Publications by authors named "Michelle C Liang"

17 Publications

  • Page 1 of 1

Bilateral serous retinal detachments in a patient with pre-eclampsia without hypertension.

Retin Cases Brief Rep 2021 Mar 18. Epub 2021 Mar 18.

Retina service, New England Eye Center, Tufts Medical Center, Boston, MA Ophthalmic Consultants of Boston, Boston, MA.

Purpose: To report a case of bilateral serous retinal detachments in a patient with preeclampsia without hypertension using multimodal ophthalmic imaging.

Methods: Case report.

Results: This case demonstrates the rare presentation of bilateral serous retinal detachment in a patient with preeclampsia without hypertension. Characteristic subretinal fluid was seen on exam and optical coherence tomography. No leakage was noted on fluorescein angiography. Treatment was deferred and the subretinal fluid resolved within 3 weeks.

Conclusion: Practitioners should be aware of the rare presentation of serous retinal detachments in preeclampsia, even in the absence of hypertension. Long term sequelae are uncommon and usually only seen in severe disease. Delivery should be considered once serous retinal detachment develops.
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http://dx.doi.org/10.1097/ICB.0000000000001145DOI Listing
March 2021

Early Experience With Brolucizumab Treatment of Neovascular Age-Related Macular Degeneration.

JAMA Ophthalmol 2021 Apr;139(4):441-448

Retina-Vitreous Associates of Florida, Tampa.

Importance: Outcome data are limited regarding early experience with brolucizumab, the most recently approved anti-vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration (nAMD).

Objective: To report clinical outcomes after intravitreous injection (IVI) of brolucizumab, 6 mg, for nAMD.

Design, Setting, And Participants: This retrospective case series conducted at 15 private or academic ophthalmological centers in the United States included all consecutive patients with eyes treated with brolucizumab by 6 retina specialists between October 17, 2019, and April 1, 2020.

Exposures: Treatment with brolucizumab IVI, 6 mg.

Main Outcomes And Measures: Change in mean visual acuity (VA) and optical coherence tomography parameters, including mean central subfield thickness and presence or absence of subretinal and/or intraretinal fluid. Secondary outcomes included ocular and systemic safety.

Results: A total of 172 eyes from 152 patients (87 women [57.2%]; mean [SD] age, 80.0 [8.0] years) were included. Most eyes (166 [96.5%]) were not treatment naive, and 65.7% of these eyes (109 of 166) were switched from the prior anti-VEGF agent because of persistent fluid detected on optical coherence tomography scans. Study eyes received a mean (SD) of 1.46 (0.62) brolucizumab IVIs. The mean (SD) VA prior to starting brolucizumab was a 64.1 (15.9) Early Treatment Diabetic Retinopathy Study (ETDRS) letter score (Snellen equivalent, 20/50) and was a 63.3 (17.2) ETDRS letter score (Snellen equivalent, 20/63) at the last study evaluation (mean difference, 0.8; 95% CI, -2.7 to 4.3; P = .65). When analyzed by number of brolucizumab IVIs, the presence or absence of fluid prior to starting brolucizumab, or the presence or absence of intraocular inflammation after receiving brolucizumab, there was no difference in mean VA prior to starting brolucizumab compared with after brolucizumab IVIs or at the final study evaluation. The mean (SD) central subfield thickness in all eyes prior to starting brolucizumab was 296.7 (88.0) μm and was 269.8 (66.5) μm at the last study examination (mean difference, 26.9 µm; 95% CI, 9.0-44.7 µm; P = .003). Intraocular inflammation was reported in 14 eyes (8.1%) and was self-limited and resolved without treatment in almost half those eyes (n = 6). One previously reported eye (0.6%) had occlusive retinal vasculitis and severe loss of vision.

Conclusions And Relevance: In this analysis of brolucizumab IVI for nAMD, VA remained stable, with a reduction in central subfield thickness. Intraocular inflammation events ranged from mild with spontaneous resolution to severe occlusive retinal vasculitis in 1 eye.
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http://dx.doi.org/10.1001/jamaophthalmol.2020.7085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907988PMC
April 2021

Hypervirulent infection in a woman with a CDH1 gene mutation.

IDCases 2021 4;23:e01000. Epub 2020 Nov 4.

Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA.

The CDH1 gene, which encodes E-cadherin, may be associated with cancer when mutated, but the significance of mutations in the context of infection is unknown. In this report, we describe a case of disseminated hypervirulent infection in a 49 year old Caucasian woman with a documented CDH1 mutation.
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http://dx.doi.org/10.1016/j.idcr.2020.e01000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677705PMC
November 2020

Paracentral Acute Middle Maculopathy After Cardiac Arrest.

