Levels of von Willebrand factor antigen and von Willebrand factor cleaving protease (ADAMTS13) activity predict clinical events in chronic heart failure.

Decreased activity of ADAMTS13, the von Willebrand factor (VWF) cleaving protease, was recently reported in cardiovascular diseases and in hepatic failure. Chronic heart failure (CHF) is characterised by abnormalities of left ventricular function accompanied by the failure of the liver and dysregulation of endothelial activation. Therefore, the aim of our study was to measure ADAMTS13 activity in CHF, and determine the prognostic value of VWF and ADAMTS13 on major clinical events in CHF. ADAMTS13 activity (measured by FRETS-VWF73 substrate) was decreased in CHF (n = 152, left ventricular ejection fraction <45%), and it correlated negatively with B-type natriuretic peptide (BNP) NYHA (New York Heart Association) classes, markers of synthetic capacity of the liver and endothelial dysfunction (all p < 0.005). Both, high VWF:Ag levels (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.189-1.943), and low ADAMTS13/VWF:Ag ratios (HR 0.70, 95% CI 0.58-0.84) independently and significantly predicted short-term (1 year follow-up) clinical adverse events in heart failure (HF). Decreased activity of ADAMTS13 with concomitant high VWF:Ag levels is a significant independent predictor of clinical events in CHF. The levels of the two molecules may integrate the impaired synthetic capacity of the liver and the disturbed endothelial regulation and can therefore be a useful tool to predict clinical events in CHF

A T-sejt aktiváció/celluláris immunválasz szabályozása: membrán mikrodomén-függő immunmoduláció és az ösztrogén közvetített nem-genomiális hormonális hatások vizsgálata = Regulation of the T-cell mediated immune response: investigation of membrane microdomain-dependent immunomodulation and estrogen-mediated nongenomial hormonal effects

A T49696 OTKA projekt (3 év) támogatásával elért főbb eredmények: Kimutattuk, hogy a sejtmembrán "tutajok" szfingolipid és koleszterin alkotóelemei fontos szabályozói a T sejtek aktiváció/sejthalál egyensúlyának, valamint a polarizált helper T sejtek válaszképességének. Megmutattuk ezen folyamatokban a ceramidok, a Kv és Cav ioncsatornák alapvető szerepét is. Az általunk leírt szignálintegrációs modell újabb immunmodulációs lehetőségeket kínál. Kimutattuk, hogy az ösztrogén steroid hormonok gyors, nem-genomiális jeleket indukálnak T és B limfocitákon (foszforiláció, szelektív kalcium szignál, stb.), egy még nem azonosított membránreceptoron keresztül, és fokozzák a T sejt-függő, antigén-indukált ellenanyagtermelést. Eredményeink elősegíthetik az ösztrogénszint és egyes autoimmunbetegségek közötti összefüggések hátterének mélyebb megértését. Új, koleszterin-specifikus IgG monoklonális ellenanyagokat (AC1, AC8) állítottunk elő, melyeknek megmutattuk celluláris-koleszterin diagnosztikai célokra történő alkalmazhatóságát. Ezen ellenanyagok képesek a HIV-infekció/ termelés gátlására monocita-makrofág és T sejteken in vitro, elsősorban a célsejtek plazmamembránjának (lipid tutajok, HIV receptorok) molekuláris átrendezése révén. A projekt eredményeit felhasználva 2 PhD tudományos fokozat született; 6 referált tudományos közlemény nemzetközi folyóiratban; 4 új kongresszusi absztrakt, melyekből folyamatos a publikálás (3 publikáció-kész közlemény) | Main results of the project T49696 supported by OTKA (3 years): We have shown that two lipid constituents of rafts (sphingolipids or cholesterol) are critical in regulating the balance of activation/cell death signaling in T cells or the functional responses of polarized Th1 or Th2 cells. Specific, important contribution of ceramides, Kv and Cav ion channels was also shown in these processes, offering new possibilites of immunomodulation. Rapid, non-genomial signals (selective phosphorylation and Ca2+ signals or NFκB nuclear translocation) of estrogen steroid hormones have been shown in both T and B lymphocytes, that may be partly responsible for augmentation of the T-dependent humoral immune response observed in in vivo mice studies. These effects, mediated by a yet unidentified E2 membrane receptor, may help us to reveal and understand the relationship between estrogen levels and several autoimmune diseases. We generated novel cholesterol-specific IgG antibodies (AC1 and AC8), that may serve as diagnostic markers of clustered cholesterol (cell-free or cellular). As one of their most intriguing biological activity - inhibition of HIV entry/production in vitro - has been elucidated and shown that the major mechanism of action is remodeling of the target cells' plasma membrane (rafts and HIV receptors). 2 PhD degrees were received based on these results; 6 reviewed research articles; 4 new Congress Abstracts (publication is continuous: 3 publication-ready manuscripts

