Evaluation of larval surface antigens from infective larvae of Strongyloides venezuelensis for the serodiagnosis of human strongyloidiasis

Serodiagnosis of strongyloidiasis is usually performed by ELISA for the detection of IgG antibodies due to its high sensitivity and practicality, but its main limitation is a constant source of S. stercoralis antigens. The use of S. venezuelensis as a heterologous source of antigens has facilitated several published studies on the serodiagnosis and epidemiology of human strongyloidiasis. The main objective of this study was to evaluate the diagnostic accuracy of surface cuticle antigens of infective larvae of S. venezuelensis extracted with CTAB detergent (L3-CTAB) in comparison with soluble somatic extracts (L3-SSE) using a panel of sera from immunocompetent and immunocompromised individuals, at three different cut-offs. ROC curve analysis showed that L3-CTAB had an AUC of 0.9926. At the first cut-off value (OD 450 nm = 0.214), sensitivity and specificity were 100% and 90.11%, respectively, with a diagnostic accuracy of 0.93. At a second cut-off value (OD 450 nm = 0.286), sensitivity and specificity were 70% and 100%, respectively, with a diagnostic accuracy of 0.91. However, at an alternative third cut-off value (OD 450 nm = 0.589), sensitivity and specificity were 95% and 97.8%, respectively, with a diagnostic accuracy of 0.97. Using L3-CTAB as an antigenic source, the seropositivity rate in immunocompromised patients was 28.13% (9/32) whereas a seropositivity rate of 34.38% (11/32) was found when L3-SSE was used in ELISA. Therefore, the L3-CTAB is simple and practical to obtain and was found to be highly sensitive and specific

Deglycosylation of the excretory-secretory antigens of Toxocara canis and their application for the serodiagnosis of human toxocariasis

O sorodiagnóstico da toxocaríase humana é geralmente baseado na detecção de anticorpos IgG anti-Toxocara spp. em amostras de soro pelo teste ELISA utilizando os antígenos de excreção-secreção de larvas de T. canis (TES). No entanto, observa-se uma ocorrência de reatividade cruzada com outras helmintíases nas áreas endémicas de poliparasitismo. Vários estudos têm mostrado que as glicanas presentes nos antígenos dos helmintos podem ser as responsáveis pela reatividade cruzada. Neste estudo, avaliamos o efeito da deglicosilação dos antígenos TES na sensibilidade e especificidade dos testes de ELISA e Western-blotting para detecção de anticorpos IgG, IgM e IgE. Para a deglicosilação dos antígenos TES, estes foram tratados com diferentes concentrações de hidróxido de sódio (NaOH) ou metaperiodato de sódio (NaIO4) e foram testados 58 amostras de soro de pacientes com toxocaríase visceral, 75 amostras de soros de pacientes com outras helmintíases, e 95 amostras de soro de indivíduos saudáveis. Nossos resultados mostraram que os antígenos TES foram totalmente deglicosilados com NaOH 100mM por 4 horas a 37°C (dTES), enquanto que o tratamento com NaIO4 não gerou bons resultados. A sensibilidade e especificidade dos antígenos TES e dTES na detecção de anticorpos IgG pelo teste de ELISA foi de 100%, com menor reatividade cruzada (5,3%) para os antígenos dTES, se comparada com os antígenos TES (13,3%). Todos os pacientes com toxocaríase mostraram anticorpos IgG contra as cinco frações dos antígenos TES (32, 45, 55, 70 e 120 kDa) e contra a única fração de 26kDa dos antígenos dTES, com sensibilidades e especificidades de 100% para ambos os antígenos. A reatividade cruzada, observada com as frações de 70 kDa, 55 kDa e 32 kDa dos antígenos TES, foi eliminada totalmente quando utilizaram-se os antígenos dTES. A detecção de anticorpos IgM pelo teste de ELISA mostrou reatividade inespecífica nos três grupos estudados, com sensibilidades de 39,7% e 34,5% e especificidades de 95,8% e 96,8%, para os antígenos TES e dTES, respectivamente, porém com ocorrência de reatividade cruzada de 24% e 28% para ambos os antígenos. Os três grupos estudados apresentaram reatividade