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1.
J Invasive Cardiol ; 34(10): E701-E708, 2022 10.
Article in English | MEDLINE | ID: mdl-36075883

ABSTRACT

OBJECTIVES: Coronary lithotripsy (CL) works by fracturing the calcified plaque, allowing mean area gain, enhancing vessel compliance, and facilitating stent deployment. This study reports the safety, effectiveness, and durability of the clinical benefit of CL at long-term follow-up of a real-world multicenter registry. METHODS: This was a prospective, multicenter, single-arm study that included consecutive patients with calcified lesions undergoing CL from August, 2018 to October, 2020 with a clinical follow-up of 20 months (interquartile range, 14.5-25). Exclusion criteria were a target lesion located in a vessel <2.5 mm and/or the presence of dissection prior to CL. The primary endpoint was the rate of major adverse cardiovascular event (MACE, defined as death or target-lesion revascularization [TLR] or myocardial infarction [MI]) at follow-up. RESULTS: This registry included 109 patients (128 lesions). The population was elderly (mean age, 74 years old), with high rates of diabetic patients (58%), renal insufficiency (32%), and multivessel disease (76%). Most of the lesions were predilated with semicompliant/noncompliant balloons (25 with cutting balloon). Rotational atherectomy was used in 20 lesions. On average, CL required the use of 1 balloon delivering a mean of 60 pulses. Twelve patients presented with ST-segment-elevation MI and a culprit calcified coronary lesion undergoing CL. Successful CL was achieved in 99% of cases. There were few procedural complications, with 30-day freedom from MACE rate of 98%. The MACE rate at long-term follow-up was 5.6%. CONCLUSION: This is the first real-world, multicenter registry that confirms the safety and long-term efficacy of percutaneous coronary intervention for calcified lesions using CL in an unselected and high-risk population with a low long-term follow-up MACE rate.


Subject(s)
Atherectomy, Coronary , Coronary Artery Disease , Lithotripsy , Percutaneous Coronary Intervention , Vascular Calcification , Aged , Atherectomy, Coronary/adverse effects , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Follow-Up Studies , Humans , Lithotripsy/adverse effects , Percutaneous Coronary Intervention/adverse effects , Prospective Studies , Registries , Treatment Outcome , Vascular Calcification/diagnosis , Vascular Calcification/therapy
2.
J Invasive Cardiol ; 33(12): E970-E973, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34783676

ABSTRACT

BACKGROUND: This study reports procedural and short-term clinical outcomes from a real-world series with the use of coronary lithotripsy in the context of primary angioplasty in ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: This was a prospective registry conducted at 2 hospitals, which included 10 patients who presented a culprit calcified lesion within acute STEMI and underwent coronary lithotripsy during primary angioplasty, between July 2019 and July 2020. Mean age was 69.2 ± 11.8 years, and there was a high proportion of hypertension (70%) and dyslipidemia (60%). All lesions (type B/C) were predilated with a semicompliant balloon. Coronary lithotripsy was performed in all cases once macroscopic thrombus was successfully retrieved by thrombus aspiration catheter. Before lithotripsy, rotational atherectomy was used in 1 case and cutting balloon was used in 2 cases. On average, coronary lithotripsy required the use of 1 lithotripsy balloon (range, 1-2) delivering a mean of 70 pulses. Two lithotripsy balloons were ruptured during lithotripsy therapy without any adverse event. Successful coronary lithotripsy was achieved in 90%. There were no periprocedural cardiac complications. CONCLUSIONS: Coronary lithotripsy seems to be a safe and effective technique in patients with STEMI and a culprit calcified lesion undergoing primary angioplasty for calcium modification in the absence of angiographic thrombus, and a suitable option to achieve adequate stent expansion and apposition.


Subject(s)
Lithotripsy , ST Elevation Myocardial Infarction , Aged , Aged, 80 and over , Angioplasty , Humans , Middle Aged , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/surgery
3.
JMIR Med Inform ; 9(1): e25149, 2021 Jan 20.
Article in English | MEDLINE | ID: mdl-33417587

