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Good Cholesterol may Fail to Protect You against Heart Disease, also increases Inflammatory response of Immune Cells called Macrophages

Lung macrophages ingested disease-causing bacteria upon exposure to high-density lipoprotein (HDL)

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London, November 18, 2016: Although well associated with lowering cardiovascular disease risk high-density lipoprotein (HDL) — known as good cholesterol — may not always be able to protect against heart disease.

A new study has suggested that it increases the inflammatory response of certain immune cells called macrophages.

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This can potentially counteract its well-established anti-inflammatory effect in various other cell types, the study said.

“Good cholesterol’s functions are not as simple as initially thought, and appear to critically depend on the target tissue and cell type,” said Marjo Donners of Maastricht University, the Netherlands.

“In the end, it is the balance between its pro- and anti-inflammatory effects that determines clinical outcome,” Donners added.

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In the study, the researchers found that HDL treatment enhanced inflammation in macrophages, in contrast to its effects in other cell types. Similarly, macrophages taken from mice with elevated HDL levels showed clear signs of inflammation.

This pro-inflammatory effect induced by HDL showed enhanced pathogen protection, the researchers said.

Lung macrophages ingested disease-causing bacteria upon exposure to HDL. On the other hand, mice with low HDL levels were impaired at clearing these bacteria from the lungs.

The results demonstrate that HDL’s pro-inflammatory activity supports the proper functioning of macrophage immune responses.

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According to Donners, these findings suggest that patients with persistent infections or specific immune disorders might benefit from HDL-raising therapies.

The research could also lead to the development of cell-specific therapies that exploit the benefits of HDL-targeted therapies while avoiding the side effects, the researchers noted.

The study was published in the journal Cell Metabolism. (IANS)

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Tiny Pacemakers Could Be Game Changers for Heart Patients

A pacemaker is a medical device which uses electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beating of the heart

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The tiny pacemakers are not right for all patients, but as the technology develops, more people will be able to benefit from the procedure.
The tiny pacemakers are not right for all patients, but as the technology develops, more people will be able to benefit from the procedure. Wikimedia Commons

Tiny, new pacemakers are making headway around the world. One type, the Micra, is keeping 15,000 people’s hearts beating in 40 countries, according to manufacturer Medtronic. One of those people is Mary Lou Trejo, a senior citizen who lives in Ohio.

A healthy heart has its own pacemaker that establishes its rhythm, but people like Trejo need the help of an artificial device.

Trejo comes from a family with a history of heart disease. Her heart skipped beats, and she could feel it going out of rhythm. Trejo wanted to do something to advance heart health, so in 2014, she volunteered to participate in a clinical trial for the Micra pacemaker. The device is 24 millimetres long implanted, one-tenth the size of traditional pacemakers.

Traditional pacemakers

Most pacemakers rely on batteries placed under the skin, usually just below the collarbone. Sometimes patients get infections after the surgery or have difficulty healing from the incision.

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Traditional pacemakers use leads with electrodes on one end that are threaded through blood vessels to connect to the heart. There can be problems with the leads as well.

A healthy heart has its own pacemaker that establishes its rhythm, but people like Trejo need the help of an artificial device.
A healthy heart has its own pacemaker that establishes its rhythm, but people like Trejo need the help of an artificial device. Wikimedia Commons

Dr Ralph Augostini at Ohio State’s Wexner Medical Center says a tiny pacemaker like the Micra avoids all of these problems.

“The electrodes are part of the can, and therefore it eliminates the lead,” he said. There’s no incision in the chest to become infected and no chance of complications with the leads.

Small and self-contained

Augostini implanted Trejo’s pacemaker in 2014. He threaded the entire device through an artery in her leg up to her heart. The pacemaker has small, flexible tines that anchor it into the folds of the heart muscle. Once it’s in place, the doctor gives it a tug to make sure the pacemaker is stable before removing the catheter used to place it in the heart.

The Wexner Medical Center was one of the sites that participated in the Micra clinical trial. Since the Micra received FDA approval in 2016, Medtronic has been training more physicians on the procedure. A company spokesman told VOA that this device is becoming available at other centres across the U.S. and countries throughout the world.

Traditional pacemakers use leads with electrodes on one end that are threaded through blood vessels to connect to the heart.
Traditional pacemakers use leads with electrodes on one end that are threaded through blood vessels to connect to the heart. Wikimedia Commons

Dr John Hummell, a cardiologist at the Wexner Medical Center, has studied the effectiveness of this new generation of pacemakers.

“We don’t leave any wires behind and the pacemaker, the battery, the wire is all just a tiny little piece of metal sitting down in the heart,” he said. Medtronic said the results of the clinical trial showed a success rate of 99.6 percent.

Dr Richard Weachter, with the University of Missouri Health Care, says the leadless pacemakers’ complication rates are about half the rate of traditional pacemakers.

The battery lasts for 14 years and after that, Weachter said, doctors, can implant another one in the same chamber of the heart. They can repeat the procedure a third time if needed.

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The pacemaker activates only when necessary to keep the heart beating normally. Studies show that the Micra and other leadless pacemakers are safe and effective.

These tiny pacemakers are not right for all patients, but as the technology develops, more people will be able to benefit from the procedure. Four years after her implant, Trejo’s doctors say she is doing fine. (VOA)