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1.
Nat Rev Mol Cell Biol ; 18(8): 507-516, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28537574

RESUMO

Genome duplication is carried out by pairs of replication forks that assemble at origins of replication and then move in opposite directions. DNA replication ends when converging replication forks meet. During this process, which is known as replication termination, DNA synthesis is completed, the replication machinery is disassembled and daughter molecules are resolved. In this Review, we outline the steps that are likely to be common to replication termination in most organisms, namely, fork convergence, synthesis completion, replisome disassembly and decatenation. We briefly review the mechanism of termination in the bacterium Escherichia coli and in simian virus 40 (SV40) and also focus on recent advances in eukaryotic replication termination. In particular, we discuss the recently discovered E3 ubiquitin ligases that control replisome disassembly in yeast and higher eukaryotes, and how their activity is regulated to avoid genome instability.


Assuntos
Replicação do DNA/fisiologia , DNA/genética , Replicação do DNA/genética , Escherichia coli/genética , Instabilidade Genômica/genética , Instabilidade Genômica/fisiologia , Saccharomyces cerevisiae/genética
2.
Cell ; 159(2): 346-57, 2014 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-25303529

RESUMO

DNA-protein crosslinks (DPCs) are caused by environmental, endogenous, and chemotherapeutic agents and pose a severe threat to genome stability. We use Xenopus egg extracts to recapitulate DPC repair in vitro and show that this process is coupled to DNA replication. A DPC on the leading strand template arrests the replisome by stalling the CMG helicase. The DPC is then degraded on DNA, yielding a peptide-DNA adduct that is bypassed by CMG. The leading strand subsequently resumes synthesis, stalls again at the adduct, and then progresses past the adduct using DNA polymerase ζ. A DPC on the lagging strand template only transiently stalls the replisome, but it too is degraded, allowing Okazaki fragment bypass. Our experiments describe a versatile, proteolysis-based mechanism of S phase DPC repair that avoids replication fork collapse.


Assuntos
Adutos de DNA/metabolismo , Reparo do DNA , Replicação do DNA , Animais , Extratos Celulares/química , DNA Polimerase Dirigida por DNA/metabolismo , Instabilidade Genômica , Óvulo/química , Xenopus
3.
Mol Cell ; 81(6): 1309-1318.e6, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33484638

RESUMO

DNA damage impedes replication fork progression and threatens genome stability. Upon encounter with most DNA adducts, the replicative CMG helicase (CDC45-MCM2-7-GINS) stalls or uncouples from the point of synthesis, yet eventually resumes replication. However, little is known about the effect on replication of single-strand breaks or "nicks," which are abundant in mammalian cells. Using Xenopus egg extracts, we reveal that CMG collision with a nick in the leading strand template generates a blunt-ended double-strand break (DSB). Moreover, CMG, which encircles the leading strand template, "runs off" the end of the DSB. In contrast, CMG collision with a lagging strand nick generates a broken end with a single-stranded overhang. In this setting, CMG translocates along double-stranded DNA beyond the break and is then ubiquitylated and removed from chromatin by the same pathway used during replication termination. Our results show that nicks are uniquely dangerous DNA lesions that invariably cause replisome disassembly, and they suggest that CMG cannot be stored on dsDNA while cells resolve replication stress.


Assuntos
Cromatina , Quebras de DNA de Cadeia Simples , DNA Helicases , Replicação do DNA , Ubiquitinação , Proteínas de Xenopus , Animais , Cromatina/química , Cromatina/genética , Cromatina/metabolismo , DNA Helicases/química , DNA Helicases/genética , DNA Helicases/metabolismo , Células Sf9 , Spodoptera , Proteínas de Xenopus/química , Proteínas de Xenopus/genética , Proteínas de Xenopus/metabolismo , Xenopus laevis
4.
EMBO J ; 41(12): e110632, 2022 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-35578785

RESUMO

Topoisomerase II (TOP2) unlinks chromosomes during vertebrate DNA replication. TOP2 "poisons" are widely used chemotherapeutics that stabilize TOP2 complexes on DNA, leading to cytotoxic DNA breaks. However, it is unclear how these drugs affect DNA replication, which is a major target of TOP2 poisons. Using Xenopus egg extracts, we show that the TOP2 poisons etoposide and doxorubicin both inhibit DNA replication through different mechanisms. Etoposide induces TOP2-dependent DNA breaks and TOP2-dependent fork stalling by trapping TOP2 behind replication forks. In contrast, doxorubicin does not lead to appreciable break formation and instead intercalates into parental DNA to stall replication forks independently of TOP2. In human cells, etoposide stalls forks in a TOP2-dependent manner, while doxorubicin stalls forks independently of TOP2. However, both drugs exhibit TOP2-dependent cytotoxicity. Thus, etoposide and doxorubicin inhibit DNA replication through distinct mechanisms despite shared genetic requirements for cytotoxicity.


