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Wołoszyn-Durkiewicz A, Iwaszkiewicz-Grześ D, Świętoń D, Kujawa MJ, Jankowska A, Durawa A, Glasner P, Trzonkowski P, Glasner L, Szurowska E, Myśliwiec M. The Complex Network of Cytokines and Chemokines in Pediatric Patients with Long-Standing Type 1 Diabetes. Int J Mol Sci 2024; 25:1565. [PMID: 38338843 PMCID: PMC10855710 DOI: 10.3390/ijms25031565] [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: 12/06/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Type 1 diabetes (T1D) is a progressive disorder leading to the development of microangiopathies and macroangiopathies. Numerous cytokines and chemokines are involved in the pathogenesis of T1D complications. The study aimed to assess the presence of complications in patients with long-standing T1D and its relationship with serum biomarker concentrations. We examined 52 T1D subjects, with a disease duration ≥4 years and 39 healthy controls. The group of T1D patients was further divided into subgroups based on the duration of the disease (<7 years and ≥7 years) and the metabolic control assessed by the HbAlc level (<8% and ≥8%). We used Luminex Technology to assess a wide range of biomarker concentrations. A 24 h urine test was done to evaluate the rate of albuminuria. Optical coherence tomography (OCT) was conducted to detect early retinopathic changes. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (IMT). T1D patients showed remarkably higher concentrations of EGF, eotaxin/CCL11, MDC/CCL22, sCD40L, TGF-α, and TNF-α. Moreover, we reported statistically significant correlations between cytokines and IMT. Biomarker concentrations depend on numerous factors such as disease duration, metabolic control, and the presence of complications. Although the majority of pediatric T1D patients do not present signs of overt complications, it is indispensable to conduct the screening for angiopathies already in childhood, as its early recognition may attenuate the further progression of complications.
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Affiliation(s)
- Anna Wołoszyn-Durkiewicz
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Dorota Iwaszkiewicz-Grześ
- Department of Medical Immunology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (D.I.-G.); (P.T.)
| | - Dominik Świętoń
- 2nd Department of Radiology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (D.Ś.); (A.J.); (A.D.); (E.S.)
| | - Mariusz J. Kujawa
- 2nd Department of Radiology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (D.Ś.); (A.J.); (A.D.); (E.S.)
| | - Anna Jankowska
- 2nd Department of Radiology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (D.Ś.); (A.J.); (A.D.); (E.S.)
| | - Agata Durawa
- 2nd Department of Radiology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (D.Ś.); (A.J.); (A.D.); (E.S.)
| | - Paulina Glasner
- Department of Ophthalmology, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (P.G.); (L.G.)
- Department of Anesthesiology and Intensive Care, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Piotr Trzonkowski
- Department of Medical Immunology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (D.I.-G.); (P.T.)
| | - Leopold Glasner
- Department of Ophthalmology, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (P.G.); (L.G.)
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (D.Ś.); (A.J.); (A.D.); (E.S.)
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
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Rasmussen VF, Hirschberg Jensen V, Thrysøe M, Vestergaard ET, Størling J, Kristensen K. Cross-sectional study investigating the association between inflammatory biomarkers and neuropathy in adolescents with type 1 diabetes. BMJ Open 2023; 13:e074992. [PMID: 37802616 PMCID: PMC10565182 DOI: 10.1136/bmjopen-2023-074992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES The aims of this study were to investigate circulating levels of inflammatory markers in adolescents with type 1 diabetes with and without different types of neuropathies and evaluate the association between inflammatory biomarkers, nerve function and clinical parameters. DESIGN Cross-sectional study. SETTING Hospitals and Steno Diabetes Center in Denmark. PARTICIPANTS Adolescents with more than 5 years of diabetes duration were investigated for large fibre, small fibre and autonomic neuropathy as a part of the T1DANES study. Blood samples from the participants were analysed for inflammatory biomarkers by Meso Scale Discovery multiplexing technology. PRIMARY AND SECONDARY OUTCOME MEASURES Inflammatory biomarkers and results of diagnostic nerve tests. RESULTS Fifty-six adolescents with type 1 diabetes and 23 healthy controls were included. The adolescents with diabetes had significantly higher interferon-gamma, tumour necrosis factor-alpha (TNF-a), interleukin (IL)-10 and soluble urokinase plasminogen activator receptor (suPAR) compared with healthy controls (p values<0.05). TNF-a was higher in the adolescents with large fibre neuropathy (LFN) (p=0.03) compared with those without LFN in the group with diabetes. A negative correlation was seen between TNF-a and conduction velocity in nervus tibialis (p=0.04), and higher TNF-a and IL-6 were associated with higher gastric motility index (TNF-a, p value=0.03; IL-6, p value=0.02). There were no significant associations between inflammatory markers and expressed symptoms, haemoglobin A1c, diabetes duration or body mass index standard derivation score (p values>0.05). The receiver operating characteristic (ROC) curves for the inflammatory markers suggested them as poor screening methods for all types of neuropathies with an area under the curve between 0.47 and 0.67. CONCLUSION Our results confirm increased low-grade inflammation in adolescents with type 1 diabetes. TNF-a was higher in adolescents with LFN and correlated negatively with nervus tibialis conduction velocity. The other inflammatory biomarkers fail to support differences in those with and without different types of diabetic neuropathies. However, TNF-a and IL-6 were positively correlated to gastric motility index.
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Grants
- Steno Diabetes Center
- The entire project was sponsored by the following: Skibsreder Per Henriksen og Hustrus Fond, Tømrermester Jørgen Holm og Hustru Lisa F. Hansens Mindelegat, Vissing Fonden, Rissfort Fonden, Kirsten Dyrløv Madsens legat, Lipperts Fond, Reinholdt W. Jorck og Hustrus fond, Helga og Peter Kornings Fond, Beckett Fonden, Dagmar Marschall Fond. Danske lægers Forsikring under Danica Pension, William Demant Fonden. Professor Iversens Rejsefond, Diabetesforeningen.
- Novo Nordisk
- Aarhus University
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Affiliation(s)
- Vinni Faber Rasmussen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pediatrics and Adolescents, Randers Regional Hospital, Randers, Denmark
| | | | - Mathilde Thrysøe
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Joachim Størling
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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Hilal F, Mahdi E, Nada A. Hemorrhagic stroke: Uncommon complication of diabetic ketoacidosis in pediatric patients. Radiol Case Rep 2022; 17:4059-4063. [PMID: 36065248 PMCID: PMC9440358 DOI: 10.1016/j.radcr.2022.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/20/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is a well-known complication of type 1 diabetes mellitus. Diabetic ketoacidosis predisposes patients into devastating neurological complications. The most common neurologic complication is cerebral edema. Stroke either ischemic or hemorrhagic are uncommon complications of DKA with worse patient's outcome. Hemorrhagic stroke can manifest as subarachnoid or intraparenchymal hemorrhage. We present a 14-year-girl presented with DKA and complicated with both subarachnoid and intraparenchymal hemorrhages. Owing to early diagnosis and prompt treatment the patient had good outcome.
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Affiliation(s)
- Fathi Hilal
- Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212, USA
| | - Eman Mahdi
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Ayman Nada
- Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212, USA
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Aleman MN, Díaz EI, Luciardi MC, Mariani AC, Bazán MC, Abregu AV. Hemostatic state of children with type 1 diabetes. Ann Pediatr Endocrinol Metab 2021; 26:99-104. [PMID: 34218631 PMCID: PMC8255861 DOI: 10.6065/apem.2040142.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Hyperglycemia is one of the factors responsible for the molecular alterations that modify hemostasis. The aim of this study was to determine the levels of circulating molecules that have a prothrombotic impact on the child and adolescent population with type 1 diabetes mellitus. METHODS There were 35 patients with type 1 diabetes mellitus (11.0±2.5 years of age and a median 3.7±2.0 years of the disease) with no vascular complications and 20 healthy controls with similar age, sex, and body mass index included in the study. The evaluated parameters were fibrinogen, plasminogen activator inhibitor-1 (PAI1), von Willebrand factor antigen, and standard coagulation tests (platelet count, prothrombin time, and activated partial thromboplastin time). Glycemic control was evaluated by hemoglobin A1c and fasting blood glucose tests, and the presence of retinopathy and nephropathy was ruled out. The data obtained were analyzed by IBM SPSS Statistics ver. 20.0 and expressed as mean±standard deviation. The Pearson correlation coefficient was applied to investigate correlations between variables. RESULTS Diabetic patients showed significantly higher levels of fibrinogen (308±66 mg/dL vs. 246±18 mg/dL, P=0.0001), PAI-1 (41.6±12 ng/mL vs. 11.7±1.0 ng/mL, P=0.0001), and von Willebrand factor antigen (284%±55% vs. 121%±19%, P=0.0001). However, standard coagulation tests did not show differences between the 2 groups. PAI-1 was correlated with glycemia, hemoglobin A1c, fibrinogen, and von Willebrand factor antigen. CONCLUSION Elevated levels of fibrinogen, PAI-1, and von Willebrand factor antigen were found in the pediatric and adolescent population with type 1 diabetes mellitus, which suggests a prothrombotic state.
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Affiliation(s)
- Mariano Nicolás Aleman
- Departamento de Bioquímica Aplicada, Facultad de Bioquímica, Universidad Nacional de Tucumán, Tucumán, Argentina,Address for correspondence: Mariano Nicolás Áleman Departamento de Bioquímica Aplicada, Facultad de Bioquímica, Universidad Nacional de Tucumán, Balcarce 747, San Miguel de Tucumán, Tucumán 4000, Argentina
| | - Elba Irma Díaz
- Departamento de Bioquímica Aplicada, Facultad de Bioquímica, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Maria Constanza Luciardi
- Departamento de Bioquímica Aplicada, Facultad de Bioquímica, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Ana Carolina Mariani
- Departamento de Bioquímica Aplicada, Facultad de Bioquímica, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Maria Cristina Bazán
- Departamento de Endocrinología, Hospital del Niño Jesús de Tucumán, Tucumán, Argentina
| | - Adela Victoria Abregu
- Departamento de Bioquímica Aplicada, Facultad de Bioquímica, Universidad Nacional de Tucumán, Tucumán, Argentina
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Reichert KP, Castro MFV, Assmann CE, Bottari NB, Miron VV, Cardoso A, Stefanello N, Morsch VMM, Schetinger MRC. Diabetes and hypertension: Pivotal involvement of purinergic signaling. Biomed Pharmacother 2021; 137:111273. [PMID: 33524787 PMCID: PMC7846467 DOI: 10.1016/j.biopha.2021.111273] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 02/07/2023] Open
Abstract
Diabetes mellitus (DM) and hypertension are highly prevalent worldwide health problems and frequently associated with severe clinical complications, such as diabetic cardiomyopathy, nephropathy, retinopathy, neuropathy, stroke, and cardiac arrhythmia, among others. Despite all existing research results and reasonable speculations, knowledge about the role of purinergic system in individuals with DM and hypertension remains restricted. Purinergic signaling accounts for a complex network of receptors and extracellular enzymes responsible for the recognition and degradation of extracellular nucleotides and adenosine. The main components of this system that will be presented in this review are: P1 and P2 receptors and the enzymatic cascade composed by CD39 (NTPDase; with ATP and ADP as a substrate), CD73 (5'-nucleotidase; with AMP as a substrate), and adenosine deaminase (ADA; with adenosine as a substrate). The purinergic system has recently emerged as a central player in several physiopathological conditions, particularly those linked to inflammatory responses such as diabetes and hypertension. Therefore, the present review focuses on changes in both purinergic P1 and P2 receptor expression as well as the activities of CD39, CD73, and ADA in diabetes and hypertension conditions. It can be postulated that the manipulation of the purinergic axis at different levels can prevent or exacerbate the insurgency and evolution of diabetes and hypertension working as a compensatory mechanism.
