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Kedar DJ, Suh HS, Park CJ, Hong JP. Soft Tissue Reconstruction After Revascularization. INT J LOW EXTR WOUND 2024; 23:27-32. [PMID: 37946321 DOI: 10.1177/15347346231210144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Diabetic foot ulcer represents the primary cause of hospital admissions, amputations, and mortality in diabetic patients. The development of diabetic foot ulcers is influenced by peripheral neuropathy, infection, and ischemia, with diabetes contributing to peripheral artery disease. Free tissue transfer combined with revascularisation of the lower extremity provides the potential opportunity for limb salvage in individuals with lower extremity defects due to critical limb ischemia and diabetic foot.
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Affiliation(s)
- Daniel J Kedar
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hyun Suk Suh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Changsik John Park
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
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2
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Lee S, Kalra K, Kashikar A, Redpath B, Bernheim A, Brewster L, Shaw L, Arya S. Evaluation of Lower Extremity Calcium Score as a Measure of Peripheral Arterial Disease Burden and Amputation Risk. Ann Vasc Surg 2023; 95:154-161. [PMID: 36889632 DOI: 10.1016/j.avsg.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/04/2023] [Accepted: 02/07/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The ankle-brachial pressure index (ABI) and toe-brachial pressure index (TBI) are commonly used diagnostic tools for peripheral artery disease (PAD) that are unreliable in the presence of calcified vessels. In this study, we aimed to demonstrate the utility of the lower extremity calcium score (LECS) in addition to ABI and TBI in measuring disease burden and predicting the risk of amputation in patients with PAD. METHODS Patients who were evaluated in the vascular surgery clinic at Emory University for PAD and who underwent noncontrast computed tomography of the aorta and lower extremities were included in the study. Aortoiliac, femoral-popliteal, and tibial calcium scores were measured using the Agatston method. ABI and TBI that were obtained within 6 months of the computed tomography scan were noted and divided into categories of PAD severity. Associations between ABI, TBI, and LECS of each anatomic segment were evaluated. Univariate and multivariate ordinal regression analyses were performed to predict the outcome of amputation. Receiver operating characteristic analysis was performed to compare LECS with other variables in its ability to predict amputation. RESULTS Fifty patients included in the study cohort were divided into LECS quartiles, with 12-13 patients in each quartile. The highest quartile tended to be older (P = 0.016), had a higher percentage of diabetics (P = 0.034), and had a higher frequency of major amputations (P = 0.004) compared to the other quartiles. Patients in the highest quartile of tibial calcium score were more likely to have stage 3 chronic kidney disease (CKD) or greater (P = 0.011) and also had a higher frequency of amputation (P < 0.005) and mortality (P = 0.041). We found no significant association between each anatomic LECS and ABI/TBI categories. On univariate analysis, CKD (Odds Ratio [OR] 12.92 (95% CI 2.01 to 82.83), P = 0.007), diabetes mellitus (OR 5.47 (95% CI 1.27 to 23.64), P = 0.023), tibial calcium score (OR 6.62 (95% CI 1.79 to 24.54), P = 0.005), and total bilateral calcium score (OR 6.32 (95% CI 1.18 to 33.78), P = 0.031) were associated with increased risk of amputation. On multivariate stepwise ordinal regression, TBI and tibial calcium score were identified as important predictors of amputation, with hyperlipidemia and CKD increasing the overall prediction of the model. On Receiver operating characteristic analysis, the addition of the tibial calcium score (area under the curve 0.94, standard error 0.048) significantly improved the prediction of amputation compared to hyperlipidemia, CKD, and TBI alone (area under the curve 0.82, standard error 0.071, P = 0.022). CONCLUSIONS The addition of tibial calcium score to other known PAD risk factors may improve the prediction of amputation in patients with PAD.
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Affiliation(s)
- Sujin Lee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Massachusetts General Hospital, Boston, MA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
| | - Kanika Kalra
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Aditi Kashikar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Benjamin Redpath
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA; Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Palo Alto VA Medical Center, Palo Alto, CA; Surgical Services, Palo Alto VA Medical Center, Palo Alto, CA
| | - Adam Bernheim
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA; Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Palo Alto VA Medical Center, Palo Alto, CA; Surgical Services, Palo Alto VA Medical Center, Palo Alto, CA
| | - Luke Brewster
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA
| | - Leslee Shaw
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Shipra Arya
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Palo Alto VA Medical Center, Palo Alto, CA; Surgical Services, Palo Alto VA Medical Center, Palo Alto, CA
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3
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Use of Recanalized Vessels for Diabetic Foot Reconstruction: Pushing the Boundaries of Reconstruction in a Vasculopathic Lower Extremity. Plast Reconstr Surg 2023; 151:485e-494e. [PMID: 36730343 DOI: 10.1097/prs.0000000000009935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Free flap after lower extremity revascularization may enable limb salvage in defects after critical limb ischemia. This study examined the outcomes of reconstruction of ischemic diabetic foot according to the severity of the vessel occlusion and assessed whether recanalized vessels may serve as a reliable recipient vessel. METHODS A total of 62 patients who underwent diabetic foot reconstruction with free flaps after successful percutaneous transluminal angioplasty (PTA) from February of 2010 to February of 2016 were identified and divided into three groups: group 1, nonoccluded vessels as recipient ( n = 11); group 2, recanalized artery after PTA for partially occluded artery ( n = 30); and group 3, recanalized artery after PTA for completely occluded artery ( n = 21). RESULTS Flap survival was statistically higher in group 2 (90%) compared with group 3 (67%) ( P < 0.05). Subsequent major amputation was significantly lower in groups 1 and 2 [0/7 and 1/30 (3.3%)] compared with group 3 [5/21 (23.8%)] ( P < 0.05). The patient survival and limb salvage rate was 90.9% at 1 and 3 years in group 1, 89.8% at 1 year and 86.3% at 3 and 5 years in group 2, and 76.2% at 1, 3, and 5 years in group 3. This difference was not statistically significant ( P = 0.485). CONCLUSIONS The use of recanalized vessels after PTA can be safe for partially occluded arteries but requires caution for completely occluded arteries. Using completely occluded vessels after PTA can be attempted when other options are not available and achieves a 76% chance of limb salvage. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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4
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Xie J, Zhu J, Mao N, Ren S, Fan J. Long‐segment restrictive tear of radial artery under ultrasound guide for arteriovenous fistula by PTA: A case report. Clin Case Rep 2022; 10:e05884. [PMID: 35600029 PMCID: PMC9117714 DOI: 10.1002/ccr3.5884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/26/2022] [Accepted: 04/22/2022] [Indexed: 11/14/2022] Open
Abstract
Considerable calcification and stenosis frequently occur in the radial artery (RA) in diabetic nephropathy. PTA was performed successfully using a balloon to expand and restrictively tear the longitudinal axis of the RA. This approach seems to be a useful measure of promoting the maturation of AVF in diabetic nephropathy.