Assuntos
DNA Topoisomerases Tipo II , Venenos , Animais , DNA , Replicação do DNA , DNA Topoisomerases Tipo II/genética , DNA Topoisomerases Tipo II/metabolismo , Doxorrubicina/farmacologia , Etoposídeo/farmacologia , Humanos , Vertebrados/genética , Vertebrados/metabolismo
5.
Genes Dev ; 31(3): 275-290, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28235849

RESUMO

A key event during eukaryotic replication termination is the removal of the CMG helicase from chromatin. CMG unloading involves ubiquitylation of its Mcm7 subunit and the action of the p97 ATPase. Using a proteomic screen in Xenopus egg extracts, we identified factors that are enriched on chromatin when CMG unloading is blocked. This approach identified the E3 ubiquitin ligase CRL2Lrr1, a specific p97 complex, other potential regulators of termination, and many replisome components. We show that Mcm7 ubiquitylation and CRL2Lrr1 binding to chromatin are temporally linked and occur only during replication termination. In the absence of CRL2Lrr1, Mcm7 is not ubiquitylated, CMG unloading is inhibited, and a large subcomplex of the vertebrate replisome that includes DNA Pol ε is retained on DNA. Our data identify CRL2Lrr1 as a master regulator of replisome disassembly during vertebrate DNA replication termination.


Assuntos
Cromatina/metabolismo , DNA Helicases/metabolismo , Replicação do DNA , DNA/metabolismo , Ubiquitina-Proteína Ligases/metabolismo , Proteínas de Xenopus/metabolismo , Xenopus laevis/genética , Adenosina Trifosfatases/metabolismo , Animais , Cromatina/genética , DNA Polimerase II/metabolismo , Componente 7 do Complexo de Manutenção de Minicromossomo/metabolismo , Proteínas Nucleares/metabolismo , Ubiquitinação , Proteínas de Xenopus/genética , Xenopus laevis/metabolismo
7.
EMBO J ; 36(21): 3212-3231, 2017 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-28982779

RESUMO

Nuclear actin regulates transcriptional programmes in a manner dependent on its levels and polymerisation state. This dynamics is determined by the balance of nucleocytoplasmic shuttling, formin- and redox-dependent filament polymerisation. Here, using Xenopus egg extracts and human somatic cells, we show that actin dynamics and formins are essential for DNA replication. In proliferating cells, formin inhibition abolishes nuclear transport and initiation of DNA replication, as well as general transcription. In replicating nuclei from transcriptionally silent Xenopus egg extracts, we identified numerous actin regulators, and disruption of actin dynamics abrogates nuclear transport, preventing NLS (nuclear localisation signal)-cargo release from RanGTP-importin complexes. Nuclear formin activity is further required to promote loading of cyclin-dependent kinase (CDK) and proliferating cell nuclear antigen (PCNA) onto chromatin, as well as initiation and elongation of DNA replication. Therefore, actin dynamics and formins control DNA replication by multiple direct and indirect mechanisms.


Assuntos
Actinas/genética , Cromatina/metabolismo , Replicação do DNA , Proteínas Fetais/genética , Proteínas dos Microfilamentos/genética , Proteínas Nucleares/genética , Transcrição Gênica , Actinas/metabolismo , Transporte Ativo do Núcleo Celular/genética , Animais , Linhagem Celular Tumoral , Núcleo Celular/metabolismo , Cromatina/química , Misturas Complexas/química , Citoplasma/metabolismo , Células Epiteliais/citologia , Células Epiteliais/metabolismo , Proteínas Fetais/metabolismo , Forminas , Regulação da Expressão Gênica , Células HeLa , Humanos , Carioferinas/genética , Carioferinas/metabolismo , Proteínas dos Microfilamentos/metabolismo , Sinais de Localização Nuclear , Proteínas Nucleares/metabolismo , Antígeno Nuclear de Célula em Proliferação/genética , Antígeno Nuclear de Célula em Proliferação/metabolismo , Transdução de Sinais , Xenopus laevis , Zigoto/química , Proteína ran de Ligação ao GTP/genética , Proteína ran de Ligação ao GTP/metabolismo
8.
Nature ; 525(7569): 345-50, 2015 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-26322582

