Inflammatory biomarkers: impact for diabetes and diabetic vascular disease

The Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Outcomes in Patients With Diabetes: A Systematic Review and Meta-Analysis

The neutrophil-to-lymphocyte ratio (NLR) has been found as a potential biomarker for acute inflammation and the prognosis of different diseases. Here, we provided a meta-analysis of studies evaluating the association of NLR with cardiovascular outcomes among patients with diabetes. We searched PubMed, Scopus, and Web of Science databases from inception to April 06, 2024, to include papers based on eligible criteria. The outcomes of interest were all-cause mortality, cardiovascular mortality, major adverse cardiovascular events, myocardial infarction, and stroke. The pooled risk ratio (RR) and corresponding 95% confidence intervals (CI) were reported. Meta-analysis was performed using StataMP 14.0. A total of 15 studies involving 407,512 participants were included. Meta-analysis revealed that both categorical and continuous NLRs are linked to increased risk of all-cause mortality (RR = 1.68; 95% CI, 1.49-1.88; P < 0.001 and RR = 1.03; 95% CI, 1.03-1.03; P < 0.001, respectively) and cardiovascular mortality (RR = 2.04; 95% CI, 1.58-2.63; P < 0.001 and RR = 1.25; 95% CI, 1.19-1.32; P < 0.001, respectively) in patients with diabetes. However, NLR was not associated with the risk of major adverse cardiovascular events, myocardial infarction, and stroke in patients with diabetes. Subgroup analysis revealed sample size as the main source of the heterogeneity found between studies. The findings suggest NLR as a prognostic marker for mortality outcomes in patients with diabetes, providing clinicians with a noninvasive and readily available indicator for risk assessment and patient management.

Multiomics insight into the role of glucagon-like peptide-1 receptor agonists in heart failure

AIMS

Cardiovascular diseases, such as atrial fibrillation, coronary artery disease, heart failure (HF) and ischaemic stroke, are leading causes of death globally and exert major global health burden. Recent studies suggest that glucagon-like peptide-1 receptor agonists (GLP1Ra), a novel class of antidiabetic drugs, may not only help manage blood glucose but also reduce the risks of cardiovascular diseases. However, the mechanisms through which GLP1Ra protects against cardiovascular diseases, remain incompletely understood.

METHODS AND RESULTS

Genome-wide association study dates were used to investigate the impact of GLP1Ra on cardiovascular diseases, including atrial fibrillation (1,202,168 European and 28,612 East Asian), coronary artery disease (501,756 European and 183,134 East Asian), heart failure (HF) (1,350,497 European and 203,040 East Asian) and ischaemic stroke (689,168 European and 192,383 East Asian). Genetic instruments were selected from the GLP1R gene region, and two-sample Mendelian randomization (MR) analyses were conducted to assess the causal effects of GLP1Ra on cardiovascular diseases in European and East Asian populations. Summary-data-based MR analyses were performed for further validation using expression quantitative trait loci data. Mediation analysis evaluates the role of circulating inflammatory proteins and metabolites in mediating the effects of GLP1Ra. Meantime, we performed a series of sensitivity analyses to confirm the robustness of the results. The result demonstrated significant causal association between GLP1Ra and HF in European populations (odds ratio: 0.60, 95% CI 0.51-0.72, P = 2.76 × 10-8), and this result was confirmed by SMR analyses. No significant associations were found for atrial fibrillation, coronary artery disease, ischaemic stroke in European populations or all cardiovascular diseases in East Asian populations. GLP1Ra was found to influence 27 circulating inflammatory proteins and 146 circulating metabolites. Among them, 4 inflammatory proteins and 17 metabolites are associated with HF. Mediation analysis indicated that the protective effect of GLP1Ra on HF was mediated by circulating fibroblast growth factor 5 (FGF5) and N-acetylglycine (NAC), with a mediated proportion of 4.37% and 8% of the total effect, respectively.

CONCLUSIONS

This study provides multiomics insight into the role of GLP1Ra in cardiovascular diseases, especially in HF and the underlying pathway. The results suggest that GLP1Ra may exert anti-HF effects by reducing the concentration of circulating FGF5 and increasing the levels of circulating NAC, and enriches the potential mechanisms through which GLP1Ra alleviates HF.

