Gabriel Szendro

N-Terminal Rather Than Full-Length Osteopontin or Its C-Terminal Fragment Is Associated With Carotid-Plaque Inflammation in Hypertensive Patients

BACKGROUND Hypertensive patients develop carotid atherosclerotic plaques with enhanced inflammation. Full-length osteopontin (OPN-FL), a multifunctional protein whose levels are elevated in association with atherosclerosis, is cleaved by thrombin and matrix metalloproteinases to form a C-terminal and a putatively biologically active N-terminal fragment (OPN-C, OPN-N, respectively). We conducted a study to examine whether plaque inflammation in hypertensive patients corresponds to the expression of OPN or of its cleaved forms or both. METHODS We collected 42 carotid plaques from 41 consecutive hypertensive patients during carotid endarterectomy. Plaque tissue was used to measure matrix metalloproteinase-12 (MMP-12) and OPN proteins, and for the classification of plaques as showing low- or high-degree inflammation through histological and immunohistochemical evaluation. RESULTS Fifteen highly inflamed plaques and 27 plaques with characteristics of low-grade inflammation were collected. Moderate to heavy staining for OPN characterized 87% of the plaques with high-degree inflammation but only 44% of those with low-degree inflammation, corresponding to the percentages of plaques that were heavily stained for the macrophage marker CD68 (93% versus 26%, respectively, P < 0.01). Western blot analysis showed that the abundance of OPN-FL and OPN-C was comparable in the two groups. However, the abundance of OPN-N was significantly greater in the highly inflamed plaques (median, 3.8 (range, 0.8-7.3) vs. median, 0.9 (range, 0.2-1.5); P = 0.017, respectively). The abundance of MMP-12 was significantly greater in the high- than in the low-degree plaque inflammation group (4.8 (range 1.9-8.8) vs. 1.1 (range 0.3-1.4), respectively; P = 0.03). CONCLUSIONS The N-terminal fragment of osteopontin, rather than OPN-FL or OPN-C, is associated with carotid plaque inflammation in hypertensive patients. Future studies should assess whether targeting OPN cleavage could present a new approach to preventing high-risk carotid plaques.

Use of ViaBahn Open Revascularisation Technique for Above-knee Femoro-popliteal Anastomosis: A Technical Note

We describe a ViaBahn Open Revascularization TEChnique (VORTEC) application in peripheral femoro-popliteal polytetrafluoroethylene (PTFE) graft bypass in 13 patients.

Malignant hypertension as a presenting symptom of Takayasu arteritis

We present an unusual case of malignant hypertension in a 20-year-old white woman. One week before hospitalization, she experienced occasional abdominal pain and claudication of both legs; otherwise, she had no remarkable medical history, including no history of high blood pressure. The origin of the patients hypertension was renovascular, and the vascular injury was due to vasculitis of the large arteries. The combination of a difference in blood pressure between the patients arms, angiographic findings, elevated erythrocyte sedimentation rate, and lack of markers for specific vasculitis led to the diagnosis of Takayasu arteritis. Surgical intervention was successful.

Preserving the left arm vein in cases of hemodialysis access generating left internal mammary artery steal syndrome.

In patients undergoing chronic hemodialysis (HD) through an arm arteriovenous fistula (AVF), coronary insufficiency can occur if the patient undergoes a coronary artery bypass graft (CABG) using the ipsilateral internal mammary artery (1–4). Therefore, the creation of a new AVF after CABG should avoid using the arm ipsilateral to the side where the internal thoracic artery was used. In cases where coronary syndrome appears when this advice is not followed, treatment should be offered aimed at overcoming the hemodynamic interference between the diminished coronary supply through the left or right internal mammary artery by closure of the existing fistula, with or without temporary central venous line insertion until the maturation of a new fistula. We suggest a different approach by moving only the arterial inflow site of the AVF to the controlateral subclavian artery, but in addition, leaving the well functioning venous outflow tract intact. In cases of left internal mammary steal it is achieved by creating a conduit running from the right subclavian artery to the left cephalic vein; therefore, creating a new arterial inflow source, connected to the existing functioning old venous outflow tract to maintain an immediately functioning new fistula without a coronary steal.

