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Posts Tagged ‘glycerophospholipids’


Peptides and anti-Cancer activity

Larry H. Bernstein, MD, FCAP, Curator

LPBI

 

PE and PS Lipids Synergistically Enhance Membrane Poration by a Peptide with Anticancer Properties

Natália Bueno Leite, Anders Aufderhorst-Roberts, Mario Sergio Palma, Simon D. Connell, João Ruggiero Neto, Paul A. Beales
Biophys J 1 Sept 2015; 109(5):936–947.   DOI: http://dx.doi.org/10.1016/j.bpj.2015.07.033
Polybia-MP1 (MP1) is a bioactive host-defense peptide with known anticancer properties. Its activity is attributed to excess serine (phosphatidylserine (PS)) on the outer leaflet of cancer cells. Recently, higher quantities of phosphatidylethanolamine (PE) were also found at these cells’ surface. We investigate the interaction of MP1 with model membranes in the presence and absence of POPS (PS) and DOPE (PE) to understand the role of lipid composition in MP1’s anticancer characteristics. Indeed we find that PS lipids significantly enhance the bound concentration of peptide on the membrane by a factor of 7–8. However, through a combination of membrane permeability assays and imaging techniques we find that PE significantly increases the susceptibility of the membrane to disruption by these peptides and causes an order-of-magnitude increase in membrane permeability by facilitating the formation of larger transmembrane pores. Significantly, atomic-force microscopy imaging reveals differences in the pore formation mechanism with and without the presence of PE. Therefore, PS and PE lipids synergistically combine to enhance membrane poration by MP1, implying that the combined enrichment of both these lipids in the outer leaflet of cancer cells is highly significant for MP1’s anticancer action. These mechanistic insights could aid development of novel chemotherapeutics that target pathological changes in the lipid composition of cancerous cells.

The antimicrobial peptide Polybia-MP1 (IDWKKLLDAAKQIL-NH2), or simply MP1, has unexpectedly been shown to exhibit selective inhibition against several types of cancerous cells and therefore could prove advantageous in the development of novel chemotherapies. Extracted from the Brazilian waspPolybia paulista, MP1 has a broad spectrum of bactericidal activities against Gram-negative and Gram-positive bacteria without being hemolytic and cytotoxic (1). Surprisingly, MP1 also selectively inhibits proliferating bladder and prostate cancer cells (2), and multidrug-resistant leukemic cells (3). Recently, it has been observed that this peptide is cytotoxic against leukemic T lymphocytes and very selective in recognizing these cells compared to healthy lymphocytes (4).

Cancer cell membranes are now known to lose the asymmetric transmembrane distribution of phospholipids that is observed in healthy cells (5, 6). In healthy mammalian cells, the anionic aminophospholipid PS (phosphatidylserine) is predominant in the inner membrane leaflet and zwitterionic phospholipids are predominant in outer membrane leaflet. In such cells, the phospholipid asymmetry is maintained by a family of aminophospholipid translocases that catalyze the transport of PS from the outer to the inner membrane leaflets (7). However, in apoptotic and cancer cells, PS is found to also be located in the outer monolayer of the plasma membrane in significant proportions (5, 6).

The molecular-scale mechanistic basis for MP1’s anticancer properties is yet to be established. Changes in the distribution and/or composition of lipids (e.g., PS) within the plasma membrane of malignant cells could be the origin of MP1’s cancer selectivity. This is a reasonable hypothesis, based upon the well-established selectivity of antimicrobial peptides for bacterial membranes over eukaryotic membranes due to their higher anionic lipid content (8, 9, 10, 11). Recently, the effect of PS on the pore-forming activity of MP1 was investigated by multiple techniques, namely, conductance measurements in planar bilayer lipid membranes, binding assays, and lytic activity on large unilamellar vesicles (4). Although an increase in affinity and lytic activity of MP1 for lipid vesicles containing PS was observed, MP1’s pore-formation activity in BLM showed no difference between PC (phosphatidylcholine) and mixed PC/PS bilayers. Significantly, it was recently reported that PE (phosphatidylethanolamine) lipids, naturally found on the inner plasma membrane of normal cells, are also externalized to the outer monolayer of the plasma membrane of apoptotic and tumor endothelial cells due to both PS and PE lipids being coregulated by the same transporters (7). These authors observed that the exposure to the outer monolayer of one of these phospholipids leads to the exposure of the other. Therefore, it is important for future work to establish the role of increased concentrations of both PE and PS lipids in the interaction of MP1 with membranes.

In this work, we address this challenge by establishing the roles of PE and PS lipids in the effects of MP1 on the structure and permeability of model membranes. Primarily, we study the permeability of giant unilamellar vesicles (GUVs) at the single vesicle level. Fluorescence confocal microscopy was used to determine the size-dependent macromolecular permeability of lipid membranes in GUV model systems by analyzing the influx of three fluorescent dyes with molecular masses of 0.37, 3.0, and 10.0 kDa into these vesicles (Fig. 1). We deconvolve the effects of PS and PE lipids by exploring their effects within DOPC (PC) membranes both separately and in combination: DOPC/POPS 80:20 (PC/PS), DOPC/DOPE 90:10 (PC/PE), and DOPC/DOPE/POPS 70:10:20 (PC/PE/PS). These experiments are corroborated by circular dichroism (CD) spectroscopy to quantify peptide binding to the membrane, fluorescence spectroscopy experiments to establish the leakage mechanism in an ensemble system of nanoscale large unilamellar vesicles (LUVs), and atomic-force microscopy (AFM) imaging of supported lipid bilayers to reveal the nanoscale perturbations of membrane structure induced by the peptide. By combining these approaches, we show that, while PS lipids significantly enhance MP1’s binding onto the membrane, PE lipids impart the most significant contribution to the rate and extent of membrane permeabilization by MP1, facilitating the opening of larger membrane defects than in bilayers lacking in PE.

Thumbnail image of Figure 1. Opens large image

http://www.cell.com/cms/attachment/2035808117/2051293431/gr1.jpgFigure 1

Schematic representation of membrane disruption by peptides and the experimental system. The helical peptide Polybia-MP1 is shown according to the helical wheel projections. Amino acids: (blue) polar with positive net charge; (purple) polar with negative net charge; (red) polar noncharged; and (green) nonpolar. Confocal microscopy was performed to investigate the influx of three dyes with distinct sizes in GUVs in the presence and absence of PE lipids: 0.37 kDa CF (green), 3k-CB (blue), 10k-AF647 (magenta), and the scale bars correspond to 10 μm. Lipid membranes are labeled with Rh-DOPE (red). The peptide interacts with the GUVs, disturbs their structure, and then enables the passage of fluorescent dyes by formation of pore-like structures. To see this figure in color, go online.

Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

Results

Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

PS lipids significantly enhance peptide binding to the membrane

The overall efficacy of a peptide at disrupting a target membrane can be broken down into the combination of two sequential steps: 1) binding of the peptide to the membrane surface, and 2) the efficiency of membrane disruption by the bound peptide resulting in membrane poration or leakage. First, we investigate the membrane binding isotherms of the MP1 peptide to our four lipid compositions of interest by CD spectroscopy by titrating a 10 μM MP1 solution with increasing lipid (LUV) concentrations (Fig. 2). Fitting these binding isotherms revealed that the partition coefficient (Kp) of the peptide was 7–8 times higher for membrane compositions containing PS (Kp values were PC 4600 M−1, PC/PE 4000 M−1, PC/PS 33,000 M−1, and PC/PE/PS 30,000 M−1). It is also interesting to note from this data that PE lipids slightly suppress peptide binding by a factor of ∼10%. Due to the cationic nature of MP1 (net charge of +2e), it is highly likely that the enhanced peptide binding to anionic-PS-containing membranes is primarily driven by electrostatic interactions.

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Figure 2

Binding isoterms show that MP1 has a higher affinity for PS-containing membranes. The binding isoterms and the partition coefficients (Kp) obtained using CD by lipid titration at 10 μM MP1 solution. LUVs are composed of (a) PC, (b) PC/PE, (c) PC/PS, and (d) PC/PE/PS.

Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations

To investigate the efficiency of membrane disruption, we measured the leakage of macromolecules across GUV model membranes by confocal fluorescence microscopy. Fluorescent passive leakage markers of different sizes were simultaneously employed: 0.37 kDa carboxyfluorescein (CF), 3 kDa dextran labeled with Cascade Blue (3k-CB), and 10 kDa dextran labeled with Alexa Fluor 647 (10k-AF647). GUVs were composed of PC, PC/PS, PC/PE, or PC/PE/PS. The dose-response of the membranes to the addition of MP1 was characterized for each membrane composition and passive leakage marker by evaluating the normalized fluorescence intensities of the probes in the intravesicular lumen of the GUVs after 30 min incubation time (Fig. 3 and Fig. S1 in the Supporting Material). Each data point in Figs. 3 and S1 shows the mean leakage of 50 individual GUVs from a minimum of two independent experiments. For determining the percentage of leaked vesicles (Fig. 3), a threshold of 20% leakage (normalized to the background probe concentration) was used to define a filled vesicle. Alternatively, this data can be analyzed in terms of the average leakage into GUVs as a percentage of the probe concentration in the external medium (Fig. S1).

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Figure 3
Dose-response curves show increased leakage of PE containing GUVs at lower peptide concentrations. (a and c) Percentage of GUVs filled by CF (0.37 kDa) after 30 min incubation time with MP1. (b and d) Percentage of GUVs filled by 10k-AF647 after 30 min incubation time with MP1. All vesicles presenting >20% of dye entry were accounted as filled. The data is plotted as a function of (a and b) total peptide concentration and (c and d) the concentration of peptide bound to the membranes. Fifty GUVs were used to construct each data point. Vesicles are composed of PC, PC/PS, PC/PE, and PC/PE/PS. To see this figure in color, go online.

