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  1. Article ; Online: PCSK9: The Nexus of Lipoprotein Metabolism and Inflammation in COVID-19.

    Goonewardena, Sascha N / Rosenson, Robert S

    Journal of the American College of Cardiology

    2023  Volume 81, Issue 3, Page(s) 235–236

    MeSH term(s) Humans ; Proprotein Convertase 9 ; COVID-19 ; Inflammation ; Lipoprotein(a) ; Receptors, LDL
    Chemical Substances PCSK9 protein, human (EC 3.4.21.-) ; Proprotein Convertase 9 (EC 3.4.21.-) ; Lipoprotein(a) ; Receptors, LDL
    Language English
    Publishing date 2023-01-10
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2022.11.014
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The Residual Risk Odyssey: From LDL to Lp(a).

    Rosenson, Robert S / Goonewardena, Sascha N

    Journal of the American College of Cardiology

    2021  Volume 78, Issue 5, Page(s) 434–436

    MeSH term(s) Cholesterol, LDL ; Humans ; Proprotein Convertase 9
    Chemical Substances Cholesterol, LDL ; Proprotein Convertase 9 (EC 3.4.21.-)
    Language English
    Publishing date 2021-07-01
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2021.04.103
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The Enigma of PCSK9 Regulation: Leveraging Therapeutics Towards Mechanistic Understanding.

    Goonewardena, Sascha N / Rosenson, Robert S

    Journal of the American College of Cardiology

    2021  Volume 78, Issue 14, Page(s) 1450–1452

    MeSH term(s) Cholesterol, LDL ; Humans ; Proprotein Convertase 9 ; Proprotein Convertases
    Chemical Substances Cholesterol, LDL ; PCSK9 protein, human (EC 3.4.21.-) ; Proprotein Convertase 9 (EC 3.4.21.-) ; Proprotein Convertases (EC 3.4.21.-)
    Language English
    Publishing date 2021-10-01
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2021.08.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Inhibition of PCSK9 with evolocumab modulates lipoproteins and monocyte activation in high-risk ASCVD subjects.

    Rosenson, Robert S / Tate, Ashley / Mar, Phyu / Grushko, Olga / Chen, Qinzhong / Goonewardena, Sascha N

    Atherosclerosis

    2024  Volume 392, Page(s) 117529

    Abstract: Background: Mechanistic studies suggest that proprotein convertase subtilisin/kexin type 9 inhibitors can modulate inflammation.: Methods: Double-blind, placebo-controlled trial randomized 41 ASCVD subjects with type 2 diabetes with microalbuminuria ... ...

    Abstract Background: Mechanistic studies suggest that proprotein convertase subtilisin/kexin type 9 inhibitors can modulate inflammation.
    Methods: Double-blind, placebo-controlled trial randomized 41 ASCVD subjects with type 2 diabetes with microalbuminuria and LDL-C level >70 mg/dL on maximum tolerated statin therapy received subcutaneous evolocumab 420 mg every 4 weeks or matching placebo. The primary outcomes were change in circulating immune cell transcriptional response, lipoproteins and blood viscosity at 2 weeks and 12 weeks. Safety was assessed in all subjects who received at least one dose of assigned treatment and analyses were conducted in the intention-to-treat population.
    Results: All 41 randomized subjects completed the 2-week visit. Six subjects did not receive study medication consistently after the 2-week visit due to COVID-19 pandemic suspension of research activities. The groups were well-matched with respect to age, comorbidities, baseline LDL-C, white blood cell counts, and markers of systemic inflammation. Evolocumab reduced LDL-C by -68.8% (p < 0.0001) and -52.8% (p < 0.0001) at 2 and 12 weeks, respectively. There were no differences in blood viscosity at baseline nor at 2 and 12 weeks. RNA-seq was performed on peripheral blood mononuclear cells with and without TLR4 stimulation ("Stress" transcriptomics). "Stress" transcriptomics unmasked immune cell phenotypic differences between evolocumab and placebo groups at 2 and 12 weeks.
    Conclusions: This trial is the first to demonstrate that PCSK9 mAB with evolocumab can modulate circulating immune cell properties and highlights the importance of "stress" profiling of circulating immune cells that more clearly define immune contributions to ASCVD.
    Language English
    Publishing date 2024-03-25
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 80061-2
    ISSN 1879-1484 ; 0021-9150
    ISSN (online) 1879-1484
    ISSN 0021-9150
    DOI 10.1016/j.atherosclerosis.2024.117529
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Clinical Trial Design for Lipoprotein(a)-Lowering Therapies: JACC Focus Seminar 2/3.

