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Wang J, Zhang Y, Ren K, Li Y, Ying K. Hyperhomocysteinemia is associated with the risk of venous thromboembolism in patients with mental illness: a case-control study. Front Psychiatry 2024; 15:1340138. [PMID: 38827445 PMCID: PMC11140473 DOI: 10.3389/fpsyt.2024.1340138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Objective The risk of venous thromboembolism in patients with mental illness has been insufficiently addressed. This study aimed to assess the correlation between hyperhomocysteinemia and venous thromboembolism prevalence among this population. Methods Patients with a diagnosis of mental illness and concurrent venous thromboembolism, admitted to Sir Run Run Shaw Hospital at Zhejiang University School of Medicine between January 2014 and December 2021, were included in the venous thromboembolism group. The control group, approximately twice the size, comprised individuals with mental illness but without venous thromboembolism. Basic clinical data were gathered for both cohorts. Results In psychiatric patients, elevated D-dimer levels(OR=5.60,95% CI 3.28-10.00), hyperhomocysteinemia (OR=2.37,95% CI 1.10-5.14), and hyperprolactinemia(OR= 2.68,95% CI 1.12-6.42)were significant risk factors for venous thromboembolism. According to further subgroup analyses, hyperhomocysteinemia is a significant risk factor associated with pulmonary embolism, with an OR of 5.08 (95% CI 1.20-21.48). An interaction effect between gender and homocysteine level was found, with a p-interaction of 0.022. A subsequent analysis confirmed the association between hyperhomocysteinemia and venous thromboembolism in female psychiatric patients, with an OR of 3.34 (95% CI 1.68-6.65), indicating that hyperhomocysteinemia is a significant risk factor for venous thromboembolism in women. Conclusion Patients with psychiatric disorders were found to have an elevated risk of venous thromboembolism, which was associated with increased levels of D-dimer, hyperprolactinemia, and hyperhomocysteinemia. A strong correlation between hyperhomocysteinemia and pulmonary embolism was identified in patients with mental illnesses. Furthermore, the study revealed that female psychiatric patients with hyperhomocysteinemia constituted a high-risk group for venous thromboembolism. This finding holds significant clinical implications, suggesting that early preventative measures could be implemented for this high-risk population to reduce the incidence of thromboembolic events during hospitalization for psychiatric patients.
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Affiliation(s)
- Jiaoyan Wang
- Division of Pulmonary and Critical Care Medicine, Wenzhou Medical University Affiliated Taizhou Hospital, Linhai, Zhejiang, China
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yingchun Zhang
- Department of mental health, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Keming Ren
- Department of mental health, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yeping Li
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kejing Ying
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Dho-Nagy EA, Brassai A, Lechsner P, Ureche C, Bán EG. COVID-19 and Antipsychotic Therapy: Unraveling the Thrombosis Risk. Int J Mol Sci 2024; 25:818. [PMID: 38255892 PMCID: PMC10815664 DOI: 10.3390/ijms25020818] [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] [Received: 12/16/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
In the context of the COVID-19 pandemic, this study investigates the potential correlation between the increased use of antipsychotic medications and the rising incidence of venous thromboembolism (VTE). As psychiatric disorders surged, the consequential escalation in antipsychotic drug use raised concerns about thrombotic risks. We conducted a comprehensive literature review using PubMed, focusing on articles that intersected COVID-19, antipsychotic medication, and thrombosis. This approach allowed for a nuanced examination of the historical and recent data on antipsychotic drugs and their association with thrombotic events. Our findings reveal a notable link between the use of antipsychotic medications, particularly second-generation antipsychotics, and an increased risk of VTE, including pulmonary embolism and deep vein thrombosis. This association was evident, despite variations in study designs and populations. The study underscores the need for cautious medication management in psychiatric care, especially during pandemic conditions like COVID-19, to mitigate thrombotic risks. It advocates a personalized approach to prescribing antipsychotics, considering individual patient factors and comorbidities, to balance the benefits against potential thrombotic complications.
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Affiliation(s)
- Eszter-Anna Dho-Nagy
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine in English, Preclinical Research Laboratory, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Attila Brassai
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine in English, Preclinical Research Laboratory, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Patrick Lechsner
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine in English, Preclinical Research Laboratory, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Corina Ureche
- Department of Internal Medicine, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Erika-Gyöngyi Bán
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine in English, Preclinical Research Laboratory, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Purdy JC, Shatzel JJ. The hematologic consequences of obesity. Eur J Haematol 2020; 106:306-319. [PMID: 33270290 DOI: 10.1111/ejh.13560] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
The prevalence of obesity is increasing and progressively influencing physician-patient interactions. While there is a sizable amount of data demonstrating that obesity is a state of low-grade inflammation, to our knowledge, there is no single review summarizing its effects on hematologic parameters and thrombotic risk. We performed a literature search which largely surfaced observational studies, with a few systematic reviews and meta-analyses of these studies. We took care to review the mechanisms driving an inflammatory state and obesity's effect on white blood cells, red blood cells, platelets, and thrombotic risk. There is an observed relative, and sometimes absolute leukocytosis driven by this inflammatory state. Obesity is also associated with increased platelet counts and an increased risk for venous thromboembolism (VTE). Lastly, the association between obesity, iron deficiency (ID), and red blood cell counts may be present but remains uncertain. Recognizing the above associations may provide clinicians with reassurance regarding otherwise unexplained hematologic abnormalities in obese individuals. We hope this review will prompt future studies to further understand the underlying mechanisms driving these abnormalities and identify modifiable risk factors and potential therapeutic targets to prevent the development of probable obesity-associated conditions with significant morbidity and mortality, such as ID and VTE.