Caralluma fimbriata Extract Improves Vascular Dysfunction in Obese Mice Fed a High-Fat Diet

BACKGROUND

Obesity is a risk factor for developing cardiovascular diseases (CVDs) by impairing normal vascular function. Natural products are gaining momentum in the clinical setting due to their high efficacy and low toxicity. Caralluma fimbriata extract (CFE) has been shown to control appetite and promote weight loss; however, its effect on vascular function remains poorly understood. This study aimed to determine the effect that CFE had on weight loss and vascular function in mice fed a high-fat diet (HFD) to induce obesity, comparing this effect to that of lorcaserin (LOR) (an anti-obesity pharmaceutical) treatment.

METHODS

C57BL/6J male mice (n = 80) were fed a 16-week HFD to induce obesity prior to being treated with CFE and LOR as standalone treatments or in conjunction. Body composition data, such as weight gain and fat mass content were measured, isometric tension analyses were performed on isolated abdominal aortic rings to determine relaxation responses to acetylcholine, and immunohistochemistry studies were utilized to determine the expression profiles on endothelial nitric oxide synthase (eNOS) and cell stress markers (nitrotyrosine (NT) and 78 kDa glucose-regulated protein (GRP78)) in the endothelial, medial and adventitial layers of aortic rings.

RESULTS

The results demonstrated that CFE and CFE + LOR treatments significantly reduced weight gain (17%; 24%) and fat mass deposition (14%; 16%). A HFD markedly reduced acetylcholine-mediated relaxation (p < 0.05, p < 0.0001) and eNOS expression (p < 0.0001, p < 0.01) and significantly increased NT (p < 0.05, p < 0.0001) and GRP78 (p < 0.05, p < 0.01, p < 0.001). Obese mice treated with CFE exhibited significantly improved ACh-induced relaxation responses, increased eNOS (p < 0.05, p < 0.01) and reduced NT (p < 0.01) and GRP78 (p < 0.05, p < 0.01) expression.

CONCLUSIONS

Thus, CFE alone or in combination with LOR could serve as an alternative strategy for preventing obesity-related cardiovascular diseases.

Inflammation: The Cause of All Diseases

Inflammation is an essential biological process that serves as the body's first line of defence against harmful stimuli, including pathogens, damaged cells, and irritants [...].

Advances in the mechanisms of Gardenia jasminoides Ellis in improving diabetes and its complications

Gardenia jasminoides Ellis (Zhi-zi), which belongs to the Rubiaceae family, has been used mainly with its fry fruit for thousands of years, and it is an herb with the homology of medicine and food. In traditional Chinese medicine (TCM) theory, Zhi-zi can be used for "Quench Xiaoke", meaning for therapying diabetes in modern medicine. Based on numerous pharmacological studies, Gardenia jasminoides Ellis (Zhi-zi), and its ingredients, mainly including iridoid glycosides and carotenoids (crocins), possess potent antioxidant and anti-inflammatory properties, and can promote insulin secretion and sensitization, stimulate GLP-1 pathway activity, and protect islet β cells and the macro- and microvascular systems. These properties are the primary reasons why Zhi-zi and its ingredients are effective in reducing glucose levels, treating diabetes, and preventing its complications. This review aims to summarize the current situation and the advances of the studies on the mechanisms of Zhi-zi in improving diabetes and its complications, and it is expected to provide useful and systematic references for future research and clinical application of Zhi-zi and its active ingredients in the therapy of diabetes and complications.

A systematic review of astragaloside IV effects on animal models of diabetes mellitus and its complications

Context

Diabetes mellitus (DM) is one of the fastest-growing diseases worldwide; however, its pathogenesis remains unclear. Complications seriously affect the quality of life of patients in the later stages of diabetes, ultimately leading to suffering. Natural small molecules are an important source of antidiabetic agents.

