Relación entre la cuantificación de calcio coronario y la composición de la microbiota intestinal en sujetos sin enfermedad cardiovascular previa: estudio piloto / Relationship between the coronary artery calcium quantification and gut microbiota composition in subjects without previous cardiovascular disease: A pilot study

Objetivo: Determinar si existe alguna asociación entre el perfil de microbiota intestinal y la carga aterosclerótica global medida mediante cuantificación de calcio coronario (CCC) en sujetos sin antecedentes de enfermedad cardiovascular (ECV). Métodos: Se incluyeron 20 pacientes mayores de edad, sin antecedentes de ECV a los que se les hizo la CCC mediante tomografía computarizada multicorte. Además, se les recogió una muestra de heces para caracterizar la composición de la microbiota intestinal mediante la secuenciación del gen 16S RNAr con técnicas de secuenciación masiva y una muestra de sangre para la cuantificación de citoquinas proinflamatorias, mediante ELISA específicos, y del metabolito bacteriano N-óxido de trimetilamina (TMAO) por cromatografía de gases/líquidos acoplada a espectrometría de masas en tándem. Resultados: La media de edad fue de 63,5 años y un 60% eran mujeres. La mitad de los pacientes (n=10) presentaron una CCC>100 y se caracterizaron por una mayor abundancia de bacterias del filo Proteobacteria, pertenecientes principalmente a las familias Enterobacteriaceae y Pasteurellaceae, que los pacientes con CCC≤100. La mayoría de los géneros bacterianos identificados, Enterobacter, Escherichia/Shigella, Klebsiella, Citrobacter y Salmonella, se asociaron positivamente con los niveles plasmáticos de TNF-α o IL-1β y con la producción de TMAO. Conclusión: Los resultados de este estudio piloto muestran un perfil de microbiota intestinal asociado a la presencia de CCC>100 en pacientes sin ECV previa, caracterizado por un aumento en la proporción de géneros bacterianos productores de TMAO. Puesto que la composición de la microbiota intestinal es altamente modulable por diversos factores, es posible que, en un futuro, podamos prevenir, e incluso intervenir, la enfermedad cardiovascular mediante estrategias nutricionales. (AU)

Aim: To investigate the relationship between gut microbiota composition and the presence of coronary atherosclerosis assessed by coronary artery calcium (CAC) quantification in individuals without previous cardiovascular disease (CVD). Methods: We included 20 patients over 18 years of age with no history of CVD who underwent multiple detector-computed tomography. From each patient, a stool sample was obtained to characterize gut microbiota composition by sequencing bacterial 16S ribosomal RNA gene. In addition, circulating levels of TNF-α and IL-1β, as well as trimethylamine N-oxide (TMAO) were determined in plasma samples by automated ELISA and capillary gas chromatography-mass spectrometry, respectively. Results: The mean age of patients was 63.5 years and 60% were women. Half of patients had CAC >100 (Agatston score), and were characterized by a higher abundance of the phylum Proteobacteria, mainly of bacteria belonging to the families Enterobacteriaceae and than patients with a CAC ≤ 100. Moreover, bacterial genera identified as biomarkers, such as Enterobacter, Escherichia/Shigella y Klebsiella, were positively associated with inflammation levels and with TMAO production. Conclusion: Our data shows a gut microbiota profile associated with the presence of coronary calcium in patients without previous CVD. Although there are no strategies to decrease the amount of coronary calcium, gut microbiota is highly malleable by several factors. The possibility of preventing and even intervening CVD progression through strategies targeted gut microbiota is a very attractive idea that deserves further studies. (AU)

Relationship between the coronary artery calcium quantification and gut microbiota composition in subjects without previous cardiovascular disease: A pilot study. / Relación entre la cuantificación de calcio coronario y la composición de la microbiota intestinal en sujetos sin enfermedad cardiovascular previa: estudio piloto.

AIM: To investigate the relationship between gut microbiota composition and the presence of coronary atherosclerosis assessed by coronary artery calcium (CAC) quantification in individuals without previous cardiovascular disease (CVD). METHODS: We included 20 patients over 18 years of age with no history of CVD who underwent multiple detector-computed tomography. From each patient, a stool sample was obtained to characterize gut microbiota composition by sequencing bacterial 16S ribosomal RNA gene. In addition, circulating levels of TNF-α and IL-1ß, as well as trimethylamine N-oxide (TMAO) were determined in plasma samples by automated ELISA and capillary gas chromatography-mass spectrometry, respectively. RESULTS: The mean age of patients was 63.5 years and 60% were women. Half of patients had CAC >100 (Agatston score), and were characterized by a higher abundance of the phylum Proteobacteria, mainly of bacteria belonging to the families Enterobacteriaceae and than patients with a CAC ≤ 100. Moreover, bacterial genera identified as biomarkers, such as Enterobacter, Escherichia/Shigella y Klebsiella, were positively associated with inflammation levels and with TMAO production. CONCLUSION: Our data shows a gut microbiota profile associated with the presence of coronary calcium in patients without previous CVD. Although there are no strategies to decrease the amount of coronary calcium, gut microbiota is highly malleable by several factors. The possibility of preventing and even intervening CVD progression through strategies targeted gut microbiota is a very attractive idea that deserves further studies.