The integrity of membranes containing both PE and PS lipids is perturbed by lower concentrations of MP1 peptide than the other membrane compositions we investigated. PC/PE/PS GUVs show significant (40–65%) leakage to the CF probe at 0.4 and 1.2 μM MP1 concentrations, whereas other membrane compositions studied leaked <30% within this concentration range (Fig. S1a).

Larger pore defects, evidenced by leakage of the larger 10k-AF647 probe, are shown to be significantly enhanced in membranes containing 10% PE. Almost all GUVs (98%) containing PE lipids are observed to leak the 10k-AF647 probe when in the presence of 4.0 μM MP1, compared to <60% of GUVs for other membrane compositions at the same peptide concentration (Fig. 3b). This is the most significant enhancement in selective perturbation for specific lipid membrane compositions observed within the dose-response data in Figs. 3 andS1. At this MP1 concentration, membranes under native conditions would be susceptible to the leakage of biological macromolecules such as small proteins and RNAs.

Interestingly, we also plot the GUV leakage data as a function of the concentration of bound peptide on the membrane using the specific partition coefficients of the peptide for different lipid compositions that were calculated inFig. 2 (see also Figs. 3, c and d, and S1, c and d). This representation of the data clearly shows that PE lipids increase the susceptibility of PC membranes to disruption by the MP1 peptide, with PC/PE lipids leaking at significantly lower bound peptide concentrations. Due to the higher bound concentration of peptide to membranes containing PS lipids, this lipid decreases the apparent susceptibility of the membrane to leakage as observed by the onset of leakage shifting to higher bound peptide concentrations. For PC/PE/PS GUVs, the apparent competing effects of PE and PS lipids on the membrane’s leakage susceptibility roughly cancel each other out, leading to intermediate membrane disruption susceptibility for a given bound peptide concentration. However, the effect of increased bound peptide concentrations due to PS far outweighs its apparent inhibition of membrane leakage, making PC/PE/PS GUVs the most susceptible to leakage for a given total peptide concentration. Therefore, the combined roles of PS in increasing membrane binding and PE in increasing the susceptibility of the membrane are both important in increasing the membrane disruptive efficacy of MP1.

Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

Confirmation of the pore-formation hypothesis in lipid vesicles

Fluorescence spectroscopy experiments using LUVs give ensemble-averaged measurements with high statistics on a large population of vesicles, complementing single-vesicle GUV imaging experiments that inherently have lower statistics but yield information on the distribution of behaviors and rare events within a sample. The fluorescence requenching method (18) enables us to distinguish the type of leakage mechanism induced by MP1 for the lipid compositions under investigation. One possibility is the all-or-none mechanism where some vesicles release all of their internal contents while the others remain intact. This is attributed to pore-formation mechanisms of membrane perturbation, or complete vesicle lysis. Another possibility is the gradual leakage mechanism where vesicles only release a fraction of their encapsulated contents during a leakage event. This is associated with transient perturbations of the membrane. A fluorophore (ANTS) and a quencher (DPX) are encapsulated within lipid vesicles at high concentrations such that the fluorescence is initially quenched; vesicle leakage results in the release of both ANTS and DPX, but quenching is decreased due to dilution of these probes. The externalized ANTS fluorescence can be suppressed by additional titration of DPX such that the remaining fluorescence signal is only due to the ANTS inside intact vesicles. The data can be represented by a plot of the degree of quenching (Qin) against the released ANTS fraction (fout). In the case of an all-or-none leakage mechanism, the plot of Qin versus fout will show no dependence of Qin on fout. In contrast, the gradual leakage mechanism causes release of only a fraction of the encapsulated contents within individual vesicles and so Qin increases with increasing fout (18).

large Image

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Figure 4

Fluorescence requenching assays for MP1 reveal all-or-none leakage in the four lipid compositions studied. Qin is constant as a function of fout for MP1, which is in agreement with the all-or-none mechanism of dye release.) (Lines) Theoretical curves for ideal graded and all-or-none dye release (18). To see this figure in color, go online.

Fig. 4 shows that the values of Qin remain constant with the increase of fout and the consequent increase of peptide/lipid molar ratios. This clearly shows that MP1 exhibits the all-or-none leakage mechanism for all lipid compositions studied, which is in contrast to what has been observed for antimicrobial peptides mastoparan X and mastoparan MP (19). We propose that this all-or-none leakage is related to peptide-induced pore formation (20, 21, 22, 23), where the vesicles are able to release all their internal contents through pore-like structures that are sufficiently long lived (23, 24, 25, 26, 27, 28). We do not solely attribute the all-or-none leakage to lysis of the vesicles because nonlysed, leaky vesicles are observed in our GUV experiments (Figs. 3 and S1). However, we do not discount the possibility that lysis might play a role in the LUV leakage at the highest peptide concentrations used in this assay. Furthermore, pore-like activity of MP1 has previously been identified from electrophysiology measurements in planar lipid bilayers composed of phytanoyl-PC and phytanoyl-PC/PS (70:30) (4).

Our fluorescence requenching results show that stable pores form with a lifetime that persists long enough for the dye efflux to reach equilibrium in LUV systems. However, this does not discount the possibility that pores might be transient over longer timescales, for example during the leakage of much larger vesicles such as GUVs where the encapsulated volume of dye that needs to be released during a leakage event is ∼106 times greater than for the LUV model system. Indeed, we will see some evidence for transient pore events and dynamic changes in membrane permeability in the single GUV leakage kinetics data that follows. Nevertheless, all-or-none leakage is clearly evident in GUVs after 30 min incubation with 1.2 and 4.0 μM MP1. Leakage histograms of the individual GUVs (an alternative representation of data shown in Figs. 3 and S1) predominantly show either Math Eq20% (unleaked) or Math Eq80% (fully leaked) leakage (Fig. S2).
Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

Synergistic enhancement of GUV leakage kinetics by PE and PS lipids

Analysis of the time delay from the start of our GUV experiments (addition of the peptide) to observations of the onset of GUV leakage reveals a synergistic reduction in this lag time for PC/PE/PS membranes (Table 1 and Fig. 5). In these GUV experiments, we add 4.0 μM MP1 to our samples and monitor the time taken for initial leakage events of GUVs to the 0.37 kDa CF probe to occur (t0tCF). This MP1 concentration is chosen as it causes significant leakage of GUVs within 30 min of peptide addition across all four lipid compositions of interest. The onset of leakage occurs approximately twice as quickly for PC/PE/PS GUVs than for other membrane compositions, with only a very slight reduction of the lag time for PC/PS membranes compared with PC/PE and PC GUVs. Therefore, this is not a purely electrostatic effect from the increased rate and extent of peptide binding to anionic PS-containing membranes; it also requires the presence of PE to significantly increase the susceptibility of the membrane to permeabilization.

Table 1Lag times between the onset of leakage of each dye and the time interval before the initial leakage takes place after the addition of peptide
Time Delays (s) PC/PE PC/PE/PS PC/PS PC
t0tCF 1600 ± 110 760 ± 120 1400 ± 60 1600
tCFt3k-CB 1.8 ± 0.6 1.5 ± 0.3 41 ± 5a 160 ± 110
tCFt10k-AF647 4.2 ± 1.5 2.0 ± 0.4 52 ± 6 220 ± 66
t3k-CBt10k-AF647 2.7 ± 0.9 1.4 ± 0.4 9.6 ± 1.2 60 ± 42

The errors represent the standard deviation of the observed GUV data set.

aFor PC/PS GUVs, the tCFt3k-CB data only includes GUVs that leaked to all three dyes; these sample conditions contained two distinct populations of GUV leakage behaviors where a second population of GUVs only leaked to the CF and 3k-CB dyes with a time delay of tCFt3k-CB = 4.8 ± 0.6 s.
large Image
Figure 5
GUV permeabilization kinetics are synergistically enhanced by PE and PS lipids. (a) Comparison between dye influx kinetics of three distinct dyes (CF-0.37kDa, 3k-CB, and 10k-AF647) for PC/PE/PS and PC/PS GUVs. The time axis represents the time after peptide addition. These individual GUV leakage profiles were chosen as they represent the average behavior of the GUVs observed under these conditions. (b) Schematic representation of the dye influx kinetics for PC/PS and PC/PE/PS GUVs in the presence of CF and 10k-AF647 passive leakage markers. This shows the average lag times for GUV leakage after the addition of 4.0 μM MP1 and the typical average leakage extent of the GUVs that resulted in these experiments. To see this figure in color, go online.
We also quantify the average delay times between leakage of the different-sized fluorescent probes between CF and 3k-CB (tCFt3k-CB), CF and 10k-AF647 (tCFt10k-AF647), and 3k-CB and 10k-AF647 (t3k-CBt10k-AF647). Once the initial leakage event occurs, PE-containing GUVs rapidly become leaky to fluorescent probes of larger sizes (3 and 10 kDa). For PC/PE/PS and PC/PE membranes, GUVs become leaky to larger 3k-CB, then 10k-AF647 passive leakage markers within seconds of permeabilization to the smallest CF (0.37 kDa) probe (Table 1). The consecutive delay times between CF and 3k-CB probes and 3k-CB and 10k-AF647 probes were approximately an order-of-magnitude longer for PC/PS membranes, and almost two orders-of-magnitude longer for purely PC membranes. This strongly implies that the presence of PE significantly enhances the favorability and rate of formation of larger membrane defects or pores.
Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

PE lipids significantly enhance pore size and membrane permeability

We use time-series confocal microscopy imaging to quantify the membrane permeability of GUVs during initial leakage. Quantification of the fluorescence intensity of the leakage markers in the intravesicular and extravesicular medium allows us to calculate the fractional leakage of individual GUVs as a function of time. The leakage kinetics of individual GUVs are monitored for up to 30 min after the addition of 4.0 μM MP1. This concentration is chosen as all lipid compositions show significant leakage within 30 min; a higher MP1 concentration of 10 μM is observed to induce significant lysis of GUV samples (Fig. S3). These experiments are conducted on GUVs of all four membrane compositions under investigation, using the CF, 3k-CB, and 10k-AF647 leakage markers simultaneously. This allows the time evolution of membrane permeability to different molecular sizes to be simultaneously measured for individual GUVs (Figs. 5a and S4). To the best of our knowledge, this is the first example of simultaneous size-dependent permeability measurements in GUVs for three different-sized leakage markers.

