scholarly journals Pericoronary and periaortic adipose tissue density are associated with inflammatory disease activity in Takayasu arteritis and atherosclerosis

2021 ◽  
Author(s):  
Christopher Wall ◽  
Yuan Huang ◽  
Elizabeth P V Le ◽  
Andrej Ćorović ◽  
Christopher P Uy ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Disease Activity ◽  
Takayasu Arteritis ◽  
Hounsfield Unit ◽  
Sensitivity Analyses ◽  
Clinical Activity ◽  
Tissue Density ◽  
Markers Of Inflammation ◽  
Positron Emission ◽  
Arterial Inflammation

Abstract Aims To examine pericoronary (PCAT) and periaortic (PAAT) adipose tissue density on coronary computed tomography angiography (CCTA) for assessing arterial inflammation in Takayasu arteritis (TAK) and atherosclerosis. Methods and results PCAT and PAAT density was measured in coronary (n = 1016) and aortic (n = 108) segments from 108 subjects (TAK+coronary artery disease (CAD), n = 36; TAK, n = 18; atherosclerotic CAD, n = 32; matched controls, n = 22). Median PCAT and PAAT densities varied between groups (mPCAT: p < 0.0001; PAAT: p = 0.0002). PCAT density was 7.01 ± SEM 1.78 Hounsfield Unit (HU) higher in coronary segments from TAK+CAD patients than stable CAD patients (p = 0.0002), and 8.20 ± SEM 2.04 HU higher in TAK patients without CAD than controls (p = 0.0001). mPCAT density was correlated with Indian Takayasu Clinical Activity Score (r = 0.43, p = 0.001) and C-reactive protein (r = 0.41, p < 0.0001), and was higher in active versus inactive TAK (p = 0.002). mPCAT density above -74 HU had 100% sensitivity and 95% specificity for differentiating active TAK from controls (AUC=0.99 [95% CI 0.97-1]). The association of PCAT density and coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography equated to an increase of 2.44 ± SEM 0.77 HU in PCAT density for each unit increase in 68Ga-DOTATATE maximum tissue-to-blood ratio (p = 0.002). These findings remained in multivariable sensitivity analyses adjusted for potential confounders. Conclusions PCAT and PAAT density are higher in TAK than atherosclerotic CAD or controls, and are associated with clinical, biochemical and PET markers of inflammation. Owing to excellent diagnostic accuracy, PCAT density could be useful as a clinical adjunct for assessing disease activity in TAK.

scholarly journals Pericoronary adipose tissue density is associated with clinical disease activity in Takayasu arteritis and coronary arterial inflammation measured by 68Ga-DOTATATE PET in atherosclerosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Wall ◽  
Y Huang ◽  
C Uy ◽  
E Le ◽  
E Tombetti ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Disease Activity ◽  
Takayasu Arteritis ◽  
Clinical Care ◽  
Somatostatin Receptor ◽  
Plaque Burden ◽  
Funding Source ◽  
Tissue Density ◽  
Markers Of Inflammation ◽  
Arterial Inflammation

Abstract Background Coronary artery disease (CAD) is an under-recognized complication of intense arterial inflammation in Takayasu arteritis (TAK). While pericoronary adipose tissue (PCAT) density is associated with arterial inflammation in CAD patients, this relationship has not previously been studied in TAK patients, nor directly compared with coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET). Purpose To compare PCAT density with clinical, biochemical and molecular imaging markers of inflammation in TAK and CAD patients. Methods PCAT density was quantified from computed tomography coronary angiography (CTCA) around each of the 17 coronary segments in patients with: (1) TAK and CAD, (2) atherosclerotic CAD, and (3) age and gender-matched healthy controls, using semi-automated software (Autoplaque). In TAK patients, PCAT density was compared to the Indian Takayasu Clinical Activity Score (ITAS) and high-sensitivity C-reactive protein (CRP). In CAD patients, PCAT density was compared to local arterial inflammation measured by coronary motion-frozen 68Ga-DOTATATE PET using image registration software (FusionQuant), and systemic (aortic) inflammation using 18F-fluorodeoxyglucose (FDG) PET. Data was acquired either during routine clinical care or prior research that established 68Ga-DOTATATE as an experimental marker of arterial inflammation that binds macrophage somatostatin receptor-2 in atherosclerotic plaques (NCT02021188). Results 60 patients were included (TAK, n=20; CAD, n=20; healthy, n=20). Non-calcified plaque burden (TAK: 95.2%; CAD: 90.4%, p<0.0001) and CRP (TAK: 25.2 ±SD 16.1 mg/L; CAD: 2.5 ±SD 1.7 mg/L, p=0.04) were greater in TAK than CAD patients. PCAT density varied significantly among the three groups (median [IQR] TAK: −72.9 [−81.2 to -66.1] Hounsfield unit [HU]; CAD: −79.9 [−88.0 to −72.2]; healthy: −83.8 [−90.1 to −75.8] HU, p<0.0001). Figure: box-plot showing the distribution of PCAT values by group, with corresponding representative multiplanar reconstructed and cross-sectional CTCA images with surrounding PCAT density displayed by color table in left anterior descending arteries. PCAT density was significantly associated with ITAS (r=0.61, p=0.004) and CRP (r=0.43, p=0.03) in TAK patients, and coronary 68Ga-DOTATATE maximum tissue-to-blood ratio (r=0.31, p<0.001) in CAD patients. PCAT density was not associated with aortic 18F-FDG uptake in CAD patients, nor subcutaneous (pre-sternal) adipose tissue density in either disease group. No significant patient-level confounders were identified using linear mixed-effects regression modelling. Conclusion PCAT density measured by CTCA is greater in TAK than CAD patients, and is associated with clinical and biochemical markers of disease activity in TAK, and coronary arterial inflammation measured by 68Ga-DOTATATE PET in CAD. PCAT could be a useful, easy to measure marker of coronary inflammation and disease activity in both TAK and CAD. PCAT density is greater in TAK than CAD Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Wellcome Trust