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Affiliation(s)
- Jing Xie
- Chengdu University of Traditional Chinese Medicine Chengdu China
- Department of Nephrology NO.1 Chengdu University of Traditional Chinese Medicine Affiliated Hospital Chengdu China
| | - Jiang‐tao Zhu
- Department of Nephrology Changzhi Hospital of Traditional Chinese Medicine, Shanxi Province Chengdu China
| | - Nan Mao
- Department of Nephrology The First Affiliated Hospital of Chengdu Medical College Chengdu China
| | - Si‐chong Ren
- Department of Nephrology The First Affiliated Hospital of Chengdu Medical College Chengdu China
- Chengdu Medical College Chengdu China
| | - Jun‐ming Fan
- Department of Nephrology The First Affiliated Hospital of Chengdu Medical College Chengdu China
- Chengdu Medical College Chengdu China
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St. Hilaire C. Medial Arterial Calcification: A Significant and Independent Contributor of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2022; 42:253-260. [PMID: 35081727 PMCID: PMC8866228 DOI: 10.1161/atvbaha.121.316252] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over 200 million individuals worldwide are estimated to have peripheral artery disease (PAD). Although the term peripheral can refer to any outer branch of the vasculature, the focus of this review is on lower-extremity arteries. The initial sequelae of PAD often include movement-induced cramping pain in the hips and legs or loss of hair and thinning of the skin on the lower limbs. PAD progresses, sometimes rapidly, to cause nonhealing ulcers and critical limb ischemia which adversely affects mobility and muscle tone; acute limb ischemia is a medical emergency. PAD causes great pain and a high risk of amputation and ultimately puts patients at significant risk for major adverse cardiovascular events. The negative impact on patients' quality of life, as well as the medical costs incurred, are huge. Atherosclerotic plaques are one cause of PAD; however, emerging clinical data now shows that nonatherosclerotic medial arterial calcification (MAC) is an equal and distinct contributor. This ATVB In Focus article will present the recent clinical findings on the prevalence and impact of MAC in PAD, discuss the known pathways that contribute specifically to MAC in the lower extremity, and highlight gaps in knowledge and tools that limit our understanding of MAC pathogenesis.
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Affiliation(s)
- Cynthia St. Hilaire
- Division of Cardiology, Departments of Medicine and Bioengineering, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, PA
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6
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Lou X, Yang Z, Wu K, Li W, Hu W, Nie R, Tu P, Duan P. Elevated Serum Osteoprotegerin is Associated with Reduced Risks of Albuminuria and CKD Progression in Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes 2022; 15:3831-3841. [PMID: 36530588 PMCID: PMC9756793 DOI: 10.2147/dmso.s390483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To analyze the correlation between serum osteoprotegerin (OPG) level and chronic kidney disease (CKD) at different CKD stages in patients with type 2 diabetes. METHODS All subjects were hospitalized patients with type 2 diabetes. Medical history collection, physical examinations, and blood and urine samples testing were performed. Stages of CKD (G1-5) were defined by eGFR, groups of persistent albuminuria (normal, microalbuminuria and massive albuminuria) were divided by UACR, and categories of CKD progression risks (low, moderate and high or very high risk) were recommended by the Kidney Disease: Improving Global Outcomes (KDIGO). Serum OPG level was determined by enzyme-linked immunosorbent assay in the central laboratory. RESULTS Four hundred and eighty-four patients were included in the study. The average level of OPG of all subjects was 941.30 (547.53-1332.62) pg/mL. The levels of OPG decreased gradually with the aggravation of albuminuria (P = 0.007, P for trend=0.003) and CKD progression (P = 0.001, P for trend=0.001). No differences were found between OPG levels and stages of CKD (P = 0.31). After the adjustment, each 100 pg/mL increase in OPG levels could reduce the risk of massive albuminuria (OR 0.92, 95% CI 0.86-0.99, P = 0.02) and the high or very high risk of CKD progression (OR 0.94, 95% CI 0.89-0.99, P = 0.04) by multivariate logistic regression analysis. No correlations were found between OPG and stages of CKD. CONCLUSION In patients with type 2 diabetes, elevated serum osteoprotegerin is associated with albuminuria and the risk of CKD progression, and may delay the progression of CKD.
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Affiliation(s)
- Xiaoyang Lou
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
- Department of Postgraduate Studies, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Zhi Yang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Kexia Wu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Weihong Li
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Wan Hu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Ronghui Nie
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
- Third Clinical School of Medicine, Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Ping Tu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Peng Duan
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
- Correspondence: Peng Duan, Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, Jiangxi, 330000, People’s Republic of China, Tel +86 13479111177, Email
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M R, Nanda N, Sagili H, Rani JM, A Naga S. Association of osteoprotegerin gene T950C polymorphism with cardiometabolic risk factors in gestational diabetes mellitus in South Indian Tamilian women. Diabetes Metab Syndr 2021; 15:102157. [PMID: 34186363 DOI: 10.1016/j.dsx.2021.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS This study was designed to explore the relevance of Osteoprotegerin (OPG) and its polymorphism in the cardiometabolic risk in gestational diabetes mellitus patients before diet-therapy (GDMA1). METHODS South Indian Tamilian pregnant women were screened and 145 were grouped as GDMA1 (n = 73) and normal pregnancy (n = 72). Serum OPG, TNF α, lipid profile, insulin and blood pressure was compared. Genomic DNA was analysed for rs2073617 T950C polymorphism. Chi square test was done to analyze the frequency distribution of alleles. Multiple regression analysis was done to assess the association among cardiometabolic parameters. RESULTS TNF α (p < 0.01), Osteoprotegerin (p < 0.01), lipid profile (p < 0.01), atherogenic indices (p < 0.01), systolic and diastolic and blood pressure (<0.001) levels were higher in GDMA1 patients. TNF α (p < 0.01) and osteoprotegerin (p < 0.01) were higher in women with CT allele. Osteoprotegerin was independently contributed by BMI in all GDMA1 cases and diastolic blood pressure (DBP) in CT allele cases. There was significantly higher odd (OR = 3.63) in the distribution of CT genotype among the multiparous women. CONCLUSIONS Osteoprotegerin, atherogenic lipid risk factor and inflammation are higher in GDMA1 women. Rise in OPG is contributed by high BMI in GDMA1 women. Higher odds of CT allele distribution in multiparous women suggests that TT allele women are at higher risk of developing GDM in their first pregnancy. Further analysis of T950C polymorphism in a larger cohort is warranted to confirm its role.
