Biomarkers in outpatient heart failure management; Are they correlated to and do they influence clinical judgment?

Aims

Heart failure (HF) management is complicated by difficulties in clinical assessment. Biomarkers may help guide HF management, but the correspondence between clinical evaluation and biomarker serum levels has hardly been studied. We investigated the correlation between biomarkers and clinical signs and symptoms, the influence of patient characteristics and comorbidities on New York Heart Association (NYHA) classification and the effect of using biomarkers on clinical evaluation.

Methods and results

This post-hoc analysis comprised 622 patients (77 ± 8 years, 76 % NYHA class ≥3, 80 % LVEF ≤45 %) participating in TIME-CHF, randomising patients to either NT-proBNP-guided or symptom-guided therapy. Biomarker measurements and clinical evaluation were performed at baseline and after 1, 3, 6, 12 and 18 months. NT-proBNP, GDF-15, hs-TnT and to a lesser extent hs-CRP and cystatin-C were weakly correlated to NYHA, oedema, jugular vein distension and orthopnoea (ρ-range: 0.12–0.33; p < 0.01). NT-proBNP correlated more strongly to NYHA class in the NT-proBNP-guided group compared with the symptom-guided group. NYHA class was significantly influenced by age, body mass index, anaemia, and the presence of two or more comorbidities.

Conclusion

In HF, biomarkers correlate only weakly with clinical signs and symptoms. NYHA classification is influenced by several comorbidities and patient characteristics. Clinical judgement seems to be influenced by a clinician’s awareness of NT-proBNP concentrations.

Electronic supplementary material

The online version of this article (doi:10.1007/s12471-013-0503-y) contains supplementary material, which is available to authorized users.     

Molecular basis of the PED/PEA15 interaction with the C-terminal fragment of phospholipase D1 revealed by NMR spectroscopy

PED/PEA15 is a small protein involved in many protein–protein interactions that modulates the function of a number of key cellular effectors involved in major cell functions, including apoptosis, proliferation and glucose metabolism. In particular, PED/PEA15 interacts with the phospholipase D (PLD) isoforms 1 and 2 increasing protein kinase C-α isoform activity and affects both insulin-stimulated glucose transport and glucose-stimulated insulin secretion.     

Obesity polymorphisms identified in genome-wide association studies interact with n-3 polyunsaturated fatty acid intake and modify the genetic association with adiposity phenotypes in Yup’ik people

n-3 Polyunsaturated fatty acids (n-3 PUFAs) have anti-obesity effects that may modulate risk of obesity, in part, through interactions with genetic factors. Genome-wide association studies (GWAS) have identified genetic variants associated with body mass index (BMI); however, the extent to which these variants influence adiposity through interactions with n-3 PUFAs remains unknown. We evaluated 10 highly replicated obesity GWAS single nucleotide polymorphisms (SNPs) for individual and cumulative associations with adiposity phenotypes in a cross-sectional sample of Yup’ik people (n = 1,073) and evaluated whether genetic associations with obesity were modulated by n-3 PUFA intake. A genetic risk score (GRS) was calculated by adding the BMI-increasing alleles across all 10 SNPs. Dietary intake of n-3 PUFAs was estimated using nitrogen stable isotope ratio (δ¹⁵N) of red blood cells, and genotype–phenotype analyses were tested in linear models accounting for familial correlations. GRS was positively associated with BMI (p = 0.012), PBF (p = 0.022), ThC (p = 0.025), and waist circumference (p = 0.038). The variance in adiposity phenotypes explained by the GRS included BMI (0.7 %), PBF (0.3 %), ThC (0.7 %), and WC (0.5 %). GRS interactions with n-3 PUFAs modified the association with adiposity and accounted for more than twice the phenotypic variation (~1–2 %), relative to GRS associations alone. Obesity GWAS SNPs contribute to adiposity in this study population of Yup’ik people and interactions with n-3 PUFA intake potentiated the risk of fat accumulation among individuals with high obesity GRS. These data suggest the anti-obesity effects of n-3 PUFAs among Yup’ik people may, in part, be dependent upon an individual’s genetic predisposition to obesity.

