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1.
Differentiation ; 130: 1-6, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36434825

RESUMO

Plastic pollution negatively affects ecosystems and human health globally, with single-use plastic representing the majority of marine litter in some areas. Life science laboratories prefer pristine conditions for experimental reliability and therefore make use of factory standardized single-use plastic products. This contributes to overall plastic waste in the United States and globally. Here, we investigate the potential of reusing plastic culture dishes and subsequently propose methods to mitigate single-use plastic waste in developmental biology research laboratories. We tested the efficacy of bleach and ethyl alcohol in sterilizing used dishes. We then tested the feasibility of washing and reusing plastic to culture Xenopus laevis embryos subjected to various manipulations. Cleaning and reusing laboratory plastic did not affect the development or survival of X. laevis, indicating that these cleaning methods do not adversely affect experimental outcome and can be used to sterilize plastic before reuse or recycling. Lastly, we performed a survey of various life science laboratories to estimate both waste reduction and savings associated with recycling single-use plastics. Standardization of these procedures would allow research laboratories to benefit economically while practicing environmentally conscious consumption.


Assuntos
Ecossistema , Plásticos , Humanos , Laboratórios , Reprodutibilidade dos Testes , Biologia do Desenvolvimento
2.
Dev Dyn ; 250(9): 1264-1279, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33522040

RESUMO

Before limbs or fins, can be patterned and grow they must be initiated. Initiation of the limb first involves designating a portion of lateral plate mesoderm along the flank as the site of the future limb. Following specification, a myriad of cellular and molecular events interact to generate a bud that will grow and form the limb. The past three decades has provided a wealth of understanding on how those events generate the limb bud and how variations in them result in different limb forms. Comparatively, much less attention has been given to the earliest steps of limb formation and what impacts altering the position and initiation of the limb have had on evolution. Here, we first review the processes and pathways involved in these two phases of limb initiation, as determined from amniote model systems. We then broaden our scope to examine how variation in the limb initiation module has contributed to biological diversity in amniotes. Finally, we review what is known about limb initiation in fish and amphibians, and consider what mechanisms are conserved across vertebrates.


Assuntos
Regulação da Expressão Gênica no Desenvolvimento , Botões de Extremidades , Animais , Evolução Biológica , Extremidades , Botões de Extremidades/metabolismo , Mesoderma/metabolismo , Vertebrados
3.
Development ; 150(16)2023 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-37647032
4.
Dev Biol ; 429(2): 401-408, 2017 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-27840200

RESUMO

John W. Saunders, Jr. made seminal discoveries unveiling how chick embryos develop their limbs. He discovered the apical ectodermal ridge (AER), the zone of polarizing activity (ZPA), and the domains of interdigital cell death within the developing limb and determined their function through experimental analysis. These discoveries provided the basis for subsequent molecular understanding of how vertebrate limbs are induced, patterned, and differentiated. These mechanisms are strongly conserved among the vast diversity of tetrapod limbs suggesting that relatively minor changes and tweaks to the molecular cascades are responsible for the diversity observed in nature. Analysis of the pathway systems first identified by Saunders in the context of animals displaying limb reduction show how alterations in these pathways have resulted in multiple mechanisms of limb and digit loss. Other classes of modification to these same patterning systems are seen at the root of other, novel limb morphological alterations and elaborations.


Assuntos
Evolução Biológica , Extremidades/embriologia , Adaptação Fisiológica , Animais , Transdução de Sinais
5.
Dev Biol ; 426(2): 245-254, 2017 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-27364468

RESUMO

The dorsal ventral axis of vertebrates requires high BMP activity for ventral development and inhibition of BMP activity for dorsal development. Presumptive dorsal regions of the embryo are protected from the ventralizing activity of BMPs by the secretion of BMP antagonists from the mesoderm. Noggin, one such antagonist, binds BMP ligands and prevents them from binding their receptors, however, a unique role for Noggin in amphibian development has remained unclear. Previously, we used zinc-finger nucleases to mutagenize the noggin locus in Xenopus tropicalis. Here, we report on the phenotype of noggin mutant frogs as a result of breeding null mutations to homozygosity. Early homozygous noggin mutant embryos are indistinguishable from wildtype siblings, with normal neural induction and neural tube closure. However, in late tadpole stages mutants present severe ventral craniofacial defects, notably a fusion of Meckel's cartilage to the palatoquadrate cartilage. Consistent with a noggin loss-of-function, mutants show expansions of BMP target gene expression and the mutant phenotype can be rescued with transient BMP inhibition. These results demonstrate that in amphibians, Noggin is dispensable for early embryonic patterning but is critical for cranial skeletogenesis.