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Affiliation(s)
- Rakchna M
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nivedita Nanda
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Haritha Sagili
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jasmine Manna Rani
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sailaja A Naga
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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8
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Bochkareva EV, Kim IV, Butina EK, Stulin ID, Trukhanov SA, Rudenko BA, Boytsov SA, Drapkina OM. Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 1. Breast Arterial Calcification: Pathomorphology, Prevalence and Risk Factors. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-2-244-250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - I. V. Kim
- National Medical Research Center for Preventive Medicine
| | - E. K. Butina
- National Medical Research Center for Preventive Medicine
| | - I. D. Stulin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - S. A. Trukhanov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - B. A. Rudenko
- National Medical Research Center for Preventive Medicine
| | | | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
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Barchetta I, Ceccarelli V, Cimini FA, Bertoccini L, Fraioli A, Alessandri C, Lenzi A, Baroni MG, Cavallo MG. Impaired bone matrix glycoprotein pattern is associated with increased cardio-metabolic risk profile in patients with type 2 diabetes mellitus. J Endocrinol Invest 2019; 42:513-520. [PMID: 30132286 DOI: 10.1007/s40618-018-0941-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Osteopontin (OPN), osteoprotegerin (OPG) and osteocalcin (OC) are matrix glycoproteins which mediate bone mineralization; moreover, their effects on glucose/insulin homeostasis have recently been demonstrated. Higher circulating OPN and OPG levels have been associated with the presence of insulin resistance, atherosclerosis and coronary heart disease. No data are available on contextual changes of these markers in type 2 diabetes mellitus (T2DM). Therefore, aims of this study were to evaluate serum OPN, OPG and OC levels in T2DM patients and their clinical correlates. METHODS We recruited 83 consecutive T2DM patients referring to our diabetes outpatient clinics at Sapienza, University of Rome, and 71 non-diabetic sex and age-comparable subjects as a control group. Study population underwent metabolic characterization and carotid ultrasound for intima-media thickness measurement. Plasma OPN, OPG and OC were measured by MILLIPLEX Multiplex Assays Luminex. RESULTS T2DM patients had significantly higher circulating OPN and OPG levels than controls (14.3 ± 13.6 vs 10.6 ± 13.7 ng/ml p < 0.001, 0.70 ± 0.60 vs 0.54 ± 4.1 ng/ml, p = 0.02) while OC levels were similar in the two cohorts (6.35 ± 5.8 vs 7.80 ± 7.0 ng/ml, p = n.s). OPN and OPG positively correlated with greater systolic blood pressure (SBP) values, HOMA-IR and HOMA-β, and with the presence of dyslipidemia and carotid atherosclerosis. The association between greater OPN and OPG levels and SBP was independent from possible confounders (both p = 0.01). CONCLUSIONS Circulating OPN and OPG levels are increased in T2DM patients and identify a particularly unfavourable metabolic profile, mostly expressed by higher SBP. Bone peptides may represent novel markers of vascular stress and accelerated atherosclerosis in diabetes, constituting a possible tool for cardiovascular risk stratification in diabetes.
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Affiliation(s)
- I Barchetta
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - V Ceccarelli
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - F A Cimini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - L Bertoccini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - A Fraioli
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - C Alessandri
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - M G Baroni
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - M G Cavallo
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy.
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Sun Z, Wang Z, Li L, Yan J, Shao C, Bao Z, Jing L, Pang Q, Geng Y, Zhang L. RAGE/galectin-3 yields intraplaque calcification transformation via sortilin. Acta Diabetol 2019; 56:457-472. [PMID: 30603868 DOI: 10.1007/s00592-018-1273-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/10/2018] [Indexed: 12/23/2022]
Abstract
AIMS Macrocalcification and microcalcification present different clinical risks, but the regulatory of their formation was unclear. Therefore, this study explored the underlying mechanisms of macrocalcification and microcalcification in diabetes mellitus. METHODS Anterior tibial arteries of amputated diabetic feet were collected. According to the calcium content, patients were divided into less-calcification group and more-calcification group. And calcification morphology in plaques was observed. For further study, an in vivo mouse diabetic atherosclerosis model and an in vitro primary mouse aortic smooth muscle cell model were established. After the receptors for AGEs (RAGE) or galectin-3 were silenced, calcified nodule sizes and sortilin expression were determined. Scanning electron microscopy (SEM) was performed to detect the aggregation of matrix vesicles with the inhibition or promotion of sortilin. RESULTS Both macro- and microcalcification were found in human anterior tibial artery plaques. Macrocalcification formed after the silencing of RAGE, and microcalcification formed after the silencing of galectin-3. In the process of RAGE- or galcetin-3-induced calcification, sortilin played an important role downstream. SEM showed that sortilin promoted the aggregation of MVs in the early stage of calcification and formed larger calcified nodules. CONCLUSION RAGE downregulated sortilin and then transmitted microcalcification signals, whereas galectin-3 upregulated sortilin, which accelerated the aggregation of MVs in the early stage of calcification and mediated the formation of macrocalcifications, These data illustrate the progression of two calcification types and suggest sortilin as a potential target for early intervention of calcification and as an effective biomarker for the assessment of long-term clinical risk and prognosis.
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MESH Headings
- Adaptor Proteins, Vesicular Transport/genetics
- Adaptor Proteins, Vesicular Transport/metabolism
- Amputation, Surgical
- Animals
- Aorta/metabolism
- Aorta/pathology
- Blood Proteins
- Cells, Cultured
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/pathology
- Diabetic Angiopathies/genetics
- Diabetic Angiopathies/metabolism
- Diabetic Angiopathies/surgery
- Diabetic Foot/pathology
- Diabetic Foot/surgery
- Galectin 3/physiology
- Galectins
- Gene Expression Regulation/drug effects
- Humans
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Plaque, Atherosclerotic/genetics
- Plaque, Atherosclerotic/metabolism
- RNA Interference
- RNA, Small Interfering/pharmacology
- Receptor for Advanced Glycation End Products/physiology
- Signal Transduction/drug effects
- Signal Transduction/genetics
- Streptozocin
- Tibial Arteries/metabolism
- Tibial Arteries/pathology
- Vascular Calcification/genetics
- Vascular Calcification/metabolism
- Vascular Calcification/pathology
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Affiliation(s)
- Zhen Sun
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China.