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Affiliation(s)
- Karine Paula Reichert
- Department of Biochemistry and Molecular Biology, Post-Graduation Program of Biological Sciences: Toxicological Biochemistry, CCNE, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Milagros Fanny Vera Castro
- Department of Biochemistry and Molecular Biology, Post-Graduation Program of Biological Sciences: Toxicological Biochemistry, CCNE, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Charles Elias Assmann
- Department of Biochemistry and Molecular Biology, Post-Graduation Program of Biological Sciences: Toxicological Biochemistry, CCNE, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Nathieli Bianchin Bottari
- Department of Biochemistry and Molecular Biology, Post-Graduation Program of Biological Sciences: Toxicological Biochemistry, CCNE, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Vanessa Valéria Miron
- Department of Biochemistry and Molecular Biology, Post-Graduation Program of Biological Sciences: Toxicological Biochemistry, CCNE, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Andréia Cardoso
- Academic Coordination, Medicine, Campus Chapecó, Federal University of Fronteira Sul, Chapecó, SC, Brazil
| | - Naiara Stefanello
- Department of Biochemistry and Molecular Biology, Post-Graduation Program of Biological Sciences: Toxicological Biochemistry, CCNE, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Vera Maria Melchiors Morsch
- Department of Biochemistry and Molecular Biology, Post-Graduation Program of Biological Sciences: Toxicological Biochemistry, CCNE, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Maria Rosa Chitolina Schetinger
- Department of Biochemistry and Molecular Biology, Post-Graduation Program of Biological Sciences: Toxicological Biochemistry, CCNE, Federal University of Santa Maria, Santa Maria, RS, Brazil.
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Castro MFV, Stefanello N, Assmann CE, Baldissarelli J, Bagatini MD, da Silva AD, da Costa P, Borba L, da Cruz IBM, Morsch VM, Schetinger MRC. Modulatory effects of caffeic acid on purinergic and cholinergic systems and oxi-inflammatory parameters of streptozotocin-induced diabetic rats. Life Sci 2021; 277:119421. [PMID: 33785337 DOI: 10.1016/j.lfs.2021.119421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
Diabetes mellitus (DM) is a metabolic disorder characterized by a chronic hyperglycemia state, increased oxidative stress parameters, and inflammatory processes. AIMS To evaluate the effect of caffeic acid (CA) on ecto-nucleoside triphosphate diphosphohydrolase (E-NTPDase) and adenosine deaminase (ADA) enzymatic activity and expression of the A2A receptor of the purinergic system, acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) enzymatic activity and expression of the α7nAChR receptor of the cholinergic system as well as inflammatory and oxidative parameters in diabetic rats. METHODS Diabetes was induced by a single dose intraperitoneally of streptozotocin (STZ, 55 mg/kg). Animals were divided into six groups (n = 10): control/oil; control/CA 10 mg/kg; control/CA 50 mg/kg; diabetic/oil; diabetic/CA 10 mg/kg; and diabetic/CA 50 mg/kg treated for thirty days by gavage. RESULTS CA treatment reduced ATP and ADP hydrolysis (lymphocytes) and ATP levels (serum), and reversed the increase in ADA and AChE (lymphocytes), BuChE (serum), and myeloperoxidase (MPO, plasma) activities in diabetic rats. CA treatment did not attenuate the increase in IL-1β and IL-6 gene expression (lymphocytes) in the diabetic state; however, it increased IL-10 and A2A gene expression, regardless of the animals' condition (healthy or diabetic), and α7nAChR gene expression. Additionally, CA attenuated the increase in oxidative stress markers and reversed the decrease in antioxidant parameters of diabetic animals. CONCLUSION Overall, our findings indicated that CA treatment positively modulated purinergic and cholinergic enzyme activities and receptor expression, and improved oxi-inflammatory parameters, thus suggesting that this phenolic acid could improve redox homeostasis dysregulation and purinergic and cholinergic signaling in the diabetic state.
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Affiliation(s)
- Milagros Fanny Vera Castro
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil.
| | - Naiara Stefanello
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Charles Elias Assmann
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Jucimara Baldissarelli
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Margarete Dulce Bagatini
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Aniélen Dutra da Silva
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Pauline da Costa
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Loren Borba
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Ivana Beatrice Mânica da Cruz
- Post-Graduate Program in Pharmacology, Center of Health Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Vera Maria Morsch
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil
| | - Maria Rosa Chitolina Schetinger
- Post-Graduate Program in Biological Sciences: Toxicological Biochemistry, Center for Natural and Exact Sciences, Federal University of Santa Maria, University Campus, Camobi District, 97105-900 Santa Maria, RS, Brazil.
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Effects of interval training on cardio metabolic risk factors and nitric oxide in type 2 diabetes patients: a randomized controlled trial. J Diabetes Metab Disord 2021; 19:669-674. [PMID: 33520794 DOI: 10.1007/s40200-019-00486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/30/2019] [Indexed: 10/23/2022]
Abstract
Purpose The purpose of this study was to investigate the effects of interval training on cardio metabolic risk factors and nitric oxide in type 2 diabetes patients. Method This single blinded randomized controlled trial was conducted at cardiology clinic of Rajaee hospital in Karaj. Thirty female patients with type 2 diabetes randomly assigned to interval training exercise (n = 15) and control (n = 15). In interval training exercise patients received interval training exercise with 18 sessions (three sessions per week). Each training session took 25 min and consists a single set of exercise with 10 time repetitions. Training was performed on a cycle ergometer set in constant watt mode at a pedal cadence of 80-100 revolutions/min. Each repetition of the training takes 60 s and there will be a 60 s recovery pried between each repetition. Each training session include a 3-min warm-up and 2-min cool-down at 50 W for a total of 25 min. Blood samples and of all the subjects were taken at baseline, 3 weeks after intervention and at the end of the study (6 weeks). Results In intervention group, comparing with controls participants, a significant decrease were observed in levels of total cholesterol, triglyceride and HA1c after training program (p < 0.05). Moreover,exercise significantly increased the level of NOx (p < 0.05). Other cardiometabolic risk factors including SBP, DBP, FPG, LDL, HDL, insulin level, insulin resistance, HR, VO2 max, did not show significant differences between the two groups (p > 0.05). Conclusion Results of current study showed that interval training as a type of planned physical activity can be effective in lowering cardiovascular risk factors, especially lowering cholesterol and triglycerides, and can also have a beneficial effect on improving NO.
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Bratseth V, Margeirsdottir HD, Heier M, Solheim S, Arnesen H, Dahl-Jørgensen K, Seljeflot I. Procoagulant activity in children and adolescents on intensive insulin therapy. Pediatr Diabetes 2020; 21:496-504. [PMID: 31943582 DOI: 10.1111/pedi.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/19/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Type 1 diabetes is associated with atherothrombosis, but limited data exist on procoagulant activity in the young. We investigated procoagulant activity in children/adolescents with type 1 diabetes using intensified insulin treatment compared with controls in a 5-year follow-up study, and further any associations with cardiovascular risk factors. METHODS The study included 314 diabetes children/adolescents and 120 healthy controls. Prothrombin fragment 1+2 (F1+2), D-dimer, tissue-factor-procoagulant-activity (TF-PCA), and tissue-factor-pathway-inhibitor (TFPI) were analyzed with ELISAs. RESULTS F1+2, D-dimer, and TF-PCA did not differ between the groups or correlate to HbA1c in the diabetes group at either time points. TFPI was significantly higher in the diabetes group compared with controls both at inclusion and follow-up (both P < .001). In the diabetes group, TFPI correlated significantly to HbA1c at both time points (r = 0.221 and 0.304, both P < .001). At follow-up, females using oral contraceptives had significantly elevated F1+2, D-dimer, and TF-PCA and lower TFPI compared to no-users (all P < .005), and females had lower TFPI (P = .017) and higher F1+2 compared with males (P = .052), also after adjusting for the use of oral contraceptives. CONCLUSIONS The current results show similar procoagulant activity in children/adolescents with type 1 diabetes compared with controls over a 5-year period, indicating that these children using modern intensified insulin treatment are not at high thrombotic risk at younger age. The elevated levels of TFPI in the diabetes group, related to hyperglycaemia, are probably reflecting increased endothelial activation. These findings highlight the significance of optimal blood glucose control in children/adolescents with type 1 diabetes, to maintain a healthy endothelium.
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Affiliation(s)
- Vibeke Bratseth
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanna D Margeirsdottir
- Pediatric Department, Oslo University Hospital Ullevaal, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Martin Heier
- Pediatric Department, Oslo University Hospital Ullevaal, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Svein Solheim
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Pediatric Department, Oslo University Hospital Ullevaal, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Kaur R, Kaur M, Singh J. Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies. Cardiovasc Diabetol 2018; 17:121. [PMID: 30170601 PMCID: PMC6117983 DOI: 10.1186/s12933-018-0763-3] [Citation(s) in RCA: 367] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/20/2018] [Indexed: 12/14/2022] Open
Abstract
The incidence and prevalence of diabetes mellitus is rapidly increasing worldwide at an alarming rate. Type 2 diabetes mellitus (T2DM) is the most prevalent form of diabetes, accounting for approximately 90-95% of the total diabetes cases worldwide. Besides affecting the ability of body to use glucose, it is associated with micro-vascular and macro-vascular complications. Augmented atherosclerosis is documented to be the key factor leading to vascular complications in T2DM patients. The metabolic milieu of T2DM, including insulin resistance, hyperglycemia and release of excess free fatty acids, along with other metabolic abnormalities affects vascular wall by a series of events including endothelial dysfunction, platelet hyperactivity, oxidative stress and low-grade inflammation. Activation of these events further enhances vasoconstriction and promotes thrombus formation, ultimately resulting in the development of atherosclerosis. All these evidences are supported by the clinical trials reporting the importance of endothelial dysfunction and platelet hyperactivity in the pathogenesis of atherosclerotic vascular complications. In this review, an attempt has been made to comprehensively compile updated information available in context of endothelial and platelet dysfunction in T2DM.
