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1.
Biol Lett ; 12(2): 20151057, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26911343

RESUMO

Sea urchins are noted for the absence of neoplastic disease and represent a novel model to investigate cellular and systemic cancer protection mechanisms. Following intracoelomic injection of the DNA alkylating agent methyl methanesulfonate, DNA damage was detected in sea urchin cells and tissues (coelomocytes, muscle, oesophagus, ampullae and gonad) by the alkaline unwinding, fast micromethod. Gene expression analyses of the coelomocytes indicated upregulation of innate immune markers, including genes involved in NF-κB signalling. Results suggest that activation of the innate immune system following DNA damage may contribute to the naturally occurring resistance to neoplastic disease observed in sea urchins.


Assuntos
Dano ao DNA , Expressão Gênica/efeitos dos fármacos , Lytechinus/efeitos dos fármacos , Metanossulfonato de Metila/toxicidade , Mutagênicos/toxicidade , Animais , Sistema Imunitário/efeitos dos fármacos , Lytechinus/genética
2.
Exp Gerontol ; 44(8): 477-84, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19454313

RESUMO

The oceans are home to many of the earth's longest lived animals with several species of non-colonial marine invertebrates documented to live for more than 100 years. Many of these animals grow and reproduce throughout their lifespans and there is no apparent functional decline or increase in mortality rate with age. Studying these animals may reveal some exceptionally effective defenses against the destructive process of aging thus providing a valuable alternative model for aging research. The life histories of commercially important marine invertebrates are well studied, but little is known of the molecular or cellular changes that occur with increasing age or the factors that determine lifespan. The objectives of this review are to present data on cellular and molecular aspects of aging in marine invertebrates with a focus on bivalves and sea urchins. This review will serve to evaluate their potential as model systems for aging and provide direction for future research efforts so that we can begin to understand the underlying molecular mechanisms responsible for the tremendous longevity and good health of key species.


Assuntos
Envelhecimento/fisiologia , Pesquisa Biomédica , Invertebrados/fisiologia , Modelos Animais , Animais , Pesquisa Biomédica/métodos , Bivalves , Longevidade , Reprodução/fisiologia
3.
Nat Genet ; 21(1): 111-4, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9916802

RESUMO

Expression of the human telomerase catalytic component, hTERT, in normal human somatic cells can reconstitute telomerase activity and extend their replicative lifespan. We report here that at twice the normal number of population doublings, telomerase-expressing human skin fibroblasts (BJ-hTERT) and retinal pigment epithelial cells (RPE-hTERT) retain normal growth control in response to serum deprivation, high cell density, G1 or G2 phase blockers and spindle inhibitors. In addition, we observed no cell growth in soft agar and detected no tumour formation in vivo. Thus, we find that telomerase expression in normal cells does not appear to induce changes associated with a malignant phenotype.


Assuntos
Transformação Celular Neoplásica , Biossíntese de Proteínas , RNA , Telomerase/biossíntese , Ácido Aspártico/análogos & derivados , Ácido Aspártico/farmacologia , Linhagem Celular , Linhagem Celular Transformada , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Proteínas de Ligação a DNA , Inibidores Enzimáticos/farmacologia , Humanos , Hidroxiureia/farmacologia , Inibidores da Síntese de Ácido Nucleico/farmacologia , Fenótipo , Ácido Fosfonoacéticos/análogos & derivados , Ácido Fosfonoacéticos/farmacologia , Fosforilação , Proteínas/genética , Proteína do Retinoblastoma/metabolismo , Telomerase/genética , Células Tumorais Cultivadas
4.
Science ; 279(5349): 349-52, 1998 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-9454332

RESUMO

Normal human cells undergo a finite number of cell divisions and ultimately enter a nondividing state called replicative senescence. It has been proposed that telomere shortening is the molecular clock that triggers senescence. To test this hypothesis, two telomerase-negative normal human cell types, retinal pigment epithelial cells and foreskin fibroblasts, were transfected with vectors encoding the human telomerase catalytic subunit. In contrast to telomerase-negative control clones, which exhibited telomere shortening and senescence, telomerase-expressing clones had elongated telomeres, divided vigorously, and showed reduced straining for beta-galactosidase, a biomarker for senescence. Notably, the telomerase-expressing clones have a normal karyotype and have already exceeded their normal life-span by at least 20 doublings, thus establishing a causal relationship between telomere shortening and in vitro cellular senescence. The ability to maintain normal human cells in a phenotypically youthful state could have important applications in research and medicine.


