is at order to elucidate the phase behavior under changing conditions, such as in a dissolution experiment. EXPERIMENTS: Confocal Raman micro-spectroscopy and time-lapse polarized light microscopy are combined to study the phase transitions taking place in the dissolution of a common anionic surfactant (sodium laurylethersulfate) in water. FINDINGS: By comparing Raman concentration profiles and polarized light images, it is found that the aqueous solution, with initial surfactant concentration of 72 wt%, undergoes a sequence of complex microstructural transformations including distortion of the initial lamellar phase, formation of an intermediate striated texture, which can be considered as a precursor of a cubic phase, and a heterogeneous hexagonal phase going through a transition region before turning into a micellar phase. The effects of the sodium counter-ion and of water confinement are also investigated by analyzing the OH-stretching bands.

15.
Sensors (Basel) ; 19(15)2019 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-31382386

RESUMEN

Tear fluid is a heterogeneous solution containing mainly proteins, lipids, mucins and electrolytes, which regulates the physiology of the human eye. The complex composition of tears can be altered in the presence of eye inflammations. The use of contact lenses is one of the most frequent causes of inflammatory responses of the eye, with the related discomfort often causing the wearer to give up using them. In this paper, we exploit the potentiality of Raman Spectroscopy to analyse the biochemical changes in tear fluid in a contact lens wearer. In particular, we analysed the tear fluid collected from a volunteer as a function of the wearing time for two types of monthly contact lenses (Hydrogel and Si-Hydrogel). Our experimental results show an alteration of the relative concentrations of proteins and lipids in both of the analysed cases. More importantly, our results highlight the diagnostic sensitivity of Raman analysis to select the proper contact lens type for each wearer and optimise the lens wearing conditions.


Asunto(s)
Espectrometría Raman , Lágrimas/química , Lentes de Contacto , Humanos , Hidrogel de Polietilenoglicol-Dimetacrilato/química , Lípidos/análisis , Análisis de Componente Principal , Proteínas/análisis , Lágrimas/metabolismo
16.
Sci Rep ; 9(1): 9001, 2019 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-31209245

RESUMEN

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

17.
J Microbiol ; 57(6): 498-508, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31054137

RESUMEN

Outer membrane vesicles (OMVs) are nanostructures of 20-200 nm diameter deriving from the surface of several Gram-negative bacteria. OMVs are emerging as shuttles involved in several mechanisms of communication and environmental adaptation. In this work, OMVs were isolated and characterized from Novosphingobium sp. PP1Y, a Gram-negative non-pathogenic microorganism lacking LPS on the outer membrane surface and whose genome was sequenced and annotated. Scanning electron microscopy performed on samples obtained from a culture in minimal medium highlighted the presence of PP1Y cells embedded in an extracellular matrix rich in vesicular structures. OMVs were collected from the exhausted growth medium during the mid-exponential phase, and purified by ultracentrifugation on a sucrose gradient. Atomic force microscopy, dynamic light scattering and nanoparticle tracking analysis showed that purified PP1Y OMVs had a spherical morphology with a diameter of ca. 150 nm and were homogenous in size and shape. Moreover, proteomic and fatty acid analysis of purified OMVs revealed a specific biochemical "fingerprint", suggesting interesting details concerning their biogenesis and physiological role. Moreover, these extracellular nanostructures do not appear to be cytotoxic on HaCaT cell line, thus paving the way to their future use as novel drug delivery systems.


Asunto(s)
Proteínas de la Membrana Bacteriana Externa/metabolismo , Membrana Celular/metabolismo , Vesículas Secretoras/química , Vesículas Secretoras/enzimología , Sphingomonadaceae/metabolismo , Proteínas de la Membrana Bacteriana Externa/aislamiento & purificación , Línea Celular , Supervivencia Celular/efectos de los fármacos , Exocitosis , Ácidos Grasos/análisis , Humanos , Queratinocitos/efectos de los fármacos , Microscopía Electrónica de Rastreo , Nanopartículas , Péptido Hidrolasas/metabolismo , Proteómica/métodos , Sphingomonadaceae/citología
18.
Biomed Opt Express ; 10(4): 1870-1881, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-31086709

