Evaluation of inflammatory biomarkers in patients with keratoconus

Monocyte to HDL ratio may predict thrombosis in patients with mechanical mitral and aortic valve prosthesis

Increased inflammatory biomarkers have been reported in prosthetic heart valve thrombosis (PHVT). Monocyte to HDL ratio (MHR) and albumin to CRP levels (CAR) are two biomarkers used widely for systemic inflammation but there is a lack of data on prosthetic heart valves. This study aimed to find out the potential predictive value of MHR and CAR for PHVT. Patients who had the diagnosis of mechanical mitral/aortic PHVT and normally functioning prosthesis were retrospectively analyzed. Laboratory data including complete blood count and biochemistry were recorded. Transesophageal echocardiography was performed to diagnose PHVT. The study included 118 patients with mechanical PHVT and 120 patients with normally functioning prosthesis. White blood count, monocyte levels, C-reactive protein, MHR and CAR were significantly higher whereas the lymphocyte, HDL and INR levels on admission were lower in patients with PHVT. Multivariate analysis showed that as well as inadequate anticoagulation, MHR, but not CAR, was found to be an independent predictor of thrombosis in patients with PHVT. Receiver operating characteristic curve analysis was performed to detect the best cut-off value of MHR in the prediction of thrombosis in patients with prosthetic valves. MHR level of > 12.8 measured on admission, yielded an AUC value of 0.791 [(CI 95% 0.733-0.848 p < 0.001) sensitivity 71%, specificity 70%]. Inadequate anticoagulation is the primary cause that leads to thrombosis in mechanical prosthetic valves. Increased MHR, but not CAR, was also shown to be an independent predictor of thrombosis in patients with mechanical mitral and aortic prosthetic valves.

Factors associated with keratoconus in Israel-A cross-sectional population-based study

PURPOSE

To identify potential factors associated with keratoconus.

METHODS

This cross-sectional study included data from Israel's largest healthcare provider for the years 2005-2020. Keratoconus patients and age-matched controls were identified. Demographic factors and comorbid conditions, including smoking, diabetes mellitus, asthma, myalgia, mental retardation, Down syndrome, atopic dermatitis and allergy/allergic rhinitis, were compared between the two cohorts. The independent risk factors associated with keratoconus were determined using a multivariable conditional logistic regression model.

RESULTS

Overall, 145 508 subjects were reviewed of which 13 228 were keratoconus patients. A ten-fold group (n = 132 280) of age-matched control subjects served as controls for comparisons. In multivariable analysis, several factors were found to be significantly associated with keratoconus. Male gender (OR = 1.27, p < 0.001), Arab ethnicity (OR = 1.50, p < 0.001), diabetes (OR = 1.19, p < 0.001), asthma (OR = 1.50, p < 0.001), myalgia (OR = 1.09, p = 0.02), mental retardation (OR = 2.63, p < 0.001), atopic dermatitis (OR = 1.35, p < 0.001) and allergic rhinitis (OR = 1.21, p < 0.001) were significantly associated with keratoconus. Smoking was significantly protective of keratoconus (OR = 0.66, p < 0.001).

CONCLUSIONS

This population-based study reports male gender, Arab ethnicity, diabetes, asthma, myalgia, mental retardation/Down syndrome, atopic dermatitis and allergic rhinitis as factors associated with keratoconus while smoking demonstrates a protective effect. The results of this study could guide enhanced screening strategies and early interventions, particularly for high-risk groups.

Monocyte-to-high-density lipoprotein ratio and systemic immune-inflammation index: Potential parameters for the evaluation of disease activity and severity in Graves' ophthalmopathy?

PURPOSE

To assess changes in monocyte-to-high-density lipoprotein (HDL) ratio (MHR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) with Graves' ophthalmopathy (GO) and their possible relation with GO disease activity and severity.

METHODS

A total of 20 patients with GO and 24 healthy controls were involved in the study. The thyroid status, MHR (monocyte count/HDL cholesterol level), NLR (neutrophil count/lymphocyte count) and SII [(neutrophil count × platelet count)/lymphocyte count] were compared between the groups. The relation of systemic inflammation parameters with disease activity and severity was evaluated.