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Affiliation(s)
- Raminderjit Kaur
- Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Manpreet Kaur
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Jatinder Singh
- Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, Punjab, India.
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Santilli F, Marchisio M, Lanuti P, Boccatonda A, Miscia S, Davì G. Microparticles as new markers of cardiovascular risk in diabetes and beyond. Thromb Haemost 2018; 116:220-34. [DOI: 10.1160/th16-03-0176] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/19/2016] [Indexed: 12/25/2022]
Abstract
SummaryThe term microparticle (MP) identifies a heterogeneous population of vesicles playing a relevant role in the pathogenesis of vascular diseases, cancer and metabolic diseases such as diabetes mellitus. MPs are released by virtually all cell types by shedding during cell growth, proliferation, activation, apoptosis or senescence processes. MPs, in particular platelet- and endothelial-derived MPs (PMPs and EMPs), are increased in a wide range of thrombotic disorders, with an interesting relationship between their levels and disease pathophysiology, activity or progression. EMP plasma levels have been associated with several cardiovascular diseases and risk factors. PMPs are also shown to be involved in the progressive formation of atherosclerotic plaque and development of arterial thrombosis, especially in diabetic patients. Indeed, diabetes is characterised by an increased procoagulant state and by a hyperreactive platelet phenotype, with enhanced adhesion, aggregation, and activation. Elevated MP levels, such as TF+ MPs, have been shown to be one of the procoagulant determinants in patients with type 2 diabetes mellitus. Atherosclerotic plaque constitutes an opulent source of sequestered MPs, called “plaque” MPs. Otherwise, circulating MPs represent a TF reservoir, named “blood-borne” TF, challenging the dogma that TF is a constitutive protein expressed in minute amounts. “Blood-borne” TF is mainly harboured by PMPs, and it can be trapped within the developing thrombus. MP detection and enumeration by polychromatic flow cytometry (PFC) have opened interesting perspectives in clinical settings, particularly for the evaluation of MP numbers and phenotypes as independent marker of cardiovascular risk, disease and outcome in diabetic patients.
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Thrombosis in diabetes: a shear flow effect? Clin Sci (Lond) 2017; 131:1245-1260. [PMID: 28592700 DOI: 10.1042/cs20160391] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/14/2017] [Accepted: 02/27/2017] [Indexed: 12/16/2022]
Abstract
Cardiovascular events are the major cause of morbidity and mortality in Type 2 diabetes (T2D). This condition is associated with heightened platelet reactivity, contributing to increased atherothrombotic risk. Indeed, individuals with diabetes respond inadequately to standard antiplatelet therapy. Furthermore, they often experience recurrent events as well as side effects that include excess bleeding. This highlights the need for identification of novel regulators of diabetes-associated thrombosis to target for therapeutic intervention. It is well established that platelet aggregation, a process essential for thrombus formation, is tightly regulated by shear stress; however, the mechanisms underlying shear activation of platelets, particularly in the setting of diabetes, are still poorly understood. This review will address the limitations of current diagnostic systems to assess the importance of shear stress in the regulation of thrombus formation in T2D, and the inability to recapitulate the pro-thrombotic phenotype seen clinically in the setting of T2D. Moreover, we will discuss recent findings utilizing new technologies to define the importance of shear stress in thrombus formation and their potential application to the setting of diabetes. Finally, we will discuss the potential of targeting shear-dependent mechanisms of thrombus formation as a novel therapeutic approach in the setting of T2D.
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Qiao YC, Chen YL, Pan YH, Tian F, Xu Y, Zhang XX, Zhao HL. The change of serum tumor necrosis factor alpha in patients with type 1 diabetes mellitus: A systematic review and meta-analysis. PLoS One 2017; 12:e0176157. [PMID: 28426801 PMCID: PMC5398633 DOI: 10.1371/journal.pone.0176157] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 04/06/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study was used meta-analysis to investigate changes of serum tumor necrosis factor-alpha (TNF-α) in patients with type 1 diabetes mellitus (T1DM). METHODS Relevant literatures were identified from PubMed, Cochrane Library, CNKI, WanFang and Chinese-Cqvip databases (published from January 1, 1999 to September 30, 2016). Eligible reports were included for pooled analysis of serum TNF-α level and subgroup analysis was performed in relation with age, disease duration and ethnicity. RESULTS A total of 23 articles (1631 T1DM cases, 1429 healthy controls) were included for this meta-analysis. Compared with the controls, the patients had significantly increased serum TNF-α level (P < 0.001). Similar results were also found among all subgroup analysis of different age, disease duration and ethnicity (with the exception of Asian) (all P < 0.05). Regression analysis indicated that age (P = 0.680), disease duration (P = 0.957), and ethnicity (P = 0.526) of patients were not significant impact factors for the high heterogeneity. The results were stable according to the sensitivity analysis and no publication bias existed in this meta-analysis. CONCLUSIONS Serum TNF-α level in T1DM patients has significantly elevated among all age, disease duration and ethnicity groups.
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Affiliation(s)
- Yong-chao Qiao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yin-ling Chen
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
- Department of Immunology, Faculty of Basic Medicine, Guilin Medical University, Guilin, China
| | - Yan-hong Pan
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
- Department of Immunology, Faculty of Basic Medicine, Guilin Medical University, Guilin, China
| | - Fang Tian
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yan Xu
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xiao-xi Zhang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
- Department of Immunology, Faculty of Basic Medicine, Guilin Medical University, Guilin, China
| | - Hai-lu Zhao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- Department of Immunology, Faculty of Basic Medicine, Guilin Medical University, Guilin, China
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Binay C, Bozkurt Turhan A, Simsek E, Bor O, Akay OM. Evaluation of Coagulation Profile in Children with Type 1 Diabetes Mellitus Using Rotational Thromboelastometry. Indian J Hematol Blood Transfus 2017; 33:574-580. [PMID: 29075072 DOI: 10.1007/s12288-017-0793-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/18/2017] [Indexed: 10/20/2022] Open
Abstract
The prothrombotic state in type 1 diabetes mellitus (T1DM) has been reported as a plausible cause of vascular complications. Rotational thromboelastometry (ROTEM) assay enables the global assessment of coagulation status. This study aimed to assess hypercoagulability in children with T1DM using ROTEM. A total of 43 T1DM children (20 females and 23 males) aged 2-18 years and age- and sex-matched 30 healthy control subjects were enrolled in the study group. ROTEM assays [intrinsic TEM (INTEM) and extrinsic TEM (EXTEM)] were used to measure and analyze coagulation time (CT), clot formation time, maximum clot firmness (MCF). Glycated hemoglobin levels (HbA1c), diabetic complications, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and dimerized plasmin fragment D (D-dimer) were determined in the study group. The mean duration of T1DM diagnosis was 3.15 ± 2.49 years, and the mean HbA1c level was 8.94 ± 1.88% (74.29 ± 20.59 mmol/mol). None of the patients had macrovascular complications. Nephropathy was present in five patients. In the T1DM group, EXTEM-CT [80.00 (66.75-108.50)] was significantly lower, and EXTEM-MCF [65.00 (64.00-70.00)] and INTEM-MCF [65.00 (62.00-68.00)] were significantly higher than in the controls (p < 0.001, p = 0.026, and p = 0.004, respectively). However, the duration of T1DM and the degree of metabolic control had no influence on these parameters. Platelet count, PT, aPTT, fibrinogen and D-dimer levels were comparable between the diabetic patients and the control group. There were statistically significant correlations between fibrinogen level and INTEM-MCF and EXTEM-MCF (p < 0.001, p = 0.002 and r = 0.545, r = 0.454, respectively) This study shows that decreased levels of CT and increased levels of MCF suggest hypercoagulability in patients with T1DM. Further studies are needed to confirm our findings on a larger number of diabetic patients.
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Affiliation(s)
- Cigdem Binay
- Division of Pediatric Endocrinology, Department of Pediatrics, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Ayse Bozkurt Turhan
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Enver Simsek
- Division of Pediatric Endocrinology, Department of Pediatrics, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Ozcan Bor
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Olga Meltem Akay
- Department of Hematology and Oncology, Osmangazi University School of Medicine, Eskisehir, Turkey
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Cimenti C, Schlagenhauf A, Leschnik B, Fröhlich-Reiterer E, Jasser-Nitsche H, Haidl H, Suppan E, Weinhandl G, Leberl M, Borkenstein M, Muntean WE. Only minor changes in thrombin generation of children and adolescents with type 1 diabetes mellitus – A case-control study. Thromb Res 2016; 148:45-49. [DOI: 10.1016/j.thromres.2016.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/07/2016] [Accepted: 10/15/2016] [Indexed: 10/20/2022]
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Garcia FADO, Rebouças JF, Balbino TQ, da Silva TG, de Carvalho-Júnior CHR, Cerqueira GS, Brito GADC, Viana GSDB. Pentoxifylline reduces the inflammatory process in diabetic rats: relationship with decreases of pro-inflammatory cytokines and inducible nitric oxide synthase. JOURNAL OF INFLAMMATION-LONDON 2015; 12:33. [PMID: 25922592 PMCID: PMC4411660 DOI: 10.1186/s12950-015-0080-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 04/15/2015] [Indexed: 12/18/2022]
Abstract
Studies suggest that inflammation is a key factor in the pathogenesis of diabetes mellitus. Pro-inflammatory cytokines, such as IL-6 and TNF-alpha, are produced by adipose tissue in large quantities, in obese and especially in diabetic individuals. Pentoxifylline (PTX) is a non-selective phosphodiesterase inhibitor with anti-inflammatory and antioxidant actions that may contribute to alleviate diabetes side effects, as neuropathy, retinopathy and nephropathy. This study aims to investigate PTX anti-inflammatory effects on the carrageenan-induced paw edema model, in alloxan-induced diabetic rats. Diabetic animals (male Wistar rats, 200–250 g) were daily treated with PTX (25, 50, 100 mg/kg, p.o.), glibenclamide (GLI, 5 mg/kg, p.o., as reference) or water, for 5 days. Afterwards, carrageenan-treated paws were dissected, their skin removed and the tissue used for preparation of homogenates and measurements of IL-6 and TNF-alpha by Elisa. Serum levels of nitrite were also determined and paw slices used for iNOS immunohistochemistry assays. We showed that diabetic rats presented an amplification of the inflammatory response, as related to non-diabetic rats, what was evident 48 h after the edema-induction. The PTX-treatment of diabetic rats reduced glycemia (as related to untreated-diabetic ones) and the paw edema. It also brought edema volumes to values similar to those of non-diabetic rats, at the same observation time. The increased TNF-alpha and IL-6 levels in paws of untreated-diabetic rats were reduced in diabetic animals after PTX treatments. Besides, the increased levels of nitrite in the serum of diabetic rats were also decreased by PTX. Furthermore, a higher number of iNOS immunostained cells was demonstrated in paw tissues from untreated-diabetic rats, as related to those of PTX-treated diabetic animals. Our results show that PTX reduces inflammatory parameters, as pro-inflammatory cytokines and iNOS expression, indicating the potential benefit of the drug for the treatment of diabetes and related pathologic conditions.
