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Zhang Y, Liu Y, Zhu G, Wang Q, Ni J, Liu L, Zhang J, Zhang J, Li Z, Wang X, Huang Y, Dong M, Zhang Y, Wang Y. Noninvasive detection of diabetes mellitus based on skin fluorescence and diffuse reflectance spectroscopy. JOURNAL OF BIOPHOTONICS 2024; 17:e202300098. [PMID: 37698142 DOI: 10.1002/jbio.202300098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
There is an urgent need for a mass population screening tool for diabetes. Skin tissue contains a large number of endogenous fluorophores and physiological parameter markers related to diabetes. We built an excitation-emission spectrum measurement system with the excited light sources of 365, 395, 415, 430, and 455 nm to extract skin characteristics. The modeling experiment was carried out to design and verify the accuracy of the recovery of tissue intrinsic discrete three-dimensional fluorescence spectrum. Blood oxygen modeling experiment results indicated the accuracy of the physiological parameter extraction algorithm based on the diffuse reflectance spectrum. A community population cohort study was carried out. The tissue-reduced scattering coefficient and scattering power of the diabetes were significantly higher than normal control groups. The Gaussian multi-peak fitting was performed on each excitation-emission spectrum of the subject. A total of 63 fluorescence features containing information such as Gaussian spectral curve intensity, central wavelength position, and variance were obtained from each person. Logistic regression was used to construct the diabetes screening model. The results showed that the area under the receiver operating characteristic curve of the model for predicting diabetes was 0.816, indicating a high diagnostic value. As a rapid and non-invasive detection method, it is expected to have high clinical value.
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Affiliation(s)
- Yuanzhi Zhang
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Yong Liu
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Guoqing Zhu
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Quanfu Wang
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Jingshu Ni
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Lin Liu
- Endocrinology Department, Peking University First Hospital, Beijing, China
| | - Jian Zhang
- Endocrinology Department, Peking University First Hospital, Beijing, China
| | - Junqing Zhang
- Endocrinology Department, Peking University First Hospital, Beijing, China
| | - Zhongsheng Li
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Xia Wang
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Yao Huang
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Meili Dong
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Yang Zhang
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
| | - Yikun Wang
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Provincial Engineering Laboratory for Medical Optical Diagnosis Treatment Technology and Instrument, Hefei, China
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Pawlak-Chomicka R, Uruski P, Krauze T, Piskorski J, Tykarski A, Guzik P. Arterial Blood Pressure Features of Hypertensive Patients with Typical and Atypical 460 nm Skin Fluorescence Response to Transient Ischaemia. J Clin Med 2023; 12:5886. [PMID: 37762826 PMCID: PMC10531863 DOI: 10.3390/jcm12185886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Flow-mediated skin fluorescence (FMSF) at 460 nm is a non-invasive method for assessing dynamic changes in the reduced form of nicotinamide adenine dinucleotide (NADH) and microcirculation in forearm skin under varying conditions of tissue perfusion. Typically, fluorescence increases during ischaemia, but atypical cases show a temporary signal decrease instead of a constant increase. This study aimed to explore the clinical implications of atypical FMSF patterns in patients with newly diagnosed untreated hypertension. NADH fluorescence and pulse wave analysis were performed on 65 patients. Differences in peripheral and arterial pulse pressure profiles were examined based on FMSF curve courses. Patients with atypical curve courses had significantly (p < 0.05 or lower for all) higher heart rate, peripheral and central diastolic pressure, tension time index, central rate pressure product, shorter diastole duration, and reservoir pressure-time integral. Hypertensive patients with atypical FMSF signals had less advantageous blood pressure profiles. Although the underlying factors causing these symptoms are unknown, the atypical FMSF pattern may reflect increased sympathetic stimulation and vascular resistance. The visual assessment of the FMSF curve may have important clinical implications that deserve further investigation.
