ABSTRACT
Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency characterized by low immunoglobulin (Ig)G and IgA, and/or IgM. In addition to bacterial infections, a large subgroup has noninfectious inflammatory and autoimmune complications. We performed 16S ribosomal RNA-based profiling of stool samples in 44 CVID patients, 45 patients with inflammatory bowel disease (disease controls), and 263 healthy controls. We measured plasma lipopolysaccharide (LPS) and markers of immune cell activation (i.e., soluble (s) CD14 and sCD25) in an expanded cohort of 104 patients with CVID and in 30 healthy controls. We found a large shift in the microbiota of CVID patients characterized by a reduced within-individual bacterial diversity (alpha diversity, P<0.001) without obvious associations to antibiotics use. Plasma levels of both LPS (P=0.001) and sCD25 (P<0.0001) were elevated in CVID, correlating negatively with alpha diversity and positively with a dysbiosis index calculated from the taxonomic profile. Low alpha diversity and high dysbiosis index, LPS, and immune markers were most pronounced in the subgroup with inflammatory and autoimmune complications. Low level of IgA was associated with decreased alpha diversity, but not independently from sCD25 and LPS. Our findings suggest a link between immunodeficiency, systemic immune activation, LPS, and altered gut microbiota.
Subject(s)
Common Variable Immunodeficiency/immunology , Common Variable Immunodeficiency/microbiology , Dysbiosis/immunology , Gastrointestinal Microbiome/immunology , Lipopolysaccharides/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Biodiversity , Biomarkers , Case-Control Studies , Female , Humans , Immunoglobulin A/immunology , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/microbiology , Interleukin-2 Receptor alpha Subunit/metabolism , Lymphocyte Activation/immunology , Male , Middle Aged , T-Lymphocytes/immunology , T-Lymphocytes/metabolism , Young AdultSubject(s)
Apoptosis , Heart Failure/pathology , Nucleosomes/pathology , Female , Humans , Male , PrognosisABSTRACT
OBJECTIVES: Recent metabolomic, experimental and clinical studies have demonstrated that trimethylamine-N-oxide (TMAO), a microbiota-dependent metabolite from dietary phosphatidylcholine and carnitine, is a strong predictor of coronary artery disease (CAD). This finding suggests a link between the gut microbiota and atherosclerosis. The potential impact of TMAO in chronic heart failure (HF) is unknown. We hypothesized that TMAO levels would provide prognostic information about adverse outcomes in chronic HF. DESIGN: Prospective, observational study including 155 consecutive patients with chronic HF. In addition, 100 patients with stable CAD without HF and 33 matched healthy individuals were included as controls. Plasma levels of TMAO and its precursors choline and betaine were measured, and associations with symptoms, aetiology and transplant-free survival in the patients with HF were explored. RESULTS: Plasma levels of TMAO (P = 0.01), choline (P < 0.001) and betaine (P < 0.001) were elevated in patients with chronic HF compared to control subjects, with the highest levels in patients with New York Heart Association (NYHA) classes III and IV. Furthermore, TMAO levels were highest in individuals with ischaemic HF, followed by those with stable CAD and nonischaemic HF. TMAO, but not choline or betaine, was associated with reduced transplant-free survival: approximately 50% of patients in the upper tertile of TMAO levels died or received a heart transplant during 5.2 years of follow-up (unadjusted Cox-regression: hazard ratio 2.24, 95% confidence interval 1.28-3.92, P = 0.005). CONCLUSIONS: TMAO levels were elevated in patients with HF and associated with NYHA class, ischaemic aetiology and adverse outcomes. Future studies should focus on gut microbiota, dietary composition and intestinal dysfunction in relation to TMAO levels and clinical outcome in HF.
