- Email: [email protected]
S34-4 MANAGEMENT OF RESTENOSIS AFTER DRUG ELUTING STENT
Abstract of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13–16 December, 2007
S34-2
S37-2
PROXIMAL PROTECTION IN SVG AND STEMI INTERVENTION
ANGIOPOIETIN-LIKE PROTEINS (ANGPTLS): POTENTIAL NEW TARGETS FOR METABOLIC SYNDROME THERAPY
Tian Hai Koh. Medical Director, Department of Cardiology, National Heart Centre, Singapore No abstract.
S34-3 THE POLYMERFREE DRUG ELUTING STENT: TECHNOLOGY, EVIDENCE AND PROSPECTIVE
Jiangtao Yu. Heart Center, Clinic of Cardiology, Central Hospital Bad Berka, German No abstract.
S34-4 MANAGEMENT OF RESTENOSIS AFTER DRUG ELUTING STENT
Junbo Ge. Director, Dept. of Cardiology, Zhongshan Hospital, Fudan University; President, Shanghai Society of Cardiology, China No abstract.
S34-5
25
Yuichi Oike. Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University; Laboratory of Vascular Biology & Metabolism, Center for Integrated, Medical Research, School of Medicine, Keio University, Japan; PRESTO, Japan Science Technology Agency (JST) Obesity enhances the occurrence of related metabolic disorders, including type 2 diabetes, hypertension and hyperlipidemia, together known as metabolic syndrome. Because metabolic syndrome is increasingly prevalent and has potentially devastating consequences, effective therapeutic approaches are currently of general interest. Recently, we and several other groups have independently identified 7 molecules, which are similar to angiopoietin (Ang1-4). Since these molecules do not bind to the angiopoietin specific receptor, TIE2, they were named angiopoietin-like proteins 1 through 7 (Angptl1-7), which are all currently orphan ligands. Among them, we identified angiopoietin-related growth factor (AGF, also known as Angptl6 and encoded by the gene Angptl6) as a member of the Angptl family and showed that it is a circulating orphan protein that counteracts obesity and related insulin resistance. More recently, we found the associations between serum AGF concentrations and several clinical parameters using our newly developed ELISA system in human. In this presentation, as the first subject, I will discuss the role of AGF/Angptl6 as a potential target to treat obesity and related insulin resistance. And then, as a second subject, I would like to show the more recent findings regarding the new role of Angptl2 in the pathogenesis of obesity and insulin resistance in mice.
DRUG-ELUTING STENT IN DIABETIC PATIENT
I-Chang Hsieh. Second Department of Cardiology, Linkou Chang-Gung Memorial Hospital, Taiwan Coronary artery disease(CAD) is the most common cause of death in diabetic patients, at least half of whom die from cardiovascular causes. Accelerated atherosclerosis and plaques instability are frequently present in diabetic patients, who is associated with multi-vessel CAD, more severe and diffuse coronary atherosclerosis with calcification, higher prevalence of stenosis in distal coronary arteries and poor collateralization. Even though new therapeutic modalities and modern techniques have improved the prognosis of CAD, diabetic patients still have higher mortality than non-diabetic patients. There is strong evidence showed that two drug-eluting stents (DES), CYPHER and TAXUS, are superior to bare metal stents (BMS) in diabetic patients in terms of lower restenosis and revascularization rates, and lower major adverse cardiac events (MACE) which was driven chiefly by a reduction in revascularization for restenosis. The ISAR-DIABETES study compared CYPHER and TAXUS in diabetic patients randomly and showed less in-segment restenosis, late loss and target lesion revascularization (TLR) in CYPHER group. However, a meta-analysis showed that no difference between the two stents in restenosis, TLR and MACE. The diabetic subgroup analysis from Endeavor II trial showed less TLR in Endeavor group than in Driver group. The same subgroup analysis from SPIRIT II trial showed less in-stent late loss in Xience V group than in TAXUS group. For diabetic patient with multi-vessel CAD, it is not conclusive that multi-vessel percutaneous coronary intervention (PCI) with DES is better than coronary artery bypass grafting (CABG) or not, in the era of DES. The on-going multi-center FREEDOM, CARDia and SYNTAX trials comparing PCI with DES against CABG will hopefully illuminate this issue.