RESULTS

The mean Clinical Activity Score (CAS) was 0.75 ± 0.78 in the GO group. None of the patients were active. The severity was mild for 14 (70.0%) patients and moderate-to-severe for 6 (30.0%) patients. MHR (17.28 ± 5.56 vs. 13.28 ± 5.08), NLR (2.51 ± 1.09 vs. 1.69 ± 0.53) and SII [600.42 (391.79-837.16) vs. 413.69 (344.26-603.82)] values were significantly increased in GO patients than in the controls (p = 0.017, p = 0.005 and p = 0.036, respectively). CAS was significantly correlated with MHR (r = 0.815, p < 0.001), NLR (r = 0.768, p = 0.017) and SII (r = 0.837, p < 0.001). The severity of GO was associated with increased MHR, NLR and SII (p = 0.019, p = 0.036 and p = 0.008, respectively). ROC analysis demonstrated that MHR, NLR and SII have a good ability to differentiate GO patients from healthy individuals.

CONCLUSION

GO patients have higher MHR and SII levels than healthy controls. Higher MHR, NLR and SII values were associated with increasing disease severity and activity, supporting the efficacy of these non-invasive, low-cost markers in determining the course of GO. Future prospective controlled trials are needed to elucidate the relation between inflammatory markers and GO.

The Potential Value of Systemic Inflammation Response Index on Delirium After Hip Arthroplasty Surgery in Older Patients: A Retrospective Study

Purpose

To explore the relationship between the systemic inflammation response index (SIRI) and postoperative delirium (POD) in older patients with hip arthroplasty surgery.

Patients and Methods

Older patients who underwent elective hip arthroplasty surgery were included in this retrospective study. SIRI, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were collected from blood routine examination at admission. Binary logistic regression analysis was performed to evaluate the association between SIRI levels and POD was analyzed.

Results

Ultimately, 116 older patients who met the inclusion criteria were assessed. Thirty-four (29%) of 116 patients diagnosed with POD were defined as the POD group, and the rest consisted of the Non-POD group. Compared with non-POD patients, POD patients showed significantly higher levels of SIRI (P < 0.001) and NLR (P = 0.002) at admission. There was no significance in the levels of PLR between two groups. SIRI was independently associated with the occurrence of POD in multivariate logistic regression analysis [odds ratio (OR) = 3.34, 95% confidence interval (95% CI) = 1.26-8.85, P = 0.016]. Receiver operating characteristic curve analysis indicated that SIRI with an optimal cutoff value of 0.987 predicted the POD with a sensitivity of 88.2% and specificity of 74.4%, and the area under the curve was 0.82 (95% CI, 0.74-0.90, P < 0.01).

Conclusion

Preoperative SIRI and NLR levels in the blood are associated with the occurrence of POD. Moreover, preoperative SIRI level is a useful candidate biomarker to identify delirium after elective hip arthroplasty surgery in older patients.

Identification of the immune-associated characteristics and predictive biomarkers of keratoconus based on single-cell RNA-sequencing and bulk RNA-sequencing

Background

Whether keratoconus (KC) is an inflammatory disease is currently debated. Hence, we aimed to investigate the immune-related features of KC based on single-cell RNA sequencing (scRNA-seq) and bulk RNA sequencing (bulk RNA-seq) data.

Methods

scRNA-seq data were obtained from the Genome Sequence Archive (GSA), bulk RNA-seq data were obtained from the Gene Expression Omnibus (GEO), and immune-associated genes(IAGs) were obtained from the ImmPort database. Cell clusters of KC were annotated, and different cell clusters were then selected. The IAG score of each cell was calculated using the AUCell package. Three bulk RNA-seq datasets were merged and used to identify the differentially expressed genes (DEGs), biological functions, and immune characteristics. Weighted gene coexpression network analysis (WGCNA) was used to select the IAG score-related hub genes. Based on scRNA-seq and bulk RNA-seq analyses, three machine learning algorithms, including random forest (RF), support vector machine (SVM), and least absolute shrinkage and selection operator (LASSO) regression analysis, were used to identify potential prognostic markers for KC. A predictive nomogram was developed based on prognostic markers.

Results

Six cell clusters were identified in KC, and decreased corneal stromal cell-5 (CSC-5) and increased CSC-6 were found in KC. CSC and immune cell clusters had the highest IAG scores. The bulk RNA-seq analysis identified 1362 DEGs (553 upregulated and 809 downregulated) in KC. We found different immune cell populations and differentially expressed cytokines in KC. More than three key IAG score-related modules and 367 genes were identified. By integrating the scRNA-seq and bulk RNA-seq analyses, 250 IAGs were selected and then incorporated into three machine learning models, and 10 IAGs (CEP112, FYN, IFITM1, IGFBP5, LPIN2, MAP1B, RNASE1, RUNX3, SMIM10, and SRGN) were identified as potential prognostic genes that were significantly associated with cytokine and matrix metalloproteinase(MMP)1-14 expression. Finally, a predictive nomogram was constructed and validated.

