PulmoBind Imaging Measures Reduction of Vascular Adrenomedullin Receptor Activity with Lack of effect of Sildenafil in Pulmonary Hypertension

International audienceEndothelial dysfunction is a core pathophysiologic process in pulmonary arterial hypertension (PAH). We developed PulmoBind (PB), a novel imaging biomarker of the pulmonary vascular endothelium. 99mTechnetium (99mTc)-labelled PB binds to adrenomedullin receptors (AM1) densely expressed in the endothelium of alveolar capillaries. We evaluated the effect of sildenafil on AM1 receptors activity using 99mTc-PB. PAH was induced in rats using the Sugen/hypoxia model and after 3 weeks, animals were allocated to sildenafil (25 or 100 mg/kg/day) for 4 weeks. 99mTc-PB uptake kinetics was assessed by single-photon emission computed tomography. PAH caused right ventricular (RV) hypertrophy that was decreased by low and high sildenafil doses. Sildenafil low and high dose also improved RV function measured from the tricuspid annulus plane systolic excursion. Mean integrated pulmonary uptake of 99mTc-PB was reduced in PAH (508% · min ± 37, p < 0.05) compared to controls (630% · min ± 30), but unchanged by sildenafil at low and high doses. Lung tissue expressions of the AM1 receptor components were reduced in PAH and also unaffected by sildenafil. In experimental angio-proliferative PAH, sildenafil improves RV dysfunction and remodeling, but does not modify pulmonary vascular endothelium dysfunction assessed by the adrenomedullin receptor ligand 99mTc-PB

Rôle d'autotaxine (ATX) dans le développement du rétrécissement aortique calcifié (RAC)

Le rétrécissement aortique calcifié (RAC), pathologie valvulaire la plus fréquente, est une maladie caractérisée par une minéralisation progressive de la valve. À l’heure actuelle, il n’existe aucun traitement médical efficace pouvant empêcher ou ralentir sa progression. Le remplacement valvulaire aortique (RVA) est le seul traitement disponible du RAC. Par conséquent, l'identification des principaux facteurs de risque ainsi que les processus moléculaires impliqués dans la pathogenèse du RAC représentent une nécessité primordiale pour développer des approches pharmacologiques. Le RAC est une maladie progressive caractérisée par une calcification ectopique des feuillets valvulaires. Pendant plusieurs années, elle était considérée comme une atteinte dégénérative liée au vieillissement. Néanmoins, de nombreuses études récentes ont révélé qu’il s’agit d’une maladie active. En effet, les premiers stades de cette maladie, nommée sclérose aortique, partagent plusieurs similitudes avec l’athérosclérose en termes de facteurs de risque associés. Il s’agit donc d’une pathologie complexe mettant en jeu plusieurs processus pathologiques, notamment la rétention des lipides et leur oxydation, l’inflammation chronique, le remodelage fibrotique et la calcification de la VA. À cet égard, l'identification des principaux facteurs de risque ainsi que les processus moléculaires par lesquelles les lipides favorisent la minéralisation de la valve aortique (VA) représentent une nécessité primordiale pour comprendre le mécanisme physiopathologique du RAC. Cela pourrait également aider à identifier de nouvelles cibles thérapeutiques et ouvre d’autres perspectives de recherche afin de développer de nouvelles thérapies médicales. Les objectifs généraux de mon projet de doctorat sont : (1) Étudier le rôle des lipides, en particulier l’axe lipoprotéine Lp (a)-autotaxine (ATX), dans la progression et le développement du RAC; (2) Élucider le mécanisme d’action par lequel l’acide lysophosphatidique (LPA), le produit final de l’enzyme ATX, favorise l’inflammation et la réponse ostéogénique des cellules interstitielles de la valve aortique (CIVs); (3) Déterminer le rôle de l’axe ATX-LPA dans un modèle murin du RAC.Calcific aortic valve disease (CAVD) is the most common valvular disease, which is characterized by a progressive mineralization of aortic valve. So far, there is no effective medical therapy able to stop or slow the natural course of this disease. Surgical aortic valve replacement is the only available treatments of severe symptomatic aortic stenosis. Therefore, identify the key factors as well as molecular processes involved in the pathogenesis of CAVD is crucial to develop efficient pharmaceutical approaches able to prevent or to slow the progression of aortic stenosis. CAVD is a progressive disease characterized by ectopic calcification of the aortic valve leaflets. It has long been considered as a degenerative process of the aortic valve linked to aging. However, a growing number of studies have revealed that this disease is an active process likely related to atherosclerosis. Therefore, CAVD seems to be a complex pathology involving several pathological processes, including lipid retention, oxidation, chronic inflammation, fibrotic remodeling and calcification. In this regard, assessment of the molecular process whereby lipids promote the mineralization of aortic valve is required to understand the pathophysiological mechanisms leading to CAVD. Furthermore, investigations are needed to identify therapeutic targets and to open novel therapeutic avenues for the treatment of CAVD. The general objectives of my PhD project are: (1) To determine the role of ATX in mediating lipid-induced mineralization of valve interstitial cells (VICs); (2) To understand the mechanisms and signaling pathways by which lysophosphatidic acid (LPA) promotes inflammation and the mineralization of the aortic valve; (3) To determine the role of ATX-LPA in a mouse model of CAVD

