Obstructive sleep apnea and acute coronary syndromes: etiology, risk, and management.

Obstructive sleep apnea (OSA) is characterized by upper airway collapse and airflow reduction despite respiratory effort, resulting in intermittent hypoxia and arousals, leading to a cascade of hemodynamic, autonomic, inflammatory, and metabolic effects, responsible for its adverse cardiovascular effect. OSA is an independent risk factor for cardiovascular disease, and its prevalence in patients presenting with acute coronary syndromes is up to 69%. Furthermore, OSA has been associated with increased risk of adverse events after an acute coronary syndrome. Continuous positive airway pressure is considered the mainstay of treatment of OSA and has been shown to reduce the risk of cardiovascular events. However, the proper time to start treatment in the acute setting is unknown. A prospective randomized clinical trial is currently underway to answer this question.

Link between automated coronary calcium volumes from intravascular ultrasound to automated carotid IMT from B-mode ultrasound in coronary artery disease population.

AIM: Establishing relationship between coronary calcium volumes from Intravascular Ultrasound (IVUS) and automated carotid intima-media thickness (cIMT) helps in understanding the genetic nature of atherosclerosis disease. In this research, we have quantified the detected calcium from IVUS video frames and associated a relationship between coronary calcium volumes computed and automated cIMT from B-mode ultrasound. METHODS: Coronary calcium volume is computed from IVUS and auto cIMTs are computed using B-mode ultrasound. An automated computer based application is developed and tested on 100 patient volumes (an average of 2549 frames per volume) to calculate lesion area and normalized coronary calcium volume. We use an integrated approach for volume computation which is based on lesion area per frame. We have measured the normalized volume from the calcium detected video frames using proposed integration method. The cIMT of 100 carotids were measured with novel and dedicated automated software analysis (AtheroEdge™ from AtheroPoint™ LLC, Roseville, CA, USA). RESULTS: The computer-based coronary calcium volume (from IVUS) showed a correlation coefficient with respect to cIMT for left and right carotids as 9.1% and 13.9%, respectively. CONCLUSION: Coronary calcium volume computed from IVUS and auto cIMT are moderately correlated. The association between auto cIMT (right side) vs. computer-based coronary calcium volume (IVUS) is stronger than the association between auto cIMT (left side) vs. computer-based coronary calcium volume.

Nerve growth factor acts through the TrkA receptor to protect sensory neurons from the damaging effects of the HIV-1 viral protein, Vpr.

Distal sensory polyneuropathy (DSP) with associated neuropathic pain is the most common neurological disorder affecting patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Viral protein R (Vpr) is a neurotoxic protein encoded by HIV-1 and secreted by infected macrophages. Vpr reduces neuronal viability, increases cytosolic calcium and membrane excitability of cultured dorsal root ganglion (DRG) sensory neurons, and is associated with mechanical allodynia in vivo. A clinical trial with HIV/AIDS patients demonstrated that nerve growth factor (NGF) reduced the severity of DSP-associated neuropathic pain, a problem linked to damage to small diameter, potentially NGF-responsive fibers. Herein, the actions of NGF were investigated in our Vpr model of DSP and we demonstrated that NGF significantly protected sensory neurons from the effects of Vpr. Footpads of immunodeficient Vpr transgenic (vpr/RAG1(-/-)) mice displayed allodynia (p<0.05), diminished epidermalinnervation (p<0.01) and reduced NGF mRNA expression (p<0.001) compared to immunodeficient (wildtype/RAG1(-/-)) littermate control mice. Compartmented cultures confirmed recombinant Vpr exposure to the DRG neuronal perikarya decreased distal neurite extension (p<0.01), whereas NGF exposure at these distal axons protected the DRG neurons from the Vpr-induced effect on their cell bodies. NGF prevented Vpr-induced attenuation of the phosphorylated glycogen synthase-3 axon extension pathway and tropomyosin-related kinase A (TrkA) receptor expression in DRG neurons (p<0.05) and it directly counteracted the cytosolic calcium burst caused by Vpr exposure to DRG neurons (p<0.01). TrkA receptor agonist indicated that NGFacted through the TrkA receptor to block the Vpr-mediated decrease in axon outgrowth in neonatal and adult rat and fetal human DRG neurons (p<0.05). Similarly, inhibiting the lower affinity NGF receptor, p75, blocked Vpr's effect on DRG neurons. Overall, NGF/TrkA signaling or p75 receptor inhibition protects somatic sensory neurons exposed to Vpr, thus laying the groundwork for potential therapeutic options for HIV/AIDS patients suffering from DSP.

Molecular cloning, pharmacological characterization, and histochemical distribution of frog vasotocin and mesotocin receptors.

The neurohypophysial nonapeptides vasotocin (VT) and mesotocin (MT) are the amphibian counterparts of arginine vasopressin (AVP) and oxytocin (OT). We have here reported the cloning and functional characterization of the receptors for vasotocin (VTR) and mesotocin (MTR) in two species of frog, Rana catesbeiana and Rana esculenta. The frog VTR and MTR cDNAs encode proteins of 419 and 384 amino acids respectively. Frog VTR exhibits a high degree of sequence identity with the mammalian AVP-1a (V1a) receptor while the frog MTR possesses a high degree of sequence identity with the mammalian OT receptor. Activation of VTR induced both c-fos promoter- and cAMP-responsive element (CRE)-driven transcriptional activities, while activation of MTR induced c-fos promoter-driven transcriptional activity but failed to evoke CRE-driven transcriptional activity, suggesting differential G protein coupling between VTR and MTR. The VTR exhibited the highest sensitivity for VT followed by OT>AVP approximately MT, whereas the MTR showed preferential ligand sensitivity for MT>OT>VT>AVP. A V1a agonist but not V2 and OT agonists substantially activated both VTR and MTR with a similar sensitivity. V1a, V2 and OT antagonists inhibited MT-induced MTR activation but not VT-induced VTR activation. In the frog brain, VTR and MTR mRNAs were found to be widely expressed in the telencephalon, diencephalon and mesencephalon, and exhibited very similar regional distribution. In the pituitary, VTR and MTR were expressed in the distal and intermediate lobes but were virtually absent in the neural lobe. Taken together, these data indicated that, although the distribution of VTR and MTR largely overlaps in the frog brain and pituitary, VT and MT may play distinct activities owing to the ligand selectivity and different signaling pathways activated by their receptors.