ABSTRACT

BACKGROUND: Testing, traceability, and isolation actions are a central strategy defined by the World Health Organization to contain the COVID-19 pandemic. In this sense, the countries have had difficulties in counting the number of people infected with SARS-CoV-2. Errors in reporting results are a common factor, as well as the lack of interoperability between laboratories and governments. Approaches aimed at sending spreadsheets via email expose patients' privacy and have increased the probability of errors due to retyping, which generates a delay in the notification of results. OBJECTIVE: This study aims to design and develop an interoperable platform to report polymerase chain reaction (PCR) SARS-CoV-2 tests from laboratories to the Chilean government. METHODS: The methodology to design and develop the interoperable platform was comprised of six well-structured stages: (1) creation of a minimum data set for PCR SARS-CoV-2 tests, (2) modeling processes and end points where institutions interchange information, (3) standards and interoperability design, (4) software development, (5) software testing, and (6) software implementation. RESULTS: The interoperable Fast Healthcare Interoperability Resources (FHIR) platform to report PCR SARS-CoV-2 tests from laboratories to the Chilean government was successfully implemented. The platform was designed, developed, tested, and implemented following a structured methodology. The platform's performance to 1000 requests resulted in a response time of 240 milliseconds, throughput of 28.3 requests per second, and process management time of 131 milliseconds. The security was assured through a private network exclusive to the Ministry of Health to ensure confidentiality and integrity. The authorization and authentication of laboratories were implemented with a JavaScript Object Notation Web Token. All the PCR SARS-CoV-2 tests were accessible through an application programming interface gateway with valid credentials and the right access control list. CONCLUSIONS: The platform was implemented and is currently being used by UC Christus Laboratory. The platform is secure. It was tested adequately for confidentiality, secure authorization, authentication, and message integrity. This platform simplifies the reporting of PCR SARS-CoV-2 tests and reduces the time and probability of mistakes in counting positive cases. The interoperable solution with FHIR is working successfully and is open for the community, laboratories, and any institution that needs to report PCR SARS-CoV-2 tests.

4.
Rev. esp. cardiol. (Ed. impr.) ; 73(12): 1003-1010, dic. 2020. ilus, tab
Article in Spanish | IBECS | ID: ibc-201126

ABSTRACT

INTRODUCCIÓN Y OBJETIVOS: La litoplastia coronaria (LC) es una técnica con balón que se utiliza para tratar lesiones calcificadas graves. Este estudio describe la experiencia inicial del tratamiento de lesiones calcificadas con LC en una población no seleccionada y de alto riesgo. MÉTODOS: Registro prospectivo, multicéntrico, que incluyó consecutivamente todos los casos con lesiones coronarias calcificadas que se trataron con LC entre agosto de 2018 y agosto de 2019. Los criterios de exclusión fueron lesiones localizadas en vaso pequeño (< 2,5mm) y la presencia de disección previa a la LC. Un laboratorio central independiente realizó la angiografía coronaria cuantitativa y el análisis de la ecocardiografía intravascular/tomografía de coherencia óptica. RESULTADOS: Este registro incluyó a 57 pacientes (66 lesiones). Una población de edad avanzada (72,6±9,4 años) con alta proporción de pacientes diabéticos (56%), enfermedad renal crónica (35%) y enfermedad multivaso (84%). Todas las lesiones eran de tipo B/C. Se predilataron más del 75% de las lesiones con balones semidistensibles/no distensibles o cutting-balloon. Se utilizó rotablación antes de la litoplastia en 5 lesiones (7,6%). En promedio, la LC necesitó 1,17 balones de litoplastia y una media de 60 pulsos. El éxito de la LC se logró en el 98%. En el 13% de los casos, el balón de litoplastia se rompió durante el procedimiento. Hubo pocas complicaciones durante el procedimiento: 2 casos de disección significativa (ninguna relacionada con ruptura del balón de litoplastia), que se trataron con éxito mediante implante de stent farmacoactivo; 1 paciente presentó trombosis del stent 2 días después de someterse con éxito a la revascularización de la lesión objetivo. CONCLUSIONES: Este es un registro multicéntrico de la práctica clínica que respalda la factibilidad, la seguridad y la eficacia a corto plazo de la intervención coronaria percutánea para lesiones coronarias calcificadas utilizando la LC con resultados prometedores en una población no seleccionada y de alto riesgo


INTRODUCTION AND OBJECTIVES: Coronary lithoplasty (CL) is a balloon-based technique used to treat calcified lesions. This study reports the initial experience of treatment of calcified lesions with CL in an unselected and high-risk population. METHODS: This was a prospective, multicenter registry, which included all consecutive cases with calcified coronary lesions that underwent CL between August, 2018 and August, 2019. Exclusion criteria consisted of a target lesion located in a small vessel (< 2.5mm) and the presence of dissection prior to CL. Quantitative coronary angiography and intravascular ultrasound/optical coherence tomography analysis were completed by an independent central core laboratory. RESULTS: This registry included 57 patients (66 lesions). The population was elderly (72.6±9.4 years) with high proportions of patients with diabetes (56%), chronic kidney disease (35%), and multivessel disease (84%). All lesions were classified as type B/C. More than 75% of lesions were predilated with noncompliant/semicompliant balloons or cutting-balloon. Rotablator was used in 5 lesions (7.6%) prelithoplasty. On average, CL required 1.17 balloons delivering a mean of 60 pulses. Successful CL was achieved in 98%. In 13% of cases, lithoplasty balloon was broken during therapy. There were few procedural complications: 2 cases of significant dissections (none related to lithoplasty balloon rupture) were successfully treated with drug-eluting stent implantation. One patient experienced stent thrombosis 2 days after successfully undergoing target lesion revascularization. CONCLUSIONS: This is a real-world multicenter registry, which supports the feasibility, safety, and short-term efficacy of PCI for calcified coronary lesions using CL in an unselected and high-risk population with promising results


