New vaccine shown promise in preventing secondary strokes after an ischemic stroke

New research published in journal Hypertension shows that vaccine called S100A9 may be able to replace oral blood thinners to reduce the risk of secondary strokes in patients with recent ischemic stroke.

Japanese researchers successfully tested an experimental vaccine in mice and found that it provided protection against blood clots for more than two months without increasing the risk of bleeding or causing an autoimmune response.

The vaccine, S100A9, inhibits blood clot formation and, during the study, protected the arteries of treated mice from forming new clots for more than two months, and additionally, worked as well as the oral blood thinner clopidogrel in a major artery, according to Hironori Nakagami, M.D., Ph.D., study co-author and professor at Osaka University, in Japan.

“Many stroke patients don’t take their blood thinning drugs as prescribed, which makes it more likely they will have another stroke. This vaccine might one day help solve this issue since it would only need to be injected periodically,” Nakagami said.

Citation: Tomohiro Kawano, M.D.; Munehisa Shimamura, M.D., Ph.D.; Tatsuya Iso, M.D., Ph.D.; Hiroshi Koriyama, M.D., Ph.D.; Shuko Takeda; Tsutomu Sasaki, M.D., Ph.D.; Manabu Sakaguchi, M.D., Ph.D.; Ryuichi Morishita, M.D., Ph.D.; and Hideki Mochizuki, M.D., Ph.D.
https://doi.org/10.1161/STROKEAHA.118.022837

Research in mice show antioxidants in blue maize have protective effect against metabolic syndrome

A new study shows that a rat model of metabolic syndrome fed a high-sugar and high-cholesterol diet and given blue maize extract showed significant improvement in systolic blood pressure, high density lipoprotein (HDL) cholesterol, and triglyceride levels compared to those not given the extract. The natural antioxidants present in blue maize may help protect against metabolic syndrome, cardiovascular disease, diabetes, and cancer, raising interest in using blue maize as a component of functional foods and nutraceuticals, according to an article published in Journal of Medicinal Food.

Credit: Pexels /Pixabay

In the article Rosa Isela Guzman-Geronimoa and coauthors from Universidad Veracruzana, Instituto Tecnologico de Veracruz, and Unidad Oaxaca/Calle Hornos, Mexico, report that the animals fed a high-sugar and high-cholesterol diet that received blue maize extract had a significantly smaller increase in abdominal fat compared to the abdominal fat gain in rats that did not receive the extract.

“Anti-obesity food materials are always in demand, and this study brings out not only the importance of blue maize in controlling adipocity, but also the potential role of cholesterol in the development of obesity,” says Journal of Medicinal Food Editor-in-Chief Sampath Parthasarathy, MBA, PhD, Florida Hospital Chair in Cardiovascular Sciences and Interim Associate Dean, College of Medicine, University of Central Florida.

Citation: Guzmán-Gerónimo Rosa Isela, Alarcón-Zavaleta Tania Margarita, Oliart-Ros Rosa María, Meza-Alvarado José Enrique, Herrera-Meza Socorro, and Chávez-Servia José Luis. “Blue Maize Extract Improves Blood Pressure, Lipid Profiles, and Adipose Tissue in High-Sucrose Diet-Induced Metabolic Syndrome in Rats.” Journal of Medicinal Food. December 2016, ahead of print. DOI:10.1089/jmf.2016.0087

Calcium channel blockers used for hypertension has potential to block cancer invasion

By screening already approved drugs, the team led by Postdoctoral Researcher Guillaume Jacquemet and Academy Professor Johanna Ivaska has discovered that calcium channel blockers can efficiently stop cancer cell invasion in vitro. Calcium channel blockers are currently used to treat hypertension, also known as high blood pressure, but their potential use in blocking cancer cell metastases has not been previously reported.

High-resolution microscope image of an invasive breast cancer cell (magenta) expressing
Myosin-10 induced “sticky-fingers” (green). Credit: Dr Guillaume Jacquemet, University of Turku.

