No description available.

No description available.

No description available.

No description available.

A troponina C é o componente do complexo heterotrimérico troponina ao qual o Ca2+ se associa. Essa associação torna a contração muscular um processo regulado por Ca2+. Pearlstone et al. (Biochemistry 31, 6545, (1992)) utilizaram o cDNA da troponina C de músculo esquelético de galinha (sTnC) para construir um mutante onde a fenilalanina da posição 29 foi substituída por triptofano (mutante F29W). Esse mutante permitiu que a ligação de Ca2+ aos sítios regulatórios amino terminais fosse acompanhada através de técnicas fluorescentes. Entretanto, algumas propriedades da sTnC foram alteradas pela mutação (Li et al. (1995) Biochemistry 34, 8330). No presente estudo, ensaios de ligação direta de Ca2+ bem como titulações de Ca2+ seguidas por fluorescência foram usadas para melhor se entenderem os efeitos da mutação Phe→Trp na posição 29 bem como a influência de certos aminoácidos componentes do sítio de ligação de Ca2+ nas propriedades do domínio regulatório. Dois novos mutantes foram construídos nos quais os análogos do triptofano 5-hidroxitriptofano ou 7 -azatriptofano foram introduzidos na posição 29 (resultando nos mutantes F29HW e F29ZW, respectivamente). Os dados mostraram que, quando comparada com a sTnC, a afinidade por Ca2+ dos sítios amino terminais foi elevada na F29W em aproximadamente seis vezes, três vezes na F29ZW e levemente diminuída na F29HW . A curva de fluorescência associada à ligação de Ca2+ à F29ZW mostrou-se bimodal, com cada fase podendo ser relacionada à ligação de Ca2+ a cada um dos sítios regulatórios. Esta é a primeira descrição através de técnicas de fluorescência da ligação sequencial de Ca2+ aos sítios amino terminais. Para investigar a influência de cada um dos sítios amino terminais nas propriedades de ligação ao Ca2+ ou propriedades fluorescentes da sTnC, F29W, F29HW e F29ZW , construímos mutantes duplos e triplos através da substituição do aspartato da posição 30 ou 66 (ou ambos) por alanina. Essas mutações afetam respectivamente a capacidade de ligação ao Ca2+ dos sítios I e II. Os dados mostraram que: 1) nas concentrações de Ca2+ analisadas, a mutação Asp→Ala na posição 30 impede somente a ligação de Ca2+ ao sítio I, enquanto a mutação Asp → Ala na posição 66 impede a ligação de Ca2+ aos sítios I e II, e 2) a mutação Asp → Ala na posição 30 torna silenciosa a substituição da fenilalanina da posição 29 por Trp, 5-hidroxitriptofano ou 7-azatriptofano. Concluímos que o sítio I é essencialmente inativo sem a ligação prévia de Ca2+ ao sítio II e que a posição 29 influencia a afinidade ao Ca2+ do sítio I \"ajustado\". / Troponin C is the Ca2+ binding component of heterotrimeric troponin. It makes skeletal muscle contraction a Ca2+ regulated process. We have previously used the cDNA of chicken skeletal TnC (sTnC) to construct a mutant where phenylalanine at position 29 was replaced by tryptophan (F29W mutant) [Pearlstone et al. (1992) Biochemistry 31, 6545]. This mutant allowed calcium binding to the regulatory amino terminal sites to be followed through fluorescence techniques, but altered some properties of sTnC [Li et al. (1995) Biochemistry 34, 8330]. In the present study, direct calcium binding assays and fluorescence followed calcium titrations were used to better understand the effects of the Phe→Trp mutation at position 29 as well as the influence of each amino site on the calcium binding properties of the regulatory domain. Two new mutants were constructed in which the tryptophan analogs 5-hydroxytryptophan or 7-azatryptophan were introduced at position 29 (resulting in F29HW and F29ZW mutants, respectively). The data showed that when compared to sTnC, the Ca2+ affinity of amino sites was increased sixfold in F29W, nearly threefold in F29ZW and slightly decreased in F29HW. The F29ZW fluorescence followed Ca2+ titration displayed a bimodal curve that could be related to Ca2+ binding to each of the amino sites. This is the first report of fluorescence detection of the sequential Ca2+ binding to the regulatory sites. To investigate the influence of each amino site in the calcium binding or fluorescence properties of sTnC, F29W, F29HW and F29ZW, we have constructed double and triple mutants by replacing aspartate at position 30 or 66 (or both) by alanine. These mutations affect respectively the binding capacity of sites I and II. The data showed that: 1) in the calcium concentration range analyzed, the Asp→Ala mutation at position 30 impairs calcium binding to site I on1y, while Asp→Ala mutation at position 66 impairs calcium binding to both sites I and II, and 2) the Asp→Ala mutation at position 30 makes silent the replacement of Phe at position 29 by Trp, 5-hydroxytryptophan or 7-azatryptophan. We conclude that site I is essentially defunct without previous binding to site II and that position 29 influences the affinity of this adjusted site I.