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
| | - Jinchuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
| | - Zhengyang Bao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
| | - Lele Jing
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
| | - Qiwen Pang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
| | - Yue Geng
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
| | - Lili Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 212001, Zhenjiang, China
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11
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Edelman RR, Koktzoglou I. Noncontrast MR angiography: An update. J Magn Reson Imaging 2019; 49:355-373. [PMID: 30566270 PMCID: PMC6330154 DOI: 10.1002/jmri.26288] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022] Open
Abstract
Both computed tomography (CT) angiography (CTA) and contrast-enhanced MR angiography (CEMRA) have proven to be useful and accurate cross-sectional imaging modalities over a wide range of vascular territories and vascular disorders. A key advantage of MRA is that, unlike CTA, it can be performed without the administration of a contrast agent. In this review article we consider the motivations for using noncontrast MRA, potential contrast mechanisms, imaging techniques, advantages, and drawbacks with respect to CTA and CEMRA, and the level of evidence for using the various MRA techniques. In addition, we explore new developments that promise to expand the reliability and range of clinical applications for noncontrast MRA, along with functional MRA capabilities not available with CTA or CEMRA. Level of Evidence: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:355-373.
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Affiliation(s)
- Robert R. Edelman
- Radiology, Northshore University HealthSystem, Evanston, IL
- Radiology, Northwestern Memorial Hospital, Chicago, IL
| | - Ioannis Koktzoglou
- Radiology, Northshore University HealthSystem, Evanston, IL
- Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL
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Serhal A, Koktzoglou I, Aouad P, Carr JC, Giri S, Morcos O, Edelman RR. Cardiovascular magnetic resonance imaging of aorto-iliac and ilio-femoral vascular calcifications using proton density-weighted in-phase stack of stars. J Cardiovasc Magn Reson 2018; 20:51. [PMID: 30078377 PMCID: PMC6091148 DOI: 10.1186/s12968-018-0479-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/19/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Comparing cardiovascular magnetic resonance (CMR) angiography with computed tomography angiography (CTA), a major deficiency has been its inability to reliably image peripheral vascular calcifications that may impact the choice of interventional strategy and influence patient prognosis. Recently, MRI using a proton density-weighted, in-phase stack of stars (PDIP-SOS) technique has proved capable of detecting these calcifications. The goal of the present study was two-fold: (1) to determine whether magnetic field strength impacts the apparent size and conspicuity of ilio-femoral arterial calcifications; and (2) to determine whether the technique can be accurately applied to image aorto-iliac arterial calcifications. MAIN BODY Two patient cohorts were studied. For the first cohort, ilio-femoral arterial calcifications were imaged at 1.5 Tesla in 20 patients and at 3 Tesla in 12 patients. For the second cohort, aorto-iliac arterial calcifications were imaged in 10 patients at 3 Tesla and one patient at 1.5 Tesla. Qualitative image analysis as well as quantitative analysis using a semi-automated technique were performed using CTA as the reference standard. Qualitatively, most PDIP-SOS CMR images showed good-to-excellent confidence to detect vascular calcifications, with good-to-excellent inter-reader agreement (κ = 0.67 for ilio-femoral region, P < 0.001; κ = 0.80 for aorto-iliac region, P < 0.01). There was an overall excellent correlation (r = 0.98, P < 0.001) and agreement (intraclass correlation coefficient = 0.97, P < 0.001) between PDIP-SOS CMR and CTA measures of calcification volume in both regions, with no overt difference in performance at 1.5 Tesla vs. 3 Tesla for ilio-femoral calcifications. CMR lesion volumes were slightly lower than those measured for CTA. CONCLUSION Using PDIP-SOS CMR, aorto-iliac and ilio-femoral calcifications could be simultaneously evaluated at 3 Tesla in less than six minutes with excellent correlation and agreement to CTA. Our results suggest that PDIP-SOS CMR provides a reliable alternative to CT for pre-interventional evaluation of peripheral vascular calcium burden.
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Affiliation(s)
- Ali Serhal
- Radiology, Northwestern Memorial Hospital, Chicago, IL USA
- Radiology, Northshore University HealthSystem, Walgreen Building, G534, 2650 Ridge Avenue, Evanston, IL 60201 USA
| | - Ioannis Koktzoglou
- Radiology, Northshore University HealthSystem, Walgreen Building, G534, 2650 Ridge Avenue, Evanston, IL 60201 USA
- Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL USA
| | - Pascale Aouad
- Radiology, Northwestern Memorial Hospital, Chicago, IL USA
| | - James C. Carr
- Radiology, Northwestern Memorial Hospital, Chicago, IL USA
| | | | - Omar Morcos
- Surgery, Northshore University HealthSystem, Evanston, IL USA
| | - Robert R. Edelman
- Radiology, Northwestern Memorial Hospital, Chicago, IL USA
- Radiology, Northshore University HealthSystem, Walgreen Building, G534, 2650 Ridge Avenue, Evanston, IL 60201 USA
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13
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Chowdhury MM, Makris GC, Tarkin JM, Joshi FR, Hayes PD, Rudd JHF, Coughlin PA. Lower limb arterial calcification (LLAC) scores in patients with symptomatic peripheral arterial disease are associated with increased cardiac mortality and morbidity. PLoS One 2017; 12:e0182952. [PMID: 28886041 PMCID: PMC5590737 DOI: 10.1371/journal.pone.0182952] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/27/2017] [Indexed: 11/19/2022] Open
Abstract
AIMS The association of coronary arterial calcification with cardiovascular morbidity and mortality is well-recognized. Lower limb arterial calcification (LLAC) is common in PAD but its impact on subsequent health is poorly described. We aimed to determine the association between a LLAC score and subsequent cardiovascular events in patients with symptomatic peripheral arterial disease (PAD). METHODS LLAC scoring, and the established Bollinger score, were derived from a database of unenhanced CT scans, from patients presenting with symptomatic PAD. We determined the association between these scores outcomes. The primary outcome was combined cardiac mortality and morbidity (CM/M) with a secondary outcome of all-cause mortality. RESULTS 220 patients (66% male; median age 69 years) were included with follow-up for a median 46 [IQR 31-64] months. Median total LLAC scores were higher in those patients suffering a primary outcome (6831 vs. 1652; p = 0.012). Diabetes mellitus (p = 0.039), ischaemic heart disease (p = 0.028), chronic kidney disease (p = 0.026) and all-cause mortality (p = 0.012) were more common in patients in the highest quartile of LLAC scores. The area under the curve of the receiver operator curve for the LLAC score was greater (0.929: 95% CI [0.884-0.974]) than for the Bollinger score (0.824: 95% CI [0.758-0.890]) for the primary outcome. A LLAC score ≥ 4400 had the best diagnostic accuracy to determine the outcome measure. CONCLUSION This is the largest study to investigate links between lower limb arterial calcification and cardiovascular events in symptomatic PAD. We describe a straightforward, reproducible, CT-derived measure of calcification-the LLAC score.