RESUMO

Eukaryotic DNA replication terminates when replisomes from adjacent replication origins converge. Termination involves local completion of DNA synthesis, decatenation of daughter molecules and replisome disassembly. Termination has been difficult to study because termination events are generally asynchronous and sequence nonspecific. To overcome these challenges, we paused converging replisomes with a site-specific barrier in Xenopus egg extracts. Upon removal of the barrier, forks underwent synchronous and site-specific termination, allowing mechanistic dissection of this process. We show that DNA synthesis does not slow detectably as forks approach each other, and that leading strands pass each other unhindered before undergoing ligation to downstream lagging strands. Dissociation of the replicative CMG helicase (comprising CDC45, MCM2-7 and GINS) occurs only after the final ligation step, and is not required for completion of DNA synthesis, strongly suggesting that converging CMGs pass one another and dissociate from double-stranded DNA. This termination mechanism allows rapid completion of DNA synthesis while avoiding premature replisome disassembly.


Assuntos
Replicação do DNA , Oócitos/metabolismo , Xenopus laevis , Animais , Extratos Celulares/farmacologia , DNA/biossíntese , DNA/metabolismo , DNA Helicases/metabolismo , Replicação do DNA/efeitos dos fármacos , Proteínas de Ligação a DNA/metabolismo , DNA Polimerase Dirigida por DNA/metabolismo , Complexos Multienzimáticos/metabolismo
9.
EMBO J ; 33(21): 2521-33, 2014 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-25193968

RESUMO

Our genome contains many G-rich sequences, which have the propensity to fold into stable secondary DNA structures called G4 or G-quadruplex structures. These structures have been implicated in cellular processes such as gene regulation and telomere maintenance. However, G4 sequences are prone to mutations particularly upon replication stress or in the absence of specific helicases. To investigate how G-quadruplex structures are resolved during DNA replication, we developed a model system using ssDNA templates and Xenopus egg extracts that recapitulates eukaryotic G4 replication. Here, we show that G-quadruplex structures form a barrier for DNA replication. Nascent strand synthesis is blocked at one or two nucleotides from the G4. After transient stalling, G-quadruplexes are efficiently unwound and replicated. In contrast, depletion of the FANCJ/BRIP1 helicase causes persistent replication stalling at G-quadruplex structures, demonstrating a vital role for this helicase in resolving these structures. FANCJ performs this function independently of the classical Fanconi anemia pathway. These data provide evidence that the G4 sequence instability in FANCJ(-/-) cells and Fancj/dog1 deficient C. elegans is caused by replication stalling at G-quadruplexes.


Assuntos
Proteínas de Caenorhabditis elegans/metabolismo , Caenorhabditis elegans/metabolismo , DNA Helicases/metabolismo , Replicação do DNA/fisiologia , DNA/biossíntese , Quadruplex G , Animais , Caenorhabditis elegans/genética , Proteínas de Caenorhabditis elegans/genética , DNA Helicases/genética , Deleção de Genes , Humanos , Xenopus laevis
10.
Mol Cell ; 38(6): 777-9, 2010 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-20620949

RESUMO

In this issue of Molecular Cell, Faure et al. (2010) establish a critical role for the Mre11 complex in the recruitment of telomerase to leading- but not lagging-strand telomeres of budding yeast.

11.
EMBO J ; 29(23): 4020-34, 2010 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-21045806

RESUMO

Essential telomere 'capping' proteins act as a safeguard against ageing and cancer by inhibiting the DNA damage response (DDR) and regulating telomerase recruitment, thus distinguishing telomeres from double-strand breaks (DSBs). Uncapped telomeres and unrepaired DSBs can both stimulate a potent DDR, leading to cell cycle arrest and cell death. Using the cdc13-1 mutation to conditionally 'uncap' telomeres in budding yeast, we show that the telomere capping protein Cdc13 protects telomeres from the activity of the helicase Pif1 and the exonuclease Exo1. Our data support a two-stage model for the DDR at uncapped telomeres; Pif1 and Exo1 resect telomeric DNA <5 kb from the chromosome end, stimulating weak checkpoint activation; resection is extended >5 kb by Exo1 and full checkpoint activation occurs. Cdc13 is also crucial for telomerase recruitment. However, cells lacking Cdc13, Pif1 and Exo1, do not senesce and maintain their telomeres in a manner dependent upon telomerase, Ku and homologous recombination. Thus, attenuation of the DDR at uncapped telomeres can circumvent the need for otherwise-essential telomere capping proteins.


