Mean platelet volume and vitamin D level

Vitamin D and cardiovascular diseases: A narrative review

Cardiovascular diseases (CVD) and vitamin D deficiency are becoming highly prevalent among general populations. Despite plausible biological mechanisms for the role of vitamin D in cardio-protection, a cause-and-effect relationship has not yet been established. The interest in vitamin D as a potential therapeutic target to attenuate cardiovascular risk has been raised. The question about the benefit of vitamin D supplementation for cardiovascular outcomes cannot be answered certainly for the moment. The association between hypovitaminosis D and CVD has been proven by some studies while other studies deny any such link. The present narrative review gives a comprehensive overview of studies on the potential impact of hypovitaminosis D on CVD. The potential role of vitamin D supplementation in the management of CVD is also evaluated. Particular emphasis is paid to those studies that achieve a high level of scientific evidence.

The effect of vitamin D deficiency on platelet parameters in patients with COVID-19

Introduction

Since there is very little information about the relationship between platelet parameters and vitamin D concentration in patients with COVID-19, the aim of this study is to investigate the relationship between serum vitamin D level and platelet parameters in patients with COVID-19 and to compare these parameters in patients with COVID-19 without vitamin D deficiency and, subsequently, the prognostic value of these parameters in cases of vitamin D deficiency.

Methods

Seven hundred and forty-three patients diagnosed with COVID-19 were enrolled in this study. Patients were divided into two groups: those with and without vitamin D deficiency. The associations between platelet indices and vitamin D levels were analyzed by Pearson's correlation analysis and a one-way ANOVA test.

Results

Platelet count and mean platelet volume (MPV) were significantly higher in the patients with vitamin D deficiency than in the patients without vitamin D deficiency. There was a significant negative correlation between platelet count and MPV with vitamin D levels in patients with vitamin D deficiency (r = -0.835, P = 0.001 & r = -0.324, P = 0.042, respectively). Vitamin D levels in COVID-19 patients can determine the platelet count and MPV of the patients.

Discussion

The aforementioned results imply that maintaining an elevated concentration of vitamin D in COVID-19 patients is important because it is associated with a decrease in MPV, which in turn reduces susceptibility to diseases such as coronary artery disease.

Effect of oral versus parenteral vitamin D3 supplementation on nuclear factor-κB and platelet aggregation in type 2 diabetic patients

Platelet hyperactivity is one of the key factors implicated in the development and progression of diabetic vascular complications. Activated platelets mediate leukocyte recruitment that further enhances inflammatory responses in vascular wall ultimately resulting in atherosclerotic complications. Since vitamin D insufficiency is highly prevalent in diabetics, we aimed to evaluate the effect of three dosage forms of vitamin D supplementation on lipid profile, NF-κB, platelet aggregation, and platelet calcium content in type 2 diabetic patients. Type 2 diabetic patients were randomized to receive daily (4000 IU/day) or weekly (50 000 IU/week) oral vitamin D3 for 3 months. Another group received a single parenteral dose (300 000 IU) of vitamin D3, whereas the control group received their antidiabetic drug(s) alone. Serum 25(OH)D, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol, NF-κB, and platelet aggregation were measured at the beginning and 3 months after vitamin D supplementation. Platelet calcium content was evaluated by measuring the fluorescence intensity of Rhod-2-stained platelets by confocal fluorescence microscopy. Results showed that serum 25(OH)D3 levels significantly increased in all vitamin D3-treated groups. However, the mean level for parenteral treated group was significantly lower than oral-treated groups. Oral and parenteral treatment were also able to decrease NF-κB level, platelet aggregation, and platelet calcium content. However, both oral doses of vitamin D3 were superior to the single parenteral dose. In conclusion, restoring normal levels of vitamin D is an important determinant to maintain normal platelet function and reduce inflammation. Nevertheless, further long-term studies are still needed.

Applying data mining techniques to predict vitamin D deficiency in diabetic patients

Vitamin D is among the vitamins necessary for both adults' and children's health. It plays a significant role in calcium absorption, the immune system, cell proliferation and differentiation, bone protection, skeletal health, rickets, muscle health, heart health, disease pathogenesis and severity, glucose metabolism, glucose intolerance, varying insulin secretion, and diabetes. Because the 25-hydroxyvitamin D (25OHD) test, which is used to measure vitamin D is expensive and may not be covered in healthcare benefits in many countries, this study aims to predict vitamin D deficiency in diabetic patients. The prediction method is based on data mining techniques combined with feature selection by using historical electronic health records. The results were compared with a filter-based feature selection algorithm, namely relief-F. Non-valuable features were eliminated effectively with the relief-F feature selection method without any performance loss in classification. The performances of the methods were evaluated using classification accuracy (ACC), sensitivity, specificity, F1-score, precision, kappa results, and receiver operating characteristic (ROC) curves. The analyses have been conducted on a vitamin D dataset of diabetic patients and the results show that the highest classification accuracy of 97.044% was obtained for the support vector machines (SVM) model using radial kernel that contains 18 features.

Mechanisms Suggesting a Relationship between Vitamin D and Erectile Dysfunction: An Overview

Vitamin D deficiency (VDD) and erectile dysfunction (ED) heavily burden the male population. The higher prevalence of both conditions in the elderly suggests a possible relationship between the two conditions. In addition, in vitro, animal, and human studies have revealed several mechanisms that may relate VDD to ED. The main mechanism by which vitamin D might exert its action on sexual function appears to be through the regulation of endothelial function. Indeed, VDD correlates with several markers of endothelial function. The action of vitamin D on the endothelium would be exercised both indirectly through its intervention in inflammatory processes and through the production of oxygen free radicals, and directly through the regulation of vascular stiffness, the production of nitric oxide, and the regulation of vessel permeability. Furthermore, the ubiquitous distribution of the vitamin D receptor in the human body means that this hormone can also exert a beneficial effect on erectile function by interfering with those comorbidities significantly associated with ED, such as hypertension, diabetes mellitus, hypercholesterolemia, chronic kidney disease, and hypogonadism. In this review, we thoroughly and carefully presented the evidence and mechanisms that would appear to relate vitamin D levels to erectile function. Furthermore, we have summarized the meta-analytic evidence for and against this association to provide a true representation of this topic. Data published to date suggest that low levels of vitamin D could contribute to worsening erectile function through several mechanisms. Therefore, vitamin D levels should be measured in patients with ED and maintained at adequate levels by specific supplementation in case of deficiency. However, the low quality and heterogeneity of clinical trials evaluating the effects of vitamin D administration on erectile function and ED-associated comorbidities do not allow for a univocal conclusion, and indicate the need for further studies to analyze these aspects.

Association Between Promoter Methylation of Vitamin D Metabolic Pathway Genes and Tuberculosis and Diabetes Comorbidity in a Chinese Han Population: A Case-Control Study

Background

Deficiency vitamin D and hyperglycemia could be related to weakened innate immune response and aggravate the progression of tuberculosis (TB). This study hypothesized that DNA promoter methylation of the pivotal genes in the vitamin D metabolic pathway might be related to diabetes and tuberculosis co-morbidity (TB-DM) susceptibility.

Methods

A total of 50 TB-DM and 50 healthy subjects (HS) were included in the present study. Targeted bisulfite sequencing was applied to detect the methylation of the promoter regions of candidate genes in the vitamin D metabolic pathway (CYP24A1, CYP27B1, CYP2R1, DHCR7, and VDR) in whole blood.