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Affiliation(s)
- Regina Pawlak-Chomicka
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (R.P.-C.); (P.U.); (A.T.)
| | - Paweł Uruski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (R.P.-C.); (P.U.); (A.T.)
| | - Tomasz Krauze
- Department of Cardiology-Intensive Therapy and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Jarosław Piskorski
- Institute of Physics, University of Zielona Gora, 65-516 Zielona Gora, Poland;
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (R.P.-C.); (P.U.); (A.T.)
| | - Przemysław Guzik
- Department of Cardiology-Intensive Therapy and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
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Pawlak-Chomicka R, Chomicki W, Krauze T, Uruski P, Guzik M, Piskorski J, Tykarski A, Guzik P. Investigating the Ischaemic Phase of Skin NADH Fluorescence Dynamics in Recently Diagnosed Primary Hypertension: A Time Series Analysis. J Clin Med 2023; 12:jcm12041247. [PMID: 36835783 PMCID: PMC9961528 DOI: 10.3390/jcm12041247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
The reduced form of nicotinamide adenine dinucleotide (NADH) is crucial in cellular metabolism. During hypoxia, NADH accumulation results from anaerobic cytoplasmic glycolysis and impaired mitochondrial function. This study aimed to compare the dynamic changes in the 460-nm forearm skin fluorescence, which reflects cellular NADH content, during transient ischaemia between healthy individuals and patients with newly diagnosed, untreated essential hypertension (HA). Sixteen healthy volunteers and sixty-five patients with HA underwent non-invasive measurement of forearm skin NADH content using the Flow Mediated Skin Fluorescence (FMSF) method at rest and during a 100-s transient ischaemia induced by inflation of the brachial cuff. The fluorescent signal was sampled at 25 Hz. All samples were normalised to the end of the ischaemic phase, which is the most stable phase of the whole recording. Slope values of 1 s linear regressions were determined for every 25-sample neighbouring set. The 1-s slopes in the early phase of skin ischaemia, indicating quicker hypoxia-induced NADH accumulation in skin, were significantly higher in patients with HA than in healthy individuals. These findings suggest that some protecting mechanisms postponing the early consequences of early cellular hypoxia and premature NADH accumulation during skin ischaemia are impaired in patients with untreated HA. Further studies are needed to investigate this phenomenon.
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Affiliation(s)
- Regina Pawlak-Chomicka
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
- Correspondence: ; Tel.: +48-618549090
| | - Wojciech Chomicki
- Department of Physics of Functional Materials, Faculty of Physics, Adam Mickiewicz University, 61-614 Poznan, Poland
| | - Tomasz Krauze
- Department of Cardiology-Intensive Therapy and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Paweł Uruski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Maria Guzik
- Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Jarosław Piskorski
- Institute of Physics, University of Zielona Gora, 65-516 Zielona Gora, Poland
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Przemysław Guzik
- Department of Cardiology-Intensive Therapy and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland
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Rechciński T, Cieślik-Guerra U, Siedlecki P, Uznańska-Loch B, Trzos E, Wierzbowska-Drabik K, Szymczyk E, Wejner-Mik P, Kurpesa M, Lipiec P, Kasprzak JD. Flow-mediated skin fluorescence: A novel method for the estimation of sleep apnea risk in healthy persons and cardiac patients. Cardiol J 2022; 29:948-953. [PMID: 33140392 PMCID: PMC9788746 DOI: 10.5603/cj.a2020.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/26/2020] [Accepted: 10/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A pilot study revealed a relationship between the results of flow mediated skin fluorescence (FMSF) and of ECG-Holter-based estimated apnea/hypopnea index (eAHI) in asymptomatic individuals. The aim of this study was to test whether the results of FMSF show a relationship with the eAHI in patients with coronary artery disease or aortic stenosis. METHODS Twenty-one patients (12 coronary disease, 9 aortic stenosis) and 37 healthy volunteers were included. FMSF was assessed before, during and after the pressure occlusion of the brachial artery, using a prototype device allowing the quantification of skin fluorescence. The values of FMSF expressed as baseline (BASE), maximum (MAX), and minimum (MIN) were analyzed. The percentages of ischemic response (IR) and hyperemic response (HR) were calculated. The eAHI was assessed from night ECG-Holter recordings. Differences between the groups and the relationships between the parameters were analyzed statistically. RESULTS Mean ± standard deviation of BASE, MAX, MIN and IR were not significantly different in both groups (p > 0.05). HR was significantly lower in cardiac patients (14.7 ± 7.5 vs. 11.8 ± 5.1; p = 0.048), whose eAHI was significantly higher (11.0 ± 7.4 vs. 36.3 ± 16.5; p < 0.01). Negative correlation for MAX and eAHI was found in volunteers and patients: r = -0.38, p = 0.02 and r = -0.47, p = 0.03, respectively. In volunteers, HR had a negative correlation with eAHI: r = -0.34, p = 0.04. CONCLUSIONS This pioneer study confirms that FMSF can be used to detect the negative correlation between MAX fluorescence and eAHI not only among healthy volunteers, but also among cardiac patients with coronary artery disease or aortic stenosis.