Myocardial infarction is a leading cause of morbidity and mortality worldwide. The purpose of this thesis was to develop strategies for the assessment of patients with suspected myocardial infarction using a high-sensitivity cardiac troponin I assay, and to evaluate the relationship between the aetiology of myocardial infarction and long term clinical outcomes to identify opportunities to modify outcomes. In the United Kingdom, approximately 1 million patients present to hospital with chest pain each year and are assessed for suspected myocardial infarction, yet fewer than 20% of patients receive this diagnosis. Prior clinical standards mandated the admission of patients for serial cardiac troponin testing to identify myocardial necrosis and determine if myocardial infarction had occurred. However, new high-sensitivity assays offer a magnitude improvement in diagnostic precision, and as such provide a novel approach to diagnose or exclude myocardial infarction at an earlier stage. In our first study, I evaluate the performance of a high-sensitivity cardiac troponin I assay as a risk stratification tool in patients with suspected acute coronary syndrome. A systematic review and individual patient-level data meta-analysis was performed, including prospective studies measuring high-sensitivity cardiac troponin I in patients with suspected acute coronary syndrome, where the diagnosis was adjudicated according to the universal definition of myocardial infarction. The primary outcome was myocardial infarction or cardiac death during the index hospitalization or at 30 days. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random effects model. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data. A total of 22,457 patients were included in the meta-analysis (age 62 [15.5] years; n=9,329 (41.5%) women), of whom 2,786 (12.4%) experienced myocardial infarction or cardiac death at 30 days. Cardiac troponin I concentrations were < 5 ng/L at presentation in 11,012 (49%) patients, with a negative predictive value of 99.5% (95% confidence interval [CI] 99.3-99.6) for myocardial infarction or cardiac death at 30 days. Lower thresholds did not improve safety, but did significantly reduce the proportion identified as low risk. This threshold of 5 ng/L formed the basis for the development of a diagnostic pathway for patients with suspected acute coronary syndrome. In a cohort study of 1,218 patients with suspected acute coronary syndrome who underwent high-sensitivity cardiac troponin I measurement at presentation, 3 and 6 or 12 hours, I derived and validated a novel pathway (rule out myocardial infarction if < 5 ng/L at presentation, or change < 3 ng/L and < 99th centile at 3 hours), and compared this with the established European Society of Cardiology 3-hour pathway (rule out myocardial infarction if < 99th centile at presentation, or at 3 hours if symptoms < 6 hours). The primary outcome was a comparison of the negative predictive value (NPV) of both pathways for myocardial infarction or cardiac death at 30 days. The primary outcome was evaluated in pre-specified subgroups stratified by age, gender, time of symptom onset and known ischaemic heart disease. In those < 99th centile at presentation, the ESC pathway ruled out myocardial infarction in 28.1% (342/1,218) and 78.9% (961/1,218) at presentation and 3 hours respectively, missing 18 index and two 30-day events (NPV 97.9%, 95% confidence intervals [CI] 96.9-98.7%). The novel pathway ruled out 40.7% (496/1,218) and 74.2% (904/1,218) at presentation and 3 hours, missing two index and two 30-day events (NPV 99.5%, 95% CI 99.0-99.9%; P < 0.001 for comparison). The NPV of the novel pathway was greater than the ESC pathway overall (P < 0.001), and in all subgroups including those presenting early or known to have ischaemic heart disease. There are a number of additional approaches for the rule out of myocardial infarction. Clinical risk scores apply conventional risk factors to estimate the probability of myocardial infarction. The most widely implemented