High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort

Background

Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events.

Methods

We studied 1,088 patients (follow-up 2.2±0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality.

Results

Hs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88–6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus P<0.01). This was not the case for hsCRP and NT-proBNP.

Conclusions

Hs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results.     

Vitamin k-antagonists accelerate atherosclerotic calcification and induce a vulnerable plaque phenotype

Background

Vitamin K-antagonists (VKA) are treatment of choice and standard care for patients with venous thrombosis and thromboembolic risk. In experimental animal models as well as humans, VKA have been shown to promote medial elastocalcinosis. As vascular calcification is considered an independent risk factor for plaque instability, we here investigated the effect of VKA on coronary calcification in patients and on calcification of atherosclerotic plaques in the ApoE^−/− model of atherosclerosis.

Methodology/Principal Findings

A total of 266 patients (133 VKA users and 133 gender and Framingham Risk Score matched non-VKA users) underwent 64-slice MDCT to assess the degree of coronary artery disease (CAD). VKA-users developed significantly more calcified coronary plaques as compared to non-VKA users. ApoE^−/− mice (10 weeks) received a Western type diet (WTD) for 12 weeks, after which mice were fed a WTD supplemented with vitamin K₁ (VK₁, 1.5 mg/g) or vitamin K₁ and warfarin (VK₁&W; 1.5 mg/g & 3.0 mg/g) for 1 or 4 weeks, after which mice were sacrificed. Warfarin significantly increased frequency and extent of vascular calcification. Also, plaque calcification comprised microcalcification of the intimal layer. Furthermore, warfarin treatment decreased plaque expression of calcification regulatory protein carboxylated matrix Gla-protein, increased apoptosis and, surprisingly outward plaque remodeling, without affecting overall plaque burden.

Conclusions/Significance

VKA use is associated with coronary artery plaque calcification in patients with suspected CAD and causes changes in plaque morphology with features of plaque vulnerability in ApoE^−/− mice. Our findings underscore the need for alternative anticoagulants that do not interfere with the vitamin K cycle.     

Experimental test of intraspecific competition mechanisms among tadpoles of Leptodactylus ocellatus (Anura: Leptodactylidae)

Intraspecific competition is predicted to strongly influence species abundance and dynamics through two main mechanisms: consumption and interference of resources. Tadpoles were used in experiments in which we tried to elucidate the relative importance of each mechanism. Our goal was to apply this experimental procedure to Leptodactylus ocellatus, a common South American anuran, a species whose larvae exhibit aggregative behavior and receive parental care. Previous work suggests that tadpole schools should present lower levels of intraspecific competition. Tadpoles from a single nest were reared in the laboratory in three densities (1, 2, and 4 individuals/container) and three food levels (1, 2, and 4 ration multiples) in a randomized three-block design for a factorial analysis of variance, up to day eight. Contrary to previous work with other species, our results show both the absence of interference competition effects, and that larval growth depends only on per capita food availability. The differences between species in intraspecific competition mechanisms are probably related to strong differences in ecology and life history. Leptodactylus ocellatus tadpoles could be directing interference competition away from their kin, reducing schooling costs. Further studies (including kinship as a factor) would give more information about these larvae, allowing a better understanding of the evolutionary and ecological mechanisms behind the biological patterns observed in Leptodactylus species.     

Current status of American bullfrog, <Emphasis Type="Italic">Lithobates catesbeianus</Emphasis>, invasion in Uruguay and exploration of chytrid infection

The American bullfrog Lithobates catesbeianus is an invasive species that can strongly affect native amphibian communities through competition, predation, or introduction of diseases. This frog has invaded multiple areas in South America, for which niche models predict suitable environments across much of the continent. This paper reveals the state of the invasion of this species in Uruguay and its possible relationship with the chytrid pathogenic fungus, Batrachochytrium dendrobatidis. Surveys at invaded sites were conducted from 2007 to 2015, identified two populations undergoing recent range expansion (one of them exponential), two populations that failed to establish, and a new record in an urban area of the capital city, Montevideo. In all the analysed feral populations, chytridiomycosis was found. Our data suggest that the invasion of L. catesbeianus in Uruguay is at an early stage, with very localized populations, which might allow for the implementation of cost-effective management plans, with eradication constituting a plausible option.     