Results

The overall methylation level of candidate genes in this study was lower in patients with TB-DM than HS, except for CYP2R1. The results of the ROC demonstrated the potential of CYP24A1, CYP27B1, DHCR7, and VDR promoter methylation as a biomarker for diagnosing TB-DM, with all the AUC above 0.7. In subgroup analysis, we found that lower circulating vitamin D is related to a low level of CYP24A1, CYP27B1, and DHCR7 promoter methylation in patients with TB-DM. With decreasing methylation level, risk of TB-DM was significantly increased (odds ratio, 95% CI 0.343, 0.144-0.821 for CYP24A1; 0.461, 0.275-0.773 for CYP27B1; 0.09, 0.015-0.530 for DHCR7; 0.006, 0.0003-0.115 for VDR). Besides, our results revealed that there was a significant correlation between DNA promoter methylation of selected genes in the vitamin D metabolic pathway and platelet indices in TB-DM. However, there was no correlation between DNA methylation of the four genes and fasting glucose and HbA1c.

Conclusion

Our results could suggest that the selected genes in the vitamin D metabolic pathway may be involved in the pathological process of TB-DM, but independent of the process of hyperglycemia to impaired immune responses to Mtb.

25-Hydroxy Vitamin D Level and Its Correlation with Mean Platelet Volume in Preeclampsia

Background

Preeclampsia is one of the challenging complications of pregnancy, of which little is known about its etiology and pathogenesis. Many studies have shown higher mean platelet volume (MPV) in preeclamptic patients. Vitamin D deficiency is in association with larger-size platelets. Thus, we aimed to determine the correlation of vitamin D with MPV in preeclamptic patients.

Methods

This prospective case-control study was conducted in two tertiary hospitals in Tehran, Iran. Overall, 85 preeclamptic pregnant women and 85 normotensive pregnant women were entered between 2017 and 2018. Serum vitamin D concentration (ng/ml) and MPV (femtoliter) were measured for all patients.

Results

MPV was significantly higher in the cases compared to controls (10.59±1.08 vs 8.10±0.95, P=0.0001). In addition, serum vitamin D level in the preeclamptic group was significantly lower in compare to the control group (17.79±11.03 vs 30.24±12.49; P=0.0001). In multivariate logistic regression analysis, high age of mother (OR: 1.13; 95% CI: 1.01-1.27; P=0.03), low level of serum vitamin D (OR: 0.93; 95% CI: 0.87-0.99; P=0.02) and high MPV (OR: 8.83; 95% CI: 4.17-18.67; P=0.0001) were independent predictors of preeclampsia. Moreover, a correlation analysis revealed that vitamin D levels correlated negatively with MPV (r= -0.41, P<0.0001).

Conclusion

Low levels of vitamin D in preeclamptic pregnancy are associated with higher platelet activity and thrombosis. In fact, the increment of MPV level might be a potential pathway for adverse outcomes of pregnancy including preeclampsia in the context of vitamin D deficiency.

25-Hydroxy vitamin D level is associated with mean platelet volume in patients with acute coronary syndrome

BACKGROUND AND AIMS

A better identification of the role of vitamin D in the thrombotic process of acute coronary syndrome (ACS) will help increase the therapeutic options for this important clinical condition. There is little published evidence that 25-hydroxy vitamin D (25(OH)D) serum levels can associate with platelet function and risk of thrombosis.

MATERIALS AND METHODS

This prospective study was conducted on 200 patients with a diagnosis of ACS, including patients with unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). In addition to demographics and angiographic data, serum concentrations of 25(OH)D and MPV were recorded in all patients.

RESULTS

The types of ACS were STEMI (35%), NSTEMI (25%), and UA (40%). The concentrations of 25(OH)D in patients with UA, NSTEMI, and STEMI were 23.53 ± 13.26, 19.25 ± 8.09 and 14.60 ± 8.24 ng/mL respectively (P < 0.001), and the values of MPV were 9.83 ± 1.35, 10.30 ± 1.21, and 11.56 ± 1.38 fL, respectively (P < 0.001). There was a negative correlation between 25(OH)D and MPV (R = -0.320, P < 0.0001). ROC analysis illustrated a moderate predictive value (AUC 0.706; 95% CI, 0.63-0.72) in identifying the discrimination threshold of MPV (≥ 9.90 fL) for vitamin D deficiency (<20 ng/mL).

CONCLUSION

The current study shows an inverse association between MPV and vitamin D levels in ACS patients, especially in the subgroup of STEMI. These findings propose the effect of vitamin D on platelet size and function, suggesting its role in thrombosis and hemostasis, which might explain the link between vitamin D deficiency and cardiovascular diseases.

Vitamin D Level in Patients with Consecutive Acute Coronary Syndrome Is Not Correlated with the Parameters of Platelet Activity

Coronary artery disease continues to be the leading cause of death in developed countries. Elevated mean platelet volume (MPV) is associated with an increased incidence of myocardial infarction (MI) and MI-related mortality. Vitamin D concentrations affect the level and function of platelets, which are the crucial mediator of atherothrombosis and plaque rupture. The main aim of this study was to examine the relationship of serum 25-hydroxyvitamin D (25(OH)D) levels with the platelet activity in patients with a history of an acute coronary syndrome (ACS). This prospective study recruited 268 patients with a history of MI who underwent coronary angiography due to the suspicion of another ACS. Serum 25(OH)D concentration was determined by electrochemiluminescence. Platelet activity was assessed using the MPV and platelet-large cell ratio (P-LCR) parameters. There was no significant difference in MPV and P-LCR values between patients diagnosed with subsequent MI and patients with chronic coronary syndrome (CCS). A significantly lower level of 25(OH)D was demonstrated in patients who had another MI compared to those with CCS (p < 0.05). No significant correlation of 25(OH)D concentrations with platelet activity parameters values was found. The subgroup of patients with consecutive MI was characterized by significantly lower serum vitamin D levels, but this was not related to the analyzed parameters of platelet activity.

Could ferritin, vitamin B12, and vitamin D play a role in the etiopathogenesis of fibromyalgia syndrome?

Introduction. Fibromyalgia syndrome (FS) comprises general body pain, sleep disturbances, and fatigue. Vitamin B₁₂ (VB), vitamin D (VD), and iron deficiencies lead to similar complaints. First, this study aimed to evaluate the VB, VD, and ferritin levels of patients with FS. Second, it aimed to investigate whether there was a relationship between these parameters and FS severity. Material and methods. The study included 58 female patients with FS and 58 healthy females as a control group. The patients completed the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), fatigue questionnaire, Pittsburgh sleep quality scale, and the Short Form-36 (SF-36). This study examined the VD, VB, and ferritin levels of the patient and control groups. Results. The VB (240.0 [110.0-394.0] vs 291.0 [210.0-609.0] pg/ml, p<0.001), VD (12.5 [3.0-45.0] vs 20.0 [5.0-54.0] ng/ml, p=0.013), and ferritin levels (21.2 [4.0-86.0] vs 32.0 [7.1-120.0], ng/ml, p=0.009) of the FS patients were determined to be significantly lower than those of the control group. A negative correlation was determined between the number of tender points and VB, VD, and ferritin levels. In the regression analysis, we found low ferritin levels (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.015-1.058, p<0.001) and VB (OR 1.010, CI 1.002-1.018, p=0.010) to be an independent risk factor for FS. Conclusions. There may be a relationship between VB, VD, and ferritin levels and the number of tender points in patients with FS. Levels of iron and VB may play a vital role in FS etiopathogenesis. However, VD levels may not be a risk factor for FS etiopathogenesis.

The effect of hypervitaminosis D and intoxication on haematological parameters

BACKGROUND

This study aims to compare the haematological parameters of patients with very high and normal 25-hydroxyvitamin-D3 (25(OH)D3) levels.