Takayasu arteritis in paediatrics

2017 ◽  
Vol 28 (3) ◽  
pp. 354-361 ◽  
Author(s):  
Marisa Di Santo ◽  
Erica V. Stelmaszewski ◽  
Alejandra Villa
Keyword(s):  
Disease Activity ◽  
Aortic Regurgitation ◽  
Takayasu Arteritis ◽  
Uncontrolled Hypertension ◽  
Limb Ischaemia ◽  
Severe Aortic Regurgitation ◽  
Non Invasive ◽  
Positron Emission ◽  
Digital Subtraction Arteriography ◽  
Risk Of Rupture

AbstractTakayasu arteritis is an idiopathic chronic granulomatous panarteritis predominantly affecting the aorta and its main branches. Although idiopathic, genetic contribution to disease susceptibility is being increasingly recognised. Rare in children, Takayasu arteritis is a worldwide disease with significant morbidity and mortality. Its diagnosis is a challenge and requires awareness of the condition as clinical features at presentation are non-specific and assessing disease activity is difficult. In the inflammatory stage, treatment is essential to prevent the insidious course and vascular damage: stenotic, occlusive lesions, aneurysms, and aortic regurgitation. New imaging modalities, such as CT scan, MRI, and 18F-fluorodeoxyglucose positron emission tomography, have expanded the possibilities for non-invasive diagnosis and monitoring; however, digital subtraction arteriography remains the gold standard for the diagnosis of Takayasu arteritis. Steroids are the first-line medical treatment. The combined use of methotrexate, cyclophosphamide, azathioprine, mycophenolate mofetil, and biological agents is common. Revascularisation therapy should be considered in uncontrolled hypertension secondary to renal artery stenosis, symptomatic coronary ischaemia, cerebrovascular disease, severe aortic regurgitation, limb ischaemia, and aneurysms at risk of rupture, using surgical or endovascular procedures and taking into consideration that complications, especially restenosis, are frequent. Disease activity increases the likelihood of complications after revascularisation. Surgical intervention has shown better long-term outcomes, although the endovascular approach is evolving. The aim of this review was to describe key points of the diagnosis, treatment, and follow-up of Takayasu arteritis in childhood.

scholarly journals CERTOLIZUMAB PEGOL IN THE TREATMENT OF TAKAYASU ARTERITIS: THE FIRST EXPERIENCE AND PROSPECTS

2018 ◽  
Vol 56 (3) ◽  
pp. 333-338 ◽  
Author(s):  
P. I. Novikov ◽  
I. O. Smitienko ◽  
M. V. Sokolova ◽  
S. V. Moiseev
Keyword(s):  
Disease Activity ◽  
Immunosuppressive Therapy ◽  
Median Duration ◽  
Takayasu Arteritis ◽  
Certolizumab Pegol ◽  
Immunosuppressive Drugs ◽  
Community Acquired Pneumonia ◽  
Remission Induction ◽  
Clinical Activity ◽  
Female Patients

Certolizumab pegol (CZP) is the only pegylated biological agent (BA) that does not contain an Fc fragment, which minimizes its transplacental transfer. Takayasu arteritis mostly occurs in reproductive-aged women.Objective: to evaluate the efficacy and safety of CZP used to treat standard immunosuppressive therapy-resistant Takayasu arteritis.Subjects and methods. The retrospective study enrolled 6 female patients aged 18 to 35 years with Takayasu arteritis who received CZP. The median disease duration before BA usage was 66 months (24 to 204 months). The median duration of immunosuppressive therapy prior to CZP treatment was 92 months (14 to 132 months). All the female patients had taken glucocorticoids and methotrexate before and during CZP therapy. Only four patients had received two to five immunosuppressive drugs at different times prior to BA administration. Three patients had previously used other BAs. The disease activity was determined by the National Institute of Health (NIH) criteria. The Indian Takayasu Clinical Activity Score (ITAS2010) was used. The disease activity was recorded in all the patients prior to CZP therapy.Results and discussion. The median duration of CZP treatment was 17 months (6 to 24 months). The median erythrocyte sedimentation rate after CZP usage decreased from 22.5 to 10.5 mm/h; the median C-reactive protein level dropped from 7.8 to 0.39 mg/dl (p<0.05), the median daily dose of prednisolone was reduced from 20 to 8.75 mg (p<0.05). All the patients achieved complete remission an average of 4 months after starting CZP therapy. Three patients were still in remission after 12–24 months. One relapse of the disease was recorded following 24 months. ITAS2010 reduced from 1–4 to 0 in five patients and to 2 in one patient with recurrence. There was a good tolerance in five female patients. The adverse events were herpes labialis in two cases, community-acquired pneumonia in one case, and postoperative abscess in one case too.Conclusion. CZP in Takayasu arteritis was shown to be an effective drug for remission induction and maintenance. The presented results of the first experience in treating this disease with CZP are indicative of its promising further investigation as a steroid-sparing drug in patients with refractory vasculitis. One of the important advantages of CZP is its supposed high safety throughout pregnancy. 