Cancer kills because of its ability to spread throughout the body and form metastases. Therefore, developing drugs that block the ability of cancer cells to disseminate is a major anti-cancer therapeutic avenue. Developing new drugs, however, is a very lengthy and expensive process and many promising drugs fail clinical trials because of unanticipated toxicity and side effects. Thus, finding new targets for drugs already in use to treat other diseases, in other words, drug repurposing, is an emerging area in developing anti-cancer therapies.

Identification of anti-hypertension drugs as potential therapeutics against breast and pancreatic cancer metastasis was a big surprise. The targets of these drugs were not known to be present in cancer cells and therefore no one had considered the possibility that these drugs might be effective against aggressive cancer types, says Professor Ivaska.

For several years, the research team from the Turku Centre for Biotechnology lead by Professor Johanna Ivaska has focused their efforts on understanding how cancer cells move and invade surrounding tissue. The team has identified that aggressively spreading cancer cells express a protein called Myosin-10 which drives cancer cell motility.

Myosin-10 expressing cancers have a large number of structures called filopodia. They are sticky finger-like structures the cancer cells extend to sense their environment and to navigate – imagine a walking blind spider, explains Dr. Jacquemet.

The team found that calcium channel blockers target specifically these sticky fingers rendering them inactive, thus efficiently blocking cancer cell movement. This suggests that they might be effective drugs against cancer metastasis. However, at this stage, much more work is required to assess if these drugs would be efficient against cancer progression.

The team and their collaborators are currently assessing the efficiency of calcium channel blockers to stop the spreading of breast and pancreatic cancer using pre-clinical models and analyzing patient data. The findings were published in Nature Communications journal.

Citation: Jacquemet, Guillaume, Habib Baghirov, Maria Georgiadou, Harri Sihto, Emilia Peuhu, Pierre Cettour-Janet, Tao He, Merja Perälä, Pauliina Kronqvist, Heikki Joensuu & Johanna Ivaska. “L-type calcium channels regulate filopodia stability and cancer cell invasion downstream of integrin signalling.” Nature Communications 7 (2016): 13297.
DOI:10.1038/ncomms13297
Adapted from press release by the University of Turku.

Pediatric Hypertension underdiagnosed and undertreated

Hypertension and prehypertension in children often go undiagnosed, according to a new study published today in Pediatrics. The study focused on children with abnormal blood pressures across the United States, and is the first to show a widespread underdiagnosis of these conditions by pediatricians in children ages 3 to 18.

Researchers analyzed the electronic health records of 400,000 children from nearly 200 pediatric primary care sites across the country, between 1999 and 2014. They found that only 23 percent of those who had blood pressures consistent with hypertension at multiple primary care visits were diagnosed with the disease, and only 10 percent of patients with symptoms of prehypertension were diagnosed. Of those children and adolescents with diagnoses of hypertension for at least a year, only 6 percent of those who needed anti-hypertension medication received a prescription.

“Although over 95 percent of children and adolescents are checked for high blood pressure, doctors taking care of children are not putting all of the pieces of the puzzle together in terms of interpreting the results and following the appropriate guidelines for treatment,” said lead author David Kaelber, MD, professor of pediatrics, internal medicine, epidemiology and biostatistics at Case Western Reserve University and chief medical informatics Officer of The MetroHealth System. He is also the co-chair of the American Academy of Pediatrics task force that is rewriting the pediatric blood pressure guidelines.

Pediatricians were more likely to diagnose hypertension and prehypertension in children who were tall, male, overweight or obese. Additionally, they were more likely to recognize the diseases in children with more abnormal blood pressure values and/or more frequent blood pressure reads. The researchers found that underdiagnosis could still occur in these populations.

