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Pubblicazioni recenti - cardio-oncology
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Cardiac Amyloidosis for the Primary Care Provider: A Practical Review to Promote Earlier Recognition of Disease.
Am J Med2021 Jan;():. doi: S0002-9343(21)00016-4.
Zhang Kathleen W, Vallabhaneni Srilakshmi, Alvarez-Cardona Jose A, Krone Ronald J, Mitchell Joshua D, Lenihan Daniel J,
Abstract
Cardiac amyloidosis is increasingly recognized as an underdiagnosed cause of heart failure. Diagnostic delays of up to three years from symptom onset may occur, and patients may be evaluated by more than five specialists prior to receiving the correct diagnosis. Newly available therapies improve clinical outcomes by preventing amyloid fibril deposition and are usually more effective in early stages of disease, making early diagnosis essential. Better awareness among primary care providers of the clinical presentation and modern treatment landscape is essential to improve timely diagnosis and early treatment of this disease. In this review, we provide practical guidance on the epidemiology, clinical manifestations, diagnostic evaluation, and treatment of transthyretin and light chain cardiac amyloidosis to promote earlier disease recognition among primary care providers.
Copyright © 2021. Published by Elsevier Inc.
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A virtual-hybrid approach to launching a cardio-oncology clinic during a pandemic.
Cardiooncology2021 Jan;7(1):2. doi: 10.1186/s40959-020-00088-2.
Brown Sherry-Ann, Patel Sahishnu, Rayan David, Zaharova Svetlana, Lin Mingqian, Nafee Tarek, Sunkara Bipin, Maddula Ragasnehith, MacLeod James, Doshi Krishna, Meskin Joshua, Marks David, Saucedo Jorge,
Abstract
BACKGROUND:
As cardiovascular disease is a leading cause of death in cancer survivors, the new subspecialty of Cardio-Oncology has emerged to address prevention, monitoring, and management of cardiovascular toxicities to cancer therapies. During the coronavirus disease of 2019 (COVID-19) pandemic, we developed a Virtual-Hybrid Approach to build a de novo Cardio-Oncology Clinic.
METHODS:
We conceptualized a Virtual-Hybrid Approach including three arms: information seeking in locations with existing Cardio-Oncology clinics, information gathering at the location for a new clinic, and information sharing to report clinic-building outcomes. A retrospective review of outcomes included collection and synthesis of data from our first 3 months (at pandemic peak) on types of appointments, cancers, drugs, and cardiotoxicities. Data were presented using descriptive statistics.
RESULTS:
A de-novo Cardio-Oncology clinic was developed structured from the ground up to integrate virtual and in-person care in a hybrid and innovative model, using the three arms of the Virtual-Hybrid Approach. First, we garnered in-person and virtual preparation through hands-on experiences, training, and discussions in existing Cardio-Oncology Clinics and conferences. Next, we gleaned information through virtual inquiry and niche-building. With partners throughout the institution, a virtual referral process was established for outpatient referrals and inpatient e-consult referrals to actualize a hybrid care spectrum for our patients administered by a multidisciplinary hybrid care team of clinicians, ancillary support staff, and clinical pharmacists. Among the multi-subspecialty clinic sessions, approximately 50% were in Cardio-Oncology, 20% in Preventive Cardiology, and 30% in General Cardiology. In the hybrid model, the Heart & Vascular Center had started to re-open, allowing for 65% of our visits to be in person. In additional analyses, the most frequent cardiovascular diagnosis was cardiomyopathy (34%), the most common cancer drug leading to referral was trastuzumab (29%), and the most prevalent cancer type was breast cancer (42%).
CONCLUSION:
This Virtual-Hybrid Approach and retrospective review provides guidance and information regarding initiating a brand-new Cardio-Oncology Clinic during the pandemic for cancer patients/survivors. This report also furnishes virtual resources for patients, virtual tools for oncologists, cardiologists, and administrators tasked with starting new clinics during the pandemic, and innovative future directions for this digital pandemic to post-pandemic era.
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COVID-19: Case fatality and ACE2 inhibitors treatment concerns in patients with comorbidities.
Med J Islam Repub Iran2020 ;34():147. doi: 10.34171/mjiri.34.147.