contra quase todas as frações dos antígenos TES e dTES. A detecção de anticorpos IgE apresentou sensibilidades de 63,79% e 62,07% e uma especificidade de 100%, e uma reatividade cruzada de 26,6% e 53,3% para ambos os antígenos. A maioria dos pacientes com toxocaríase (74,1%) mostraram anticorpos contra as frações de 32, 55 e 70 kDa, em quanto que não houve reatividade nos pacientes com outras helmintíases ou nos indivíduos saudáveis. Estes resultados mostraram que a deglicosilação dos antígenos TES permite reduzir a ocorrência de reatividade cruzada nos pacientes com outras helmintíases, elevando o valor diagnóstico da detecção de anticorpos IgG. No entanto, este procedimento não permite melhorar a sensibilidade e especificidade na detecção de anticorpos IgM e não permite elevar a sensibilidade na detecção de anticorpos IgE pelo teste de ELISA. Por outro lado, os resultados discordantes na especificidade do Western-blotting para a detecção de anticorpos IgG, IgM e IgE sugerem a presença de epítopos conformacionais presentes no estado nativo dos antígenos TES que estariam implicados na reação cruzada observada no teste de ELISASerodiagnosis of human toxocariasis is usually based on the detection of anti-Toxocara spp. IgG antibodies in serum samples by ELISA test using T.canis larvae excretory-secretory (TES) antigens. However, a cross-reactivity occurrence is observed in endemic areas of polyparasitism. Many studies have shown that the glycan structures, present in helminth antigens, can be the responsible for the cross-reactivity. In this study, we evaluated the deglycosylation of the TES antigens on the sensitivity and specificity of both the ELISA and Western-blotting for the detection of IgG, IgM, and IgE antibodies. For the deglycosylation of the TES antigens, they were treated with different concentrations of sodium hydroxide (NaOH) or sodium metaperiodate (NaIO4), and 58 serum samples of 58 patients with visceral toxocariasis, 75 serum samples of patients with other helminth infections, and 95 serum samples of healthy individuals. Our results show that the TES antigens were totally deglycosylated with 100 mM NaOH for 4 hours at 37°C (dTES), whereas not good results were obtained with sodium metaperiodate. The sensitivity and specificity of both TES and dTES antigens were 100% in detecting IgG antibodies by ELISA; the cross-reactivity observed with TES antigens (13.3%) was reduced (5.3%) when dTES antigens were used. All toxocariasis patients showed IgG antibodies against the five fractions of TES antigens (32, 45, 55, 70, and 120 kDa), but also with the 26-kDa single fraction of dTES antigens, with sensitivities and specificities of 100% for both antigens. The occurrence of cross-reactivity, observed mainly with the 32-, 55-, and 70 kDa fractions of the TES antigens, was totally eliminated when the dTES antigens were used. The detection of IgM antibodies by ELISA test showed unspecific reactivity in all studied groups, with sensitivities of 39.7% and 34.5%, and specificities of 95.8% and 96.8% for both antigens; the occurrence of cross-reactivity for both antigens were 24% and 28%, respectively. All studied groups have IgM antibodies against almost all fractions of TES antigens and the single fraction of dTES. The detection of IgE antibodies by ELISA test showed sensitivities of 63.8% and 62%, specificities of 100%, and occurrence of reactivity of 26.6% and 53.3% for TES and dTES antigens, respectively. The majority of the toxocariasis patients (74.1%) showed IgE antibodies against the 32-, 55-, and 70 kDa fractions of the TES antigens, whereas there was not reactivity in sera from patients with other helminth infections or healthy individuals. These results showed that the deglycosylation of the TES antigens reduces the occurrence of cross-reactivity in patients with other helminth infections, increasing the diagnostic value for the detection of IgG antibodies. However, this procedure does not improve the sensitivity nor reduces the occurrence of cross-reactivity in the detection of IgM antibodies. Likewise, this procedure does not improve the sensitivity in the detection of IgE antibodies by the ELISA test. On the other hand, the high specificity obtained in the detection of IgG, IgM, and IgE by Western-blotting suggest that conformational epitopes of the TES antigens may also be the responsible for the cross-reactivity in the ELISA tes