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Affiliation(s)
| | | | | | | | - Ewa Trzos
- Department of Cardiology, Bieganski Hospital, Lodz, Poland
| | | | - Ewa Szymczyk
- Department of Cardiology, Medical University of Lodz, Poland
| | | | | | - Piotr Lipiec
- Department of Cardiology, Medical University of Lodz, Poland
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Los-Stegienta A, Borkowska A, Cypryk K. Assessment of microvascular function using a novel technique Flow Mediated Skin Fluorescence (FMSF) in patients with diabetic kidney disease: A preliminary study. Microvasc Res 2022; 144:104417. [PMID: 35931125 DOI: 10.1016/j.mvr.2022.104417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diabetic kidney disease (DKD) plays an important role in morbidity and mortality in patients with diabetes mellitus. The pathogenesis of this microangiopathy is mainly due to impaired vascular endothelial function. The Flow Mediated Skin Fluorescence (FMSF) method is an innovative, non-invasive tool for assessing the microcirculation function (especially microcirculatory response to hypoxia), also in patients with complications of diabetes mellitus (DM). MATERIAL AND METHODS The study was conducted at the Medical University of Lodz, Poland. Total of 84 volunteers including 30 patients with DKD, 33 patients with DM without complications, and 21 healthy subjects underwent microvascular function assessments using FMSF. This technique measures changes in the intensity of nicotinamide adenine dinucleotide (NADH) fluorescence from the skin on the forearm as a function of time, in response to blocking and releasing blood flow in the forearm. In this study we asses two key parameters: Reactive Hyperemia Response (RHR) and Hypoxia Sensitivity [log(HS)] to characterize vascular circulation in patients with DKD and their response to transient ischemia. RESULTS The patients with low reactive hyperemic response (the RHR parameter) had a significantly higher sCr than patients with moderate and high RHR value (p < 0.001, p < 0.05, respectively) and a significantly lower eGFR than the patients with moderate and high RHR parameter (p < 0.001, p < 0.01, respectively). The patients with very low and low log(HS) values had a significantly higher sCr than the patients with high log(HS) (p < 0.001, p < 0.01, respectively), and a significantly lower eGFR than the patients with high log(HS) parameter (p < 0.001, p < 0.01, respectively). The patients with very low log(HS) had a significantly higher sCr and a significantly lower eGFR than the patients with moderate (p < 0.05, p < 0.01, respectively). The mean value of the RHR parameter was significantly lower in DKD patients (18.31 ± 5.06 %) compared to both healthy subjects (34.37 ± 8.18 %, p < 0.001) and DM without complications subgroup (28.75 ± 7.12 %, p < 0.001). Similar trends were noted with the mean value of log(HS) parameter in DKD subgroup (1.03 ± 0.5) vs. healthy subjects (1.59 ± 0.53, p < 0.001), and vs. DM without complications subgroup (1.73 ± 0.52, p < 0.001). We observed a significant inverse correlation between the RHR parameter and serum creatinine (sCr) and a significant positive correlations with eGFR (R = -0.3; p < 0.05, R = 0.61; p < 0.001, respectively). We found also a significant negative correlations of the log(HS) measure with sCr and a significant positive correlations with eGFR (R = -0.33; p < 0.01, R = 0.55; p < 0.001, respectively). We observed also a significant inverse correlation between the RHR and log(HS) parameters and advanced glycation end products (AGEs) (R = -0.6; p < 0.001, R = -0.32; p < 0.01, respectively). The AGEs parameter was also a significantly higher in patients with low RHR parameter than in patients with moderate (p < 0.01) and high (p < 0.001). CONCLUSIONS The FMSF technique makes it possible to identify impairments of the microvascular function in patients with DKD. This study confirms that the simple two-parametric approach diagnostic tool perfectly characterizes the state of the microvascular system in diabetic patients with impaired renal function. These preliminary results require further validation in a larger patients cohort.