Ophthalmology 2017 04;124(4):511

New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.ophtha.2016.10.007DOI Listing
April 2017

MICROBIOLOGIC SPECTRUM AND VISUAL OUTCOMES OF ACUTE-ONSET ENDOPHTHALMITIS UNDERGOING THERAPEUTIC PARS PLANA VITRECTOMY.

Retina 2017 Jul;37(7):1246-1251

*Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; †Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida; ‡Associated Retinal Consultants, William Beaumont Hospital, Oakland University School of Medicine, Royal Oak, Michigan; §Ophthalmic Consultants of Boston, Boston, Massachusetts; and ¶New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.

Purpose: To report the clinical presentation, microbiologic spectrum, and visual outcomes associated with acute-onset infectious endophthalmitis undergoing therapeutic pars plana vitrectomy.

Methods: Multicenter interventional retrospective noncomparative consecutive case series. Billing records were reviewed to identify all charts for patients undergoing pars plana vitrectomy within 14 days of diagnosis of acute-onset infectious endophthalmitis over a 4-year period at 5 large tertiary referral retina practices. Statistical analysis was performed to assess for factors associated with visual outcomes.

Results: Seventy patients were identified. The most common clinical setting was postcataract surgery (n = 20). Only 3 patients (4.3%) presented with 20/400 or better visual acuity (VA). Although most of the patients initially underwent vitreous tap and intravitreal antibiotic injection (n = 47, 67.1%), all patients eventually underwent pars plana vitrectomy within 14 days of presentation with 68.5% (48/70) of patients undergoing pars plana vitrectomy within 48 hours of presentation. Positive intraocular cultures were obtained in 56 patients (80%). The most common identified organism was Streptococcus sp (n = 19). Visual acuity at last follow-up was 20/400 or better in 19 patients (27.1%). Three patients underwent evisceration or enucleation (4.3%). Last recorded postoperative VA (mean LogMAR 1.99 ± 0.94, Snellen VA equivalent finger count) improved from presenting VA (mean LogMAR 2.37 ± 0.38, Snellen VA hand motions) (P ≤ 0.001). There was no statistically significant correlation between the underlying etiology or the timing of surgery with this VA outcome.

Conclusion: Although less than one-third of patients achieved 20/400 or better VA, this VA often improved significantly from presenting VA.
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http://dx.doi.org/10.1097/IAE.0000000000001358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400738PMC
July 2017

PARS PLANA VITRECTOMY FOR LATE VITREORETINAL SEQUELAE OF INFECTIOUS ENDOPHTHALMITIS: Surgical Management and Outcomes.

Retina 2017 Apr;37(4):651-656

*Associated Retinal Consultants, William Beaumont Hospital, Oakland University School of Medicine, Royal Oak, Michigan; †Mid Atlantic Retina, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania; ‡Bascom Palmer Eye Institute, University of Miami Hospital, Miami, Florida; §Ophthalmic Consultants of Boston, Boston, Massachusetts; ¶New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; and **Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.

Purpose: To report the visual acuity outcomes after pars plana vitrectomy for delayed vitreoretinal sequelae of infectious endophthalmitis. All eyes were initially treated with intravitreal antibiotics (Abx).

Methods: Multicenter, retrospective, consecutive case series.

Results: Forty-two eyes met the study criteria. The mean follow-up was 48 weeks (SD ± 61.8). Mean interval from Abx to pars plana vitrectomy was 13 weeks (SD ± 14.3, range 2-70). Indications for pars plana vitrectomy included vitreous opacities (VO) (n = 22), epiretinal membrane (n = 9), and retinal detachment (n = 11). LogMAR visual acuity improved from 1.87 (Snellen equivalent: 20/1,482) preoperatively to 1.35 (Snellen equivalent: 20/447) at final evaluation (P < 0.001). LogMAR visual acuity improved significantly for patients with vitreous opacities (P < 0.01) and retinal detachment (P = 0.02) but not for patients with epiretinal membranes (P = 0.08).

Conclusion: Patients with infectious endophthalmitis can gain vision if they have a pars plana vitrectomy for delayed sequelae such as vitreous opacities or for retinal detachment.
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http://dx.doi.org/10.1097/IAE.0000000000001208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269601PMC
April 2017

Subretinal Fluid Associated With MEK Inhibitor Use in the Treatment of Systemic Cancer.

JAMA Ophthalmol 2016 Aug;134(8):855-62

Ophthalmic Consultants of Boston, Boston, Massachusetts.