Assuntos
Região Branquial/crescimento & desenvolvimento , Proteínas de Transporte/fisiologia , Proteínas de Xenopus/fisiologia , Xenopus/crescimento & desenvolvimento , Alelos , Animais , Padronização Corporal , Proteínas Morfogenéticas Ósseas/farmacologia , Proteínas Morfogenéticas Ósseas/fisiologia , Proteínas de Transporte/genética , Cartilagem/anormalidades , Diferenciação Celular , Embrião não Mamífero/metabolismo , Embrião não Mamífero/ultraestrutura , Folistatina/deficiência , Folistatina/genética , Técnicas de Inativação de Genes , Glicoproteínas/deficiência , Glicoproteínas/genética , Homozigoto , Peptídeos e Proteínas de Sinalização Intercelular/deficiência , Peptídeos e Proteínas de Sinalização Intercelular/genética , Larva , Mandíbula/anormalidades , Morfolinos/farmacologia , Crânio/anormalidades , Xenopus/embriologia , Proteínas de Xenopus/deficiência , Proteínas de Xenopus/genética
6.
Development ; 141(8): 1683-93, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24715458

RESUMO

Amphibian neural development occurs as a two-step process: (1) induction specifies a neural fate in undifferentiated ectoderm; and (2) transformation induces posterior spinal cord and hindbrain. Signaling through the Fgf, retinoic acid (RA) and Wnt/ß-catenin pathways is necessary and sufficient to induce posterior fates in the neural plate, yet a mechanistic understanding of the process is lacking. Here, we screened for factors enriched in posterior neural tissue and identify spalt-like 4 (sall4), which is induced by Fgf. Knockdown of Sall4 results in loss of spinal cord marker expression and increased expression of pou5f3.2 (oct25), pou5f3.3 (oct60) and pou5f3.1 (oct91) (collectively, pou5f3 genes), the closest Xenopus homologs of mammalian stem cell factor Pou5f1 (Oct4). Overexpression of the pou5f3 genes results in the loss of spinal cord identity and knockdown of pou5f3 function restores spinal cord marker expression in Sall4 morphants. Finally, knockdown of Sall4 blocks the posteriorizing effects of Fgf and RA signaling in the neurectoderm. These results suggest that Sall4, activated by posteriorizing signals, represses the pou5f3 genes to provide a permissive environment allowing for additional Wnt/Fgf/RA signals to posteriorize the neural plate.


Assuntos
Padronização Corporal , Linhagem da Célula , Neurônios/citologia , Proteínas Repressoras/metabolismo , Fatores de Transcrição/metabolismo , Proteínas de Xenopus/metabolismo , Xenopus laevis/metabolismo , Animais , Biomarcadores/metabolismo , Padronização Corporal/genética , Diferenciação Celular/genética , Linhagem da Célula/efeitos dos fármacos , Linhagem da Célula/genética , Embrião não Mamífero/efeitos dos fármacos , Embrião não Mamífero/metabolismo , Fatores de Crescimento de Fibroblastos/farmacologia , Regulação da Expressão Gênica no Desenvolvimento , Técnicas de Silenciamento de Genes , Testes Genéticos , Morfolinos/farmacologia , Placa Neural/metabolismo , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Proteínas Repressoras/genética , Rombencéfalo/metabolismo , Medula Espinal/citologia , Medula Espinal/efeitos dos fármacos , Medula Espinal/embriologia , Fatores de Transcrição/genética , Transcrição Gênica , Tretinoína/farmacologia , Via de Sinalização Wnt/efeitos dos fármacos , Via de Sinalização Wnt/genética , Proteínas de Xenopus/genética , Xenopus laevis/embriologia , Xenopus laevis/genética
7.
Proc Natl Acad Sci U S A ; 108(17): 7052-7, 2011 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-21471457

RESUMO

The frog Xenopus, an important research organism in cell and developmental biology, currently lacks tools for targeted mutagenesis. Here, we address this problem by genome editing with zinc-finger nucleases (ZFNs). ZFNs directed against an eGFP transgene in Xenopus tropicalis induced mutations consistent with nonhomologous end joining at the target site, resulting in mosaic loss of the fluorescence phenotype at high frequencies. ZFNs directed against the noggin gene produced tadpoles and adult animals carrying up to 47% disrupted alleles, and founder animals yielded progeny carrying insertions and deletions in the noggin gene with no indication of off-target effects. Furthermore, functional tests demonstrated an allelic series of activity between three germ-line mutant alleles. Because ZFNs can be designed against any locus, our data provide a generally applicable protocol for gene disruption in Xenopus.