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Affiliation(s)
- Johanna C Purdy
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Joseph J Shatzel
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA.,Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Vanholder R, Pletinck A, Schepers E, Glorieux G. Biochemical and Clinical Impact of Organic Uremic Retention Solutes: A Comprehensive Update. Toxins (Basel) 2018; 10:toxins10010033. [PMID: 29316724 PMCID: PMC5793120 DOI: 10.3390/toxins10010033] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/21/2017] [Accepted: 12/23/2017] [Indexed: 02/07/2023] Open
Abstract
In this narrative review, the biological/biochemical impact (toxicity) of a large array of known individual uremic retention solutes and groups of solutes is summarized. We classified these compounds along their physico-chemical characteristics as small water-soluble compounds or groups, protein bound compounds and middle molecules. All but one solute (glomerulopressin) affected at least one mechanism with the potential to contribute to the uremic syndrome. In general, several mechanisms were influenced for each individual solute or group of solutes, with some impacting up to 7 different biological systems of the 11 considered. The inflammatory, cardio-vascular and fibrogenic systems were those most frequently affected and they are one by one major actors in the high morbidity and mortality of CKD but also the mechanisms that have most frequently been studied. A scoring system was built with the intention to classify the reviewed compounds according to the experimental evidence of their toxicity (number of systems affected) and overall experimental and clinical evidence. Among the highest globally scoring solutes were 3 small water-soluble compounds [asymmetric dimethylarginine (ADMA); trimethylamine-N-oxide (TMAO); uric acid], 6 protein bound compounds or groups of protein bound compounds [advanced glycation end products (AGEs); p-cresyl sulfate; indoxyl sulfate; indole acetic acid; the kynurenines; phenyl acetic acid;] and 3 middle molecules [β2-microglobulin; ghrelin; parathyroid hormone). In general, more experimental data were provided for the protein bound molecules but for almost half of them clinical evidence was missing in spite of robust experimental data. The picture emanating is one of a complex disorder, where multiple factors contribute to a multisystem complication profile, so that it seems of not much use to pursue a decrease of concentration of a single compound.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Anneleen Pletinck
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Eva Schepers
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Debeij J, van Zaane B, Dekkers OM, Smit JWA, Büller HR, Rosendaal FR, Gerdes VEA, Cannegieter SC, Stuijver DJF. Levels of prolactin in relation to coagulation factors and risk of venous thrombosis. Thromb Haemost 2017; 108:499-507. [DOI: 10.1160/th12-04-0225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/19/2012] [Indexed: 11/05/2022]
Abstract
SummaryThe pituitary hormone prolactin is thought to influence coagulation. We aimed to study the relation between prolactin levels, coagulation factors and risk of venous thrombosis (VT). We used data from a large population based case-control study into aetiology of first VT (MEGA-study). Prolactin levels were determined in 2,068 patients with VT and 2,785 age- and sex matched control subjects. The relation between levels of coagulation factors and prolactin was studied among the controls. In addition, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated for the risk of VT for different cut-off points of prolactin levels based on percentiles determined in the controls. Restricted analysis was performed among cases in whom blood was sampled within six months after VT. We found a rise in factor VIII and von Willebrand factor with increasing levels of prolactin in the controls. An increased risk of VT was observed when blood was sampled within six months after thrombosis (OR 2.9, 95%CI 1.1–8.1) for prolactin levels above the 99th percentile (42.6 μg/l) relative to levels between the 20th to 80th percentile. When blood was sampled more than six months after VT no clear association could be observed (OR 1.3, 95%CI 0.7–2.3). In conclusion, we found a modest association between pro-lactin and symptomatic venous thromboembolism, particularly when blood was sampled close to the event. This may be explained by a causal relation or by prolactin being a marker of stress due to the thrombotic event.
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Inflammatory Cytokines as Uremic Toxins: "Ni Son Todos Los Que Estan, Ni Estan Todos Los Que Son". Toxins (Basel) 2017; 9:toxins9040114. [PMID: 28333114 PMCID: PMC5408188 DOI: 10.3390/toxins9040114] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/13/2017] [Accepted: 03/16/2017] [Indexed: 01/03/2023] Open
Abstract
Chronic kidney disease is among the fastest growing causes of death worldwide. An increased risk of all-cause and cardiovascular death is thought to depend on the accumulation of uremic toxins when glomerular filtration rate falls. In addition, the circulating levels of several markers of inflammation predict mortality in patients with chronic kidney disease. Indeed, a number of cytokines are listed in databases of uremic toxins and uremic retention solutes. They include inflammatory cytokines (IL-1β, IL-18, IL-6, TNFα), chemokines (IL-8), and adipokines (adiponectin, leptin and resistin), as well as anti-inflammatory cytokines (IL-10). We now critically review the cytokines that may be considered uremic toxins. We discuss the rationale to consider them uremic toxins (mechanisms underlying the increased serum levels and evidence supporting their contribution to CKD manifestations), identify gaps in knowledge, discuss potential therapeutic implications to be tested in clinical trials in order to make this knowledge useful for the practicing physician, and identify additional cytokines, cytokine receptors and chemokines that may fulfill the criteria to be considered uremic toxins, such as sIL-6R, sTNFR1, sTNFR2, IL-2, CXCL12, CX3CL1 and others. In addition, we suggest that IL-10, leptin, adiponectin and resistin should not be considered uremic toxins toxins based on insufficient or contradictory evidence of an association with adverse outcomes in humans or preclinical data not consistent with a causal association.
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Prolactin as a predictor of endothelial dysfunction and arterial stiffness progression in menopause. J Hum Hypertens 2017; 31:520-524. [PMID: 28332508 DOI: 10.1038/jhh.2017.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/30/2016] [Accepted: 01/25/2017] [Indexed: 12/26/2022]
Abstract
Postmenopausal women are at increased risk for progression of arteriosclerosis and hypertension. Recent cross-sectional evidence suggests that high normal circulating prolactin levels may accelerate vascular ageing in menopause. Postmenopausal women (n=201) were consecutively recruited from a Menopause Clinic and re-evaluated in at least one follow-up visit within the next 3 years. Baseline circulating prolactin levels were measured while both baseline and follow-up vascular and biochemical measurements were performed. Endothelial function was assessed by flow-mediated dilation (FMD), aortic stiffness by pulse-wave velocity (PWV) and arterial wave reflections by applanation tonometry. Baseline prolactin significantly correlated with lower FMD at follow-up (P=0.005). After multivariable adjustment for age, follow-up time, blood pressure (BP), body mass index, smoking and medication, this correlation remained significant (P=0.003). In addition, baseline circulating prolactin levels were independently associated with changes in mean BP (β=0.131, P=0.021), peripheral diastolic BP (β=0.169, P=0.004) and new-onset hypertension (OR=1.235, P=0.001). Owing to significant interaction between baseline prolactin and age for changes in PWV over time (P=0.036), a subgroup analysis based on median age was performed. This analysis revealed that in women younger than 55 years, prolactin was an independent predictor of changes in PWV over time (P=0.008). In conclusion, high normal circulating prolactin levels predict changes in haemodynamic indices and worsening endothelial function in healthy postmenopausal women. Particularly in young postmenopausal women, prolactin predicts accelerated arterial stiffening.