Characterization of Strongyloides venezuelensis excretome/secretome and its application in the immunodiagnosis of human strongyloidiasis

O presente estudo caracterizou, mediante análise imunoproteômica, os produtos de excreção/secreção (E/S) de larvas infectantes (iL3) de S. venezuelensis que foram mantidas a 37°C por 24 horas em meio RPMI 1640 (E/S-RPMI) ou em tampão fosfato salino, pH 7,2 (E/S-PBS) e avaliar sua aplicação no imunodiagnóstico da estrongiloidíase humana. Os resultados mostraram que os produtos E/S-RPMI e E/S- PBS possuem 20 e 21 bandas proteicas, com pesos moleculares entre 10 a 348 kDa, e presença de serinoproteases e metaloproteases. O Western-blotting demonstrou que ambos os tipos de produtos de E/S possuem ao menos 16 bandas antigênicas que foram reconhecidas pelo soro de pacientes com estrongiloidíase, das quais apenas uma banda de 36 kDa possui 93% de sensibilidade, 100% de especificidade e sem ocorrência de reatividade cruzada. A espectrometria de massas identificou um total de 71 e 62 proteínas nos produtos E/S-RPMI e E/S-PBS, respectivamente, das quais apenas 14 proteínas antigênicas foram compartilhadas entre ambos os tipos de produtos de E/S. A análise bioinformática sugere que mais de 50% das proteínas identificadas nos produtos de E/S são secretadas ao meio extracelular dentro de vesículas extracelulares ou exossomos e menos de 20% são realmente secretadas pela via clássica. Entre as diferentes proteínas identificadas no presente estudo, pode se ressaltar a presença de uma arginina quinase não glicosilada de 37 kDa, presente em ambos os tipos de produtos de E/S, que coincide com a banda de 36 kDa anteriormente mencionada. Existe uma proteína de domínio CAP que possui 50% de identidade com a proteína recombinante NIE de S. stercoralis, tem o potencial para capturar ácidos graxos e leucotrienos, e possui a sequência KGD com capacidade para se unir específicamente à integrina das plaquetas, inibindo assim a agregação plaquetária. Por outro lado, existe uma enolase de 47 kDa identificada em ambos os produtos de E/S que coincide com uma banda antigênica de 47 kDa reconhecida por mais do 96% dos pacientes com estrongiloidíase. Esta enolase possui o potencial para se unir ao plasminogênio, podendo ser utilizada ativamente pela iL3 de S. ix venezuelensis durante sua migração pelos tecidos do hospedeiro. Destaca-se a também a presença de duas proteínas 14-3-3 identificadas em ambos os tipos de produtos de E/S e com um alto grau de similaridade com seus homólogos presentes no ser humano e no camundongo. A análise bioinformática mostrou que as duas proteínas 14-3-3 são potencialmente antigênicas e são secretadas dentro de vesículas extracelulares. A análise estrutural mostrou que as duas proteínas 14-3-3 possuem a capacidade de união a diferentes proteínas fosforiladas, relacionadas com a ativação de linfócitos T e B, sugerindo um possível papel fundamental na modulação da inflamação e da resposta imune do hospedeiro. Todos estes resultados mostram que S. venezuelensis possui um interessante conjunto de proteínas com potencial antigênico que podem ser explorados como possíveis novos marcadores para o sorodiagnóstico da estrongiloidíase humanaThe present study characterized, through immunoproteomic analysis, the excretory/secretory (E/S) products of infective larvae (iL3) of S. venezuelensis obtained by incubating at 37°C for 24 hours in RPMI 1640 medium (E/S-RPMI) or in saline phosphate, pH 7.2 (E/S-PBS) and to evaluate its application in the immunodiagnosis of human strongyloidiasis. The results showed that the E/S-RPMI