scores, HEART, EDACS, GRACE and TIMI, have been extensively validated when used alongside contemporary troponin assays, however, their impact on pathways applying high-sensitivity cardiac troponin testing is less clear. In 1,935 patients with suspected acute coronary syndrome, I evaluated the safety and efficacy of our novel pathway or the European Society of Cardiology 3-hour pathway alone, or in conjunction with low-risk TIMI (0 or 1), GRACE (≤108), EDACS (< 16) or HEART (≤3) scores. Myocardial infarction or cardiac death at 30-days occurred in 14.3% (276/1,935). The ESC pathway ruled out 70% with 27 missed events giving a negative predictive value (NPV) of 97.9% (95% confidence interval [CI], 97.1 to 98.6%). Addition of a HEART score ≤3 reduced the proportion ruled out by the ESC pathway to 25%, but improved the NPV to 99.7% (95%CI 99.0 to 100%, P < 0.001). The novel pathway ruled out 65% with three missed events for a NPV of 99.7% (95%CI 99.4 to 99.9%). No risk score improved the NPV, but all reduced the proportion ruled out (24-47%, P < 0.001 for all). Whilst myocardial infarction due to atherosclerotic plaque rupture and thrombosis (type 1) is well described, the natural disease course of myocardial infarction due to oxygen supply-demand imbalance without atherothrombosis (type 2) is poorly understood. I aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury. Consecutive patients (n=2,122) with elevated cardiac troponin I concentrations (≥0.05 μg/L) were identified at a tertiary cardiac centre. All diagnoses were adjudicated as per the Universal Definition of Myocardial Infarction. The primary outcome was all-cause death. Secondary outcomes included major adverse cardiovascular events (MACE; non-fatal myocardial infarction or cardiovascular death) and non-cardiovascular death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models. The adjudicated index diagnosis was type 1 or type 2 myocardial infarction or myocardial injury in 1,171 (55.2%), 429 (20.2%) and 522 (24.6%) patients, respectively. At five years, all-cause death rates were higher in those with type 2 myocardial infarction (62.5%) or myocardial injury (72.4%) compared with type 1 myocardial infarction (36.7%). The majority of excess deaths in those with type 2 myocardial infarction or myocardial injury were due to non-cardiovascular causes (HR 2.32, 95%CI 1.92-2.81, versus type 1 myocardial infarction). Despite this, the observed crude MACE rates were similar between groups (30.6% versus 32.6%), with differences apparent after adjustment for co-variates (HR 0.82, 95%CI 0.69-0.96). Coronary heart disease was an independent predictor of MACE in those with type 2 myocardial infarction or myocardial injury (HR 1.71, 95%CI 1.31-2.24). Patients with type 2 myocardial infarction were less likely to receive secondary prevention therapy, suggesting a treatment gap may exist and there may be potential to modify clinical outcomes. A risk stratification threshold has been defined using high-sensitivity cardiac troponin I which identifies patients at very low risk of myocardial infarction or cardiac death. A diagnostic pathway incorporating this risk stratification threshold appears safer than established guidelines which apply the 99th centile alone. The use of clinical risk scores does not appear to improve the safety of this approach, however, does significantly reduce efficacy. Overall, these findings demonstrate the potential of high-sensitivity cardiac troponin testing to improve the efficiency of the assessment of patients with suspected acute coronary syndrome without compromising patient safety. The observations in those with myocardial injury and infarction have identified a phenotype of patients with type 2 myocardial infarction and coronary artery disease who are at increased cardiovascular risk, and who may benefit from targeted secondary prevention. The studies presented will inform the design of future clinical trials, and may inform international guidelines for the assessment of patients with suspected acute coronary syndrome.