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Simiti LAV, Todor I, Stoia MA, Goidescu CM, Anton FP, Farcas AD. Better prognosis in overweight/obese coronary heart disease patients with high plasma levels of leptin. ACTA ACUST UNITED AC 2016; 89:65-71. [PMID: 27004027 PMCID: PMC4777471 DOI: 10.15386/cjmed-524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 01/05/2023]
Abstract
Background and aim The involvement of leptin in atherosclerosis is very complex, including inflammation, the oxidative stress and thrombosis. Leptin has atherogenic and also antiatherogenic actions. In obesity elevated leptin levels are not sufficient to prevent disturbances of energy balance, suggesting that obese people are leptin resistant. The aim of the study was to investigate the relationship between baseline plasma levels of leptin and the incidence of new ischemic events in patients with CHD. Methods Plasma levels of leptin in fifty nine consecutive patients (29 men and 30 women) with CHD hospitalized in the County Emergency Clinical Hospital of Cluj-Napoca were measured using commercially available ELISA at admission. Patients with active infectious disease, neoplasia, acute coronary syndrome, stroke, hepatic or renal failure and severe heart failure were excluded The relationship between leptin levels and incident cardiovascular events (angina, nonfatal myocardial infarction or heart failure) over two years follow-up was studied using MEDCALC version 9.6. Results 73.6% patients with CHD were overweight or suffered of obesity. There were no significant differences between women and men regarding the plasma levels of leptin, the body mass index (BMI), the number of rehospitalizations, rehospitalizations/patient, diabetes mellitus, hypertension or dyslipidemia. Only in women plasma levels of leptin are correlated with BMI. As compared with men with overweight and obesity (BMI≥25kg/m2), plasma levels of leptin were significantly higher in women with overweight and obesity (3905.97±463.91 pg/ml vs 1835.17±533.9 pg/ml) (p<0.002). Patient gender could not be demonstrated to influence prognosis. During the two years we recorded one or more readmissions in 26 patients (44%). The analysis of time till readmission using Kaplan-Meier curves, showed that leptin level (cut-off 2000 pg/ml, HR 0.38, 95% CI 0.17–0.83; p=0.01) and BMI (cut-off 28 kg/m2, HR 0.3164, 95% CI 0.145–0.0689; p<0.01) were significantly associated with prognosis. Conclusion Patients with plasma levels of leptin >2000 pg/ml and BMI >28kg/m2 had a better prognosis, suggesting a protective role of leptin in overweight/mild obesity.
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Affiliation(s)
- Luminita Animarie Vida Simiti
- 1 Department of Internal Medicine, Cardiology and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Irina Todor
- Department of Cardiology, Clinical Hospital County, Cluj-Napoca, Romania
| | - Mirela Anca Stoia
- 1 Department of Internal Medicine, Cardiology and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cerasela Mihaela Goidescu
- 1 Department of Internal Medicine, Cardiology and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florin Petru Anton
- 1 Department of Internal Medicine, Cardiology and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Daniela Farcas
- 1 Department of Internal Medicine, Cardiology and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Shen M, Liu X, Zhang H, Guo SW. Transforming growth factor β1 signaling coincides with epithelial-mesenchymal transition and fibroblast-to-myofibroblast transdifferentiation in the development of adenomyosis in mice. Hum Reprod 2015; 31:355-69. [PMID: 26689216 DOI: 10.1093/humrep/dev314] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/25/2015] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION Do platelets have any role in the development of adenomyosis? SUMMARY ANSWER Activated platelets coincide with the release of transforming growth factor (TGF)-β1 and induction of the TGF-β/Smad signaling pathway as well as evidence of epithelial-mesenchymal transition (EMT) and fibroblast-to-myofibroblast transdifferentiation (FMT) in a mouse model of adenomyosis, resulting ultimately in fibrosis, as in adenomyosis. WHAT IS KNOWN ALREADY Both EMT and FMT are known to play vital roles in fibrogenesis in general and in endometriosis in particular. EMT has been implicated in the development of adenomyosis, but this was based primarily on cross-sectional observation. It is unclear as to whether adenomyotic lesions and their microenvironment have the machinery to promote EMT and FMT, resulting ultimately in fibrosis. There has not been any published study on the role of platelets in the development of adenomyosis, even though adenomyotic lesions undergo repeated cycles of tissue injury and repair, which implicates the involvement of platelets and constitutes an environment conducive for fibrogenesis. STUDY DESIGN, SIZE, DURATION Adenomyosis was induced in 28 female ICR mice by neonatal dosing of tamoxifen. Another 32 were neonatally dosed without tamoxifen. These mice were sacrificed serially and their tissue samples were subsequently evaluated. PARTICIPANTS/MATERIALS, SETTING, METHODS Female ICR mice with and without induced adenomyosis were sacrificed in batch at 5, 10, 15, 42 and 60 days of age. The depth of myometrial infiltration of endometrial tissues was assessed and immunohistochemistry analysis of biomarkers of EMT and FMT, as well as TGF-β1, phosphorylated Smad3 (p-Smad3) and markers of proliferation, angiogenesis and extracellular matrix (ECM) deposits was performed in ectopic (for adenomyotic mice) and eutopic (controls) endometrial tissue samples. Masson trichrome and Van Gieson stainings were performed to quantify the extent of fibrosis in lesions. Progesterone receptor isoform B (PR-B) staining also was performed. MAIN RESULTS AND THE ROLE OF CHANCE While TGF-β1 immunoreactivity was consistently low in control endometrium, its level was increased dramatically starting from Day 10, along with the extent of platelet aggregation. Staining for TGF-β1 and p-Smad3 increased progressively as adenomyosis progressed, along with markers for proliferation, angiogenesis and ECM deposits. Consistently, staining of vimentin (a marker for stromal or mesenchymal cells) was also increased while that of E-cadherin (a marker for epithelial cells) was reduced. PR-B staining also decreased progressively. Starting from Day 42, α-SMA staining, a marker for myofibroblasts, was elevated in lesions, while in control endometrium, it was negative. Concomitantly, the extent of fibrosis also was increased. LIMITATIONS, REASONS FOR CAUTION This study is limited by the use of histochemistry and immunohistochemistry analyses only and the lack of intervention. WIDER IMPLICATIONS OF THE FINDINGS Like their endometriotic counterpart, adenomyotic lesions and their microenvironment may contain all the necessary molecular machinery to promote fibrogenesis. Platelet-induced activation of the TGF-β/Smad signaling pathway may be a driving force in EMT and FMT in the development of adenomyosis, leading to fibrosis. This study provides the first piece of evidence that adenomyotic lesions are wounds that undergo repeated injury and healing, and as such, platelets play critical roles in the development of adenomyosis. It suggests the potential for the use of anti-platelet therapy in the treatment of adenomyosis, and also opens a new venue for developing novel biomarkers for diagnostic or prognostic purposes. STUDY FUNDING/COMPETING INTERESTS Support for data collection and analysis was provided by grants from the National Science Foundation of China. None of the authors has anything to disclose.