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Affiliation(s)
- Mohammed M. Chowdhury
- Division of Vascular and Endovascular Surgery, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
- * E-mail:
| | - Gregory C. Makris
- Division of Vascular and Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Jason M. Tarkin
- Division of Cardiovascular Medicine, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
| | | | - Paul D. Hayes
- Division of Vascular and Endovascular Surgery, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
| | - James. H. F. Rudd
- Division of Cardiovascular Medicine, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
| | - Patrick A. Coughlin
- Division of Vascular and Endovascular Surgery, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
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14
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Ouyang L, Zhang K, Chen J, Wang J, Huang H. Roles of platelet-derived growth factor in vascular calcification. J Cell Physiol 2017; 233:2804-2814. [PMID: 28467642 DOI: 10.1002/jcp.25985] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023]
Abstract
Vascular calcification (VC) is prevalent in aging, and patients with hypertension, chronic kidney disease (CKD), or diabetes. VC is regarded as an active and complex process that involves multiple mechanisms responsible for calcium deposition in vessel wall. In light of the complicated pathogenesis of VC, effective therapy for ameliorating VC is limited. Thus, it is urgent to explore the potential mechanisms and find new targets for the therapy of VC. Platelet-derived growth factor (PDGF), a potent mitogen, and chemoattractant have been found to disturb the vascular homeostasis by inducing inflammation, oxidative stress, and phenotype transition, all of which accelerate the process of VC. The aim of current review is to present a review about the roles of PDGF in affecting VC and to establish a potential target for treating VC.
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Affiliation(s)
- Liu Ouyang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong Province, China
| | - Kun Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong Province, China
| | - Jie Chen
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong Province, China.,Department of Radiation Oncology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingfeng Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong Province, China
| | - Hui Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong Province, China
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15
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Patidar A, Singh DK, Thakur S, Winocour P, Farrington K, Baydoun AR. Diabetes confers in vitro calcific potential on serum which associates with in vivo vascular calcification. Clin Sci (Lond) 2017; 131:991-1000. [PMID: 28320782 PMCID: PMC5900545 DOI: 10.1042/cs20160882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/01/2017] [Accepted: 03/19/2017] [Indexed: 11/17/2022]
Abstract
Although vascular calcification (VC) is prevalent in Type 2 diabetes mellitus (T2DM), underlying mechanisms remain unclear. Neither is it known whether T2DM confers calcific potential (CP) on serum, enabling it to induce VC outside the disease milieu. We, therefore, investigated the CP of serum from controls and subjects with T2DM with and without in vivo VC. Samples from 20 healthy controls and 44 age- and sex-matched patients with T2DM with modification of diet in renal disease estimated glomerular filtration rate (MDRD-4 eGFR) > 60 ml·min-1 were analysed for CP using rat aortic smooth muscle cells in vitro CT scans of femoral arteries identified individuals with in vivo calcification. Serum from subjects with T2DM revealed significantly greater CP than controls. This was further enhanced in the presence of in vivo VC. Addition of β-glycerophosphate (β-GP) plus CaCl2 increased the CP of T2DM serum but not of controls. Along with age, CP was an independent predictor of the presence of VC. In receiver operator curve (ROC) analysis, CP was a significant predictor of femoral arterial VC (C-statistic 0.70: P=0.009). The distribution of CP was bimodal around a cutoff of 100 nmoles of Ca2+ protein mg-1, with a higher proportion of Type 2 diabetes subjects with in vivo calcification (T2DM+) sera above the cutoff value. This group also showed elevated levels of osteoprotegerin (OPG) and matrix Gla protein (MGP). Diabetes confers CP on the serum which is enhanced by the presence of in vivo VC. The CP acquired may be dependent on levels of OPG and MGP. These findings may be clinically relevant for early identification of individuals at risk of VC and for informing therapeutic strategies.
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Affiliation(s)
- Ashish Patidar
- School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB, U.K
| | - Dhruv K Singh
- School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB, U.K
- Renal Unit, Lister Hospital, Coreys Mill Lane, Stevenage SG1 4AB, U.K
| | - Shori Thakur
- School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB, U.K
| | - Peter Winocour
- Department of Diabetes and Endocrinology, QEII Hospital, Howlands, Welwyn Garden City, AL7 4HQ, U.K
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB, U.K
- Renal Unit, Lister Hospital, Coreys Mill Lane, Stevenage SG1 4AB, U.K
| | - Anwar R Baydoun
- School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB, U.K.
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16
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Gong C, Li L, Qin C, Wu W, Liu Q, Li Y, Gan L, Ou S. The Involvement of Notch1-RBP-Jk/Msx2 Signaling Pathway in Aortic Calcification of Diabetic Nephropathy Rats. J Diabetes Res 2017; 2017:8968523. [PMID: 29464183 PMCID: PMC5804331 DOI: 10.1155/2017/8968523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/27/2017] [Accepted: 10/26/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study explored the changes in expression of vascular smooth muscle cell (VSMC) markers and osteogenic markers, as well as the involvement of Notch1-RBP-Jk/Msx2 pathway in a rat model of diabetic nephropathy (DN) with vascular calcification. METHODS A rat model of DN with concomitant vascular calcification was created by intraperitoneal injection of streptozotocin followed by administration of vitamin D3 and nicotine. Biochemical analysis and histological examination of aortic tissue were performed. VSMC markers and osteogenic markers as well as target molecules in Notch1-RBP-Jk/Msx2 were determined by quantitative real-time polymerase chain reaction and immunohistochemical analysis. RESULTS Serum calcium and phosphorus levels were significantly increased in model rats as compared to that in normal controls. Diabetic rats with vascular calcification exhibited mineral deposits in aortic intima-media accompanied by decreased expression of VSMC markers and increased expression of osteogenic markers. Notch1, RBP-Jk, Msx2, Jagged1, and N1-ICD were barely expressed in the aortic wall of normal rats. In contrast, these were significantly increased in the model group at all time points (8, 12, and 16 weeks), as compared to that in the normal rats. CONCLUSION Activation of the Notch1-RBP-Jk/Msx2 signaling pathway may be involved in the development and progression of vascular calcification in DN.