Typical leakage kinetic profiles for different membrane compositions and probe sizes are shown in Figs. S4 and 5a. It can be qualitatively seen from these example profiles that membrane compositions containing 10% PE exhibit full and rapid membrane leakage for all three sizes of leakage marker, consistent with the leakage kinetics data in Table 1, which is also outlined in Fig. 5b. For membrane compositions lacking PE, the leakage rates can sometimes be seen to increase and decrease intermittently, sometime plateauing before full leakage is achieved; this is particularly evident in the leakage profile of a single PC/PS GUV shown in Fig. S5. We attribute these observations to membrane self-healing events, where the pores/defects reseal and the membrane regains its permeability barrier, followed by later phases of increased leakage. This is particularly observed for the larger 3k-CB and 10k-AF647 leakage probes. Therefore, the membrane permeability for PC and PC/PS GUVs, in particular, can change dynamically during the observed leakage events; this is a result of the competition between the lipid bilayer and peptides in maintaining their barrier properties and inducing membrane pores, respectively (Fig. S5).

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Figure 6

PE lipids facilitate much greater membrane permeability in GUV membranes. (a) Typical log-linear plot of time-dependent dye influx: −R/3ln(1−c) (105) versus time, for the three dyes in a single GUV of PC/PS. (b) Distributions of the obtained permeabilities in single GUVs composed of PC/PS. (c) Typical log-linear plot of time-dependent dye influx: −R/3ln(1−c) (10−5) versus time, for the three dyes in a single GUV of PC/PE/PS. (d) Distributions of the obtained permeabilities in single GUVs composed of PC/PE/PS. The permeabilities are obtained from the slopes of the log-linear plots of the time-dependent influx of dyes into single GUVs. To see this figure in color, go online.

Our leakage kinetic profiles were used to calculate the membrane permeability to the different-sized probes using a diffusional model for membrane translocation (29); the membrane permeability is the gradient of the log-linear plot as seen in the example data in Fig. 6, a and c. Average permeability values for each membrane composition to each probe size during the initial leakage events are shown in Table 2. It can be seen that, for all membrane compositions tested, average permeability decreases with increasing probe size. However, the most significant finding from this data is the large, one-order-of-magnitude increase, in membrane permeability for membrane compositions containing 10% PE. This can be observed for all three leakage markers studied. It can also be seen that the presence of PS in the membrane imparts a modest, but significant, increase in permeability on the membranes upon perturbation by MP1. This effect can be seen further in Fig. 6, b and d, which show the distributions of permeability measurements for PC/PS and PC/PE/PS GUVs to the CF and 10k-AF647 leakage markers, respectively. For both probe sizes, the majority of permeability measurements for PC/PS membranes were in the 0–25 nm/s range, whereas when PE was included in the membrane formulations, a large proportion of permeability measurements were >500 nm/s.

Table 2Average permeability values (〈Pm〉) and the average fractional permeated area per vesicle (〈Ap〉/〈Av〉) obtained from the average permeability values for each probe size and membrane composition
PmCF(nm/s) Ap〉/〈AvCF(106) Pm3k-CB(nm/s) Ap〉/〈Av3k-CB(106) Pm10k-AF647(nm/s) Ap〉/〈Av10k-AF647 (106)
PC 46 ± 14 0.45 ± 0.14 17 ± 6 0.50 ± 0.16 8 ± 2 0.44 ± 0.08
PC/PS 59 ± 12 0.58 ± 0.12 29 ± 6 0.90 ± 0.20 23 ± 4 1.30 ± 0.20
PC/PE 466 ± 143 4.60 ± 1.40 207 ± 102 6.50 ± 3.40 158 ± 53 8.80 ± 2.90
PC/PE/PS 589 ± 142 5.80 ± 1.40 333 ± 73 10.40 ± 2.80 169 ± 52 9.40 ± 2.90

The errors represent the standard deviation of the observed GUV data set.

It should be noted that the observed permeability distributions (Fig. 6, b and d) are broad due to the fact that peptide-induced pores do not have well-defined structures, pore formation events are stochastic, and the membrane interfaces are fluid, giving rise to this wide distribution of individual permeability events when measured at the single vesicle level. Indeed, it has previously been reported that the initial pores that form during peptide-induced pore formation might be far from equilibrium and can, for example, relax to a smaller size over longer timescales as has been observed for the peptides Bax-α5 (23) and magainin 2 (30).

The permeability data was used to calculate the effective fractional permeable area of the membrane for each probe size using the expression (29)

Math Eq

where Ap is the permeable area of membrane on a GUV, Av is the total area of the vesicle, Pm is the permeability, and δ is the thickness of the membrane. The Stokes-Einstein diffusion constant of the leakage marker is D0 = kT/6πηR0, where kT is the thermal energy, η is the solvent viscosity, and R0 is the hydrodynamic radius of the fluorescent dye that was estimated with the relationR0 = 0.0332(Mw)0.463 in nanometers (31); Mw is the molecular weight of the dye. A brief derivation of this equation is presented in the Supporting Material. It should be noted that this equation is most accurate for the formation of large membrane pores as it assumes that the diffusion constant of the dye within the pore is the same as its diffusion constant in bulk solution. However, we believe this to be a reasonable assumption because these passive leakage markers will have a very short residence time within the pore itself due to the bilayer only being ∼5-nm thick; these solutes are not expected to interact strongly with the membrane itself.

Values of the fractional permeable areas are shown in Table 2. The fractional permeable areas were also found to be an order-of-magnitude greater for membrane compositions containing PE than for those that did not. Note that slightly larger permeable areas were measured for the larger leakage markers; these represent a later time point in the membrane disruption of GUVs by MP1 as the smaller leakage markers translocate the membrane at earlier times (Table 1). This extended delay time therefore allows for a greater area of membrane disruption to occur before the initiation of leakage to the larger Mw dyes.

Besides the order-of-magnitude increase in membrane permeabilization in the presence of PE lipids, we found an interesting correlation between PE content and membrane morphological response to MP1. Without PE, PC and PC/PS GUVs exhibited bright spots of fluorescent lipids at specific locations on the membrane surface in the presence of 4.0 μM MP1 (Fig. 7). We attribute these observations to local aggregation of peptides and lipids at the GUV surface. These peptide-induced lipid aggregates may be in competition with the pore-/defect-forming activity of the peptides. Such dense lipid structures were not seen on GUVs containing PE (PC/PE and PC/PE/PS) upon introduction of the peptide. Therefore, we speculate that the PE suppresses the intramembrane lipid aggregation by more easily facilitating the poration of the membrane.

large Image
Figure 7

Lipid aggregation is observed within the membranes of GUVs lacking in PE. Images of local lipid aggregation at the GUV surface (bright localized spots of fluorescence) seen after peptide addition (Cp = 4.0 μM). This effect is frequently observed in PC and PC/PS GUVs, but not for the lipid mixtures containing 10 mol % PE. To see this figure in color, go online.

While localized lipid aggregation was not observed on the surface of the PE-containing GUVs, these GUVs were observed to decrease in diameter by ∼10–15% over a period of ∼1 h after peptide addition (Fig. S6). Contrary to this, PC and PC/PS GUVs remained at a constant size for up to 2 h after addition of MP1. Therefore, MP1 results in the significant loss of lipid from only those GUVs that contain PE lipids.

Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

Direct imaging of peptide-induced pores by AFM

AFM imaging of supported lipid bilayers confirms the role of PE in potentiating the formation of larger transmembrane pores. MP1 was added at 10 μM concentration to induce significant pore formation on the relatively small patches of membrane imaged by the AFM within a reasonable experimental timescale (<2 h); resultant pores/defects were observed to be much larger in PC/PE/PS membranes (250 ± 110 nm in diameter) compared to PC/PS (54 ± 30 nm in diameter) (Fig. 8). Similar-sized transmembrane pores were observed in PC/PE/PS and PC/PE membranes (290 ± 200 nm in diameter), but significantly fewer defects formed in PC/PE membranes. Note that the large standard deviations in these average pore diameters represent a significant size polydispersity in the defects formed. No pores were evident in PC membranes 2 h after peptide addition (Fig. S7); however, pores would need to be several nanometers in diameter to be observable by AFM, considerably larger than those that can be detected by passive dye influx into the GUVs we used to investigate the early stages of GUV poration.

Our AFM studies also clearly show a difference in pore formation and growth mechanisms dependent on the presence of PE. The large transmembrane pores in PC/PE/PS and PC/PE membranes are seen to grow by the stepwise loss of lipid aggregates from the edge of the pore, implying that vesicle micellization is important for pore growth in the these membranes (Fig. S8). This is consistent with the small decrease (within experimental error) in GUV size observed for PE-containing GUVs by phase contrast microscopy (Fig. S6). Conversely, in PC/PS membranes, raised areas of lipid are first seen to form on the membrane (Fig. S9), which may correlate to the dense lipid structures observed in Fig. 7. These raised areas of membrane later evolve into comparatively small pores; many of the defects seen in Fig. 8 (bottom left) only span half the bilayer, with only the center of a few of these defects showing full bilayer pores (Fig. S10). This indicates that pores in these membranes may form via a half-membrane intermediate state. Finally the timescale for observation of membrane defects by AFM was much faster for PC/PE/PS membranes than for other lipid mixtures, with defects observed almost immediately after peptide addition (Fig S7), compared with a few tens of minutes for other mixtures.