Subject(s)
Humans , Aged , Coronary Artery Disease , Drug-Eluting Stents , Lithotripsy , Percutaneous Coronary Intervention , Vascular Calcification , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Prospective Studies , Treatment Outcome , Vascular Calcification/diagnosis , Vascular Calcification/surgery
5.
J Clin Med ; 9(9)2020 Aug 21.
Article in English | MEDLINE | ID: mdl-32839385

ABSTRACT

BACKGROUND: The prognostic value of a prolonged QT interval in SARS-Cov2 infection is not well known. OBJECTIVE: To determine whether the presence of a prolonged QT on admission is an independent factor for mortality in SARS-Cov2 hospitalized patients. METHODS: Single-center cohort of 623 consecutive patients with positive polymerase-chain-reaction test (PCR) to SARS Cov2, recruited from 27 February to 7 April 2020. An electrocardiogram was taken on these patients within the first 48 h after diagnosis and before the administration of any medication with a known effect on QT interval. A prolonged QT interval was defined as a corrected QT (QTc) interval >480 milliseconds. Patients were followed up with until 10 May 2020. RESULTS: Sixty-one patients (9.8%) had prolonged QTc and only 3.2% had a baseline QTc > 500 milliseconds. Patients with prolonged QTc were older, had more comorbidities, and higher levels of immune-inflammatory markers. There were no episodes of ventricular tachycardia or ventricular fibrillation during hospitalization. All-cause death was higher in patients with prolonged QTc (41.0% vs. 8.7%, p < 0.001, multivariable HR 2.68 (1.58-4.55), p < 0.001). CONCLUSIONS: Almost 10% of patients with COVID-19 infection have a prolonged QTc interval on admission. A prolonged QTc was independently associated with a higher mortality even after adjustment for age, comorbidities, and treatment with hydroxychloroquine and azithromycin. An electrocardiogram should be included on admission to identify high-risk SARS-CoV-2 patients.

6.
Rev Esp Cardiol (Engl Ed) ; 73(12): 1003-1010, 2020 Dec.
Article in English, Spanish | MEDLINE | ID: mdl-32430261

ABSTRACT

INTRODUCTION AND OBJECTIVES: Coronary lithoplasty (CL) is a balloon-based technique used to treat calcified lesions. This study reports the initial experience of treatment of calcified lesions with CL in an unselected and high-risk population. METHODS: This was a prospective, multicenter registry, which included all consecutive cases with calcified coronary lesions that underwent CL between August, 2018 and August, 2019. Exclusion criteria consisted of a target lesion located in a small vessel (< 2.5mm) and the presence of dissection prior to CL. Quantitative coronary angiography and intravascular ultrasound/optical coherence tomography analysis were completed by an independent central core laboratory. RESULTS: This registry included 57 patients (66 lesions). The population was elderly (72.6±9.4 years) with high proportions of patients with diabetes (56%), chronic kidney disease (35%), and multivessel disease (84%). All lesions were classified as type B/C. More than 75% of lesions were predilated with noncompliant/semicompliant balloons or cutting-balloon. Rotablator was used in 5 lesions (7.6%) prelithoplasty. On average, CL required 1.17 balloons delivering a mean of 60 pulses. Successful CL was achieved in 98%. In 13% of cases, lithoplasty balloon was broken during therapy. There were few procedural complications: 2 cases of significant dissections (none related to lithoplasty balloon rupture) were successfully treated with drug-eluting stent implantation. One patient experienced stent thrombosis 2 days after successfully undergoing target lesion revascularization. CONCLUSIONS: This is a real-world multicenter registry, which supports the feasibility, safety, and short-term efficacy of PCI for calcified coronary lesions using CL in an unselected and high-risk population with promising results.


Subject(s)
Coronary Artery Disease , Drug-Eluting Stents , Lithotripsy , Percutaneous Coronary Intervention , Vascular Calcification , Aged , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Humans , Prospective Studies , Registries , Treatment Outcome , Vascular Calcification/diagnosis , Vascular Calcification/surgery
7.
Cureus ; 11(10): e5941, 2019 Oct 18.
Article in English | MEDLINE | ID: mdl-31799083