Assuntos
Alelos , Proteínas de Transporte/genética , Desoxirribonucleases/genética , Marcação de Genes/métodos , Proteínas de Xenopus/genética , Animais , Animais Geneticamente Modificados , Proteínas de Transporte/metabolismo , Desoxirribonucleases/metabolismo , Xenopus , Proteínas de Xenopus/metabolismo , Dedos de Zinco
8.
Curr Biol ; 31(22): R1487-R1490, 2021 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-34813756

RESUMO

Almost all living tetrapods exhibit postaxial dominance in digit formation, apart from urodele amphibians, which show preaxial dominance. Recent work shines light on the genetic differences between the two modes of limb development, suggesting that differences in 5'Hoxd expression, mediated by Gli3, may explain the switch in axial polarity.


Assuntos
Anfíbios , Extremidades , Animais , Biologia do Desenvolvimento , Extremidades/crescimento & desenvolvimento
9.
Cell Rep ; 34(1): 108574, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33406418

RESUMO

The zinc finger transcription factor SALL4 is highly expressed in embryonic stem cells, downregulated in most adult tissues, but reactivated in many aggressive cancers. This unique expression pattern makes SALL4 an attractive therapeutic target. However, whether SALL4 binds DNA directly to regulate gene expression is unclear, and many of its targets in cancer cells remain elusive. Here, through an unbiased screen of protein binding microarray (PBM) and cleavage under targets and release using nuclease (CUT&RUN) experiments, we identify and validate the DNA binding domain of SALL4 and its consensus binding sequence. Combined with RNA sequencing (RNA-seq) analyses after SALL4 knockdown, we discover hundreds of new SALL4 target genes that it directly regulates in aggressive liver cancer cells, including genes encoding a family of histone 3 lysine 9-specific demethylases (KDMs). Taken together, these results elucidate the mechanism of SALL4 DNA binding and reveal pathways and molecules to target in SALL4-dependent tumors.


Assuntos
Carcinoma Hepatocelular/metabolismo , Proteínas de Ligação a DNA/metabolismo , Células-Tronco Embrionárias/metabolismo , Regulação Neoplásica da Expressão Gênica , Histona Desmetilases/metabolismo , Fatores de Transcrição/metabolismo , Dedos de Zinco , Motivos de Aminoácidos , Sequência de Aminoácidos , Carcinoma Hepatocelular/genética , Linhagem Celular Tumoral , Proteínas de Ligação a DNA/genética , Técnicas de Silenciamento de Genes , Células HEK293 , Células HeLa , Histona Desmetilases/genética , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/metabolismo , Análise Serial de Proteínas , Ligação Proteica , Análise de Sequência de RNA , Fatores de Transcrição/genética
10.
PLoS Pathog ; 3(3): e27, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17335347

RESUMO

Anthrax toxin (AnTx) plays a key role in the pathogenesis of anthrax. AnTx is composed of three proteins: protective antigen (PA), edema factor, and lethal factor (LF). PA is not toxic but serves to bind cells and translocate the toxic edema factor or LF moieties to the cytosol. Recently, the low-density lipoprotein receptor-related protein LRP6 has been reported to mediate internalization and lethality of AnTx. Based on its similarity to LRP6, we hypothesized that LRP5 may also play a role in cellular uptake of AnTx. We assayed PA-dependent uptake of anthrax LF or a cytotoxic LF fusion protein (FP59) in cells and mice harboring targeted deletions of Lrp5 or Lrp6. Unexpectedly, we observed that uptake was unaltered in the presence or absence of either Lrp5 or Lrp6 expression. Moreover, we observed efficient PA-mediated uptake into anthrax toxin receptor (ANTXR)-deficient Chinese hamster ovary cells (PR230) that had been stably engineered to express either human ANTXR1 or human ANTXR2 in the presence or absence of siRNA specific for LRP5 or LRP6. Our results demonstrate that neither LRP5 nor LRP6 is necessary for PA-mediated internalization or lethality of anthrax lethal toxin.