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Affiliation(s)
- Minhong Shen
- Shanghai Obstetrics/Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Xishi Liu
- Shanghai Obstetrics/Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai 200011, China
| | - Hongqi Zhang
- Department of Anatomy, Histology and Embryology, Shanghai Medical Collage, Fudan University, Shanghai 200032, China
| | - Sun-Wei Guo
- Shanghai Obstetrics/Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai 200011, China
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Doğan BA, Arduç A, Tuna MM, Nasıroğlu NI, Işık S, Berker D, Güler S. Evaluation of atherosclerosis after cessation of cabergoline therapy in patients with prolactinoma. Anatol J Cardiol 2015; 16:440-7. [PMID: 26680550 PMCID: PMC5331378 DOI: 10.5152/anatoljcardiol.2015.6416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine whether atherosclerotic risk markers exist at the moment and after withdrawal of cabergoline (CAB) therapy in patients who had taken a suitable dose of CAB therapy for a suitable period of time before cessation of CAB. METHODS This study was designed as prospective cross-sectional. Out of a total of 115 patients with prolactinoma, 42 non-obese women with microprolactinoma, who met the Pituitary Society criteria (2006) for the withdrawal of long-term CAB therapy, and 30 healthy patients participated in our study. The number of patients excluded from the study were as follows: 34 patients with tumor shrinkage of less than 50%; 10 who received DA treatments for less than 2 years; 9 who were treated with bromocriptine; and 20 who had diabetes mellitus, hypertension, hyperlipidemia, obesity, renal disease, coronary arterial disease, or were tobacco smokers. The patients were evaluated for anthropometric, metabolic, and inflammatory parameters at the time of cessation of CAB therapy and at the 3rd and 12th months after the withdrawal of CAB therapy. Endothelial dysfunction was determined by flow-mediated dilation (FMD) of the brachial artery and carotid intima media thickness (IMT), which were assessed by high resolution ultrasonography (USG) by the same practitioner. RESULTS At the moment of cessation of CAB therapy, the FMD percentage in patients with prolactinoma was worse than that in healthy controls (p=0.0029). After the withdrawal of CAB treatment, fibrinogen (p=0.036), mean platelet volume (MPV) (p<0.001), carotid IMT (p=0.041), and high-density lipoprotein cholesterol (HDL C) (p=0.048) were worse in the relapse patients than those in the remission patients. Furthermore, only MPV values were found to be significantly related to a relapse of hyperprolactinemia among all atherosclerotic risk markers [area under the curve: 0.830 (95% CI 0.685-0.974) (p<0.001)]. CONCLUSION Unfavorable cardiovascular risk profiles are a problem for patients with prolactinoma during cessation and after CAB withdrawal.
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Affiliation(s)
- Berçem Ayçiçek Doğan
- Endocrinology and Metabolism Disease, Ankara Numune Training and Research Hospital; Ankara-Turkey.
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Yilmaz Ö, Calan M, Kume T, Temur M, Yesil P, Senses MY. The effect of prolactin levels on MPV in women with PCOS. Clin Endocrinol (Oxf) 2015; 82:747-52. [PMID: 25359296 DOI: 10.1111/cen.12647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/20/2014] [Accepted: 10/23/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is associated with cardiovascular risk factors including hypertension, obesity, hyperlipidaemia and glucose intolerance. Several studies demonstrated the link between PCOS and an increased risk of cardiovascular disease. Platelets play a crucial role in the development of atherothrombotic disease. Mean platelet volume (MPV) is a marker of platelet size that reflects its activity. Research points to a link between prolactin (PRL) and platelet activation. The purpose of this study was to investigate whether prolactin levels are associated with MPV in women with PCOS. DESIGN The research was designed as a cross-sectional study. PATIENTS Participants were divided into three groups-PCOS patients with mildly elevated PRL levels (n = 72), patients with PCOS with normal PRL levels (n = 207) and healthy controls (n = 90). They were body mass index and age-matched and consecutively recruited. MEASUREMENTS Complete blood counts, serum glucose, prolactin, insulin, lipids, high-sensitivity C-reactive protein and free-testosterone levels were measured. RESULTS Among the three groups, MPV levels were higher in women with PCOS having mildly elevated PRL levels (P < 0·001) and MPV was found to be correlated with PRL levels (r = 0·387, P < 0·001). Multiple regression analysis showed that PRL levels were associated with MPV levels (R(2) = 0·239, β = 0·354, P < 0·001). CONCLUSION Mean platelet volume levels are significantly increased in women with PCOS having mildly elevated PRL. Our results suggest that there is a link between prolactin and MPV levels. In women with PCOS, elevated PRL levels may increase the risk of developing atherothrombotic events via the activation of platelets.
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Affiliation(s)
- Özgür Yilmaz
- Department of Obstetrics and Gynecology, Manisa Merkezefendi State Hospital, Inciralti, Turkey; Department of Obstetrics and Gynecology, Manisa Akhisar State Hospital, Inciralti, Turkey
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Li X, Wu X, Ma Y, Hao Z, Chen S, Fu T, Chen H, Wang H. Oral administration of 5-hydroxytryptophan aggravated periodontitis-induced alveolar bone loss in rats. Arch Oral Biol 2015; 60:789-98. [PMID: 25766472 DOI: 10.1016/j.archoralbio.2015.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/26/2014] [Accepted: 01/31/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE 5-Hydroxytryptophan (5-HTP) is the precursor of serotonin and 5-HTP has been widely used as a dietary supplement to raise serotonin level. Serotonin has recently been discovered to be a novel and important player in bone metabolism. As peripheral serotonin negatively regulates bone, the regular take of 5-HTP may affect the alveolar bone metabolism and therefore influence the alveolar bone loss induced by periodontitis. The aim of this study was to investigate the effect of 5-HTP on alveolar bone destruction in periodontitis. DESIGN Male Sprague-Dawley rats were randomly divided into the following four groups: (1) the control group (without ligature); (2) the 5-HTP group (5-HTP at 25 mg/kg/day without ligature); (3) the L group (ligature+saline placebo); and (4) the L+5-HTP group (ligature+5-HTP at 25 mg/kg/day). Serum serotonin levels were determined by ELISA. The alveolar bones were evaluated with micro-computed tomography and histology. Tartrate-resistant acid phosphatase staining was used to assess osteoclastogenesis. The receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG) expression in the periodontium as well as the interleukin-6 positive osteocytes were analysed immunohistochemically. RESULTS 5-HTP significantly increased serum serotonin levels. In rats with experimental periodontitis, 5-HTP increased alveolar bone resorption and worsened the micro-structural destruction of the alveolar bone. 5-HTP also stimulated osteoclastogenesis and increased RANKL/OPG ratio and the number of IL-6 positive osteocytes. However, 5-HTP treatment alone did not cause alveolar bone loss in healthy rats. CONCLUSION The present study showed that 5-HTP aggravated alveolar bone loss, deteriorated alveolar bone micro-structure in the presence of periodontitis, which suggests 5-HTP administration may increase the severity of periodontitis.