METHODS

This study was designed as a retrospective cross-sectional study. The patients were divided into three groups according to their 25(OH)D3 levels: groups 1, 2 and 3 are patients with normal 25(OH)D3 levels (30-88 ng/mL), hypervitaminosis D (89-149 ng/mL) and vitamin D intoxication (>150 ng/mL), respectively. According to vitamin D levels, statistical analysis was performed by comparing the biochemical and haematological data between the groups.

RESULTS

This study evaluated 120 patients (40 patients) in three equal groups. A statistically significant difference was found between the three groups in haemoglobin (p = 0.03), haematocrit (p = 0.01), red blood cell levels (p = 0.03), leukocyte count (p < 0.001), neutrophil count (p < 0.001), lymphocyte count (p = 0.006), mean platelet volume (p = 0.04), and neutrophil/lymphocyte ratio (p = 0.03). In post hoc analysis, haemoglobin, haematocrit and RBC were significantly higher in group 1 than in group 3 (post hoc Tukey, p < 0.05). A statistically significant negative correlation was noted between 25(OH)D3 level and haemoglobin (r = -0.236), haemotocrit (r = -0.230), and red blood cell (r = -0.265) levels.

CONCLUSIONS

Vitamin D intoxication has been observed to affect haemoglobin, haematocrit, and RBC levels negatively. However, more studies are needed to clarify the effects and mechanisms of high vitamin D levels on the haematopoietic system.

Relationship of serum vitamin D deficiency with coronary artery disease severity using multislice CT coronary angiography

AIM

To assess the relationship between vitamin D deficiency and severity of coronary artery disease using multislice CT coronary angiography.

METHODS

100 patients diagnosed with coronary artery disease during multislice CT coronary angiography were subjected to full evaluation of coronary artery disease severity followed by measurement of serum vitamin D level.

RESULTS

The mean value of serum vitamin D level was 13.35±7.49ng/ml. 76% of the patients had vitamin D deficiency (<20ng/ml). 41% of the patients had single vessel disease, 28% had two vessel diseases, and 31% had multi-vessel disease. Patients with vitamin D deficiency had higher degree of coronary stenosis, higher coronary Ca score (p<0.001) and higher number of affected vessels compared with normal vitamin D level subgroup (p<0.001). Vitamin D level showed a significant negative correlations with age (r=-0.290, p=0.003), coronary Ca score (r=-0.630, p<0.001) and severity of coronary lesions. Multivariate linear regression analysis showed that dyslipidemia and vitamin D level were independent predictors of percent severity of coronary stenosis.

CONCLUSION

In addition to traditional cardiovascular risk factors, vitamin D deficiency looks to be independent predictor of coronary artery disease severity including percent stenosis, number of the affected vessels as well as degree of coronary calcification.

Vitamin D Status and Clinical Outcomes in Acute Respiratory Distress Syndrome: A Secondary Analysis From the Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury (ALVEOLI) Trial

BACKGROUND

Acute respiratory distress syndrome (ARDS) is a highly morbid condition that has limited therapeutic options. Optimal vitamin D status has been linked to immunological effects that may benefit critically ill patients. Therefore, we investigated whether admission 25-hydroxyvitamin D levels (25OHD) are associated with clinical outcomes in ARDS patients.

METHODS

We performed a secondary analysis of data from a randomized, controlled trial comparing oxygenation strategies in 549 patients with ARDS (NCT00000579). Baseline 25OHD was measured in stored plasma samples. We investigated the relationship between vitamin D status and ventilator-free days (VFD) as well as 90-day survival, using linear regression and Cox proportional hazard models, respectively. Analyses were adjusted for age, race, and Acute Physiology and Chronic Health Evaluation III score.

RESULTS

Baseline 25OHD was measured in 476 patients. 90% of these individuals had 25OHD <20 ng/ml and 40% had 25OHD <10 ng/ml. Patients with 25OHD <20 ng/ml were likely to be ventilated for 3 days longer than patients with levels ≥20 ng/ml (ß 3.41; 95%CI 0.42-6.39: P = 0.02). Patients with 25OHD <10 ng/ml were likely to be ventilated for 9 days longer (ß 9.27; 95%CI 7.24-11.02: P < 0.001) and to have a 34% higher risk of 90-day mortality (HR 1.34; 95% CI 1.06-1.71: P = 0.02) compared to patients with levels >10 ng/ml.

CONCLUSIONS

In patients with ARDS, vitamin D status is associated with duration of mechanical ventilation and 90-day mortality. Randomized, controlled trials are warranted to determine whether vitamin D supplementation improves clinical outcomes in ARDS patients.

The impact of platelet indices on clinical outcome in heart failure: results from the MyoVasc study

Aims

Platelet indices have been associated with traditional cardiovascular risk factors, cardiovascular diseases and all‐cause mortality. This study aimed to investigate the role of platelet count, mean platelet volume (MPV) and platelet‐to‐leukocyte ratio, including platelet‐to‐monocyte and platelet‐to‐lymphocyte ratio with cardiac function, heart failure (HF) phenotypes and clinical outcome, worsening of HF.

Methods and results

Univariate and multivariable linear and Cox regression analyses were used to investigate the associations between platelet indices, cardiac function and worsening of HF in 3250 subjects enrolled in the MyoVasc study. Higher MPV, lower platelet count, lower platelet‐to‐leukocyte and platelet‐to‐monocyte ratios have been associated with reduced left ventricular ejection fraction (beta estimate [β]_{MPV [fL]} = −0.05 [−0.09; −0.02], β_{platelet count (× 10/L)}⁹ = 3.4 [1.2; 5.6], β_{platelet‐to‐leukocyte ratio} = 1.4 [1.1; 1.8], β_{platelet‐to‐monocyte ratio} = 28 [20; 36]) and increased E/E' ratio (β _{MPV [fL]} = 0.04 [0.003; 0.07], β_{platelet count (× 10/L)}⁹ = −3.1 [−5.3; −0.92], β_{platelet‐to‐leukocyte ratio} = −0.83 [−1.2; −0.46], β_{platelet‐to‐monocyte ratio} = −20 [−28; −12]), independent of age and sex. Cox regression demonstrated an increased risk for worsening of HF in subjects with MPV > 75th percentile (hazard ratio [HR] = 1.47 [1.16; 1.87]), platelet count < 25th percentile (HR = 1.36 [1.07; 1.74]), platelet‐to‐leukocyte < 25th percentile (HR = 1.53 [1.20; 1.95]), platelet‐to‐monocyte < 25th percentile (HR = 1.38 [1.08; 1.77]) and platelet‐to‐lymphocyte > 75th percentile (HR = 1.50 [1.17; 1.93]) ratios, independent of potential confounders. MPV > 75th percentile and platelet count < 25th percentile were strongly related to outcome in HFpEF vs. HFrEF (P for difference = 0.040). Platelet‐to‐leukocyte ratios were associated with worse outcome in both HF phenotypes, without a significant difference between HFpEF and HFrEF.

Conclusions

Platelet indices are linked with worse cardiac function and adverse clinical outcome, independent of subjects' underlying cardiovascular profile. This study emphasizes their important value to provide additional information on pathophysiology and risk stratification in HF syndrome.