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Affiliation(s)
| | | | | | | | | | - Gilberto Santos Cerqueira
- Faculty of Medicine of the Federal University of Ceará, Rua Barbosa de Freitas, 130/1100, Fortaleza, CEP: 60170-020 Brazil
| | - Gerly Anne de Castro Brito
- Faculty of Medicine of the Federal University of Ceará, Rua Barbosa de Freitas, 130/1100, Fortaleza, CEP: 60170-020 Brazil
| | - Glauce Socorro de Barros Viana
- Faculty of Medicine Estácio of Juazeiro do Norte, Juazeiro do Norte, Brazil ; Faculty of Medicine of the Federal University of Ceará, Rua Barbosa de Freitas, 130/1100, Fortaleza, CEP: 60170-020 Brazil
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Jørgensen LB, Skov O, Yderstræde K. Newly diagnosed type 1 diabetes complicated by ketoacidosis and peripheral thrombosis leading to transfemoral amputation. BMJ Case Rep 2014; 2014:bcr-2013-202139. [PMID: 24842351 DOI: 10.1136/bcr-2013-202139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Peripheral vascular thromboembolism is a rarely described complication of diabetic ketoacidosis. We report a 41-year-old otherwise healthy man admitted with ketoacidosis and ischaemia of the left foot. The patient was unsuccessfully treated with thromboendarterectomy, and the extremity was ultimately amputated. The patient had no family history of cardiovascular disease, and all blood sample analyses for hypercoagulability were negative. We recommend an increased focus on peripheral thromboembolism, when treating patients with severe ketoacidosis.
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Affiliation(s)
| | - Ole Skov
- Department of Orthopaedic Surgery, Odense University Hospital (OUH), Odense C, Denmark
| | - Knud Yderstræde
- Department of Medical Endocrinology, Odense University Hospital (OUH), Odense C, Denmark
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Kyrgios I, Maggana I, Giza S, Stergidou D, Mouzaki K, Kotanidou EP, Papadakis E, Galli-Tsinopoulou A. Suboptimal glycaemic control enhances the risk of impaired prothrombotic state in youths with type 1 diabetes mellitus. Diab Vasc Dis Res 2014; 11:208-16. [PMID: 24668409 DOI: 10.1177/1479164114528821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate markers of prothrombotic state and endothelial dysfunction in youths with type 1 diabetes mellitus (T1DM) and investigate possible associations with anthropometric/demographic data, glycaemic control and lipid profile. METHODS In a cross-sectional design, we recruited 155 youths with T1DM and determined levels of plasminogen activator inhibitor-1-antigen (PAI-1-Ag), von Willebrand factor-antigen (vWF-Ag), fibrinogen (FB), lipids and glycosylated haemoglobin (HbA1c). RESULTS Of all the participants, 76 (49%) had increased levels of at least one of prothrombotic factors. Suboptimal glycaemic control was associated with a worse lipid profile and an eightfold increased risk of elevated vWF-Ag levels. Higher vWF-Ag concentrations were also correlated with impaired lipid profile and increased HbA1c values, whereas PAI-1-Ag was positively correlated only with triglyceride levels. After adjustment for potential confounders, only HbA1c contributed independently to the variation in vWF-Ag levels. CONCLUSION Impaired prothrombotic state and consequently endothelial dysfunction are present in youths with T1DM, representing a cumulative risk factor for future cardiovascular disease (CVD). Achievement and maintenance of euglycaemia and normolipidaemia are crucial to decelerate progress of this process.
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Affiliation(s)
- Ioannis Kyrgios
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Matheus ASDM, Tannus LRM, Cobas RA, Palma CCS, Negrato CA, Gomes MDB. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens 2013; 2013:653789. [PMID: 23533715 PMCID: PMC3603160 DOI: 10.1155/2013/653789] [Citation(s) in RCA: 274] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/31/2013] [Accepted: 01/31/2013] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular diseases are the most prevalent cause of morbidity and mortality among patients with type 1 or type 2 diabetes. The proposed mechanisms that can link accelerated atherosclerosis and increased cardiovascular risk in this population are poorly understood. It has been suggested that an association between hyperglycemia and intracellular metabolic changes can result in oxidative stress, low-grade inflammation, and endothelial dysfunction. Recently, epigenetic factors by different types of reactions are known to be responsible for the interaction between genes and environment and for this reason can also account for the association between diabetes and cardiovascular disease. The impact of clinical factors that may coexist with diabetes such as obesity, dyslipidemia, and hypertension are also discussed. Furthermore, evidence that justify screening for subclinical atherosclerosis in asymptomatic patients is controversial and is also matter of this review. The purpose of this paper is to describe the association between poor glycemic control, oxidative stress, markers of insulin resistance, and of low-grade inflammation that have been suggested as putative factors linking diabetes and cardiovascular disease.
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Affiliation(s)
- Alessandra Saldanha de Mattos Matheus
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Lucianne Righeti Monteiro Tannus
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Roberta Arnoldi Cobas
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Catia C. Sousa Palma
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Carlos Antonio Negrato
- Department of Internal Medicine, Bauru's Diabetics Association, Rua Saint Martin 27-07, 17.012-433 Bauru, SP, Brazil
| | - Marilia de Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
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Jialal I, Kaur H, Devaraj S. Human C-reactive protein accentuates macrophage activity in biobreeding diabetic rats. J Diabetes Complications 2013; 27:23-8. [PMID: 22520400 PMCID: PMC3404262 DOI: 10.1016/j.jdiacomp.2012.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/13/2012] [Accepted: 03/15/2012] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Type 1 diabetes (T1DM) is a pro-inflammatory state characterized by high C-reactive protein (CRP) levels. However, there is a paucity of data examining the role of CRP in promoting the pro-inflammatory state of diabetes. Thus, we examined the pro-inflammatory effects of human CRP using spontaneously diabetic bio-breeding (BB) rats. METHODS Diabetic rats (n=9/group) were injected with Human serum albumin (huSA) or Human CRP (hCRP, 20 mg/kg body weight; i.p.) for 3 consecutive days. Blood and peritoneal macrophages (MØ) were obtained following euthanasia. Peritoneal macrophages were used for measuring superoxide anion release, NF-κB DNA binding activity, proinflammatory mediator secretion. RESULTS hCRP administration resulted in significantly increased superoxide anion production, along with increased release of cytokines/chemokines, and plasminogen activator inhibitor (PAI-1) and Tissue Factor (TF) activity in diabetic rats compared to huSA. hCRP-treated BB rat MØ showed significant induction of protein kinase C (PKC)-alpha, PKC-delta and p47 phox expression and NF-κB compared to huSA. CONCLUSIONS Thus, our data suggest that human CRP exacerbates in-vivo the pro-inflammatory, pro-oxidant and procoagulant states of diabetes predominantly via increased macrophage activity and this could have implications with respect to vascular complications and anti-inflammatory therapies.
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Affiliation(s)
- Ishwarlal Jialal
- Laboratory of Atherosclerosis and Metabolic Research, Department of Pathology and Laboratory Medicine, University of California at Davis, Sacramento, CA, USA.
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21
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Diabetes Mellitus. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Diabetes mellitus and thrombosis. Thromb Res 2011; 129:371-7. [PMID: 22197180 DOI: 10.1016/j.thromres.2011.11.052] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/29/2011] [Accepted: 11/30/2011] [Indexed: 02/06/2023]
Abstract
Atherothrombosis is the leading cause of morbidity and mortality in patients with diabetes mellitus. Several mechanisms contribute to the diabetic prothrombotic state, including endothelial dysfunction, coagulative activation and platelet hyper-reactivity. In particular, diabetic platelets are characterised by dysregulation of several signaling pathways leading to enhanced adhesion, activation and aggregation. These alterations result from the interaction among hyperglycemia, insulin resistance, inflammation and oxidative stress. This review will provide an overview of the current status of knowledge on mechanisms of accelerated atherothrombosis in patients with diabetes mellitus.
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Foster JR, Morrison G, Fraser DD. Diabetic ketoacidosis-associated stroke in children and youth. Stroke Res Treat 2011; 2011:219706. [PMID: 21423557 PMCID: PMC3056450 DOI: 10.4061/2011/219706] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 11/12/2010] [Accepted: 12/04/2010] [Indexed: 01/14/2023] Open
Abstract
Diabetic ketoacidosis (DKA) is a state of severe insulin deficiency, either absolute or relative, resulting in hyperglycemia and ketonemia. Although possibly underappreciated, up to 10% of cases of intracerebral complications associated with an episode of DKA, and/or its treatment, in children and youth are due to hemorrhage or ischemic brain infarction. Systemic inflammation is present in DKA, with resultant vascular endothelial perturbation that may result in coagulopathy and increased hemorrhagic risk. Thrombotic risk during DKA is elevated by abnormalities in coagulation factors, platelet activation, blood volume and flow, and vascular reactivity. DKA-associated cerebral edema may also predispose to ischemic injury and hemorrhage, though cases of stroke without concomitant cerebral edema have been identified. We review the current literature regarding the pathogenesis of stroke during an episode of DKA in children and youth.
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Affiliation(s)
- Jennifer Ruth Foster
- Critical Care Medicine and Paediatrics, University of Western Ontario, London, ON, Canada N6A 5W9
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Bertoluci MC, Cé GV, da Silva AMV, Puñales MKC. [Endothelial dysfunction in type 1 diabetes]. ACTA ACUST UNITED AC 2009; 52:416-26. [PMID: 18438553 DOI: 10.1590/s0004-27302008000200030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 12/16/2007] [Indexed: 11/21/2022]
Abstract
Vascular complications are the main cause of mortality and morbidity in diabetes. Mechanisms involved in the development of micro and macrovascular disease are complex and partially understood, but invariably begin as a dysfunctional endothelium. Nitric oxide is an important regulator of endothelial function and the impairment of its activity is determinant of the endothelial dysfunction. In type 1 diabetes, many factors like acute, chronic and post-prandial hyperglycemia, as well as the duration of diabetes or autonomic neuropathy and microalbuminuria are associated to endothelial dysfunction. Oxidative stress, polyol pathway activation, protein kinase C activation and the presence of advanced glycation end-products are potential mechanisms involved in the development of endothelial dysfunction. Early detection of endothelial dysfunction has prognostic value for the development of vascular complications and may be important in strategies for primary prevention of cardiovascular endpoints in type 1 diabetes.