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Affiliation(s)
- Agnieszka Los-Stegienta
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland.
| | - Anna Borkowska
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland.
| | - Katarzyna Cypryk
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland.
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The Effect of Antihypertensive Drugs on NADH in Newly Diagnosed Primary Hypertension. Cardiol Res Pract 2022; 2022:6159883. [PMID: 35402043 PMCID: PMC8989586 DOI: 10.1155/2022/6159883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/13/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Some antihypertensive medications alter cellular energy production, presumably by modification of the mitochondrial function. In vivo studies of such effects are challenging in humans. We applied a noninvasive forearm skin measurement of the 460-nm fluorescence specific for the reduced form of nicotinamide adenine dinucleotide (NADH) to study the 6-week effects of four different antihypertensive medications on mitochondrial function using the Flow-Mediated Skin Fluorescence (FMSF). Methods In a prospective open-label study, we compared the long-term effects of a 6-week treatment with either amlodipine (5 mg), perindopril (5 mg), nebivolol (5 mg), or metoprolol (50 mg) on the dynamic flow-mediated changes in the skin NADH content in 76 patients (29 women) with untreated primary arterial hypertension (HA). Patients underwent 24-hour ambulatory blood pressure monitoring. To study mitochondrial function, the FMSF was measured at rest, during 100-second ischemia and postischemic reperfusion. The control group consisted of 18 healthy people (7 women). Results There were no significant differences in the FMSF parameters between the control and the study group before medication. After the 6-week treatment, all drugs similarly reduced blood pressure. Neither amlodipine, perindopril, nor nebivolol changed the flow-mediated 460-nm skin fluorescence significantly. However, metoprolol raised this fluorescence at rest, during ischemia and reperfusion (P at most <0.05), indicating an increase in the total NADH skin content. Conclusion Amlodipine, perindopril, and nebivolol appear neutral for the skin NADH content during the 6-week antihypertensive treatment. Similar treatment with metoprolol increased skin NADH at rest, during ischemia and reperfusion, probably due to an effect on microcirculation and altered mitochondrial function. Explanation of the potential mechanisms behind metoprolol influence on the skin NADH metabolism requires further investigation.
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Assessment of microvascular function and pharmacological regulation in genetically confirmed familial hypercholesterolemia. Microvasc Res 2021; 138:104216. [PMID: 34182004 DOI: 10.1016/j.mvr.2021.104216] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a genetic lipid disorder leading to accelerated atherosclerosis, premature cardiovascular disease and death. Microvascular endothelial dysfunction is one of the earliest vascular pathology manifestations and may precede symptomatic atherosclerosis. METHODS In this paper, microvascular endothelial function was assessed in FH patients and healthy controls using flow mediated skin fluorescence (FMSF), based on measurements of nicotinamide adenine dinucleotide fluorescence intensity during brachial artery occlusion (ischemic response, IR) and immediately after occlusion (hyperemic response, HR). Low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were used to assess its relation with microvascular parameters evaluated in vivo. RESULTS LDL-C levels were significantly correlated to both HRmax (r = -0.548, p = 0.001) and HRindex (r = -0.514, p = 0.003). Similarly, there was a significant inverse correlation of TC levels and both HRmax (r = -0.538, p = 0.002) and HRindex (r = -0.512, p = 0.003). All FMSF parameters were found lower in FH patients compared to age- and sex-matched healthy controls. Hyperemic response (HRmax) was significantly higher in FH patients examined on statins compared to those without any lipid-lowering treatment (19.9 ± 3.1 vs. 16.4 ± 4.2 respectively, p = 0.022). CONCLUSIONS This study shows that, in patients with FH, microvascular endothelial-dependent hyperemic response is impaired and inversely correlated to plasma cholesterol levels. Microvascular function was found better in FH patients receiving statins.