Aghili Rokhsareh, Honardoost Maryam, Khamseh Mohammad E,
Abstract
The Corona Virus Disease 2019 (COVID-19) outbreak is becoming pandemic with the highest mortality in patients with associated comorbidities. These RNA viruses containing 4 structural proteins usually use spike protein to enter the host cell. Angiotensin-converting enzyme 2 (ACE2) acts as a host receptor for the virus. Therefore, medications acting on renin-angiotensin-aldosterone system can lead to serious complications, especially in patients with diabetes and hypertension. To avoid this, other potential treatment modalities should be used in COVID-19 patients with associated comorbidities.
© 2020 Iran University of Medical Sciences.
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Fluoropyrimidine-induced cardiotoxicity.
World J Clin Oncol2020 Dec;11(12):1008-1017. doi: 10.5306/wjco.v11.i12.1008.
Deac Andrada Larisa, Burz Claudia Cristina, Bocsan Ioana Corina, Buzoianu Anca Dana,
Abstract
Cardio-oncology is a discipline based on early screening, monitoring, and treating chemotherapy-induced cardiotoxicity. There are many chemotherapeutics known for their cardiac toxic effects, including fluoropyrimidines. Fluoropyrimidine represents the cornerstone of many types of cancer and each year almost two million cancer patients undergo this treatment. Fluoropyrimidine-induced cardiotoxicity can be manifested in several forms, from angina pectoris to sudden death. This paper is a review of how the cardiotoxicity of fluoropyrimidines is presented, the mechanisms of its occurrence, its diagnosis, and management.
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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Interferon Regulatory Factor 9 Promotes Lung Cancer Progression via Regulation of Versican.
Cancers (Basel)2021 Jan;13(2):. doi: E208.
Brunn David, Turkowski Kati, Günther Stefan, Weigert Andreas, Muley Thomas, Kriegsmann Mark, Winter Hauke, Dammann Reinhard H, Stathopoulos Georgios T, Thomas Michael, Guenther Andreas, Grimminger Friedrich, Pullamsetti Soni S, Seeger Werner, Savai Rajkumar,
Abstract
Transcription factors can serve as links between tumor microenvironment signaling and oncogenesis. Interferon regulatory factor 9 (IRF9) is recruited and expressed upon interferon stimulation and is dependent on cofactors that exert in tumor-suppressing or oncogenic functions via the JAK-STAT pathway. IRF9 is frequently overexpressed in human lung cancer and is associated with decreased patient survival; however, the underlying mechanisms remain to be elucidated. Here, we used stably transduced lung adenocarcinoma cell lines (A549 and A427) to overexpress or knockdown . Overexpression led to increased oncogenic behavior in vitro, including enhanced proliferation and migration, whereas knockdown reduced these effects. These findings were confirmed in vivo using lung tumor xenografts in nude mice, and effects on both tumor growth and tumor mass were observed. Using RNA sequencing, we identified versican () as a novel downstream target of IRF9. Indeed, and expression levels were found to be correlated. We showed for the first time that IRF9 binds at a newly identified response element in the promoter region of to regulate its transcription. Using an siRNA approach, VCAN was found to enable the oncogenic properties (proliferation and migration) of IRF9 transduced cells, perhaps with involvement. The targeted inhibition of IRF9 in lung cancer could therefore be used as a new treatment option without multimodal interference in microenvironment JAK-STAT signaling.
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Cardiac substructures exposure in left-sided breast cancer radiotherapy: Is the mean heart dose a reliable predictor of cardiac toxicity?
Cancer Radiother2021 Jan;():. doi: S1278-3218(20)30353-X.
Naimi Z, Moujahed R, Neji H, Yahyaoui J, Hamdoun A, Bohli M, Kochbati L,
Abstract
PURPOSE:
This study aimed to assess radiation dose distribution to cardiac subvolumes in left-sided breast cancer radiotherapy (LBCRT) and to clarify whether the mean heart dose (MHD) reliably reflects cardiac substructures exposure.
MATERIALS AND METHODS:
Fifty women referred for adjuvant LBCRT were prospectively evaluated. All patients received 3D-conformal hypofractionated radiotherapy (40Gy delivered in 15 fractions of 2.67Gy±boost of 13.35Gy). Cardiac substructures were contoured using the F. Duane's cardiac atlas. Dose distribution to cardiac chambers, left main (LM), left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA)) was assessed. Dosimetric associations were analysed.