and E/S-PBS products have 20 and 21 protein bands, respectively, with molecular weights between 10 and 348 kDa, with presence of serine proteases and metalloproteases. Western-blotting demonstrated that both types of E/S products have at least 16 antigenic bands that were recognized by the sera of patients with strongyloidiasis, of which only a 36 kDa band has 93% sensitivity, 100% specificity, and no cross-reactivity. Mass spectrometry identified a total of 71 and 62 proteins in the E/S-RPMI and E/S-PBS products, respectively, of which only 14 antigenic proteins were shared between both types of E-S products. Bioinformatic analysis suggests that more than 50% of the proteins identified in the E/S products are secreted to the extracellular medium within extracellular vesicles or exosomes and less than 20% are actually secreted by the classical pathway. Among the different proteins identified in the present study, the presence of a non-glycosylated arginine kinase of 37 kDa, present in both types of E/S products, which coincides with the previously mentioned 36 kDa band, can be highlighted. There is a CAP domain protein that has 50% identity with the recombinant protein NIE of S. stercoralis, has the potential to capture fatty acids and leukotrienes, and has the sequence KGD with the ability to bind to platelet integrin, inhibiting platelet aggregation. On the other hand, a 47 kDa enolase was identified in both E-S products and coincides with a 47 kDa antigenic band recognized by more than 96% of patients with strongyloidiasis. This enolase has the potential to bind to plasminogen and can be actively used by S. venezuelensis iL3 during its migration through host tissues. It was xi also identified the presence of two 14-3-3 proteins identified in both types of E/S products and with a high degree of similarity with their homologs present in humans and mice. Bioinformatic analysis showed that these two 14-3-3 proteins are potentially antigenic and are secreted into extracellular vesicles. Furthermore, these two 14-3-3 proteins have the ability to bind phosphorylated proteins related to the activation of T and B lymphocytes, suggesting a possible fundamental role in modulating the host inflammation and immune response. All these results show that S. venezuelensis has an interesting set of proteins with antigenic potential that can be explored as possible new markers for the seroodiagnosis of human strongyloidiasi

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN

Relation of Lipoprotein(a) Levels to Incident Type 2 Diabetes and Modification by Alirocumab Treatment

none1691siOBJECTIVE: In observational data, lower levels of lipoprotein(a) have been associated with greater prevalence of type 2 diabetes. Whether pharmacologic lowering of lipoprotein(a) influences incident type 2 diabetes is unknown. We determined the relationship of lipoprotein(a) concentration with incident type 2 diabetes and effects of treatment with alirocumab, a PCSK9 inhibitor. RESEARCH DESIGN AND METHODS: In the ODYSSEY OUTCOMES trial alirocumab was compared with placebo in patients with acute coronary syndrome. Incident diabetes was determined from laboratory, medication, and adverse event data. RESULTS: Among 13,480 patients without diabetes at baseline, 1,324 developed type 2 diabetes over a median 2.7 years. Median baseline lipoprotein(a) was 21.9 mg/dL. With placebo, 10 mg/dL lower baseline lipoprotein(a) was associated with hazard ratio 1.04 (95% CI 1.02-1.06, P < 0.001) for incident type 2 diabetes. Alirocumab reduced lipoprotein(a) by a median 23.2% with greater absolute reductions from higher baseline levels and no overall effect on incident type 2 diabetes (hazard ratio 0.95, 95% CI 0.85-1.05). At low baseline lipoprotein(a) levels, alirocumab tended to reduce incident type 2 diabetes, while at high baseline lipoprotein(a) alirocumab tended to increase incident type 2 diabetes compared with placebo (treatment-baseline lipoprotein(a) interaction P = 0.006). In the