Discussion

Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

Biophysical implications for MP1-lipid membrane interactions

We have shown a synergistic enhancement of the rate and extent of membrane permeabilization by MP1 peptides when PE and PS lipids are present in the lipid membrane. This picture is confirmed and corroborated by complementary experiments using three different model membrane systems: LUVs, GUVs, and planar-supported bilayers. We consider the perturbation of the membrane by MP1 peptides in two steps: 1) binding of the peptides to the membrane, and 2) perturbation of the bilayer structure by bound peptides to induce leakage.

Binding isotherms (Fig. 2) reveal that PS lipids cause a 7–8-fold increase in peptide bound to the membrane. This strongly outweighs the small ∼10% reduction in bound peptide concentration caused by the PE lipids. Therefore, we find that the dominant role of PS lipids’ contribution to the membrane disruption by MP1 is a large increase in peptide binding to the membrane.

The role of PE lipids in MP1-induced membrane disruption is twofold: 1) PE increases the susceptibility of the membrane to permeabilization by bound peptides, and 2) PE facilitates the formation of larger transmembrane pores. First, when the extent of GUV leakage is normalized to bound peptide concentration in the dose-response curves in Fig. 3, c and d, it can be seen that 4–5 times lower bound peptide concentration is required to induce a similar leakage response compared to comparable GUVs without PE lipids. Second, GUV and AFM experiments corroborate the effect of larger pores forming in the presence of PE. Quantitative analysis of GUV leakage profiles in Fig. 6 andTable 2 reveal that the presence of PE increases the permeability of membranes by an order of magnitude compared to membranes lacking in PE. Furthermore, once pores formed in GUVs, they quickly (within seconds) grew large enough in size to allow larger macromolecules (3 and 10 kDa) to permeate the membrane (Table 1); this compared to several tens of seconds for larger pores to form in GUVs lacking PE. Crucially, the formation of larger pores for PE-containing membranes is directly visualized by AFM (Fig. 8), where the observed pore diameters are ∼5 times larger in the presence of PE (and hence ∼20–30 times larger in average pore area, consistent with the order-of-magnitude increase in permeability reported for the GUVs).

The formation of transmembrane pores was confirmed by complementary experimental systems and techniques. Rapid translocation of membrane-impermeable leakage markers across GUV membranes, an all-or-none LUV fluorescence leakage assay, and direct visualization of transmembrane defects by AFM imaging of planar bilayers, all confirm this to be true. While these pores are fairly long lived, the membranes were sometimes observed to temporarily reseal, regaining their barrier properties. This can clearly be seen in the leakage profiles of individual GUVs in Figs. 5a, S4, and S5. GUV and planar bilayer imaging experiments also strongly suggest differences in the mechanism of pore formation depending on whether PE lipids are present. Images of GUVs that did not contain PE lipids often exhibited bright spots of increased local lipid concentrations on the membrane, which we interpret to be local aggregation of peptides and lipid (Fig. 7). Similarly, AFM images showed locally raised regions of lipid scattered across the membrane for these lipid compositions (Fig. S9) before the formation of pores (Fig. S10). This contrasted to the pore-formation mechanism observed in the presence of PE, where local aggregates were not directly observed on the GUV surface and time-resolved AFM imaging showed pore growth to occur by the stepwise micellization and loss of lipid from the edge of the pores (Fig. S8).

Besides the increased binding due to PS and the increased membrane susceptibility and pore size due to PE, the synergistic enhancement of membrane disruption facilitated by these lipids can be observed in the kinetics of initial permeabilization events. GUV experiments showed that PC/PE/PS GUVs leaked a factor-of-two quicker than other membrane compositions (Table 1). This is again corroborated by the AFM studies where defects were observed in PC/PE/PS membranes almost immediately after peptide addition, whereas perturbations of other membrane compositions took a few 10 s of minutes to evolve. The complementary pore-promoting effects of PS on bound peptide concentrations and PE on membrane susceptibility far outweigh their slight inhibitory effects on each other’s roles (PE causes a slight reduction in binding affinity (Fig. 2) and PS causes a decrease in the membrane susceptibility to bound peptide (Fig. 3, c and d)). This is apparent from the effects of MP1 on GUVs, where PC/PE/PS membranes experience the greatest membrane perturbation for any given total peptide concentration (Fig. 3, a and b) and the larger number of pores observed on the membrane surface by AFM (Fig. 8). Therefore, our combined results provide a detailed mechanistic picture of the importance of increased PS and PE lipid concentrations in synergistically enhancing the membrane’s propensity for significant disruption of its barrier properties by MP1 peptides.

Variations in lipid composition are responsible for differences in membrane properties such as charge, fluidity, lateral pressure profiles, and mechanical moduli. Changes in these fundamental membrane properties directly affect their interactions with extraneous compounds, such as antimicrobial peptides. The cationic nature of the MP1 peptide is likely an important component in the initial step of peptide action, in which the peptide recognizes the target membrane due to electrostatic interactions and binds to it in a structured form, most of the time as a helix. Therefore, the inclusion of anionic PS lipids in these membranes increases these electrostatic interactions with the MP1 peptide (net charge = +2e). However, MP1-membrane interactions cannot be solely driven by electrostatics as these peptides were also found to disrupt zwitterionic PC and PC/PE membranes, likely through secondary hydrophobic initial binding interactions that lead to a significantly lower bound concentration of peptide compared to the anionic membranes.

Next, insertion of the peptide into the bilayer likely takes place due to the hydrophobic effect, where nonpolar MP1 residues insert into the bilayer core, and defects may then be opened within the membrane structure, leading to its disruption. Furthermore, taking account of the fact that MP1 is a short peptide (14 amino acids) and hence not long enough to form a bilayer-spanning barrel stave pore (9, 32), we anticipate that these pores will be disorganized toroidal structures formed by lipids and peptides, as described by many molecular-dynamics studies (33, 34). PE is known to significantly modulate the lateral pressure profile through membranes and thereby induce negative curvature stress in the bilayer. Negative curvature stress has been shown to enhance the formation of toroidal lipid pores within a membrane by stabilizing the curvature of these structures (35). Therefore, PE would be expected to favor the formation of pore-like defects in the membrane, consistent with the increase susceptibility of these membranes to MP1-induced poration and the order-of-magnitude increase in membrane permeability that we find for PE-containing membranes upon interaction with MP1 peptides.

Jump to Section
Introduction
Materials and Methods
  Materials
  Peptide synthesis and purification
  Mass spectrometry analysis
  GUV formation
  LUV preparation
  CD spectroscopy for binding isotherms
  Confocal microscopy
  Analysis of confocal images and movies
  ANTS/DPX requenching measurements
  AFM
  Phase contrast microscopy
Results
  PS lipids significantly enhance peptide binding to the membrane
  MP1 dose-response studies reveal that PE and PS lipids enhance membrane permeability at lower peptide concentrations
  Confirmation of the pore-formation hypothesis in lipid vesicles
  Synergistic enhancement of GUV leakage kinetics by PE and PS lipids
  PE lipids significantly enhance pore size and membrane permeability
  Direct imaging of peptide-induced pores by AFM
Discussion
  Biophysical implications for MP1-lipid membrane interactions
  Implications for the chemotherapeutic potential of MP1 peptides
Author Contributions
Supporting Material
References

Implications for the chemotherapeutic potential of MP1 peptides

The MP1 peptide has been shown to have selective inhibition against numerous cancer lines compared to healthy cells (2, 3). Such malignant cells are also known to have increased expression of PS and PE lipids on their outer plasma membrane (5, 6, 7). This study strongly correlates the enhanced tumor inhibitory effects of these peptides with this pathological change in plasma membrane lipid composition, where the upregulation of PS and PE lipids can synergistically enhance the membrane-permeabilizing activity of MP1. This membrane permeabilization is likely to be the primary mechanism of cancer cell death induced by these peptides.

This suggests that MP1 might be a candidate therapeutic for development of novel cancer therapies, or at least guide the development of novel lead compounds for treatment of these diseases. One challenge for the application of antimicrobial peptides in medicine is that they often do not show high enough selectivity to their target cells to result in a favorable therapeutic index for these compounds (36). However, MP1 does not exhibit hemolytic activity to rat erythrocytes but presents chemotaxis for polymorphonucleated leukocytes and potent antimicrobial action against Gram-positive and Gram-negative bacteria (12), suggesting it could have favorable selectivity. It may also be of interest to test MP1 in a combination therapy with other chemotherapeutics that have intracellular targets. The selectivity of the MP1 peptide to disrupt the membranes of cancer cells may act synergistically with these other drugs to significantly enhance the therapeutic potency. Therefore, the therapeutic potential of this and other membrane-active peptides within the field of oncology is worthy of further investigation.

