A novel truncated form of apolipoprotein A-I transported by dense LDL is increased in diabetic patients

Diabetic (DM) patients have exacerbated atherosclerosis and high CVD burden. Changes in lipid metabolism, lipoprotein structure, and dysfunctional HDL are characteristics of diabetes. Our aim was to investigate whether serum ApoA-I, the main protein in HDL, was biochemically modified in DM patients. By using proteomic technologies, we have identified a 26 kDa ApoA-I form in serum. MS analysis revealed this 26 kDa form as a novel truncated variant lacking amino acids 1-38, ApoA-IΔ(1-38). DM patients show a 2-fold increase in ApoA-IΔ(1-38) over nondiabetic individuals. ApoA-IΔ(1-38) is found in LDL, but not in VLDL or HDL, with an increase in LDL3 and LDL4 subfractions. To identify candidate mechanisms of ApoA-I truncation, we investigated potentially involved enzymes by in silico data mining, and tested the most probable molecule in an established animal model of diabetes. We have found increased hepatic cathepsin D activity as one of the potential proteases involved in ApoA-I truncation. Cathepsin D-cleaved ApoA-I exhibited increased LDL binding affinity and decreased antioxidant activity against LDL oxidation. In conclusion, we show for the first time: a) presence of a novel truncated ApoA-I form, ApoA-IΔ(1-38), in human serum; b) ApoA-IΔ(1-38) is transported by LDL; c) ApoA-IΔ(1-38) is increased in dense LDL fractions of DM patients; and d) cathepsin D-ApoA-I truncation may lead to ApoA-IΔ(1-38) binding to LDLs, increasing their susceptibility to oxidation and contributing to the high cardiovascular risk of DM patients. This research was originally published in Lipid Research. A novel truncated form of apolipoprotein A-I transported by dense LDL is increased in diabetic patients. Journal of Lipid Research. 2015. 56: 1762-1773 © the American Society for Biochemistry and Molecular Biology.Peer Reviewe

Allogenic adipose-derived stem cell therapy overcomes ischemia-induced microvessel rarefaction in the myocardium : systems biology study

Altres ajuts: This work was supported by the Spanish Cardiovascular Network of Cell Therapy (Red TerCel RD16/0011/018) and Ciber CV(CB16/11/00411) from the Instituto Salud Carlos III (to LB). Additional funding was received from Plan Nacional de Salud (PNS SAF2016-76819-R to LB, 2015-71653-R to GV) from the Spanish Ministry of Science and Innovation and FEDER funds; from Instituto de Salud Carlos III (CPII13/00012 to GA); and support from a grant from the Muy Ilustrísima Administración from the Hospital de la Santa Creu I Sant Pau (to MG). The authors thank Fundacion Jesus Serra, Barcelona for continuous support.Myocardial microvascular loss after myocardial infarction (MI) remains a therapeutic challenge. Autologous stem cell therapy was considered as an alternative; however, it has shown modest benefits due to the impairing effects of cardiovascular risk factors on stem cells. Allogenic adipose-derived stem cells (ASCs) may overcome such limitations, and because of their low immunogenicity and paracrine potential may be good candidates for cell therapy. In the present study we investigated the effects of allogenic ASCs and their released products on cardiac rarefaction post MI. Pig subcutaneous adipose tissue ASCs were isolated, expanded and GFP-labeled. ASC angiogenic function was assessed by the in-vivo chick chorioallantoic membrane (CAM) model. Pigs underwent MI induction and 7 days after were randomized to receive: allogenic ASCs (intracoronary infusion); conditioned media (CM; intravenous infusion); ASCs + CM; or PBS/placebo (control). Cardiac damage and function were monitored by 3-T cardiac magnetic resonance imaging upon infusion (baseline CMR) and 1 and 3 weeks thereafter. We assessed in the myocardium: microvessel density; angiogenic markers (CD105, CD31, TF, VEGFR2, VEGFR1, vWF, eNOS, CD62); collagen deposition; and reparative fibrosis (TGFβ/TβRII/collagen). Differential proteomics of ASCs and CM was performed to characterize the ASC protein signature. CAM indicated a significant ASC proangiogenic capacity. In pigs after MI, only PBS/placebo animals displayed an impaired cardiac function 3 weeks after infusion (p < 0.05 vs baseline). Administration of ASCs + CM significantly enhanced neovessel formation and favored cardiac repair post MI (p < 0.05 vs the other groups). Molecular markers of angiogenesis were significantly upregulated both at transcriptional and protein levels (p < 0.05). The in-silico bioinformatics analysis of the ASC and CM proteome (interactome) indicated activation of a coordinated protein network involved in the formation of microvessels and the resolution of rarefaction. Coadministration of allogenic ASCs and their CM synergistically contribute to the neovascularization of the infarcted myocardium through a coordinated upregulation of the proangiogenic protein interactome. The online version of this article (doi:10.1186/s13287-017-0509-2) contains supplementary material, which is available to authorized users