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Affiliation(s)
- Xianxian Li
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Xiangnan Wu
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Yuanyuan Ma
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, PR China
| | - Zhichao Hao
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Shenyuan Chen
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing 401147, PR China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, PR China
| | - Taozi Fu
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Helin Chen
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Hang Wang
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China.
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Adya R, Tan BK, Randeva HS. Differential effects of leptin and adiponectin in endothelial angiogenesis. J Diabetes Res 2015; 2015:648239. [PMID: 25650072 PMCID: PMC4310451 DOI: 10.1155/2015/648239] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/22/2014] [Indexed: 12/11/2022] Open
Abstract
Obesity is a major health burden with an increased risk of cardiovascular morbidity and mortality. Endothelial dysfunction is pivotal to the development of cardiovascular disease (CVD). In relation to this, adipose tissue secreted factors termed "adipokines" have been reported to modulate endothelial dysfunction. In this review, we focus on two of the most abundant circulating adipokines, that is, leptin and adiponectin, in the development of endothelial dysfunction. Leptin has been documented to influence a multitude of organ systems, that is, central nervous system (appetite regulation, satiety factor) and cardiovascular system (endothelial dysfunction leading to atherosclerosis). Adiponectin, circulating at a much higher concentration, exists in different molecular weight forms, essentially made up of the collagenous fraction and a globular domain, the latter being investigated minimally for its involvement in proinflammatory processes including activation of NF-κβ and endothelial adhesion molecules. The opposing actions of the two forms of adiponectin in endothelial cells have been recently demonstrated. Additionally, a local and systemic change to multimeric forms of adiponectin has gained importance. Thus detailed investigations on the potential interplay between these adipokines would likely result in better understanding of the missing links connecting CVD, adipokines, and obesity.
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Affiliation(s)
- Raghu Adya
- Division of Translational and Systems Medicine-Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- *Raghu Adya:
| | - Bee K. Tan
- Division of Translational and Systems Medicine-Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Department of Obstetrics and Gynaecology, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
| | - Harpal S. Randeva
- Division of Translational and Systems Medicine-Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Alix PM, Guebre-Egziabher F, Soulage CO. Leptin as an uremic toxin: Deleterious role of leptin in chronic kidney disease. Biochimie 2014; 105:12-21. [PMID: 25010649 DOI: 10.1016/j.biochi.2014.06.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/30/2014] [Indexed: 12/27/2022]
Abstract
White adipose tissue secretes a large variety of compounds named adipokines amongst which, leptin exhibits pleiotropic metabolic actions. Leptin is an anorexigenic hormone, secreted in proportion of fat mass, with additional effects on the regulation of inflammation, cardiovascular system, immunity, hematopoiesis and bone metabolism. Chronic kidney disease (CKD) is characterized by an increase of plasma leptin concentration that may be explained by a lack of renal clearance. Hyperleptinemia plays a key role in the pathogenesis of complications associated with CKD such as cachexia, protein energy wasting, chronic inflammation, insulin resistance, cardiovascular damages and bone complications. Leptin is also involved in the progression of renal disease through its pro-fibrotic and pro-hypertensive actions. Most of the adverse effects of leptin have been documented both experimentally and clinically. Leptin may therefore be considered as an uremic toxin in CKD. The aim of this review is to summarize the pathophysiological and clinical role of leptin in in vitro studies, experimental models, as well as in patients suffering from CKD.
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Affiliation(s)
- Pascaline M Alix
- Université de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1, F-69621 Villeurbanne, France; Hospices Civils de Lyon, Department of Nephrology, Hôpital E Herriot, Lyon F-69003, France.
| | - Fitsum Guebre-Egziabher
- Université de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1, F-69621 Villeurbanne, France; Hospices Civils de Lyon, Department of Nephrology, Hôpital E Herriot, Lyon F-69003, France
| | - Christophe O Soulage
- Université de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1, F-69621 Villeurbanne, France
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15
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Agustí A, Barberà JA, Wouters EFM, Peinado VI, Jeffery PK. Lungs, bone marrow, and adipose tissue. A network approach to the pathobiology of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 188:1396-406. [PMID: 24175885 DOI: 10.1164/rccm.201308-1404pp] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often suffer other concomitant disorders, such as cardiovascular diseases and metabolic disorders, that influence significantly (and independently of lung function) their health status and prognosis. Thus, COPD is not a single organ condition, and disturbances of a complex network of interorgan connected responses occur and modulate the natural history of the disease. Here, we propose a novel hypothesis that considers a vascularly connected network with (1) the lungs as the main external sensor of the system and a major source of "danger signals"; (2) the endothelium as an internal sensor of the system (also a potential target tissue); and (3) two key responding elements, bone marrow and adipose tissue, which produce both inflammatory and repair signals. According to the model, the development of COPD, and associated multimorbidities (here we focus on cardiovascular disease as an important example), depend on the manner in which the vascular connected network responds, adapts, or fails to adapt (dictated by the genetic and epigenetic background of the individual) to the inhalation of particles and gases, mainly in cigarette smoke. The caveats and limitations of the hypothesis, as well as the experimental and clinical research needed to test and explore the proposed model, are also briefly discussed.