scholarly journals Contrast-enhanced Ultrasonography for Monitoring Arterial Inflammation in Takayasu Arteritis

2019 ◽  
Vol 46 (6) ◽  
pp. 616-622 ◽  
Author(s):  
ZhiQin Li ◽  
ZhaoHui Zheng ◽  
Jin Ding ◽  
XiaoFeng Li ◽  
YongFeng Zhao ◽  
...  
Keyword(s):  
Disease Activity ◽  
Takayasu Arteritis ◽  
Fdg Pet ◽  
Vascular Inflammation ◽  
Inactive Disease ◽  
Clinical Activity ◽  
Visual Grade ◽  
Fdg Uptake ◽  
Contrast Enhanced ◽  
Bilateral Carotid

Objective.To evaluate the utility of contrast-enhanced ultrasound (CEUS) compared with 18F-fluorodeoxyglucose–positron emission tomography (FDG-PET) in assessing vessel inflammation of Takayasu arteritis (TA).Methods.This is a retrospective analysis of 71 patients with TA who had undergone carotid CEUS. Twenty-two of 71 patients underwent FDG-PET after CEUS. Clinical disease activity was assessed by Kerr criteria and the Indian Takayasu Clinical Activity Score 2010 (ITAS2010). We investigated the correlation between carotid vascularization on CEUS and clinical data. The consistency of carotid CEUS and PET data has been analyzed for TA disease activity.Results.There was a statistically significant correlation between the results of CEUS and ITAS2010 (p = 0.004) or Kerr criteria (p < 0.001). According to ITAS2010, thirty-four of 71 patients with TA were clinically inactive. Assessment of 34 TA patients with clinically inactive disease yielded 11 CEUS scans that showed active lesions (visual grade ≥ 2) in the left or right carotid artery. In 22 cases that underwent CEUS and FDG-PET, 12 were active and 10 were inactive on the basis of ITAS2010. Moreover, bilateral carotid CEUS vascularization score positively correlated with vascular FDG uptake in these patients with TA (p = 0.004). When vascular inflammation was defined as FDG uptake with visual grade ≥ 2, carotid CEUS showed sensitivity of 100% and specificity of 80%.Conclusion.For TA patients with clinically inactive disease, CEUS could help clinicians to identify active lesions in the carotid vascular region. Carotid CEUS may be a rapid and cost-effective imaging tool in the followup of patients with TA.

Functional characterization of human brown adipose tissue metabolism

2020 ◽  
Vol 477 (7) ◽  
pp. 1261-1286 ◽  
Author(s):  
Marie Anne Richard ◽  
Hannah Pallubinsky ◽  
Denis P. Blondin
Keyword(s):  
Adipose Tissue ◽  
Brown Adipose Tissue ◽  
Functional Characterization ◽  
Human Infants ◽  
Positron Emission ◽  
Brown Adipose ◽  
Treatment Of Obesity ◽  
And Function

Brown adipose tissue (BAT) has long been described according to its histological features as a multilocular, lipid-containing tissue, light brown in color, that is also responsive to the cold and found especially in hibernating mammals and human infants. Its presence in both hibernators and human infants, combined with its function as a heat-generating organ, raised many questions about its role in humans. Early characterizations of the tissue in humans focused on its progressive atrophy with age and its apparent importance for cold-exposed workers. However, the use of positron emission tomography (PET) with the glucose tracer [18F]fluorodeoxyglucose ([18F]FDG) made it possible to begin characterizing the possible function of BAT in adult humans, and whether it could play a role in the prevention or treatment of obesity and type 2 diabetes (T2D). This review focuses on the in vivo functional characterization of human BAT, the methodological approaches applied to examine these features and addresses critical gaps that remain in moving the field forward. Specifically, we describe the anatomical and biomolecular features of human BAT, the modalities and applications of non-invasive tools such as PET and magnetic resonance imaging coupled with spectroscopy (MRI/MRS) to study BAT morphology and function in vivo, and finally describe the functional characteristics of human BAT that have only been possible through the development and application of such tools.

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