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MacKenzie KE, Wiltshire EJ, Peña AS, Gent R, Hirte C, Piotto L, Couper JJ. Hs-CRP is associated with weight, BMI, and female sex but not with endothelial function in children with type 1 diabetes. Pediatr Diabetes 2009; 10:44-51. [PMID: 18798827 DOI: 10.1111/j.1399-5448.2008.00456.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Atherosclerosis is an inflammatory process, and high-sensitivity C-reactive protein (Hs-CRP), a marker of inflammation, predicts cardiovascular events in adults. Vascular endothelial and smooth muscle dysfunction, measurable precursors of atherosclerosis, begin in childhood. Therefore, we sought to determine if Hs-CRP is associated with vascular endothelial and smooth muscle dysfunction in children with type 1 diabetes mellitus (T1DM) and healthy control subjects. METHODS Hs-CRP and endothelial function assessed by flow-mediated dilatation (FMD) and smooth muscle function assessed by glyceryl-trinitrate (GTN)-induced dilatation were measured in 121 subjects with T1DM aged 14.1 (2.9) yr, of whom 31 were also studied at 4 and 8 wk, and in 33 healthy controls aged 14.2 (3.6) yr. RESULTS Hs-CRP did not differ between subjects with T1DM and healthy, age-matched controls. In both controls and subjects with T1DM, Hs-CRP did not relate to FMD or GTN at baseline or at intervals over 8 wk in T1DM. Hs-CRP did not change over time. In T1DM, but not healthy controls, Hs-CRP related to body mass index (BMI) z-score (r = 0.47, p < 0.001), weight z-score (r = 0.41, p < 0.001), and female sex (p = 0.008). CONCLUSIONS Hs-CRP is not associated with early vascular dysfunction in children with T1DM. However, in children and adolescents with T1DM, Hs-CRP was associated with female sex and children with higher BMI, suggesting that these groups may be at greater cardiovascular risk. Maintenance of a healthy BMI may be important in the prevention of vascular disease of T1DM.
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Affiliation(s)
- Karen E MacKenzie
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
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Lopes-Virella MF, Carter RE, Gilbert GE, Klein RL, Jaffa M, Jenkins AJ, Lyons TJ, Garvey WT, Virella G. Risk factors related to inflammation and endothelial dysfunction in the DCCT/EDIC cohort and their relationship with nephropathy and macrovascular complications. Diabetes Care 2008; 31:2006-12. [PMID: 18628568 PMCID: PMC2551645 DOI: 10.2337/dc08-0659] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Because endothelial cell dysfunction and inflammation are key contributors to the development of complications in type 1 diabetes, we studied risk factors related to endothelial dysfunction and inflammation (C-reactive protein and fibrinogen, soluble vascular cell adhesion molecule-1, intracellular adhesion molecule-1, and E-selectin, and fibrinolytic markers) in a subgroup of patients from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Intervention and Complications (EDIC) study cohort. RESEARCH DESIGN AND METHODS We determined which of these risk factors or clusters thereof are associated with the presence of and subsequent development of nephropathy and macrovascular complications (reflected by carotid intima-media thickness [IMT]). RESULTS After adjustment for conventional risk factors (age, sex, DCCT treatment group, diabetes duration, A1C, systolic blood pressure, waist-to-hip ratio, total and HDL cholesterol, and smoking status), fibrinogen remained strongly associated with progression of internal and common carotid IMT (P < 0.01) and soluble E-selectin had a strong association with nephropathy (P < 0.01). CONCLUSIONS The best predictor for IMT progression in the DCCT/EDIC cohort was plasma fibrinogen, and the levels of soluble E-selectin discriminate patients with albuminuria better than conventional risk factors.
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Affiliation(s)
- Maria F Lopes-Virella
- Department of Medicine and Laboratory Services, Medical University of South Carolina and Ralph H Johnson VA Medical Center, Charleston, South Carolina, USA.
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Zorena K, Myśliwska J, Myśliwiec M, Balcerska A, Hak Ł, Lipowski P, Raczyńska K. Serum TNF-alpha level predicts nonproliferative diabetic retinopathy in children. Mediators Inflamm 2008; 2007:92196. [PMID: 17641733 PMCID: PMC1906713 DOI: 10.1155/2007/92196] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 02/28/2007] [Accepted: 03/01/2007] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was identification of the immunologic markers of the damage to the eye apparatus at early stages of diabetes mellitus (DM) type 1 children. One hundred and eleven children with DM type 1 were divided into two groups: those with nonproliferative diabetic retinopathy (NPDR) and without retinopathy. All the children had their daily urine albumin excretion, HbA1c, C-peptide measured, 24-hour blood pressure monitoring, and ophthalmologic examination. Levels of TNF-alpha, IL-6, and IL-12 in serum were measured by ELISA tests (Quantikine High Sensitivity Human by R&D Systems, Minneapolis, Minn, USA). The NPDR children demonstrated a significantly longer duration of the disease in addition to higher HbA1c, albumin excretion rate, C-reactive protein, systolic blood pressure, as well as TNF-alpha and IL-6 levels than those without retinopathy. The logistic regression revealed that the risk of NPDR was strongly dependent on TNF-alpha [(OR 4.01; 95%CI 2.01-7.96)]. TNF-alpha appears to be the most significant predictor among the analyzed parameters of damage to the eye apparatus. The early introduction of the TNF-alpha antagonists to the treatment of young patients with DM type 1 who show high serum activity of the TNF-alpha may prevent them from development of diabetic retinopathy.
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Affiliation(s)
- Katarzyna Zorena
- Department of Immunology, Medical University of Gdańsk, Dębinki 1, 80-210 Gdańsk, Poland
- *Katarzyna Zorena:
| | - Jolanta Myśliwska
- Department of Immunology, Medical University of Gdańsk, Dębinki 1, 80-210 Gdańsk, Poland
| | - Małgorzata Myśliwiec
- Diabetological Department, Clinic of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdańsk,
80-210 Gdańsk, Poland
| | - Anna Balcerska
- Diabetological Department, Clinic of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdańsk,
80-210 Gdańsk, Poland
| | - Łukasz Hak
- Department of Immunology, Medical University of Gdańsk, Dębinki 1, 80-210 Gdańsk, Poland
| | - Paweł Lipowski
- Department and Clinic of Ophthalmology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Krystyna Raczyńska
- Department and Clinic of Ophthalmology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Kwon O, Hong SM, Sutton TA, Temm CJ. Preservation of peritubular capillary endothelial integrity and increasing pericytes may be critical to recovery from postischemic acute kidney injury. Am J Physiol Renal Physiol 2008; 295:F351-9. [PMID: 18562634 DOI: 10.1152/ajprenal.90276.2008] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Decreased renal blood flow following an ischemic insult contributes to a reduction in glomerular filtration. However, little is known about the underlying cellular or subcellular mechanisms mediating reduced renal blood flow in human ischemic acute kidney injury (AKI) or acute renal failure (ARF). To examine renal vascular injury following ischemia, intraoperative graft biopsies were performed after reperfusion in 21 cadaveric renal allografts. Confocal fluorescence microscopy was utilized to examine vascular smooth muscle and endothelial cell integrity as well as peritubular interstitial pericytes in the biopsies. The reperfused, transplanted kidneys exhibited postischemic injury to the renal vasculature, as demonstrated by disorganization/disarray of the actin cytoskeleton in vascular smooth muscle cells and disappearance of von Willebrand factor from vascular endothelial cells. Damage to peritubular capillary endothelial cells was more severe in subjects destined to have sustained ARF than in those with rapid recovery of their graft function. In addition, peritubular pericytes/myofibroblasts were more pronounced in recipients destined to recover than those with sustained ARF. Taken together, these data suggest damage to the renal vasculature occurs after ischemia-reperfusion in human kidneys. Preservation of peritubular capillary endothelial integrity and increasing pericytes may be critical to recovery from postischemic AKI.
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Affiliation(s)
- Osun Kwon
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Abstract
Early childhood overweight and obesity have alarmingly increased over the years. Adulthood obesity is a well demonstrated significant independent predictor of cardiovascular risk (CVR) and/or mortality, which predisposes to the major components of metabolic syndrome (MS). Evidence of MS in obese children has been also reported associated with biochemical and inflammatory factors that affect vascular physiologic function. Assessment of vascular function can be measured noninvasively in children allowing early detection of endothelial dysfunction and severe increase of arterial stiffness before clinical manifestations of atherosclerosis. Impairment of endothelial function related to the severity of obesity and to the degree of insulin resistance is considered as a condition that confers a premature atherogenicity status and is linked to adult conventional cardiovascular risk factors. Adipose tissue factors that interfere with insulin action and endothelial cell function have also been identified as major precursors of CVR factors. The metabolic and cardiovascular consequences of childhood obesity are well demonstrated and have a major impact on the development of atherosclerosis and lifetime CVR. The development of programs involving both diet and exercise for children with overt overweight/obesity appears to be essential to improve vascular function and metabolic disorders. Such interventions should be complemented by a primary prevention against childhood obesity.
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Affiliation(s)
- Yacine Aggoun
- Department of Paediatrics, Paediatric Cardiology Unit. University Hospital of Geneva, 1211 Geneva, Switzerland.
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Schwab KO, Doerfer J, Krebs A, Krebs K, Schorb E, Hallermann K, Superti-Furga A, Zieger B, März W, Schmidt-Trucksäss A, Winkler K. Early atherosclerosis in childhood type 1 diabetes: role of raised systolic blood pressure in the absence of dyslipidaemia. Eur J Pediatr 2007; 166:541-8. [PMID: 17387514 DOI: 10.1007/s00431-007-0440-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 01/31/2007] [Accepted: 02/02/2007] [Indexed: 10/23/2022]
Abstract
The intentions of our investigation were (1) to search for atherogenic risk factors and signs of incipient atherosclerosis in children and adolescents with type 1 diabetes (T1DM) in comparison to well-matched control subjects, (2) to evaluate risk factor associations with carotid intima media thickness (cIMT) in diabetic patients and control subjects, and (3) to acquire a better knowledge of early atherogenesis in children and adolescents with and without T1DM. 94 diabetic children (age median 12.3 years, HbA1c median 7.7%) and 40 non-diabetic controls (age median 12.3 years) were investigated. Mean cIMT was determined using high-resolution B-mode ultrasound with an automated contour identification procedure. Compared to controls, subjects with diabetes had significantly elevated cIMT (p = 0.041) and systolic BP (p = 0.007) but showed a less atherogenic lipid profile. Most markers of inflammation, endothelial function and fibrinolytic activity were higher in diabetic subjects than in controls. Multiple linear regression analysis revealed a significant relationship (r = 0.53, p = 0.036) between bilateral mean cIMT and diverse risk factors in patients with T1DM. Spearman rank correlation showed that diabetes duration (rho = 0.32, p = 0.029), systolic BP (rho = 0.32, p = 0.004), weight (rho = 0.257, p = 0.022), and height (rho = 0.265, p = 0.018) significantly correlated with bilateral mean cIMT in the 94 diabetic patients. In conclusion, in well-controlled type 1 diabetic children systolic BP may be of greater importance than dyslipidaemia in early atherogenesis. BMI, markers of sustained inflammation, endothelial dysfunction and fibrinolytic activity are increased in diabetic versus non-diabetic children but none of them correlates significantly with cIMT. Their prognostic value remains to be determined.