ABSTRACT

Introduction Bed bug infestations have risen dramatically in many industrialized nations in recent decades. Most people fed upon by bed bugs will develop a pruritic rash although the frequency with which this occurs is not definitively known and may depend on host factors including the duration of the infestation. Methods Surveys were completed from 706 emergency department (ED) patients in Cleveland, OH about their current and past exposure with bed bugs. Subjects were asked about any post-bed bug feeding rashes that developed. Results There were 24% (169/698) of subjects reporting either a current or past home bed bug infestation, with 37% (253/698) reporting they had previously been fed upon by a bed bug. Of those reporting a previous bed bug feeding, 68% (172/253) reported a pruritic post-bed bug feeding rash and 24% (57/237) reported developing a blister. Overall, 5% (37/705) of ED patients reported currently having a rash, but only 2% (14/698) of ED patients reported currently have bed bugs at home and of those, only 14% (2/14) said they currently had a rash. Conclusion While 68% of ED patients reported a pruritic post-bed bug feeding pruritic rash, almost a third of persons did not report developing the rash. Post-bed bug feeding blister reactions are less common. Asking ED patients about a rash had a low sensitivity of 14% (2-43%) and a specificity 95% (93-96%) to identify persons reporting home bed bugs.

8.
J Community Health ; 44(6): 1061-1068, 2019 12.
Article in English | MEDLINE | ID: mdl-31152304

ABSTRACT

Bed bugs are a significant and under-studied public health nuisance. We surveyed 706 emergency department patients and found bed bug infestations were more likely (p < 0.05) among subjects having persons 19-64 years of age in the house, living in a group home, a previous history with bed bugs, and knowing someone who currently has bed bugs. Sleeping in a hotel, recent homelessness, obtaining used clothing or furniture and using a laundromat were not associated with increased risk (p > 0.05) for infestation. Individuals with less education and income were more likely (p < 0.05) to have bed bugs and express concern about getting bed bugs. Younger persons were more likely to correctly identify a picture of a bed bug compared to those over the age of 60 years (p < 0.001).


Subject(s)
Bedbugs , Ectoparasitic Infestations/epidemiology , Emergency Service, Hospital , Adult , Aged , Aged, 80 and over , Animals , Educational Status , Female , Health Surveys , Humans , Income , Male , Middle Aged , Ohio/epidemiology , Risk Factors , Self Report , Urban Health , Young Adult
9.
Emerg Med Int ; 2019: 8721829, 2019.
Article in English | MEDLINE | ID: mdl-31210990

ABSTRACT

Cimex lectularius L., the common bed bug, is a hematophagous human ectoparasite that has undergone a global resurgence in the past two decades. We surveyed 706 active emergency department (ED) patients about their experiences with bed bugs. We found that 2% of ED patients reported having a current bed bug infestation, significantly more than the historical number of ED patients upon which we find bed bug; 37% of ED patients report previously having been fed on by a bed bug; 15% currently know someone with an active infestation; and 59% know someone that has had an infestation within ≤ 5 years. Only 18% of bed bug infested patients reported their infestation to emergency medicine providers and only 21% were put in isolation precautions. We found that 25% of patients with bed bugs worried about receiving worse healthcare because of their infestation. Persons with bed bugs were more likely compared to those without bed bugs to be older (52 vs. 41 years) and arrive by ambulance (57% vs. 14%) (p < 0.05), but not reporting insomnia (50% vs. 49%) (p = 1.0). Bed bug infested patients can be common in the ED. Most bed bug infested patients are older, arrive to the ED by ambulance, do not report their infestation to healthcare providers, and are not adequately placed into isolation precautions, potentially putting other patients and providers at risk for acquiring the infestation.

10.
Microb Cell Fact ; 16(1): 198, 2017 Nov 14.
Article in English | MEDLINE | ID: mdl-29137641

ABSTRACT

Efficient growth of E. coli, especially for production of recombinant proteins, has been a challenge for the biotechnological industry since the early 1970s. By employing multiple approaches, such as different media composition, various growth strategies and specific genetic manipulations, it is now possible to grow bacteria to concentrations exceeding 100 g/L and to achieve high concentrations of recombinant proteins. Although the growth conditions are carefully monitored and maintained, it is likely that during the growth process cells are exposed to periodic stress conditions, created by fluctuations in pH, dissolved oxygen, temperature, glucose, and salt concentration. These stress circumstances which can occur especially in large volume bioreactors, may affect the growth and production process. In the last several years, it has been recognized that small non-coding RNAs can act as regulators of bacterial gene expression. These molecules are found to be specifically involved in E. coli response to different environmental stress conditions; but so far, have not been used for improving production strains. The review provides summary of small RNAs identified on petri dish or in shake flask culture that can potentially affect growth characteristics of E. coli grown in bioreactor. Among them MicC and MicF that are involved in response to temperature changes, RyhB that responds to iron concentration, Gady which is associated with lower pH, Sgrs that is coupled with glucose transport and OxyS that responds to oxygen concentration. The manipulation of some of these small RNAs for improving growth of E. coli in Bioreactor is described in the last part of the review. Overexpression of SgrS was associated with improved growth and reduced acetate expression, over expression of GadY improved cell growth at acidic conditions and over expression of OxyS reduced the effect of oxidative stress. One of the possible advantages of manipulating sRNAs for improving cell growth is that the modifications occur at a post-translational level. Therefore, the use of sRNAs may exert minimal effect on the overall bacterial metabolism. The elucidation of the physiological role of newly discovered sRNAs will open new possibilities for creating strains with improved growth and production capabilities.