“The new reality for pediatricians is that we’re taking care of more and more children who are winding up with chronic conditions, such as hypertension, that were previously seen primarily in adults,” said senior author Alexander Fiks, MD, MSCE, a pediatrician at Children’s Hospital of Philadelphia (CHOP), faculty member at CHOP’s PolicyLab and director of the Pediatric Research in Office Settings network at the American Academy of Pediatrics that coordinated this research. “This study shows that many pediatricians are not responding to this new reality – not only are we underdiagnosing hypertension, but we’re often not providing recommended treatment to children with the condition in order to minimize health risks.”

Hypertension (high blood pressure) is one of the ten most common chronic diseases in childhood, and predisposes children to adult hypertension. Children with hypertension can also show early signs of cardiovascular disease, that if left untreated can increase long-term morbidity and mortality.

In 2007, Dr. Kaelber found that within one health care system, studying approximately 15,000 pediatric patients, less than 25 percent with hypertension were diagnosed. The current study used “big data,” combining electronic health record data from almost 200 practices around the U.S. to show a very similar result at the national level. The authors said this demonstrates the importance of combining electronic health record data across many practices and health systems to examine treatments and outcomes that rarely occur.

Citation: “Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study”. David C. Kaelber, Weiwei Liu, Michelle Ross, A. Russell Localio, Janeen B. Leon, Wilson D. Pace, Richard C. Wasserman, Alexander G. Fiks, for the Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER2) Consortium. Pediatrics Nov 2016, e20162195; DOI: http://dx.doi.org/10.1542/peds.2016-2195
Research funding: Health Resources and Services Administration.
Adapted from press release by Children’s Hospital of Philadelphia (CHOP), CHOP policy lab.

Research finds bi-directional association between fatty liver disease and heart disease

Researchers have shown that a bi-directional relationship exists between fatty liver disease and cardiovascular disease. Fatty liver disease can lead to increased cardiovascular disease risk and vice versa. The findings, which appear in the Journal of Hepatology, are important in understanding the link between fatty liver disease and cardiovascular disease, which continues to be one of the major causes of morbidity and mortality worldwide.

Due to the increased prevalence of obesity, non-alcoholic fatty liver disease has become the most common liver disease in the U.S., affecting 20-30 percent of the adult population. Obesity is also an independent risk factor for cardiovascular disease — so both diseases exist in many patients. Previous studies have shown that there is a link between fatty liver and cardiovascular disease however it is not fully understood if fatty liver disease precedes or develops after cardiovascular disease.

Using data from participants in the Framingham Heart Study, researchers saw that individuals with fatty liver disease developed cardiovascular diseases such as high blood pressure and type 2 diabetes within six years. In a parallel analysis, individuals with high blood pressure, type 2 diabetes, or high triglycerides had a higher likelihood of developing fatty liver disease.

In our study, we observed a bi-directional association between fatty liver and cardiovascular disease,” explained corresponding author Michelle Long, MD, assistant professor of medicine at Boston University School of Medicine (BUSM), who also is a gastroenterologist at Boston Medical Center (BMC). “We observed that fatty liver was an important factor in the development of high blood pressure and diabetes and the opposite also stands true – various cardiovascular diseases were associated with the development of fatty liver disease over six years,” she added.

Long believes this study highlights the need to develop both preventative and treatment strategies for fatty liver disease in order to improve the cardiovascular health of all people.

Citation: Ma, Jiantao, Shih-Jen Hwang, Alison Pedley, Joseph M. Massaro, Udo Hoffmann, Raymond T. Chung, Emelia J. Benjamin, Daniel Levy, Caroline S. Fox, and Michelle T. Long. “Bidirectional relationship between fatty liver and cardiovascular disease risk factors.” Journal of Hepatology (2016).
DOI: http://dx.doi.org/10.1016/j.jhep.2016.09.022
Funding: NIH/National Heart, Lung and Blood Institute, Boston University School of Medicine.

Adapted from press release by Boston University School of Medicine.

Researchers find that acupuncture produces natural opioid enkephalin which reduce high blood pressure in mice

Researchers with the UCI Susan Samueli Center for Integrative Medicine have found that regular electro-acupuncture treatment can lower hypertension by increasing the release of a kind of opioid in the brainstem region that controls blood pressure.