Assuntos
Antígenos de Bactérias/fisiologia , Bacillus anthracis/imunologia , Toxinas Bacterianas/metabolismo , Proteínas Relacionadas a Receptor de LDL/fisiologia , Animais , Antraz/etiologia , Antraz/fisiopatologia , Antraz/prevenção & controle , Antígenos de Bactérias/imunologia , Antígenos de Bactérias/metabolismo , Transporte Biológico/fisiologia , Células CHO , Células Cultivadas , Cricetinae , Cricetulus , Endocitose/fisiologia , Regulação da Expressão Gênica , Humanos , Proteínas Relacionadas a Receptor de LDL/genética , Proteína-5 Relacionada a Receptor de Lipoproteína de Baixa Densidade , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade , Camundongos , Camundongos Knockout , RNA Interferente Pequeno/farmacologia
11.
Mol Cancer Ther ; 7(3): 648-58, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18319331

RESUMO

We hypothesized that signaling through multiple mitogen-activated protein kinase (MAPK) kinase (MKK) pathways is essential for the growth and vascularization of soft-tissue sarcomas, which are malignant tumors derived from mesenchymal tissues. We tested this using HT-1080, NCI, and Shac fibrosarcoma-derived cell lines and anthrax lethal toxin (LeTx), a bacterial toxin that inactivates MKKs. Western blots confirmed that LeTx treatment reduced the levels of phosphorylated extracellular signal-regulated kinase and p38 MAPK in vitro. Although short treatments with LeTx only modestly affected cell proliferation, sustained treatment markedly reduced cell numbers. LeTx also substantially inhibited the extracellular release of angioproliferative factors including vascular endothelial growth factor, interleukin-8, and basic fibroblast growth factor. Similar results were obtained with cell lines derived from malignant fibrous histiocytomas, leiomyosarcomas, and liposarcomas. In vivo, LeTx decreased MAPK activity and blocked fibrosarcoma growth. Growth inhibition correlated with decreased cellular proliferation and extensive necrosis, and it was accompanied by a decrease in tumor mean vessel density as well as a reduction in serum expression of angioproliferative cytokines. Vital imaging using high-resolution ultrasound enhanced with contrast microbubbles revealed that the effects of LeTx on tumor perfusion were remarkably rapid (<24 h) and resulted in a marked reduction of perfusion within the tumor but not in nontumor tissues. These results are consistent with our initial hypothesis and lead us to propose that MKK inhibition by LeTx is a broadly effective strategy for targeting neovascularization in fibrosarcomas and other similar proliferative lesions.


Assuntos
Divisão Celular , Fibrossarcoma/irrigação sanguínea , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Neovascularização Patológica , Transdução de Sinais , Antígenos de Bactérias/farmacologia , Toxinas Bacterianas/farmacologia , Ciclo Celular , Linhagem Celular Tumoral , Proliferação de Células , Fibrossarcoma/patologia , Humanos
12.
Curr Biol ; 29(2): R52-R54, 2019 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-30668947

RESUMO

Hox genes are known to determine vertebral identity along with being required for normal limb patterning. A new study now finds that differential expression timing of Hox genes in the lateral plate mesoderm determines limb placement as well.


Assuntos
Gastrulação , Genes Homeobox , Animais , Padronização Corporal , Biologia do Desenvolvimento , Membro Anterior , Regulação da Expressão Gênica no Desenvolvimento , Mesoderma
13.
Curr Biol ; 29(21): 3681-3691.e5, 2019 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-31668620

