Weight-Loss Induced Changes in Plasma Factor VII Coagulant Activity and Relation to the Factor VII Arg/Gln353 Polymorphism in Moderately Obese Adults

Acquired factor VII deficiency in pediatric inflammatory bowel disease: Report of three cases

Bleeding disorders can exacerbate gastrointestinal bleeding in inflammatory bowel disease (IBD) at the time of diagnosis or flares. Factor VII (FVII) deficiency is a life-threatening rare congenital bleeding disorder in childhood. This study describes three adolescent patients with IBD accompanied by acquired FVII deficiency. This is the first case series of patients with IBD accompanied by FVII deficiency. We hypothesized that inflammation, accelerated consumption, disease severity, and weight loss can cause decreased FVII activity in patients diagnosed with IBD. To control intestinal bleeding, we must keep in mind factor deficiencies in IBD.

Reduced carotid intima-media thickness in systemic lupus erythematosus patients treated with cyclosporine A

BACKGROUND

Patients with systemic lupus erythematosus (SLE) are at risk of atherosclerosis. An increased carotid intima-media thickness (IMT) is considered to be a marker of early atherosclerosis. Objective To determine influential factors for increased carotid IMT in SLE patients.

METHODS

We evaluated the impact of conventional risk factors for atherosclerosis on carotid IMT in 427 healthy controls and of clinical factors on carotid IMT in 94 SLE patients. Carotid IMT was measured by using a newly developed computer-automated system. Unconditional logistic regression was used to assess the adjusted odds ratios (ORs) and 95 % confidence intervals (95 % CI).

RESULTS

Multivariate-adjusted mean carotid IMT (mm) was significantly reduced in SLE patients (0.51, 95 % CI = 0.36-0.66) compared to healthy controls (0.55, 95 % CI = 0.40-0.70) (P = 0.003). The SLE Disease Activity Index (SLEDAI) was associated with carotid IMT in a dose-dependent manner (Ptrend = 0.041). The current use of cyclosporine A (adjusted OR = 0.02, 95 % CI = 0.01-0.40, P = 0.011) and a history of steroid pulse therapy (adjusted OR = 0.01, 95 % CI = 0.01-0.25, P = 0.006) were significantly associated with a decreased risk of increased carotid IMT.

CONCLUSIONS

Our findings suggest that the current use of cyclosporine A can protect against increased carotid IMT, leading to a decreased risk of arteriosclerosis. Future studies with a larger sample size need to confirm that this association holds longitudinally.

Network analysis of hepatic genes responded to high-fat diet in C57BL/6J mice: nutrigenomics data mining from recent research findings

Obesity and its associated complications, including diabetes, dyslipidemia, atherosclerosis, and some cancers, have been a global health problem with a rapid increase of the obese population. In this study, we selected 31 obesity candidate genes in the liver of high-fat-induced obese C57BL/6J mice through investigation of literature search and analyzed functional protein-protein interaction of the genes using the STRING database. Most of the obesity candidate genes were closely connected through lipid metabolism, and in particular acyl-coenzyme A oxidase 1 appeared to be a core obesity gene. Overall, genes involved in fatty acid beta-oxidation, fatty acid synthesis, and gluconeogenesis were up-regulated, and genes involved in sterol biosynthesis, insulin signaling, and oxidative stress defense system were down-regulated with a high-fat diet. Future identification of core obesity genes and their functional targets is expected to provide a new way to prevent obesity by phytochemicals or functional foods on the basis of food and nutritional genomics.

Genetic variants influencing effectiveness of weight loss strategies

Body weight excess has an increasingly high prevalence in the world. Obesity is a complex disease of multifactorial origin with a polygenic condition affected by environmental factors. Weight loss is a primary strategy to treat obesity and its morbidities. Weight changes through life depend on the interaction of environmental, behavioral and genetic factors. Interindividual variation of weight loss in response to different types of interventions (behavioral, caloric restriction, exercise, drug or surgery) has been observed. In this article, currently available data on the role of candidate gene polymorphisms in weight loss are reviewed. Even though control of weight loss by genotype was described in twin and family studies, it is premature to recommend use of genotyping in the design of therapeutic diets or drug treatment. Future studies will have to be large in order to assess the effects of multiple polymorphisms, and will have to control factors other than diet.

Carotid intima-media thickness and markers of inflammation, endothelial damage and hemostasis

BACKGROUND

Different soluble molecules involved in inflammation, endothelial damage, or hemostasis are recognized as potential cardiovascular risk markers. Studies to assess the role of these markers in the atherosclerotic process by evaluating their relationship to carotid intima-media thickness (C-IMT) tend to provide contrasting results.

PURPOSE

To perform a review of studies addressing the association between C-IMT and soluble markers and to investigate whether the observed inconsistencies could be explained by the characteristics of the patients included in different studies, for example prevalence of atherosclerotic disease (atherosclerotic burden), gender, age, or occurrence of specific vascular risk factors (VRFs).

DATA SOURCES

PubMed and Embase (January 1990 to March 2006).

STUDY SELECTION

Articles in English reporting original cross-sectional studies.

DATA EXTRACTION

Two authors independently extracted data on study design, population, sample size, ultrasonic methodology, and statistical approach.

DATA SYNTHESIS

Despite the marked heterogeneity of results presented in the literature, meta-analysis established that studies showing positive associations between C-IMT and plasma levels of C-reactive protein (CRP) or fibrinogen are in the majority. Funnel plot analyses suggested the absence of an important publication bias. Data on the relationships between C-IMT and other soluble markers are by contrast scanty, contradictory, or unconfirmed by multivariate (as opposed to univariate) analyses, and the freedom from publication bias here cannot be vouched for. The degree of atherosclerotic burden in the population studied does not account for the heterogeneity of findings reported. Gender, noninsulin-dependent diabetes mellitus (NIDDM) and hypercholesterolemia influence the association between C-IMT and CRP. Blood pressure and hypercholesterolemia influence the association between C-IMT and fibrinogen. For all the other soluble markers considered, the number of groups was too small for this kind of statistical considerations.