Vitamin D and Hospital Admission in Older Adults: A Prospective Association

The health effects of vitamin D are well documented, with increasing evidence of its roles beyond bone. There is, however, little evidence of the effects of vitamin D on hospitalisation among older adults. This study aimed to prospectively determine the relationship of vitamin D status in older adults with hospital admission and emergency department (ED) attendance. Trinity University of Ulster Department of Agriculture (TUDA) is a large cross-sectional study of older adults with a community population from three disease-defined cohorts (cognitive dysfunction, hypertension, and osteoporosis). Participants included in this analysis were recruited between 2008 and 2012. ED and hospital admission data were gathered from the date of TUDA participation until June 2013, with a mean follow up of 3.6 years. Of the 3093 participants, 1577 (50.9%) attended the ED during the period of follow-up. Attendees had lower mean serum 25(OH)D concentrations than non-attendees (59.1 vs. 70.6 nmol/L). Fully adjusted models showed an inverse association between vitamin D and ED attendance (Hazard Ratio (HR) 0.996; 95% Confidence Interval (CI) 0.995-0.998; p < 0.001). A total of 1269 participants (41%) were admitted to hospital during the follow-up. Those admitted had lower mean vitamin D concentrations (58.4 vs. 69.3 nmol/L, p < 0.001). In fully adjusted models, higher vitamin D was inversely associated with hospital admission (HR 0.996; 95% CI 0.994-0.998; p < 0.001) and length of stay (LOS) (β = -0.95, p = 0.006). This study showed independent prospective associations between vitamin D deficiency and increased hospitalisation by older adults. The need for further evaluation of current recommendations in relation to vitamin D supplementation, with consideration beyond bone health, is warranted and should focus on randomised controlled trials.

Serum Gamma Glutamyltransferase Is Associated with 25-Hydroxyvitamin D Status in Elderly Patients with Stable Coronary Artery Disease

Background: No previous study has investigated the association between gamma glutamyltransferase (GGT) and vitamin D in patients with stable coronary artery disease (CAD). We investigated the cross-sectional associations between vitamin D status as assessed by serum 25(OH)D and GGT. Methods: 169 patients were enrolled. Study population was divided into three groups: 1: 25(OH)D < 10 ng/mL (n = 59); 2: 25(OH)D 10–20 ng/mL (n = 82), and 3: 25(OH)D > 20 ng/mL (n = 28). Based on a cut-off GGT value identified in ROC analysis, we also divided the study population to compare the following groups: GGT ≤19 (n = 66) and GGT >19 (n = 103). Results: GGT activity was the highest in vitamin D severely deficient patients and the lowest in vitamin D insufficient patients. GGT was inversely correlated with 25(OH)D concentrations (R = −0.23; p = 0.002). The receiver operating characteristics curve identified the discrimination threshold of GGT of >19 U/L in predicting vitamin D deficiency. Higher leukocyte and neutrophil counts and lower 25(OH)D concentration were found in patients with GGT > 19 U/L. Conclusions: We identified an interaction between declining 25(OH)D levels and rising GGT levels with increasing age, which resulted in an unfavorable 25(OH)D-to-GGT ratio in stable CAD patients. These results suggest that these changes might further contribute to a high cardiovascular risk in the elderly.

Pleiotropic actions of Vitamin D in composite musculoskeletal trauma

Composite tissue injuries are the result of high energy impacts caused by motor vehicle accidents, gunshot wounds or blasts. These are highly traumatic injuries characterized by wide-spread, penetrating wounds affecting the entire musculoskeletal system, and are generally defined by frank volumetric muscle loss with concomitant segmental bone defects. At the tissue level, the breadth of damage to multiple tissue systems, and potential for infection from penetration, have been shown to lead to an exaggerated, often chronic inflammatory response with subsequent dysregulation of normal musculoskeletal healing mechanisms. Aside from the direct effects of inflammation on myogenesis and osteogenesis, frank muscle loss has been shown to directly impair fracture union and ultimately contribute to failed wound regeneration. Care for these injuries requires extensive surgical intervention and acute care strategies. However, often these interventions do not adequately mitigate inflammation or promote proper musculoskeletal injury repair and force amputation of the limb. Therefore, identification of factors that can promote tissue regeneration and mitigate inflammation could be key to restoring wound healing after composite tissue injury. One such factor that may directly affect both inflammation and tissue regeneration in response to these multi-tissue injuries may be Vitamin D. Beyond traditional roles, the pleiotropic and localized actions of Vitamin D are increasingly being recognized in most aspects of wound healing in complex tissue injuries - e.g., regulation of inflammation, myogenesis, fracture callus mineralization and remodeling. Conversely, pre-existing Vitamin D deficiency leads to musculoskeletal dysfunction, increased fracture risk or fracture non-unions, decreased strength/function and reduced capacity to heal wounds through increased inflammation. This Vitamin D deficient state requires acute supplementation in order to quickly restore circulating levels to an optimal level, thereby facilitating a robust wound healing response. Herein, the purpose of this review is to address the roles and critical functions of Vitamin D throughout the wound healing process. Findings from this review suggest that careful monitoring and/or supplementation of Vitamin D may be critical for wound regeneration in composite tissue injuries.

The relationship between erectile dysfunction severity, mean platelet volume and vitamin D levels

Background: The aim of this study was to evaluate the relationship between mean platelet volume (MPV) and vitamin D levels according to ED severity.Methods: Between October 2015 and September 2017, patients who applied to the andrology outpatient clinic with an ED complaint were retrospectively reviewed. Patients with diabetes, hypertension, hyperlipidemia, malignancy, late-onset hypogonadism and smokers were not included in the study. The International Erectile Function Index-Erectile Function (IIEF-EF) questionnaire was used to assess the levels of erectile function. According to this scoring system, patients were divided into two groups. IIEF score: between 17 and 25 = mild ED (Group 1) and IIEF score between 16 and 0 = moderate-severe ED (Group 2). Blood samples of the patients were taken from antecubital vein and MPV and 25-hydroxyvitamin D [25(OH)D] levels were evaluated.Results: Ninety patients were included in the study (Group 1: n = 41, Group 2: n = 49). The mean age of the patients was 41.07 ± 8.56 and the mean body mass index (BMI) was 27.59 ± 3.91. 25(OH)D levels were found to be statistically lower in Group 2 (18.85 ± 6.09; 13.98 ± 7.10; p = .001). MPV levels were found to be statistically higher in Group 2 (10.05 ± 0.81; 10.78 ± 1.16; p = .001). Correlation between IIEF-EF scores and 25(OH)D levels was positive (p = .03, r = 0.22). There was negative correlation between IIEF-EF scores and MPV and between 25(OH)D levels and MPV levels [p = .003 for IIEF-EF/MPV, p = .04, r = -0.23 for 25(OH)D/MPV].Conclusion: There is a significant positive correlation between ED severity and 25(OH)D levels and there is a significant negative correlation between ED severity and MPV levels.

Mean platelet volume and coronary artery disease

PURPOSE OF REVIEW

To critically review the literature describing links between mean platelet volume (MPV) and cardiovascular disease (CVD). We will focus on coronary artery disease (CAD). The MPV is measured routinely as part of a routine blood count.

RECENT FINDINGS

There is accumulating evidence showing that the MPV may predict CVD, as well as outcomes in patients with CAD. There is also evidence linking MPV and comorbidities (e.g. diabetes mellitus and impaired glycaemic control) that are expected in patients with CAD. The effect on MPV of drugs commonly used to treat CAD has not been clarified, but there is some evidence that they may exert a beneficial effect on the MPV. More specifically, the MPV may predict the effect of antiplatelet drugs (e.g. clopidogrel). There is also evidence relating MPV to stroke, atrial fibrillation, coronary artery ectasia and periprocedural outcomes after percutaneous coronary intervention (PCI).

SUMMARY

Measuring the MPV may prove useful in CVD risk assessment in patients with established CAD or at risk of developing CAD. Overall, there is evidence pointing to the role of MPV as a contributor rather than simple marker of CVD.