Importance: The use of mitogen-activated protein kinase (MAPK) kinase (MEK) inhibitors has become more common in the treatment of systemic cancer. These agents have been associated with a central serous-like retinopathy in some patients. Recognition of such retinal findings and the relatively benign nature of these events is important to avoid unnecessary intervention, including the cessation of a potentially life-prolonging medication.

Objectives: To evaluate the presence and characteristics of subretinal fluid (SRF) associated with the use of MEK inhibitors in the treatment of systemic cancer and to correlate the presence of SRF with visual acuity and symptoms over time.

Design, Setting, And Participants: Post hoc analysis was conducted of prospectively collected data from 51 patients with locally advanced or metastatic cancer undergoing treatment with the MEK inhibitor binimetinib in 1 of 4 clinical trials. All clinical trial participants underwent complete ophthalmic examination by retina specialists at a private practice in Boston, Massachusetts, and were monitored between February 29, 2012, and January 8, 2014. The examination included Snellen-measured visual acuity, dilated fundus examination, and spectral-domain optical coherence tomography at baseline, biweekly for 2 months, then monthly for the remainder of their trial participation. Post hoc design and data analysis were performed between December 1, 2013, and June 20, 2014.

Main Outcomes And Measures: Visual symptoms, visual acuity, fundus appearance, and the presence and characteristics of SRF noted on optical coherence tomography. The characteristics of angiograms performed at the discretion of the treating physician were reviewed.

Results: Of the 51 participants, 18 (35%) were men; the mean (SD) age was 60 (13) years (range, 32-87 years). Forty-six (90%) study participants developed SRF during the study period, with 9 (20%) experiencing symptoms at any point. The mean (SD) central retinal thickness of 39 study participants who developed SRF at the first visit increased from 280 (26) µm at baseline to 316 (43) µm at the first visit after starting binimetinib treatment (paired t test, P < .001). On examination, SRF appeared as elevated, yellow-orange pockets in the fovea and/or along the arcades. Corresponding optical coherence tomographic imaging revealed SRF beneath the interdigitation zone. The fovea was affected in 37 of 46 (80%) individuals; the location of SRF accumulation varied. Visual symptoms were mild and mainly transient, occurring in 9 participants with SRF (20%; 95% CI, 10%-33%). Only 2 participants (4%) were found to have SRF at the last study visit after discontinuation of treatment with binimetinib. Both had Snellen-measured visual acuity of 20/25 or better.

Conclusions And Relevance: The presence of SRF was common in study participants undergoing treatment with the MEK inhibitor binimetinib. Visual symptoms were mild and mainly transient. The presence of SRF did not lead to permanent ocular sequelae. Cessation of life-extending treatment with MEK inhibitors is not indicated when SRF is present.
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http://dx.doi.org/10.1001/jamaophthalmol.2016.0090DOI Listing
August 2016

CORRELATION OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND CLINICAL ACTIVITY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

Retina 2016 Dec;36(12):2265-2273

*New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and †Tufts University School of Medicine, Boston, Massachusetts.

Purpose: To characterize the features of choroidal neovascularization (CNV) in neovascular age-related macular degeneration with spectral domain optical coherence tomography angiography (OCTA) and to determine whether OCTA can be used to determine clinical activity of CNV.

Methods: Observational, retrospective, consecutive case series.

Results: Optical coherence tomography angiography revealed CNV in 28 eyes (62.2%) while 17 eyes (37.8%) did not demonstrate CNV vessels. Choroidal neovascularization was classified as well circumscribed in 12 eyes (42.8%) and poorly circumscribed in 16 eyes (57.2%). Twenty-two eyes with a CNV on OCTA were clinically active, whereas six eyes with visible CNV on OCTA were clinically inactive. Of the 17 eyes that did not have evidence of CNV on OCTA imaging, 14 were clinically inactive and 3 were clinically active. Presence of CNV on OCTA correlated with clinical activity and absence of CNV correlated with inactivity (P < 0.0001).

Conclusion: Optical coherence tomography angiography is a noninvasive imaging technique that can be used to visualize blood flow comprising CNV. Optical coherence tomography angiography detects CNV vessels in some albeit not all eyes with neovascular age-related macular degeneration. Although the presence or absence of CNV vessels on OCTA highly correlated with clinical activity of CNV, the morphologic appearance of CNV on OCTA did not have significant correlation with clinical activity.
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http://dx.doi.org/10.1097/IAE.0000000000001102DOI Listing
December 2016

Optical Coherence Tomography Angiography of Mixed Neovascularizations in Age-Related Macular Degeneration.

Dev Ophthalmol 2016 15;56:62-70. Epub 2016 Mar 15.

Purpose: To describe the imaging of mixed neovascular age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA).