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Summary – Volume 4, Part 2: Translational Medicine in Cardiovascular Diseases


Summary – Volume 4, Part 2:  Translational Medicine in Cardiovascular Diseases

Author and Curator: Larry H Bernstein, MD, FCAP

 

We have covered a large amount of material that involves

  • the development,
  • application, and
  • validation of outcomes of medical and surgical procedures

that are based on translation of science from the laboratory to the bedside, improving the standards of medical practice at an accelerated pace in the last quarter century, and in the last decade.  Encouraging enabling developments have been:

1. The establishment of national and international outcomes databases for procedures by specialist medical societies

Stent Design and Thrombosis: Bifurcation Intervention, Drug Eluting Stents (DES) and Biodegrable Stents
Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/08/06/stent-design-and-thrombosis-bifurcation-intervention-drug-eluting-stents-des-and-biodegrable-stents/

On Devices and On Algorithms: Prediction of Arrhythmia after Cardiac Surgery and ECG Prediction of an Onset of Paroxysmal Atrial Fibrillation
Author, and Content Consultant to e-SERIES A: Cardiovascular Diseases: Justin Pearlman, MD, PhD, FACC
https://pharmaceuticalintelligence.com/2013/05/07/on-devices-and-on-algorithms-arrhythmia-after-cardiac-surgery-prediction-and-ecg-prediction-of-paroxysmal-atrial-fibrillation-onset/

Mitral Valve Repair: Who is a Patient Candidate for a Non-Ablative Fully Non-Invasive Procedure?
Author, and Content Consultant to e-SERIES A: Cardiovascular Diseases: Justin Pearlman, MD, PhD, FACC and Article Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/11/04/mitral-valve-repair-who-is-a-candidate-for-a-non-ablative-fully-non-invasive-procedure/

Cardiovascular Complications: Death from Reoperative Sternotomy after prior CABG, MVR, AVR, or Radiation; Complications of PCI; Sepsis from Cardiovascular Interventions
Author, Introduction and Summary: Justin D Pearlman, MD, PhD, FACC and Article Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/07/23/cardiovascular-complications-of-multiple-etiologies-repeat-sternotomy-post-cabg-or-avr-post-pci-pad-endoscopy-andor-resultant-of-systemic-sepsis/

Survivals Comparison of Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI) /Coronary Angioplasty
Larry H. Bernstein, MD, Writer And Aviva Lev-Ari, PhD, RN, Curator
https://pharmaceuticalintelligence.com/2013/06/23/comparison-of-cardiothoracic-bypass-and-percutaneous-interventional-catheterization-survivals/

Revascularization: PCI, Prior History of PCI vs CABG
Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/04/25/revascularization-pci-prior-history-of-pci-vs-cabg/

Outcomes in High Cardiovascular Risk Patients: Prasugrel (Effient) vs. Clopidogrel (Plavix); Aliskiren (Tekturna) added to ACE or added to ARB
Reporter and Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2012/08/27/outcomes-in-high-cardiovascular-risk-patients-prasugrel-effient-vs-clopidogrel-plavix-aliskiren-tekturna-added-to-ace-or-added-to-arb/

Endovascular Lower-extremity Revascularization Effectiveness: Vascular Surgeons (VSs), Interventional Cardiologists (ICs) and Interventional Radiologists (IRs)
Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2012/08/13/coronary-artery-disease-medical-devices-solutions-from-first-in-man-stent-implantation-via-medical-ethical-dilemmas-to-drug-eluting-stents/

and more

2. The identification of problem areas, particularly in activation of the prothrombotic pathways, infection control to an extent, and targeting of pathways leading to progression or to arrythmogenic complications.

Cardiovascular Complications: Death from Reoperative Sternotomy after prior CABG, MVR, AVR, or Radiation; Complications of PCI; Sepsis from Cardiovascular Interventions Author, Introduction and Summary: Justin D Pearlman, MD, PhD, FACC and Article Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/07/23/cardiovascular-complications-of-multiple-etiologies-repeat-sternotomy-post-cabg-or-avr-post-pci-pad-endoscopy-andor-resultant-of-systemic-sepsis/

Anticoagulation genotype guided dosing
Larry H. Bernstein, MD, FCAP, Author and Curator
https://pharmaceuticalintelligence.com/2013/12/08/anticoagulation-genotype-guided-dosing/

Stent Design and Thrombosis: Bifurcation Intervention, Drug Eluting Stents (DES) and Biodegrable Stents
Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/08/06/stent-design-and-thrombosis-bifurcation-intervention-drug-eluting-stents-des-and-biodegrable-stents/

The Effects of Aprotinin on Endothelial Cell Coagulant Biology
Co-Author (Kamran Baig, MBBS, James Jaggers, MD, Jeffrey H. Lawson, MD, PhD) and Curator
https://pharmaceuticalintelligence.com/2013/07/20/the-effects-of-aprotinin-on-endothelial-cell-coagulant-biology/

Outcomes in High Cardiovascular Risk Patients: Prasugrel (Effient) vs. Clopidogrel (Plavix); Aliskiren (Tekturna) added to ACE or added to ARB
Reporter and Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2012/08/27/outcomes-in-high-cardiovascular-risk-patients-prasugrel-effient-vs-clopidogrel-plavix-aliskiren-tekturna-added-to-ace-or-added-to-arb/

Pharmacogenomics – A New Method for Druggability  Author and Curator: Demet Sag, PhD
https://pharmaceuticalintelligence.com/2014/04/28/pharmacogenomics-a-new-method-for-druggability/

Advanced Topics in Sepsis and the Cardiovascular System at its End Stage    Author: Larry H Bernstein, MD, FCAP
https://pharmaceuticalintelligence.com/2013/08/18/advanced-topics-in-Sepsis-and-the-Cardiovascular-System-at-its-End-Stage/

3. Development of procedures that use a safer materials in vascular management.

Stent Design and Thrombosis: Bifurcation Intervention, Drug Eluting Stents (DES) and Biodegrable Stents
Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/08/06/stent-design-and-thrombosis-bifurcation-intervention-drug-eluting-stents-des-and-biodegrable-stents/

Biomaterials Technology: Models of Tissue Engineering for Reperfusion and Implantable Devices for Revascularization
Author and Curator: Larry H Bernstein, MD, FACP and Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/05/05/bioengineering-of-vascular-and-tissue-models/

Vascular Repair: Stents and Biologically Active Implants
Author and Curator: Larry H Bernstein, MD, FACP and Curator: Aviva Lev-Ari, RN, PhD
https://pharmaceuticalintelligence.com/2013/05/04/stents-biologically-active-implants-and-vascular-repair/

Drug Eluting Stents: On MIT’s Edelman Lab’s Contributions to Vascular Biology and its Pioneering Research on DES
Author: Larry H Bernstein, MD, FACP and Curator: Aviva Lev-Ari, PhD, RN
http://PharmaceuticalIntelligence.com/2013/04/25/Contributions-to-vascular-biology/

MedTech & Medical Devices for Cardiovascular Repair – Curations by Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2014/04/17/medtech-medical-devices-for-cardiovascular-repair-curation-by-aviva-lev-ari-phd-rn/

4. Discrimination of cases presenting for treatment based on qualifications for medical versus surgical intervention.

Treatment Options for Left Ventricular Failure – Temporary Circulatory Support: Intra-aortic balloon pump (IABP) – Impella Recover LD/LP 5.0 and 2.5, Pump Catheters (Non-surgical) vs Bridge Therapy: Percutaneous Left Ventricular Assist Devices (pLVADs) and LVADs (Surgical)
Author: Larry H Bernstein, MD, FCAP And Curator: Justin D Pearlman, MD, PhD, FACC
https://pharmaceuticalintelligence.com/2013/07/17/treatment-options-for-left-ventricular-failure-temporary-circulatory-support-intra-aortic-balloon-pump-iabp-impella-recover-ldlp-5-0-and-2-5-pump-catheters-non-surgical-vs-bridge-therapy/

Coronary Reperfusion Therapies: CABG vs PCI – Mayo Clinic preprocedure Risk Score (MCRS) for Prediction of in-Hospital Mortality after CABG or PCI
Writer and Curator: Larry H. Bernstein, MD, FCAP and Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/06/30/mayo-risk-score-for-percutaneous-coronary-intervention/

ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery Reporter: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/11/05/accaha-guidelines-for-coronary-artery-bypass-graft-surgery/

Mitral Valve Repair: Who is a Patient Candidate for a Non-Ablative Fully Non-Invasive Procedure?
Author, and Content Consultant to e-SERIES A: Cardiovascular Diseases: Justin Pearlman, MD, PhD, FACC and Article Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/11/04/mitral-valve-repair-who-is-a-candidate-for-a-non-ablative-fully-non-invasive-procedure/ 

5.  This has become possible because of the advances in our knowledge of key related pathogenetic mechanisms involving gene expression and cellular regulation of complex mechanisms.

What is the key method to harness Inflammation to close the doors for many complex diseases?
Author and Curator: Larry H Bernstein, MD, FCAP
https://pharmaceuticalintelligence.com/2014/03/21/what-is-the-key-method-to-harness-inflammation-to-close-the-doors-for-many-complex-diseases/

CVD Prevention and Evaluation of Cardiovascular Imaging Modalities: Coronary Calcium Score by CT Scan Screening to justify or not the Use of Statin
Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2014/03/03/cvd-prevention-and-evaluation-of-cardiovascular-imaging-modalities-coronary-calcium-score-by-ct-scan-screening-to-justify-or-not-the-use-of-statin/

Richard Lifton, MD, PhD of Yale University and Howard Hughes Medical Institute: Recipient of 2014 Breakthrough Prizes Awarded in Life Sciences for the Discovery of Genes and Biochemical Mechanisms that cause Hypertension
Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2014/03/03/richard-lifton-md-phd-of-yale-university-and-howard-hughes-medical-institute-recipient-of-2014-breakthrough-prizes-awarded-in-life-sciences-for-the-discovery-of-genes-and-biochemical-mechanisms-tha/

Pathophysiological Effects of Diabetes on Ischemic-Cardiovascular Disease and on Chronic Obstructive Pulmonary Disease (COPD)
Curator:  Larry H. Bernstein, MD, FCAP
https://pharmaceuticalintelligence.com/2014/01/15/pathophysiological-effects-of-diabetes-on-ischemic-cardiovascular-disease-and-on-chronic-obstructive-pulmonary-disease-copd/

Atherosclerosis Independence: Genetic Polymorphisms of Ion Channels Role in the Pathogenesis of Coronary Microvascular Dysfunction and Myocardial Ischemia (Coronary Artery Disease (CAD))
Reviewer and Co-Curator: Larry H Bernstein, MD, CAP and Curator: Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/2013/12/21/genetic-polymorphisms-of-ion-channels-have-a-role-in-the-pathogenesis-of-coronary-microvascular-dysfunction-and-ischemic-heart-disease/

Notable Contributions to Regenerative Cardiology  Author and Curator: Larry H Bernstein, MD, FCAP and Article Commissioner: Aviva Lev-Ari, PhD, RD
https://pharmaceuticalintelligence.com/2013/10/20/notable-contributions-to-regenerative-cardiology/

As noted in the introduction, any of the material can be found and reviewed by content, and the eTOC is identified in attached:

http://wp.me/p2xfv8-1W

 

This completes what has been presented in Part 2, Vol 4 , and supporting references for the main points that are found in the Leaders in Pharmaceutical Intelligence Cardiovascular book.  Part 1 was concerned with Posttranslational Modification of Proteins, vital for understanding cellular regulation and dysregulation.  Part 2 was concerned with Translational Medical Therapeutics, the efficacy of medical and surgical decisions based on bringing the knowledge gained from the laboratory, and from clinical trials into the realm opf best practice.  The time for this to occur in practice in the past has been through roughly a generation of physicians.  That was in part related to the busy workload of physicians, and inability to easily access specialty literature as the volume and complexity increased.  This had an effect of making access of a family to a primary care provider through a lifetime less likely than the period post WWII into the 1980s.