Assuntos
Divisão Celular , Senescência Celular , Proteínas/metabolismo , RNA , Telomerase/metabolismo , Telômero/fisiologia , Biomarcadores , Catálise , Linhagem Celular , Transformação Celular Neoplásica , Clonagem Molecular , Proteínas de Ligação a DNA , Fibroblastos/citologia , Homeostase , Humanos , Cariotipagem , Fenótipo , Epitélio Pigmentado Ocular/citologia , Proteínas/genética , DNA Polimerase Dirigida por RNA/genética , DNA Polimerase Dirigida por RNA/metabolismo , Células-Tronco/citologia , Células-Tronco/enzimologia , Telomerase/genética , Telômero/metabolismo , Telômero/ultraestrutura , Transfecção , Células Tumorais Cultivadas , beta-Galactosidase/metabolismo
5.
Nat Genet ; 17(4): 498-502, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9398860

RESUMO

The maintenance of chromosome termini, or telomeres, requires the action of the enzyme telomerase, as conventional DNA polymerases cannot fully replicate the ends of linear molecules. Telomerase is expressed and telomere length is maintained in human germ cells and the great majority of primary human tumours. However, telomerase is not detectable in most normal somatic cells; this corresponds to the gradual telomere loss observed with each cell division. It has been proposed that telomere erosion eventually signals entry into senescence or cell crisis and that activation of telomerase is usually required for immortal cell proliferation. In addition to the human telomerase RNA component (hTR; ref. 11), TR1/TLP1 (refs 12, 13), a protein that is homologous to the p80 protein associated with the Tetrahymena enzyme, has been identified in humans. More recently, the human telomerase reverse transcriptase (hTRT; refs 15, 16), which is homologous to the reverse transcriptase (RT)-like proteins associated with the Euplotes aediculatus (Ea_p123), Saccharomyces cerevisiae (Est2p) and Schizosaccharomyces pombe (5pTrt1) telomerases, has been reported to be a telomerase protein subunit. A catalytic function has been demonstrated for Est2p in the RT-like class but not for p80 or its homologues. We now report that in vitro transcription and translation of hTRT when co-synthesized or mixed with hTR reconstitutes telomerase activity that exhibits enzymatic properties like those of the native enzyme. Single amino-acid changes in conserved telomerase-specific and RT motifs reduce or abolish activity, providing direct evidence that hTRT is the catalytic protein component of telomerase. Normal human diploid cells transiently expressing hTRT possessed telomerase activity, demonstrating that hTRT is the limiting component necessary for restoration of telomerase activity in these cells. The ability to reconstitute telomerase permits further analysis of its biochemical and biological roles in cell aging and carcinogenesis.


Assuntos
DNA Polimerase Dirigida por RNA/genética , DNA Polimerase Dirigida por RNA/metabolismo , RNA/metabolismo , Telomerase/genética , Sequência de Aminoácidos , Animais , Catálise , Humanos , Dados de Sequência Molecular , Mutagênese Sítio-Dirigida , RNA/biossíntese , RNA/genética , DNA Polimerase Dirigida por RNA/biossíntese , Coelhos , Alinhamento de Sequência , Moldes Genéticos
6.
Hum Mol Genet ; 6(6): 935-42, 1997 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9175742

RESUMO

Depletion of mitochondrial DNA (mtDNA) appears to be an important cause of mitochondrial dysfunction in neonates and infants. We have identified another child in whom depletion of mtDNA was demonstrated in liver and serial skeletal muscle biopsies. A primary myoblast culture from the patient initially showed normal levels of mtDNA, but there was a progressive loss of mtDNA in later cell passages and clonal myoblast cell cultures, similar to that observed in the skeletal muscle tissue of the patient. Thus, these clonal myoblast cultures provide an in vitro model of the in vivo mtDNA dynamics. The levels of mitochondrial mRNAs for subunits I and II of cytochrome c oxidase declined with declining mtDNA levels, but the fall in mitochondrial transcript levels lagged behind that of the mtDNA levels. Levels of cytochrome c oxidase subunit I and II polypeptides, however, declined ahead of declining mtDNA levels. Immunocytochemistry showed that between individual cells of the clonal myoblast cultures, the expression of the mitochondrially encoded subunit I of cytochrome c oxidase was heterogeneous, suggesting variable levels of mtDNA. Transfer of patient mitochondria with residual mtDNA levels to control cells devoid of mtDNA (rho0 cells) led to restoration of mtDNA levels and, hence, suggests a nuclear involvement in the depletion.