Conclusion

Taken together, our results identified CSCs and immune cell clusters that may play a key role during KC progression by regulating immunological features and maintaining cell stability.

Inflammatory profile of keratoconic corneal epithelium

BACKGROUND

Recent studies have presented inflammatory features on keratoconus (KC) and many inflammatory markers are described in the tears of patients with this disease. The KC pathogenesis is still unknown just like the correlation with inflammatory patterns. However, environmental and genetic issues may be part of the progress of KC. In addition, some systemic features, such as allergy and obesity, seem to be related to the progression of KC. Our purpose was to evaluate the neuropeptides vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), chemokines ligand 2 (CCL-2) and 5 (CCL-5), and interleukins 6 (IL-6) and 8 (IL-8) on corneal epithelial cells and blood of patients with KC and in healthy controls. In addition, the neutrophil-to-lymphocyte ratio (NLR) was evaluated to predict inflammation.

METHODS

This including prospective observational study included 32 KC patients who underwent corneal crosslinking (CXL) and 32 control patients who underwent photorefractive keratectomy (PRK). Patients' corneal epithelial cells were removed surgically, and blood (buffy coat) was analyzed. Samples in triplicate were evaluated on rt-PCR for neuropeptides (VIP e NPY), interleukins (IL-6 e IL-8), and chemokines (CCL-2 and CCL-5).

RESULTS

Our study showed statistically higher CCL-5 and IL-8 on corneal epithelial cells in patients with KC. Blood cells were statistically higher in VIP and NPY in the KC group. Interleukin-8 on blood cells was statistically significant in KC'S group; for CCL-2 and CCL-5 they were statistically lower in patients with KC compared with controls. NLR showed no difference between the groups.

CONCLUSIONS

Our data support the findings of other studies that suggested altering KC status, such as inflammatory corneal disease. The presence of IL-8 in the cornea and blood samples of KC's group suggested systemic disease with a possible local or repercussion action. Further studies are warranted to elucidate KC pathogenesis and its correlation to systemic disease.

Characteristics of Hematologic Parameters in Young Patients with Retinal Vein Occlusion

INTRODUCTION

The aim of this study was to investigate the characteristics of hematologic parameters in young patients with retinal vein occlusion (RVO).

METHODS

All participants underwent routine ocular examinations and blood sample tests. Hematologic parameters obtained from a complete blood count, as well as the calculation of specific inflammatory indices, were compared between young patients with RVO and the control subjects. Correlations between hematologic inflammatory biomarkers and aqueous humor inflammatory cytokines were also investigated.

RESULTS

A total of 64 patients with RVO and 64 age- and gender-matched control subjects were included in this study. The white blood cell count, neutrophil cell count, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI) in young patients with RVO were significantly higher than in the controls (all p < 0.05). Compared to patients with nonischemic RVO, patients with ischemic RVO had higher NLR, SII, and SIRI values (p = 0.032, p = 0.035, and p = 0.039, respectively). The areas under the receiver operator characteristic curve were 0.725, 0.651, 0.649, and 0.634 for the MPV, NLR, SII, and SIRI, respectively. In addition, a higher NLR was related to higher levels of interleukin 6 (IL-6; p = 0.046, R = 0.463), and a higher SII was related to higher levels of IL-6 (p = 0.034, R = 0.488) and vascular endothelial growth factor (p = 0.020, R = 0.528).

CONCLUSION

The NLR, SII, and SIRI were significantly elevated in young patients with RVO, especially in young patients with ischemic RVO. NLR and SII were positively correlated with IL-6 levels in aqueous humor, which indicated that systemic inflammation plays an important role in the onset of RVO in young patients.

Serum inflammatory biomarkers are associated with increased choroidal thickness in keratoconus

Inflammation may play a significant role in Keratoconus (KC), but the relationship between inflammatory markers and choroidal thickness (CT) is unknown. The purpose of this study was to evaluate serum inflammatory markers and correlate them with the choroidal profile of KC patients and control subjects. Forty patients with KC and 26 age-matched control subjects were enrolled in a cross-sectional case-control study. Choroidal profile was studied with a Spectralis Heidelberg apparatus and venous blood samples were collected. Neutrophil/lymphocyte ratio (NLR), monocyte/HDL ratio (MHR), platelet/lymphocyte ratio (PLR) and systemic immune inflammation index (SII) were calculated. Serum inflammatory biomarkers IL-1, IL-6 and TNF-alfa were also analyzed. KC group presented thicker choroids in each evaluated point when compared to the control group (subfoveal CT 417.38 ± 79.79 vs 299.61 ± 76.13, p < 0.001 for all measured locations). Mean values of NLR, PLR and SII were significantly higher in patients with KC (NLR p = 0.001; PLR p = 0.042; SII p = 0.007). Although KC patients presented higher mean levels of MHR, IL-1, IL-6 and TNF-α than control group, no significant differences were achieved. Positive correlations were found between subfoveal CT and NLR and SII (0.408, p = 0.001 and 0.288, p = 0.019 respectively). The results presented are in favor of a relationship between the increased CT and inflammatory mechanisms in KC patients. The elevated serum inflammatory indices NLR, SII and PLR provide additional evidence of a role for systemic inflammation in the pathophysiology of KC.