However, the growth of knowledge has accelerated in the specialties since the 1980’s so that the use of physician referral in time became a concern about the cost of medical care.  This is not the place for or a matter for discussion here.  It is also true that the scientific advances and improvements in available technology have had a great impact on medical outcomes.  The only unrelated issue is that of healthcare delivery, which is not up to the standard set by serial advances in therapeutics, accompanied by high cost due to development costs, marketing costs, and development of drug resistance.

I shall identify continuing developments in cardiovascular diagnostics, therapeutics, and bioengineering that is and has been emerging.

1. Mechanisms of disease

REPORT: Mapping the Cellular Response to Small Molecules Using Chemogenomic Fitness Signatures 

Science 11 April 2014:
Vol. 344 no. 6180 pp. 208-211
http://dx.doi.org/10.1126/science.1250217

Abstract: Genome-wide characterization of the in vivo cellular response to perturbation is fundamental to understanding how cells survive stress. Identifying the proteins and pathways perturbed by small molecules affects biology and medicine by revealing the mechanisms of drug action. We used a yeast chemogenomics platform that quantifies the requirement for each gene for resistance to a compound in vivo to profile 3250 small molecules in a systematic and unbiased manner. We identified 317 compounds that specifically perturb the function of 121 genes and characterized the mechanism of specific compounds. Global analysis revealed that the cellular response to small molecules is limited and described by a network of 45 major chemogenomic signatures. Our results provide a resource for the discovery of functional interactions among genes, chemicals, and biological processes.

Yeasty HIPHOP

Laura Zahn
Sci. Signal. 15 April 2014; 7(321): ec103.   http://dx.doi.org/10.1126/scisignal.2005362

In order to identify how chemical compounds target genes and affect the physiology of the cell, tests of the perturbations that occur when treated with a range of pharmacological chemicals are required. By examining the haploinsufficiency profiling (HIP) and homozygous profiling (HOP) chemogenomic platforms, Lee et al.(p. 208) analyzed the response of yeast to thousands of different small molecules, with genetic, proteomic, and bioinformatic analyses. Over 300 compounds were identified that targeted 121 genes within 45 cellular response signature networks. These networks were used to extrapolate the likely effects of related chemicals, their impact upon genetic pathways, and to identify putative gene functions

Key Heart Failure Culprit Discovered

A team of cardiovascular researchers from the Cardiovascular Research Center at Icahn School of Medicine at Mount Sinai, Sanford-Burnham Medical Research Institute, and University of California, San Diego have identified a small, but powerful, new player in thIe onset and progression of heart failure. Their findings, published in the journal Nature  on March 12, also show how they successfully blocked the newly discovered culprit.
Investigators identified a tiny piece of RNA called miR-25 that blocks a gene known as SERCA2a, which regulates the flow of calcium within heart muscle cells. Decreased SERCA2a activity is one of the main causes of poor contraction of the heart and enlargement of heart muscle cells leading to heart failure.

Using a functional screening system developed by researchers at Sanford-Burnham, the research team discovered miR-25 acts pathologically in patients suffering from heart failure, delaying proper calcium uptake in heart muscle cells. According to co-lead study authors Christine Wahlquist and Dr. Agustin Rojas Muñoz, developers of the approach and researchers in Mercola’s lab at Sanford-Burnham, they used high-throughput robotics to sift through the entire genome for microRNAs involved in heart muscle dysfunction.

Subsequently, the researchers at the Cardiovascular Research Center at Icahn School of Medicine at Mount Sinai found that injecting a small piece of RNA to inhibit the effects of miR-25 dramatically halted heart failure progression in mice. In addition, it also improved their cardiac function and survival.

“In this study, we have not only identified one of the key cellular processes leading to heart failure, but have also demonstrated the therapeutic potential of blocking this process,” says co-lead study author Dr. Dongtak Jeong, a post-doctoral fellow at the Cardiovascular Research Center at Icahn School of  Medicine at Mount Sinai in the laboratory of the study’s co-senior author Dr. Roger J. Hajjar.

Publication: Inhibition of miR-25 improves cardiac contractility in the failing heart.Christine Wahlquist, Dongtak Jeong, Agustin Rojas-Muñoz, Changwon Kho, Ahyoung Lee, Shinichi Mitsuyama, Alain Van Mil, Woo Jin Park, Joost P. G. Sluijter, Pieter A. F. Doevendans, Roger J. :  Hajjar & Mark Mercola.     Nature (March 2014)    http://www.nature.com/nature/journal/vaop/ncurrent/full/nature13073.html

 

“Junk” DNA Tied to Heart Failure

Deep RNA Sequencing Reveals Dynamic Regulation of Myocardial Noncoding RNAs in Failing Human Heart and Remodeling With Mechanical Circulatory Support

Yang KC, Yamada KA, Patel AY, Topkara VK, George I, et al.
Circulation 2014;  129(9):1009-21.
http://dx.doi.org/10.1161/CIRCULATIONAHA.113.003863              http://circ.ahajournals.org/…/CIRCULATIONAHA.113.003863.full

The myocardial transcriptome is dynamically regulated in advanced heart failure and after LVAD support. The expression profiles of lncRNAs, but not mRNAs or miRNAs, can discriminate failing hearts of different pathologies and are markedly altered in response to LVAD support. These results suggest an important role for lncRNAs in the pathogenesis of heart failure and in reverse remodeling observed with mechanical support.

Junk DNA was long thought to have no important role in heredity or disease because it doesn’t code for proteins. But emerging research in recent years has revealed that many of these sections of the genome produce noncoding RNA molecules that still have important functions in the body. They come in a variety of forms, some more widely studied than others. Of these, about 90% are called long noncoding RNAs (lncRNAs), and exploration of their roles in health and disease is just beginning.

The Washington University group performed a comprehensive analysis of all RNA molecules expressed in the human heart. The researchers studied nonfailing hearts and failing hearts before and after patients received pump support from left ventricular assist devices (LVAD). The LVADs increased each heart’s pumping capacity while patients waited for heart transplants.

In their study, the researchers found that unlike other RNA molecules, expression patterns of long noncoding RNAs could distinguish between two major types of heart failure and between failing hearts before and after they received LVAD support.

“The myocardial transcriptome is dynamically regulated in advanced heart failure and after LVAD support. The expression profiles of lncRNAs, but not mRNAs or miRNAs, can discriminate failing hearts of different pathologies and are markedly altered in response to LVAD support,” wrote the researchers. “These results suggest an important role for lncRNAs in the pathogenesis of heart failure and in reverse remodeling observed with mechanical support.”

‘Junk’ Genome Regions Linked to Heart Failure

In a recent issue of the journal Circulation, Washington University investigators report results from the first comprehensive analysis of all RNA molecules expressed in the human heart. The researchers studied nonfailing hearts and failing hearts before and after patients received pump support from left ventricular assist devices (LVAD). The LVADs increased each heart’s pumping capacity while patients waited for heart transplants.

“We took an unbiased approach to investigating which types of RNA might be linked to heart failure,” said senior author Jeanne Nerbonne, the Alumni Endowed Professor of Molecular Biology and Pharmacology. “We were surprised to find that long noncoding RNAs stood out.

In the new study, the investigators found that unlike other RNA molecules, expression patterns of long noncoding RNAs could distinguish between two major types of heart failure and between failing hearts before and after they received LVAD support.

“We don’t know whether these changes in long noncoding RNAs are a cause or an effect of heart failure,” Nerbonne said. “But it seems likely they play some role in coordinating the regulation of multiple genes involved in heart function.”

Nerbonne pointed out that all types of RNA molecules they examined could make the obvious distinction: telling the difference between failing and nonfailing hearts. But only expression of the long noncoding RNAs was measurably different between heart failure associated with a heart attack (ischemic) and heart failure without the obvious trigger of blocked arteries (nonischemic). Similarly, only long noncoding RNAs significantly changed expression patterns after implantation of left ventricular assist devices.

