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At the ESC Congress, Dr. Milton Packer highlighted recent research into beta blocker treatment for myocardial infarction. Credit: luchschenF via Shutterstock. A shift in the beta-blocker treatment paradigm has arrived with the changing myocardial infarction treatment landscape, said a researcher at the European Society of Cardiology (ESC) Congress, held from 31 August to 2 September. Over the past 40 years, the research space has operated on an understanding that immediate inhibition by beta-blockers reduces left ventricular rupture, and further myocardial infarction , said Dr. Milton Packer, distinguished scholar in cardiovascular science at Baylor University Medical Center, Dallas. Additionally, the belief was that delayed long-term blockade can lead to left ventricular dysfunction, he said. Beta-blockers are a class of drugs that act by inhibiting the actions of hormones such as adrenaline to slow down the heart. Commonly used beta blockers include Abbott ’s Tenormin (atenolol), MSD’s Cardicor (bisoprolol), and GSK ’s Trandate (labetalol). However, Packer explained that the beta blocker response has changed as percutaneous interventions, reperfusion therapies, antiplatelet drugs and more have entered the treatment landscape for myocardial infarction. At the ongoing ESC Congress talk titled “Should we give beta blockers post-myocardial infarction?” Packer said that questions have been raised surrounding the use of the drugs in patients with myocardial infarction and preserved ejection fraction, referencing the Phase IIII REDUCE-AMI study (NCT03278509). See Also: Novavax wins FDA emergency approval for updated Covid-19 vaccine Combating Pharmaceutical Crime with On-Dose Authentication REDUCE-AMI, which was funded by the Swedish Research Council, tested the use of beta-blockers after myocardial infarction and preserved ejection fraction. The study found that for patients with acute myocardial infarction who underwent early coronary angiography and had preserved left ventricular ejection fraction, long-term beta-blocker treatment did not lower the risk of death from any cause or new myocardial infarctions compared to no beta-blocker use. Despite the conclusion of the REDUCE-AMI study, Packer highlighted the fact that researchers have only investigated and proven the effectiveness of non-selective beta blockers in post-myocardial infarction trials, so further research is required. He added that physicians will have to take into account the degree of beta-blockade in future treatment regimens.

Abnormal blood flow in the aorta is linked to inflammation and breakdown of the vessel wall in conditions where the aorta is dilated. The findings can contribute to better diagnosis and open up new ways to assess the risk of serious and usually fatal complications, such as rupture of the aorta. Abnormal blood flow in the aorta is linked to inflammation and breakdown of the vessel wall in conditions where the aorta is dilated. This is shown in a study led by researchers at Linköping University. The findings can contribute to better diagnosis and open up new ways to assess the risk of serious and usually fatal complications, such as rupture of the aorta. All blood in the body passes through the heart about once a minute. With every heartbeat, blood from the heart is pumped up into the aorta. Dilation can occur in all parts of the aorta. It is unclear exactly how this happens, but one explanation may be weakening of the connective tissue in the vessel wall. Factors such as elevated blood pressure, age and various hereditary conditions increase the risk. A person affected by aortic dilation usually does not notice anything. But more and more people with aortic dilation are being discovered by healthcare -- often by chance. "In healthcare, we're doing more and more imaging where we look at, for example, the heart or lungs, and then we can find that the patient's aorta is a little larger than normal in some parts. There's a need for more tools to guide doctors on how to handle these patients. In a minority of them, the aorta will unfortunately dilate more, and, in the worst case, the aorta will rupture, which is usually fatal," says Filip Hammaréus, PhD student at the Department of Health, Medicine and Caring Sciences at Linköping University and intern physician at Ryhov County Hospital in Jönköping. Most people with aortic dilation are offered regular surveillance of the aortic diameter -- the larger the diameter, the higher the risk. Sometimes the aorta is operated on preventively to avoid acute complications, but it can rupture before dilation has become so pronounced that surgery is considered appropriate. At the same time, many examinations are made of people whose aortic diameter does not change. New methods for early identification of patients at elevated risk of growth could contribute to more individualised and cost-effective care. Therefore, the researchers behind the current study, published in the journal European Heart Journal -- Cardiovascular Imaging, are investigating new methods for understanding both the risk and the condition itself. "We can be onto something new, which can say something more about the severity of the disease than what the aortic diameter shows," says Petter Dyverfeldt, professor