Cardiovascular Risk Factors and Haematological Indexes of Inflammation in Paralympic Athletes with Different Motor Impairments

Haematological indexes of both inflammation and platelet activation have been suggested as predictive markers of cardiovascular disease (CVD), which has high prevalence in Paralympic athletes (PA). Different mechanisms could play a role in increasing CVD risk in PA with spinal cord injury (PA-SCI), lower limb amputation (PA-LLA), or upper limb impairment (PA-ULI). We compared, in 4 groups of PA competing in power, intermittent (mixed metabolism), and endurance sports, Framingham Risk Score (FRS), metabolic syndrome criteria (MetS-C), inflammation (INFLA) Score, 5 haematological indexes of platelet activation (mean platelet volume (MPV), platelet distribution width (PDW), and the ratios between MPV and platelet (MPVPR), between MPV and lymphocyte (MPVLR), and between PDW and lymphocyte (PDWLR)) and the endogenous antioxidants uric acid (UA) and bilirubin (BR). A retrospective chart review of PA from preparticipation examinations' records (London 2012 and Sochi 2014 Paralympics) was performed. We included 25 PA-SCI (13 with high and 12 with low lesion, PA-SCI-H and PA-SCI-L), 15 PA-LLA, and 10 PA-ULI. FRS and INFLA Score did not differ among groups, but PA-SCI-H had lower HDL, compared to PA-SCI-L and PA-ULI. PA-LLA had more MetS diagnostic criteria with significant higher glucose levels than other groups. PA-SCI-H had significantly lower lymphocytes' count compared to PA-LLA and higher MPV, PDW, MPVPR, MPVLR, and PDWLR. SCI-H had lower BR, haemoglobin, haematocrit, proteins, and creatinine. No interaction was found between the 3 kinds of sitting sports and the 2 groups of health conditions (PA-SCI and PA-LLA). In conclusion, PA-LLA had a higher cardiometabolic risk, whereas PA-SCI-H had a higher platelet-derived cardiovascular risk. Further larger studies are needed to investigate the relationship between indexes of inflammation/oxidation and dietary habit, body composition, and physical fitness/performance in PA with motor impairments.

Non-genomic effects of nuclear receptors: insights from the anucleate platelet

Nuclear receptors (NRs) have the ability to elicit two different kinds of responses, genomic and non-genomic. Although genomic responses control gene expression by influencing the rate of transcription, non-genomic effects occur rapidly and independently of transcriptional regulation. Due to their anucleate nature and mechanistically well-characterized and rapid responses, platelets provide a model system for the study of any non-genomic effects of the NRs. Several NRs have been found to be present in human platelets, and multiple NR agonists have been shown to elicit anti-platelet effects by a variety of mechanisms. The non-genomic functions of NRs vary, including the regulation of kinase and phosphatase activity, ion channel function, intracellular calcium levels, and production of second messengers. Recently, the characterization of mechanisms and identification of novel binding partners of NRs have further strengthened the prospects of developing their ligands into potential therapeutics that offer cardio-protective properties in addition to their other defined genomic effects.

GWAS and PheWAS of red blood cell components in a Northern Nevadan cohort

In this study, we perform a full genome-wide association study (GWAS) to identify statistically significantly associated single nucleotide polymorphisms (SNPs) with three red blood cell (RBC) components and follow it with two independent PheWASs to examine associations between phenotypic data (case-control status of diagnoses or disease), significant SNPs, and RBC component levels. We first identified associations between the three RBC components: mean platelet volume (MPV), mean corpuscular volume (MCV), and platelet counts (PC), and the genotypes of approximately 500,000 SNPs on the Illumina Infimum DNA Human OmniExpress-24 BeadChip using a single cohort of 4,673 Northern Nevadans. Twenty-one SNPs in five major genomic regions were found to be statistically significantly associated with MPV, two regions with MCV, and one region with PC, with p<5x10^-8. Twenty-nine SNPs and nine chromosomal regions were identified in 30 previous GWASs, with effect sizes of similar magnitude and direction as found in our cohort. The two strongest associations were SNP rs1354034 with MPV (p = 2.4x10^-13) and rs855791 with MCV (p = 5.2x10^-12). We then examined possible associations between these significant SNPs and incidence of 1,488 phenotype groups mapped from International Classification of Disease version 9 and 10 (ICD9 and ICD10) codes collected in the extensive electronic health record (EHR) database associated with Healthy Nevada Project consented participants. Further leveraging data collected in the EHR, we performed an additional PheWAS to identify associations between continuous red blood cell (RBC) component measures and incidence of specific diagnoses. The first PheWAS illuminated whether SNPs associated with RBC components in our cohort were linked with other hematologic phenotypic diagnoses or diagnoses of other nature. Although no SNPs from our GWAS were identified as strongly associated to other phenotypic components, a number of associations were identified with p-values ranging between 1x10^-3 and 1x10^-4 with traits such as respiratory failure, sleep disorders, hypoglycemia, hyperglyceridemia, GERD and IBS. The second PheWAS examined possible phenotypic predictors of abnormal RBC component measures: a number of hematologic phenotypes such as thrombocytopenia, anemias, hemoglobinopathies and pancytopenia were found to be strongly associated to RBC component measures; additional phenotypes such as (morbid) obesity, malaise and fatigue, alcoholism, and cirrhosis were also identified to be possible predictors of RBC component measures.

Monocyte to Lymphocyte Ratio, Neutrophil to Lymphocyte Ratio, and Red Cell Distribution Width are the Associates with Gouty Arthritis

BACKGROUND

Neutrophils, monocytes, and macrophages activations are associated with a gout attack. Monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), and mean platelet volume (MPV) are well-known inflammation markers. In this study, we aimed to investigate whether they could be a predictive marker to the gout attack.

MATERIAL AND METHODS

A hundred and ten gout patients (male/female, 86/24) and 90 (male/female, 64/26) age-, gender-, and body mass index-matched volunteer controls were included in the study. Blood samples were obtained in the intercritical and attack period of the patients. Hemogram, serum uric acid (SUA), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) values were studied.

RESULTS

In the attack period NLR (p < 0.001), PLR (p < 0.05), MLR (p < 0.001), RDW (p < 0.05), MPV (p < 0.05), ESR (p < 0.001), CRP (p < 0.001) and SUA (p < 0.001) values were significantly higher than intercritical period values. According to the results of regression analysis; There was an independent strong relationship between the gout attack and SUA, (Beta [β] = 0.352, p < 0.001), ESR (β = 0.329, p < 0.001), CRP (β = 0.286, p < 0.001), MLR (β = 0.126, p < 0.001), RDW (β = 0.100, p = 0.003) and NLR (β = 0.082, p = 0.014).

CONCLUSIONS

MLR, RDW, and NLR may be a strong predictive marker for a gout attack. MPV and PLR values in the gout attack may be associated with systemic inflammation.

The hypolipidemic effects of Tamarindus indica fruit pulp extract in normal and diet-induced hypercholesterolemic hamsters are associated with altered levels of serum proteins

The hypolipidemic effects of Tamarindus indica fruit pulp extract (Ti-FPE) have been earlier reported but the underlying molecular mechanisms are still uncertain. In this study, hamsters fed with Ti-FPE, both in the absence and presence of high-cholesterol diet, were shown to have significantly reduced levels of serum triglyceride, LDL-C and total cholesterol. The Ti-FPE-fed non-hypercholesterolemic hamsters also showed significant enhanced levels of serum apolipoprotein A1, antithrombin III, transferrin and vitamin D binding protein. In diet-induced hypercholesterolemic hamsters, apolipoprotein A1, antithrombin III and transferrin, which were relatively low in levels, became significantly enhanced when the hamsters were fed with Ti-FPE. These Ti-FPE-fed hypercholesterolemic hamsters also showed significant higher levels of serum vitamin D binding protein. When the different treated groups of hamsters were analyzed for the levels of the four serum proteins by ELISA, similar altered abundance were detected. Ingenuity Pathway Analysis of the Ti-FPE modulated serum proteins singled out "Lipid metabolism, molecular transport, small molecule biochemistry" as the top network. Our results suggest that the hypolipidemic effects of Ti-FPE are associated with alterations of serum proteins that are known to be cardioprotective and involved in the metabolism of lipids. The MS data have been deposited to the ProteomeXchange Consortium with the dataset identifier PXD010232.