Assuntos
DNA Mitocondrial , Complexo IV da Cadeia de Transporte de Elétrons/genética , Núcleo Celular , Células Cultivadas , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Técnica Indireta de Fluorescência para Anticorpo , Teste de Complementação Genética , Humanos , Lactente , Masculino , Síndrome
7.
Exp Cell Res ; 228(1): 58-64, 1996 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-8892971

RESUMO

The progressive shortening of the ends of chromosomes (telomeres) during cell division may serve as a mitotic clock for replicative senescence. Telomerase, a ribonucleoprotein which synthesizes telomeric DNA and maintains telomere length, is absent from most normal somatic cells but is expressed in immortal cells. Low levels of telomerase activity have been detected in peripheral blood mononuclear cells (PBMC) and hematopoietic cells and an increase in telomerase activity during T cell activation has recently been reported. In this study, we show that the increase in telomerase activity during T cell activation was transient and did not prevent the loss of telomeres in long-term T cell cultures. Analysis of the mechanism of telomerase induction showed that the increase in telomerase activity was accompanied by an increase in the levels of hTR, the RNA component of human telomerase. Moreover, telomerase induction occurred in the presence of aphidicolin, indicating that DNA synthesis was not required. Increased telomerase expression was observed when PBMC were activated with phorbol myristate acetate (PMA) and ionomycin, indicating that it was independent of early transmembrane signals. It was, however, linked to the T cell signal transduction pathway, as inhibiting protein kinase C with bisindolylmaleimide prevented the increase in telomerase activity.


Assuntos
Ativação Linfocitária/fisiologia , Linfócitos T/enzimologia , Linfócitos T/imunologia , Telomerase/biossíntese , Adulto , Afidicolina/farmacologia , Sequência de Bases , DNA/biossíntese , Primers do DNA/genética , Indução Enzimática/efeitos dos fármacos , Inibidores Enzimáticos/farmacologia , Humanos , Técnicas In Vitro , Indóis/farmacologia , Ionomicina/farmacologia , Ionóforos/farmacologia , Ativação Linfocitária/efeitos dos fármacos , Maleimidas/farmacologia , Pessoa de Meia-Idade , Inibidores da Síntese de Ácido Nucleico/farmacologia , Reação em Cadeia da Polimerase , Proteína Quinase C/antagonistas & inibidores , Transdução de Sinais , Linfócitos T/efeitos dos fármacos , Telomerase/genética , Acetato de Tetradecanoilforbol/farmacologia
8.
Biochem J ; 305 ( Pt 3): 817-22, 1995 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-7848281

RESUMO

We have characterized cultured skin fibroblasts from two siblings affected with a fatal mitochondrial disease caused by a nuclear genetic defect. Mitochondrial respiratory-chain function was severely decreased in these cells. Southern-blot analysis showed that the fibroblasts had reduced levels of mitochondrial DNA (mtDNA). The mtDNA was unstable and was eliminated from the cultured cells over many generations, generating the rho0 genotype. As the mtDNA level decreased, the cells became more dependent upon pyruvate and uridine for growth. Nuclear-encoded subunits of respiratory-chain complexes were synthesized and imported into the mitochondria of the mtDNA-depleted cells, albeit at reduced levels compared with the controls. Mitochondrial protein synthesis directed by the residual mtDNA indicated that the mtDNA was expressed and that the defect specifically involves the replication or maintenance of mtDNA. This is a unique example of a respiratory-deficient human cell line exhibiting defective mtDNA replication.