RESULTS:
The mean MHD was 3.08Gy (EQD2=3.67Gy). The mean Dmean/Dmax LAD was 11.45Gy (EQD2=13.64Gy)/29.5Gy (EQD2=35.15Gy). Low doses were delivered to LM, LCx, and RCA (Dmean?1.3Gy). The left ventricle (LV) was the most exposed cardiac chamber with Dmean/Dmax of 4.78Gy/37Gy. The strongest correlation with MHD was found for Dmean LAD (r=0.81). For every 1Gy increase in MHD, Dmean LAD rose by 3.4Gy. However, the proportion of variance in Dmean LAD predictable from MHD was moderate (R=0.65). For all other cardiac substructures, R values were<0.7.
CONCLUSION:
Our study showed high exposure of LAD and LV in LBCRT. With poor predictive value, MHD may underestimate doses to cardiac substructures. For optimal heart sparing radiotherapy, we recommend to consider LV and LAD as separate organ at risk.
Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.
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Prognostic Impact of Pretherapeutic Hemoglobin Levels on All-cause Mortality in Cardiooncology.
Anticancer Res2021 Jan;41(1):369-378. doi: 10.21873/anticanres.14785.
Hohneck Anna, Rosenkaimer Stephanie, Sieburg Tina, Holzwarth Jakob, Hofheinz Ralf D, Akin Ibrahim, Borggrefe Martin, Gerhards Stefan,
Abstract
BACKGROUND/AIM:
We investigated the prognostic impact of hemoglobin (Hb) levels in tumour patients receiving routine cardiological surveillance during anticancer treatment. The aim of the study was to identify independent predictors of all-cause mortality in a cardio-oncological collective.
PATIENTS AND METHODS:
A total of 551 patients (273 males, 278 females) were enrolled in the Mannheim Registry for Cardiooncology and were included in the present analysis. Median follow-up was 41 months (95% CI=40-43).
RESULTS:
Patients were grouped according to a pretherapeutic Hb-threshold (determined by ROC analysis) into cohorts with Hb<11.4 g/dl (n=232, 42.1%) and Hb >11.4 g/dl (n=319, 57.9%). Patients with lower Hb levels were older at the time of first diagnosis (63.8±14.4 vs. 59.9±15.4 years, p=0.003) and were more likely to have advanced tumour stages (92 (39.7%) vs. 83 (26.0%), p=0.0007). There were no differences regarding cardiovascular comorbidities such as hypertension or diabetes, while chronic kidney disease was more common in patients with lower Hb. Anticoagulants were used more often in patients with lower Hb (88 (37.9%) vs. 84 (26.3%), p=0.01). Left ventricular ejection fraction (LVEF) was lower in patients with Hb <11.4 g/dl (51.9±11.0% vs. 55.1±9.7%, p=0.003). Correlation analysis revealed a significant correlation of Hb levels and LVEF (R=0.07, p<0.0001). During follow-up, a total of 140 patients (25.4%) were deceased, with significantly more deaths occurring in the group of patients with low Hb values [108 (46.6%) vs. 32 (10.0%), p<0.0001]. In multivariable analysis, Hb was identified as independent predictor for mortality (OR=5.3, CI=0.41-0.89, p<0.0001).
CONCLUSION:
Low Hb levels were identified as an independent predictor of mortality in patients with cancer. There was a significant correlation of Hb and LVEF, suggesting that low Hb values are not solely due to anaemia, but rather reflect the severity of cancer.
Copyright© 2021, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Chemotherapy and Radiation-Associated Cardiac Autonomic Dysfunction.
Curr Oncol Rep2021 Jan;23(2):14. doi: 10.1007/s11912-020-01013-7.
Teng Alexandra E, Noor Benjamin, Ajijola Olujimi A, Yang Eric H,
Abstract
PURPOSE OF REVIEW:
Cardiovascular autonomic dysfunction (AD) among cancer survivors is increasingly being recognized. However, the mechanisms and incidence are poorly understood. In this review, the clinical features, diagnostic modalities, proposed mechanisms, and currently available treatments of cardiovascular AD in cancer survivors are described.