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Affiliation(s)
- Karl Otfried Schwab
- Department of Pediatrics and Adolescents Medicine, University Hospital, Mathilden Str. 1, Freiburg, Germany.
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31
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Xu JW, Morita I, Ikeda K, Miki T, Yamori Y. C-reactive protein suppresses insulin signaling in endothelial cells: role of spleen tyrosine kinase. Mol Endocrinol 2006; 21:564-73. [PMID: 17095576 DOI: 10.1210/me.2006-0354] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although few epidemiological studies have demonstrated that C-reactive protein (CRP) is related to insulin resistance, no study to date has examined the molecular mechanism. Here, we show that recombinant CRP attenuates insulin signaling through the regulation of spleen tyrosine kinase (Syk) on small G-protein RhoA, jun N-terminal kinase (JNK) MAPK, insulin receptor substrate-1 (IRS-1), and endothelial nitric oxide synthase in vascular endothelial cells. Recombinant CRP suppressed insulin-induced NO production, inhibited the phosphorylation of Akt and endothelial nitric oxide synthase, and stimulated the phosphorylation of IRS-1 at the Ser307 site in a dose-dependent manner. These events were blocked by treatment with an inhibitor of RhoA-dependent kinase Y27632, or an inhibitor of JNK SP600125, or the transfection of dominant negative RhoA cDNA. Next, anti-CD64 Fcgamma phagocytic receptor I (FcgammaRI), but not anti-CD16 (FcgammaRIIIa) or anti-CD32 (FcgammaRII) antibody, partially blocked the recombinant CRP-induced phosphorylation of JNK and IRS-1 and restored, to a certain extent, the insulin-stimulated phosphorylation of Akt. Furthermore, we identified that recombinant CRP modulates the phosphorylation of Syk tyrosine kinase in endothelial cells. Piceatannol, an inhibitor of Syk tyrosine kinase, or infection of Syk small interference RNA blocked the recombinant CRP-induced RhoA activity and the phosphorylation of JNK and IRS-1. In addition, piceatannol also restrained CRP-induced endothelin-1 production. We conclude that recombinant CRP induces endothelial insulin resistance and dysfunction, and propose a new mechanism by which recombinant CRP induces the phosphorylation of JNK and IRS-1 at the Ser307 site through a Syk tyrosine kinase and RhoA-activation signaling pathway.
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Affiliation(s)
- Jin-Wen Xu
- Frontier Health Science, School of Human Environmental Science, Mukogawa Women's University, Nishinomiya, Hyogo 663-8179, Japan.
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Myśliwiec M, Zorena K, Balcerska A, Myśliwska J, Lipowski P, Raczyńska K. The activity of N-acetyl-beta-D-glucosaminidase and tumor necrosis factor-alpha at early stage of diabetic retinopathy development in type 1 diabetes mellitus children. Clin Biochem 2006; 39:851-6. [PMID: 16696964 DOI: 10.1016/j.clinbiochem.2006.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 03/22/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The assessment of the clinical significance of TNF-alpha, IL-10 and NAG with its A and B isoforms concentrations in children with DM type 1 for the detection of early stages of both diabetic retinopathy and nephropathy. PATIENTS AND METHODS One hundred and two children with DM type 1 and 35 healthy controls were analyzed. Levels of TNF-alpha, IL10 and total NAG enzyme activity with its A and B isoforms were measured in serum and urine of all participants. RESULTS Children with diabetic retinopathy had a significantly higher levels of TNFalpha in serum (P=0.01) in comparison to those without retinopathy. The activity of NAG (P=0.002) and its isoform A (P=0.006) and isoform B (P=0.001) were significantly higher in children with diabetic retinopathy in comparison to those without this complication. Conversely, within the group with retinopathy, more children had detectable concentrations of IL10 in serum as compared to those without retinopathy (P=0.01). CONCLUSIONS These results suggest that NAG activity and TNF-alpha concentration in diabetic retinopathy patients might show a relationship with a degree of renal glomeruli epithelial cells and renal proximal tubules damage.
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Affiliation(s)
- Małgorzata Myśliwiec
- Institute of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdańsk, ul. Debinki 7, 80-952 Gdańsk, Poland.
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Schwab KO, Doerfer J, Hecker W, Grulich-Henn J, Wiemann D, Kordonouri O, Beyer P, Holl RW. Spectrum and prevalence of atherogenic risk factors in 27,358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care 2006; 29:218-25. [PMID: 16443863 DOI: 10.2337/diacare.29.02.06.dc05-0724] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this data analysis was to ascertain the type and prevalence rate as well as age and sex distribution of cardiovascular risk factors in type 1 diabetic patients up to 26 years of age. RESEARCH DESIGN AND METHODS Cardiovascular risk factors such as obesity, hypertension, dyslipidemia, poor glycemic control, and smoking were analyzed in 27,358 patients who were divided into three groups (prepubertal, pubertal, and adult) using specifically designed diabetes software for prospective disease documentation. RESULTS More than half of the patients per age-group had at least one cardiovascular risk factor. Two risk factors were age dependently found in 6.2-21.7% and three or four risk factors in 0.5-4.7%. Elevated values of HbA(1c), total cholesterol, and BMI were found most frequently. Hypertension, smoking, and HDL cholesterol were observed more frequently in males, and elevated BMI, total cholesterol, and LDL cholesterol more often in females. Although 28.6% of the patients had dyslipidemia, merely 0.4% of them received medical treatment, and of the 8.1% of the patients with hypertension, only 2.1% of them were given antihypertensive medication. CONCLUSIONS With increasing age, a greater number of patients with cardiovascular risk factors were observed. Significant sex differences were seen in the majority of risk factors. Despite the high prevalence of risk factors, only a small minority of patients received antihypertensive or lipid-lowering treatment. Early identification, prevention, and treatment of additional risk factors seem to be necessary, particularly in light of the high incidence of future cardiovascular disease.
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Affiliation(s)
- K Otfried Schwab
- Department of Pediatrics and Adolescence Medicine, Freiburg University Hospital, Mathilden Str. 1, D-79106 Freiburg, Germany.
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34
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Derosa G, Avanzini MA, Geroldi D, Fogari R, Lorini R, De Silvestri A, Tinelli C, Rondini G, d'Annunzio G. Matrix metalloproteinase 2 may be a marker of microangiopathy in children and adolescents with type 1 diabetes mellitus. Diabetes Res Clin Pract 2005; 70:119-25. [PMID: 16188574 DOI: 10.1016/j.diabres.2005.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 02/14/2005] [Accepted: 03/04/2005] [Indexed: 11/22/2022]
Abstract
Matrix metalloproteinases (MMPs) 2 and 9 are responsible for extracellular matrix breakdown and their abnormal circulating levels may pre-date clinical evidence of diabetic angiopathy. We detected by ELISA, plasma MMP-2 and MMP-9 levels and associated activity in 25 children and adolescents with T1DM. Thirteen male and 12 female patients were evaluated at the clinical diagnosis and onset of T1DM and again at a 5-year follow-up. Twelve patients had developed microangiopathic complications at the follow-up evaluation. MMP-2 and MMP-9 levels and activity were detected in samples obtained at T1DM diagnosis and at the 5-year follow-up. As controls, 19 healthy subjects who were the same age as the patients were also evaluated at baseline and again after 5 years. MMP-2 levels and activity were significantly higher in the patients than in the controls at disease onset. This was particularly evident when patients who developed microangiopathic complications were compared to controls and patients without complications. At the 5-year follow-up, a significant increase in MMP-2 levels and a significant decrease in MMP-2 activity were found only in the control group compared to the baseline levels. MMP-2 levels and activity were higher in patients with microangiopathy. MMP-9 levels and activity were increased in all groups compared to baseline levels. MMP-9 levels were lower in patients with microangiopathy compared to controls, but no difference was found between the two patient groups. It is well known that MMP-9 is an index of the severity and stability of macroangiopathy while our results allow us to postulate that MMP-2 may be a marker of microangiopathy.
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Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, P. le C. Golgi 2, 27100 Pavia, Italy.
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35
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Umpaichitra V, Hussain MM, Castells S. Plasminogen activator inhibitor-1 and tissue-plasminogen activator in minority adolescents with type 2 diabetes and obesity. Pediatr Res 2005; 58:483-7. [PMID: 15901895 DOI: 10.1203/01.pdr.0000164307.92308.09] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Increased plasminogen activator inhibitor-1 (PAI-1) and decreased tissue-plasminogen activator (t-PA) activities lead to impaired fibrinolysis, which is critical for cardiovascular disease. We studied these hemostatic factors at fasting state and after an oral fat load in 12 type 2 diabetic and 17 nondiabetic obese adolescents, matched for age, sex, body mass index, and sexual maturation. Plasma PAI-1, t-PA, and glucose as well as serum C-peptide, insulin, total cholesterol, triglyceride, and HDL and LDL cholesterol levels were measured at 0, 2, 4, and 6 h after the fat load. Metabolic responses were expressed as the area under the curve (AUC). PAI-1 activities were significantly greater in patients than in control subjects [fasting, 23.4 +/- 2.6 versus 12.9 +/- 2.0 U/mL (p < 0.004); AUC, 101.7 +/- 12.1 versus 57.6 +/- 6.5 U . h [corrected] . mL(-1) (p < 0.003)]. Fasting t-PA activities were significantly lower in the patients than in the control subjects (0.8 +/- 0.3 versus 6.5 +/- 2.7 U/mL; p < 0.001). Triglyceride was the only lipid parameter that was significantly different in the patients than in the control subjects [fasting, 1.5 +/- 0.2 versus 0.9 +/- 0.1 mM (p < 0.05); AUC, 15.7 +/- 2.9 versus 7.9 +/- 0.6 mmol . h(-1) . L(-1) (p < 0.02)]. The PAI-1 activities decreased significantly during the loading tests (p < 0.0001), whereas the t-PA activities did not change. Insulin resistance estimated by the homeostasis model assessment was greater in the patients than in the control subjects (14.4 +/- 2.8 versus 4.6 +/- 0.7; p < 0.0001). We conclude that elevated PAI-1 and diminished t-PA activities, suggestive of suppressed fibrinolysis, are present in our adolescents with type 2 diabetes; adding another risk factor for cardiovascular disease and acute high fat load does not further negatively affect this suppressed fibrinolysis.
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Affiliation(s)
- Vatcharapan Umpaichitra
- Department of Pediatrics, Brookdale University Hospital and Medical Center [corrected] Brooklyn, NY 11212, USA.