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Affiliation(s)
- Caipan Gong
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Li Li
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Chunmei Qin
- Department of Nephrology, Luzhou People's Hospital, Luzhou, Sichuan 646000, China
| | - Weihua Wu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Qi Liu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Ying Li
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Linwang Gan
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Santao Ou
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
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17
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Zobel EH, von Scholten BJ, Lajer M, Jorsal A, Tarnow L, Rasmussen LM, Holstein P, Parving HH, Hansen TW, Rossing P. High osteoprotegerin is associated with development of foot ulcer in type 1 diabetes. J Diabetes Complications 2016; 30:1603-1608. [PMID: 27469295 DOI: 10.1016/j.jdiacomp.2016.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/24/2016] [Accepted: 07/14/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM The bone-related peptide osteoprotegerin has been linked to vascular calcification and peripheral vascular disease. We investigated the association between osteoprotegerin and development of foot complications in persons with type 1 diabetes. MATERIALS AND METHODS Prospective observational study of 573 persons with type 1 diabetes, 225 women; age [mean±SD] 42.3±10.3years. Plasma osteoprotegerin was measured by ELISA. RESULTS Median (IQR) osteoprotegerin was 2.80(2.35-3.63)μg/L and follow-up time (median (range)) was 12.7(0.1-15.6)years. Endpoints included: new foot ulceration (n=153), Charcot foot (n=14), vascular surgery/amputation (n=53), loss of foot pulse (n=57), and peripheral neuropathy (n=99). In unadjusted analyses, higher osteoprotegerin was associated with development of all endpoints (p≤0.026). Higher osteoprotegerin remained associated with development of foot ulcer, and the combination of vascular surgery/amputation, loss of foot pulse and neuropathy (p≤0.001) in a sex and age adjusted model. After further adjustment (nephropathy status, smoking, HbA1c, systolic blood pressure, serum cholesterol, high sensitivity C-reactive protein, eGFR, and presence of neuropathy and/or claudication and/or foot ulcer at baseline), higher osteoprotegerin remained associated with development of foot ulcer (HR (95% CI) per doubling: 1.75 (1.04-2.97); p=0.037). CONCLUSION Higher osteoprotegerin levels were associated with development of foot ulcer, even after comprehensive adjustment.
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Affiliation(s)
| | | | | | - Anders Jorsal
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Lise Tarnow
- Department of Clinical Research, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark; Health, Aarhus University, Aarhus, Denmark
| | - Lars M Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark; Center for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | - Per Holstein
- Steno Diabetes Center, Gentofte, Denmark; Department of Dermato-venerology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University Hospital of Copenhagen, Denmark
| | - Hans-Henrik Parving
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | - T W Hansen
- Steno Diabetes Center, Gentofte, Denmark
| | - P Rossing
- Steno Diabetes Center, Gentofte, Denmark; Health, Aarhus University, Aarhus, Denmark; Novo Nordisk Foundation Center for Metabolic Research, Copenhagen, Denmark
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Harper E, Forde H, Davenport C, Rochfort KD, Smith D, Cummins PM. Vascular calcification in type-2 diabetes and cardiovascular disease: Integrative roles for OPG, RANKL and TRAIL. Vascul Pharmacol 2016; 82:30-40. [DOI: 10.1016/j.vph.2016.02.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/01/2016] [Accepted: 02/21/2016] [Indexed: 12/14/2022]
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19
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Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease. J Vasc Surg 2016; 64:e1-e21. [DOI: 10.1016/j.jvs.2016.03.420] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/12/2016] [Indexed: 12/13/2022]
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20
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Deas DS, Marshall AP, Bian A, Shintani A, Guzman RJ. Association of cardiovascular and biochemical risk factors with tibial artery calcification. Vasc Med 2015; 20:326-31. [PMID: 25907899 PMCID: PMC5079269 DOI: 10.1177/1358863x15581448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The cardiovascular risk factors that contribute to coronary calcification have been extensively studied while those related to tibial artery calcium are less well defined. We sought to determine the associations between cardiovascular risk factors and tibial artery calcification in a cohort of patients with and without significant peripheral atherosclerosis. A total of 222 patients without end-stage renal disease were identified in a prospectively maintained database containing tibial artery calcification (TAC) scores, and demographic, cardiovascular, and biochemical risk factor information. Patients with prevalent tibial artery calcification were more likely to be older, male, and have a history positive for hypertension, hyperlipidemia, diabetes, and tobacco use. Patients with an abnormal ankle-brachial index (ABI) or symptoms of peripheral artery disease (PAD) were also more likely to have higher calcium values. In analyses using multivariable logistic regression, age, gender, diabetes, and tobacco use maintained their association with prevalent tibial calcification while hypertension, hyperlipidemia and body mass index did not. These associations remained when PAD was added to the model. After adjusting for relevant cardiovascular risk factors, we found that only abnormal ABI, current PAD symptoms, and lower serum calcium values were associated with the presence of tibial artery calcification. In conclusion, in patients without end-stage renal disease, tibial artery calcification has risk factors that are similar but not identical to those for coronary artery calcification and peripheral atherosclerosis.
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Affiliation(s)
- Dale S Deas
- University of Alabama School of Medicine, Birmingham, AL, USA
| | - Andre P Marshall
- Division of Vascular Surgery, Vanderbilt Medical Center, Nashville, TN, USA
| | - Aihua Bian
- Division of Biostatistics, Vanderbilt Medical Center, Nashville, TN, USA
| | - Ayumi Shintani
- Division of Biostatistics, Vanderbilt Medical Center, Nashville, TN, USA
| | - Raul J Guzman
- Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Pérez de Ciriza C, Lawrie A, Varo N. Osteoprotegerin in Cardiometabolic Disorders. Int J Endocrinol 2015; 2015:564934. [PMID: 26078757 PMCID: PMC4442310 DOI: 10.1155/2015/564934] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
Osteoprotegerin (OPG), a glycoprotein traditionally implicated in bone remodelling, has been recently related to cardiovascular disease (CVD). Human studies show a positive relationship between circulating OPG, vascular damage, and CVD, and as such OPG has emerged as a potential biomarker for CVD. This review focuses on the relationship between circulating OPG and different endocrine cardiometabolic alterations such as type 1 and 2 diabetes. The association of OPG with diabetic complications (neuropathy, nephropathy, or retinopathy) as well as with atherosclerosis, coronary artery calcification, morbidity, and mortality is pointed out. Moreover, OPG modulation by different treatments is also established. Besides, other associated diseases such as obesity, hypertension, and metabolic syndrome, which are known cardiovascular risk factors, are also considered.