RECENT FINDINGS:
Much of our current understanding of cardiovascular AD is based on disease states such as diabetes, multisystem atrophy, and Parkinson's disease. Several non-invasive tests, measurements, and scoring systems have been developed as surrogates for autonomic function, with some even demonstrating associations with all-cause mortality. The mechanism of cardiovascular AD specifically in the cancer population, however, has not been directly studied. The etiology of cardiovascular AD in cancer survivors is likely multifactorial, and proposed mechanisms include direct nerve damage by chemoradiation, the pro-inflammatory state associated with malignancy, and paraneoplastic syndromes. It may also be that cardiovascular AD is an early marker of global cardiomyopathy rather than its own condition. Current pharmacologic options for cardiovascular AD are extrapolated from how it has been treated in other disease processes, and these agents have not been studied in the cancer population or compared head-to-head. Cardiovascular AD in cancer survivors can cause significant debilitation and may be associated with all-cause mortality. Current diagnostic modalities have several limitations, such as standardization and validity. However, given the nonspecific nature of cardiovascular AD, these tools provide an objective marker for diagnosis and tracking treatment response. While the mechanism of cardiovascular AD in cancer survivors has not been directly studied, it may be useful to evoke mechanisms of cardiovascular AD in other disease states such as diabetes, Parkinson's disease, and multisystem atrophy in addition to identifying unique conditions associated with malignancy like a pro-inflammatory state. Until further studies are performed, management of cardiovascular AD as seen in other disease states may serve as a guide for symptom management in cancer survivors.
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Cardiovascular Toxicity of Immune Checkpoint Inhibitors: Clinical Risk Factors.
Curr Oncol Rep2021 Jan;23(2):13. doi: 10.1007/s11912-020-01002-w.
Pirozzi Flora, Poto Remo, Aran Luisa, Cuomo Alessandra, Galdiero Maria Rosaria, Spadaro Giuseppe, Abete Pasquale, Bonaduce Domenico, Marone Gianni, Tocchetti Carlo Gabriele, Varricchi Gilda, Mercurio Valentina,
Abstract
PURPOSE OF REVIEW:
Immune checkpoint inhibitors, such as monoclonal antibodies targeting CTLA-4, PD-1, and PD-L1, have improved the outcome of many malignancies, but serious immune-related cardiovascular adverse events have been observed. Patients' risk factors for these toxicities are currently being investigated.
RECENT FINDINGS:
Interfering with the CTLA-4 and PD-1 axes can bring to several immune-related adverse events, including cardiotoxic events such as autoimmune myocarditis, pericarditis, and vasculitis, suggesting that these molecules play an important role in preventing autoimmunity. Risk factors (such as pre-existing cardiovascular conditions, previous and concomitant cardiotoxic treatments, underlying autoimmune diseases, tumor-related factors, simultaneous immune-related toxic effects, and genetic factors) should be always recognized for the correct management of these toxicities.
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Cardiovascular Complications of Prostate Cancer Treatment.
Front Pharmacol2020 ;11():555475. doi: 10.3389/fphar.2020.555475.
Wilk Micha?, Wa?ko-Grabowska Anna, Szmit Sebastian,
Abstract
Treatment of prostate cancer (PC) is a rapidly evolving field of pharmacology research. In recent years, numerous novel therapeutics that improve survival and ameliorate disease control have been approved. Currently, the systemic treatment for prostate neoplasm consists of hormonal therapy, chemotherapy, immunotherapy, radiopharmaceuticals, targeted therapy, and supportive agents (e.g., related to bone health). Unfortunately, many of them carry a risk of cardiovascular complications, which occasionally pose a higher mortality threat than cancer itself. This article provides a unique and comprehensive overview of the prevalence and possible mechanisms of cardiovascular toxicities of all PC therapies, including state-of-the-art antineoplastic agents. Additionally, this article summarizes available recommendations regarding screening and prevention of the most common cardiac complications among patients with advanced cancer disease.
Copyright © 2020 Wilk, Grabowska and Szmit.
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Predicted Heart Age Among Cancer Survivors - United States, 2013-2017.
MMWR Morb Mortal Wkly Rep2021 Jan;70(1):1-6. doi: 10.15585/mmwr.mm7001a1.