Vitamin D Deficiency, Supplementation, and Cardiovascular Health

Vitamin D has been traditionally recognized as a vitamin quintessential for bone-mineral health. In the past 2 decades, numerous experimental and observational studies have highlighted the role of vitamin D in immunity, metabolic syndrome (obesity and diabetes), cancers, renal disease, memory, and neurological dysfunction. In this article, we review important studies that focused on the impact of vitamin D on blood pressure, myocardial infarction, peripheral arterial disease, heart failure, and statin intolerance. Amidst the current pool of ambiguous evidence, we intend to discuss the role of vitamin D in "high-value cardiovascular health care".

Mean platelet volume is associated with serum 25-hydroxyvitamin D concentrations in patients with stable coronary artery disease

There is little published data on the association of platelet function and 25(OH)D concentration. We investigated the associations between mean platelet volume (MPV) and 25(OH)D concentration in patients with stable coronary artery disease. Study population was divided into three groups: group 1-25(OH)D < 10 ng/mL (N = 22), group 2-25(OH)D 10-20 ng/mL (N = 42), and group 3-25(OH)D > 20 ng/mL (N = 14). Study groups shared similar demographics. MPV values were the highest in group 1, moderate in group 2, and the lowest in group 3 (11.1 vs 10.4 vs 9.8 fL P < 0.001). There was a negative correlation between MPV and 25(OH)D (R = - 0.38, P = 0.001). ROC analysis demonstrated a moderate predictive value (AUC 0.70) in identifying the discrimination thresholds of MPV (> 10.5 fL) for vitamin D deficiency and a weak predictive value (AUC 0.65) in identifying the discrimination thresholds of 25(OH)D concentration (≤ 15.5 ng/mL) for the presence of large platelets (MPV over the upper limit of normal). In conclusion, even though the effect of vitamin D on platelet size and function is probably multifactorial, our study provides further evidence linking vitamin D to thrombosis and hemostasis. Platelets are another potential element through which vitamin D deficiency could exert adverse cardiovascular outcomes.

Polycystic ovarian syndrome-associated cardiovascular complications: An overview of the association between the biochemical markers and potential strategies for their prevention and elimination

Polycystic ovarian syndrome (PCOS) is associated with multiple cardiovascular risk factors (CVRF) including endothelial dysfunction (ED) and presence of metabolic syndrome (MS). The probable reason suggested for elevated CVRF in PCOS is oxidative stress (OS), which is an integral factor in cardiometabolic complications (CMC) seen in PCOS women. The interrelated mechanisms by which CVRF instigate clinical manifestation plays a crucial role in identification of a strategy to treat different comorbidities in PCOS. The existing treatment for PCOS mostly focuses on management of individual disorders, however, therapeutic strategies or novel targets to address cardiovascular complications in PCOS deserve extensive analysis.

Association of Vitamin D Deficiency and Degree of Coronary Artery Disease in Cardiac Patients with Type 2 Diabetes

Several modifiable factors may influence cardiac function in diabetic patients. The aim of the study was to evaluate the influence of vitamin D level on the stage of coronary atherosclerosis in cardiac patients diagnosed with type 2 diabetes. The study was performed in 337 consecutive patients undergoing coronarography. The stage of atherosclerosis was evaluated using Coronary Artery Surgery Study Score. The plasma 25(OH)D concentration was determined by an electrochemiluminescence method. Patients without significant lesions in coronary arteries presented the highest 25(OH)D level, significantly higher than patients with one-, two-, and three-vessel coronary artery disease (CAD) (p < 0.01). Significantly lower level of the 25(OH)D was observed in patients hospitalized due to acute coronary syndrome (ACS) in comparison to patients hospitalized due to stable CAD (p < 0.001). Lower 25(OH)D levels were observed in patients with the history of myocardial infarction (MI) in comparison to patients without previous MI (p < 0.001). In cardiac patients with diabetes, the higher number of stenotic coronary arteries is associated with lower values of the 25(OH)D. A group of male cardiac patients with diabetes with significant stenosis in three coronary arteries, hospitalized due to acute coronary syndrome, with a history of previous MI and hyperlipidemia presented the lowest vitamin D level.

Low levels of Vitamin D an emerging risk for cardiovascular diseases: A review

Sunlight is regarded among greatest gifts that are presented in abundance to the human beings from the God. Sunlight is also a rich source of Vitamin D (Vit D) that prevents us from numerous ailments such as autoimmune disorders, various types of cancer, and the above all cardiovascular diseases (CVD). Evident from recent research that Vit D deficiency may be the cause for hypertension, cardiac autonomic imbalance, vascular endothelial dysfunction, metabolic syndrome, and even diabetes. Concurrently, many studies present research outcomes that are contradictory to earlier results and also raised a concern not for general public but also among their treating physicians. The sole focus of this review is to systematically present the available research data and critically evaluate the link between Vit D deficiency and development of risk factors for CVD.

[Research advances in association between vitamin D and Kawasaki disease and related mechanisms of action]

Vitamin D is an important steroid hormone, which has a wide biological effect and is the protective factor against cardiovascular disease and other diseases. At present, the etiology and pathogenesis of Kawasaki disease (KD) remain unknown, but recent studies have shown that vitamin D insufficiency or deficiency is associated with KD. Vitamin D insufficiency or deficiency may affect KD via its influence on inflammatory response, adipokine, endothelial function, platelet function, and DNA methylation and increase the risk of coronary artery lesions. This article reviews the research advances in the association between vitamin D and KD and possible mechanisms of action.

[Research advances in association between vitamin D and Kawasaki disease and related mechanisms of action]

Vitamin D is an important steroid hormone, which has a wide biological effect and is the protective factor against cardiovascular disease and other diseases. At present, the etiology and pathogenesis of Kawasaki disease (KD) remain unknown, but recent studies have shown that vitamin D insufficiency or deficiency is associated with KD. Vitamin D insufficiency or deficiency may affect KD via its influence on inflammatory response, adipokine, endothelial function, platelet function, and DNA methylation and increase the risk of coronary artery lesions. This article reviews the research advances in the association between vitamin D and KD and possible mechanisms of action.

Evaluation of the relationship between c-Kit expression and mean platelet volume in classic Kaposi's sarcoma

BACKGROUND

c-Kit is a proto-oncogene that encodes tyrosine kinase receptor (CD117). Mean platelet volume (MPV) is a useful marker, providing information on platelet function and diameter.

OBJECTIVE

To investigate c-Kit expression and intensity in patients with Kaposi's sarcoma (KS) and to investigate the relation between Ki-67 proliferation and MPV.

METHODS

A total of 32 patients, diagnosed with classic cutaneous KS, were included in this study. We reevaluated the histopathological reports with the preparations, confirmed the diagnosis and then determined the patients' histopathological stages. c-Kit expression and Ki-67 proliferation were investigated immunohistochemically in KS cases, while MPV in all cases was checked.

RESULTS

Although c-Kit expression was detected in 22 cases (68.8%), it was not expressed in 10 cases (31.2%). We detected 8 cases with + (25%), 6 with ++ (18.8%) and 8 with +++ (25%). Ki-67 expression was 5.0% (min-max 1.0-20.0). Relapse was observed in 5 cases (15.6%) out of 32. There was positive correlation between c-Kit expression and MPV (rs=0.598, p<0.001), and between c-Kit intensity and MPV (rs=0.588, p<0.001).