Subject(s)
Betaine/blood , Choline/blood , Heart Failure/diagnosis , Intestines/microbiology , Lipotropic Agents/blood , Methylamines/blood , Microbiota , Oxidants/blood , Aged , Biomarkers/blood , Chronic Disease , Female , Heart Failure/blood , Heart Failure/metabolism , Heart Failure/mortality , Humans , Intestinal Mucosa/metabolism , Male , Middle Aged , Predictive Value of Tests , Prognosis , Prospective Studies , Risk Assessment , Risk Factors , Sensitivity and Specificity , Severity of Illness Index , Survival AnalysisABSTRACT
BACKGROUND AND PURPOSE: Levosimendan is known as a calcium sensitizer, although it is also known to inhibit PDE3. We aimed to isolate each component and estimate their contribution to the increased cardiac contractility induced by levosimendan. EXPERIMENTAL APPROACH: Contractile force was measured in electrically stimulated ventricular strips from explanted failing human hearts and left ventricular strips from normal male Wistar rats. PDE activity was measured in a two-step PDE activity assay on failing human ventricle. KEY RESULTS: Levosimendan exerted a positive inotropic effect (PIE) reaching maximum at 10(-5) M in ventricular strips from failing human hearts. In the presence of the selective PDE3 inhibitor cilostamide, the PIE of levosimendan was abolished. During treatment with a PDE4 inhibitor and a supra-threshold concentration of isoprenaline, levosimendan generated an amplified inotropic response. This effect was reversed by ß-adrenoceptor blockade and undetectable in strips pretreated with cilostamide. Levosimendan (10(-6) M) increased the potency of ß-adrenoceptor agonists by 0.5 log units in failing human myocardium, but not in the presence of cilostamide. Every inotropic response to levosimendan was associated with a lusitropic response. Levosimendan did not affect the concentration-response curve to calcium in rat ventricular strips, in contrast to the effects of a known calcium sensitizer, EMD57033 [5-(1-(3,4-dimethoxybenzoyl)-1,2,3,4-tetrahydroquinolin-6-yl)-6-methyl-3,6-dihydro-2H-1,3,4-thiadiazin-2-one]. PDE activity assays confirmed that levosimendan inhibited PDE3 as effectively as cilostamide. CONCLUSIONS AND IMPLICATIONS: Our results indicate that the PDE3-inhibitory property of levosimendan was enough to account for its inotropic effect, leaving a minor, if any, effect to a calcium-sensitizing component.
Subject(s)
Cardiotonic Agents/pharmacology , Heart Failure/physiopathology , Hydrazones/pharmacology , Phosphodiesterase 3 Inhibitors/pharmacology , Pyridazines/pharmacology , Adrenergic beta-Agonists/pharmacology , Animals , Calcium/physiology , Heart/physiopathology , Humans , In Vitro Techniques , Isoproterenol/pharmacology , Male , Milrinone/pharmacology , Myocardial Contraction/drug effects , Phosphodiesterase 4 Inhibitors/pharmacology , Quinolines/pharmacology , Quinolones/pharmacology , Rats, Wistar , Rolipram/pharmacology , Simendan , Thiadiazines/pharmacologyABSTRACT
OBJECTIVES: Experimental studies have shown involvement of Wnt signalling in heart failure (HF). We hypothesized that secreted frizzled-related protein 3 (sFRP3), a modulator of Wnt signalling, is related to the progression of HF. DESIGN: Circulating sFRP3 was measured in 153 HF patients and compared with 25 healthy controls. The association of sFRP3 with mortality was evaluated in 1202 patients (GISSI-HF trial). sFRP3 mRNA expression was assessed in failing human and murine left ventricles (LV), and cellular localization was determined after fractioning of myocardial tissue. In vitro studies were carried out in cardiac fibroblasts subjected to cyclic mechanical stretch. RESULTS: (i) Heart failure patients had significantly raised serum sFRP3 levels compared with controls, (ii) during a median follow-up of 47 months, 315 patients died in the GISSI-HF substudy. In univariable Cox regression, tertiles of baseline sFRP3 concentration were significantly associated with all-cause and cardiovascular mortality. After adjustment for demographic and clinical variables, but not for CRP and NT-proBNP, the associations with mortality remained significant for the third tertile (all-cause, HR 1.45, P = 0.011; cardiovascular, HR 1.66, P = 0.003), (iii) sFRP3 mRNA expression was increased in failing human LV, with a decline following LV assist device therapy. LV from post-MI mice showed an increased sFRP3 mRNA level, particularly in cardiac fibroblasts, and (iv) mechanical stretch enhanced sFRP3 expression and release in myocardial fibroblasts. CONCLUSION: There is an association between increased sFRP3 expression and adverse outcome in HF, suggesting that the failing myocardium itself contributes to an increase in circulating sFRP3.