Prevalence and risk factors of keratoconus (including oxidative stress biomarkers) in a cohort study of Shiraz university of medical science employees in Iran

BACKGROUND

To determine the prevalence of keratoconus in Shiraz University of Medical Sciences Employees and the related risk factors including oxidative stress biomarkers.

METHODS

2546 subjects' mean age ± SD, 40.35 ± 6.70 (46% male) were recruited. All participants underwent objective refraction using auto-refractometer and retinoscopy, followed by subjective refraction, and bio-microscopy. Pentacam imaging was performed for the detected keratoconus patients. The prevalence of keratoconus and frequency of the visual impairment among keratoconus cases were evaluated. Potential risk factors of sex, age, family history of keratoconus, body mass index ≥ 30 kg/m², serum levels of glucose ≥ 100 mg/d, low-density-lipoprotein-cholesterol (LDL) ≥ 110 mg/dL, high-density-lipoprotein-cholesterol ≤ 40 mg/d, and triglycerides ≥ 150 mg/dL in the blood were evaluated.

RESULTS

The prevalence of keratoconus at least in one eye was 0.98% (95% CI: 0.6- 1.4%). The best corrected visual acuity in the keratoconus group was 0.06 ± 0.1 and the rest of the population was 0.01 ± 0.07 logMAR (p < 0.001). The frequency of visual impairment in the keratoconus group was zero. Odds ratios of the family history of keratoconus (21.00, 95% CI: 9.00-48.00, p < 0.001) and LDL ≥ 110 mg/dL (3.00, 95% CI: 1.20-6.40, p = 0.01) were significant.

CONCLUSIONS

Keratoconus is rare and is not considered a risk factor for visual impairment. A family history of keratoconus and elevated serum LDL levels are contributing risk factors, suggesting an inflammatory background for the disease. Serum levels of LDL ≥ 110 mg/dL in the blood increased the risk of keratoconus three folds.

Evaluation of the optic nerve head and macular vessel density in keratoconus patients using optical coherence tomography angiography- a cross-sectional study

PURPOSE

Our study evaluated macular and optic disc vascular density (VD) changes in patients diagnosed with keratoconus, as compared with gender and age-matched healthy controls, in relation to the keratoconus stage.

METHODS

This comparative cross-sectional study included adult patients who received a diagnosis of keratoconus at the Cornea Clinic. All scans consisted of two 4.5 mm × 4.5 mm images of the optic disc area and 6 × 6 mm images of the macular area using optical coherence tomography angiography.

RESULTS

The study included 67 patients (26 women (38.8%) and 41 men (61.2%)) and 74 controls (31 women (41.9%) and 43 men (58.1%)). The mean ages of the keratoconus group and the control group were 30.0 ± 8.0 and 31.1 ± 7.5, respectively. Macular VD (whole, superficial, and deep) and peripapillary VD (whole) values were decreased statistically significant compared with the control group (p < 0.01 and p = 0.015, respectively). The keratoconus stage was negatively correlated with both the macular VD (p = 0.048, r = -0.314) and whole-peripapillary VD values (p = 0.03, r = -0.34).

CONCLUSION

Keratoconus might affect the posterior and anterior segments due to similar etiologies, including diminished collagen quality. Therefore, examination of the posterior segment should be performed thoroughly in keratoconus patients.

Association between serum uric acid/HDL-cholesterol ratio and chronic kidney disease: a cross-sectional study based on a health check-up population

OBJECTIVE

Evidence suggests that both serum uric acid (SUA) and high-density lipoprotein cholesterol (HDL-C) are risk factors for chronic kidney disease (CKD). The SUA-to-HDL-C ratio (UHR) has recently attracted attention as a new biomarker to evaluate the role between inflammatory and anti-inflammatory substances. Thus, we explored the association between UHR and CKD in a large Chinese population.

DESIGN

A cross-sectional study.

SETTING

Annual health check-up population in Nanjing.

PARTICIPANTS

19 458 individuals who underwent an annual health check-up in 2019 were included in our study.