    Malick, Waqas A / Goonewardena, Sascha N / Koenig, Wolfgang / Rosenson, Robert S

    Journal of the American College of Cardiology

    2023  Volume 81, Issue 16, Page(s) 1633–1645

    Abstract: Lipoprotein(a) [Lp(a)] is a source of residual risk in patients with atherosclerotic cardiovascular disease (ASCVD). Clinical trials of fully human monoclonal antibodies targeting proprotein convertase subtilisin kexin 9 have shown that reductions in Lp( ... ...

    Abstract Lipoprotein(a) [Lp(a)] is a source of residual risk in patients with atherosclerotic cardiovascular disease (ASCVD). Clinical trials of fully human monoclonal antibodies targeting proprotein convertase subtilisin kexin 9 have shown that reductions in Lp(a) concentrations may be a predictor of event reduction with this class of cholesterol-lowering therapy. With the advent of selective therapies targeting Lp(a) such as antisense oligonucleotides, small-interfering RNA-based therapies, and gene editing, lowering of Lp(a) may lead to reduction in ASCVD. The phase 3 Lp(a)HORIZON (Assessing the Impact of Lipoprotein(a) Lowering with TQJ230 on Major Cardiovascular Events in Patients With CVD) outcomes trial is currently testing the effect of pelacarsen, an antisense oligonucleotide, on ASCVD risk. Olpasiran is a small-interfering RNA that is in a phase 3 clinical trial. As these therapies enter clinical trials, challenges in trial design will have to be addressed to optimize patient selection and outcomes.
    MeSH term(s) Humans ; Lipoprotein(a)/genetics ; Clinical Trials as Topic ; Proprotein Convertase 9 ; Atherosclerosis/drug therapy ; Oligonucleotides, Antisense/therapeutic use ; RNA ; Cardiovascular Diseases/prevention & control ; Cardiovascular Diseases/drug therapy ; Risk Factors
    Chemical Substances Lipoprotein(a) ; olpasiran ; Proprotein Convertase 9 (EC 3.4.21.-) ; Oligonucleotides, Antisense ; RNA (63231-63-0)
    Language English
    Publishing date 2023-04-17
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2023.02.033
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: The Impact of Social Determinants of Health and Lifestyle on the Association of Lipoprotein(a) with Myocardial Infarction and Stroke.

    Brandt, Eric J / Kirch, Matthias / Patel, Nimai / Chennareddy, Chaitanya / Murthy, Venkatesh L / Goonewardena, Sascha N

    medRxiv : the preprint server for health sciences

    2023  

    Abstract: ... The primary outcomes were time until first fatal or nonfatal MI or stroke.: Results: ARIC (n=15,072; median ... Lp(a)=17.3 mg/dL) had 16.2 years average follow up. MESA (n=6,822; median Lp(a)=18.3 mg/dL had 12.3 ...

    Abstract Background: In European cohorts, a higher Mediterranean diet or Life's Simple 7 (LS7) score abolished or attenuated the risk associated with increasing Lipoprotein(a) [Lp(a)] on cardiovascular outcomes. This is unstudied in US cohorts. The impact of social determinants of health (SDOH) on the association of Lp(a) with cardiovascular outcomes remains unstudied. We sought to test if a SDOH score and LS7 score impacts the association of Lp(a) with myocardial infarction (MI) or stroke.
    Methods: Observational Cohort of US Adults from the Atherosclerosis Risk in Communities (ARIC) and Multi-Ethnic Study of Atherosclerosis (MESA) cohorts. We performed sequential multivariable Cox proportional hazard analysis, first adjusting for age, gender, non-HDL-C, race and ethnicity, then added SDOH and LS7 scores sequentially. The primary outcomes were time until first fatal or nonfatal MI or stroke.
    Results: ARIC (n=15,072; median Lp(a)=17.3 mg/dL) had 16.2 years average follow up. MESA (n=6,822; median Lp(a)=18.3 mg/dL had 12.3 years average follow-up. In multivariable analyses adjusted for age, gender, race and ethnicity, and non-HDL-C, Lp(a) was associated (HR, p-value) with MI in ARIC (1.10, <0.001) and MESA (1.09, <0.001), and stroke in ARIC (1.08, <0.001) but not MESA (0.97, 0.50). With SDOH and LS7 added to the model associations remained similar (association of Lp(a) with MI in ARIC 1.09, <0.001 and in MESA 1.10, 0.001, with stroke in ARIC 1.06, <0.003 and in MESA 0.96, 0.39). In models with all covariates, each additional SDOH correlated positively with MI (ARIC 1.13, <0.001; MESA 1.11, <0.001) and stroke (ARIC 1.17, <0.001; HR 1.07, p=0.11) and each additional LS7 score point correlated negatively with MI (ARIC 0.81, <0.001; MESA 0.84, <0.001) and stroke (ARIC 0.82, <0.001; MESA 0.84, <0.001).
    Conclusions and relevance: SDOH and lifestyle factors were predictors for MI and stroke that did not impact the association between Lp(a) and cardiovascular events. Our findings support that Lp(a) is an independent risk factor for MI and possibly stroke.
    Language English
    Publishing date 2023-09-03
    Publishing country United States
    Document type Preprint
    DOI 10.1101/2023.09.01.23294968
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Optimizing Cholesterol Management Improves the Benefits of Percutaneous Coronary Intervention.

