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Altered immune response and inflammation characterize patients with aortic valve sclerosis in acute myocardial infarction

ABSTRACT: Background: Aortic valve sclerosis (AVSc) presents similar pathogenetic mechanisms to coronary artery disease (CAD) and is associated with both short- and long-term mortality. In the context of acute myocardial infarction (AMI), evidence of specific systemic mechanisms characterizing AVSc are currently lacking. Objective: To evaluate the systemic pathophysiological landscape that might differentiate AVSc from non-AVSc subjects in AMI. Methods: Whole-blood transcriptome of AVSc (n=44) and no-AVSc (n=66) patients with AMI was assessed by RNA-sequencing. A bioinformatic workflow, including feature selection, differential expression and enrichment analysis was performed to identify gene expression signatures discriminating AVSc from no-AVSc and infer functional association. Multivariable Cox regression analysis was used to estimate hazard ratio of AVSc versus no-AVSc patients. Results: A signature of 100 informative genes allowed classifying AVSc from no-AVSc with 94% accuracy. Significant differences in 143 genes were also identified, 30 of which withstood association independently of age and previous AMI, or cardiac interventions. Functional inference unveiled significant association of AVSc with acute inflammatory and type I interferons (IFNs) response, platelet activation and hemostasis. AMI patients with AVSc showed a significantly higher incidence of adverse cardiovascular events within 10 years of follow-up with a full adjusted hazard ratio of 2.4 (95% CI 1.3–4.5). Conclusions: During AMI, AVSc patients showed increased type I IFNs response and associated adverse cardiovascular outcomes at follow-up. Novel pharmacological therapies aiming to inhibit response to type I IFNs during or immediately after AMI might improve poor cardiovascular outcomes of AMI patients with AVSc.

ORGANISM(S): Homo sapiens

PROVIDER: GSE218474 | GEO | 2024/01/31

REPOSITORIES: GEO

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Project description:Whole-genome gene expression analysis has been successfully utilized to diagnose, prognosticate, and identify potential therapeutic targets for cardiovascular disease. However, the utility of this approach to identify outcome-related genes and dysregulated pathways following first-time myocardial infarction (AMI) remains unknown and may offer a novel strategy to detect affected expressome networks that predict long-term outcome. Whole-genome microarray and targeted cytokine expression profiling on blood samples from normal cardiac function controls and first-time AMI patients within 48-hours post-MI revealed expected differential gene expression profiles enriched for inflammation and immune-response pathways in AMI patients. To determine molecular signatures at the time of AMI that could prognosticate long-term outcomes, transcriptional profiles from sub-groups of AMI patients with (n=5) or without (n=22) any recurrent events over an 18-month follow-up were compared. This analysis identified 559 differentially expressed genes. Bioinformatic analysis of this differential gene set for associated pathways revealed 1) increasing disease severity in AMI patients is associated with a decreased expression of the developmental epithelial-to-mesenchymal transition, and 2) modulation of cholesterol transport genes that include ABCA1, CETP, APOA1, and LDLR is associated with clinical outcome. In conclusion, differentially regulated genes and modulated pathways were identified that predicted recurrent cardiovascular outcomes in first-time AMI patients. This cell-based approach for risk stratification in AMI warrants a larger study to determine the role of metabolic remodeling and regenerative processes required for optimal outcomes. A validated transcriptome assay could represent a novel, non-invasive platform to anticipate modifiable pathways and therapeutic targets to optimize long-term outcome for AMI patients. The overall experimental design includes blood samples from 21 control and 31 myocardial infaction patient groups. Among the 31patients, 5 patients have recurrent events. Microarray were peformed on the blood samples and comparisons of control vs patient and patients with recurrent events vs patients without recurrent events were performed to identify differential genes related to disease or patients groups with recurrent events for the following bioinformatic analysis.

Project description:BACKGROUND; Cisplatin-containing chemotherapy is the standard of care for patients with locally advanced and metastatic transitional cell carcinoma of the urothelium. The response rate is around 50% and tumor derived molecular prognostic markers are needed for estimation of response and survival. METHODS; Affymetrix GeneChip expression profiling was carried out using tumor material from 30 patients. A set of genes having an expression with high correlation to survival time after chemotherapy was identified. Two of these genes were selected for validation by immunohistochemistry (IHC) in tumor tissue from 149 cisplatin treated patients having complete follow-up data. RESULTS; Fifty-five differentially expressed genes correlated significantly to survival time. Two of these (Emmprin and Survivin) were validated using IHC, and multivariate analysis (n=145) identified Emmprin expression (hazard ratio 2.38; p<0.0001) and Survivin expression (hazard ratio 2.34; p<0.0001) as independent prognostic markers for poor outcome, together with the presence of visceral metastases (hazard ratio 2.72; p<0.0001). In the good prognosis group of patients without visceral metastases, both markers showed significant discriminating power as supplemental risk factors (p<0.0001). Within this group of patients, the subgroups of patients with no positive, one positive or two positive IHC stainings (Emmprin and Survivin) had estimated 5-year survival rates (+- SE) of 35.6+-?%, 6.3+-?%, and 0+?%, respectively. Response to chemotherapy could also be predicted with an OddsRatio of 4.60 (2.13-9.93) and 2.59 (1.25-5.38) for Emmprin and Survivin respectively. CONCLUSION; Emmprin and Survivin proteins were identified as strong independent prognostic predictors for response and survival after cisplatin-containing chemotherapy in patients with bladder cancer. Experiment Overall Design: Tumors from 30 patients with advanced bladder cancer used in the study. A SAM analysis was used for identifying genes co-varying with treatment response.

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Altered immune response and inflammation characterize patients with aortic valve sclerosis in acute myocardial infarction

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