Soluble CD14 is associated with the structural failure of bioprostheses

Introduction: Aortic valve bioprostheses, which do not mandate chronic anticoagulation, are prone to structural valve degeneration (SVD). The processes involved in SVD are likely multifactorial. We hypothesized that inflammation and macrophage activation could be involved in SVD. Methods: In 203 patients with an aortic valve bioprosthesis, we evaluated the association between the macrophage activation marker soluble CD14 (sCD14) and SVD. Results: After a mean follow-up of 8 ± 3 years, 42 (21%) patients developed SVD. Patients with SVD had higher peak (44 ± 13 mmHg vs. 25 ± 12 mmHg, p < .0001) and mean (24 ± 7 mmHg vs. 12 ± 5 mmHg, p < .0001) transprosthetic gradients. On univariable analysis, low-density lipoprotein cholesterol (LDL) and sCD14 were associated with SVD. After correction for covariates, sCD14 (OR: 1.12, 95%CI: 1.02–1.23, p = .01) remained independently associated with SVD. In turn, sCD14 was associated with the HOMA index and high-density lipoprotein (HDL) level. Patients with a metabolic syndrome (MetS) had higher level of sCD14. In a model corrected for age, sex, HOMA and HDL, the MetS remained independently associated with sCD14 levels (β = 0.65, SE = 0.30, p = .03). Conclusion: Circulating level of sCD14 is an independent predictor of SVD. In turn, patients with MetS have higher sCD14 levels

Association between plasma lipoprotein levels and bioprosthetic valve structural degeneration

Introduction: Structural valve degeneration (SVD) leads to the failure of aortic valve bioprostheses. It is suspected that lipid-derived factors could play a role in SVD. We hypothesised that oxidised low-density lipoprotein (OxLDL), OxLDL/LDL, OxLDL/high-density lipoprotein (OxLDL/HDL) and proprotein convertase subtilisin/kexin 9 (PCSK9) may be associated with SVD. Methods: We included 199 patients who underwent an aortic valve replacement with a bioprosthesis and had an echocardiography follow-up to evaluate the function of the prosthesis. SVD was defined as an increase in mean transprosthetic gradient (=10 mm Hg) or a worsening of transprosthetic regurgitation (=1/3) during the follow-up. Results: After a mean follow-up of 8±3.5 years, 41(21%) patients developed SVD. The univariate predictors of SVD were LDL (p=0.03), apolipoprotein B (p=0.01), OxLDL (p=0.02), OxLDL/HDL (p=0.009) and LDL associated with small, dense particles (LDL-C<255Å) (p=0.02). In a model adjusted for covariates, only OxLDL/HDL (OR 1.49, 95%CI 1.08 to 2.07 per 10 units, p=0.01) remained associated with SVD. There was a significant interaction between OxLDL/HDL and PCSK9 on SVD (p=0.05). After adjustment, compared with patients with low OxLDL/HDL (median, <25.4) and low PCSK9 (median, <298 ng/mL) (referent), patients with both an elevated OxLDL/HDL ratio and PCSK9 had a higher risk of SVD (OR 2.93, 95% CI 1.02 to 9.29, p=0.04). Conclusions: OxLDL/HDL ratio is independently associated with SVD