Subject(s)
Escherichia coli/growth & development , Escherichia coli/genetics , Gene Expression Regulation, Bacterial , RNA, Bacterial/genetics , RNA, Small Untranslated/genetics , Acetates/metabolism , Batch Cell Culture Techniques , Bioreactors/microbiology , Escherichia coli/metabolism , Escherichia coli Proteins/genetics , Recombinant Proteins , Stress, Physiological , Temperature
11.
Nat Commun ; 8: 14030, 2017 01 17.
Article in English | MEDLINE | ID: mdl-28094788

ABSTRACT

The ability to interconvert information between electronic and ionic modalities has transformed our ability to record and actuate biological function. Synthetic biology offers the potential to expand communication 'bandwidth' by using biomolecules and providing electrochemical access to redox-based cell signals and behaviours. While engineered cells have transmitted molecular information to electronic devices, the potential for bidirectional communication stands largely untapped. Here we present a simple electrogenetic device that uses redox biomolecules to carry electronic information to engineered bacterial cells in order to control transcription from a simple synthetic gene circuit. Electronic actuation of the native transcriptional regulator SoxR and transcription from the PsoxS promoter allows cell response that is quick, reversible and dependent on the amplitude and frequency of the imposed electronic signals. Further, induction of bacterial motility and population based cell-to-cell communication demonstrates the versatility of our approach and potential to drive intricate biological behaviours.


Subject(s)
Electronics/instrumentation , Escherichia coli/metabolism , Gene Expression Regulation, Bacterial , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Electronics/methods , Escherichia coli/chemistry , Escherichia coli/cytology , Escherichia coli/genetics , Escherichia coli Proteins/genetics , Escherichia coli Proteins/metabolism , Oxidation-Reduction , Promoter Regions, Genetic , Signal Transduction , Synthetic Biology , Trans-Activators/genetics , Trans-Activators/metabolism , Transcription Factors/genetics , Transcription Factors/metabolism
12.
Blood Press ; 25(5): 280-5, 2016 10.
Article in English | MEDLINE | ID: mdl-27104796

ABSTRACT

Home blood pressure monitoring (HBPM) is recommended in patients with chronic kidney disease (CKD) and hypertension (HTN). However, little is known about the use and pattern of HBPM in CKD patients. A cross-sectional study was conducted in an out-patient nephrology clinic. A total of 285 patients participated in the study. Of all patients, 66% reported using HBPM. Self-reported compliance with BP medications (93.9% vs. 85.1%, p 0.03), exercise >3 days/week (45.9 vs. 26.3%, p <0.001) and dietary sodium restriction (85.6% vs. 71.6%, p < 0.001) were more common in HBPM users vs. non-HBPM users. Most patients with HBPM used upper arm cuff (82.3%), reported receiving education on correct use of HBPM (82.5%), had perception that home BP was controlled (75.4%) and believed that HBPM is helpful in managing hypertension (85.4%). Most common reason for not using HBPM was lack of advice by a physician (43.4%). HBPM use is common in patients with CKD and HTN. HBPM users are more likely to follow life-style and dietary modifications for blood pressure control.


Subject(s)
Blood Pressure Monitors , Hypertension/drug therapy , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Cross-Sectional Studies , Humans , Renal Insufficiency, Chronic
13.
Vascular ; 24(6): 610-620, 2016 Dec.
Article in English | MEDLINE | ID: mdl-26864776

ABSTRACT

BACKGROUND: Applications to integrated (0 + 5) vascular surgery residencies have increased, while total applications have stayed relatively constant. This survey sought to document the perceptions of 0 + 5 vascular surgery applicants. METHODS: Academic faculty conducted interviews for 0 + 5 residency match at an academic medical center in preparation for the National Resident Matching Program (NRMP) Main Residency Match. Applicant pool (n = 20) perceptions were determined with surveys. Participation was anonymous and voluntary. RESULTS: Nineteen interviewees (26.3% female: 73.7% male), age (26.8 ± 2.6 years) responded (95% response rate). Of 19 respondents, 68% became interested in vascular surgery in their third year with 53% becoming aware of 0 + 5 programs in their third year. All respondents identified a vascular surgery attending at their institution as significant mentors. Forty-seven percent identified their mentor during their third year of medical school. All respondents felt that 0 + 5 training would prepare them adequately for the workforce and board certification exams. Almost all (89%) had plans to seek jobs immediately upon completion of residency. CONCLUSION: Applicants remained positive about their planned training and career paths. Attending vascular surgeons were identified as the strongest mentors, yet most students decided only in their third and fourth years to pursue 0 + 5 residencies. Educational debt remains a concern, and there may be consideration for a concerted effort to recruit potential candidates sooner.