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Affiliation(s)
- Alvar Agustí
- 1 Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Wahlberg J, Tillmar L, Ekman B, Lindahl TL, Landberg E. Effects of prolactin on platelet activation and blood clotting. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 73:221-8. [PMID: 23570413 DOI: 10.3109/00365513.2013.765963] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Increased levels of prolactin often coincide with an increased risk for thromboembolic events, but it is unclear whether a direct causal relation exists. Our aim was to examine the effect of prolactin on platelet function. In addition to using recombinant prolactin for experiments in vitro, we analyzed platelet function by flow cytometry in a group of 13 females with hyperprolactinaemia and 18 healthy female controls. Platelet activation was measured by P-selectin expression and by the amount of platelet-bound fibrinogen after stimulation with adenosine di phosphate (ADP), collagen-related peptide and the protease activated receptor (thrombin receptor) (PAR)-activating peptides PAR4-AP and PAR1-AP. Free oscillation rheometry was used to measure clotting time in whole blood. No significant effect on platelet activation or clotting time could be seen in in vitro experiments by adding recombinant prolactin. However, significantly lower P-selectin expression was found in the hyperprolactinemic group when platelets were activated by ADP (5 and 10 μM) or PAR4-AP. The expression of fibrinogen did not differ between the two groups for any of the activators used. For all samples, inverse significant correlations between P-selectin expression and prolactin concentration were found for both 5 μM ADP (r = - 0.61, p < 0.01), 10 μM ADP (r = - 0.62, p < 0.001) and PAR4-AP (r = - 0.69, p < 0.001). Thrombin cleavage of recombinant prolactin resulting in a 16 kDa C-terminal fragment did not alter the P-selectin expression upon activation. We found an indirect inhibitory effect of prolactin on platelets in hyperprolactinemic patients, suggesting that prolactin might have a protective role in thromboembolic disease.
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Affiliation(s)
- Jeanette Wahlberg
- Division of Endocrinology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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van Zaane B, Squizzato A, Reuwer AQ, van Zanten AP, Twickler MT, Dekkers OM, Cannegieter SC, Büller HR, Gerdes VE, Brandjes DP. Prolactin and Venous Thrombosis. Arterioscler Thromb Vasc Biol 2011; 31:672-7. [DOI: 10.1161/atvbaha.110.209569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bregje van Zaane
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Alessandro Squizzato
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Anne Q. Reuwer
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Anton P. van Zanten
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Marcel T.B. Twickler
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Olaf M. Dekkers
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Suzanne C. Cannegieter
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Harry R. Büller
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Victor E.A. Gerdes
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
| | - Dees P.M. Brandjes
- From the Departments of Internal Medicine (B.v.Z., V.E.A.G., D.P.M.B.) and Clinical Biochemistry (A.P.v.Z.), Slotervaart Hospital, Amsterdam, the Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (B.v.Z., A.S., A.Q.R., H.R.B., V.E.A.G.); Department of Clinical Medicine, University of Insubria, Varese, Italy (A.S., M.T.B.T.); Departments of Clinical Epidemiology (O.M.D., S.C.C.) and Endocrinology and Metabolic Diseases (O.M.D.),
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Landberg E, Dahlström U, Alehagen U. Serum prolactin and macroprolactin in heart failure: no relation to established laboratory or clinical parameters. Ann Clin Biochem 2010; 48:51-6. [DOI: 10.1258/acb.2010.010164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background A few smaller studies have reported that the prolactin concentration is elevated in connection with heart failure. As heart failure is combined with disturbances of several biological systems any or all of which may also influence prolactin concentrations, we wanted to evaluate the relation of prolactin to prognosis in elderly patients. Methods A total of 462 elderly patients from a primary health-care centre, all with symptoms of heart failure, were included. In addition to clinical examination including echocardiography, concentrations of prolactin, macroprolactin, C-reactive protein, thyroid-stimulating hormone and N-terminal pro B-type natriuretric peptide (NT-proBNP) were measured. Patients were then followed for 10 y, and all incidents of cardiovascular mortality were registered. Results After excluding patients with macroprolactin, hyperprolactinaemia was found in 3.7% of the patients. There were no differences in prolactin concentrations or in the frequency of macroprolactin between patients with heart failure and those with normal cardiac function, defined as left ventricular ejection fraction of at least 50%. No significant correlation could be found between NT-proBNP and prolactin. Neither could any association be found between cardiovascular mortality and prolactin concentration during 10 y of follow-up. Conclusions Prolactin concentrations were not associated with cardiovascular mortality or any clinical or biochemical marker of heart failure. Macroprolactin was found in similar frequency among patients with and without heart failure, and showed no correlation with mortality risk.
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Affiliation(s)
- Eva Landberg
- Division of Clinical Chemistry, Department of Clinical and Experimental Medicine
| | - Ulf Dahlström
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Urban Alehagen
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
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Praprotnik S, Agmon-Levin N, Porat-Katz BS, Blank M, Meroni PL, Cervera R, Miesbach W, Stojanovich L, Szyper-Kravitz M, Rozman B, Tomsic M, Shoenfeld Y. Prolactin’s role in the pathogenesis of the antiphospholipid syndrome. Lupus 2010; 19:1515-1519. [DOI: 10.1177/0961203310373781] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Increased levels of serum prolactin have been reported in patients with various autoimmune diseases and have been associated with lupus disease activity. Currently, there is a lack of data regarding hyperprolactinaemia in patients with the antiphospholipid syndrome. Hence, this study was carried out in order to evaluate the prevalence and clinical significance of hyperprolactinaemia in antiphospholipid syndrome. A total of 172 European patients with antiphospholipid syndrome and 100 geographically and sex-matched healthy controls were included in the study; none had obvious causes of hyperprolactinaemia. All patients underwent clinical assessment for disease manifestations, in addition to laboratory assessment for serum prolactin, antiphospholipid antibodies and some other biomarkers of autoimmune diseases. The tests were performed utilizing the LIAISON® Analyzer (DiaSorin, Sallugia Italy). Hyperprolactinaemia was detected in 21/172 patients with antiphospholipid syndrome and 0/100 controls (p < 0.001). This significant difference was present in both genders and was obvious even after subgrouping the patients into primary and secondary antiphospholipid syndrome. When clinical features were compared, hyperprolactinaemia was associated with reproductive failure, including early and late pregnancy loss (p < 0.05), as well as intrauterine growth retardation (p < 0.05). Hyperprolactinaemia was negatively related to arthralgias, venous thrombosis, pulmonary microthrombosis, pulmonary hypertension in both primary antiphospholipid syndrome and antiphospholipid syndrome secondary to other diseases, and to neurological manifestations in primary antiphospholipid syndrome (p<0.05). The data indirectly imply that prolactin may play a role in the pathogenesis of antiphospholipid syndrome, especially antiphospholipid syndrome-related reproductive failure.