No description available.

A troponina C é o componente do complexo heterotrimérico troponina ao qual o Ca2+ se associa. Essa associação torna a contração muscular um processo regulado por Ca2+. Pearlstone et al. (Biochemistry 31, 6545, (1992)) utilizaram o cDNA da troponina C de músculo esquelético de galinha (sTnC) para construir um mutante onde a fenilalanina da posição 29 foi substituída por triptofano (mutante F29W). Esse mutante permitiu que a ligação de Ca2+ aos sítios regulatórios amino terminais fosse acompanhada através de técnicas fluorescentes. Entretanto, algumas propriedades da sTnC foram alteradas pela mutação (Li et al. (1995) Biochemistry 34, 8330). No presente estudo, ensaios de ligação direta de Ca2+ bem como titulações de Ca2+ seguidas por fluorescência foram usadas para melhor se entenderem os efeitos da mutação Phe&#8594;Trp na posição 29 bem como a influência de certos aminoácidos componentes do sítio de ligação de Ca2+ nas propriedades do domínio regulatório. Dois novos mutantes foram construídos nos quais os análogos do triptofano 5-hidroxitriptofano ou 7 -azatriptofano foram introduzidos na posição 29 (resultando nos mutantes F29HW e F29ZW, respectivamente). Os dados mostraram que, quando comparada com a sTnC, a afinidade por Ca2+ dos sítios amino terminais foi elevada na F29W em aproximadamente seis vezes, três vezes na F29ZW e levemente diminuída na F29HW . A curva de fluorescência associada à ligação de Ca2+ à F29ZW mostrou-se bimodal, com cada fase podendo ser relacionada à ligação de Ca2+ a cada um dos sítios regulatórios. Esta é a primeira descrição através de técnicas de fluorescência da ligação sequencial de Ca2+ aos sítios amino terminais. Para investigar a influência de cada um dos sítios amino terminais nas propriedades de ligação ao Ca2+ ou propriedades fluorescentes da sTnC, F29W, F29HW e F29ZW , construímos mutantes duplos e triplos através da substituição do aspartato da posição 30 ou 66 (ou ambos) por alanina. Essas mutações afetam respectivamente a capacidade de ligação ao Ca2+ dos sítios I e II. Os dados mostraram que: 1) nas concentrações de Ca2+ analisadas, a mutação Asp&#8594;Ala na posição 30 impede somente a ligação de Ca2+ ao sítio I, enquanto a mutação Asp &#8594; Ala na posição 66 impede a ligação de Ca2+ aos sítios I e II, e 2) a mutação Asp &#8594; Ala na posição 30 torna silenciosa a substituição da fenilalanina da posição 29 por Trp, 5-hidroxitriptofano ou 7-azatriptofano. Concluímos que o sítio I é essencialmente inativo sem a ligação prévia de Ca2+ ao sítio II e que a posição 29 influencia a afinidade ao Ca2+ do sítio I \"ajustado\". / Troponin C is the Ca2+ binding component of heterotrimeric troponin. It makes skeletal muscle contraction a Ca2+ regulated process. We have previously used the cDNA of chicken skeletal TnC (sTnC) to construct a mutant where phenylalanine at position 29 was replaced by tryptophan (F29W mutant) [Pearlstone et al. (1992) Biochemistry 31, 6545]. This mutant allowed calcium binding to the regulatory amino terminal sites to be followed through fluorescence techniques, but altered some properties of sTnC [Li et al. (1995) Biochemistry 34, 8330]. In the present study, direct calcium binding assays and fluorescence followed calcium titrations were used to better understand the effects of the Phe&#8594;Trp mutation at position 29 as well as the influence of each amino site on the calcium binding properties of the regulatory domain. Two new mutants were constructed in which the tryptophan analogs 5-hydroxytryptophan or 7-azatryptophan were introduced at position 29 (resulting in F29HW and F29ZW mutants, respectively). The data showed that when compared to sTnC, the Ca2+ affinity of amino sites was increased sixfold in F29W, nearly threefold in F29ZW and slightly decreased in F29HW. The F29ZW fluorescence followed Ca2+ titration displayed a bimodal curve that could be related to Ca2+ binding to each of the amino sites. This is the first report of fluorescence detection of the sequential Ca2+ binding to the regulatory sites. To investigate the influence of each amino site in the calcium binding or fluorescence properties of sTnC, F29W, F29HW and F29ZW, we have constructed double and triple mutants by replacing aspartate at position 30 or 66 (or both) by alanine. These mutations affect respectively the binding capacity of sites I and II. The data showed that: 1) in the calcium concentration range analyzed, the Asp&#8594;Ala mutation at position 30 impairs calcium binding to site I on1y, while Asp&#8594;Ala mutation at position 66 impairs calcium binding to both sites I and II, and 2) the Asp&#8594;Ala mutation at position 30 makes silent the replacement of Phe at position 29 by Trp, 5-hydroxytryptophan or 7-azatryptophan. We conclude that site I is essentially defunct without previous binding to site II and that position 29 influences the affinity of this adjusted site I.

Three novel mutations (G159D, L29Q and E59D/D75Y) in cardiac troponin C (CTnC) associate their clinical outcomes with a given cardiomyopathy. Current paradigms propose that sarcomeric mutations associated with dilated cardiomyopathy (DCM) decrease the myofilament calcium sensitivity while those associated with hypertrophic (HCM) cardiomyopathy increase it. Therefore, we incorporated the mutant CTnCs into skinned cardiac muscle in order to determine if their effects on the calcium regulation of tension and ATPase activity coincide with the current paradigms and phenotypic outcomes. This required the development of new calculator programs to solve complex ionic equilibria to more accurately buffer and expand the free calcium range of our test solutions. In accordance with the DCM paradigms, our result show that G159D and E59D/D75Y CTnC decrease the myofilament calcium sensitivity and force generating capabilities which would likely increase the rate of muscle relaxation and weaken the contractile force of the myocardium. Alternatively, the lack of myofilament change from L29Q CTnC (associated with HCM) may explain why the only proband is seemingly unaffected. Notably, the changes in the calcium sensitivity of tension (in fibers) do not necessarily occur in the isolated CTnC and vice versa. These counter-intuitive findings are justified through a transition in calcium affinity occurring at the level of cardiac troponin (CTn) and higher, implying that the true effects of these mutations become apparent as the hierarchal level of the myofilament increases. Despite these limitations, the regulated thin filament (RTF) retains its role as the calcium regulatory unit and best indicates a mutation's ability to sensitize (+) or desensitize (-) the muscle to calcium. Since multiple forms of cardiomyopathies exist, the identification of new drugs that sensitize (+) or desensitize (-) the calcium sensitivity could potentially reverse (+ or -) these aberrant changes in myofilament sensitivity. Therefore, we have developed an RTF mediated High Throughput Screening assay to identify compounds in libraries of molecules that can specifically modulate the calcium sensitivity of cardiac contraction. The knowledge gained from these studies will help us and others to uncover new pharmacological agents for the investigation and treatments of cardiomyopathies, hypertension and other forms of cardiovascular diseases.