    Rosenson, Robert S / Colantonio, Lisandro D / Goonewardena, Sascha N

    Journal of the American College of Cardiology

    2020  Volume 76, Issue 12, Page(s) 1451–1454

    MeSH term(s) Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Humans ; Hypercholesterolemia ; Percutaneous Coronary Intervention
    Chemical Substances Cholesterol, LDL ; Cholesterol (97C5T2UQ7J)
    Language English
    Publishing date 2020-09-17
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2020.07.050
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  8. Article ; Online: Repurposing low-dose naltrexone for the prevention and treatment of immunothrombosis in COVID-19.

    Pitt, Bertram / Tate, Ashley M / Gluck, David / Rosenson, Robert S / Goonewardena, Sascha N

    European heart journal. Cardiovascular pharmacotherapy

    2022  Volume 8, Issue 4, Page(s) 402–405

    Abstract: Coronavirus disease 2019 (COVID-19) is characterized by striking dysregulation of the immune system, with evidence of hyperinflammation, an impaired induction of interferons, and delayed adaptive immune responses. In addition to dysfunctional immune ... ...

    Abstract Coronavirus disease 2019 (COVID-19) is characterized by striking dysregulation of the immune system, with evidence of hyperinflammation, an impaired induction of interferons, and delayed adaptive immune responses. In addition to dysfunctional immune responses, thrombosis is a hallmark of severe COVID-19. Because traditional anticoagulation strategies are associated with increased bleeding, novel strategies that address both the immune and thrombotic dysfunction associated with COVID-19 would be of tremendous benefit. In this commentary, we discuss the unique properties of low dose naltrexone (LDN) which could be leveraged to reduce the immune-mediated thrombotic complications in COVID-19. Mechanistically, LDN can blunt innate immune responses and Toll-like receptor (TLR) signaling, reducing interleukin1 (IL-1), tumor necrosis factor-alpha (TNF-α), and interferon (IFN) levels. Because of the immune-mediated thrombotic mechanisms that underlie COVID-19, we hypothesize that the immune-modulating and known pharmacologic properties of LDN could be leveraged as a novel therapeutic strategy in COVID-19.
    MeSH term(s) COVID-19 ; Humans ; Immunity, Innate ; Naltrexone/pharmacology ; Thromboinflammation ; Thrombosis/prevention & control
    Chemical Substances Naltrexone (5S6W795CQM)
    Language English
    Publishing date 2022-02-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2808613-2
    ISSN 2055-6845 ; 2055-6837
    ISSN (online) 2055-6845
    ISSN 2055-6837
    DOI 10.1093/ehjcvp/pvac014
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Monocyte-Mediated Thrombosis Linked to Circulating Tissue Factor and Immune Paralysis in COVID-19.

    Goonewardena, Sascha N / Chen, Qinzhong / Tate, Ashley M / Grushko, Olga G / Damodaran, Dilna / Blakely, Pennelope K / Hayek, Salim S / Pinsky, David J / Rosenson, Robert S

    Arteriosclerosis, thrombosis, and vascular biology

    2024  Volume 44, Issue 5, Page(s) 1124–1134

    Abstract: ... of subjects with COVID-19 (n=35), circulating markers of inflammation (CCL23 [C-C motif chemokine ligand 23 ...