Comment

Decoding the noncoding transcripts in human heart failure

Xiao XG, Touma M, Wang Y
Circulation. 2014; 129(9): 958960,  http://dx.doi.org/10.1161/CIRCULATIONAHA.114.007548 

Heart failure is a complex disease with a broad spectrum of pathological features. Despite significant advancement in clinical diagnosis through improved imaging modalities and hemodynamic approaches, reliable molecular signatures for better differential diagnosis and better monitoring of heart failure progression remain elusive. The few known clinical biomarkers for heart failure, such as plasma brain natriuretic peptide and troponin, have been shown to have limited use in defining the cause or prognosis of the disease.1,2 Consequently, current clinical identification and classification of heart failure remain descriptive, mostly based on functional and morphological parameters. Therefore, defining the pathogenic mechanisms for hypertrophic versus dilated or ischemic versus nonischemic cardiomyopathies in the failing heart remain a major challenge to both basic science and clinic researchers. In recent years, mechanical circulatory support using left ventricular assist devices (LVADs) has assumed a growing role in the care of patients with end-stage heart failure.3 During the earlier years of LVAD application as a bridge to transplant, it became evident that some patients exhibit substantial recovery of ventricular function, structure, and electric properties.4 This led to the recognition that reverse remodeling is potentially an achievable therapeutic goal using LVADs. However, the underlying mechanism for the reverse remodeling in the LVAD-treated hearts is unclear, and its discovery would likely hold great promise to halt or even reverse the progression of heart failure.

 

Efficacy and Safety of Dabigatran Compared With Warfarin in Relation to Baseline Renal Function in Patients With Atrial Fibrillation: A RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) Trial Analysis

Circulation. 2014; 129: 951-952     http://dx.doi.org/10.1161/​CIR.0000000000000022

In patients with atrial fibrillation, impaired renal function is associated with a higher risk of thromboembolic events and major bleeding. Oral anticoagulation with vitamin K antagonists reduces thromboembolic events but raises the risk of bleeding. The new oral anticoagulant dabigatran has 80% renal elimination, and its efficacy and safety might, therefore, be related to renal function. In this prespecified analysis from the Randomized Evaluation of Long-Term Anticoagulant Therapy (RELY) trial, outcomes with dabigatran versus warfarin were evaluated in relation to 4 estimates of renal function, that is, equations based on creatinine levels (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and cystatin C. The rates of stroke or systemic embolism were lower with dabigatran 150 mg and similar with 110 mg twice daily irrespective of renal function. Rates of major bleeding were lower with dabigatran 110 mg and similar with 150 mg twice daily across the entire range of renal function. However, when the CKD-EPI or MDRD equations were used, there was a significantly greater relative reduction in major bleeding with both doses of dabigatran than with warfarin in patients with estimated glomerular filtration rate ≥80 mL/min. These findings show that dabigatran can be used with the same efficacy and adequate safety in patients with a wide range of renal function and that a more accurate estimate of renal function might be useful for improved tailoring of anticoagulant treatment in patients with atrial fibrillation and an increased risk of stroke.

Aldosterone Regulates MicroRNAs in the Cortical Collecting Duct to Alter Sodium Transport.

Robert S Edinger, Claudia Coronnello, Andrew J Bodnar, William A Laframboise, Panayiotis V Benos, Jacqueline Ho, John P Johnson, Michael B Butterworth

Journal of the American Society of Nephrology (Impact Factor: 8.99). 04/2014;     http://dx. DO.org/I:10.1681/ASN.2013090931

Source: PubMed

ABSTRACT A role for microRNAs (miRs) in the physiologic regulation of sodium transport in the kidney has not been established. In this study, we investigated the potential of aldosterone to alter miR expression in mouse cortical collecting duct (mCCD) epithelial cells. Microarray studies demonstrated the regulation of miR expression by aldosterone in both cultured mCCD and isolated primary distal nephron principal cells.

Aldosterone regulation of the most significantly downregulated miRs, mmu-miR-335-3p, mmu-miR-290-5p, and mmu-miR-1983 was confirmed by quantitative RT-PCR. Reducing the expression of these miRs separately or in combination increased epithelial sodium channel (ENaC)-mediated sodium transport in mCCD cells, without mineralocorticoid supplementation. Artificially increasing the expression of these miRs by transfection with plasmid precursors or miR mimic constructs blunted aldosterone stimulation of ENaC transport.

Using a newly developed computational approach, termed ComiR, we predicted potential gene targets for the aldosterone-regulated miRs and confirmed ankyrin 3 (Ank3) as a novel aldosterone and miR-regulated protein.

A dual-luciferase assay demonstrated direct binding of the miRs with the Ank3-3′ untranslated region. Overexpression of Ank3 increased and depletion of Ank3 decreased ENaC-mediated sodium transport in mCCD cells. These findings implicate miRs as intermediaries in aldosterone signaling in principal cells of the distal kidney nephron.

 

2. Diagnostic Biomarker Status

A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and 6-month mortality in patients admitted to ICU with non-cardiac diagnoses.

Marlies Ostermann, Jessica Lo, Michael Toolan, Emma Tuddenham, Barnaby Sanderson, Katie Lei, John Smith, Anna Griffiths, Ian Webb, James Coutts, John hambers, Paul Collinson, Janet Peacock, David Bennett, David Treacher

Critical care (London, England) (Impact Factor: 4.72). 04/2014; 18(2):R62.   http://dx.doi.org/:10.1186/cc13818

Source: PubMed

ABSTRACT Troponin T (cTnT) elevation is common in patients in the Intensive Care Unit (ICU) and associated with morbidity and mortality. Our aim was to determine the epidemiology of raised cTnT levels and contemporaneous electrocardiogram (ECG) changes suggesting myocardial infarction (MI) in ICU patients admitted for non-cardiac reasons.
cTnT and ECGs were recorded daily during week 1 and on alternate days during week 2 until discharge from ICU or death. ECGs were interpreted independently for the presence of ischaemic changes. Patients were classified into 4 groups: (i) definite MI (cTnT >=15 ng/L and contemporaneous changes of MI on ECG), (ii) possible MI (cTnT >=15 ng/L and contemporaneous ischaemic changes on ECG), (iii) troponin rise alone (cTnT >=15 ng/L), or (iv) normal. Medical notes were screened independently by two ICU clinicians for evidence that the clinical teams had considered a cardiac event.
Data from 144 patients were analysed [42% female; mean age 61.9 (SD 16.9)]. 121 patients (84%) had at least one cTnT level >=15 ng/L. A total of 20 patients (14%) had a definite MI, 27% had a possible MI, 43% had a cTNT rise without contemporaneous ECG changes, and 16% had no cTNT rise. ICU, hospital and 180 day mortality were significantly higher in patients with a definite or possible MI.Only 20% of definite MIs were recognised by the clinical team. There was no significant difference in mortality between recognised and non-recognised events.At time of cTNT rise, 100 patients (70%) were septic and 58% were on vasopressors. Patients who were septic when cTNT was elevated had an ICU mortality of 28% compared to 9% in patients without sepsis. ICU mortality of patients who were on vasopressors at time of cTNT elevation was 37% compared to 1.7% in patients not on vasopressors.
The majority of critically ill patients (84%) had a cTnT rise and 41% met criteria for a possible or definite MI of whom only 20% were recognised clinically. Mortality up to 180 days was higher in patients with a cTnT rise.

 

Prognostic performance of high-sensitivity cardiac troponin T kinetic changes adjusted for elevated admission values and the GRACE score in an unselected emergency department population.

Moritz BienerMatthias MuellerMehrshad VafaieAllan S JaffeHugo A Katus,Evangelos Giannitsis

Clinica chimica acta; international journal of clinical chemistry (Impact Factor: 2.54). 04/2014;   http://dx.doi.org/10.1016/j.cca.2014.04.007

Source: PubMed

ABSTRACT To test the prognostic performance of rising and falling kinetic changes of high-sensitivity cardiac troponin T (hs-cTnT) and the GRACE score.
Rising and falling hs-cTnT changes in an unselected emergency department population were compared.
635 patients with a hs-cTnT >99th percentile admission value were enrolled. Of these, 572 patients qualified for evaluation with rising patterns (n=254, 44.4%), falling patterns (n=224, 39.2%), or falling patterns following an initial rise (n=94, 16.4%). During 407days of follow-up, we observed 74 deaths, 17 recurrent AMI, and 79 subjects with a composite of death/AMI. Admission values >14ng/L were associated with a higher rate of adverse outcomes (OR, 95%CI:death:12.6, 1.8-92.1, p=0.01, death/AMI:6.7, 1.6-27.9, p=0.01). Neither rising nor falling changes increased the AUC of baseline values (AUC: rising 0.562 vs 0.561, p=ns, falling: 0.533 vs 0.575, p=ns). A GRACE score ≥140 points indicated a higher risk of death (OR, 95%CI: 3.14, 1.84-5.36), AMI (OR,95%CI: 1.56, 0.59-4.17), or death/AMI (OR, 95%CI: 2.49, 1.51-4.11). Hs-cTnT changes did not improve prognostic performance of a GRACE score ≥140 points (AUC, 95%CI: death: 0.635, 0.570-0.701 vs. 0.560, 0.470-0.649 p=ns, AMI: 0.555, 0.418-0.693 vs. 0.603, 0.424-0.782, p=ns, death/AMI: 0.610, 0.545-0.676 vs. 0.538, 0.454-0.622, p=ns). Coronary angiography was performed earlier in patients with rising than with falling kinetics (median, IQR [hours]:13.7, 5.5-28.0 vs. 20.8, 6.3-59.0, p=0.01).
Neither rising nor falling hs-cTnT changes improve prognostic performance of elevated hs-cTnT admission values or the GRACE score. However, rising values are more likely associated with the decision for earlier invasive strategy.

 

Troponin assays for the diagnosis of myocardial infarction and acute coronary syndrome: where do we stand?