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Affiliation(s)
- S. Praprotnik
- Department of Rheumatology, University Clinical Center Ljubljana, Ljubljana, Slovenia
| | - N. Agmon-Levin
- The Zabludowicz Center for Autoimmune Diseases and Department of Medicine B, Sheba Medical Center, Tel-Aviv Israel
| | - BS Porat-Katz
- Faculty of Agricultural, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - M. Blank
- The Zabludowicz Center for Autoimmune Diseases and Department of Medicine B, Sheba Medical Center, Tel-Aviv Israel
| | - PL Meroni
- Division of Rheumatology, Department of Internal Medicine-University of Milan, Italy
| | - R. Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - W. Miesbach
- Medical Clinic , Institute of Transfusion Medicine, University Hospital, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - L. Stojanovich
- Bezhanijska Kosa University Medical Center, Beograd, Serbia
| | - M. Szyper-Kravitz
- The Zabludowicz Center for Autoimmune Diseases and Department of Medicine B, Sheba Medical Center, Tel-Aviv Israel
| | - B. Rozman
- Department of Rheumatology, University Clinical Center Ljubljana, Ljubljana, Slovenia
| | - M. Tomsic
- Department of Rheumatology, University Clinical Center Ljubljana, Ljubljana, Slovenia
| | - Y. Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases and Department of Medicine B, Sheba Medical Center, Tel-Aviv Israel, Incumbent of the Laura Schwarz-Kip Chair for Research of Autoimmune Diseases, Tel-Aviv University, Tel-Aviv, Israel,
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Deligeoroglou E, Athanasopoulos N, Tsimaris P, Dimopoulos KD, Vrachnis N, Creatsas G. Evaluation and management of adolescent amenorrhea. Ann N Y Acad Sci 2010; 1205:23-32. [DOI: 10.1111/j.1749-6632.2010.05669.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Wiens L, Lutze G, Luley C, Westphal S. Platelet count and platelet activation: Impact of a fat meal and day time. Platelets 2009; 18:171-3. [PMID: 17365867 DOI: 10.1080/09537100600930946] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Hyperprolactinaemia is a common condition with varied aetiology. It is more frequent in women, but also seen in men and even in adolescence and childhood. Prolactin is mainly a lactogenic hormone but has other actions. Most cases present with amenorrhoea and infertility and are managed by gynaecologists. However, multidisciplinary involvement may be required in some cases. Evidence relating to aetiology, clinical features, pathogenesis and management has been discussed.
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Balci H, Akgun-Dar K, Gazioglu N, Kapucu A, Bolayirli M, Oz B. The relationship between prolactin (PRL), leptin, nitric oxide (NO), and cytokines in patients with hyperprolactinemia. Pituitary 2009; 12:170-6. [PMID: 18752070 DOI: 10.1007/s11102-008-0140-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Leptin is a key mediator in the maintenance of neuroendocrine homeostasis. The aim of this study was to determine the changes in serum leptin, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), nitric oxide (NO) levels in patients with hyperprolactinemia. The study consists of 16 consecutive patients with high prolactin (PRL) levels (group I) and a control group of 11 normoprolactinemic patients (group II). Pituitary tumor tissues of patients in groups I and II were analyzed for immunohistochemical (IHC) expression of prolactin and leptin. Group I has significantly higher levels of leptin than group II (P < 0.001). There is a strong correlation between PRL and leptin concentrations in group I. However, there were no statistically significant differences for NO, TNF-alpha, IL-6 between the two groups. IHC staining showed that there was strong immunoreactivity for leptin protein in PRL-secreting pituitary adenomas. Double immunostaining of adenoma tissues with PRL and leptin showed that the adenoma cells expressed both. These findings together are suggestive that leptin co-secretion from a prolactinoma may be the cause of increased serum leptin concentration, independently from the peripheral action of prolactin.
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Affiliation(s)
- Huriye Balci
- Cerrahpaşa Medical Faculty, Fikret Biyal Central Research Laboratory, Istanbul University, Istanbul 34300, Turkey.
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Kennedy RL, Malabu U, Kazi M, Shahsidhar V. Management of obesity in the elderly: too much and too late? J Nutr Health Aging 2008; 12:608-21. [PMID: 18953458 DOI: 10.1007/bf03008271] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- R L Kennedy
- James Cook University School of Medicine, Queensland, Australia.
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Baldini M, Airaghi L, Orsatti A, Tedeschi A, Ceraldi T, Sina C, Cappellini MD. Unusual association of a pituitary adenoma and a neurological emergency: case report and diagnostic steps. Intern Emerg Med 2008; 3:297-300. [PMID: 18293056 DOI: 10.1007/s11739-008-0135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
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Ates O, Keles M, Bilen H, Kiziltunc A, Kocer I, Kulacoglu DN, Türkeli M, Baykal O. Increased serum levels of leptin in retinal vein occlusion. TOHOKU J EXP MED 2008; 215:373-6. [PMID: 18679012 DOI: 10.1620/tjem.215.373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Retinal vein occlusion is an important cause of visual loss. Several ocular and systemic conditions have been reported for retinal vein occlusion. The pathogenesis of thrombus formation in the retinal vein, which results in retinal vein occlusion, is unclear. The aim of this study was to investigate the correlation between increased serum leptin levels and the occurrence of retinal vein occlusion (RVO). The study group consisted of 40 patients with RVO (58.1 +/- 6 years old; 17 males and 23 females): 15 patients with central RVO, 23 with branch RVO, and 2 with hemispheric RVO. The patients who had any ocular or systemic pathology were not included in the study. The control group consisted of 40 healthy individuals of similar gender, age, date and type of health survey, and geographic region. The blood samples of the RVO patients (n = 40) and controls (n = 40) were obtained antecubitally. Leptin levels were measured by an enzyme-linked immunosorbent assay (ELISA) method, and Student's t-test was used to determine differences between the groups. The mean serum leptin levels were 12.5 +/- 1.64 ng/ml in patients with RVO and 8.4 +/- 1.22 ng/ml in the control subjects; namely, the mean serum leptin levels were significantly higher in the patients with RVO (p < 0.001). These results suggest that leptin may be involved in the pathogenesis of venous thrombosis in the retina probably through its effects on homeostasis of the vessel wall.