Medicalized Hotel as an Alternative to Hospital Care for Management of Noncritical COVID-19

Background: Since the first wave of COVID-19, alternatives to conventional hospitalization have been proposed for the provision of different levels of care, ranging from shelter during quarantine to hospital-level medical care. Objective: To describe the adaptation of a hotel by a hospital-at-home team to provide hospital-level care to patients with COVID-19 during the first wave of the pandemic in Barcelona, Spain. Methods: Hospital Clínic de Barcelona (HCB) is a 750-bed, public, tertiary teaching hospital serving 560 000 persons in the metropolitan area of Barcelona, Spain. In March 2020, the hospital-at-home unit was instructed to medicalize a hotel ('health hotel' [HH]) in downtown Barcelona. The aim of this initiative was to help decongest hospitals in the area by admitting patients with low dependency (Barthel Index score >60) and mild to severe COVID-19 from emergency departments or COVID-19 hospital wards, according to Centers for Disease Control and Prevention clinical guideline

Identificación de nuevos biomarcadores en los síndromes coronarios agudos

[spa] La aterosclerosis, engrosamiento de la pared arterial, puede progresar gradualmente hasta complicarse con la aparición de un trombo ocasionando una obstrucción brusca de una arteria con obliteración del flujo en el órgano irrigado por dicha arteria. Según su localización, esta oclusión puede dar lugar a un accidente cerebrovascular (CVA), una obstrucción arterial periférica o a un síndrome coronario agudo (ACS). Dentro de los ACS podemos encontrar la angina inestable, el infarto agudo de miocardio con y sin elevación de ST y la muerte súbita. Estas manifestaciones agudas de la enfermedad cardíaca comparten un mismo fenómeno patofisiológico: la aterotrombosis coronaria y resultan de una isquemia aguda del miocardio. Aunque se han producido grandes avances en el tratamiento de esta enfermedad, la medicina actual no es capaz de predecir el riesgo de sufrir patología cardiovascular. Pese a la gran influencia de los factores de riesgo clásicos tales como la dislipemia, la diabetes, la hipertensión y la obesidad, una proporción importante de los eventos ocurren en individuos que no presentan ninguno de estos factores. De ello deriva la actual necesidad de identificar nuevos biomarcadores que mejoren la predicción global de riesgo de enfermedad cardiovascular. En los últimos años la proteómica se ha convertido en una estrategia básica para el estudio del perfil proteico y de asociaciones proteicas complejas en una muestra biológica. Mediante el uso de técnicas proteómicas se pueden determinar modificaciones en la estructura de una proteína, así como sus niveles de expresión y la presencia de modificaciones post-traduccionales, que pueden estar asociadas a una patología determinada y tener valor diagnóstico, pronóstico y terapéutico. Se han propuesto muchas moléculas como marcadores de la aterotrombosis, pero los resultados no son consistentes y la mayoría de ellos no ha llegado a utilizarse en la práctica clínica. Por eso cada vez hay una mayor necesidad de integrar las técnicas proteómicas en el descubrimiento de nuevos biomarcadores lo que permitirá conocer nuevos mediadores y vías patofisiológicas sin una asociación previa a las patologías cardiovasculares. En este trabajo se han aplicado técnicas de proteómica diferencial para el estudio de los cambios que se dan a nivel sérico en la fase aguda tras un infarto agudo de miocardio (AMI) de nueva presentación. Mediante la comparación del perfil proteómico de pacientes AMI e individuos sanos se han detectado importantes cambios en el patrón de distribución de dos grupos de proteínas: relacionadas con el metabolismo de las lipoproteínas de alta densidad (HDL) y relacionadas con el metabolismo del retinol, vía no asociada hasta el momento con el AMI. Dentro de las proteínas del metabolismo de las HDL encontramos cambios en la fase aguda post-AMI en la apolipoproteína J y la transtiretina (TTR). Ésta última también muestra cambios en situaciones de alto riesgo cardiovascular como la hipercolesterolemia familiar. A su vez, también se han detectado cambios en la proteína mayoritaria de las HDL, la apolipoproteína A-I, pero en este caso en una fase más tardía post-AMI y en pacientes diabéticos. Las proteínas