CONCLUSION

c-Kit is highly positive in KS. c-Kit positivity indicates a high risk of tumor growth, invasion and relapse. Furthermore, c-Kit expression stimulates megakaryocytes to release young and large thrombocytes into the periphery. Thus, high MPV, c-Kit expression and immunostaining intensity indicate high invasion and relapse in KS subjects.

Evaluation of the relationship between c-Kit expression and mean platelet volume in classic Kaposi's sarcoma

BACKGROUND

c-Kit is a proto-oncogene that encodes tyrosine kinase receptor (CD117). Mean platelet volume (MPV) is a useful marker, providing information on platelet function and diameter.

OBJECTIVE

To investigate c-Kit expression and intensity in patients with Kaposi's sarcoma (KS) and to investigate the relation between Ki-67 proliferation and MPV.

METHODS

A total of 32 patients, diagnosed with classic cutaneous KS, were included in this study. We reevaluated the histopathological reports with the preparations, confirmed the diagnosis and then determined the patients' histopathological stages. c-Kit expression and Ki-67 proliferation were investigated immunohistochemically in KS cases, while MPV in all cases was checked.

RESULTS

Although c-Kit expression was detected in 22 cases (68.8%), it was not expressed in 10 cases (31.2%). We detected 8 cases with + (25%), 6 with ++ (18.8%) and 8 with +++ (25%). Ki-67 expression was 5.0% (min-max 1.0-20.0). Relapse was observed in 5 cases (15.6%) out of 32. There was positive correlation between c-Kit expression and MPV (rs=0.598, p<0.001), and between c-Kit intensity and MPV (rs=0.588, p<0.001).

CONCLUSION

c-Kit is highly positive in KS. c-Kit positivity indicates a high risk of tumor growth, invasion and relapse. Furthermore, c-Kit expression stimulates megakaryocytes to release young and large thrombocytes into the periphery. Thus, high MPV, c-Kit expression and immunostaining intensity indicate high invasion and relapse in KS subjects.

Mean Platelet Volume, Vitamin D and C Reactive Protein Levels in Normal Weight Children with Primary Snoring and Obstructive Sleep Apnea Syndrome

Introduction

Studies on Mean Platelet Volume (MPV) in children with Sleep Disordered Breathing (SDB) report conflicting results and the hypothesis of an intermittent hypoxemia leading to a systemic inflammation is reaching consensus. Vitamin D exerts anti-inflammatory properties and its deficiency has been supposed to play a role in sleep disorders. Emerging interest is rising about Primary Snoring (PS) since it is reasonable that also undetectable alteration of hypoxia might predispose to an increased production of inflammatory mediators. In this perspective, in a group of children affected by SDB, our aim was to investigate MPV, vitamin D and C Reactive Protein (CRP) levels, which had been previously evaluated separately in different studies focused only on Obstructive Sleep Apnea Syndrome (OSAS).

Materials and Methods

We enrolled 137 children: 70 healthy controls (HC), 67 affected by SDB undergoing a polysomnographic evaluation, 22 with a diagnosis of PS and 45 with a diagnosis of OSAS. All patients underwent routine biochemical evaluations including blood cell counts, CRP and vitamin D.

Results

Children affected by SDB had a mean age of 8.49±2.19 and were prevalently males (23 females, 34%; 44 males, 66%). MPV levels were higher in OSAS and PS when compared to HC; platelet count (PLT) and CRP levels were higher while Vitamin D levels were lower in children with SDB when compared to HC. MPV levels were correlated with PLT (r = -0.54; p<0.001), vitamin D (r = -0.39; p<0.001) and CRP (r = 0.21; p<0.01). A multiple regression was run to predict MPV levels from vitamin D, CRP and PLT and these variables significantly predicted MPV (F = 17.42, p<0.0001; adjusted R2 = 0.37). Only platelet count and vitamin D added statistically significantly to the prediction (p<0.05).

Conclusion

The present study provides evidence of higher MPV and lower vitamin D levels in children with PS as well as in children with OSAS, and supports the underlying inflammation, hence, highlighting the importance of an early diagnosis of this previously considered benign form of SDB.

Cistromic and genetic evidence that the vitamin D receptor mediates susceptibility to latitude-dependent autoimmune diseases

The vitamin D receptor (VDR) is a ligand-activated transcription factor that regulates gene expression in many cell types, including immune cells. It requires binding of 1,25 dihydroxy vitamin D3 (1,25D3) for activation. Many autoimmune diseases show latitude-dependent prevalence and/or association with vitamin D deficiency, and vitamin D supplementation is commonly used in their clinical management. 1,25D3 is regulated by genes associated with the risk of autoimmune diseases and predominantly expressed in myeloid cells. We determined the VDR cistrome in monocytes and monocyte-derived inflammatory (DC1) and tolerogenic dendritic cells (DC2). VDR motifs were highly overrepresented in ChIP-Seq peaks in stimulated monocyte (40%), DC1 (21%) and DC2 (47%), P<E(-100) for all. Of the nearly 11 000 VDR-binding peaks identified across the genome in DC1s, 1317 were shared with DC2s (91% of DC2 sites) and 1579 with monocytes (83% of monocyte sites). Latitude-dependent autoimmune disease risk polymorphisms were highly overrepresented within 5 kb of the peaks. Several transcription factor recognition motifs were highly overrepresented in the peaks, including those for the autoimmune risk gene, BATF. This evidence indicates that VDR regulates hundreds of myeloid cell genes and that the molecular pathways controlled by VDR in these cells are important in maintaining tolerance.

Intrauterine endotoxin-induced impairs pulmonary vascular function and right ventricular performance in infant rats and improvement with early vitamin D therapy

High pulmonary vascular resistance (PVR), proximal pulmonary artery (PA) impedance, and right ventricular (RV) afterload due to remodeling contribute to the pathogenesis and severity of pulmonary hypertension (PH). Intra-amniotic exposure to endotoxin (ETX) causes sustained PH and high mortality in rat pups at birth, which are associated with impaired vascular growth and RV hypertrophy in survivors. Treatment of ETX-exposed pups with antenatal vitamin D (vit D) improves survival and lung growth, but the effects of ETX exposure on RV-PA coupling in the neonatal lung are unknown. We hypothesized that intrauterine ETX impairs RV-PA coupling through sustained abnormalities of PA stiffening and RV performance that are attenuated with vit D therapy. Fetal rats were exposed to intra-amniotic injections of ETX, ETX+vit D, or saline at 20 days gestation (term = 22 days). At postnatal day 14, pups had pressure-volume measurements of the RV and isolated proximal PA, respectively. Lung homogenates were assayed for extracellular matrix (ECM) composition by Western blot. We found that ETX lungs contain decreased α-elastin, lysyl oxidase, collagen I, and collagen III proteins (P < 0.05) compared control and ETX+vit D lungs. ETX-exposed animals have increased RV mechanical stroke work (P < 0.05 vs. control and ETX+vit D) and elastic potential energy (P < 0.05 vs. control and ETX+vit D). Mechanical stiffness and ECM remodeling are increased in the PA (P < 0.05 vs. control and ETX+vit D). We conclude that intrauterine exposure of fetal rats to ETX during late gestation causes persistent impairment of RV-PA coupling throughout infancy that can be prevented with early vit D treatment.

Relationship between mean platelet volume and vitamin D deficiency in gestational diabetes mellitus

OBJECTIVE

To investigate whether vitamin D deficiency is associated with high mean platelet volume (MPV) in pregnancies diagnosed with gestational diabetes mellitus (GDM) compared to healthy pregnancies.