Subject(s)
Career Choice , Education, Medical, Graduate/methods , Internship and Residency , Perception , Students, Medical/psychology , Vascular Surgical Procedures/education , Adult , Education, Medical, Graduate/economics , Female , Humans , Internship and Residency/economics , Job Description , Life Style , Male , Mentors , Surveys and Questionnaires , Workload , Young Adult
14.
Nat Commun ; 6: 10006, 2015 Dec 01.
Article in English | MEDLINE | ID: mdl-26624227

ABSTRACT

Diseases of ectopic calcification of the vascular wall range from lethal orphan diseases such as generalized arterial calcification of infancy (GACI), to common diseases such as hardening of the arteries associated with aging and calciphylaxis of chronic kidney disease (CKD). GACI is a lethal orphan disease in which infants calcify the internal elastic lamina of their medium and large arteries and expire of cardiac failure as neonates, while calciphylaxis of CKD is a ubiquitous vascular calcification in patients with renal failure. Both disorders are characterized by vascular Mönckeburg's sclerosis accompanied by decreased concentrations of plasma inorganic pyrophosphate (PPi). Here we demonstrate that subcutaneous administration of an ENPP1-Fc fusion protein prevents the mortality, vascular calcifications and sequela of disease in animal models of GACI, and is accompanied by a complete clinical and biomarker response. Our findings have implications for the treatment of rare and common diseases of ectopic vascular calcification.


Subject(s)
Infant, Newborn, Diseases/enzymology , Infant, Newborn, Diseases/prevention & control , Phosphoric Diester Hydrolases/metabolism , Pyrophosphatases/metabolism , Vascular Calcification/enzymology , Vascular Calcification/prevention & control , Animals , Arteries/enzymology , Arteries/pathology , Disease Models, Animal , Female , Humans , Immunoglobulin Fc Fragments/administration & dosage , Immunoglobulin Fc Fragments/genetics , Immunoglobulin Fc Fragments/metabolism , Immunoglobulin G/genetics , Immunoglobulin G/metabolism , Infant, Newborn , Infant, Newborn, Diseases/genetics , Infant, Newborn, Diseases/mortality , Male , Mice, Inbred C57BL , Phosphoric Diester Hydrolases/administration & dosage , Phosphoric Diester Hydrolases/genetics , Pyrophosphatases/administration & dosage , Pyrophosphatases/genetics , Vascular Calcification/genetics , Vascular Calcification/mortality
15.
Microb Cell Fact ; 14: 148, 2015 Sep 18.
Article in English | MEDLINE | ID: mdl-26383169

ABSTRACT

BACKGROUND: Escherichia coli responds to acid stress by applying various physiological, metabolic, and proton-consuming mechanisms depending on the growth media composition, cell density, growth phase, pH, and aerobic or anaerobic growth conditions. It was reported that at mild acidic conditions (pH 5.8), the Hfq-associated sRNA GadY is activated. It was also reported that the two decarboxylase systems-the lysine decarboxylase system (LDS) and the glutamate decarboxylase system (GDS)-are activated to maintain intracellular balance of protons. The purpose of this study was to establish the role of GadY in high density growth of E. coli and to evaluate the possibility of using this small RNA to create an acid-resistant strain suitable for industrial applications. RESULTS: Parental E. coli K-12 and constitutively expressing GadY strains were grown to high cell densities in a bioreactor at pH 7.0 and pH 6.0. At pH 7.0, both strains grew to similar cell densities of 43 OD, but the constitutively expressing GadY strain produced around 6 g/L acetate compared with 10 g/L by the parental strain. At pH 6.0, the parental strain grew to an OD of 20 and produced 10 g/L of acetate while the GadY strain grew to an average OD of 31 and produced 4 g/L acetate. After analyzing 17 genes associated with acid stress, it was found that at pH 7.0 LDS was expressed in the early exponential phase and GDS was expressed in the late exponential phase in both strains. However, at pH.6.0, GDS was expressed in the late exponential phase only in the parental strain and not in the constitutively expressing GadY strain, while there was no difference in the LDS expression pattern; it was expressed in the early exponential phase in both strains. This indicates that GadY affects GDS expression at low pH since the GDS was not detected in the GadY strain at pH 6.0. CONCLUSIONS: The constitutive expression of GadY improves E. coli growth at pH 6.0 by deactivating the expression of the GDS in the late exponential growth phase. The expression of GadY also decreases acetate production regardless of pH, which decreases the inhibitory effect of this acid on bacterial growth.