relacionadas con el metabolismo del retinol que muestran un perfil diferencial son la TTR y la proteína plasmática de unión a retinol (RBP4). En una segunda parte de este trabajo se han estudiado los cambios proteómicos que se dan a nivel de tejido cardíaco en un modelo experimental porcino de AMI y se ha encontrado por primera vez una asociación de la vía de señalización del receptor del hidrocarburo de arilo con el daño producido por la reperfusión posterior a un AMI.. Además se ha visto que la aplicación de un procedimiento cardioprotector como es el post-condicionamiento isquémico atenua la activación de dicha vía inducida por la reperfusión.[eng] Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality. Atherosclerosis, the underlying mechanism of cardiovascular diseases, progresses gradually until the blood flow is compromissed leading to the precipitaton of an acute ischemic event such as acute coronary syndrome (ACS) or ictus. Identifying subjects at risk of developing an acute ischemic event remains one of the great challenges of cardiovascular medicine. Classical approaches, such as the presence of cardiovascular risk factors, are unable to accurately predict cardiovascular events. During the last years several studies have been focussed on the search for new plasma biomarkers of acute ischemic events. Although many potential molecules have been described, the results have not been consistent enough and most of them are not used in clinical practice. Until now, the only group of accepted biomarkers for the diagnosis of acute myocardial ischemic events are troponins. Nevertheless, these structural proteins are released to the circulation as a consequence of an irreversible injury of the myocardium. Therefore there is still a need for the identification of new biomarkers that will allow the early detection of an ischemic event before the irreversible necrosis of the myocardium occurs. Proteomic technologies allow the identification of molecules related to new pathways that together with traditional markers could act as a multibiomarker for diagnosis, prognosis and treatment, and therefore become a key tool for the development of new approaches in the prevention of cardiovascular diseases. In this study by applying proteomic technologies such as bi-dimensional electrophoresis we have compared the serum proteomic profile of patients with an acute new-onset myocardial infarction (AMI) to that of healthy individuals and found important changes in two main group of proteins: HDL-related proteins (apolipoproteins J and A-I, and TTR) and retinol metabolism associated proteins (TTR and RBP4). In a second part of the work by the study of proteomic changes that occur in the myocardial tissue after an AMI in a swine experimental model we have found, for the first time, an association of the aryl hidrocarbon receptor signalling pathway with the reperfusion injury after an AMI. Moreover, we have found an attenuation of the same pathway in response to a cardioprotective approach such as ischemic post-conditioning

Pathophysiology of acute coronary syndromes in the elderly

Elderly patients represent an important proportion of the acute coronary syndrome (ACS) population. Furthermore, this group of ACS patients is continuously growing because of the progressive ageing of the population. The ageing process implies marked changes in patient physiology that directly impact in their risk. However, there is a differential distribution in the risk of elderly patients, revealing the existence of a discrepancy between the chronological and the "biological age". This discrepancy has highlighted the need of performing individual risk assessment in order to identify those patients at higher risk. In addition, the lack of representation of elderly patients in clinical trials leads to the underutilization of evidence-based therapies in this group of patients. All these factors influence not only the high prevalence of ACS presentation in the elderly but also their worse prognosis after suffering an ischaemic event. Herein we will explore the pathophysiological mechanisms behind the age-related changes at the vascular and the cardiac level that explain the high risk of elderly subjects of suffering ACS and their worse prognosis

Methods and kits for the diagnosis and risk stratification of patients with ischemia