Objective

Astragaloside IV (AS-IV) is an active ingredient of Astragalus mongholicus (Fisch.) Bunge. We reviewed the efficacy and mechanism of action of AS-IV in animal and cellular models of diabetes and the mechanism of action of AS-IV on diabetic complications in animal and cellular models. We also summarized the safety of AS-IV and provided ideas and rationales for its future clinical application.

Methods

Articles on the intervention in DM and its complications using AS-IV, such as those published in SCIENCE, PubMed, Springer, ACS, SCOPUS, and CNKI from the establishment of the database to February 2022, were reviewed. The following points were systematically summarized: dose/concentration, route of administration, potential mechanisms, and efficacy of AS-IV in animal models of DM and its complications.

Results

AS-IV has shown therapeutic effects in animal models of DM, such as alleviating gestational diabetes, delaying diabetic nephropathy, preventing myocardial cell apoptosis, and inhibiting vascular endothelial dysfunction; however, the potential effects of AS-IV on DM should be investigated.

Conclusion

AS-IV is a potential drug for the treatment of diabetes and its complications, including diabetic vascular disease, cardiomyopathy, retinopathy, peripheral neuropathy, and nephropathy. In addition, preclinical toxicity studies indicate that it appears to be safe, but the safe human dose limit is yet to be determined, and formal assessments of adverse drug reactions among humans need to be further investigated. However, additional formulations or structural modifications are required to improve the pharmacokinetic parameters and facilitate the clinical use of AS-IV.

The benefits of physical activity in middle-aged individuals for cardiovascular disease outcomes

Regular physical activity (PA) has a positive role in preventing cardiovascular disease (CVD). Due to a trend toward a more sedentary lifestyle, the middle-aged population (35-65 years) is at greater risk of developing CVD. It is well established that PA improves cardiorespiratory fitness and reduces the risk of cardiovascular mortality and cardiovascular events, including stroke, coronary heart disease, heart failure, hypercholesterolemia, atherosclerosis, diabetes, and blood pressure. PA can potentially decrease oxidative stress and systemic inflammation, which are the two main underlying mechanisms leading to CVD. By reducing CRP, TNF-α, INF-γ, NF-κB and increasing IL-10, IL-4, and IL-8, PA can prevent the initiation and progression of CVD in middle-aged adults, highlighting the importance of being physically active for this age group. The general recommendation for PA to prevent CVD is at least 150 min/week at a moderate level of intensity; the type of PA should be adapted to the fitness level and medical condition of the individual. However, standardized guidelines for middle-aged individuals with cardiovascular events still need to be established.

Glycemic Control and Plasma Levels of Pro-Inflammatory and Pro-Thrombotic Biomarkers in Diabetic Patients Presenting with Acute Pulmonary Embolism

Type I and type II diabetes are closely associated with a pro-inflammatory state and to a pro-thrombotic state. The role of glycemic control in pulmonary embolism (PE) is poorly understood and requires additional investigation. The aim of this study is to investigate the relationship between glycemic control and thrombo-inflammatory biomarkers in a PE patient cohort compared to normal samples. Demographic and clinical information for 86 diabetic patients and 106 non-diabetic patients presenting with acute PE was collected via retrospective chart review. Plasma levels of pro-inflammatory (C-reactive protein [CRP], tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]) and pro-thrombotic (d-dimer, plasminogen activator inhibitor-1 [PAI-1], tissue plasminogen activator [tPA], thrombin activatable fibrinolysis inhibitor [TAFI], von-Willebrand factor [vWF], endogenous glycosaminoglycans [GAGs]) biomarkers were drawn within 24 hours of diagnosis of acute PE. Data was also obtained for a population of healthy adult controls. All the pro-inflammatory and pro-thrombotic biomarkers were elevated in diabetic PE patients in comparison to healthy controls. None of the biomarkers were elevated in diabetic PE patients when compared to non-diabetic PE patients. There was no difference in the levels of the pro-inflammatory biomarkers according to glycemic control. The plasma level of TAFI was elevated in diabetic patients with poor glycemic control. Diabetic patients were more likely to have a more severe PE. These studies demonstrate that thrombo-inflammatory biomarkers are elevated in diabetic PE patients with associated comorbidities in comparison to normal individuals. However, there is no difference between the PE cohort alone in comparison to PE with diabetes. The role of TAFI within the continuum of diabetic vascular disease warrants additional investigation.