Es wurden Studien zur biochemischen Evaluierung des akuten Koronarsyndroms unter drei Aspekten unternommen: (1) Die klinische Anwendung der biochemischen Marker zur Diagnosesicherung und Risikostratifizierung bei Patienten mit akutem Koronarsyndrom, (2) die Bedeutung kardialer Troponine unter besonderen physiologischen und pathophysiologischen Bedingungen und (3) die tierexperimentelle Evaluierung passagerer Ischämie mit der Fragestellung, ob eine Erhöhung kardialer Troponine im Plasma bei reversibler Myokardschädigung auftreten kann. Die klinische Anwendung der kardialen Marker kann zuverlässig nach aktuellen Richtlinien erfolgen und sollte immer auch die Messung eines kardialen Troponins beinhalten. Troponin-Testsysteme sollten in klinischen Studien hinsichtlich des diagnostischen und prognostischen Nutzens evaluiert worden sein. Die in dieser Arbeit untersuchten Systeme wiesen nachweisbare Unterschiede auf, die jedoch für den klinischen Einsatz nicht bedeutsam sind. Geringe Troponin T-Erhöhungen bei Patienten mit akutem Koronarsyndrom und eher geringer oder atypischer Symptomatik haben eine eindeutige prognostische Aussagekraft und ergänzen damit signifikant die klinische Einschätzung und das EKG. Kardiale Troponine können bei herzgesunden Probanden unter extremer körperlicher Leistung gering erhöht sein. Die prognostische Bedeutung dieser Befunde ist unklar. Kardiales Troponin kann bei kardial asymptomatischen Patienten mit Niereninsuffizienz ohne sichere prognostische Bedeutung erhöht sein. Tierexperimentell ergeben sich Hinweise darauf, daß es bei reversibler Ischämie im Sinne eines "continuous release" zur Freisetzung von kardialem Troponin bzw. zumindest von Degradationsprodukten desselben kommen kann. Die zukünftige Entwicklung von Richtlinien zum Einsatz biochemischer Marker wird entscheidend davon abhängen, ob auf den erhobenen Befunden therapeutische Strategien mit nachgewiesenem Nutzen im Sinne einer "evidence based medicine" aufbauen. / Three studies with respect to the biochemical evaluation of acute coronary syndromes were undertaken : (1) The clinical application of biochemical markers for diagnosis and risk stratification in patients with acute coronary syndroms. (2) The value of cardiac troponins under different physiological and pathophysiological conditions. (3) Experimental transient myocardial ischemia in an animal model with respect to the question, whether elevation of cardiac troponins in plasma perhaps occur after reversible myocardial damage. The clinical appilication of cardiac markers is sufficiently possible following actual guidelines and should include cardiac troponin measurement. The troponin test-system has to be evaluated in clinical studies with respect to its diagnostic and prognostic properties. In this study significant differences between two cardiac troponin I test-systems could be shown. The differences were below clinical relevance. Mild to moderate elevations of cardiac troponin T in patients with acute coronary syndromes and low grade Braunwald class angina are of prognostic value and add on information obtained by history and ECG. Cardiac troponins may be found elevated in apparently healthy athletes after exhaustive exercise. The prognostic significance of these findings remains unclear. Cardiac troponins are frequently elevated in renal insufficiency patients without cardiac symptoms. These elevations had no prognostic value in our study. The experimental data suggest that troponins are released in reversible myocardial damage during transient ischemia. This adds evidence on the continuous release hypothesis of cardiac troponins and degradation products. The future development of guidelines for the use of cardiac markers in daily routine will strictly depend on therapeutic consequences which base on the analytical results in the sense of evidence based medicine.