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Affiliation(s)
- C. Pérez de Ciriza
- Department of Clinical Chemistry, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008 Pamplona, Spain
| | - A. Lawrie
- Department of Cardiovascular Science, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - N. Varo
- Department of Clinical Chemistry, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008 Pamplona, Spain
- *N. Varo:
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Bourron O, Aubert CE, Liabeuf S, Cluzel P, Lajat-Kiss F, Dadon M, Komajda M, Mentaverri R, Brazier M, Pierucci A, Morel F, Jacqueminet S, Massy ZA, Hartemann A. Below-knee arterial calcification in type 2 diabetes: association with receptor activator of nuclear factor κB ligand, osteoprotegerin, and neuropathy. J Clin Endocrinol Metab 2014; 99:4250-8. [PMID: 25013993 DOI: 10.1210/jc.2014-1047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Calcification of the arterial wall in diabetes contributes to the arterial occlusive process occurring below the knee. The osteoprotegerin (OPG)/receptor activator of nuclear factor κB ligand (RANKL) system is suspected to be involved in the calcification process. OBJECTIVE The aim of the study was to investigate whether there is a link between arterial calcification in type 2 diabetes and 1) conventional cardiovascular risk factors, 2) serum RANKL and OPG levels, and 3) neuropathy. PATIENTS AND METHODS We objectively scored, in a cross-sectional study, infrapopliteal vascular calcification using computed tomography scanning in 198 patients with type 2 diabetes, a high cardiovascular risk, and a glomerular filtration rate >30 mL/min. Color duplex ultrasonography was performed to assess peripheral arterial occlusive disease, and mediacalcosis. Peripheral neuropathy was defined by a neuropathy disability score >6. RANKL and OPG were measured in the serum by routine chemistry. RESULTS Below-knee arterial calcification was associated with arterial occlusive disease. In multivariate logistic regression analysis, the variables significantly and independently associated with the calcification score were age (odds ratio [OR] = 1.08; 95% confidence interval [CI] = 1.04-1.13; P < .0001), male gender (OR = 3.53; 95% CI = 1.54-8.08; P = .003), previous cardiovascular disease (OR = 2.78; 95% CI = 1.39-5.59; P = .005), and neuropathy disability score (per 1 point, OR = 1.21; 95% CI = 1.05-1.38; P = .006). The association with ln OPG, significantly associated with calcification score in univariate analysis (OR = 3.14; 95% CI = 1.05-9.40; P = .045), was no longer significant in multivariate analysis. RANKL and OPG/RANKL were not significantly associated with the calcification score. CONCLUSIONS Below-knee arterial calcification severity is clearly correlated with peripheral neuropathy severity and with several usual cardiovascular risk factors, but not with serum RANKL level.
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Affiliation(s)
- Olivier Bourron
- Diabetes and Metabolic Diseases (O.B., C.E.A., S.J., A.H.), Radiology (P.C.), Vascular Surgery (F.L.-K., M.D.), Biostatistics and Clinical Research (A.P.), and Cardiology (M.K.) Departments and Laboratory of Biochemistry (F.M.), Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75013 Paris, France; Sorbonne Universités (O.B., P.C., M.K., A.H.), Université Pierre et Marie Curie University Paris 06, Paris, France; Inserm U1088 (S.L., R.M., M.B., Z.A.M.), Unité de formation et de recherche de Médecine et Pharmacie, Jules Verne Université of Picardy, Amiens, France; Clinical Research Centre Division of Clinical Pharmacology (S.L.), Amiens University Hospital and the Jules Verne University of Picardy, 80000 Amiens, France; Division of Nephrology (Z.A.M.), Ambroise Paré Hospital, 92100 Boulogne-Billancourt, France; Institute of Cardiometabolism and Nutrition (O.B., P.C., M.K., A.H.), 75013 Paris, France; and INSERM UMR_S 1138, Centre de recherche des Cordeliers (O.B., A.H.), 75006 Paris, France
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Petrova NL, Shanahan CM. Neuropathy and the vascular-bone axis in diabetes: lessons from Charcot osteoarthropathy. Osteoporos Int 2014; 25:1197-207. [PMID: 24091593 DOI: 10.1007/s00198-013-2511-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
Emerging evidence from the last two decades has shown that vascular calcification (VC) is a regulated, cell-mediated process orchestrated by vascular smooth muscle cells (VSMCs) and that this process bears many similarities to bone mineralization. While many of the mechanisms driving VSMC calcification have been well established, it remains unclear what factors in specific disease states act to promote vascular calcification and in parallel, bone loss. Diabetes is a condition most commonly associated with VC and bone abnormalities. In this review, we describe how factors associated with the diabetic milieu impact on VSMCs, focusing on the role of oxidative stress, inflammation, impairment of the advanced glycation end product (AGE)/receptor for AGE system and, importantly, diabetic neuropathy. We also explore the link between bone and VC in diabetes with a specific emphasis on the receptor activator of nuclear factor κβ ligand/osteoprotegerin system. Finally, we describe what insights can be gleaned from studying Charcot osteoarthropathy, a rare complication of diabetic neuropathy, in which the occurrence of VC is frequent and where bone lysis is extreme.
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Affiliation(s)
- N L Petrova
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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Huang CL, Wu IH, Wu YW, Hwang JJ, Wang SS, Chen WJ, Lee WJ, Yang WS. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease. PLoS One 2014; 9:e90201. [PMID: 24587279 PMCID: PMC3936008 DOI: 10.1371/journal.pone.0090201] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/27/2014] [Indexed: 11/19/2022] Open
Abstract
Objective The clinical implication of the coronary artery calcium score (CS) is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. Methods and Results Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years) were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03). During the follow-up period (21±11 months), 29 (35%) patients underwent amputation, and 24 (29%) patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18–12.72, p = 0.03) and a 5.16-fold (95% CI 1.13–21.61, p = 0.04) higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. Conclusion Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.
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Affiliation(s)
- Chi-Lun Huang
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - I-Hui Wu
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yen-Wen Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Nuclear Medicine and Cardiovascular Medical Center (Cardiology), Far Eastern Memorial Hospital, New Taipei City, Taiwan
- National Yang-Ming University School of Medicine, Taipei City, Taiwan
| | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shoei-Shen Wang
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Wen-Jone Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan
| | - Wen-Jeng Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
- * E-mail: (WSY); (WJL)
| | - Wei-Shiung Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
- * E-mail: (WSY); (WJL)
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Aubert CE, Cluzel P, Kemel S, Michel PL, Lajat-Kiss F, Dadon M, Hartemann A, Bourron O. Influence of peripheral vascular calcification on efficiency of screening tests for peripheral arterial occlusive disease in diabetes--a cross-sectional study. Diabet Med 2014; 31:192-9. [PMID: 23952656 DOI: 10.1111/dme.12309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/10/2013] [Accepted: 08/12/2013] [Indexed: 01/09/2023]
Abstract
AIMS Pulse palpation and ankle brachial index are recommended to screen for peripheral arterial occlusive disease in people with diabetes. However, vascular calcification can be associated with false negative tests (arteriopathy present despite normal screening tests). We therefore studied the impact of peripheral vascular calcification on the performance of these tests. METHODS This cross-sectional study included 200 people with diabetes at high risk of cardiovascular disease. The main exclusion factor was an estimated glomerular filtration rate < 30 ml/min. Peripheral arterial occlusive disease was diagnosed by colour duplex ultrasonography and peripheral vascular calcification scored by computed tomography scan. We measured sensitivity, specificity, predictive values, accuracy and likelihood ratios of pulse palpation and ankle brachial index, and looked for the impact of calcification on false negative tests (arteriopathy present despite normal screening tests). RESULTS Ankle brachial index alone had poor sensitivity and negative predictive value and high negative likelihood ratio. Pulse palpation had higher sensitivity and negative predictive value. An abnormal pulse palpation, defined by weak or missing pulses, combined with an abnormal ankle brachial index, had the highest sensitivity and negative predictive value (92.3 and 89.8%, respectively). Vascular calcification score was higher in patients with false negative tests, for both pulse palpation and ankle brachial index (P < 0.0001 for all). Ankle systolic blood pressure was higher in patients with false negative tests for pulse palpation (P = 0.004). CONCLUSIONS Below-knee vascular calcification gave a high rate of false negative results for ankle brachial index. Refined pulse palpation combined with ankle brachial index remained the best strategy to screen for peripheral arteriopathy.