Scott Lia C, Yang Quanhe, Dowling Nicole F, Richardson Lisa C,
Abstract
Approximately 15.5 million cancer survivors were alive in the United States in 2016 with expected growth to 26.1 million by 2040 (1). Cancer survivors are living longer because of advances in early detection and treatment, but face psychosocial, cognitive, financial, and physical challenges (1,2). Physical challenges include cardiovascular complications, partly because cancer and cardiovascular disease (CVD) share some cumulative risk factors including tobacco use, physical inactivity, obesity, poor diet, hypertension, diabetes, and dyslipidemia (3). In addition, many cancer treatments damage the heart, and some cancer types increase risk for developing CVD (4). The recognition and management of heart disease in cancer survivors has given rise to the discipline of cardio-oncology, which focuses on the cardiovascular health of this population (5). CVD risk has been previously estimated using prediction models, and studies suggest that physician-patient communication using predicted heart age rather than predicted 10-year risk has led to a more accurate perception of excess heart age, encouraged actions to adopt a healthy lifestyle, and improved modifiable CVD risk factors (6,7). Using the nonlaboratory-based Framingham Risk Score (FRS) to estimate 10-year risk for developing CVD, predicted heart age is estimated from the 10-year risk of CVD (predicted by age, sex, diabetes status, smoking status, systolic blood pressure, hypertension treatment status, and body mass index); it is the age of an otherwise healthy person with the same predicted risk, with all other risk factors included in the prediction model at the normal level (systolic blood pressure of 125 mmHg, no hypertension treatment, body mass index of 22.5, nonsmoker, and nondiabetic) (6). Using data from the Behavioral Risk Factor Surveillance System (BRFSS), this study estimates predicted heart age, excess heart age (difference between predicted heart age and actual age), and racial/ethnic and sociodemographic disparities in predicted heart age among U.S. adult cancer survivors and noncancer participants aged 30-74 years using previously published methods (7). A total of 22,759 men and 46,294 women were cancer survivors with a mean age of 48.7 and 48.3 years, respectively. The predicted heart age and excess heart age among cancer survivors were 57.2 and 8.5 years, respectively, for men and 54.8 and 6.5 years, respectively, for women, and varied by age, race/ethnicity, education and income. The use of predicted heart age by physicians to encourage cancer survivors to improve modifiable risk factors and make heart healthy choices, such as tobacco cessation, regular physical activity, and a healthy diet to maintain a healthy weight, can engage survivors in informed cancer care planning after diagnosis.
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Role of cardiovascular magnetic resonance imaging in cardio-oncology.
Eur Heart J Cardiovasc Imaging2021 Jan;():. doi: jeaa345.
Saunderson Christopher E D, Plein Sven, Manisty Charlotte H,
Abstract
Advances in cancer therapy have led to significantly longer cancer-free survival times over the last 40?years. Improved survivorship coupled with increasing recognition of an expanding range of adverse cardiovascular effects of many established and novel cancer therapies has highlighted the impact of cardiovascular disease in this population. This has led to the emergence of dedicated cardio-oncology services that can provide pre-treatment risk stratification, surveillance, diagnosis, and monitoring of cardiotoxicity during cancer therapies, and late effects screening following completion of treatment. Cardiovascular imaging and the development of imaging biomarkers that can accurately and reliably detect pre-clinical disease and enhance our understanding of the underlying pathophysiology of cancer treatment-related cardiotoxicity are becoming increasingly important. Multi-parametric cardiovascular magnetic resonance (CMR) is able to assess cardiac structure, function, and provide myocardial tissue characterization, and hence can be used to address a variety of important clinical questions in the emerging field of cardio-oncology. In this review, we discuss the current and potential future applications of CMR in the investigation and management of cancer patients.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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[Cardio-oncology: radiation dose to the heart during thoracic radiotherapy].
Strahlenther Onkol -
Neoplasia-Associated Pericarditis-Predictor of Cancer Progression?
Diagnostics (Basel)2021 Jan;11(1):. doi: E58.
Boldan Anca, Negru Alina Gabriela, Boldan Maria, Mazilu Laura, Tudor Anca, Popovici Dorel, S?ftescu Sorin, Luca Constantin Tudor, Negru ?erban Mircea,
Abstract
Pericarditis may signal the presence of cancer, even in the absence of other clinical or paraclinical signs. Corollary, the following question arises: Could the discovery of a newly developed pericarditis be used in patients with known neoplasia as a marker of cancer progression? In an attempt to find an answer to this question, this two-centre study included 341 consecutive patients with a confirmed diagnosis of cancer and evidence of pericardial effusion at echocardiography and/or CT/MRI scan. The patients' data were collected retrospectively if they further fulfilled the following inclusion criteria: available medical data from confirmation of pericarditis until evidence of cancer progression or until at least 12 months without progression. The average age of the patients was 62.16 years (22-86 years), and the study comprised 44.28% males and 55.71% females. All types of the most common neoplasms were represented. The results showed that 85.33% of patients had cancer progression temporally linked to pericarditis. Of these, 41.64% had cancer progression within 18 months after the diagnosis of pericarditis with a median time to progression of 5.03 months, ranging from 0 to 17 months; 43.69% had progression within a maximum of 2 months before the diagnosis of pericarditis. Only 14.66% had no cancer progression during the observation period. We concluded that pericarditis could be a sensitive marker of cancer evolution that could be widely used as a follow-up investigation for cancer patients as a marker of progression or recidive.