Subject(s)
Disease Models, Animal , Heart Failure , Myocardial Infarction/metabolism , Proteins , Aged , Animals , Disease Progression , Female , Gene Expression Regulation , Heart Failure/etiology , Heart Failure/genetics , Heart Failure/metabolism , Heart Failure/mortality , Heart Failure/pathology , Heart Failure/physiopathology , Humans , Kaplan-Meier Estimate , Male , Mice , Mice, Inbred C57BL , Middle Aged , Myocardium/metabolism , Myocardium/pathology , Patient Acuity , Proportional Hazards Models , Proteins/genetics , Proteins/metabolism , Ventricular Dysfunction, Left/metabolism , Ventricular Dysfunction, Left/pathology , Ventricular Dysfunction, Left/physiopathology , Wnt Signaling Pathway/geneticsABSTRACT
OBJECTIVES: To examine the prognostic value of osteoprotegerin (OPG) levels in relation to all-cause mortality in patients with symptomatic severe aortic stenosis (AS). DESIGN: We measured plasma OPG levels in 136 patients with symptomatic severe AS and investigated associations with transvalvular gradients, valve area, valve calcification (using ultrasonic backscatter analysis as an estimate) and measures of heart failure. Then, we assessed the prognostic value of elevated plasma OPG in determining all-cause mortality (n = 29) in these patients. RESULTS: Elevated OPG was poorly correlated with the degree of AS but was associated with increased backscatter measurements and impaired cardiac function. Furthermore, OPG was associated with all-cause mortality in patients with symptomatic AS, even after adjustment for conventional risk markers. The strongest association was obtained by using a combination of high levels of both OPG and N-terminal pro-brain natriuretic peptide (NT-proBNP), suggesting that these markers may reflect distinct pathways in the development and progression of AS. CONCLUSION: The level of circulating OPG is significantly associated with all-cause mortality alone and in combination with NT-proBNP in patients with severe symptomatic AS.
Subject(s)
Aortic Valve Stenosis/blood , Aortic Valve Stenosis/mortality , Osteoprotegerin/blood , Aged , Aged, 80 and over , Biomarkers/blood , Female , Humans , Logistic Models , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Norway , Peptide Fragments/blood , Predictive Value of TestsABSTRACT
OBJECTIVES: Free fatty acids (FFAs) are the major energy sources of the heart, and fatty acids (FAs) are active components of biological membranes. Data indicate that levels of FAs and their composition may influence myocardial function and inflammation. The aim of this study was to investigate whether total levels and composition of FAs and FFAs in plasma are altered in clinical heart failure (HF) and whether any alterations in these parameters are correlated with the severity of HF. SUBJECTS: Plasma from 183 patients with stable HF was compared with plasma from 44 healthy control subjects. RESULTS: Our main findings are as follows: (i) patients with HF had decreased levels of several lipid parameters and increased levels of FFAs in plasma, compared with controls, which were significantly correlated with clinical disease severity. (ii) Patients with HF also had a decreased proportion in the plasma of several n-3 polyunsaturated FAs, an increased proportion of several monounsaturated FAs, and a decreased proportion of some readily oxidized long-chain saturated FAs. (iii) These changes in FA composition were significantly associated with functional class, impaired cardiac function (i.e., decreased cardiac index and increased plasma N-terminal pro-B-type natriuretic peptide levels) and enhanced systemic inflammation (i.e., increased high-sensitivity C-reactive protein levels). (iv) Low levels of C20:4n-3 (eicosatetraenoic acid) and in particular high levels of C18:1n-7 (vaccenic acid) were significantly associated with total mortality in this HF population. CONCLUSIONS: Our data demonstrate that patients with HF are characterized by a certain FA phenotype and may support a link between disturbed FA composition and the progression of HF.
Subject(s)
Arachidonic Acids/blood , Heart Failure/blood , Heart Failure/mortality , Inflammation/blood , Oleic Acids/blood , Adult , Aged , Biomarkers/blood , C-Reactive Protein/metabolism , Chronic Disease , Confounding Factors, Epidemiologic , Disease Progression , Fatty Acids, Unsaturated/blood , Female , Heart Failure/physiopathology , Humans , Inflammation/physiopathology , Kaplan-Meier Estimate , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Predictive Value of Tests , Severity of Illness IndexABSTRACT
OBJECTIVE: Matrix Gla protein (MGP) is a calcification inhibitor and alterations in circulating MGP have been observed in different populations characterized by vascular calcification. We hypothesized that patients with calcific valvular aortic stenosis (AS) would have dysregulated circulating MGP levels. DESIGN AND SUBJECTS: We examined plasma levels of nonphosphorylated carboxylated and undercarboxylated MGP (dp-cMGP and dp-ucMGP, respectively) in 147 patients with symptomatic severe AS and in matched healthy controls. MAIN OUTCOME MEASURES: We further investigated the relationship between MGP levels and aortic pressure gradients and valve area by echocardiography and measures of heart failure. Finally, we assessed the prognostic value of elevated plasma dp-ucMGP level in relation to all-cause mortality in patients with AS. RESULTS: We found markedly enhanced plasma levels of dp-cMGP and in particular of dp-ucMGP in patients with symptomatic AS. Although only weak correlations were found with the degree of AS, circulating dp-ucMGP was associated with cardiac function and long-term mortality in multivariate analysis. CONCLUSIONS: A dysregulated MGP system may have a role in the development of left ventricular dysfunction in patients with symptomatic AS.