RESUMO

Powered flight was fundamental to the establishment and radiation of birds. However, flight has been lost multiple times throughout avian evolution. Convergent losses of flight within the ratites (flightless paleognaths, including the emu and ostrich) often coincide with reduced wings. Although there is a wealth of anatomical knowledge for several ratites, the genetic mechanisms causing these changes remain debated. Here, we use a multidisciplinary approach employing embryological, genetic, and genomic techniques to interrogate the mechanisms underlying forelimb heterochrony in emu embryos. We show that the initiation of limb formation, an epithelial to mesenchymal transition (EMT) in the lateral plate mesoderm (LPM) and myoblast migration into the LPM, occur at equivalent stages in the emu and chick. However, the emu forelimb fails to subsequently proliferate. The unique emu forelimb expression of Nkx2.5, previously associated with diminished wing development, initiates after this stage (concomitant with myoblast migration into the LPM) and is therefore unlikely to cause this developmental delay. In contrast, RNA sequencing of limb tissue reveals significantly lower Fgf10 expression in the emu forelimb. Artificially increasing Fgf10 expression in the emu LPM induces ectodermal Fgf8 expression and a limb bud. Analyzing open chromatin reveals differentially active regulatory elements near Fgf10 and Sall-1 in the emu wing, and the Sall-1 enhancer activity is dependent on a likely Fgf-mediated Ets transcription factor-binding site. Taken together, our results suggest that regulatory changes result in lower expression of Fgf10 and a concomitant failure to express genes required for limb proliferation in the early emu wing bud.


Assuntos
Proteínas Aviárias/genética , Dromaiidae/genética , Transição Epitelial-Mesenquimal/genética , Fator 10 de Crescimento de Fibroblastos/genética , Regulação da Expressão Gênica no Desenvolvimento , Asas de Animais/embriologia , Animais , Proteínas Aviárias/metabolismo , Dromaiidae/embriologia , Fator 10 de Crescimento de Fibroblastos/metabolismo , Botões de Extremidades/embriologia , Transdução de Sinais
14.
Catheter Cardiovasc Interv ; 71(3): 367-74, 2008 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-18288729

RESUMO

Progressive atherosclerotic disease is responsible for many of the late adverse clinical events that detract from the high procedural and clinical success of percutaneous coronary intervention. Despite recent advances in catheter based technology for the treatment of obstructive coronary artery disease, the greater risk to the patient over time may in fact come from the significant rate of acute coronary events triggered by nonculprit and/or nonobstructive coronary artery lesions. These areas of vulnerability within the epicardial coronary tree have generated a great deal of interest surrounding the concepts of vulnerable plaque (VP), vulnerable blood and the vulnerable patient. This 'state of the art' review discusses the limitations of coronary angiography alone in providing risk assessment; reviews the underlying biological concepts of VP; discusses evolving noninvasive and invasive imaging technologies for the detection of VP; and finally provides a futuristic look at how the field of interventional cardiology may transcend the traditional angiogram and move toward a more comprehensive treatment approach that benefits the patients' overall coronary health.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/terapia , Diagnóstico por Imagem/métodos , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Aterosclerose , Cateterismo Cardíaco/métodos , Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Progressão da Doença , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Análise Espectral/métodos , Análise de Sobrevida , Resultado do Tratamento , Ultrassonografia de Intervenção
15.
Clin Cancer Res ; 13(19): 5926-34, 2007 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-17908989

RESUMO

PURPOSE: In this study, we tested the hypothesis that inhibition of mitogen-activated protein kinase kinases (MKK) inhibits tumor growth by acting on angiogenic signaling and by extension may form the basis of an effective strategy for treatment of Kaposi's sarcoma. EXPERIMENTAL DESIGN: Murine endothelial cells expressing the human herpes virus 8 G protein-coupled receptor (vGPCR-SVEC) were treated with anthrax lethal toxin (LeTx). LeTx is a binary toxin ordinarily secreted by Bacillus anthracis and is composed of two proteins: protective antigen (the binding moiety) and lethal factor (the active moiety). Lethal factor is a protease that cleaves and inactivates MKKs. RESULTS: In vitro, treatment of vGPCR-SVEC with LeTx inhibited MKK signaling, moderately inhibited cell proliferation, and blocked the ability of these cells to form colonies in soft agar. Treatment with LeTx also blocked the ability of these cells to release several angioproliferative cytokines, notably vascular endothelial growth factor (VEGF). In contrast, inhibition of mitogen-activated protein kinase/extracellular signal-regulated kinase 1/2 with U0126 caused a substantial inhibition of proliferation but only modestly inhibited VEGF release. In xenograft models, i.v. injection of LeTx caused reduced tumor growth characterized immunohistochemically by inhibition of MKK signaling, decreased rates of proliferation, and reduced levels of VEGF and VEGF receptor 2, with a corresponding decrease in vascular density. CONCLUSIONS: These data support a role for MKK signaling in tumor growth and vascularization and are consistent with the hypothesis that inhibition of MKK signaling by LeTx or a similar agent may be an effective strategy for the treatment of Kaposi's sarcoma as well as other vascular tumors.