MAIN OUTCOME MEASURE

CKD was diagnosed according to an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m².

RESULTS

Correlation analysis showed that UHR was negatively associated with eGFR after adjusting for confounding factors (r=-0.34). In addition, participants in the highest quartile of UHR had a higher risk of CKD than those in the lowest quartiles (OR=9.28, p<0.001).

CONCLUSION

We found that high UHR values were positively associated with CKD risk in health check-up population. An increased UHR may be a useful measure by which to assess CKD risk in the preclinical stage.

Relationship between certain hematological parameters and risk of breast cancer

Aim: To explore the association between preoperative hemoglobin-to-red cell distribution width ratio (HRR), platelet-to-monocyte ratio or monocyte-to-high-density lipoprotein ratio and risk of breast cancer. Materials & methods: The clinical data of 226 patients with breast cancer were retrospectively analyzed and compared with 199 healthy controls by multivariate logistic regression analysis. Results: Multivariate logistic regression analysis revealed that HRR (p < 0.001) and monocyte-to-high-density lipoprotein ratio (p < 0.001) were independent predictors of breast cancer and lower HRR was associated with longer hospitalization, larger red cell distribution width value and lower hemoglobin level (p < 0.05). Conclusion: A significant association was found between HRR and clinical characteristics in breast cancer patients. Therefore, HRR is expected to become a novel and promising predictor of breast cancer.

Single-cell atlas of keratoconus corneas revealed aberrant transcriptional signatures and implicated mechanical stretch as a trigger for keratoconus pathogenesis

Keratoconus is a common ectatic corneal disorder in adolescents and young adults that can lead to progressive visual impairment or even legal blindness. Despite the high prevalence, its etiology is not fully understood. In this study, we performed single-cell RNA sequencing (scRNA-Seq) analysis on 39,214 cells from central corneas of patients with keratoconus and healthy individuals, to define the involvement of each cell type during disease progression. We confirmed the central role of corneal stromal cells in this disease, where dysregulation of collagen and extracellular matrix (ECM) occurred. Differential gene expression and histological analyses revealed two potential novel markers for keratoconus stromal cells, namely CTSD and CTSK. Intriguingly, we detected elevated levels of YAP1 and TEAD1, the master regulators of biomechanical homeostasis, in keratoconus stromal cells. Cyclical mechanical experiments implicated the mechanical stretch in prompting protease production in corneal stromal cells during keratoconus progression. In the epithelial cells of keratoconus corneas, we observed reduced basal cells and abnormally differentiated superficial cells, unraveling the corneal epithelial lesions that were usually neglected in clinical diagnosis. In addition, several elevated cytokines in immune cells of keratoconus samples supported the involvement of inflammatory response in the progression of keratoconus. Finally, we revealed the dysregulated cell-cell communications in keratoconus, and found that only few ligand-receptor interactions were gained but a large fraction of interactional pairs was erased in keratoconus, especially for those related to protease inhibition and anti-inflammatory process. Taken together, this study facilitates the understanding of molecular mechanisms underlying keratoconus pathogenesis, providing insights into keratoconus diagnosis and potential interventions.

Keratoconus patients exhibit a distinct ocular surface immune cell and inflammatory profile

Inflammatory factors have been considered to contribute to keratoconus (KC) pathogenesis. This study aims to determine the immune cells subsets and soluble inflammatory factor profile on the ocular surface of KC patients. 32 KC subjects (51 eyes) across different grades of severity and 15 healthy controls (23 eyes) were included in the study. Keratometry and pachymetry measurements were recorded. Ocular surface immune cells (collected by ocular surface wash) immunophenotyped using flow cytometry include leukocytes, neutrophils, macrophages, natural killer (NK) cells, pan-T cells, gamma delta T (γδT) cells and NKT cells. Tear fluid collected using Schirmer's strip was used to measure 50 soluble factors by multiplex ELISA. Proportions of activated neutrophils, NK cells and γδT cells were significantly increased in KC patients. Significantly higher levels of tear fluid IL-1β, IL-6, LIF, IL-17A, TNFα, IFNα/β/γ, EPO, TGFβ1, PDGF-BB, sVCAM, sL-selectin, granzyme-B, perforin, MMP2, sFasL and IgE, along with significantly lower levels of IL-1α and IL-9 were observed in KC patients. Alterations observed in few of the immuno-inflammatory parameters correlated with grades of disease, allergy, eye rubbing and keratometry or pachymetry measurements. The observation implies a distinct immuno-inflammatory component in KC pathogenesis and its potential as an additional therapeutic target in KC management.