alirocumab group, a 10 mg/dL decrease in lipoprotein(a) from baseline was associated with hazard ratio 1.07 (95% CI 1.03-1.12; P = 0.0002) for incident type 2 diabetes. CONCLUSIONS: In patients with acute coronary syndrome, baseline lipoprotein(a) concentration associated inversely with incident type 2 diabetes. Alirocumab had neutral overall effect on incident type 2 diabetes. However, treatment-related reductions in lipoprotein(a), more pronounced from high baseline levels, were associated with increased risk of incident type 2 diabetes. Whether these findings pertain to other therapies that reduce lipoprotein(a) is undetermined.restrictedSchwartz G.G.; Szarek M.; Bittner V.A.; Bhatt D.L.; Diaz R.; Goodman S.G.; Jukema J.W.; Loy M.; Manvelian G.; Pordy R.; White H.D.; Steg P.G. ODYSSEY OUTCOMES Committees and Investigators: Gregory G Schwartz, Philippe Gabriel Steg, Deepak L Bhatt, Vera A Bittner, Rafael Diaz, Shaun G Goodman, Robert A Harrington, J Wouter Jukema, Michael Szarek, Harvey D White, Andreas M Zeiher, Pierluigi Tricoci, Matthew T Roe, Kenneth W Mahaffey, Jay M Edelberg, Corinne Hanotin, Guillaume Lecorps, Angèle Moryusef, Robert Pordy, William J Sasiela, Jean-François Tamby, Philip E Aylward, Heinz Drexel, Peter Sinnaeve, Mirza Dilic, Renato D Lopes, Nina N Gotcheva, Juan-Carlos Prieto, Huo Yong, Patricio López-Jaramillo, Ivan Pećin, Zeljko Reiner, Petr Ostadal, Margus Viigimaa, Markku S Nieminen, Vakhtang Chumburidze, Nikolaus Marx, Nicolas Danchin, Evangelos Liberopoulos, Pablo Carlos Montenegro Valdovinos, Hung-Fat Tse, Robert Gabor Kiss, Denis Xavier, Doron Zahger, Marco Valgimigli, Takeshi Kimura, Hyo Soo Kim, Sang-Hyun Kim, Andrejs Erglis, Aleksandras Laucevicius, Sasko Kedev, Khalid Yusoff, Gabriel Arturo Ramos López, Marco Alings, Sigrun Halvorsen, Roger M Correa Flores, Andrzej Budaj, Joao Morais, Maria Dorobantu, Yuri Karpov, Arsen D Ristic, Terrance Chua, Jan Murin, Zlatko Fras, Anthony J Dalby, José Tuñón, H Asita de Silva, Emil Hagström, Ulf Landmesser, Chern-En Chiang, Piyamitr Sritara, Sema Guneri, Alexander Parkhomenko, Kausik K Ray, Patrick M Moriarty, Robert Vogel, Bernard Chaitman, Sheryl F Kelsey, Anders G Olsson, Jean-Lucien Rouleau, Maarten L Simoons, Karen Alexander, Chiara Meloni, Robert Rosenson, Eric J G Sijbrands, Pierluigi Tricoci, John H Alexander, Luciana Armaganijan, Akshay Bagai, Maria Cecilia Bahit, J Matthew Brennan, Shaun Clifton, Adam D DeVore, Shalonda Deloatch, Sheila Dickey, Keith Dombrowski, Grégory Ducrocq, Zubin Eapen, Patricia Endsley, Arleen Eppinger, Robert W Harrison, Connie Ng Hess, Mark A Hlatky, Joseph Dedrick Jordan, Joshua W Knowles, Bradley J Kolls, David F Kong, Sergio Leonardi, Linda Lillis, David J Maron, Jill Marcus, Robin Mathews, Rajendra H Mehta, Robert J Mentz, Humberto Graner Moreira, Chetan B Patel, Sabrina Bernardez-Pereira, Lynn Perkins, Thomas J Povsic, Etienne Puymirat, William Schuyler Jones, Bimal R Shah, Matthew W Sherwood, Kenya Stringfellow, Darin Sujjavanich, Mustafa Toma, Charlene Trotter, Sean Van Diepen, Matthew D Wilson, Andrew T Yan, Lilia B Schiavi, Marcelo Garrido, Andrés F Alvarisqueta, Sonia A Sassone, Anselmo P Bordonava, Alberto E Alves De Lima, Jorge M Schmidberg, Ernesto A Duronto, Orlando C Caruso, Leonardo P Novaretto, Miguel Angel Hominal, Oscar R Montaña, Alberto Caccavo, Oscar A Gomez Vilamajo, Alberto J Lorenzatti, Luis R Cartasegna, Gustavo A Paterlini, Ignacio J Mackinnon, Guillermo D Caime, Marcos Amuchastegui, Oscar Salomone, Oscar R Codutti, Horacio O Jure, Julio O E Bono, Adrian D Hrabar, Julio A Vallejos, Rodolfo A Ahuad Guerrero, Federico Novoa, Cristian A Patocchi, Cesar J Zaidman, Maria E Giuliano, Ricardo D Dran, Marisa L Vico, Gabriela S Carnero, Pablo N Guzman, Juan C Medrano Allende, Daniela F Garcia Brasca, Miguel H Bustamante Labarta, Sebastian Nani, Eduardo D S Blumberg, Hugo R Colombo, Alberto Liberman, Victorino Fuentealba, Hector L Luciardi, Gabriel D Waisman, Mario A Berli, Ruben O Garcia Duran, Horacio G Cestari, Hugo