Assuntos
Antígenos de Bactérias/farmacologia , Toxinas Bacterianas/farmacologia , Células Endoteliais/metabolismo , Receptores de Quimiocinas/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Linhagem Celular Tumoral , Proliferação de Células , Camundongos , Microcirculação , Células NIH 3T3 , Transplante de Neoplasias , Neovascularização Patológica , Molécula-1 de Adesão Celular Endotelial a Plaquetas/biossíntese , Sarcoma de Kaposi/metabolismo , Sarcoma de Kaposi/terapia , Transdução de Sinais , Fatores de Tempo
16.
Rev Cardiovasc Med ; 8 Suppl 1: S3-10, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17401309

RESUMO

Percutaneous coronary intervention with drug-eluting stents (DES) is currently the preferred approach to the treatment of obstructive coronary artery disease. Large, randomized trials have demonstrated a significant reduction in the incidence of restenosis and the need for target vessel revascularization following implantation of DES compared with bare-metal stents. Follow-up data extending out to 2 to 4 years have demonstrated efficacy in maintaining luminal patency, but recent concerns regarding potential late adverse effects with DES have been raised. These include aneurysm formation and hypersensitivity reactions, as well as subacute and late stent thrombosis requiring compliance with antiplatelet therapy for protracted periods of time. Evolving strategies to mitigate late adverse events with DES include acceleration of endothelialization, gene therapy targeting pro-healing pathways (ie, nitric oxide donors), smooth muscle cell growth inhibitors, bioabsorbable metal and polymeric stents, and concurrent use of local as well as systemic chemotherapy.


Assuntos
Implante de Prótese Vascular/instrumentação , Materiais Revestidos Biocompatíveis , Sistemas de Liberação de Medicamentos/instrumentação , Oclusão de Enxerto Vascular , Inibidores da Agregação Plaquetária/uso terapêutico , Stents/efeitos adversos , Túnica Íntima/patologia , Implante de Prótese Vascular/efeitos adversos , Reestenose Coronária/etiologia , Reestenose Coronária/patologia , Reestenose Coronária/prevenção & controle , Estenose Coronária/cirurgia , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/patologia , Oclusão de Enxerto Vascular/prevenção & controle , Humanos , Revascularização Miocárdica/efeitos adversos , Prognóstico , Fatores de Tempo
17.
J Am Coll Cardiol ; 45(12): 1932-8, 2005 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-15963389

RESUMO

OBJECTIVES: The objective of this study was to confirm that the efficacy and safety of percutaneous coronary intervention (PCI) in diabetic patients are not compromised by a bivalirudin-based antithrombotic strategy. BACKGROUND: Previous studies have shown a survival benefit with use of platelet glycoprotein (GP) IIb/IIIa inhibitors in diabetic patients undergoing PCI. The Randomized Evaluation in Percutaneous Coronary Intervention Linking Angiomax to Reduced Clinical Events (REPLACE)-2 trial showed the non-inferiority of a strategy of bivalirudin with provisional GP IIb/IIIa inhibition compared with routine GP IIb/IIIa inhibition. The relative efficacy of these two strategies in diabetic patients has not been studied. METHODS: We evaluated the diabetic patients enrolled in the REPLACE-2 trial to assess the impact of these antithrombotic strategies on the short- and long-term outcome after PCI. RESULTS: The REPLACE-2 trial enrolled 1,624 diabetic patients and 4,368 non-diabetic patients. Compared with non-diabetic patients, diabetic patients had similar short-term outcome but higher mortality at 1 year (3.06% vs. 1.85%, p = 0.004). There was no difference in short-term or long-term ischemic events among the diabetic patients randomized to the two arms. Specifically, the 1-year mortality rate was non-significantly lower in the bivalirudin arm, suggesting no differential survival impact of the two strategies (2.3% vs. 3.9%). There was less minor bleeding in the bivalirudin arm in diabetic patients (12.6% vs. 24.4%, p < 0.001), whereas no difference was seen in the incidence of major bleeding (3.0% vs. 3.3%, p = 0.69). CONCLUSIONS: Compared with routine GP IIb/IIIa inhibition, the use of bivalirudin with provisional GP IIb/IIIa inhibitors in diabetic patients is associated with no differences in clinical outcomes at 30 days, a trend toward lesser mortality at 1 year, and a reduction in minor bleeding.