Electronic supplementary material

The online version of this article (doi:10.1007/s12263-013-0340-z) contains supplementary material, which is available to authorized users.     

Proteomic identification of the candidate target proteins of 15‐deoxy‐delta12,14‐prostaglandin J2

15‐Deoxy‐delta12, 14‐prostaglandin J₂ (15d‐PGJ₂) is an endogenous anti‐inflammatory lipid derived from PGD₂. One potential mechanism for its activity is the covalent modification of cellular proteins, via a reactive α,β‐unsaturated carbonyl group in its cyclopentenone ring, which in turn alters protein function. In order to identify the candidate target proteins covalently modified by 15d‐PGJ₂ in human aortic endothelial cell (EC), EC was treated with biotinylated‐15d‐PGJ₂, the modified proteins extracted by Neutravidin affinity‐purification and the proteins identified by LTQ Orbitrap mass spectrometer. Classification of the 358 identified proteins was performed using PANTHER classification system ( www.pantherdb.org ), showing that the proteins mapped to metabolic process, cellular process, and transport activity. This protein data set highlights the potential for 15d‐PGJ₂ to covalently modify cellular proteins and provides a source of data that will aid further studies on the mechanism of action of this endogenous regulator of inflammation.     

Synthesis and characterization of blue long‐lasting BaCa2Al8O15:Eu2+, Dy3+ phosphor

We have synthesized and characterized a new BaCa₂Al₈O₁₅:Eu²⁺,Dy³⁺ phosphor prepared by the combustion method. X‐ray diffraction, thermoluminescence, scanning electron microscope, time decay and optical spectral analysis photoluminescence excitation, emission spectra were used to characterize the phosphors. Broadband ultraviolet excited luminescence of the BaCa₂Al₈O₁₅:Eu²⁺,Dy³⁺ was observed in the blue region (λ_max = 435 nm) due to transitions from the 4f⁶5d¹ to the 4f⁷ configuration of the Eu²⁺ ion. Scanning electron microscopy has been used for exploring the morphological properties of the prepared phosphors. The BaCa₂Al₈O₁₅:Eu²⁺ phosphor has a blue afterglow when Dy³⁺ ions were co‐doped. The thermoluminescence spectra show that the Dy³⁺ ion induces a proper trap in the phosphor with a depth of 0.67 eV and results in a long afterglow phosphorescence. Copyright © 2013 John Wiley & Sons, Ltd.     

Growth differentiation factor 15 in cardiovascular diseases: from bench to bedside

Context: Growth differentiation factor 15 (GDF-15) is a novel cytokine showing close association with cardiovascular diseases. The biological mechanism and clinical use of GDF-15 in cardiovascular diseases have been well demonstrated. We review recent investigations from both basic research and clinical trials into the biological role of GDF-15.

Methods: The data were obtained mainly from MedLine via PubMed and from our own investigations.

Results: Laboratory investigations revealed that GDF-15 has biphasic effects on cellular survival by several signaling pathways. GDF-15 participates in several cardiovascular pathological processes such as cardiac remodeling, ischemia/reperfusion injury and atherosclerotic plaque formation. As well, GDF-15 was found a prognostic biomarker of heart failure and acute coronary syndrome. The evidence for diagnostic or therapeutic utility is poor.

Conclusion: GDF-15 has great potential as a biomarker in cardiovascular diseases, especially for prognosis, and is seen as a myocardial protective cytokine, but the exact mechanism of GDF-15 in cardiovascular diseases remains unknown.     

Adaptor Protein Complexes AP‐4 and AP‐5: New Players in Endosomal Trafficking and Progressive Spastic Paraplegia

The adaptor proteins (APs) are a family of five heterotetrameric complexes with important functions in vesicle trafficking. While the roles of APs 1–3 are broadly established, comparatively little is known about AP‐4 and AP‐5. Current evidence suggests that AP‐4 mediates TGN to endosome transport of specific cargo proteins, such as the amyloid precursor protein APP, and that it is involved in basolateral sorting in polarized cells. Furthermore, several independent studies have reported human patients with mutations in AP‐4 genes. AP‐4 deficiency causes severe intellectual disability and progressive spastic para‐ or tetraplegia, supporting an important role for AP‐4 in brain function and development. The newly discovered AP‐5 complex appears to be involved in endosomal dynamics; its precise localization and function are still unclear. Intriguingly, AP‐5 deficiency is also associated with progressive spastic paraplegia, suggesting that AP‐5, like AP‐4, plays a fundamental role in neuronal development and homeostasis. The unexpected phenotypic parallels between AP‐4 and AP‐5 patients may in turn suggest a functional relationship of the two APs in vesicle trafficking.     