Methods: Literature review and case series.

Results: A review of mixed neovascularization in AMD is discussed, focusing on the different subtypes of neovascularization and the associated characteristics on imaging, including fluorescein angiography, optical coherence tomography, and OCTA. Three cases are presented.

Conclusion: OCTA is a method of identifying mixed neovascularization in AMD. Neovascular vessels can be seen on en face images of the retina, both below and above the retinal pigment epithelium, corresponding to different types of leakage observed on conventional angiography.
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http://dx.doi.org/10.1159/000442780DOI Listing
December 2016

SPECTRAL DOMAIN-OPTICAL COHERENCE TOMOGRAPHY FINDINGS OF COMMOTIO RETINAE WITH ASSOCIATED SEROUS RETINAL DETACHMENT.

Retin Cases Brief Rep 2017 Winter;11(1):63-66

*Eye Physicians of Virginia, Reston, Virginia; and †New England Eye Center, Tufts Medical Center, Boston, Massachusetts.

Purpose: To describe the appearance of a serous retinal detachment associated with commotio retinae on spectral domain optical coherence tomography.

Methods: Case report.

Results: This case demonstrates the rare presentation of subretinal fluid in commotio retinae. Characteristic outer retinal changes associated with commotio retinae were also seen. Treatment was deferred and the subretinal fluid resolved within 1 week.

Conclusion: Commotio retinae is rarely associated with a serous retinal detachment. This presentation is important to identify as it can avoid unnecessary workup and treatment.
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http://dx.doi.org/10.1097/ICB.0000000000000289DOI Listing
April 2017

Retinoschisis and outer retinal hole formation in a patient with papillorenal syndrome.

Ophthalmic Surg Lasers Imaging Retina 2015 Apr;46(4):477-80

This report describes a 19-year-old patient with the rare association of macular retinoschisis and outer retinal hole formation with papillorenal syndrome. Initially diagnosed with transplant-related central serous chorioretinopathy, she presented several years later with worsening vision and distortion in her right eye. On examination, she was found to have bilateral optic nerve dysplasia, bilateral macular and extramacular retinoschisis, and a serous retinal detachment with outer hole formation in the right eye. A history of prior renal transplantation due to poor kidney development led to the diagnosis of papillorenal syndrome.
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http://dx.doi.org/10.3928/23258160-20150422-13DOI Listing
April 2015

Progressive Outer Retinal Necrosis Secondary to Herpes Simplex Virus Type 2.

Ophthalmic Surg Lasers Imaging Retina 2014 Jun 4:1-2. Epub 2014 Jun 4.

Progressive outer retinal necrosis is an aggressive form of necrotizing herpetic retinitis that presents in immunocompromised patients. It is usually secondary to varicella zoster virus or, rarely, herpes simplex virus type 1. The authors report a case of progressive outer retinal necrosis associated with herpes simplex virus type 2 in a patient with a history of congenital herpes. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:xxx-xxx.].
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http://dx.doi.org/10.3928/23258160-20140625-01DOI Listing
June 2014

Retinal pigment epithelial detachment with disgorgement in age-related macular degeneration observed with OCT.

Ophthalmic Surg Lasers Imaging Retina 2013 Nov-Dec;44(6 Suppl):S30-2

This report describes a rare appearance of retinal pigment epithelial changes in a 71-year-old woman with known long-standing, non-exudative age-related macular degeneration. She presented with visual distortion in her right eye and was found to have a retinal pigment epithelial detachment (RPED) on optical coherence tomography (OCT). Over the following 8 years, sequential OCT imaging revealed an appearance and progression of a break in the existing RPED, disgorgement of material from within the RPED, and appearance of hyper-reflective spots within the inner retinal layers, suggesting pigment epithelial cell migration. Visual acuity remained stable over this period. The RPED resolved spontaneously without treatment. The patient later developed new intraretinal hemorrhage, which was treated with intravitreal bevacizumab.
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http://dx.doi.org/10.3928/23258160-20131101-05DOI Listing
May 2014

Analysis of the thickness and vascular layers of the choroid in eyes with geographic atrophy using spectral-domain optical coherence tomography.

Retina 2014 Feb;34(2):306-12

*Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and †UMDNJ - Robert Wood Johnson Medical School, Piscataway, New Jersey.

Purpose: To analyze the total choroidal thickness and thickness of the individual vascular layers of the choroid in eyes with geographic atrophy (GA), using spectral-domain optical coherence tomography.

Methods: A cross-sectional retrospective review identified 17 patients with GA (17 eyes) and 14 age-matched healthy subjects (14 eyes), who underwent high-definition raster scanning at New England Eye Center, Boston, MA. Patients were diagnosed with GA based on clinical examination and investigations. Two independent raters evaluated the thickness and vascular layers of the choroid.