SYMPOSIUM 37
RECENT ADVANCE IN NOVEL BIO-MOLECULES FOR CARDIOVASCULAR DISEASE
S37-3 IMPORTANT ROLE OF PLACENTAL GROWTH FACTOR ON THE HEALING PROCESS AND SURVIVAL AFTER ACUTE MYOCARDIAL INFARCTION
Shiro Uemura, Yoshihiko Saito. First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan Recent studies have indicated that bone marrow derived blood cells play important roles on the healing process after acute myocardial infarction (AMI) through angiogenesis and tissue reconstruction. However, critical molecules that mediate the interaction between injured heart and bone marrow cells have not been elucidated. Among many candidate molecules, we have investigated the role of placental growth factor (PlGF), a member of VEGF family, which specifically binds to VEGF receptor-1 (flt-1). In patients with AMI, infarct myocardium produced and released PlGF into coronary venous circulation, and elevated plasma levels of PlGF in peripheral blood positively correlated with both peripheral monocyte and CD34 positive cell counts (p<0.005). Furthermore, PlGF was proved to be the strongest independent predictor for the restoration of LVEF in chronic phase (p=0.0098). In mouse model of AMI, tissue PlGF mRNA expression was increased 26.6 fold (p<0.001) compared with control heart within 24 hours after AMI. PlGF protein was over-expressed mainly in endothelial cells of coronary artery in the infarct region. Treatment of AMI mice with recombinant PlGF dimer protein (rPlGF) induced peripheral mobilization of endothelial progenitor cells and significantly improved the survival rate in rPlGF group than controls (70.0 vs. 33.3%) (p<0.05). rPlGF also significantly reduced infarct area (4.25+2.04 vs. 5.95+1.54mm2), and stimulated the CD31-positive vascular endothelial cells, as well as a-smooth muscle actin-positive vessels, indicating both angiogenesis and arteriogenesis contributes to the improvement of cardiac function. Conclusion: we have shown that PlGF importantly involved in healing process after AMI. It seems likely rPlGF-treatment preserves left ventricular function and survival rate through enhancing neovascularization and arteriogenesis.
S37-1
S37-4
C-REACTIVE PROTEIN IN ATHEROSCLEROSIS
ADHESION MOLECULES IN CONGESTIVE HEART FAILURE
Subodh Verma. Adjunct Professor of Pharmacology, University of Calgary, Canada
Wei-Hsian Yin 1,3 , Jaw-Wen Chen 2,3 , Shing-Jong Lin 2,3 . 1 Division of Cardiology, Cheng-Hsin Rehabilitation Medical Center, 2 Taipei-Veterans General Hospital, 3 Cardiovascular Research Center, National Yang-Ming University, School of Medicine, Taiwan
No abstract.
Background: Recent studies suggest that heart failure (HF) may, in part, be an inflammatory disease. The interaction between endothelial cells, leukocytes
S34-2
S37-2
PROXIMAL PROTECTION IN SVG AND STEMI INTERVENTION
ANGIOPOIETIN-LIKE PROTEINS (ANGPTLS): POTENTIAL NEW TARGETS FOR METABOLIC SYNDROME THERAPY
Tian Hai Koh. Medical Director, Department of Cardiology, National Heart Centre, Singapore No abstract.
S34-3 THE POLYMERFREE DRUG ELUTING STENT: TECHNOLOGY, EVIDENCE AND PROSPECTIVE
Jiangtao Yu. Heart Center, Clinic of Cardiology, Central Hospital Bad Berka, German No abstract.
S34-4 MANAGEMENT OF RESTENOSIS AFTER DRUG ELUTING STENT
Junbo Ge. Director, Dept. of Cardiology, Zhongshan Hospital, Fudan University; President, Shanghai Society of Cardiology, China No abstract.
S34-5
25
Yuichi Oike. Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University; Laboratory of Vascular Biology & Metabolism, Center for Integrated, Medical Research, School of Medicine, Keio University, Japan; PRESTO, Japan Science Technology Agency (JST) Obesity enhances the occurrence of related metabolic disorders, including type 2 diabetes, hypertension and hyperlipidemia, together known as metabolic syndrome. Because metabolic syndrome is increasingly prevalent and has potentially devastating consequences, effective therapeutic approaches are currently of general interest. Recently, we and several other groups have independently identified 7 molecules, which are similar to angiopoietin (Ang1-4). Since these molecules do not bind to the angiopoietin specific receptor, TIE2, they were named angiopoietin-like proteins 1 through 7 (Angptl1-7), which are all currently orphan ligands. Among them, we identified angiopoietin-related growth factor (AGF, also known as Angptl6 and encoded by the gene Angptl6) as a member of the Angptl family and showed that it is a circulating orphan protein that counteracts obesity and related insulin resistance. More recently, we found the associations between serum AGF concentrations and several clinical parameters using our newly developed ELISA system in human. In this presentation, as the first subject, I will discuss the role of AGF/Angptl6 as a potential target to treat obesity and related insulin resistance. And then, as a second subject, I would like to show the more recent findings regarding the new role of Angptl2 in the pathogenesis of obesity and insulin resistance in mice.