Subject(s)
Escherichia coli Proteins/metabolism , Escherichia coli/growth & development , RNA, Small Untranslated/metabolism , Acetates/metabolism , Carboxy-Lyases/genetics , Carboxy-Lyases/metabolism , Escherichia coli/metabolism , Escherichia coli Proteins/genetics , Glutamate Decarboxylase/genetics , Glutamate Decarboxylase/metabolism , Hydrogen-Ion Concentration , RNA/isolation & purification , RNA/metabolism , RNA, Small Untranslated/genetics
16.
Mol Cell ; 54(6): 1012-1021, 2014 Jun 19.
Article in English | MEDLINE | ID: mdl-24837675

ABSTRACT

Chromosomal rearrangements often occur at genomic loci with DNA secondary structures, such as common fragile sites (CFSs) and palindromic repeats. We developed assays in mammalian cells that revealed CFS-derived AT-rich sequences and inverted Alu repeats (Alu-IRs) are mitotic recombination hotspots, requiring the repair functions of carboxy-terminal binding protein (CtBP)-interacting protein (CtIP) and the Mre11/Rad50/Nbs1 complex (MRN). We also identified an endonuclease activity of CtIP that is dispensable for end resection and homologous recombination (HR) at I-SceI-generated "clean" double-strand breaks (DSBs) but is required for repair of DSBs occurring at CFS-derived AT-rich sequences. In addition, CtIP nuclease-defective mutants are impaired in Alu-IRs-induced mitotic recombination. These studies suggest that an end resection-independent CtIP function is important for processing DSB ends with secondary structures to promote HR. Furthermore, our studies uncover an important role of MRN, CtIP, and their associated nuclease activities in protecting CFSs in mammalian cells.


Subject(s)
Carrier Proteins/metabolism , Chromosome Fragile Sites/genetics , DNA Breaks, Double-Stranded , DNA Repair/genetics , Inverted Repeat Sequences/genetics , Nuclear Proteins/metabolism , Acid Anhydride Hydrolases , Alu Elements/genetics , Base Composition/genetics , Carrier Proteins/genetics , Cell Cycle Proteins/genetics , Cell Line , DNA Repair Enzymes/genetics , DNA-Binding Proteins/genetics , Endodeoxyribonucleases , Endonucleases/genetics , Homologous Recombination/genetics , Humans , MRE11 Homologue Protein , Mitosis/genetics , Nuclear Proteins/genetics , Recombination, Genetic
17.
J Virol Methods ; 195: 240-6, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24157258

ABSTRACT

Attenuated viruses, inactivated viruses and virus like particles (VLPs) are known to be efficient vaccines partially due to their particulate structure. A potential HIV vaccine candidate engineered as a VLP (HIV gag-VLP) and produced in insect cells is currently under preclinical trials demanding large amounts. Due to their extreme fragility and sensitivity to shear forces the recovery and concentration of these extracellular enveloped particles of approximately 120 nm in size is challenging. The current bench scale gradient ultracentrifugation and precipitation methods have been found unsuitable for larger scale processes. In this study a two-step tangential flow filtration (TFF) process using hollow fibers was developed for the clarification and concentration of HIV gag-VLPs. The first step is microfiltration for cell removal and the second step is ultrafiltration for concentrating the HIV gag-VLPs. The chosen parameters for the microfiltration step were hollow fiber membranes of 0.45 µm cut off 5000 s(-1) shear force and a flux of 10 LMH. The chosen parameters for the ultrafiltration step were a 500 kDa cut off membrane, 6000 s(-1) shear force and a trans-membrane pressure (TMP) of 1.25 bar. The utilization of these parameters provided with concentrated HIV-gag VLPs from 2L of starting cell suspension within 6h of processing time. These downstream processing conditions are extremely valuable for the further large-scale purification process development for HIV gag-VLPs and other particulate bioproducts.


Subject(s)
AIDS Vaccines/isolation & purification , Filtration/methods , HIV Antigens/biosynthesis , Animals , Insecta , Recombinant Proteins/biosynthesis , Vaccines, Virus-Like Particle
18.
Horm Res Paediatr ; 80(4): 281-6, 2013.
Article in English | MEDLINE | ID: mdl-24060766

ABSTRACT

BACKGROUND: Obesity is related to an increase in the rates of cardiovascular disease. OBJECTIVE: To establish the impact of obesity on vascular function (endothelial function and arterial stiffness) in children and adolescents and its relationship to cardiovascular risk factors. METHODS: In obese (OB) children and adolescents, endothelial function and arterial stiffness were evaluated by a pulse plethysmography method (reactive hyperemia and index of digital volume waveforms, respectively). Data were compared with the non-obese (non-OB) group (body mass index >10th to <97th percentile). Anthropometric parameters, body fat percentage, fasting glucose, lipid profile, insulinemia, HOMA-IR and hemodynamic parameters were determined in both groups. RESULTS: Body mass index, weight, waist circumference, body fat, insulinemia and HOMA-IR were significantly higher in the OB group. The OB group showed impaired endothelial function (15.8 ± 0.2%, n = 37) compared to the non-OB group (41.4 ± 5%, n = 20; p < 0.001) and increased arterial stiffness. Endothelial function was only negatively correlated with waist circumference and HOMA-IR in the OB group, whereas a positive correlation was found between insulinemia and HOMA-IR. CONCLUSIONS: This study shows that impaired vascular function is already present in OB children and adolescents. The fact that obesity is associated with some markers of cardiovascular risk suggests the importance of early lifestyle interventions in this population to prevent cardiovascular disease.