Protocolo de actuación ante valores críticos en pruebas de laboratorio en el lugar de asistencia al paciente en una unidad neonatal / Critical values protocol for point of care testing in a neonatal unit

Introducción. En las unidades asistenciales que realizan pruebas de laboratorio en el lugar de asistencia al paciente (POCT) sería recomendable establecer las mismas políticas de calidad que en el laboratorio central, entre ellas disponer de un protocolo de actuación ante valores críticos. El objetivo del estudio consistió en elaborar el listado de valores críticos para pruebas POCT realizadas en una unidad neonatal y establecer el protocolo de actuación. Material y métodos. Las magnitudes estudiadas fueron pH, pCO2, pO2, saturación de oxígeno, hemoglobina, sodio, potasio, calcio ionizado, glucosa, bilirrubina y lactato. Estas magnitudes fueron determinadas en un analizador ABL90 FLEX. El listado de valores críticos se elaboró mediante revisión de la bibliografía y consenso con los neonatólogos. El protocolo de actuación se adaptó a partir del protocolo del laboratorio de urgencias. La revisión del listado preliminar se basó en la práctica clínica y en los datos de frecuencia de aparición de valores críticos. Resultados. Se expone nuestra experiencia en la elaboración de un listado de valores críticos para POCT y en la implantación del protocolo de actuación. Conclusiones. Para establecer el listado de valores críticos y protocolo de actuación resultó fundamental la experiencia del laboratorio central. Para conseguir la implantación de un protocolo de actuación ante valores críticos en POCT es necesaria una estrecha colaboración entre la unidad asistencial y el personal del laboratorio. La frecuencia de aparición de valores críticos y la experiencia de los clínicos son herramientas que se complementan en la revisión del listado de valores críticos (AU)

Introduction. Care units performing point of care testing (POCT) should have the same quality policies as the central laboratory, including having a protocol for critical values. The aim of the study was to develop a list of critical values for POCT in a neonatal unit, and set the protocol performance. Material and methods. The tests included in the protocol were pH, pCO2, pO2, oxygen saturation, haemoglobin, sodium, potassium, ionized calcium, glucose, bilirubin, and lactate. These tests were determined using a POCT ABL90FLEX analyser. To prepare the list of critical values, a bibliography review was performed, as well as meetings with the neonatologists. The revision of the preliminary list was based on clinical practice and data frequency of critical values. To set the protocol, an adaptation of our emergency laboratory protocol was performed. Results. We show our experience in the preparation of a list of critical values for POCT and the implementation of a protocol. Conclusions. Central laboratory experience was a key element in establishing the list of critical values and action protocol. A close collaboration between health care unit and laboratory was required to achieve the implementation of a POCT critical values protocol. The frequency of critical values and clinician experience were complementary tools to revise the list of critical values (AU)

The effects of adiponectin and leptin on human endothelial cell proliferation: a live-cell study.

The effect of adiponectin and leptin on the proliferation of the human microvascular endothelial cell line (HMEC-1) was studied in the absence or presence of fetal bovine serum (FBS). The participation of extracellular signal-regulated kinase (ERK) and phosphatidylinositol 3-kinase/Akt (PI-3K/Akt) pathways in this effect were evaluated. We studied the effect of both adipokines on the motility, mitosis, proliferation and cell death processes of HMEC-1 cells using live-cell imaging techniques. Adiponectin but not leptin further increased the proliferative effect induced by FBS on HMEC-1. This effect seems to be the consequence of an increase in the mitotic index in adiponectin-treated cells when compared to untreated ones. The presence of either the mitogen-activated protein kinase (MAPK) inhibitor (PD98059), or PI-3K inhibitor (LY294002), reduced the effect of adiponectin in a dose-dependent manner. Neither adipokine was able to affect HMEC-1 proliferation in FBS-free conditions. Duration of mitosis, cell motility and the cell death process were similar in all conditions. These data suggest that adiponectin and leptin exert different effects on endothelial cell function. Adiponectin was able to potentiate proliferation of HMEC-1. This effect involves the activation of both PI3-K/Akt and ERK/MAPK pathways. However, it seems to exert minimal effects on HMEC-1 function in the case of leptin.