In tests on rats, UCI cardiology researcher Zhi-Ling Guo and colleagues noted that reduced blood pressure lasted for at least three days after electro-acupuncture by increasing the gene expression of enkephalins, which one of the three major opioid peptides produced by the body.

Their study, which appears in the Nature’s Scientific Reports, presents the first evidence of the molecular activity behind electro-acupuncture’s hypertension-lowering benefits.

Last year, the UCI team reported patients treated with acupuncture at certain wrist locations experienced drops in their blood pressure. The present study shows that repetitive electro-acupuncture evokes a long-lasting action in lowering blood pressure in hypertension, suggesting that this therapy may be suitable for treating clinical hypertension.

Hypertension affects about one third of the adult population of the world, and its consequences, such as stroke and heart attacks, are enormous public health problems, and the potential advantages of acupuncture over conventional medical therapy include few, if any, of side effects.

Citation: Li, Min, Stephanie C. Tjen-A-Looi, Zhi-Ling Guo, and John C. Longhurst. “Repetitive Electro-acupuncture Attenuates Cold-Induced Hypertension through Enkephalin in the Rostral Ventral Lateral Medulla.” Scientific Reports 6 (2016).
DOI: http://dx.doi.org/10.1038/srep35791
Adapted from press release by University of California Irvine

Research shows that positive airway pressure therapy for sleep apnea has positive impact on hypertensive patients

A new study shows that positive airway pressure (PAP) therapy for sleep apnea may have a positive impact on sleep-related functional outcomes among patients who also suffer from hypertension. The findings suggest that untreated sleep apnea may explain the quality of life impairments reported by many patients with high blood pressure.

Results show consistent improvement of patient-reported outcomes in response to positive airway pressure therapy for sleep apnea in hypertensive patients. The study found significant improvement in daytime sleepiness, depressive symptoms and fatigue severity within a year following treatment initiation. Results were significant even in patients with resistant hypertension.

“We found that consistently and notably there was no difference in patient-reported outcomes between resistant hypertension and non-resistant hypertension groups,” said lead author Harneet Walia, MD, assistant professor of family medicine in the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. “What we found was that the improvement in the patient-reported outcomes was more pronounced in those with objective adherence to positive airway pressure therapy.” Study results are published in the Oct. 15 issue of the Journal of Clinical Sleep Medicine.

According to the American Academy of Sleep Medicine, 30 to 40 percent of patients with hypertension also suffer from obstructive sleep apnea, which is a sleep-related breathing disorder characterized by repetitive episodes of complete or partial upper airway obstruction occurring during sleep. Adhering to sleep apnea treatment is a proven means of decreasing blood pressure and improving overall health.

The single-center, observational study involved nearly 900 patients with sleep apnea and hypertension, of which 15 percent had resistant hypertension. Their mean age was 58 years, 52 percent were male, and 72 percent were Caucasian. They were being treated with positive airway pressure therapy through the Cleveland Clinic Sleep Disorders Center. Questionnaire-based patient reported outcomes were evaluated using the Epworth Sleepiness Scale, Patient Health Questionnaire-9 (depression), and Fatigue Severity Scale.

The authors report that to their knowledge no previous study has examined changes in sleep-related functional outcomes with positive airway pressure therapy in a cohort comprising patients with hypertension, including some with resistant hypertension.

Citation: Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients. Authors: Harneet K. Walia, Sandra D. Griffith, Nicolas R. Thompson, Douglas E. Moul, Nancy Foldvary-Schaefer, Reena Mehra.
DOI: http://dx.doi.org/10.5664/jcsm.6188
Journal: Journal of Clinical Sleep Medicine
Research funding: National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), Center for Outcomes Research and Evaluation at the Cleveland Clinic Neurological Institute.
Adapted from press release by American Academy of Sleep Medicine