Assuntos
Replicação do DNA , DNA Mitocondrial/genética , Transporte de Elétrons , Fibroblastos/metabolismo , Mitocôndrias/metabolismo , Mutação , Western Blotting , Divisão Celular , Linhagem Celular , DNA Mitocondrial/metabolismo , Feminino , Fibroblastos/ultraestrutura , Humanos , Masculino , Biossíntese de Proteínas
9.
Am J Hum Genet ; 53(3): 663-9, 1993 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8394647

RESUMO

We have studied cultured skin fibroblasts from a patient with a fatal mitochondrial disease manifesting soon after birth. These fibroblasts were found to grow only in the presence of pyruvate and uridine, a characteristic of cells lacking mtDNA (rho0 cells). Southern blot and PCR analyses confirmed that the patient's fibroblasts contained less than 2% of control levels of mtDNA. Biochemical analyses indicated that the activities of all the respiratory-chain enzymes were severely decreased in mitochondria isolated from these fibroblasts. In order to elucidate the underlying molecular defect, cell fusions were performed between enucleated fibroblasts from this patient and a human-derived rho0 cell line (rho0 A549.B2). The resulting cybrids were plated in medium lacking pyruvate and uridine, to select for the restoration of respiratory-chain function. Complementation was observed between the nuclear genome of the rho0 A549.B2 cells and the mtDNA of the patient's cells, restoring mtDNA levels and respiratory-chain function in the cybrid cells. These results indicate that mtDNA depletion in our patient is under the control of the nuclear genome.


Assuntos
Aberrações Cromossômicas/genética , DNA Mitocondrial/genética , Mitocôndrias/patologia , Miopatias Mitocondriais/enzimologia , Miopatias Mitocondriais/genética , Fusão Celular , Núcleo Celular , Citrato (si)-Sintase/deficiência , Citrato (si)-Sintase/genética , Deficiência de Citocromo-c Oxidase , DNA Mitocondrial/análise , Complexo I de Transporte de Elétrons , Complexo IV da Cadeia de Transporte de Elétrons/genética , Fibroblastos/enzimologia , Regulação Enzimológica da Expressão Gênica , Teste de Complementação Genética , Humanos , Células Híbridas , Recém-Nascido , Malato Desidrogenase/deficiência , Malato Desidrogenase/genética , Masculino , Mitocôndrias/enzimologia , Mitocôndrias Musculares/enzimologia , Mitocôndrias Musculares/patologia , NADH NADPH Oxirredutases/deficiência , NADH NADPH Oxirredutases/genética , Doença da Deficiência do Complexo de Piruvato Desidrogenase/genética , Succinato Citocromo c Oxirredutase/deficiência , Succinato Citocromo c Oxirredutase/genética
10.
EMBO J ; 10(11): 3255-62, 1991 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-1680677

RESUMO

Several peroxisomal proteins do not contain the previously identified tripeptide peroxisomal targeting signal (PTS) at their carboxy-termini. One such protein is the peroxisomal 3-ketoacyl CoA thiolase, of which two types exist in rat [Hijikata et al. (1990) J. Biol. Chem., 265, 4600-4606]. Both rat peroxisomal thiolases are synthesized as larger precursors with an amino-terminal prepiece of either 36 (type A) or 26 (type B) amino acids, that is cleaved upon translocation of the enzyme into the peroxisome. The prepieces are necessary for import of the thiolases into peroxisomes because expression of an altered cDNA encoding only the mature thiolase, which lacks any prepiece, results in synthesis of a cytosolic enzyme. When appended to an otherwise cytosolic passenger protein, the bacterial chloramphenicol acetyltransferase (CAT), the prepieces direct the fusion proteins into peroxisomes, demonstrating that they encode sufficient information to act as peroxisomal targeting signals. Deletion analysis of the thiolase B prepiece shows that the first 11 amino acids are sufficient for peroxisomal targeting. We conclude that we have identified a novel PTS that functions at amino-terminal or internal locations and is distinct from the C-terminal PTS. These results imply the existence of two different routes for targeting proteins into the peroxisomal matrix.