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Theodorakopoulou MP, Bakaloudi DR, Dipla K, Zafeiridis A, Boutou AK. Vascular endothelial damage in COPD: current functional assessment methods and future perspectives. Expert Rev Respir Med 2021; 15:1121-1133. [PMID: 33874819 DOI: 10.1080/17476348.2021.1919089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Cardiovascular disease is a major cause of death in chronic obstructive pulmonary disease (COPD), but the relationship between these two entities is not fully understood; smoking, inflammation, arterial stiffness and endothelial dysfunction are significant determinants. Endothelial dysfunction is not only associated with cardiovascular disease, but also with COPD severity.Areas covered: Several functional methods have been developed to evaluate endothelial function in healthy and diseased individuals; from the invasive angiography of epicardial coronary arteries and Venous-Occlusion-Plethysmography, to more modern, noninvasive approaches such as Flow-Mediated-Dilatation, Peripheral-Arterial-Tonometry and Near-Infrared-Spectroscopy, all these methods have boosted clinical research in this field. In this context, this narrative review, which included articles published in PubMed and Scopus up to 25-November-2020, summarizes available functional methods for endothelial damage assessment in COPD and discusses existing evidence on their associations with comorbidities and outcomes in this population.Expert opinion: Accumulated evidence suggests that endothelial dysfunction occurs in early stages of CΟPD and worsens with pulmonary obstruction severity and during acute exacerbations. Novel methods evaluating endothelial function offer a detailed, real-time assessment of different parameters related to vascular function and should be increasingly used to shed more light on the role of endothelial damage on cardiovascular and COPD progression.
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Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
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Nizinski J, Filberek P, Sibrecht G, Krauze T, Zielinski J, Piskorski J, Wykretowicz A, Guzik P. Non-invasive in vivo human model of post-ischaemic skin preconditioning by measurement of flow-mediated 460-nm autofluorescence. Br J Clin Pharmacol 2021; 87:4283-4292. [PMID: 33792076 DOI: 10.1111/bcp.14845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/02/2021] [Accepted: 03/13/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS Transient ischaemia and reperfusion (TIAR) induce early ischaemic preconditioning (IPC) in different tissues and organs, including the skin. IPC protects tissues by modifying the mitochondrial function and decreasing the amount of the reduced form of nicotinamide adenine dinucleotide (NADH). Skin 460-nm autofluorescence is proportional to the NADH content and can be non-invasively measured during TIAR. We propose a non-invasive in vivo human model of skin IPC for studying the effects of repeated TIARs on the NADH content. METHODS Fifty-one apparently healthy volunteers (36 women) underwent three 100-second forearm ischaemia episodes induced by inflation of brachial pressure cuff to the pressure of 60 mmHg above systolic blood pressure, followed by 500-second long reperfusion episodes. Changes in skin NADH content were measured using 460-nm fluorescence before and during each of the three TIARs. RESULTS The first two TIARs caused a significant reduction in the skin NADH content before (P = .0065) and during the third ischaemia (P = .0011) and reperfusion (P = .0003) up to 3.0%. During the third TIAR, the increase in skin NADH was 20% lower than during the first ischaemia (P = .0474). CONCLUSIONS The measurement of the 460-nm fluorescence during repeated TIARs allows for a non-invasive in vivo investigation of human skin IPC. Although IPC reduces the overall NADH skin content, the most noticeable NADH reduction appears during ischaemia after earlier TIARs. Studying the skin model of IPC may provide new avenues for in vivo physiological, clinical and pharmacological research on mitochondrial metabolism.