SUBJECTS AND METHODS

This study included 200 pregnant women. 25-hydroxyvitamin D3(25(OH)D3) and MPV values were monitored between pregnant women with GDM and normal glucose metabolism. Correlation between 25(OH)D3 and MPV was calculated both in GDM and healthy pregnancies. Both 25(OH)D3 level in different MPV percentile (≤ 50, 50-75, 75-90, ≥ 90 percentile) and MPV value in different 25(OH)D3 level (≤ 10, 10-20, ≥ 20 ng/mL) were calculated.

RESULTS

Low 25(OH)D3 level and high MPV were observed both in GDM group (p = 0.007, p = 0.06, respectively) and in glucose metabolism disorders (GMD) group (p = 0.03, p = 0.04, respectively). There was no significant relationship between 25(OH)D3 and MPV in healthy pregnancies. Whereas, it is observed that there is a negative, but statistically insignificant correlation between MPV and 25(OH)D3 pregnant women with GMD (r = 0.1, r = -0.7, respectively). MPV values had significantly higher in vitamin D deficient group than pregnant women with normal 25(OH)D3 level in GMD group (p = 0.04). The optimal 25(OH)D3 cut off point for predicting future cardiovascular risk was 10.4 ng/ mL (area under curve (AUC) = 0.58).

CONCLUSIONS

Vitamin D deficiency may contribute to an increased risk for future cardiovascular diseases and a risk of thrombotic complications in pregnant women with GDM.

Nesfatin-1 and Vitamin D levels may be associated with systolic and diastolic blood pressure values and hearth rate in polycystic ovary syndrome

Obesity, insulin resistance (IR), inflammation, and hyperandrogenism may lead to polycystic ovary syndrome (PCOS) and hypertension. Nesfatin-1 (N1) may be related to IR, obesity, and hypertension. Furthermore, a vitamin D (VD) deficiency is associated with hypertension and PCOS. We aimed to investigate N1 and VD levels in PCOS that have an effect on systolic and diastolic blood pressure (BP) and heart rate (HR).This study included 54 patients with PCOS and 48 age-body mass index (BMI)-matched healthy controls. PCOS was diagnosed according to clinical practice guidelines. Ferriman-Gallwey scores (FGS) were calculated, while N1, VD, and other hormonal and biochemical parameters were measured for all subjects. Systolic and diastolic BP was measured as well. HR was calculated using an electrocardiogram.The levels of N1 (p < 0.001), high-sensitivity C-reactive protein (hs-CRP) (p = 0.036), homeostasis model assessment as an index of insulin resistance (HOMA-IR) (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) BP and HR (p < 0.001) in the PCOS group were significantly higher than in the control group. However, the VD levels of the PCOS group were lower than the control group (p = 0.004). N1 had a strong positive correlation with BMI, HOMA-IR, hs-CRP, luteinizing hormone, systolic and diastolic BP, and HR. VD levels were negatively correlated with HOMA-IR and luteinizing hormone.Elevated N1 and decreased VD levels may be related to the presence of high-normal BP or hypertension in PCOS subjects.  N1 level may be associated with an increased BP due to its relation to inflammation and IR.

Nesfatin-1 and Vitamin D levels may be associated with systolic and diastolic blood pressure values and hearth rate in polycystic ovary syndrome

Obesity, insulin resistance (IR), inflammation, and hyperandrogenism may lead to polycystic ovary syndrome (PCOS) and hypertension. Nesfatin-1 (N1) may be related to IR, obesity, and hypertension. Furthermore, a vitamin D (VD) deficiency is associated with hypertension and PCOS. We aimed to investigate N1 and VD levels in PCOS that have an effect on systolic and diastolic blood pressure (BP) and heart rate (HR).This study included 54 patients with PCOS and 48 age-body mass index (BMI)-matched healthy controls. PCOS was diagnosed according to clinical practice guidelines. Ferriman-Gallwey scores (FGS) were calculated, while N1, VD, and other hormonal and biochemical parameters were measured for all subjects. Systolic and diastolic BP was measured as well. HR was calculated using an electrocardiogram.The levels of N1 (p < 0.001), high-sensitivity C-reactive protein (hs-CRP) (p = 0.036), homeostasis model assessment as an index of insulin resistance (HOMA-IR) (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) BP and HR (p < 0.001) in the PCOS group were significantly higher than in the control group. However, the VD levels of the PCOS group were lower than the control group (p = 0.004). N1 had a strong positive correlation with BMI, HOMA-IR, hs-CRP, luteinizing hormone, systolic and diastolic BP, and HR. VD levels were negatively correlated with HOMA-IR and luteinizing hormone.Elevated N1 and decreased VD levels may be related to the presence of high-normal BP or hypertension in PCOS subjects.  N1 level may be associated with an increased BP due to its relation to inflammation and IR.

Links between Vitamin D Deficiency and Cardiovascular Diseases

The aim of the present paper was to review the most important mechanisms explaining the possible association of vitamin D deficiency and cardiovascular diseases, focusing on recent experimental and clinical data. Low vitamin D levels favor atherosclerosis enabling vascular inflammation, endothelial dysfunction, formation of foam cells, and proliferation of smooth muscle cells. The antihypertensive properties of vitamin D include suppression of the renin-angiotensin-aldosterone system, renoprotective effects, direct effects on endothelial cells and calcium metabolism, inhibition of growth of vascular smooth muscle cells, prevention of secondary hyperparathyroidism, and beneficial effects on cardiovascular risk factors. Vitamin D is also involved in glycemic control, lipid metabolism, insulin secretion, and sensitivity, explaining the association between vitamin D deficiency and metabolic syndrome. Vitamin D deficit was associated in some studies with the number of affected coronary arteries, postinfarction complications, inflammatory cytokines and cardiac remodeling in patients with myocardial infarction, direct electromechanical effects and inflammation in atrial fibrillation, and neuroprotective effects in stroke. In peripheral arterial disease, vitamin D status was related to the decline of the functional performance, severity, atherosclerosis and inflammatory markers, arterial stiffness, vascular calcifications, and arterial aging. Vitamin D supplementation should further consider additional factors, such as phosphates, parathormone, renin, and fibroblast growth factor 23 levels.

Relationships between C-kit expression and mean platelet volume in benign, preneoplastic and neoplastic endometrium

BACKGROUND

c-Kit is a proto-oncogene that encodes a tyrosine kinase receptor (CD117). Mean platelet volume (MPV) is a useful marker for demonstrating thrombocyte function. We aimed to investigate whether c-kit is expressed in benign, preneoplastic and neoplastic endometrial tissues and whether MPV has a relation with c-kit expression and its intensity.

MATERIALS AND METHODS

c-Kit expression was investigated immunohistochemically in 10 samples of normal endometrium (n=10), simple endometrial hyperplasia (5 cases with atypia and 10 cases without atypia), complex endometrial hyperplasia (10 cases with atypia and 10 cases without atypia) and endometrial cancer (EC) (10 cases grade I and 10 cases grade II) and MPV of all cases was checked.

RESULTS

c-Kit expression was observed at very low rates in cases with normal endometrial tissues (NE) and in hyperplasia without atypia. c-Kit expression and immunostaining were strong in endometrial atypia and EC. MPV levels of complex atypical endometrial hyperplasia (CAEH) (p:0.002), EC grade I (ECG I) (p<0.001) and EC grade II (ECG II) (p<0.001) were significantly elevated when compared with the NE group. Both c-kit expression and intensity of immunostaining had a positive correlation with MPV level.

CONCLUSIONS

While c-kit expression and intensity of immunostaining were mildly positive in NE and hyperplasia without atypia, they were clearly observed in EC and hyperplasia with atypia. As c-kit expression is related to the mutagenesis a long-term follow- up may be needed in these cases. A high MPV level may be a good test for demonstrating c-kit expression and intensity of immunostaining.