Evolution of multiple mycotic aneurysms

Mycotic aneurysms have been recognised for nearly a century. 1 They carry significant morbidity and mortality and need urgent treatment. Multiple lesions are rare, but have been described in various locations. 2-s We report a case of multiple mycotic aneurysms in branches of the abdominal aorta, with a rare documentat ion of their progress over 1 month between two consecutive angiograms. Surgery or alternative treatment is recommended to prevent further complications. 3-s Successful selective coil embolisations cured the patient.

Angiotensin 1–7, but not the thrombin-cleaved osteopontin C-terminal fragment, attenuates osteopontin-mediated macrophage-induced endothelial-cell inflammation

Objective and designEvaluating the pro-/anti-inflammatory activity of the C-terminal cleavage product of osteopontin in comparison to angiotensin 1–7.Material and subjectsHuman coronary endothelial cells (hcEC) treated with conditioned media from human U937 macrophages.TreatmentMacrophages were (pre)treated with C-terminal, full-length or N-terminal osteopontin (OPN-C, OPN-FL, OPN-N, respectively), angiotensin II, angiotensin 1–7 or TNF-α. OPN-C modulatory capacity was compared to that of Ang1–7 in inhibiting subsequent Ag II, OPN-FL or OPN-N-induced macrophage-mediated endothelial inflammation.MethodsProtein expression of NFκB, IκB, vCAM-1 and iCAM-1 was assessed using western blot. Promotor activation by NFκB was also assessed by dual-luciferase reporter assay.ResultsConditioned media of macrophages treated with OPN-C induced hcECs’ NfκB activation to a lower degree than OPN-FL or OPN-N. Priming of macrophages with angiotensin 1–7 attenuated the endothelial pro-inflammatory effect induced by subsequent exposure of the macrophages to angiotensin II, OPN-FL or OPN-N. This was evidenced by both NfκB activation and vCAM and iCAM expression. In contrast, priming macrophages with OPN-C did not significantly attenuate the subsequent response to the pro-inflammatory cytokines.ConclusionsOPN-C induces lower macrophage-induced endothelial inflammation compared to OPN-FL or OPN-N, but unlike angiotensin 1–7, fails to prevent endothelial inflammation induced by subsequent pro-inflammatory macrophage stimulation.

Duplex Waveform Analysis of the Subclavian Artery in a Case with Internal Mammary Steal Syndrome

In patients undergoing chronic hemodialysis through an arteriovenous fistula (AVF), coronary insufficiency may occur if the patient undergoes coronary artery bypass grafting (CABG) using the ipsilateral internal mammary artery (left internal mammary artery [LIMA] or right internal mammary artery [RIMA]). Creation of a new AVF after CABG should therefore avoid using the arm ipsilateral to the side where the internal mammary artery was used. In cases where coronary syndrome appears when this advice was not followed, treatment should be offered aiming to overcome the hemodynamic interference between the diminished coronary supply through the LIMA/RIMA and the excessive flow through the AVF. By using subclavian artery (SCA) waveform analysis on a duplex scan, a noninvasive evaluation of the flow through the SCA ipsilateral to the side of the mammary artery and the fistula can be performed both with the patent (functioning) and closed fistula. Waveform analysis can enlighten the phenomena of steal syndrome through the internal mammary artery and is highly recommended in this small and unusual group of patients.

Prominent somnolence and cerebellar syndrome in subclavian artery thrombosis--a case report.

A patient suffering from acute left subclavian artery thrombosis presented with an unusual syndrome of prominent somnolence, right cerebellar signs, and left upper extremity ischemia. Clinical, angiologic, and electrophysiologic stud ies confirmed a brain stem and reticular formation dysfunction due to vertebro basilar ischemia. Urgent thromboembolectomy led to neurologic improvement and satisfactory revascularization of the involved upper limb.