Using wearable biological sensors to provide personalized feedback to motivate behavioral changes: Study protocol for a randomized controlled physical activity intervention in cancer survivors (Project KNOWN)

Regular physical activity reduces the progression of several cancers and offers physical and mental health benefits for cancer survivors. However, many cancer survivors are not sufficiently active to achieve these health benefits. Possible biological mechanisms through which physical activity could affect cancer progression include reduced systemic inflammation and positive changes in metabolic markers. Chronic and acute hyperglycemia could have downstream effects on cell proliferation and tumorigenesis. One novel strategy to motivate cancer survivors to be more active is to provide personalized biological-based feedback that demonstrates the immediate positive impact of physical activity. Continuous glucose monitors (CGMs) have been used to demonstrate the acute beneficial effects of physical activity on insulin sensitivity and glucose metabolisms in controlled lab settings. Using personal data from CGMs to illustrate the immediate impact of physical activity on glucose patterns could be particularly relevant for cancer survivors because they are at a higher risk for developing type 2 diabetes (T2D). As a pilot project, this study aims to (1) test the preliminary effect of a remotely delivered physical activity intervention that incorporates personalized biological-based feedback on daily physical activity levels, and (2) explore the association between daily glucose patterns and cancer-related insulin pathway and inflammatory biomarkers in cancer survivors who are at high risk for T2D. We will recruit 50 insufficiently active, post-treatment cancer survivors who are at elevated risk for T2D. Participants will be randomly assigned into (1) a group that receives personalized biological feedback related to physical activity behaviors; and (2) a control group that receives standard educational material. The feasibility and preliminary efficacy of this wearable sensor-based, biofeedback-enhanced 12-week physical activity intervention will be evaluated. Data from this study will support the further refinement and enhancement of a more comprehensive remotely delivered physical activity intervention that targets cancer survivors.

Trial registration: ClinicalTrials.gov Identifier: NCT05490641.

Effect of Calorie Restriction and Exercise on Type 2 Diabetes

Type-2 diabetes (T2D) is a chronic condition, generally regarded as an irreversible, that is among the top 10 causes of death globally. The hallmark of T2D is hyperglycemia, which results from disturbances in insulin sensitivity, insulin secretion, β-cell dysfunction and insulin resistance. Several clinical and lifestyle factors are involved in the progression of T2D, such as obesity and physical inactivity. A high-calorie diet is the main contributor to the development of obesity, which results in T2D, as obesity or increased intra-abdominal adipose tissue is related to insulin resistance. Technological advances have contributed to individuals having a more sedentary lifestyle, leading to obesity and T2D. T2D can be treated with lifestyle interventions, such as diet and exercise. Herein, we highlight the positive impact of a very low-calorie diet (VLCD) and lifestyle modalities in the treatment and prevention of T2D. An inclusion of VLCD 400-800 kcal/day for 8 weeks and ≥ 150 minutes exercise 5 times a week as lifestyle interventions can decrease glucose levels to normal, reduce HbA1c and improve insulin resistance and sensitivity. Therefore, a potential mechanism in maintaining glucose homeostasis and remission of T2D by VLCD and exercise reduces body weight.

The Anti-Inflammatory Effect of Taurine on Cardiovascular Disease

Taurine is a non-protein amino acid that is expressed in the majority of animal tissues. With its unique sulfonic acid makeup, taurine influences cellular functions, including osmoregulation, antioxidation, ion movement modulation, and conjugation of bile acids. Taurine exerts anti-inflammatory effects that improve diabetes and has shown benefits to the cardiovascular system, possibly by inhibition of the renin angiotensin system. The beneficial effects of taurine are reviewed.

Type 2 Diabetes in People from Culturally and Linguistically Diverse Backgrounds: Perspectives for Training and Practice from Nutritional Therapy and Dietician Professions

OBJECTIVE

To explore the perspectives of nutritional therapy and dietician practitioners, undergraduate students and academics working with people with type 2 diabetes and who are from culturally and linguistically diverse (CALD) backgrounds.