A Luquez, Jorge A Giordano, Silvia S Saavedra, Gerardo Zapata, Osvaldo Costamagna, Susana Llois, Jonathon H Waites, Nicholas Collins, Allan Soward, Chris L S Hii, James Shaw, Margaret A Arstall, John Horowitz, Daniel Ninio, James F Rogers, David Colquhoun, Romulo E Oqueli Flores, Philip Roberts-Thomson, Owen Raffel, Sam J Lehman, Constantine Aroney, Steven G M Coverdale, Paul J Garrahy, Gregory Starmer, Mark Sader, Patrick A Carroll, Ronald Dick, Robert Zweiker, Uta Hoppe, Kurt Huber, Rudolf Berger, Georg Delle-Karth, Bernhard Frey, Franz Weidinger, Dirk Faes, Kurt Hermans, Bruno Pirenne, Attilio Leone, Etienne Hoffer, Mathias C M Vrolix, Luc De Wolf, Bart Wollaert, Marc Castadot, Karl Dujardin, Christophe Beauloye, Geert Vervoort, Harry Striekwold, Carl Convens, John Roosen, Emanuele Barbato, Marc Claeys, Frank Cools, Ibrahim Terzic, Fahir Barakovic, Zlatko Midzic, Belma Pojskic, Emir Fazlibegovic, Mehmed Kulić, Azra Durak-Nalbantic, Dusko Vulic, Adis Muslibegovic, Boris Goronja, Gilmar Reis, Luciano Sousa, Jose C Nicolau, Flavio E Giorgeto, Ricardo P Silva, Lilia Nigro Maia, Rafael Rech, Paulo R F Rossi, Maria José A G Cerqueira, Norberto Duda, Renato Kalil, Adrian Kormann, José Antonio M Abrantes, Pedro Pimentel Filho, Ana Priscila Soggia, Mayler O N de Santos, Fernando Neuenschwander, Luiz C Bodanese, Yorghos L Michalaros, Freddy G Eliaschewitz, Maria H Vidotti, Paulo E Leaes, Roberto V Botelho, Sergio Kaiser, Euler Roberto Fernandes Manenti, Dalton B Precoma, Jose C Moura Jorge, Pedro G Silva, Jose A Silveira, Wladmir Saporito, Jose A Marin-Neto, Gilson S Feitosa, Luiz Eduardo F Ritt, Juliana A de Souza, Fernando Costa, Weimar K S B Souza, Helder J L Reis, Leandro Machado, José Carlos Aidar Ayoub, Georgi V Todorov, Fedya P Nikolov, Elena S Velcheva, Maria L Tzekova, Haralambi O Benov, Stanislav L Petranov, Haralin S Tumbev, Nina S Shehova-Yankova, Dimitar T Markov, Dimitar H Raev, Mihail N Mollov, Kostadin N Kichukov, Katya A Ilieva-Pandeva, Raya Ivanova, Maryana Gospodinov, Valentina M Mincheva, Petar V Lazov, Bojidar I Dimov, Manohara Senaratne, James Stone, Jan Kornder, Stephen Pearce, Danielle Dion, Daniel Savard, Yves Pesant, Amritanshu Pandey, Simon Robinson, Gilbert Gosselin, Saul Vizel, Gordon Hoag, Ronald Bourgeois, Anne Morisset, Eric Sabbah, Bruce Sussex, Simon Kouz, Paul MacDonald, Ariel Diaz, Nicolas Michaud, David Fell, Raymond Leung, Tycho Vuurmans, Christopher Lai, Frank Nigro, Richard Davies, Gustavo Nogareda, Ram Vijayaraghavan, John Ducas, Serge Lepage, Shamir Mehta, James Cha, Robert Dupuis, Peter Fong, Sohrab Lutchmedial, Josep Rodes-Cabau, Hussein Fadlallah, David Cleveland, Thao Huynh, Iqbal Bata, Adnan Hameed, Cristian Pincetti, Sergio Potthoff, Monica Acevedo, Arnoldo Aguirre, Margarita Vejar, Mario Yañez, Guillermo Araneda, Mauricio Fernandez, Luis Perez, Paola Varleta, Fernando Florenzano, Laura Huidobro, Carlos A Raffo, Claudia Olivares, Leonardo Nahuelpan, Humberto Montecinos, Jiyan Chen, Yugang Dong, Weijian Huang, Jianzhong Wang, Shi'An Huang, Zhuhua Yao, Xiang Li, Lan Cui, Wenhua Lin, Yuemin Sun, Jingfeng Wang, Jianping Li, Xuelian Zhang, Hong Zhu, Dandan Chen, Lan Huang, Shaohong Dong, Guohai Su, Biao Xu, Xi Su, Xiaoshu Cheng, Jinxiu Lin, Wenxia Zong, Huanming Li, Yi Feng, Dingli Xu, Xinchun Yang, Yuannan Ke, Xuefeng Lin, Zheng Zhang, Zeqi Zheng, Zhurong Luo, Yundai Chen, Chunhua Ding, Yi Zhong, Yang Zheng, Xiaodong Li, Daoquan Peng, Shuiping Zhao, Ying Li, Xuebo Liu, Meng Wei, Shaowen Liu, Yihua Yu, Baiming Qu, Weihong Jiang, Yujie Zhou, Xingsheng Zhao, Zuyi Yuan, Ying Guo, Xiping Xu, Xubo Shi, Junbo Ge, Guosheng Fu, Feng Bai, Weiyi Fang, Xiling Shou, Xiangjun Yang, Jian'An Wang, Meixiang Xiang, Yingxian Sun, Qinghua Lu, Ruiyan Zhang, Jianhua Zhu, Yizhou Xu, Zhongcai Fan, Tianchang Li, Chun Wu, Nicolas Jaramillo, Gregorio Sanchez Vallejo, Diana C Luna Botia, Rodrigo Botero Lopez, Dora I Molina De Salazar, Alberto J Cadena Bonfanti, Carlos Cotes Aroca, Juan Diego Higuera, Marco Blanquicett, Sandra I Barrera