Subject(s)
Endothelium, Vascular/physiopathology , Obesity/physiopathology , Vascular Stiffness , Adolescent , Body Mass Index , Child , Endothelium, Vascular/pathology , Female , Humans , Hyperemia/pathology , Hyperemia/physiopathology , Male , Obesity/pathology , Plethysmography , Waist Circumference
19.
N Biotechnol ; 30(2): 269-73, 2013 Jan 25.
Article in English | MEDLINE | ID: mdl-22107968

ABSTRACT

When exposed to the nonmetabolized glucose derivative alpha methyl glucoside (αMG), both Escherichia coli K-12 (JM109 and MG1655) and E. coli B (BL21) respond by reducing the concentration of the mRNA of the ptsG gene which is responsible for the biosynthesis of the glucose transporter EIICB(glu). This occurs through the over-expression of the noncoding small RNA SgrS, which interacts specifically with the mRNA of the ptsG gene and prevents its translation. However, when these bacteria are exposed to a glucose concentration of 40 g/L, over-expression of SgrS is observed only in E. coli B (BL21). Unlike E. coli K-12 (JM109 and MG1655), which are affected by high glucose concentration and produce higher levels of acetate, E. coli B (BL21) is not affected. Based on this information, it was assumed that over-expression of SgrS enables E. coli B (BL21) to reduce its acetate excretion by controlling the glucose transport. When SgrS was over-expressed in both E. coli K-12 strains from a multicopy plasmid, it was possible to reduce their acetate excretion levels to those seen in E. coli B. This observation opens a new approach towards controlling bacterial metabolism through the use of noncoding RNA.


Subject(s)
Acetates/metabolism , Escherichia coli K12/metabolism , Escherichia coli Proteins/metabolism , Escherichia coli K12/genetics , Escherichia coli K12/growth & development , Escherichia coli Proteins/genetics , Glucose/metabolism , Phosphoenolpyruvate Sugar Phosphotransferase System/genetics , Phosphoenolpyruvate Sugar Phosphotransferase System/metabolism , Transcription, Genetic
20.
J Biol Chem ; 287(38): 31747-56, 2012 Sep 14.
Article in English | MEDLINE | ID: mdl-22833675

ABSTRACT

The Mre11-Rad50-Nbs1 (MRN) complex plays critical roles in checkpoint activation and double-stranded break (DSB) repair. The Rad50 zinc hook domain mediates zinc-dependent intercomplex associations of MRN, which is important for DNA tethering. Studies in yeast suggest that the Rad50 zinc hook domain is essential for MRN functions, but its role in mammalian cells is not clear. We demonstrated that the human Rad50 hook mutants are severely defective in various DNA damage responses including ATM (Ataxia telangiectasia mutated) activation, homologous recombination, sensitivity to IR, and activation of the ATR pathway. By using live cell imaging, we observed that the Rad50 hook mutants fail to be recruited to chromosomal DSBs, suggesting a novel mechanism underlying the severe defects observed for the Rad50 hook mutants. In vitro analysis showed that Zn(2+) promotes wild type but not the hook mutant of MR to bind double-stranded DNA. In vivo, the Rad50 hook mutants are defective in being recruited to chromosomal DSBs in both H2AX-proficient and -deficient cells, suggesting that the Rad50 hook mutants are impaired in direct binding to chromosomal DSB ends. We propose that the Rad50 zinc hook domain is important for the initial binding of MRN to DSBs, leading to ATM activation to phosphorylate H2AX, which recruits more MRN to the DSB-flanking chromosomal regions. Our studies reveal a critical role for the Rad50 zinc hook domain in establishing and maintaining MRN recruitment to chromosomal DSBs and suggest an important mechanism of how the Rad50 zinc hook domain contributes to DNA repair and checkpoint activation.


Subject(s)
DNA Repair Enzymes/metabolism , DNA-Binding Proteins/chemistry , DNA-Binding Proteins/metabolism , Zinc/chemistry , Acid Anhydride Hydrolases , Amino Acid Motifs , Ataxia Telangiectasia Mutated Proteins , Cell Cycle Proteins/chemistry , Cell Separation , Chromosomes/ultrastructure , DNA Breaks, Double-Stranded , DNA Damage , Flow Cytometry , Gene Silencing , Genome , Genomics , HEK293 Cells , Histones/chemistry , Humans , MRE11 Homologue Protein , Microscopy, Fluorescence/methods , Mutation , Protein Binding , Protein Serine-Threonine Kinases/chemistry , Recombination, Genetic , Tumor Suppressor Proteins/chemistry
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