Autotaxin interacts with lipoprotein(a) and oxidized phospholipids in predicting the risk of calcific aortic valve stenosis in patients with coronary artery disease

Background. Studies have shown that lipoprotein(a) [Lp(a)], an important carrier of oxidized phospholipids, is causally related to calcific aortic valve stenosis (CAVS). Recently, we found that Lp(a) mediates the development of CAVS through autotaxin (ATX). Objective. To determine the predictive value of circulating ATX mass and activity for CAVS. Methods. We performed a case-control study in 300 patients with coronary artery disease (CAD). Patients with CAVS plus CAD (cases, n = 150) were age- and gender-matched (1 : 1) to patients with CAD without aortic valve disease (controls, n = 150). ATX mass and enzymatic activity and levels of Lp(a) and oxidized phospholipids on apolipoprotein B-100 (OxPL-apoB) were determined in fasting plasma samples. Results. Compared to patients with CAD alone, ATX mass (P < 0.0001), ATX activity (P = 0.05), Lp(a) (P = 0.003) and OxPL-apoB (P < 0.0001) levels were elevated in those with CAVS. After adjustment, we found that ATX mass (OR 1.06, 95% CI 1.03–1.10 per 10 ng mL 1 , P = 0.001) and ATX activity (OR 1.57, 95% CI 1.14–2.17 per 10 RFU min 1 , P = 0.005) were independently associated with CAVS. ATX activity interacted with Lp(a) (P = 0.004) and OxPL-apoB (P = 0.001) on CAVS risk. After adjustment, compared to patients with low ATX activity (dichotomized at the median value) and low Lp(a) (<50 mg dL 1 ) or OxPL-apoB (<2.02 nmol L 1 , median) levels (referent), patients with both higher ATX activity (≥84 RFU min 1 ) and Lp(a) (≥50 mg dL 1 ) (OR 3.46, 95% CI 1.40–8.58, P = 0.007) or OxPL-apoB (≥2.02 nmol L 1 , median) (OR 5.48, 95% CI 2.45–12.27, P < 0.0001) had an elevated risk of CAVS. Conclusion. Autotaxin is a novel and independent predictor of CAVS in patients with CAD

Autotaxin Derived From Lipoprotein(a) and Valve Interstitial Cells Promotes Inflammation and Mineralization of the Aortic Valve

Background—Mendelian randomization studies have highlighted that lipoprotein(a) [Lp(a)] was associated with calcific aortic valve disease (CAVD). Lp(a) transports oxidized phospholipids (OxPLs) with a high content in lysophosphatidylcholine (LPC). Autotaxin (ATX) transforms LPC into lysophosphatidic acid. We hypothesized that ATX-lysophosphatidic acid could promote inflammation/mineralization of the aortic valve. Methods and Results—We have documented the expression of ATX in control and mineralized aortic valves. By using different approaches we have also investigated the role of ATX- lysophosphatidic acid on the mineralization of isolated valves interstitial cells (VICs) and in a mouse model of CAVD. Enzyme specific ATX activity was elevated by 60% in mineralized aortic valves compared to control valves. Immunohistochemistry studies showed a high level of ATX in mineralized aortic valves, which co-localized with OxPL and apolipoprotein(a). We detected a high level of ATX activity in the Lp(a) fraction in circulation. Interaction between ATX and Lp(a) was confirmed by in situ proximity ligation assay. Moreover, we documented that VICs also expressed ATX in CAVD. We showed that ATX-lysophosphatidic acid promote the mineralization of the aortic valve through a NF-¿B/IL-6/BMP2 pathway. In LDLR-/-/ApoB100/100/IGFII mice, ATX is overexpressed and lysophosphatidic acid promotes a strong deposition of hydroxyapatite of calcium in aortic valve leaflets and accelerates the development of CAVD. Conclusions—ATX is transported in the aortic valve by Lp(a) and is also secreted by VICs. ATX-lysophosphatidic acid promotes inflammation and mineralization of the aortic valve and thus could represent novel therapeutic targets in CAVD