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Lu Q, Björkhem I, Wretlind B, Diczfalusy U, Henriksson P, Freyschuss A. Effect of ascorbic acid on microcirculation in patients with Type II diabetes: a randomized placebo-controlled cross-over study. Clin Sci (Lond) 2005; 108:507-13. [PMID: 15675894 DOI: 10.1042/cs20040291] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Manifestations of vascular disease, including microvascular changes, constitute the major part of the morbidity and mortality in diabetic patients. Oxidative stress has been suggested to play an important role in the vascular dysfunction of diabetic patients. Furthermore, epidemiological observations indicate a beneficial effect of an increased dietary intake of antioxidants. The present study tested the hypothesis that the antioxidant ascorbic acid influences microcirculatory function in patients with Type II diabetes. Patients with Type II diabetes were treated with 1 g of ascorbic acid three times a day for 2 weeks in a randomized placebo-controlled double-blind cross-over design. Microvascular reactivity was assessed by vital capillaroscopy and PRH (post-occlusive reactive hyperaemia). hs-CRP (high-sensitivity C-reactive protein), IL-6 (interleukin-6), IL-1ra (interleukin-1 receptor antagonist) and ox-LDL (oxidized low-density lipoprotein) were analysed. The results showed no significant change in microvascular reactivity assessed after 2 weeks of ascorbic acid treatment. TtP (time to peak) was 12.0+/-3.3 s before and 11.2+/-3.5 s after ascorbic acid (n=17). In comparison, TtP was 11.5+/-2.9 s before and 10.6+/-2.8 s after placebo (not significant). IL-1ra, IL-6, hs-CRP and ox-LDL did not change significantly after ascorbic acid, neither as absolute or relative values. In conclusion, in contrast with some studies reported previously, we could not demonstrate an effect of continuous oral treatment with ascorbic acid on microvascular reactivity assessed at the level of individual capillaries. Furthermore, we found no indication of an effect on inflammatory cytokines or ox-LDL.
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Affiliation(s)
- Qing Lu
- Division of Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm SE-141 86, Sweden
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Aggoun Y, Szezepanski I, Bonnet D. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events in children. Pediatr Res 2005; 58:173-8. [PMID: 16055929 DOI: 10.1203/01.pdr.0000170900.35571.cb] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Noninvasive assessment of vascular dysfunction in the pediatric population has taken advantage of the development of high-resolution ultrasound techniques. The most frequently used methods are the quantification of flow-mediated endothelium-dependent dilation of the brachial artery and measurement of the intima-media thickening of the carotid artery. Both reduced flow-mediated dilation and increased intima-media thickness have been proven to correlate with late cardiovascular events and/or mortality in adults. As these noninvasive methods can easily be applied in children, there have been recent investigations in high-risk pediatric patients harboring classical cardiovascular risk factors. Endothelial dysfunction and increased thickness of the intima media are currently observed in children with familial hypercholesterolemia, obesity, and type 1 diabetes mellitus. The association of early vascular dysfunction with a known risk factor is an important issue as these anomalies precede the formation of atherosclerotic plaques. Therefore, they may help in stratification of the risk for cardiovascular event and to better tailor therapeutic interventions in at risk children. Finally, these methods have been applied in specific pediatric populations, such as children with end-stage renal disease, chronic parenteral nutrition, HIV infection, and coarctation of the aorta. In these conditions, endothelial dysfunction and vascular remodeling are also present early in life and these data raise new possibilities in the understanding of the pathogenesis of atherosclerosis in these populations.
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Affiliation(s)
- Yacine Aggoun
- Pediatric Cardiology, Hôpital Necker-Enfants Malades, 75015 Paris, France
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Chiarelli F, Di Marzio D, Santilli F, Mohn A, Blasetti A, Cipollone F, Mezzetti A, Verrotti A. Effects of irbesartan on intracellular antioxidant enzyme expression and activity in adolescents and young adults with early diabetic angiopathy. Diabetes Care 2005; 28:1690-7. [PMID: 15983321 DOI: 10.2337/diacare.28.7.1690] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Defective intracellular antioxidant enzyme production (IAP) has been demonstrated in adults with diabetic nephropathy. The objective of this study was to evaluate the effects of irbesartan, an angiotensin II receptor antagonist, on IAP in adolescents and young adults with type 1 diabetes and early signs of retinopathy and nephropathy. RESEARCH DESIGN AND METHODS This prospective, matched case-control study was conducted between November 2001 and December 2002 among 14 type 1 diabetic patients with early signs of angiopathy (ages 14-21 years), 11 type 1 diabetic patients without angiopathy (ages 12-22 years), and 10 healthy volunteers (ages 16-22 years). Skin fibroblasts were obtained by skin biopsies from the anterior part of the forearm and cultured in Dulbecco's modified Eagle's medium. The activity and mRNA expression of CuZn superoxide dismutase (CuZnSOD), Mn superoxide dismutase (MnSOD), catalase (CAT), and glutathione peroxidase (GPX) were measured before and after 6 months of treatment with irbesartan (150 mg/day); on both occasions, antioxidant enzyme activity was evaluated at different glucose concentrations (5 and 22 mmol/l). RESULTS At a normal glucose concentration (5 mmol/l), the activity and mRNA expression of CuZnSOD (0.50 +/- 0.21 units/mg protein, 4.4 +/- 1.5 mRNA/glyceraldehyde-3-phosphate dehydrogenase), MnSOD (0.26 +/- 0.04 units/mg protein, 0.08 +/- 0.07 mRNA), CAT (0.32 +/- 0.08 units/mg protein, 4.8 +/- 1.3 mRNA), and GPX (0.53 +/- 0.09 units/mg protein, 2.2 +/- 0.9 mRNA) were not different among the three groups (only values of diabetic subjects with angiopathy are shown). At high glucose concentrations, the activity and mRNA expression of CuZnSOD increased similarly in all groups (diabetic subjects with angiopathy: 0.93 +/- 0.26 units/mg protein, 9.4 +/- 2.1 mRNA); that of CAT and GPX increased in only control subjects and diabetic subjects without angiopathy (diabetic subjects with angiopathy: 0.33 +/- 0.09 units/mg protein and 5.0 +/- 1.4 mRNA; 0.54 +/- 0.10 units/mg protein and 2.3 +/- 1.0 mRNA, respectively). MnSOD did not change in any group. Treatment with irbesartan in adolescents with diabetic angiopathy was able to restore CAT and GPX activity and mRNA expression after exposure to high glucose concentrations. Markers of oxidative stress (serum malondialdehyde, fluorescent products of lipid peroxidation, monocyte chemoattractant protein-1, and 8-isoprostanes prostaglandin F(2alpha)) were significantly reduced after treatment with irbesartan. CONCLUSIONS Adolescents and young adults with early signs of diabetic angiopathy have defective intracellular antioxidant enzyme production and activity. Treatment with irbesartan can substantially improve the activity and production of these enzymes in skin fibroblasts.
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Affiliation(s)
- Francesco Chiarelli
- Department of Pediatrics, University of Chieti, Ospedale Policlinico, Via dei Vestini, 5, I-66100 Chieti, Italy.
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Abstract
UNLABELLED Although clinical manifestations of atherosclerotic coronary heart disease occur in adult life, the initial stages of its development commence in childhood. Therefore, elucidating the pathogenesis of early atherosclerosis and identifying the network of risk factors have become fundamental priorities for both cardiovascular healthcare providers and scientists. There is mounting evidence from both human studies and animal experiments that infectious pathogens could be implicated in atherosclerosis development. The vulnerability of the arterial wall to the adverse effects of infection is probably augmented when additional risk factors and/or certain proatherogenic genetic profiles are also present. The precise mechanisms whereby infection, alone or in synergy with conventional cardiovascular risk factors, could contribute to atherosclerosis are not fully understood. CONCLUSION Injury to the vascular endothelium, which could be elicited by infection through inflammatory, metabolic, autoimmune, and pathogen-related mechanisms, might be a central link between infection and early atherosclerosis.
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Affiliation(s)
- Petru Liuba
- Division of Paediatric Cardiology, Children's Hospital, University Hospital Lund, Lund, Sweden.
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40
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Abstract
Diabetes and the metabolic syndrome, including insulin resistance, that underlies it are hyper-coagulable states. Increased platelet reactivity,augmented activity of the coagulation system,and impaired fibrinolysis are characteristic and understood to a remarkable extent. In aggregate,these derangements contribute to accelerated atherosclerosis, premature coronary artery dis-ease, and a profound toll from both.
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Affiliation(s)
- Burton E Sobel
- Department of Medicine, University of Vermont, Colchester Research Facility, 208 South Park Drive, Colchester, VT 05446, USA.
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41
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Abstract
Diabetes is a well-recognised risk factor for atherosclerotic cardiovascular disease and in fact most diabetic patients die from vascular complications. The Diabetes Control and Complications Trial (DCCT) and the U.K. Prospective Diabetes Study (UKPDS) indicate a consistent relationship between hyperglycaemia and the incidence of chronic vascular complications in patients with diabetes. Platelets are essential for haemostasis, and abnormalities of platelet function may cause vascular disease in diabetes. Diabetic patients have hyperreactive platelets with exaggerated adhesion, aggregation and thrombin generation. In summary, the entire coagulation cascade is dysfunctional in diabetes. This review provides a comprehensive overview of the physiological role of platelets in maintaining haemostasis and of the pathophysiological processes that contribute to platelet dysfunction in diabetes and associated cardiovascular diseases, with special emphasis on proteomic approaches and leukocyte-platelet cross-talk.
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Affiliation(s)
- Bernd Stratmann
- Herz- und Diabeteszentrum NRW, Georgstral3e 11, 32545 Bad Oeynhausen, Germany
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Coulon J, Willems D, Dorchy H. Augmentation de la concentration plasmatique de la protéine C-réactive dans le diabète de l’enfant et de l’adulte jeune. Presse Med 2005; 34:89-93. [PMID: 15687975 DOI: 10.1016/s0755-4982(05)88234-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate whether high sensitivity C-reactive protein (hs CRP) levels are elevated in young type 1 diabetic patients and to determine the relationships with age, degree of metabolic control determined by glycated hemoglobin (HbA1c), blood lipids, and subclinical complications. METHODS High sensitivity CRP was determined in young type 1 diabetic patients and in healthy controls. Blood lipids and HbA1c were also determined. The patients were divided into 2 groups. In group A, patients were free from subclinical complications (retinopathy, nephropathy and neuropathy) and in group B, patients had at least one subclinical complication. RESULTS The hs CRP concentrations were significantly higher in the 126 diabetic patients (55 girls and 71 boys) than in the 52 controls (2.6+/-4mg/L vs 0.7+/-0.7mg/L; p<0.001). This difference persisted when comparing the normal subjects with the 81 patients of group A (2.0+/-3.1mg/L; p<0.01) and the 45 patients of group B (3.6+/-5.1mg/L; p<0.001). The hs CRP concentrations were significantly correlated with total cholesterol, total cholesterol/HDL-cholesterol ratio, and LDL cholesterol for the 2 groups of patients. In the patients of group A, significant correlations were observed between hs CRP and age or duration of diabetes. No correlation was observed between hs CRP levels and glycaemia, HbA1c and HDL-cholesterol in the two groups of patients. CONCLUSION Levels of hs CRP were 3-fold greater in diabetic patients without complications than in controls and 5-fold greater in diabetic patients with subclinical complications. High sensitive CRP therefore appears to be an interesting indicator of the risk for developing complications.