Association of Ficolin-3 with Severity and Outcome of Chronic Heart Failure

BACKGROUND: Inflammatory mechanisms involving complement activation has been shown to take part in the pathophysiology of congestive heart failure, but the initiating mechanisms are unknown. We hypothesized that the main initiator molecules of the lectin complement pathway mannose-binding lectin (MBL), ficolin-2 and ficolin-3 were related to disease severity and outcome in chronic heart failure. METHODS AND RESULTS: MBL, ficolin-2 and ficolin-3 plasma concentrations were determined in two consecutive cohorts comprising 190 patients from Hungary and 183 patients from Norway as well as controls. Disease severity and clinical parameters were determined at baseline, and all-cause mortality was registered after 5-years follow-up. In univariate analysis a low level of ficolin-3, but not that of MBL or ficolin-2, was significantly associated with advanced heart failure (New York Heart Association Class IV, p<0.001 for both cohorts) and showed inverse correlation with B- type natriuretic peptide (BNP) levels (r = -0.609, p<0.001 and r = -0.467, p<0.001, respectively). In multivariable Cox regression analysis, adjusted for age, gender and BNP, decreased plasma ficolin-3 was a significant predictor of mortality (HR 1.368, 95% CI 1.052-6.210; and HR 1.426, 95% CI 1.013-2.008, respectively). Low ficolin-3 levels were associated with increased complement activation product C3a and correspondingly decreased concentrations of complement factor C3. CONCLUSIONS: This study provides evidence for an association of low ficolin-3 levels with advanced heart failure. Concordant results from two cohorts show that low levels of ficolin-3 are associated with advanced heart failure and outcome. The decrease of ficolin-3 was associated with increased complement activation

Complement lectin pathway activation is associated with COVID-19 disease severity, independent of MBL2 genotype subgroups

IntroductionWhile complement is a contributor to disease severity in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, all three complement pathways might be activated by the virus. Lectin pathway activation occurs through different pattern recognition molecules, including mannan binding lectin (MBL), a protein shown to interact with SARS-CoV-2 proteins. However, the exact role of lectin pathway activation and its key pattern recognition molecule MBL in COVID-19 is still not fully understood.MethodsWe therefore investigated activation of the lectin pathway in two independent cohorts of SARS-CoV-2 infected patients, while also analysing MBL protein levels and potential effects of the six major single nucleotide polymorphisms (SNPs) found in the MBL2 gene on COVID-19 severity and outcome.ResultsWe show that the lectin pathway is activated in acute COVID-19, indicated by the correlation between complement activation product levels of the MASP-1/C1-INH complex (p=0.0011) and C4d (p&lt;0.0001) and COVID-19 severity. Despite this, genetic variations in MBL2 are not associated with susceptibility to SARS-CoV-2 infection or disease outcomes such as mortality and the development of Long COVID.ConclusionIn conclusion, activation of the MBL-LP only plays a minor role in COVID-19 pathogenesis, since no clinically meaningful, consistent associations with disease outcomes were noted

Copeptin (C-terminal pro Arginine-Vasopressin) is an Independent Long-Term Prognostic Marker in Heart Failure with Reduced Ejection Fraction.