Assuntos
Angioplastia Coronária com Balão , Anticoagulantes/uso terapêutico , Doença da Artéria Coronariana/terapia , Diabetes Mellitus Tipo 2/complicações , Fragmentos de Peptídeos/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Proteínas Recombinantes/uso terapêutico , Idoso , Doença da Artéria Coronariana/etiologia , Método Duplo-Cego , Feminino , Heparina/uso terapêutico , Hirudinas , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
18.
Am J Cardiol ; 95(4): 511-4, 2005 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-15695142

RESUMO

A novel, low-profile filter embolic protection device was deployed in 26 patients who underwent stent deployment for saphenous vein graft stenoses in a multicenter trial. Major adverse cardiovascular events were observed in only 2 patients (7.7%) and angiographic flow grades were improved.


Assuntos
Embolia/prevenção & controle , Filtração/instrumentação , Oclusão de Enxerto Vascular/cirurgia , Veia Safena/transplante , Idoso , Ligas , Angiografia Coronária , Feminino , Humanos , Masculino , Stents , Resultado do Tratamento
19.
Rev Cardiovasc Med ; 6 Suppl 1: S48-58, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15665798

RESUMO

Patients with diabetes have worse clinical outcomes following both surgical revascularization and percutaneous coronary intervention (PCI). Although coronary stenting has improved late outcomes (versus balloon angioplasty) following PCI, both angiographic restenosis and the requirement for repeat revascularization are increased in diabetics versus nondiabetics and limit the durability of PCI compared with surgery. Polymer-based drug-eluting stents (DES) have markedly reduced late coronary lumen loss and angiographic restenosis as well as the need for repeat revascularization when compared with conventional (non-drug-eluting) coronary stent deployment. Specifically, the CYPHER sirolimus-eluting stent (Cordis Cardiology, Miami Lakes, FL) has demonstrated durable clinical and angiographic benefit for diabetic patients in both randomized clinical trials and postmarket surveillance registries. Data on the more recently approved paclitaxel-eluting TAXUS (Boston Scientific, Natick, MA) stent suggest similar efficacy for the treatment of diabetic patients. By markedly reducing restenosis, DES significantly improve or eliminate the major limitation of conventional stenting/PCI in diabetic patients. The advent of DES promises a paradigm shift from surgical revascularization in diabetic patients (especially those with multivessel disease) to PCI. Nevertheless, continued improvement in DES delivery as well as optimal adjunctive pharmacotherapy and control of hyperglycemia will be required to achieve the best clinical outcomes following PCI with DES in patients with diabetes.


Assuntos
Angioplastia Coronária com Balão , Materiais Revestidos Biocompatíveis/uso terapêutico , Doença das Coronárias/terapia , Diabetes Mellitus/terapia , Stents , Implante de Prótese Vascular , Doença das Coronárias/epidemiologia , Diabetes Mellitus/epidemiologia , Humanos , Estados Unidos/epidemiologia
20.
Drugs ; 62(18): 2589-601, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12465999

RESUMO

The past decade has seen major advances in adjunctive pharmacotherapy for percutaneous coronary intervention. Pharmacological therapeutic advances have resulted from a greater understanding of the pathophysiological mechanisms underlying platelet activation and aggregation, thrombin generation and thrombus formation. Specifically, refinements in the use of unfractionated heparin, developments in the use of low molecular weight heparins and direct antithrombin agents as well as improvement in both oral and parenteral adjunctive antiplatelet therapies have occurred and are reviewed herein.


Assuntos
Angioplastia Coronária com Balão , Trombose Coronária/prevenção & controle , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Ensaios Clínicos como Assunto , Quimioterapia Combinada , Fibrinolíticos/administração & dosagem , Fibrinolíticos/uso terapêutico , Heparina/administração & dosagem , Heparina/uso terapêutico , Humanos , Período Intraoperatório , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Trombina/antagonistas & inibidores
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