Assuntos
Quebras de DNA de Cadeia Dupla , DNA Helicases/metabolismo , Exodesoxirribonucleases/metabolismo , Proteínas de Saccharomyces cerevisiae/metabolismo , Saccharomyces cerevisiae/metabolismo , Telômero/metabolismo , Reparo do DNA , Mutação , Saccharomyces cerevisiae/enzimologia , Saccharomyces cerevisiae/genética , Proteínas de Saccharomyces cerevisiae/genética , Proteínas de Ligação a Telômeros/genética , Proteínas de Ligação a Telômeros/metabolismo
12.
Nat Protoc ; 19(7): 1940-1983, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38594502

RESUMO

A major obstacle to studying DNA replication is that it involves asynchronous and highly delocalized events. A reversible replication barrier overcomes this limitation and allows replication fork movement to be synchronized and localized, facilitating the study of replication fork function and replication coupled repair. Here we provide details on establishing a reversible replication barrier in vitro and using it to monitor different aspects of DNA replication. DNA template containing an array of lac operator (lacO) sequences is first bound to purified lac repressor (LacR). This substrate is then replicated in vitro using a biochemical replication system, which results in replication forks stalled on either side of the LacR array regardless of when or where they arise. Once replication forks are synchronized at the barrier, isopropyl-ß-D-thiogalactopyranoside can be added to disrupt LacR binding so that replication forks synchronously resume synthesis. We describe how this approach can be employed to control replication fork elongation, termination, stalling and uncoupling, as well as assays that can be used to monitor these processes. We also explain how this approach can be adapted to control whether replication forks encounter a DNA lesion on the leading or lagging strand template and whether a converging fork is present. The required reagents can be prepared in 1-2 weeks and experiments using this approach are typically performed over 1-3 d. The main requirements for utilizing the LacR replication barrier are basic biochemical expertise and access to an in vitro system to study DNA replication. Investigators should also be trained in working with radioactive materials.


Assuntos
Replicação do DNA , Repressores Lac/metabolismo , Repressores Lac/genética , DNA/metabolismo , DNA/genética
13.
Chromosoma ; 121(2): 117-30, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22203190

RESUMO

Telomeric DNA is present at the ends of eukaryotic chromosomes and is bound by telomere "capping" proteins, which are the (Cdc13-Stn1-Ten1) CST complex, Ku (Yku70-Yku80), and Rap1-Rif1-Rif2 in budding yeast. Inactivation of any of these complexes causes telomere "uncapping," stimulating a DNA damage response (DDR) that frequently involves resection of telomeric DNA and stimulates cell cycle arrest. This is presumed to occur because telomeres resemble one half of a DNA double-strand break (DSB). In this review, we outline the DDR that occurs at DSBs and compare it to the DDR occurring at uncapped telomeres, in both budding yeast and metazoans. We give particular attention to the resection of DSBs in budding yeast by Mre11-Xrs2-Rad50 (MRX), Sgs1/Dna2, and Exo1 and compare their roles at DSBs and uncapped telomeres. We also discuss how resection uncapped telomeres in budding yeast is promoted by the by 9-1-1 complex (Rad17-Mec3-Ddc1), to illustrate how analysis of uncapped telomeres can serve as a model for the DDR elsewhere in the genome. Finally, we discuss the role of the helicase Pif1 and its requirement for resection of uncapped telomeres, but not DSBs. Pif1 has roles in DNA replication and mammalian and plant CST complexes have been identified and have roles in global genome replication. Based on these observations, we suggest that while the DDR at uncapped telomeres is partially due to their resemblance to a DSB, it may also be partially due to defective DNA replication. Specifically, we propose that the budding yeast CST complex has dual roles to inhibit a DSB-like DDR initiated by Exo1 and a replication-associated DDR initiated by Pif1. If true, this would suggest that the mammalian CST complex inhibits a Pif1-dependent DDR.