BACKGROUND: The level of copeptin, a stable fragment of pro-arginine-vasopressin (AVP), correlates with disease severity. It is an established, short-term prognostic marker for patients with heart failure with reduced ejection fraction (HFREF). We aimed to examine the association between copeptin and long-term mortality. We also studied the clinical usefulness of copeptin as a prognostic biomarker by analysing the improvement of net reclassification. METHODS: Copeptin concentrations were measured in a cohort of 195 consecutive patients with HFREF. Disease severity and clinical parameters were determined at baseline, and all-cause mortality was recorded after five-year follow-up. RESULTS: One hundred and ten patients died during the five-year follow-up (five-year mortality rate: 0.56). Univariate analysis identified copeptin (HR 2.168 [95% CI 1.740-2.700]) as a predictor of mortality. The final, multivariable Cox survival model identified a number of independent predictors of death. These included higher NHYA functional class, previous MI, at least one hospitalisation for worsening HF (within the two years before inclusion into the study), elevated blood urea nitrogen, NT-proBNP-, and copeptin levels, as well as increased red blood cell distribution width, and decreased GFR. The addition of copeptin alone to the baseline predictive model (NT-proBNP only) resulted in a minor (8.21%) improvement, whereas the final, multivariable model showed a significant increase in net reclassification (10.26%, p=0.015). CONCLUSIONS: These data indicate that copeptin is an independent long-term prognostic marker in HFREF, with possible clinical relevance for multimarker risk prediction algorithms

Long-Term Survival and Apolipoprotein A1 Level in Chronic Heart Failure: Interaction With Tumor Necrosis Factor alpha -308 G/A Polymorphism.

BACKGROUND: Apolipoprotein A1 (ApoA1), a major constituent of high-density lipoprotein (HDL), has antiinflammatory and antioxidative properties and plays a prognostic role in chronic heart failure (CHF). Despite increased tumor necrosis factor alpha (TNFalpha) levels being linked to worse outcome of HF, the results are ambiguous about the association of functionally active 308 promoter polymorphism of the TNFalpha gene. The aims of our study were to investigate the association of ApoA1 and TNFalpha levels with mortality and to evaluate potential interaction between these factors and TNFalpha -308 polymorphism. METHODS: Together with several parameters ApoA1, TNFalpha levels and TNFalpha-308 polymorphism were determined in a cohort of 195 patients with CHF who were followed for 5 years. RESULTS: Low ApoA1 and high TNFalpha levels were associated with more severe disease, and ApoA1 showed the strongest relationship with HDL, total cholesterol, C-reactive protein, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). TNFalpha -308 A carriers had significantly higher ApoA1 levels than wild-type (GG) patients (1.41 +/- 0.268 vs 1.29 +/- 0.324 g/L; P = .007), whereas levels of TNFalpha were the same in these groups. Decreased ApoA1 levels were significant predictors of 5-year mortality (NT-proBNP-adjusted HR for 1 decile decrease in ApoA1 level was 1.10 (P = .011). Interaction was found between the ApoA1 level and TNFalpha -308 polymorphism, because in patients with GG haplotype the adverse effect of low ApoA1 level on survival was more prevalent. CONCLUSIONS: Lower ApoA1 levels were strongly associated with adverse outcome in CHF patients in a TNFalpha -308 polymorphism dependent manner. These observations support the complex involvement of malnutrition and inflammation in the pathogenesis of CHF

Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state.

Here we validate the strong, independent prediction of morbidity and mortality in HF by RDW. The described correlations between RDW and inflammation, ineffective erythropoiesis, undernutrition, and impaired renal function may facilitate the understanding why this marker is associated with adverse outcomes in HF