at Linköping University and affiliated to the Center for Medical Image Science and Visualization, who has led the study. When blood is pushed out of the heart into the aorta, a frictional force occurs between the flowing blood and the vessel wall. This is important for a type of cell that is located in the vessel wall and can sense blood flow. When the frictional force is normal, the cells tend to be healthy. However, if the friction significantly changes direction, or becomes very low or abnormal in other ways, there seems to be a signalling into the vessel wall that can eventually lead to a weakening. Blood flow through the body's large vessels and in the heart can be measured and visualised with magnetic resonance imaging, using an advanced technology called 4D flow MRI that is available in a small number of hospitals. This gives the researchers a picture of how blood flow affects the vessel wall. In the current study, the researchers have carried out such measurements and also measured various proteins in the blood. It turned out that there existed interesting relationships between the effect of blood flow on the aortic wall and various proteins that relate to inflammation and the build-up and degradation of connective tissue. "We see that in patients with dilated aorta, abnormal blood flow dynamics are associated with increased inflammation and turnover of connective tissue -- something we believe can reflect processes in the vessel wall. This seems reasonable based on the mechanisms that have been shown in previous research, but it's completely new to show the connections in the way we do now using a combination of magnetic resonance imaging and blood samples," says Filip Hammaréus. The findings strengthen previous research, but also bring new insights. "What's interesting about the findings in our study is that the measures of how blood flow affects the aortic wall were not linked to the diameter of the aorta. So, the traditional measure that's often used in healthcare was not part of the relationship we see in the study between abnormal blood flow, inflammation and breakdown of the vessel wall," says Petter Dyverfeldt. The study was conducted on 47 men and women who participated in the Swedish CArdioPulmonary bioImage study (SCAPIS) and whose aortic diameter was over 40 mm. They were compared with 50 control subjects who were matched by sex and age. The research has been funded with support from, among others, ALF Grants, Region Östergötland, Linköping University, Region Jönköping (Futurum) and the Swedish Research Council. The main funder of SCAPIS is the Swedish Heart-Lung Foundation. Facts:

Researchers have succeeded in delivering targeted cancer treatment via small membrane bubbles that our cells use to communicate. A new study shows that the treatment reduces tumor growth and improves survival in mice. Researchers at Karolinska Institutet in Sweden have succeeded in delivering targeted cancer treatment via small membrane bubbles that our cells use to communicate. A new study published in Nature Biomedical Engineering shows that the treatment reduces tumour growth and improves survival in mice. When our cells communicate, they send out small membrane bubbles known as extracellular vesicles which contain various signalling molecules. Interest in these tiny bubbles, sometimes referred to as the body's 'message in a bottle', has increased in recent years as they could be used to deliver medicines. Antibodies seek out tumours Researchers at Karolinska Institutet have now created a targeted cancer treatment by loading these bubbles with a chemotherapeutic drug and attaching antibodies against tumours to their surface. In addition to targeting tumour cells, the antibodies act as a form of immunotherapy, resulting in an enhanced therapeutic effect. The treatment reduced tumour growth and improved survival when given as an injection to mice with breast cancer or melanoma. "By attaching different antibodies to extracellular vesicles, we can target them to virtually any tissue and we can load them with other types of drugs as well," says Oscar Wiklander, physician and researcher at the Department of Laboratory Medicine, Karolinska Institutet, and joint first author with Doste Mamand, researcher at the same department. "Therefore, the treatment has the potential to be used against other diseases and cancer types." More effective and fewer side effects The hope is that the new treatment will be more specific and effective in eliminating tumour cells without affecting healthy tissue, compared to current treatment strategies. The researchers plan to investigate whether different combinations of antibodies and drugs can further improve treatment. "Among other things, we want to investigate the possibility of delivering mRNA as an anticancer drug," says the study's last author Samir EL Andaloussi, Professor at the Department of Laboratory Medicine, Karolinska Institutet. "Ultimately, we hope this can lead to a new treatment platform that can improve treatment efficacy and reduce side effects in difficult-to-treat diseases, especially cancer." The research was mainly funded by the Swedish Cancer Society, the Swedish Research Council, the European Research Council (ERC) and CIMED. Several of the authors have a financial interest in Evox Therapeutics.