Assuntos
Quebras de DNA de Cadeia Dupla , Reparo do DNA/fisiologia , Modelos Biológicos , Complexos Multiproteicos/metabolismo , Proteínas de Ligação a Telômeros/metabolismo , Telômero/genética , Animais , Proteínas de Ciclo Celular/metabolismo , Proteínas Cromossômicas não Histona/metabolismo , DNA Helicases/genética , DNA Helicases/metabolismo , Reparo do DNA/genética , Exodesoxirribonucleases/metabolismo , Mamíferos , Proteínas de Saccharomyces cerevisiae/genética , Proteínas de Saccharomyces cerevisiae/metabolismo , Saccharomycetales
14.
Nat Struct Mol Biol ; 30(1): 115-124, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36593312

RESUMO

Genotoxins cause nascent strand degradation (NSD) and fork reversal during DNA replication. NSD and fork reversal are crucial for genome stability and are exploited by chemotherapeutic approaches. However, it is unclear how NSD and fork reversal are triggered. Additionally, the fate of the replicative helicase during these processes is unknown. We developed a biochemical approach to study synchronous, localized NSD and fork reversal using Xenopus egg extracts and validated this approach with experiments in human cells. We show that replication fork uncoupling stimulates NSD of both nascent strands and progressive conversion of uncoupled forks to reversed forks. Notably, the replicative helicase remains bound during NSD and fork reversal. Unexpectedly, NSD occurs before and after fork reversal, indicating that multiple degradation steps take place. Overall, our data show that uncoupling causes NSD and fork reversal and elucidate key events that precede fork reversal.


Assuntos
Replicação do DNA , Proteínas de Ligação a DNA , Animais , Humanos , Proteínas de Ligação a DNA/metabolismo , DNA Helicases/metabolismo , Instabilidade Genômica , Xenopus laevis/metabolismo
15.
Cell Rep ; 42(2): 112109, 2023 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-36807139

RESUMO

Topological stress can cause converging replication forks to stall during termination of vertebrate DNA synthesis. However, replication forks ultimately overcome fork stalling, suggesting that alternative mechanisms of termination exist. Using proteomics in Xenopus egg extracts, we show that the helicase RTEL1 and the replisome protein MCM10 are highly enriched on chromatin during fork convergence and are crucially important for fork convergence under conditions of topological stress. RTEL1 and MCM10 cooperate to promote fork convergence and do not impact topoisomerase activity but do promote fork progression through a replication barrier. Thus, RTEL1 and MCM10 play a general role in promoting progression of stalled forks, including when forks stall during termination. Our data reveal an alternate mechanism of termination involving RTEL1 and MCM10 that can be used to complete DNA synthesis under conditions of topological stress.


Assuntos
Cromatina , Replicação do DNA , Animais , DNA/metabolismo , Xenopus laevis
16.
Bioinformatics ; 27(9): 1299-306, 2011 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-21414991

RESUMO

MOTIVATION: The rise of high-throughput technologies in the post-genomic era has led to the production of large amounts of biological data. Many of these datasets are freely available on the Internet. Making optimal use of these data is a significant challenge for bioinformaticians. Various strategies for integrating data have been proposed to address this challenge. One of the most promising approaches is the development of semantically rich integrated datasets. Although well suited to computational manipulation, such integrated datasets are typically too large and complex for easy visualization and interactive exploration. RESULTS: We have created an integrated dataset for Saccharomyces cerevisiae using the semantic data integration tool Ondex, and have developed a view-based visualization technique that allows for concise graphical representations of the integrated data. The technique was implemented in a plug-in for Cytoscape, called OndexView. We used OndexView to investigate telomere maintenance in S. cerevisiae. AVAILABILITY: The Ondex yeast dataset and the OndexView plug-in for Cytoscape are accessible at http://bsu.ncl.ac.uk/ondexview.


Assuntos
Biologia Computacional/métodos , Bases de Dados Genéticas , Armazenamento e Recuperação da Informação/métodos , Biologia de Sistemas/métodos , Internet , Saccharomyces cerevisiae/genética , Telômero/genética
17.
Methods Mol Biol ; 2444: 105-123, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35290634

RESUMO

DNA replication is crucial for cell viability and genome integrity. Despite its crucial role in genome duplication, the final stage of DNA replication, which is termed termination, is relatively unexplored. Our knowledge of termination is limited by cellular approaches to study DNA replication, which cannot readily detect termination. In contrast, the Xenopus laevis egg extract system allows for all of DNA replication to be readily detected. Here we describe the use of this system and assays to monitor replication termination.