METHODS

A qualitative study design of in-depth semi-structured one-on-one interviews with a total of 24 participants (8 practitioners, 8 students and 8 academics) in the fields of nutritional therapy and dietetics. Open-ended questions focused on the perspectives and experiences (learning, practice and teaching) of working with people of CALD backgrounds who have type 2 diabetes. All interviews were recorded for thematic and textual analysis.

RESULTS

Inter-related themes which were confirmed with investigator triangulation were the understanding of (i) the concepts of culture and diversity, (ii) the concepts and influences of health, diabetes and food across cultures, (iii) influences within and across cultures and (iv) systems and resourcing. Overarching perspectives across these themes suggested frustration in having sufficient capacity to assess comprehensively, to deliver effective, comprehensive and high quality management plans, and to achieve required health behavioural changes with people from different CALD backgrounds.

CONCLUSIONS

There's a need for improvements in the undergraduate education and training and in professional development programs; training and resourcing of interpreters in delivery of health-related information and working with health professionals; for focus on culturally appropriate management plans that involve consultation with key decision makers in families and communities; and, reviews of the systems for supporting and resourcing nutritional therapists and dieticians in professional development from undergraduate to practice levels.

Single-Photon Emission Computed Tomography Myocardial Ischemia Detection in High-Risk Asymptomatic Patients: Correlation with Coronary Calcium Score and High-Sensitivity C-Reactive Protein

Background

The association between myocardial ischemia in high-risk patients with coronary calcium score (CCS) and high-sensitivity C-reactive protein (hs-CRP) is not well established.

Aims

We evaluated the correlation between hs-CRP, CCS, and myocardial ischemia in asymptomatic high-risk patients without known coronary artery disease (CAD).

Materials and Methods

We prospectively assessed 68 asymptomatic high-risk outpatients without known CAD. One-day rest-stress Tc-99m single-photon emission computed tomography (SPECT) myocardial perfusion imaging and multislice computed tomography were performed. Multivariate regression analysis was performed for the assessment of predictors of myocardial ischemia. Standard risk factors and hs-CRP values were analyzed.

Results

CCS >0 Agatston score was observed in 26 patients (46.4%). Seven patients had CCS between 10 and 99 AU, 8 patients between 100 and 400 AU, and 11 patients had CCS >400 AU. Mild ischemia was noted in 11 patients, moderate ischemia in 10 patients, and severe ischemia in 6 patients. Hs-CRP was >1 mg/L in 39 patients, of whom 8 patients had CCS >0, 13 patients had normal SPECT results, 6 patients had mild ischemia, and 12 patients had moderate and severe ischemia. Multivariate regression analysis showed independent predictors for increased CCS: low-density lipoprotein cholesterol (odds ratio [OR]: 2.891; P = 0.001); age >70 years (OR: 2.568; P = 0.001); and smoking (OR: 1.931; P = 0.001). We found hs-CRP to be an independent predictor of myocardial ischemia (OR: 4.145; 95% confidence interval: 1.398-7.471, P = 0.001).

Conclusion

hs-CRP was an independent predictor of myocardial ischemia. hs-CRP might improve the selection of high-risk asymptomatic patients for myocardial SPECT imaging.

Anti-hypertensive peptides released from milk proteins by probiotics

The development of agricultural products as well as the industrialization of food production have led to dramatic lifestyle changes, particularly in dietary patterns, which in turn has increased the occurrence of chronic diseases and hypertension. In order to help overcome this, the food industry has developed functional milk products. Milk products, particularly fermented milk containing probiotics, are popular. Probiotics may promote gut health, reduce allergenicity, increase the bio-accessibility of fats/proteins in foods, and lower blood pressure because they contain poly-amines and bioactive peptides. Bioactive peptides have been shown to lower the risk of hypertension and cancer. Herein, we discuss the potential role of fermented milk as a functional drink acting against hypertension. However, longer-term research studies are necessary to evaluate the role of fermented milk drinks in supporting human health.