The invention relates to methods for the diagnosis of ischemia or ischemic tissue damage, methods for predicting the progression of ischemia in a patient having suffered an ischemic event, for determining the prognosis of a patient having suffered an ischemic event and for determining the risk that a patient suffering from stable coronary disease suffers a recurrent ischemic event based on the detection of the levels of glycosylated Apo J. The invention relates as well to a method for the determination of glycosylated Apo J in a sample.Institut Catalá de Ciències Cardiovasculars, Consejo Superior de Investigaciones Científicas (España)A1 Solicitud de patente con informe sobre el estado de la técnic

ApoL1 levels in high density lipoprotein and cardiovascular event presentation in patients with familial hypercholesterolemia

HDL composition rather than HDL-cholesterol (HDL-C) levels seems to be a key determinant of HDL-induced atheroprotection. Heterozygous familial hypercholesterolemia (FH) patients, with lifelong exposure to high LDL levels, show a high prevalence of premature coronary artery disease. We hypothesized that HDL of FH patients might have a modified protein composition and investigated the proteomic signature of HDL obtained from FH patients and their unaffected relatives. HDLs were characterized by 2D electrophoresis/MS in 10 families from the SAFEHEART cohort (3 individuals/family: 2 with genetic FH diagnosis and 1 non-FH relative) clinically characterized and treated as per guidelines. FH patients had lower apoA-I levels and a differential HDL distribution profile of apoL1 and apoA-IV. ELISA validation revealed decreased apoL1 serum levels in FH patients. ApoL1 levels were able to predict presentation of an ischemic cardiac event, and apoL1/HDL-C ratio was associated with the survival rate after the event. FH patients who died because of a fatal cardiac event had lower apoL1 and LCAT content in HDL3 an average of 3.5 years before the event than those who survived. Changes in HDL protein composition could affect patients prognosis. The proteomic profile of apoL1 is modified in HDLs of high cardiovascular risk patients, and apoL1 plasma levels are significantly lower in serum and in HDL3 of patients that will suffer an adverse cardiac event within 3 years. Cubedo, J., T. Padr, R. Alonso, P. Mata, and L. Badimon. ApoL1 levels in high density lipoprotein and cardiovascular event presentation in patients with familial hypercholesterolemia

Uso de las isoformas de Apo J como biomarcadores de lesión tisular

La invención se refiere al uso de las formas glicosiladas de la Apolipoproteína J como marcadores de daño tisular, más concretamente producido de infarto agudo de miocardio, así como a un método de diagnóstico de dicho daño y a un kit que comprende los elementos necesarios para llevar a cabo dicho diagnóstico. En la presente invención se demuestra que las diversas formas glicosiladas varían su expresión si existe daño tisular lo que permite utilizarlas como marcadores en caso de existir este daño.Peer reviewedConsejo Superior de Investigaciones Científicas (España), Institut Catalá de Ciencies CardiovascularsA1 Solicitud de patente con informe sobre el estado de la técnic

Methods and kits for the diagnosis and risk stratification of patients with ischemia

The invention relates to methods for the diagnosis of ischemia or ischemic tissue damage, methods for predicting the progression of ischemia in a patient having suffered an ischemic event, for determining the prognosis of a patient having suffered an ischemic event and for determining the risk that a patient suffering from stable coronary disease suffers a recurrent ischemic event based on the detection of the levels of glycosylated Apo J. The invention relates as well to a method for the determination of glycosylated Apo J in a sample.Peer reviewedInstitut Catalá de Ciències Cardiovasculars, Consejo Superior de Investigaciones Científicas (España)E Solicitud de patente europe

Methods and kits for the diagnosis and risk stratification of patients with ischemia

The invention relates to methods for the diagnosis of ischemia or ischemic tissue damage, methods for predicting the progression of ischemia in a patient having suffered an ischemic event, for determining the prognosis of a patient having suffered an ischemic event and for determining the risk that a patient suffering from stable coronary disease suffers a recurrent ischemic event based on the detection of the levels of glycosylated Apo J. The invention relates as well to a method for the determination of glycosylated Apo J in a sample.Institut Catalá de Ciències Cardiovasculars, Consejo Superior de Investigaciones Científicas (España)A1 Solicitud de patente con informe sobre el estado de la técnic