Results: Mean choroidal thickness was significantly lower in eyes with GA when compared with age-matched healthy eyes (P < 0.0001). Subfoveal choroidal thickness in eyes with GA was significantly less when compared with healthy eyes (158.1 ± 23.65 μm versus 267.5 ± 19.27 μm, P = 0.001). Subfoveal large choroidal vessel layer thickness and medium choroidal vessel layer/choriocapillaris layer thickness were significantly reduced in eyes with GA when compared with healthy eyes (P = 0.001 and P < 0.0001, respectively).

Conclusion: The choroid is significantly thinner in eyes with GA involving the fovea when compared with healthy eyes. Choroidal thinning in GA involves all its vascular layers. Further studies involving prospective correlation of choroidal vascular changes to the quantitative progression of GA is expected to provide further insight on the choroidal angiopathy associated with GA.
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http://dx.doi.org/10.1097/IAE.0b013e3182993e09DOI Listing
February 2014

Solid-appearing retinal cysts in diabetic macular edema: a novel optical coherence tomography finding.

Retin Cases Brief Rep 2013 ;7(3):255-8

New England Eye Center, Tufts Medical Center, Boston, Massachusetts.

Purpose: To describe a novel finding of solid-appearing retinal cysts in patients with diabetic macular edema.

Methods: Case series of four patients with diabetic retinopathy discovered to have solid-appearing retinal cysts on spectral-domain optical coherence tomography.

Results: These cases demonstrate the presence of inner retinal hyporeflective cysts filled with an isoreflective substance on spectral-domain optical coherence tomography. These solid-appearing cysts arise from previously fluid-filled cysts and are not found in relation to intraretinal hemorrhage. Treatment with intravitreal anti-vascular endothelial growth factor agents did not seem to directly alter their natural course.

Conclusion: The authors report solid-appearing retinal cysts as a new optical coherence tomography finding in four patients with diabetic macular edema. The exact composition of this isoreflective material is unknown. The authors hypothesize that fibrin or other inflammatory by-products fill these spaces.
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http://dx.doi.org/10.1097/ICB.0b013e31828eef49DOI Listing
January 2015

Diagnostic and therapeutic challenges.

Retina 2013 Jul-Aug;33(7):1471-4

New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1097/IAE.0b013e318285ce03DOI Listing
January 2014

Progressive left ventricular remodeling, myocyte apoptosis, and protein signaling cascades after myocardial infarction in rabbits.

Biochim Biophys Acta 2005 Jun 8;1740(3):499-513. Epub 2004 Dec 8.

Cardiology Unit, Department of Medicine, University of Rochester Medical Center, NY 14642, USA.

To determine the temporal changes in oxidative stress, mitogen-activated protein (MAP) kinases and mitochondrial apoptotic proteins, and their relationship to myocyte apoptosis in the remote noninfarcted myocardium after myocardial infarction (MI), rabbits were randomly assigned to either coronary artery ligation to produce MI or sham operation. The animals were sacrificed at 1, 4, 8, or 12 weeks after coronary artery occlusion. Sham rabbits were sacrificed at 12 weeks after surgery. MI rabbits exhibited progressive increases of left ventricular (LV) end-diastolic pressure and end-diastolic dimension, and progressive decreases of LV fractional shortening and dP/dt over 12 weeks. The LV remodeling with LV chamber dilation and LV systolic dysfunction was temporally associated with progressive increases of cardiac oxidative stress as evidenced by decreased myocardial reduced-to-oxidized-glutathione ratio and increased myocardial 8-hydroxydeoxyguanosine and myocyte apoptosis. The ERK and JNK activities were decreased while p38 MAP kinase activity was increased with age of MI. The extent of p38 MAP kinase activation correlated with Bcl-2 phosphorylation. Bcl-2 protein was decreased in both mitochondrial and cytosolic fractions with age of MI. Bax protein was increased in both mitochondrial and cytosolic fractions. Cytochrome c was reduced in mitochondrial fraction and increased in cytosolic fraction in a time-dependent manner after MI. Cleaved caspase 9 and caspase 3 proteins were time-dependently increased after MI. These data suggest that p38 MAP kinase activation is not only time-dependent after MI, but also correlates with oxidative stress, Bcl-2 phosphorylation, and myocyte apoptosis. These changes in the remote noninfarcted myocardium may contribute to LV remodeling and dysfunction after MI.
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http://dx.doi.org/10.1016/j.bbadis.2004.11.007DOI Listing
June 2005