RESUMEN

The phenomenon of glistenings, often appearing in intraocular lenses (IOLs) of patients after some time from the surgical operation, is potentially able to induce a poor quality of vision and, therefore, frustrate IOL implantation itself. In this paper, we combine optical microscopy with micro-Raman spectroscopy to get a deeper insight on the mechanism ruling, at microscopic scale, glistening formation. In particular, we have analyzed two types of IOLs, characterized by a different internal hydrophobicity but a similar polymer hydration coefficient. Raman imaging of single microvacuoles reveals that water creeps into the polymeric network, which traps water. Finally, applying the Principal Component Analysis (PCA) to Raman data, we provide information on the probable mechanism leading to water trapping in the two kinds of analyzed IOLs.

19.
Sci Rep ; 9(1): 1832, 2019 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-30755643

RESUMEN

Sensitive detection of altered proteins expression in plasma membranes is of fundamental importance, for both diagnostic and prognostic purposes. Surface-Enhanced Raman Scattering (SERS) has proven to be a quite sensitive approach to detect proteins, even in very diluted samples. However, proteins detection in complex environment, such as the cellular membrane, is still a challenge. Herein, we demonstrate a SERS-based platform to reveal the overexpression of target proteins in cell membranes. As a proof of concept, we implemented ectopic expression of carbonic anhydrase IX (CA IX) and epidermal growth factor receptor (EGFR) in the plasma membrane of the SKOV3 tumor cell line. Our outcomes demonstrate that SERS signals from cells put in contact with a hyperuniform SERS substrate allow highlighting subtle differences in the biochemical composition of cell membranes, normally hidden in spontaneous Raman confocal microscopy. This opens new opportunities for a label-free membrane analysis and bio-sensing in a broader sense.


Asunto(s)
Antígenos de Neoplasias/metabolismo , Anhidrasa Carbónica IX/metabolismo , Membrana Celular/metabolismo , Espectrometría Raman , Técnicas Biosensibles , Línea Celular Tumoral , Separación Celular , Receptores ErbB/metabolismo , Citometría de Flujo , Humanos , Microscopía Confocal , Análisis Multivariante , Análisis de Componente Principal , Dispersión de Radiación
20.
J Am Soc Nephrol ; 29(12): 2890-2899, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30420421

RESUMEN

BACKGROUND: The comparative effectiveness of treatment with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or their combination in people with albuminuria and cardiovascular risk factors is unclear. METHODS: In a multicenter, randomized, open label, blinded end point trial, we evaluated the effectiveness on cardiovascular events of ACE or ARB monotherapy or combination therapy, targeting BP<130/80 in patients with moderate or severe albuminuria and diabetes or other cardiovascular risk factors. End points included a primary composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for cardiovascular causes and a revised end point of all-cause mortality. Additional end points included ESRD, doubling of serum creatinine, albuminuria, eGFR, BP, and adverse events. RESULTS: Because of slow enrollment, the trial was modified and stopped 41% short of targeted enrollment of 2100 participants, corresponding to 35% power to detect a 25% reduced risk in the primary outcome. Our analysis included 1243 adults, with median follow-up of 2.7 years. Efficacy outcomes were similar between groups (ACE inhibitor versus ARB, ACE inhibitor versus combination, ARB versus combination) as were rates of serious adverse events. The rate of permanent discontinuation for ARB monotherapy (6.3%) was significantly lower than for ACE inhibitor monotherapy (15.7%) or combined therapy (18.3%). CONCLUSIONS: Patients may tolerate ARB monotherapy better than ACE inhibitor monotherapy. However, data from this trial and similar trials, although as yet inconclusive, show no trend suggesting differences in mortality and renal outcomes with ACE inhibitors or ARBs as dual or monotherapy in patients with albuminuria and diabetes or other cardiovascular risk factors.


Asunto(s)
Albuminuria/tratamiento farmacológico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Diabetes Mellitus/tratamiento farmacológico , Anciano , Antagonistas de Receptores de Angiotensina/administración & dosificación , Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/mortalidad , Quimioterapia Combinada , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Sistema Renina-Angiotensina/efectos de los fármacos , Factores de Riesgo , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...