    Abstract Background: SARS-CoV-2 infections cause COVID-19 and are associated with inflammation, coagulopathy, and high incidence of thrombosis. Myeloid cells help coordinate the initial immune response in COVID-19. Although we appreciate that myeloid cells lie at the nexus of inflammation and thrombosis, the mechanisms that unite the two in COVID-19 remain largely unknown.
    Methods: In this study, we used systems biology approaches including proteomics, transcriptomics, and mass cytometry to define the circulating proteome and circulating immune cell phenotypes in subjects with COVID-19.
    Results: In a cohort of subjects with COVID-19 (n=35), circulating markers of inflammation (CCL23 [C-C motif chemokine ligand 23] and IL [interleukin]-6) and vascular dysfunction (ACE2 [angiotensin-converting enzyme 2] and TF [tissue factor]) were elevated in subjects with severe compared with mild COVID-19. Additionally, although the total white blood cell counts were similar between COVID-19 groups, CD14+ (cluster of differentiation) monocytes from subjects with severe COVID-19 expressed more TF. At baseline, transcriptomics demonstrated increased IL-6, CCL3, ACOD1 (aconitate decarboxylase 1), C5AR1 (complement component 5a receptor), C5AR2, and TF in subjects with severe COVID-19 compared with controls. Using stress transcriptomics, we found that circulating immune cells from subjects with severe COVID-19 had evidence of profound immune paralysis with greatly reduced transcriptional activation and release of inflammatory markers in response to TLR (Toll-like receptor) activation. Finally, sera from subjects with severe (but not mild) COVID-19 activated human monocytes and induced TF expression.
    Conclusions: Taken together, these observations further elucidate the pathological mechanisms that underlie immune dysfunction and coagulation abnormalities in COVID-19, contributing to our growing understanding of SARS-CoV-2 infections that could also be leveraged to develop novel diagnostic and therapeutic strategies.
    MeSH term(s) Humans ; COVID-19/immunology ; COVID-19/blood ; COVID-19/complications ; Thromboplastin/metabolism ; Thromboplastin/genetics ; Monocytes/immunology ; Monocytes/metabolism ; Male ; Middle Aged ; Female ; Thrombosis/immunology ; Thrombosis/blood ; Thrombosis/etiology ; SARS-CoV-2/immunology ; SARS-CoV-2/pathogenicity ; Aged ; Proteomics/methods ; Biomarkers/blood ; Adult
    Chemical Substances Thromboplastin (9035-58-9) ; Biomarkers
    Language English
    Publishing date 2024-03-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1221433-4
    ISSN 1524-4636 ; 1079-5642
    ISSN (online) 1524-4636
    ISSN 1079-5642
    DOI 10.1161/ATVBAHA.122.318721
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Approaching the asymptote: obstacles and opportunities for nanomedicine in cardiovascular disease.

    Goonewardena, Sascha N

    Current atherosclerosis reports

    2012  Volume 14, Issue 3, Page(s) 247–253

    Abstract: Over the past decades, tremendous advances have been made in the understanding, diagnosis, and treatment of cardiovascular disease. However, we now face new challenges, including an aging population and increases in metabolic risk factors, that threaten ... ...

    Abstract Over the past decades, tremendous advances have been made in the understanding, diagnosis, and treatment of cardiovascular disease. However, we now face new challenges, including an aging population and increases in metabolic risk factors, that threaten to slow and even reverse these gains. To overcome these new challenges, fundamental insights from the life sciences must be integrated with advances from the physical sciences to develop novel molecular tools to better diagnose, monitor, and treat this complex disease. Nanotechnology has emerged from the intersection of several disciplines and, if combined with our evolving molecular understanding of atherogenesis, has the potential to revolutionize our management of patients at risk for or with existing cardiovascular disease. However, to realize this potential, we must understand the principles governing the interactions between nanomaterials and biological systems. This review explores nanoparticle attributes and how they can be leveraged to develop novel molecular tools for the diagnosis and treatment of cardiovascular disease.
    MeSH term(s) Animals ; Cardiovascular Diseases/therapy ; Evolution, Molecular ; Humans ; Nanomedicine/methods ; Nanoparticles/therapeutic use
    Language English
    Publishing date 2012-04-29
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057369-8
    ISSN 1534-6242 ; 1523-3804
    ISSN (online) 1534-6242
    ISSN 1523-3804
    DOI 10.1007/s11883-012-0249-9
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