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Affiliation(s)
- J Coulon
- Clinique de diabétologie, Hôpital universitaire des Enfants Reine Fabiola, Bruxelles, Belgique
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Gibney J, Turner B, Weis U, Meeking DR, Cansfield J, Watts GF, Shaw KM, Cummings MH. Reduced forearm reactive hyperaemia in normoalbuminuric subjects with Type 1 diabetes and retinopathy. Diabet Med 2004; 21:931-5. [PMID: 15270801 DOI: 10.1111/j.1464-5491.2004.01203.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To determine whether the forearm vasodilatory response to reactive hyperaemia (RH) is reduced in normoalbuminuric subjects with Type 1 diabetes mellitus and retinopathy compared with subjects with no retinopathy. METHODS Forearm RH, an indicator of endothelial function, was measured, using strain-gauge plethysmography, in 39 normoalbuminuric subjects (22 with retinopathy) with long-standing Type 1 diabetes mellitus. RESULTS were evaluated in relation to conventional risk factors for atherosclerosis, and C-reactive protein (CRP), which we have recently determined to be an independent correlate of forearm RH. RESULTS Forearm RH was decreased in subjects with retinopathy compared with those with no retinopathy (219 +/- 182 vs. 473 +/- 355, P < 0.01). Both retinopathy and CRP proved to be independent and negative predictors, and explain 27% of the variance, in forearm RH. CONCLUSION Retinopathy in subjects with Type 1 diabetes mellitus may reflect a generalized process of endothelial dysfunction, even in the absence of microalbuminuria.
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Affiliation(s)
- J Gibney
- Queen Alexandra Hospital, Portsmouth, Hampshire, UK.
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Zaletel J, Cerne D, Lenart K, Zitta S, Jürgens G, Estelberger W, Kocijancic A. Renal functional reserve in patients with Type 1 diabetes mellitus. Wien Klin Wochenschr 2004; 116:246-51. [PMID: 15143864 DOI: 10.1007/bf03041055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Decreased renal functional reserve might precede incipient diabetic nephropathy in patients with Type 1 diabetes. The aim of this study was to assess the relationship between renal functional reserve and easily assessable estimates of systemic endothelial dysfunction in normoalbuminuric patients with Type 1 diabetes and diabetic retinopathy. METHODS Renal functional reserve was calculated as the relative change in glomerular filtration rate after protein ingestion. Glomerular filtration rate was measured using pharmacokinetic compartmental analysis of single-shot plasma sinistrin clearance. We measured the activity of von Willebrand factor and concentrations of C-reactive protein and apolipoprotein B, as easily assessable estimates of systemic endothelial dysfunction. RESULTS Twenty-two patients were studied. Renal functional reserve was inversely associated with activity of von Willebrand factor (R=-0.431, p=0.045) and, in a multivariate model, with concentration of C-reactive protein (R=0.652, p=0.031). CONCLUSION Renal functional reserve is inversely associated with concentration of C-reactive protein in normoalbuminuric patients with Type 1 diabetes and diabetic retinopathy. This finding provides evidence that decreased renal functional reserve might reflect endothelial dysfunction. We speculate that decreased renal functional reserve might possibly show as an early marker of diabetic nephropathy.
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Affiliation(s)
- Jelka Zaletel
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Piccirillo LJ, Gonçalves MDFR, Clemente ELS, Gomes MDB. Marcadores de inflamação em pacientes com Diabetes Mellitus tipo 1. ACTA ACUST UNITED AC 2004; 48:253-60. [PMID: 15640880 DOI: 10.1590/s0004-27302004000200008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Para avaliar a resposta inflamatória, representada pelas proteínas de fase aguda, estudamos 48 pacientes com diabetes tipo 1 (DM1) sem complicações [23F:25M; 19,9±9,8 anos e 5 (1-21) anos de duração da doença& e 66 indivíduos sem DM, pareados quanto ao sexo, idade e estadiamento puberal (critérios de Tanner). Foram dosadas proteína C reativa (PCR), alfa1-glicoproteína ácida (alfa-1GPA) e fibrinogênio, por imuno-turbidimetria. A taxa de excreção de albumina (EUA) foi determinada por RIE, em amostra de urina de 10h, definindo-se normoalbuminúria como duas taxas de EUA <20µg/min. Pacientes com DM1 foram avaliados quanto à presença de retinopatia por oftalmoscopia indireta. No DM1 os níveis de PCR [0,23 (0,01-2,90) vs. 0,14 (0,01-2,41) mg/dl, p= 0,0172& e de alfa1-GPA [53,5 (37-115) vs. 40 (19-78) mg/dl, p< 0,0001& foram maiores quando comparados aos sem DM. Não houve diferença em relação ao fibrinogênio. Na regressão linear múltipla em stepwise, tendo a a1-GPA como variável dependente, as variáveis independentes associadas e preditoras foram a HbA1c (r²= 0,26; p< 0,05) e a glicemia (r²= 0,26; p< 0,05); tendo a PCR e o fibrinogênio como variáveis dependentes, nenhuma variável independente foi significativa. Na correlação de Pearson, a PCR correlacionou-se com HbA1c (r= 0,18; p= 0,05). Concluímos que a PCR e alfa1-GPA estão aumentadas no DM1, independente da presença da microalbuminúria, retinopatia e doença macrovascular clínica. Estudo prospectivo será necessário para estabelecermos o valor preditivo destes marcadores na evolução para complicações crônicas micro e macrovasculares.
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Affiliation(s)
- Laura J Piccirillo
- Departamento de Medicina Interna, Universidade do Estado do Rio de Janeiro-UERJ, Rio de Janeiro, RJ
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46
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Affiliation(s)
- Naji Yazbek
- Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA
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Golomb MR, Rafay M, Armstrong D, Massicotte P, Curtis R, Hune S, deVeber GA. Intra-arterial tissue plasminogen activator for thrombosis complicating cerebral angiography in a 17-year-old girl. J Child Neurol 2003; 18:420-3. [PMID: 12886978 DOI: 10.1177/08830738030180060301] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few reports describe the use of intraarterial recombinant tissue plasminogen activator to treat intracranial thrombosis in children. A 17-year-old girl with a history of prior venous thrombosis developed a left middle cerebral artery thrombus during diagnostic cerebral angiogram. Therapy with intra-arterial tissue plasminogen activator was initiated. An immediate follow-up angiogram demonstrated recanalization, and diffusion-weighted magnetic resonance imaging 9 hours later showed no evidence of infarction. Following the angiogram, femoral artery thrombosis developed. Treatment with supratherapeutic levels of heparin, localized delivery of intra-arterial tissue plasminogen activator, embolectomy, danaparoid, and dipyridamole failed to re-establish perfusion to the lower leg, and below the knee amputation was required. Neurologic examination remained normal 1 year later. Cerebral damage was avoided with the use of emergency intra-arterial tissue plasminogen activator for cerebral artery thrombosis in this child.
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Carl GF, Hoffman WH, Passmore GG, Truemper EJ, Lightsey AL, Cornwell PE, Jonah MH. Diabetic ketoacidosis promotes a prothrombotic state. Endocr Res 2003; 29:73-82. [PMID: 12665320 DOI: 10.1081/erc-120018678] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cerebrovascular accidents are one of the life-threatening complications of diabetic ketoacidosis (DKA) in children and adolescents. Our objective was to evaluate the effect of DKA and its treatment on factors known to affect thrombotic activity (protein C; protein S; von Willebrand factor, fibrinogen; homocysteine; and folate) by comparing seven adolescents with DKA prior to treatment and at 6, 24, and 120 hours after initiation of treatment. We found that protein C activity was significantly decreased by DKA, but normalized slowly following treatment. Free protein S was low throughout the study. Protein C antigen and protein S antigen showed varying degrees ofchange within the first 24 hours, but remained in the normal range, with the exception of the initial value of protein C antigen, which was elevated. von Willebrand factor (vWF) antigen and vWF activity were both significantly increased prior to treatment, but decreased with treatment. However, vWF activity remained elevated at 120 hours. Fibrinogen concentrations showed no significant changes throughout the study. Homocysteine was significantly decreased prior to treatment and increased with the initiation of treatment Folate was significantly increased prior to treatment, and decreased to high normal levels. The increased vWF and the decreased levels of protein C activity and of free protein S support the hypothesis that DKA and its treatment results in a prothrombotic state and activation of the vascular endothelium, which, in turn, predispose to cerebrovascular accidents.
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Affiliation(s)
- G F Carl
- Department of Neurology, Veteran's Administration Medical Center, Augusta, Georgia, USA
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50
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Abstract
PURPOSE OF REVIEW The inflammatory response is essential in the response to pathogens. TNF-alpha, IL-1 and IL-6 are key mediators of the response. They initiate metabolic changes to provide nutrients for the immune system, from host tissues. These changes include hyperlipidemia and increased gluconeogenesis. Insulin resistance and disordering of lipid metabolism occur in obesity, diabetes mellitus, atherosclerosis. This review examines recent research that links inflammation to insulin insensitivity. RECENT FINDINGS Population studies show a strong association between indices of inflammation, and abnormal lipid and carbohydrate metabolism, obesity and atherosclerosis. TNF-alpha is produced, by cells of the immune system and by adipocytes. It may provide the link between inflammation and insulin sensitivity. TNF-alpha results in insulin insensitivity, indirectly by stimulating stress hormone production and directly by sustained induction of SOCS-3 which decreases insulin-induced insulin receptor substrate 1 (IRS1) tyrosine phosphorylation and its association with the p85, regulatory subunit of phosphatidylinositol-3 kinase; and by negative regulation of PPAR gamma. Adipose tissue produces both TNF-alpha and leptin. Production of the latter relates positively to adipose tissue mass and through its actions on immune function exerts a pro-inflammatory influence. SUMMARY Recent studies on diseases which involve insulin insensitivity (e.g. obesity, type 2 diabetes and atherosclerosis) also show increased cytokine production and markers of inflammation. Evidence at present favours chronic inflammation as a trigger for chronic insulin insensitivity, rather than the reverse situation.
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Affiliation(s)
- Robert F Grimble
- Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton SO16 7PX, UK.
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