LIMITATIONS

Heterogeneity in ultrasound methodologies and in statistical approach limited comparability between studies. For most soluble markers, publication bias of positive results cannot be excluded.

CONCLUSIONS

Only CRP and fibrinogen seem to be unequivocally related to C-IMT. For all the other soluble markers considered, no clear-cut conclusions can be drawn.

Adipose Tissue and Atherothrombosis

Obesity is associated with increased cardiovascular mortality and morbidity mainly through insulin resistance. Dysregulation of protein secretion by adipose tissue is involved in obesity-related diseases. Adipose tissue contributes to create a subinflammatory status which could explain the disturbances in the haemostatic and fibrinolytic systems observed in obesity. Elevated plasma levels of PAI-1 demonstrated the strongest association with the degree of insulin resistance and could be an underlying mechanism for the thrombotic tendency and the progression of atherothrombosis during obesity. The effect of PAI-1 was examined on adipose tissue growth in several mouse models as well as on adipocyte differentiation in vitro. Most of the data indicate that PAI-1 can effectively modulate weight gain and may be a potential therapeutic target for controlling cardiovascular morbidity in obese subjects.

Effects of HMG-CoA reductase inhibitors on coagulation and fibrinolysis processes

Recent large clinical trials have demonstrated that HMG-CoA reductase inhibitors, or statins, markedly reduce morbidity and mortality when used in the primary and secondary prevention of cardiovascular disease. It has been established that the benefits of statin therapy in cardiovascular disease can be explained not only by the lipid-lowering potential of statins but also by nonlipid-related mechanisms (so-called "pleiotropic effects") that contribute to the positive effect of statins on the incidence of cardiovascular events. The coagulation and fibrinolytic systems are two separate but reciprocally linked enzyme cascades that regulate the formation and breakdown of fibrin. Numerous studies have demonstrated that disturbances of coagulation and fibrinolysis contribute to the development and progression of atherosclerosis, and that they affect the incidence of atherosclerosis-related clinical events. High plasma levels or activities of fibrinogen, factor VII, factor VIII, von Willebrand factor (vWF), soluble thrombomodulin, tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) are thought to be associated with increased morbidity and mortality related to cardiovascular disease. Experimental studies and many clinical studies have recently shown that statins produce favourable effects on haemostatic parameters, including those that are risk factors for cardiovascular disease. Statins diminish procoagulant activity, which is observed at different stages of the coagulation cascade, including tissue factor (TF) activity, conversion of prothrombin to thrombin and thrombin activity. In some studies, statins also reduced fibrinogen levels. By altering the levels and activities of tPA and PAI-1, statins seem to stimulate fibrinolysis. The data on the effects of combined treatment with statins and other drugs on haemostasis are rather limited. They suggest that statins combined with fibric acid derivatives, omega-3 fatty acids and 17beta-estradiol are superior to statins alone. The only two clinical studies performed in patients with acute coronary syndromes showed a relatively weak effect of statins on haemostasis in those patients. Although various statins may produce different effects on individual variables, there are no convincing data showing that differences in their physicochemical and pharmacokinetic properties significantly alter their net effect on excessive procoagulant activity. Apart from the lipid-lowering effect, statins suppress the synthesis of several important nonsterol isoprenoids derived from the mevalonate pathway, especially farnesyl and geranylgeranyl pyrophosphates, which via enhanced protein prenylation, are involved in the regulation of many cellular processes. It is presumed that the inhibitory effect of statins on the mevalonate pathway is involved in the regulation of some key steps of coagulation and fibrinolysis processes. In this way they probably regulate the synthesis of TF, tPA and PAI-1, and perhaps they also control the generation and activity of thrombin. The beneficial effects of statins on coagulation and fibrinolysis may be responsible for their ability to decrease the number of cardiovascular events. The lipid-independent effects of statins on haemostasis may contribute to the marked decrease in the incidence rates of mortality, hospitalisation and revascularisation in patients treated with these drugs.

Interaction of physical activity and diet: implications for haemostatic factors

Regular moderate intensity physical activity and habitual diet providing no more than one third of energy from fats have been recommended for the prevention of atherosclerotic diseases. The background for these guidelines is the key role of plasma lipids. However, the importance of thrombogenesis in acute myocardial infarction has become obvious during the last decade. Hyperlipidaemia and excess of adipose tissue increase platelet aggregability and blood coagulation, and decrease fibrinolysis. Both regular physical activity and dietary fat reduction decrease blood lipids and body fat thereby diminishing the risk of thrombosis. Currently, data on interactions between physical activity and diet on haemostasis are scarce, and the few studies available have not demonstrated additional effects when these two lifestyle modifications have been combined. This paper is restricted only to studies using controlled randomized design. Regular moderate intensity physical activity as well as diet rich in omega-3 fatty acids decrease platelet aggregability. The effects of regular physical activity on plasma fibrinogen remain contradictory, while the impact of diet is even less clear. Plasminogen activator inhibitor-1, a possible link between insulin resistance syndrome and coronary heart disease, may decrease due to physical training or low fat diet. It can be hypothesized that moderation in physical activity and diet carries a more powerful impact on blood coagulation and fibrinolysis than either lifestyle modification alone. Studies focusing on the interactions of regular moderate physical activity and fat-modified diet are needed in efforts to optimize the preventive actions by lifestyle changes.