Cardiovascular diseases are the main cause of death in industrialized countries. Among them, atherosclerosis has the highest prevalence and constitutes a common pathological pathway responsible for the majority of cases of chronic ischemic heart disease, acute myocardial infarction, heart failure and cerebrovascular disease. Classic studies have confirmed well-established etiopathogenic factors of atherosclerosis based on genetic and immunological components and environmental modifying agents such as diet and exercise. But in addition, recent experimental studies have shown that dysbiosis (alteration of the microbiota) may be an additional factor that participates in the onset and progression of atherosclerosis. The objective of this study is to identify the potential interactions between changes in the microbiota, changes in the immune status, the clinical evolution and the instability and progression of atherosclerosis.
The study will prospectively study two groups of patients : 1) patients with acute coronary syndrome and 2) age and sex matched patients with chronic stable documented atherosclerosis. Immune cell populations and immune-related metabolites will be characterized, the genetic profile of the main known functional variants will be determined, and the oral, gastrointestinal, and blood microbiota will be compared in both groups in a transversal observational design. In addition, 1-year clinical follow-up will be performed and correlation with the evolution of the microbiota and immune response in a longitudinal design will be conducted. Besides, an angiographic substudy, for those patients included in the study but that require revascularization of culprit artery according to clinical indication, will be 1 year follow-up and functional assessment and intravascular imaging and the degree of remodelling of the atherosclerotic plaque will be correlated with the evolution of the microbiota and immune response in a longitudinal design.
Study Type
OBSERVATIONAL
Enrollment
156
In patients who have been successfully revascularized the artery responsible for AMI and also present an intermediate lesion (40-80%) in another coronary territory, the clinical care protocol of the Cardiology Service stipulates the need for a physiological assessment with guidance of pressure (FFR). The thickness of the fibrous cap shall be measured using optical coherence tomography. In addition to the FFR measurement, a complete physiological assessment with a Doppler-pressure guide. This will allow the procedure to be performed without additional risk to the patient. The physiological study will include the analysis of endothelium-dependent vascular function and endothelium-independent vascular function.
From the blood samples of the patients, the total DNA will be extracted and the main functional variants identified in the literature will be genotyped
From the samples of blood, feces, oral cavity and blood, the DNA of the microbiota will be extracted using specific extraction kits and the microbiome will be analyzed through the study of 16S ribosomal RNA amplicons.
A study of immunological cell populations and cytokines will be carried out from fresh blood samples using antibody panels and flow cytometry
Clinical evaluation including hemostasis and biochemical studies and questionaries for diet and exercice registration
Hospital General Universitario Gregorio Maranon
Madrid, Spain
Change from baseline in clinical evaluation at 12 months
Cardiac events register including hemostasis and biochemical determinations
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
Change from baseline in fibrous cap thickness at 12 months
Angiographic substudy-Change from baseline in the thickness of the fibrous cap (μm) of an atherosclerotic plaque in the nonculprit vessel as measured using optical coherence tomography
Time frame: Inclusion and 12 months
Endothelial dysfunction
Angiographic substudy-Micro and macrovascular endothelial function measured using a Doppler pressure guidewire
Time frame: Inclusion and 12 months
Intestinal microbiota composition changes 16S
Changes from baseline in intestinal microbiota will be analysed using the 16S rRNA target gene sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
Intestinal microbiota composition changes metagenome
Changes from baseline in intestinal microbiota will be analysed using the metagenome sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
Blood microbiota composition changes 16S
Changes from baseline in blood microbiota will be analysed using the 16S rRNA target gene sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
Blood microbiota composition changes metagenome
Changes from baseline in blood microbiota will be analysed using the metagenome sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
Oral microbiota composition changes 16S
Changes from baseline in oral microbiota will be analysed using the 16S rRNA target gene sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
Oral microbiota composition changes metagenome
Changes from baseline in oral microbiota will be analysed using the genome sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
Adaptive immune system status changes
Changes from baseline of adaptive immune cell lineages will be assessed dynamically using high performance cytometry at 1 week, 1 month, 3 months, 6 months and 12 months
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
Innate immune system status changes
Changes from baseline of innate immune cell lineages will be assessed dynamically using high performance cytometry at 1 week, 1 month, 3 months, 6 months and 12 months
Time frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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