Silva, Henry J Garcia Lozada, Julian A Coronel Arroyo, Jose L Accini Mendoza, Ricardo L Fernandez Ruiz, Alvaro M Quintero Ossa, Fernando G Manzur Jatin, Aristides Sotomayor Herazo, Jeffrey Castellanos Parada, Rafael Suarez Arambula, Miguel A Urina Triana, Angela M Fernandez Trujillo, Maja Strozzi, Siniša Car, Melita Jerić, Davor Miličić, Martina Lovrić Benčić, Hrvoje Pintarić, Đeiti Prvulović, Jozica Šikić, Viktor Peršić, Dean Mileta, Kresimir Štambuk, Zdravko Babić, Vjekoslav Tomulic, Josip Lukenda, Stanka Mejic-Krstulovic, Boris Starcevic, Jindrich Spinar, David Horak, Zdenek Velicka, Josef Stasek, David Alan, Vilma Machova, Ales Linhart, Vojtech Novotny, Vladimir Kaucak, Richard Rokyta, Robert Naplava, Zdenek Coufal, Vera Adamkova, Ivo Podpera, Jiri Zizka, Zuzana Motovska, Ivana Marusincova, Premysl Svab, Petr Heinc, Jiri Kuchar, Petr Povolny, Jiri Matuska, Steen H Poulsen, Bent Raungaard, Peter Clemmensen, Lia E Bang, Ole May, Morten Bøttcher, Jens D Hove, Lars Frost, Gunnar Gislason, John Larsen, Peter Betton Johansen, Flemming Hald, Peter Johansen, Jørgen Jeppesen, Tonny Nielsen, Kjeld S Kristensen, Piotr Maria Walichiewicz, Jens D Lomholdt, Ib C Klausen, Peter Kaiser Nielsen, Flemming Davidsen, Lars Videbaek, Mai Soots, Veiko Vahula, Anu Hedman, Üllar Soopõld, Kaja Märtsin, Tiina Jurgenson, Arved Kristjan, Juhani K Airaksinen, Saila Vikman, Heikki Huikuri, Pierre Coste, Emile Ferrari, Olivier Morel, Gilles Montalescot, Jacques Machecourt, Gilles Barone-Rochette, Jacques Mansourati, Yves Cottin, Florence Leclercq, Abdelkader Belhassane, Nicolas Delarche, Franck Boccara, Franck Paganelli, Jérôme Clerc, Francois Schiele, Victor Aboyans, Vincent Probst, Jacques Berland, Thierry Lefèvre, Bernard Citron, Irakli Khintibidze, Tamaz Shaburishvili, Zurab Pagava, Ramaz Ghlonti, Zaza Lominadze, George Khabeishvili, Rayyan Hemetsberger, Kemala Edward, Ursula Rauch-Kröhnert, Matthias Stratmann, Karl-Friedrich Appel, Ekkehard Schmidt, Heyder Omran, Christoph Stellbrink, Thomas Dorsel, Emmanouil Lianopoulos, Hans Friedrich Vöhringer, Roger Marx, Andreas Zirlik, Detlev Schellenberg, Thomas Heitzer, Ulrich Laufs, Christian Werner, Nikolaus Marx, Stephan Gielen, Sebastian Nuding, Bernhard Winkelmann, Steffen Behrens, Karsten Sydow, Mahir Karakas, Gregor Simonis, Thomas Muenzel, Nikos Werner, Stefan Leggewie, Dirk Böcker, Rüdiger Braun-Dullaeus, Nicole Toursarkissian, Michael Jeserich, Matthias Weißbrodt, Tim Schaeufele, Joachim Weil, Heinz Völler, Johannes Waltenberger, Mohammed Natour, Susanne Schmitt, Dirk Müller-Wieland, Stephan Steiner, Lothar Heidenreich, Elmar Offers, Uwe Gremmler, Holger Killat, Werner Rieker, Sotiris Patsilinakos, Athanasios Kartalis, Athanassios Manolis, Dimitrios Sionis, Geargios Chachalis, Ioannis Skoumas, Vasilios Athyros, Panagiotis Vardas, Frangkiskos Parthenakis, Dimitrios Alexopoulos, Georgios Hahalis, John Lekakis, Apostolos Hatzitolios, Sergio R Fausto Ovando, Juan L Arango Benecke, Edgar R Rodriguez De Leon, Bryan P Y Yan, David C W Siu, Tibor Turi, Bela Merkely, Imre Ungi, Geza Lupkovics, Lajos Nagy, András Katona, István Édes, Gábor Müller, Iván Horvath, Tibor Kapin, Zsolt Szigeti, József Faluközy, Mukund Kumbla, Manjinder Sandhu, Sharath Annam, Naveen Reddy Proddutur, Reddy Regella, Rajendra K Premchand, Ajaykumar Mahajan, Sudhir Pawar, Atul D Abhyanakar, Prafulla Kerkar, Ravishankar A Govinda, Abraham Oomman, Dhurjati Sinha, Sachin N Patil, Dhiman Kahali, Jitendra Sawhney, Abhijeet B Joshi, Sanjeev Chaudhary, Pankaj Harkut, Santanu Guha, Sanjay Porwal, Srimannarayana Jujjuru, Ramesh B Pothineni, Minguel R Monteiro, Aziz Khan, Shamanna S Iyengar, Jasprakash Singh Grewal, Manoj Chopda, Mahesh C Fulwani, Aparna Patange, Patil Sachin, Vijay K 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Valgimigli Marco, Giovanni Licciardello, Carla Auguadro, Filippo Scalise, Claudio Cuccia, Alessandro Salvioni, Giuseppe Musumeci, Michelle Senni, Paolo Calabrò, Salvatore Novo, Pompilio Faggiano, Marco Metra, Nicoletta B De