A case study for late Archean and Proterozoic biogeochemical iron‐ and sulphur cycling in a modern habitat—the Arvadi Spring

As a consequence of Earth's surface oxygenation, ocean geochemistry changed from ferruginous (iron(II)‐rich) into more complex ferro‐euxinic (iron(II)‐sulphide‐rich) conditions during the Paleoproterozoic. This transition must have had profound implications for the Proterozoic microbial community that existed within the ocean water and bottom sediment; in particular, iron‐oxidizing bacteria likely had to compete with emerging sulphur‐metabolizers. However, the nature of their coexistence and interaction remains speculative. Here, we present geochemical and microbiological data from the Arvadi Spring in the eastern Swiss Alps, a modern model habitat for ferro‐euxinic transition zones in late Archean and Proterozoic oceans during high‐oxygen intervals, which enables us to reconstruct the microbial community structure in respective settings for this geological era. The spring water is oxygen‐saturated but still contains relatively elevated concentrations of dissolved iron(II) (17.2 ± 2.8 μM) and sulphide (2.5 ± 0.2 μM) with simultaneously high concentrations of sulphate (8.3 ± 0.04 mM). Solids consisting of quartz, calcite, dolomite and iron(III) oxyhydroxide minerals as well as sulphur‐containing particles, presumably elemental S⁰, cover the spring sediment. Cultivation‐based most probable number counts revealed microaerophilic iron(II)‐oxidizers and sulphide‐oxidizers to represent the largest fraction of iron‐ and sulphur‐metabolizers in the spring, coexisting with less abundant iron(III)‐reducers, sulphate‐reducers and phototrophic and nitrate‐reducing iron(II)‐oxidizers. 16S rRNA gene 454 pyrosequencing showed sulphide‐oxidizing Thiothrix species to be the dominating genus, supporting the results from our cultivation‐based assessment. Collectively, our results suggest that anaerobic and microaerophilic iron‐ and sulphur‐metabolizers could have coexisted in oxygenated ferro‐sulphidic transition zones of late Archean and Proterozoic oceans, where they would have sustained continuous cycling of iron and sulphur compounds.     

Uptake of homologous haemolymph protein by salivary glands of Chironomus thummi

Radioisotopically labelled homologous protein fractions were injected into the haemolymph of Chironomus larvae. Among four different protein fractions, fraction II appears to enter the salivary gland and accumulates in the glandular lumen. Lack of blood pigmentation in the gland and secretion lumen indicates that the haemoglobin is probably not secreted, but a portion of the haemoglobin molecule or a fraction co-precipitating with haemoglobin in fraction II is being transported by the gland. Since only a portion of fraction II is taken up and secreted, the specificity of the process suggests to us a molecular basis for the activity which must ultimately be reflected in the genes of the transporting tissue.     

Recent advances in JAK3 inhibition: Isoform selectivity by covalent cysteine targeting

Janus kinases (JAKs) are a family of four cytosolic protein kinases with a high degree of structural similarity. Due to its very restricted role in immune regulation, JAK3 was promoted as an excellent target for immunosuppression for more than a decade, but clinical validation of this concept is still elusive. During the last years, speculation arose that kinase activity of JAK1, which cooperates with JAK3 in cytokine receptor signaling, may have a dominant role over the one of JAK3. Until recently, however, this issue could not be appropriately addressed due to a lack of highly isoform-selective tool compounds. With the recent resurgence of covalent drugs, targeting of a specific cysteine that distinguishes JAK3 from other JAK family members became an attractive design option. By applying this strategy, a set of JAK3 inhibitors with excellent selectivity against other JAK isoforms and the kinome was developed during the last three years and used to decipher JAK3-dependent signaling. The data obtained with these tool compounds demonstrates that selective JAK3 inhibition is sufficient to block downstream signaling. Since one of these inhibitors is currently under evaluation in phase II clinical studies against several inflammatory disorders, it will soon become apparent whether selective JAK3 inhibition translates into clinical efficacy.