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Affiliation(s)
- Orhan Ates
- Department of Ophthalmology, Medical Faculty, Ataturk University, Erzurum, Turkey.
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Affiliation(s)
- Kwang Kon Koh
- Vascular Medicine and Atherosclerosis Unit, Division of Cardiology, Gachon University Gil Medical Center, 1198 Kuwol-dong, Namdong-gu, Incheon, South Korea 405-760.
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Sagdilek E, Buyukcoskun NI, Ozluk K. Evaluation of platelet function and lack of response to epinephrine in pregnant women. Int J Lab Hematol 2007; 29:302-9. [PMID: 17617081 DOI: 10.1111/j.1365-2257.2006.00844.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previous studies in healthy subjects have demonstrated a lack of response of platelets to epinephrine at a rate of 16-40% on an aggregometer. An association between the increased procoagulant factors during pregnancy and venous thromboembolism is known, and it has also been shown that prolactin levels increase platelet aggregation. We evaluated whether platelet functions in pregnant women and also assessed the lack of response to epinephrine during this period. We compared 27 healthy and volunteering pregnant women with 26 similar control subjects. Platelet functions were assessed with an aggregometer and a Platelet Function Analyzer (PFA-100). Less than 40% response to epinephrine on the aggregometer was defined as an impaired epinephrine response. The aggregation response of epinephrine was normal in 25 of the 27 pregnant women, while two of them showed a late-rising response. Eight of the 26 subject control group (30.8%) showed an impaired response to epinephrine. When we compared the 25 pregnant and 18 control subjects with normal aggregation responses, the maximum aggregation responses to ADP and epinephrine, and the Col/Epi and Col/ADP cartridge closure time values were significantly lower in pregnant women. There were no difference between second and third trimesters as regards platelet function parameters. The fact that no impaired response to epinephrine was detected in pregnant women while a 30% rate was observed in non-pregnant women indicates that the platelet malfunction caused by a disorder in the Gi protein and intracellular mechanisms is bypassed during pregnancy thanks to some physiological changes.
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Affiliation(s)
- E Sagdilek
- Department of Physiology, Faculty of Medicine, Uludag University, Bursa, Turkey.
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Abstract
Leptin, a 167-amino acid peptide hormone produced by white adipose tissue, is primarily involved in the regulation of food intake and energy expenditure. Leptin receptors are expressed in many tissues including the cardiovascular system. Plasma leptin concentration is proportional to body adiposity and is markedly increased in obese individuals. Recent studies suggest that hyperleptinemia may play an important role in obesity-associated cardiovascular diseases including atherosclerosis. Leptin exerts many potentially atherogenic effects such as induction of endothelial dysfunction, stimulation of inflammatory reaction, oxidative stress, decrease in paraoxonase activity, platelet aggregation, migration, hypertrophy and proliferation of vascular smooth muscle cells. Leptin-deficient and leptin receptor-deficient mice are protected from arterial thrombosis and neointimal hyperplasia in response to arterial wall injury. Several clinical studies have demonstrated that high leptin level predicts acute cardiovascular events, restenosis after coronary angioplasty, and cerebral stroke independently of traditional risk factors. In addition, plasma leptin correlates with markers of subclinical atherosclerosis such as carotid artery intima-media thickness and coronary artery calcifications. Inhibition of leptin signaling may be a promising strategy to slow the progression of atherosclerosis in hyperleptinemic obese subjects.
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Affiliation(s)
- Jerzy Beltowski
- Department of Pathophysiology, Medical University, ul. Jaczewskiego 8, 20-090 Lublin, Poland.
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Canavan B, Salem RO, Schurgin S, Koutkia P, Lipinska I, Laposata M, Grinspoon S. Effects of physiological leptin administration on markers of inflammation, platelet activation, and platelet aggregation during caloric deprivation. J Clin Endocrinol Metab 2005; 90:5779-85. [PMID: 16076944 DOI: 10.1210/jc.2005-0780] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Leptin is a nutritionally regulated adipocyte-derived cytokine. Previous studies in obese patients have demonstrated increased inflammatory markers and increased platelet aggregation in association with leptin. However, the effects of leptin administration on markers of inflammation and platelet aggregation in a human model of undernutrition have not previously been studied. OBJECTIVE The objective of the study was to investigate markers of inflammation, platelet activation, and platelet aggregation in a model of caloric deprivation and increased leptin sensitivity. DESIGN This study was a randomized, placebo-controlled study conducted between November 2002 and November 2003. SETTING The study was conducted at an inpatient care setting at the General Clinical Research Center. PARTICIPANTS Twenty healthy, young (18-35 yr old), normal-weight (body mass index, 20-26 kg/m2) women were recruited from local advertisements. No subjects withdrew due to adverse effects. INTERVENTION The effects of physiological recombinant methionyl human leptin or identical placebo administration were investigated over a 4-d fast. MAIN OUTCOME MEASURES The primary outcome measures for this study were C-reactive protein (CRP) and indices of platelet activity. RESULTS Leptin administration prevented the fasting-induced decline in leptin (P < 0.05 vs. placebo at each time point). Leptin administration increased CRP (6.3 +/- 2.4 vs. 0.7 +/- 0.3 mg/liter; P = 0.04), circulating P-selectin (11.6 +/- 10.2 vs. -28.9 +/- 15.6 ng/ml; P = 0.04), and induction of platelet aggregation (5.8 +/- 2.6 vs. -2.7 +/- 2.9%, P = 0.04, percent maximum platelet aggregation) relative to placebo administration (change in leptin vs. change in placebo, respectively, for each variable). Leptin tended to increase serum amyloid A [0.1 +/- 0.2 vs. -0.3 +/- 0.1 log10 (ng/ml); P = 0.07], and the changes in serum amyloid A and CRP were highly correlated (r = 0.83; P < 0.0001). No changes in TNFalpha, IL-6, IL-10, plasminogen activator inhibitor-1, haptoglobin, intercellular adhesion molecule, or vascular cell adhesion molecule were seen between the groups. CONCLUSIONS Our data provide evidence that physiological leptin administration stimulates inflammatory and platelet responses in humans during caloric deprivation.
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Affiliation(s)
- Bridget Canavan
- Program in Nutritional Metabolism, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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STRATMANN B, TSCHOEPE D. Hemostatic abnormalities associated with obesity and the metabolic syndrome. J Thromb Haemost 2005. [DOI: 10.1111/j.1538-7836.2005.01302.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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