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Book review: cancer and the heart.
Cardiooncology2021 Jan;7(1):1. doi: 10.1186/s40959-020-00089-1.
Sharma Umesh C, Pokharel Saraswati,
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Echocardiographic evaluation of patients undergoing cancer therapy.
Eur Heart J Cardiovasc Imaging2021 Jan;():. doi: jeaa341.
Frey Maria Klara, Bergler-Klein Jutta,
Abstract
As advances in oncology therapies lead to significant improvement in life expectancy of many cancer entities, short-, and long-term cardiac side effects of oncology treatments gain increasing importance. In search of new screening modalities, echocardiography currently presents the best established and clinically easily feasible tool to detect cardiotoxicity in patients undergoing cancer therapy. This review focusses on the most commonly used oncology therapies and aims to give a practical approach to guide clinicians caring for this growing number of patients.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Characterization and outcomes of acute myocardial injury in COVID-19 intensive care patients.
Infection2021 Jan;():. doi: 10.1007/s15010-020-01560-y.
Labbé Vincent, Ederhy Stephane, Lapidus Nathanael, Salem Joe-Elie, Trinh-Duc Antoine, Cohen Ariel, Fartoukh Muriel, Voiriot Guillaume,
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The year in cardiovascular medicine 2020: epidemiology and prevention.
Eur Heart J -
Astrocyte-derived Wnt growth factors are required for endothelial blood-brain barrier maintenance.
Prog Neurobiol2020 Dec;():101937. doi: S0301-0082(20)30192-1.
Guérit Sylvaine, Fidan Elif, Macas Jadranka, Czupalla Cathrin Jaqueline, Figueiredo Ricardo, Vijikumar Aruvi, Yalcin Burak Hasan, Thom Sonja, Winter Peter, Gerhardt Holger, Devraj Kavi, Liebner Stefan,
Abstract
Maintenance of the endothelial blood-brain-barrier (BBB) through Wnt/?-catenin signalling is essential for neuronal function. The cells however, providing Wnt growth factors at the adult neurovascular unit (NVU) are poorly explored. Here we show by conditionally knocking out the evenness interrupted (Evi) gene in astrocytes (Evi) that astrocytic Wnt release is crucial for BBB and NVU integrity. Evi mice developed brain oedema and increased vascular tracer leakage. While brain vascularization and endothelial junctions were not altered in 10 and 40 week-old mice, endothelial caveolin(Cav)-1-mediated vesicle formation was increased in vivo and in vitro. Moreover, astrocytic end-feet were swollen, and aquaporin-4 distribution was disturbed, coinciding with decreased astrocytic Wnt activity. Vascular permeability correlated with increased neuronal activation by c-fos staining, indicative of altered neuronal function. Astrocyte-derived Wnts thus serve to maintain Wnt/?-catenin activity in endothelia and in astrocytes, thereby controlling Cav-1 expression, vesicular abundance, and end-feet integrity at the NVU.
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Immune Checkpoint Inhibitor Myocarditis with Normal Cardiac Magnetic Resonance Imaging: Importance of Cardiac Biopsy and Early Diagnosis.
Can J Cardiol2020 Dec;():. doi: S0828-282X(20)31189-2.
Ederhy Stephane, Fenioux Charlotte, Cholet Clement, Rouvier Philippe, Redheuil Alban, Cohen Ariel, Salem Joe-Elie,
Abstract
Immune checkpoint inhibitors (ICI) have improved the management and the prognosis of patients with cancer but are associated with an increased risk of toxicities that can affect every organ. ICI-associated myocarditis has a low incidence (<1%) but a high fatality rate (30-50%). Here, we report a patient treated with ICI admitted for suspicion of myocarditis. Cardiac magnetic resonance imaging (cMRI) was normal. An endomyocardial-biopsy (EMB) was in favour of ICI-related myocarditis with cardiac lymphohistiocytic infiltrate. This case highlights the role of a systematic evaluation with ECG and troponin and the potential value of EMB in patients without a suggestive cMRI.
Copyright © 2020. Published by Elsevier Inc.
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