Assuntos
Replicação do DNA , Oócitos , Animais , Genoma , Xenopus laevis/genética
18.
Methods Enzymol ; 672: 317-338, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35934482

RESUMO

When a replication fork encounters a nick in the parental DNA, the replisome dissociates and the replication fork structure is lost. This outcome is referred to as replication fork "collapse." Collapsed forks can be highly cytotoxic and mutagenic if not appropriately repaired by the cell. However, the events that occur during and after replication fork collapse are unclear. Here, we describe an in vitro system to induce site specific, strand specific replication fork collapse using Xenopus egg extracts, which contain the full set of DNA replication and repair enzymes. We also describe simple assays to monitor the stability of DNA nicks and the different structures formed during replication fork collapse. This methodology permits detailed mechanistic analysis of collapsed forks in vitro.


Assuntos
Reparo do DNA , Replicação do DNA , Animais , DNA , Quebras de DNA de Cadeia Dupla , Xenopus laevis/genética
19.
Cell Rep ; 29(2): 422-436.e5, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31597101

RESUMO

Termination of DNA replication occurs when two replication forks converge upon the same stretch of DNA. Resolution of topological stress by topoisomerases is crucial for fork convergence in bacteria and viruses, but it is unclear whether similar mechanisms operate during vertebrate termination. Using Xenopus egg extracts, we show that topoisomerase II (Top2) resolves topological stress to prevent converging forks from stalling during termination. Under these conditions, stalling arises due to an inability to unwind the final stretch of DNA ahead of each fork. By promoting fork convergence, Top2 facilitates all downstream events of termination. Converging forks ultimately overcome stalling independently of Top2, indicating that additional mechanisms support fork convergence. Top2 acts throughout replication to prevent the accumulation of topological stress that would otherwise stall converging forks. Thus, termination poses evolutionarily conserved topological problems that can be mitigated by careful execution of the earlier stages of replication.


Assuntos
Replicação do DNA , DNA Topoisomerases Tipo II/metabolismo , Xenopus/metabolismo , Animais , DNA/metabolismo , DNA Polimerase Dirigida por DNA/metabolismo , Feminino , Humanos , Masculino , Modelos Biológicos , Complexos Multienzimáticos/metabolismo , Ligação Proteica
20.
Cardiovasc Revasc Med ; 19(6S): 12-15, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29804796

RESUMO

BACKGROUND: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with a high risk of angiographic complication, incomplete stent expansion, and restenosis. The prevalence of calcification is increased in diabetics (DM) and the PCI outcome in this population is often suboptimal. Treatment with orbital atherectomy (OA) in severely calcified lesions has been shown to result in favorable procedural outcomes and low reintervention rates; in DM and non-DM. We sought to determine the acute safety of OA in a center without on-site surgical backup in DM and non-DM. METHODS: All comers treated with OA at Sanford Bemidji Heart and Vascular Center (Bemidji, MN) from 8/30/16 to 4/14/17 were included in this retrospective analysis. Baseline, procedure, and acute outcome data were compared in DM and non-DM patients. RESULTS: Of the 70 patients treated with OA, 40% were DM. History of hypertension and chronic renal disease were more prevalent in the DM group. Successful stent delivery occurred in 96.4% of DM and 100% in non-DM, respectively. None of the patients treated with OA died or experienced abrupt closure, severe dissection, embolization, or no reflow. The overall perforation and slow flow rates were 1.4%. One non-DM patient had a non-target vessel MI due to side branch closure. CONCLUSIONS: Our study demonstrates the safety of OA in a center without on-site surgical backup. In this study, OA treatment resulted in a high rate of successful stent delivery and low rates of angiographic complications and acute MACE, in DM and non-DM patients. SUMMARY: In this retrospective study we sought to determine the acute safety of coronary orbital atherectomy treatment in a center without on-site surgical backup in diabetic and non-diabetic patients. None of the patients treated with orbital atherectomy died or experienced abrupt closure, severe dissection, embolization, or no reflow; the overall perforation and slow flow rates were 1.4% and one non-diabetic patient had a non-target vessel myocardial infarction due to side branch closure. Our study demonstrates the safety of orbital atherectomy in a center without on-site surgical backup; orbital atherectomy treatment resulted in a high rate of successful stent delivery and low rates of angiographic complications and acute major adverse cardiac events in diabetic and non-diabetic patients.


Assuntos
Aterectomia Coronária , Doença da Artéria Coronariana/cirurgia , Angiopatias Diabéticas/terapia , Calcificação Vascular/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aterectomia Coronária/efeitos adversos , Comorbidade , Doença da Artéria Coronariana/diagnóstico por imagem , Angiopatias Diabéticas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem
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