Arie Eisenman

ABSTRACT: Under normal circumstances, most intracellular troponin is part of the muscle contractile apparatus, and only a small percentage (< 2-8%) is free in the cytoplasm. The presence of a cardiac-specific troponin in the circulation at levels above normal is good evidence of damage to cardiac muscle cells, such as myocardial infarction, myocarditis, trauma, unstable angina, cardiac surgery or other cardiac procedures. Troponins are released as complexes leading to various cut-off values depending on the assay used. This makes them very sensitive and specific indicators of cardiac injury. As with other cardiac markers, observation of a rise and fall in troponin levels in the appropriate time-frame increases the diagnostic specificity for acute myocardial infarction. They start to rise approximately 4-6 h after the onset of acute myocardial infarction and peak at approximately 24 h, as is the case with creatine kinase-MB. They remain elevated for 7-10 days giving a longer diagnostic window than creatine kinase. Although the diagnosis of various types of acute coronary syndrome remains a clinical-based diagnosis, the use of troponin levels contributes to their classification. This Editorial elaborates on the nature of troponin, its classification, clinical use and importance, as well as comparing it with other currently available cardiac markers.

Expert Review of Cardiovascular Therapy 07/2006; 4(4):509-14.   http://dx.doi.org/:10.1586/14779072.4.4.509 

 

Impact of redefining acute myocardial infarction on incidence, management and reimbursement rate of acute coronary syndromes.

Carísi A Polanczyk, Samir Schneid, Betina V Imhof, Mariana Furtado, Carolina Pithan, Luis E Rohde, Jorge P Ribeiro

ABSTRACT: Although redefinition for acute myocardial infarction (AMI) has been proposed few years ago, to date it has not been universally adopted by many institutions. The purpose of this study is to evaluate the diagnostic, prognostic and economical impact of the new diagnostic criteria for AMI. Patients consecutively admitted to the emergency department with suspected acute coronary syndromes were enrolled in this study. Troponin T (cTnT) was measured in samples collected for routine CK-MB analyses and results were not available to physicians. Patients without AMI by traditional criteria and cTnT > or = 0.035 ng/mL were coded as redefined AMI. Clinical outcomes were hospital death, major cardiac events and revascularization procedures. In-hospital management and reimbursement rates were also analyzed. Among 363 patients, 59 (16%) patients had AMI by conventional criteria, whereas additional 75 (21%) had redefined AMI, an increase of 127% in the incidence. Patients with redefined AMI were significantly older, more frequently male, with atypical chest pain and more risk factors. In multivariate analysis, redefined AMI was associated with 3.1 fold higher hospital death (95% CI: 0.6-14) and a 5.6 fold more cardiac events (95% CI: 2.1-15) compared to those without AMI. From hospital perspective, based on DRGs payment system, adoption of AMI redefinition would increase 12% the reimbursement rate [3552 Int dollars per 100 patients evaluated]. The redefined criteria result in a substantial increase in AMI cases, and allow identification of high-risk patients. Efforts should be made to reinforce the adoption of AMI redefinition, which may result in more qualified and efficient management of ACS.

International Journal of Cardiology 03/2006; 107(2):180-7. · 5.51 Impact Factor   http://www.sciencedirect.com/science/article/pii/S0167527305005279

 

3. Biomedical Engineerin3g

Safety and Efficacy of an Injectable Extracellular Matrix Hydrogel for Treating Myocardial Infarction 

Sonya B. Seif-Naraghi, Jennifer M. Singelyn, Michael A. Salvatore,  et al.
Sci Transl Med 20 February 2013 5:173ra25  http://dx.doi.org/10.1126/scitranslmed.3005503

Acellular biomaterials can stimulate the local environment to repair tissues without the regulatory and scientific challenges of cell-based therapies. A greater understanding of the mechanisms of such endogenous tissue repair is furthering the design and application of these biomaterials. We discuss recent progress in acellular materials for tissue repair, using cartilage and cardiac tissues as examples of application with substantial intrinsic hurdles, but where human translation is now occurring.

 Acellular Biomaterials: An Evolving Alternative to Cell-Based Therapies

J. A. Burdick, R. L. Mauck, J. H. Gorman, R. C. Gorman,
Sci. Transl. Med. 2013; 5, (176): 176 ps4    http://stm.sciencemag.org/content/5/176/176ps4

Acellular biomaterials can stimulate the local environment to repair tissues without the regulatory and scientific challenges of cell-based therapies. A greater understanding of the mechanisms of such endogenous tissue repair is furthering the design and application of these biomaterials. We discuss recent progress in acellular materials for tissue repair, using cartilage and cardiac tissues as examples of applications with substantial intrinsic hurdles, but where human translation is now occurring.


Instructive Nanofiber Scaffolds with VEGF Create a Microenvironment for Arteriogenesis and Cardiac Repair

Yi-Dong Lin, Chwan-Yau Luo, Yu-Ning Hu, Ming-Long Yeh, Ying-Chang Hsueh, Min-Yao Chang, et al.
Sci Transl Med 8 August 2012; 4(146):ra109.   http://dx.doi.org/ 10.1126/scitranslmed.3003841

Angiogenic therapy is a promising approach for tissue repair and regeneration. However, recent clinical trials with protein delivery or gene therapy to promote angiogenesis have failed to provide therapeutic effects. A key factor for achieving effective revascularization is the durability of the microvasculature and the formation of new arterial vessels. Accordingly, we carried out experiments to test whether intramyocardial injection of self-assembling peptide nanofibers (NFs) combined with vascular endothelial growth factor (VEGF) could create an intramyocardial microenvironment with prolonged VEGF release to improve post-infarct neovascularization in rats. Our data showed that when injected with NF, VEGF delivery was sustained within the myocardium for up to 14 days, and the side effects of systemic edema and proteinuria were significantly reduced to the same level as that of control. NF/VEGF injection significantly improved angiogenesis, arteriogenesis, and cardiac performance 28 days after myocardial infarction. NF/VEGF injection not only allowed controlled local delivery but also transformed the injected site into a favorable microenvironment that recruited endogenous myofibroblasts and helped achieve effective revascularization. The engineered vascular niche further attracted a new population of cardiomyocyte-like cells to home to the injected sites, suggesting cardiomyocyte regeneration. Follow-up studies in pigs also revealed healing benefits consistent with observations in rats. In summary, this study demonstrates a new strategy for cardiovascular repair with potential for future clinical translation.

Manufacturing Challenges in Regenerative Medicine

I. Martin, P. J. Simmons, D. F. Williams.
Sci. Transl. Med. 2014; 6(232): fs16.   http://dx.doi.org/10.1126/scitranslmed.3008558

Along with scientific and regulatory issues, the translation of cell and tissue therapies in the routine clinical practice needs to address standardization and cost-effectiveness through the definition of suitable manufacturing paradigms.

 

 

 

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Reporter and Curator: Dr. Sudipta Saha, Ph.D.

The prostate has long been known to exhibit unique metabolite profiles. In the last decade, advances in nuclear magnetic resonance spectroscopy and mass spectrometry have been applied toward identifying metabolic alterations in prostate cancer that may provide clinically useful biomarkers. As with genomics and proteomics, advances in technology and bioinformatics have led to the application of metabolomic profiling to prostate cancer—the high throughput evaluation of a large complement of metabolites in the prostate and how they are altered by disease perturbations. Recently, high profile publications have drawn attention to the potential of metabolomic analysis to identify biomarkers for early detection or disease progression from readily accessible body fluids as well as tissue specimens from biopsy and surgery.

Worldwide, the number of prostate cancer cases is approaching one million, and it is the sixth leading cause of cancer deaths in men. Both incidence and mortality are increasing in many traditionally low risk countries in Asia, and Central and Eastern Europe. Testing with serum prostate specific antigen has contributed to decreases in prostate cancer mortality in many developed countries, but the test and the diagnostic paradigm suffer from a number of problems, including low specificity of prostate specific antigen, inability to specify a cut-point below which cancer is unlikely, non-trivial false-negative rate for prostate biopsy, and over-diagnosis and over-treatment of relatively indolent tumors with low potential for morbidity or death if left untreated. For men diagnosed with prostate cancer, a number of algorithms primarily based on tumor pathology and prostate specific antigen are available to predict the likely clinical outcome. Although these prediction tools generally work well, there is still significant variability in outcomes for men at both the low and high end of the risk spectrum. Although distinct metabolic characteristics of the prostate have long been known, global metabolomic profiling of prostate cancer is at an early stage.

Studies of the metabolic alterations associated with prostate cancer have demonstrated characteristic decreases in citrate and polyamines, and increases in cholines, glycerophospholipids, lactate, and components of a number of pathways of amino acid metabolism. Results for sarcosine have been prominent but inconsistent. However, it is likely that inconsistent findings are not unique to sarcosine. Rather, the attention given to sarcosine has resulted in reports of validation efforts focused on this molecule, whereas reports from other metabolomic profiling studies have focused on discovery and have not emphasized null associations. Metabolite profiles with potential relevance to prostate cancer biology have been identified in tissue, bone, urine, expressed prostatic fluid, and plasma, and have correlated with clinical progression as well as established prognostic attributes. Given the relatively low cost of metabolomic profiling compared with the other ‘omics’ disciplines, and the parallel advances being made in molecular magnetic resonance imaging, metabolomics has great potential for application to detection of clinically significant disease and monitoring disease progression, in both the active surveillance and post-treatment settings. In addition, because of their functional significance, metabolomic biomarkers or profiles hold particular promise for addressing one of the current challenges to personalized medicine: co-development of targeted therapeutics and companion diagnostics.

Source References:

http://www.ncbi.nlm.nih.gov/pubmed/21930089

http://people.ucalgary.ca/~adeleon/paper_prostate.pdf

http://www.ctsi.ufl.edu/wp-content/uploads/2012/06/DeFeo-2011-A-decade-in-prostate.pdf

http://www.fasebj.org/cgi/content/meeting_abstract/21/6/A768-c

http://onlinelibrary.wiley.com/doi/10.1002/pros.22704/abstract

http://dept.stat.lsa.umich.edu/~gmichail/journal.pone.0021417.pdf

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