Assuntos
Acetil-CoA C-Aciltransferase/metabolismo , Microcorpos/metabolismo , Acetil-CoA C-Acetiltransferase/genética , Acetil-CoA C-Acetiltransferase/metabolismo , Acetil-CoA C-Aciltransferase/genética , Sequência de Aminoácidos , Animais , Sequência de Bases , Western Blotting , Células Cultivadas , DNA/genética , Imunofluorescência , Haplorrinos , Isoenzimas/metabolismo , Rim/citologia , Dados de Sequência Molecular , Plasmídeos , Ratos , Transfecção
11.
Biochem Cell Biol ; 69(8): 499-508, 1991 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1760154

RESUMO

We have characterized the integral membrane polypeptides of liver peroxisomes from untreated rats and rats treated with clofibrate, a peroxisome proliferator. Membranes, prepared by treatment of purified peroxisomes with sodium carbonate, were used to raise an antiserum in rabbits. Immunoblot analysis demonstrated the reaction of this antiserum with six peroxisomal integral membrane polypeptides (molecular masses, 140, 69, 50, 36, 22, and 15 kDa). Treatment of rats with the hypolipidemic drug clofibrate caused a 4- to 10-fold induction in the 69-kDa integral membrane polypeptide, while the other integral membrane polypeptides remained unchanged or varied to a lesser extent. The anti-peroxisomal membrane serum reacted with two integral membrane polypeptides of the endoplasmic reticulum which co-migrated with the 50- and 36-kDa integral membrane polypeptides of the peroxisome. Biochemical and immunoblot analyses indicated that these integral membrane polypeptides were co-localized to peroxisomes and endoplasmic reticulum. Immunoprecipitation of in vitro translation products of RNA isolated from free and membrane-bound polysomes indicated that the 22-, 36-, and 69-kDa integral membrane polypeptides were synthesized on free polysomes, while the 50-kDa integral membrane polypeptide was predominantly synthesized on membrane-bound polysomes. The predominant synthesis of the 50-kDa integral membrane polypeptide on membrane-bound polysomes raises interesting possibilities concerning its biosynthesis.


Assuntos
Clofibrato/farmacologia , Proteínas de Membrana/química , Microcorpos/química , Animais , Biomarcadores , Fracionamento Celular , Fígado/química , Fígado/efeitos dos fármacos , Lisossomos/química , Lisossomos/imunologia , Proteínas de Membrana/imunologia , Microcorpos/efeitos dos fármacos , Microcorpos/imunologia , Mitocôndrias Hepáticas/química , Mitocôndrias Hepáticas/imunologia , Testes de Precipitina , Biossíntese de Proteínas , Ratos , Ratos Endogâmicos
12.
Gene ; 91(2): 193-9, 1990 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-2210380

RESUMO

3-Ketoacyl-coenzyme A thiolase (thiolase) catalyzes the final step of the fatty acid beta-oxidation pathway in peroxisomes. Thiolase is unique among rat liver peroxisomal enzymes in that it is synthesized as a precursor possessing a 26-amino acid (aa) N-terminal extension which is cleaved to generate the mature enzyme. To facilitate further examination of the synthesis, intracellular transport and processing of this enzyme, cDNA clones were selected from a lambda gt11 rat liver library using antiserum raised against peroxisomal thiolase. Upon sequencing several cDNA clones, it was revealed that there are at least two distinct thiolase enzymes localized to rat liver peroxisomes, one identical to the previously published rat liver peroxisomal thiolase (thiolase 1) [Hijikata et al., J. Biol. Chem. 262 (1987) 8151-8158] and a novel thiolase (thiolase 2). The THL2 cDNA possesses a single open reading frame of 1302 nucleotides (nt) encoding a protein of 434 aa (Mr 44790). The coding region of THL2 cDNA exhibits 94.6% nt sequence identity with THL1 and 95.4% identity at the level of aa sequence. Northern-blot analysis indicates that the mRNA encoding thiolase 2 is approx. 1.7 kb in size. The mRNA encoding thiolase 2 is induced approx. twofold upon treatment of rats with the peroxisome-proliferating drug, clofibrate. In contrast, the thiolase 1 mRNA is induced more than tenfold under similar conditions.


