Over the last decade, a tremendous progress has been made in cardiovascular medicine. The progress includes the treatment of coronary artery disease (CAD) and peripheral artery disease. In CAD,... Show moreOver the last decade, a tremendous progress has been made in cardiovascular medicine. The progress includes the treatment of coronary artery disease (CAD) and peripheral artery disease. In CAD, several advances have been made in the management of patients with acute myocardial infarction (AMI) such as: 1) the importance of networking in the treatment of AMI; 2) perspectives on how to improve the results of primary percutaneous coronary intervention (PCI) procedures including: (i) the administration of a glycoprotein IIb/ IIIa inhibitor (GPI); (ii) strategies for __fighting__ the coronary thrombus during primary PCI; (iii) choice of vascular access site (radial versus femoral artery approach) for primary PCI; (iv) choice of stents (drug eluting versus bare metal stent) for patients with acute ST-segment elevation myocardial infarction (STEMI); and 3) the use of intra-aortic balloon pump (IABP) in acute coronary syndrome (ACS) patients. Another important perspective related to patients with AMI is the utilization of simple, inexpensive but accurate biomarkers with prognostic value such as plasma uric acid concentration and leukocyte count, which are particularly useful in a rural area when other established markers are not available. Show less
Ischemia-reperfusion injury (IRI) is a pathophysiological event that occurs in many clinical conditions, ranging from surgery, acute artery occlusion to transplantation. Complement activation is... Show moreIschemia-reperfusion injury (IRI) is a pathophysiological event that occurs in many clinical conditions, ranging from surgery, acute artery occlusion to transplantation. Complement activation is thought to be a crucial step in IRI, because complement inhibition and complement deficiency considerably attenuate irreversible injury. However, the specific complement pathway remains unclear. All three complement pathways: the classical, the alternative, and the mannose-binding lectin dependent pathway may be involved in the development of IRI, depending on the model, the tissue, and the time course of inflammation. Ischemia leads to the exposition of neoantigens on the jeopardized tissues, which could be recognized by C-reactive protein (CRP) and natural IgM antibodies. The binding of CRP and IgM to these neoepitopes is followed by complement activation. In this thesis, we demonstrated that both proteins bind to jeopardized tissues and activate the complement system, in particular intestines from rats subjected to IRI. Furthermore, it was shown that IgM levels against altered phospholipids correlated with the levels of inflammatory mediators in patients subjected to tissue damage suggesting that IgM participates in amplification of inflammation. The development of strategies to prevent binding of CRP and/or IgM is an attractive approach for a therapy for reducing IRI. Show less