Subject(s)
Aortic Valve Stenosis/blood , Aortic Valve Stenosis/mortality , Calcium-Binding Proteins/metabolism , Extracellular Matrix Proteins/blood , Heart Failure/blood , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Aorta/diagnostic imaging , Aorta/pathology , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Aortic Valve Stenosis/drug therapy , Biomarkers/blood , Blood Pressure/physiology , Calcinosis/blood , Calcinosis/mortality , Calcium-Binding Proteins/blood , Cause of Death , Echocardiography , Female , Humans , Male , Middle Aged , Prognosis , Warfarin/therapeutic use , Matrix Gla ProteinABSTRACT
BACKGROUND AND PURPOSE: The left ventricle in failing hearts becomes sensitive to 5-HT parallelled by appearance of functional G(s)-coupled 5-HT(4) receptors. Here, we have explored the regulatory functions of phosphodiesterases in the 5-HT(4) receptor-mediated functional effects in ventricular muscle from failing rat and human heart. EXPERIMENTAL APPROACH: Extensive myocardial infarctions were induced by coronary artery ligation in Wistar rats. Contractility was measured in left ventricular papillary muscles of rat, 6 weeks after surgery and in left ventricular trabeculae from explanted human hearts. cAMP was quantified by RIA. KEY RESULTS: In papillary muscles from postinfarction rat hearts, 5-HT(4) stimulation exerted positive inotropic and lusitropic effects and increased cAMP. The inotropic effect was increased by non-selective PDE inhibition (IBMX, 10 microM) and selective inhibition of PDE3 (cilostamide, 1 microM), but not of PDE2 (EHNA, 10 microM) or PDE4 (rolipram, 10 microM). Combined PDE3 and PDE4 inhibition enhanced inotropic responses beyond the effect of PDE3 inhibition alone, increased the sensitivity to 5-HT, and also revealed an inotropic response in control (sham-operated) rat ventricle. Lusitropic effects were increased only during combined PDE inhibition. In failing human ventricle, the 5-HT(4) receptor-mediated positive inotropic response was regulated by PDEs in a manner similar to that in postinfarction rat hearts. CONCLUSIONS AND IMPLICATIONS: 5-HT(4) receptor-mediated positive inotropic responses in failing rat ventricle were cAMP-dependent. PDE3 was the main PDE regulating this response and involvement of PDE4 was disclosed by concomitant inhibition of PDE3 in both postinfarction rat and failing human hearts. 5-HT, PDE3 and PDE4 may have pathophysiological functions in heart failure.
Subject(s)
Cyclic Nucleotide Phosphodiesterases, Type 3/metabolism , Cyclic Nucleotide Phosphodiesterases, Type 4/metabolism , Heart Failure/physiopathology , Receptors, Serotonin, 5-HT4/metabolism , Animals , Coronary Vessels/surgery , Cyclic AMP/metabolism , Heart Ventricles/physiopathology , Humans , Ligation , Male , Middle Aged , Myocardial Contraction/drug effects , Myocardial Infarction/physiopathology , Phosphodiesterase 3 Inhibitors , Phosphodiesterase 4 Inhibitors , Radioimmunoassay , Rats , Rats, WistarABSTRACT
Acetabular fractures, although relatively rare, are often serious injuries requiring complex treatment. Major associated injuries are common and the mortality rate continues to approach 20% (8). We retrospectively evaluated 38 acetabular fractures. Twenty-six fractures were treated operatively, with adequate followup available for 23. Anatomic reduction or reduction to within 3 mm was achieved operatively in 21 (81%). The average Harris hip score was 90. The five poorly reduced fractures had an average Harris hip score of 54. Twelve patients were treated nonoperatively with adequate followup available for nine. Six patients with nondisplaced or minimally displaced fracture treated nonoperatively had an average hip score of 96. Six patients had displaced fractures which failed to reduce with nonoperative treatment. Their average hip score was 59. This study reaffirms the importance of adequate fracture reduction in the treatment of acetabular injuries.