基于Te-OnAdvanced的肺癌细胞15-脂氧化酶-2基因表达载体的构建与表达

目的：构建肺癌细胞15-脂氧化酶-2（15-Lox-2）的可诱导性真核表达载体pTRE-Tight-15-Lox-2,并在肺癌细胞中检测其是否可受强力霉素（DOX）诱导表达。方法：pcDNA3-15-LOX-2载体经＆0RI和XbaI双酶切线性化,回收15-LOX-2cDNA片段,将其克隆入pTRE-Tight载体的EcoRI和XbaI位点;采用脂质体法将pTet-0n-Ad-vanced与构建的pTRE-Tight-15-Lox-2共转染肺腺癌A549细胞,DOX诱导表达后,Western印迹检测15-Lox-2的表达水平。结果：构建了pTRE-Tight-15-Lox-2诱导表达载体;Western印迹检测表明,该载体能在肺癌细胞内表达,且其表达受DOX调控。结论：Tet-OnAdvanced系统能严密高效地调控15-LOX-2在肺癌细胞中的表达,为进一步研究15-LOX-2在肺癌中的作用奠定了基础。     

A novel neuroprotective agent with antioxidant and nitric oxide synthase inhibitory action

N^α-vanillyl-N^ω-nitroarginine (N ? 1) that combines the active functions of natural antioxidant and nitric oxide synthase inhibitor was developed for its neuroprotective properties. N ? 1 exhibited protective effects against hydrogen peroxide-induced cell damage and the inhibitory effect on nitric oxide ‘NO’ production induced by calcium ionophore in NG 108-15 cells. N ? 1 inhibited the constitutive NOS isolated from rat cerebellar in a greater extent than constitutive NOS from human endothelial cells. Low binding energy ( ? 10.2 kcal/mol) obtained from docking N ? 1 to nNOS supported the additional mode of action of N ? 1 as an nNOS inhibitor. The in vivo neuroprotective effect on kainic acid-induced nitric oxide production and neuronal cell death in rat brain was investigated via microdialysis. Rats were injected intra-peritonially with N ? 1 at 75 μmol/kg before kainic acid injection (10 mg/kg). The significant suppression effect on kainic acid-induced NO and significant increase in surviving cells were observed in the hippocampus at 40 min after the induction.     

Aldo-keto reductase 1C15 as a quinone reductase in rat endothelial cell: Its involvement in redox cycling of 9,10-phenanthrenequinone

Abstract

9,10-Phenanthrenequinone (9,10-PQ), a redox-active quinone in diesel exhausts, triggers cellular apoptosis via reactive oxygen species (ROS) generation in its redox cycling. This study found that induction of CCAAT/enhancer-binding protein-homologous protein (CHOP), a pro-apoptotic factor derived from endoplasmic reticulum stress, participates in the mechanism of rat endothelial cell damage. The 9,10-PQ-mediated CHOP induction was strengthened by a proteasome inhibitor (MG132) and the MG132-induced cell sensitization to the 9,10-PQ toxicity was abolished by a ROS inhibitor, suggesting that ROS generation and consequent proteasomal dysfunction are responsible for the CHOP up-regulation caused by 9,10-PQ. Aldo-keto reductase (AKR) 1C15 expressed in rat endothelial cells reduced 9,10-PQ into 9,10-dihydroxyphenanthrene concomitantly with superoxide anion formation, implying its participation in evoking the 9,10-PQ-redox cycling. The 9,10-PQ-induced damage was augmented by AKR1C15 over-expression. 9,10-PQ also provoked the AKR1C15 up-regulation, which sensitized against the quinone toxicity. These results suggest the presence of a negative feedback loop exacerbating the quinone toxicity in rat endothelial cells.