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Affiliation(s)
- C E Aubert
- Diabetes and Metabolic Diseases Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Internal Medicine Department, Fribourg Cantonal Hospital, Fribourg, Switzerland
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26
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Zhou YB, Gao Q, Li P, Han Y, Zhang F, Qi YF, Tang CS, Gao XY, Zhu GQ. Adrenomedullin attenuates vascular calcification in fructose-induced insulin resistance rats. Acta Physiol (Oxf) 2013; 207:437-46. [PMID: 23121999 DOI: 10.1111/apha.12033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/24/2012] [Accepted: 10/29/2012] [Indexed: 12/31/2022]
Abstract
AIM To determine the therapeutic effects of adrenomedullin (ADM) on vascular calcification and related molecular mechanism in fructose-induced insulin resistance rats. METHODS Rats received ordinary drinking water or 10% fructose in drinking water for 12 weeks and subcutaneous injection of normal saline or ADM (3.6 μg kg(-1) ) twice a day for the last 4 weeks. Levels of ADM, calcitonin receptor-like receptors (CRLR), receptor activity-modifying proteins (RAMP) as well as calcium content, alkaline phosphatase (ALP) activity, osteoblastic and contractile smooth muscle markers in aortic media were measured. RESULTS The levels of ADM, CRLR, RAMP2 and RAMP3 in aortic media were increased in fructose-fed rats. ADM treatment attenuated the fructose-induced insulin resistance, increased blood pressure, fasting glucose, insulin, triglycerides and cholesterol levels. It improved VSMCs proliferation and disordered arrangement and hyperplasia of elastic fibres in fructose-fed rats. Calcium deposits, calcium content and ALP activity in the aortic media were increased in fructose-fed rats, which were attenuated by ADM treatment. The osteoblastic markers such as osteopontin (OPN), bone morphogenetic protein 2 (BMP2) proteins and core binding factor alpha-1 (Cbfα-1) protein and mRNA expressions were increased in fructose-fed rats. ADM treatment increased the OPN protein expression, but reduced the BMP2 protein, Cbfα-1 protein and mRNA expression. Contractile smooth muscle markers such as α-actin and smooth muscle 22α (SM-22α) were downregulated in fructose-fed rats, which were recovered by ADM treatment. CONCLUSION Administration of ADM attenuates insulin resistance, calcium deposition and osteogenic transdifferentiation in aortic media in fructose-fed rats.
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Affiliation(s)
- Y.-B. Zhou
- Department of Physiology; Key Laboratory of Cardiovascular Disease and Molecular Intervention; Nanjing Medical University; Nanjing; China
| | - Q. Gao
- Department of Physiology; Key Laboratory of Cardiovascular Disease and Molecular Intervention; Nanjing Medical University; Nanjing; China
| | - P. Li
- Department of Physiology; Key Laboratory of Cardiovascular Disease and Molecular Intervention; Nanjing Medical University; Nanjing; China
| | - Y. Han
- Department of Physiology; Key Laboratory of Cardiovascular Disease and Molecular Intervention; Nanjing Medical University; Nanjing; China
| | - F. Zhang
- Department of Physiology; Key Laboratory of Cardiovascular Disease and Molecular Intervention; Nanjing Medical University; Nanjing; China
| | - Y.-F. Qi
- Key Laboratory of Molecular Cardiovascular Science; Ministry of Education; Beijing; China
| | - C.-S. Tang
- Key Laboratory of Molecular Cardiovascular Science; Ministry of Education; Beijing; China
| | - X.-Y. Gao
- Department of Physiology; Key Laboratory of Cardiovascular Disease and Molecular Intervention; Nanjing Medical University; Nanjing; China
| | - G.-Q. Zhu
- Department of Physiology; Key Laboratory of Cardiovascular Disease and Molecular Intervention; Nanjing Medical University; Nanjing; China
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Aoki A, Murata M, Asano T, Ikoma A, Sasaki M, Saito T, Otani T, Jinbo S, Ikeda N, Kawakami M, Ishikawa SE. Association of serum osteoprotegerin with vascular calcification in patients with type 2 diabetes. Cardiovasc Diabetol 2013; 12:11. [PMID: 23302066 PMCID: PMC3558393 DOI: 10.1186/1475-2840-12-11] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/31/2012] [Indexed: 01/22/2023] Open
Abstract
Background Osteoprotegerin is a member of the tumor necrosis factor-related family and inhibits RANK stimulation of osteoclast formation as a soluble decoy receptor. The goal of this study was to determine the relationship of serum osteoprotegerin with vascular calcification in patients with type 2 diabetes. Methods The subjects were 124 patients with type 2 diabetes mellitus, including 88 males and 36 females with a mean (± SD) age of 65.6 ± 8.2 years old. Serum levels of osteoprotegerin, osteocalcin, fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D3 and adiponectin were measured by ELISA. Vascular calcification in the cervical artery was examined by ultrasound sonography. The subjects were divided into 4 quartiles depending on serum osteoprotegerin levels. Results Vascular calcification was significantly higher in the 4th quartile and significantly lower in the 1st quartile of serum osteoprotegerin levels, compared to other quartiles. There were no differences in serum osteoprotegerin and vascular calcification among patients with different stages of diabetic nephropathy, but serum FGF23 levels were elevated in those with stage 4 diabetic nephropathy. Simple regression analysis showed that serum osteoprotegerin levels had significant positive correlations with age, systolic blood pressure and serum adiponectin levels, and significant negative correlations with BMI and serum 25-hydroxyvitamin D3. Conclusions These findings suggest that elevated serum osteoprotegerin may be involved in vascular calcification independently of progression of diabetic nephropathy in patients with type 2 diabetes.
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Affiliation(s)
- Atsushi Aoki
- Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
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