Cesare, Sergio Berti, Claudio Cavallini, Enrico Puccioni, Marcello Galvani, Maurizio Tespili, Piermarco Piatti, Michela Palvarini, Giuseppe De Luca, Roberto Violini, Alessandro De Leo, Zoran Olivari, Pasquale Perrone Filardi, Maurizio Ferratini, Vittorio Racca, Kazuoki Dai, Yuji Shimatani, Haruo Kamiya, Kenji Ando, Yoshihiro Takeda, Yoshihiro Morino, Yoshiki Hata, Kazuo Kimura, Koichi Kishi, Ichiro Michishita, Hiroki Uehara, Toshinori Higashikata, Atsushi Hirayama, Keiji Hirooka, Yasuji Doi, Satoru Sakagami, Shuichi Taguchi, Akihiro Koike, Hiroyuki Fujinaga, Shinji Koba, Ken Kozuma, Tomohiro Kawasaki, Yujiro Ono, Masatoshi Shimizu, Yousuke Katsuda, Atsuyuki Wada, Toshiro Shinke, Takeshi Kimura, Junya Ako, Kenshi Fujii, Toshiyuki Takahashi, Tomohiro Sakamoto, Koichi 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Marcel J J A Bokern, Remco Nijmeijer, Ferry M R J Hersbach, Frank F Willems, Antonius T M Gosselink, Saman Rasoul, John Elliott, Gerard Wilkins, Raewyn Fisher, Douglas Scott, Hamish Hart, Ralph Stewart, Scott Harding, Ian Ternouth, Nicholas Fisher, Samuel Wilson, Denise Aitken, Russell Anscombe, Laura Davidson, Tadeusz Tomala, Ottar Nygård, Jon Arne Sparby, Kjell Andersen, Lars Gullestad, Jarle Jortveit, Peter S Munk, Erlend Gyllensten Singsaas, Ulf Hurtig, Jorge R Calderon Ticona, Julio R Durand Velasquez, Sandra A Negron Miguel, Enrique S Sanabria Perez, Jesus M Carrion Chambilla, Carlos A Chavez Ayala, Reynaldo P Castillo Leon, Rolando J Vargas Gonzales, Jose D Hernandez Zuniga, Luis A Camacho Cosavalente, Jorge E Bravo Mannucci, Javier Heredia Landeo, Nassip C Llerena Navarro, Yudy M Roldan Concha, Víctor E Rodriguez Chavez, Henry A Anchante Hernandez, Carlos A Zea Nunez, Walter Mogrovejo Ramos, Arthur Ferrolino, Rosa Allyn G Sy, Louie Tirador, Rody G Sy, Generoso Matiga, Raul 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Bengus, Constantin Militaru, Doina Rosu, Irinel R Parepa, Adrian V Matei, Tom M Alexandru, Mihaela Malis, Ioan Coman, Rodica Stanescu-Cioranu, Doina Dimulescu, Yury Shvarts, Olga Orlikova, Zhanna Kobalava, Olga L Barbarash, Valentin Markov, Nadezhda Lyamina, Alexander Gordienko, Konstantin Zrazhevsky, Alexander Y Vishnevsky, Victor Gurevich, Raisa Stryuk, Nikita V Lomakin, Igor Bokarev, Tatiana Khlevchuk, Sergey Shalaev, Larisa Khaisheva, Petr Chizhov, Inna Viktorova, Natalya Osokina, Vladimir Shchekotov, Evgenia Akatova, Galina Chumakova, Igor Libov, Mikhail I Voevoda, Tatyana V Tretyakova, Evgeny Baranov, Sergey Shustov, Sergey Yakushin, Ivan Gordeev, Niiaz Khasanov, Olga Reshetko, Tatiana Sotnikova, Olga Molchanova, Konstantin Nikolaev, Liudmila Gapon, Elena Baranova, Zaur Shogenov, Elena Kosmachova, Yuriy Karpov, Anton Povzun, Liudmila Egorova, Vadim V Tyrenko, Igor G Ivanov, Masterov Ilya, Sergey Kanorsky, Dragan Simic, Nikola Ivanovic, Goran Davidovic, Nebojsa Tasic, Milika R 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Sarvan, Joseph H Mynhardt, Helmuth Reuter, Rajendran Moodley, Manuel Vida, Angel R Cequier Fillat, Vicente Bodí Peris, Francisco Fuentes Jimenez, Francisco Marín, Jose M Cruz Fernández, Rafael Jesus Hidalgo Urbano, Blas Gil-Extremera, Pablo Toledo, Fernando Worner Diz, David Garcia-Dorado, Andres Iñiguez, José Tuñón Fernández, Jose R Gonzalez-Juanatey, Javier Fernandez Portales, Fernando Civeira Murillo, Laia Matas Pericas, Jose Luis Zamorano, Manuel De Mora Martin, Jordi Bruguera Cortada, Joaquin J Alonso Martin, Jose Maria Serrano Antolin, José R De Berrazueta Fernández, José Antonio Vázquez de Prada, Jose Francisco Díaz Fernández, José Alberto García Lledó, Juan Cosín Sal

Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol

International audienceBackground: Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk.Objectives: In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels.Methods: ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was 13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43.Conclusions: In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402)