DRUG-ELUTING STENT IN DIABETIC PATIENT
I-Chang Hsieh. Second Department of Cardiology, Linkou Chang-Gung Memorial Hospital, Taiwan Coronary artery disease(CAD) is the most common cause of death in diabetic patients, at least half of whom die from cardiovascular causes. Accelerated atherosclerosis and plaques instability are frequently present in diabetic patients, who is associated with multi-vessel CAD, more severe and diffuse coronary atherosclerosis with calcification, higher prevalence of stenosis in distal coronary arteries and poor collateralization. Even though new therapeutic modalities and modern techniques have improved the prognosis of CAD, diabetic patients still have higher mortality than non-diabetic patients. There is strong evidence showed that two drug-eluting stents (DES), CYPHER and TAXUS, are superior to bare metal stents (BMS) in diabetic patients in terms of lower restenosis and revascularization rates, and lower major adverse cardiac events (MACE) which was driven chiefly by a reduction in revascularization for restenosis. The ISAR-DIABETES study compared CYPHER and TAXUS in diabetic patients randomly and showed less in-segment restenosis, late loss and target lesion revascularization (TLR) in CYPHER group. However, a meta-analysis showed that no difference between the two stents in restenosis, TLR and MACE. The diabetic subgroup analysis from Endeavor II trial showed less TLR in Endeavor group than in Driver group. The same subgroup analysis from SPIRIT II trial showed less in-stent late loss in Xience V group than in TAXUS group. For diabetic patient with multi-vessel CAD, it is not conclusive that multi-vessel percutaneous coronary intervention (PCI) with DES is better than coronary artery bypass grafting (CABG) or not, in the era of DES. The on-going multi-center FREEDOM, CARDia and SYNTAX trials comparing PCI with DES against CABG will hopefully illuminate this issue.
SYMPOSIUM 37
RECENT ADVANCE IN NOVEL BIO-MOLECULES FOR CARDIOVASCULAR DISEASE
S37-3 IMPORTANT ROLE OF PLACENTAL GROWTH FACTOR ON THE HEALING PROCESS AND SURVIVAL AFTER ACUTE MYOCARDIAL INFARCTION
Shiro Uemura, Yoshihiko Saito. First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan Recent studies have indicated that bone marrow derived blood cells play important roles on the healing process after acute myocardial infarction (AMI) through angiogenesis and tissue reconstruction. However, critical molecules that mediate the interaction between injured heart and bone marrow cells have not been elucidated. Among many candidate molecules, we have investigated the role of placental growth factor (PlGF), a member of VEGF family, which specifically binds to VEGF receptor-1 (flt-1). In patients with AMI, infarct myocardium produced and released PlGF into coronary venous circulation, and elevated plasma levels of PlGF in peripheral blood positively correlated with both peripheral monocyte and CD34 positive cell counts (p<0.005). Furthermore, PlGF was proved to be the strongest independent predictor for the restoration of LVEF in chronic phase (p=0.0098). In mouse model of AMI, tissue PlGF mRNA expression was increased 26.6 fold (p<0.001) compared with control heart within 24 hours after AMI. PlGF protein was over-expressed mainly in endothelial cells of coronary artery in the infarct region. Treatment of AMI mice with recombinant PlGF dimer protein (rPlGF) induced peripheral mobilization of endothelial progenitor cells and significantly improved the survival rate in rPlGF group than controls (70.0 vs. 33.3%) (p<0.05). rPlGF also significantly reduced infarct area (4.25+2.04 vs. 5.95+1.54mm2), and stimulated the CD31-positive vascular endothelial cells, as well as a-smooth muscle actin-positive vessels, indicating both angiogenesis and arteriogenesis contributes to the improvement of cardiac function. Conclusion: we have shown that PlGF importantly involved in healing process after AMI. It seems likely rPlGF-treatment preserves left ventricular function and survival rate through enhancing neovascularization and arteriogenesis.
S37-1
S37-4
C-REACTIVE PROTEIN IN ATHEROSCLEROSIS
ADHESION MOLECULES IN CONGESTIVE HEART FAILURE
Subodh Verma. Adjunct Professor of Pharmacology, University of Calgary, Canada
Wei-Hsian Yin 1,3 , Jaw-Wen Chen 2,3 , Shing-Jong Lin 2,3 . 1 Division of Cardiology, Cheng-Hsin Rehabilitation Medical Center, 2 Taipei-Veterans General Hospital, 3 Cardiovascular Research Center, National Yang-Ming University, School of Medicine, Taiwan
No abstract.
Background: Recent studies suggest that heart failure (HF) may, in part, be an inflammatory disease. The interaction between endothelial cells, leukocytes