27 research outputs found

    Translational opportunities of single-cell biology in atherosclerosis

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    The advent of single-cell biology opens a new chapter for understanding human biological processes and for diagnosing, monitoring, and treating disease. This revolution now reaches the field of cardiovascular disease (CVD). New technologies to interrogate CVD samples at single-cell resolution are allowing the identification of novel cell communities that are important in shaping disease development and direct towards new therapeutic strategies. These approaches have begun to revolutionize atherosclerosis pathology and redraw our understanding of disease development. This review discusses the state-of-the-art of single-cell analysis of atherosclerotic plaques, with a particular focus on human lesions, and presents the current resolution of cellular subpopulations and their heterogeneity and plasticity in relation to clinically relevant features. Opportunities and pitfalls of current technologies as well as the clinical impact of single-cell technologies in CVD patient care are highlighted, advocating for multidisciplinary and international collaborative efforts to join the cellular dots of CVD

    Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

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    IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

    The complete works of Menno Simon,

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    Temporal niche switching and reduced nest attendance in response to heat dissipation limits in lactating common voles (<i>Microtus arvalis</i>)

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    According to the heat dissipation limit theory, maximum metabolic turnover is limited by the capacity of the body to dissipate excess heat. Small mammals, including common voles (Microtus arvalis), face a heat dissipation limitation during lactation. Pup growth and milk production are reduced under higher ambient temperatures. Heat dissipation problems might in part be alleviated by modifying behavior, such as reducing nest attendance and being active at energetically optimal times of day. According to the circadian thermo-energetics hypothesis, animals can make use of daily ambient temperature fluctuations to alter their energetic expenditure. In this study we test whether heat challenged (housing at 30 °C compared to 21 °C) lactating common voles allocate their time differently among behaviors and whether their ultradian and circadian behavioral rhythmicity are altered. Behavior was scored every 13 min from automated picture recordings, while general locomotor activity was measured by passive infrared detectors to assess ultradian and circadian organization. The effects of ambient temperature on the ultradian organization of behavior were assessed by determining the ultradian period length and the distribution of activity within the ultradian bout. Changes in circadian organization were assessed by the distribution of activity over the light and dark phase. As a complementary measure nest temperature recordings were used to quantify nest attendance distribution between day and night. Lactating dams at 30 °C reduced the fraction of time spent on the nest while increasing the fraction of time resting without pups away from the nest. The ultradian period of locomotor activity was longer in voles housed at 30 °C during pregnancy and lactation, but not after weaning when the pups were removed. No differences in the distribution of activity within the ultradian bout could be detected. The circadian organization was also modulated by ambient temperature. Lactating voles housed at 30 °C became more day active and a loss of day–night differences in nest temperature suggests a shift of nest attendance towards the night. Reducing the time attending the nest can reduce the risk of hyperthermia, and may be the behavioral component resulting in lower milk production and hence reproductive output. Becoming more day active allows feeding and nursing of the pups during the rest phase to occur during the night at which lower ambient temperatures are expected in the field. In natural situations this strategy will increase heat dissipation and lactation capacity. Whether there are similar benefits associated with a longer ultradian period is currently unknown, but these are likely to result from decreased energy turnover at 30 °C. In conclusion, our study shows that lactating common voles facing heat dissipation problems re-organize their behavior in a way that can maximize heat dissipation capabilities and thereby optimize lactation capacity
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