Assuntos
Acetil-CoA C-Aciltransferase/genética , Fígado/enzimologia , Microcorpos/enzimologia , Acetil-CoA C-Aciltransferase/metabolismo , Sequência de Aminoácidos , Animais , Sequência de Bases , Northern Blotting , Clonagem Molecular , DNA/genética , Immunoblotting , Metionina/análise , Dados de Sequência Molecular , Reação em Cadeia da Polimerase , Biossíntese de Proteínas , Processamento de Proteína Pós-Traducional , Ratos , Mapeamento por Restrição , Homologia de Sequência do Ácido Nucleico
13.
J Cell Sci ; 95 ( Pt 3): 463-70, 1990 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-2384524

RESUMO

We report a methodology for the isolation of peroxisome membranes from the yeast Candida tropicalis pK233 grown on oleic acid, and the characterization of the polypeptide and lipid compositions of these membranes. Peroxisomes purified in either sucrose or Nycodenz gradients are treated with Tris-HCl (pH 8.5) and then with sodium carbonate (pH 11.5) to yield a final peroxisome membrane preparation (hereafter called 'peroxisome membranes'). Electron microscopy revealed peroxisome membranes that are approximately 8.1 nm thick, have a typical trilaminar appearance, and form either flattened sheets or whorled structures. Peroxisome membranes contain 3.1% and 2.2% of the total protein of sucrose- and Nycodenz-gradient-purified peroxisomes, respectively. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis showed three predominant polypeptide bands of 34 (PMP 34), 29 (PMP 29), and 24 (PMP 24) x 10(3) Mr in peroxisome membranes. Immunoblotting with an antiserum to PMP 24 showed that PMP 24 segregates with the peroxisome membrane fractions and is induced by growth of Candida tropicalis on oleic acid. Peroxisome membranes contain neutral lipids and phospholipids. The principal phospholipids are phosphatidyl choline and phosphatidyl ethanolamine. The phospholipid/protein ratio of peroxisome membranes is approximately 430 nmol mg-1.


Assuntos
Candida/ultraestrutura , Membranas Intracelulares/análise , Microcorpos/análise , Candida/efeitos dos fármacos , Cromatografia em Camada Fina , Meios de Cultura , Lipídeos de Membrana/análise , Microcorpos/ultraestrutura , Microscopia Eletrônica , Ácidos Oleicos/farmacologia
15.
Cardiovasc Clin ; 14(3): 247-64, 1984.
Artigo em Inglês | MEDLINE | ID: mdl-6722854

RESUMO

We have reviewed the risks and benefits of anticoagulation for cardiac valve disease before and after valve surgery. Though the absence of standardized reporting of complications and the paucity of well-designed comparative studies mandate careful consideration of the variables of individual cases, we have made the following general recommendations: Unoperated patients with rheumatic mitral valvular disease and atrial fibrillation should be chronically treated with warfarin, regardless of the hemodynamic severity of their valvular lesion. The presence of right- or left-sided heart failure is an indication for warfarin treatment, in the absence of significant contraindications. There is emerging evidence that platelet-suppressant therapy may be of benefit in diminishing the thromboembolic risk of at least a subset of patients with rheumatic valvular disease and decreased platelet survival. Until platelet-survival studies are more readily available and larger-scale studies can be performed, however, we do not recommend routine treatment with platelet-active agents. We recommend chronic warfarin anticoagulation in all patients with mechanical prostheses in either the aortic or mitral position, regardless of cardiac rhythm or prosthesis model. We do not routinely add platelet-active agents except in the case of embolism despite adequate anticoagulation with warfarin. Patients with aortic bioprostheses generally do not require warfarin treatment for more than 3 months following valve replacement. The presence of atrial fibrillation and marked depression of postoperative ventricular function are indications for chronic anticoagulation. In the case of mitral bioprostheses, we recommend indefinite warfarin treatment for patients with atrial fibrillation, depressed ventricular function, or low cardiac output. We consider a preoperative history of embolism or an operative finding of left atrial thrombus to be an additional indication for anticoagulation, in the absence of significant contraindications. Patients on anticoagulant therapy should be followed closely--when possible in specialized anticoagulation clinics--to minimize the risks of treatment. Specific recommendations are made for management of anticoagulation during infective endocarditis, pregnancy, and noncardiac surgery.


Assuntos
Anticoagulantes/uso terapêutico , Embolia/prevenção & controle , Doenças das Valvas Cardíacas/cirurgia , Anticoagulantes/efeitos adversos , Valva Aórtica/cirurgia , Bioprótese , Feminino , Próteses Valvulares Cardíacas , Humanos , Valva Mitral/cirurgia , Cuidados Pós-Operatórios , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Cuidados Pré-Operatórios , Prognóstico , Risco
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