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Affiliation(s)
- Jan Nizinski
- Department of Cardiology Intensive Care Therapy and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Filberek
- Department of Cardiology Intensive Care Therapy and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Greta Sibrecht
- Department of Cardiology Intensive Care Therapy and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Krauze
- Department of Cardiology Intensive Care Therapy and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Zielinski
- Department of Athletics, Strength and Conditioning, Poznan University of Physical Education, Poznan, Poland
| | | | - Andrzej Wykretowicz
- Department of Cardiology Intensive Care Therapy and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemyslaw Guzik
- Department of Cardiology Intensive Care Therapy and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Du B, Si D, Zhao D, Zhao Y, Wagatsuma K, He Y, Yang P. A new peripheral endothelial function measurement improves prediction of symptomatic coronary artery disease. J Int Med Res 2020; 48:300060520932818. [PMID: 32589086 PMCID: PMC7323288 DOI: 10.1177/0300060520932818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to determine whether a peripheral artery volume (PAV) test can improve the predictive value of the age-adjusted Framingham risk score (AFRS) for coronary artery disease (CAD) in symptomatic patients. Methods A total of 317 consecutive patients who were referred for coronary angiography were prospectively enrolled. Before cardiac catheterization, a PAV test was performed to measure changes in pulsatile blood flow volume following reactive hyperemia. Results PAV was significantly lower in patients with CAD than in those without CAD (1.21 ± 0.32 vs. 1.50 ± 0.45). Multivariate logistic regression analysis showed that PAV and the AFRS were independent predictors of CAD. Pairwise comparison of receiver operating characteristic curves showed that the predictive power for CAD increased when PAV was incorporated into the AFRS (area under the curve: from 0.76 to 0.80). The net reclassification index was also improved when PAV was added to the AFRS (0.65, 95% confidence interval: 0.44–0.85). Conclusions Digital endothelial function measurement is an independent predictor of CAD. PAV is potentially useful for identifying patients at high risk for CAD.
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Affiliation(s)
- Beibei Du
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China
| | - Daoyuan Si
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China
| | - Dong Zhao
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China
| | - Yanan Zhao
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China
| | - Kenji Wagatsuma
- Tsukuba Heart Center, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Yuquan He
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China
| | - Ping Yang
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China
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Katarzynska J, Borkowska A, Los A, Marcinek A, Cypryk K, Gebicki J. Flow-Mediated Skin Fluorescence (FMSF) Technique for Studying Vascular Complications in Type 2 Diabetes. J Diabetes Sci Technol 2020; 14:693-694. [PMID: 31855069 PMCID: PMC7576949 DOI: 10.1177/1932296819895544] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Anna Borkowska
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Poland
| | - Agnieszka Los
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Poland
| | - Andrzej Marcinek
- Angionica Ltd., Lodz, Poland
- Institute of Applied Radiation Chemistry, Lodz University of Technology, Poland
| | - Katarzyna Cypryk
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Poland
| | - Jerzy Gebicki
- Angionica Ltd., Lodz, Poland
- Institute of Applied Radiation Chemistry, Lodz University of Technology, Poland
- Jerzy Gebicki, PhD, Institute of Applied Radiation Chemistry, Lodz University of Technology, Zeromskiego 116, Lodz 90-924, Poland. Emails: ;
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Changes of NADH Fluorescence from the Skin of Patients with Systemic Lupus Erythematosus. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5897487. [PMID: 31930128 PMCID: PMC6942734 DOI: 10.1155/2019/5897487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
Introduction The blood circulation of the skin is an accessible and representative vascular bed for examining the mechanisms of microcirculatory function. Endothelial function is impaired in systemic lupus erythematosus (SLE), which implies disorders in cell metabolism dependent on blood circulation; however, noninvasive monitoring of metabolism at the tissue and cell level is absent in daily clinical practice. Objective The aim of the study was to examine changes of NADH fluorescence from the epidermis of a forearm measured with the flow mediated skin fluorescence (FMSF) technique in patients with SLE and to investigate whether they are associated with clinical manifestation of the disease. Materials and Methods The study enrolled 36 patients with SLE and 34 healthy individuals. Changes of NADH fluorescence were measured using FMSF on the forearm in response to blocking and releasing of blood flow. The results were represented as ischemic (IR max and IR auc) and hyperemic response maximum and area under the curve (HR max and HR auc). Results IR max, IR auc, HR max, and HR auc were all lower in patients with SLE (p < 0.05) compared with controls. All four parameters were negatively correlated (p < 0.05) with patient age. No difference was found in NADH fluorescence between SLE patients with malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, renal disorder, hematologic disorder, or immunologic disorder and those without. No correlation was revealed between the SLEDAI score and NADH fluorescence. Conclusion Changes of NADH fluorescence indicate the reduction in NADH restoration, observed especially during reperfusion, and suggest the occurrence of disorders in the microcirculation of the skin and/or at the mitochondrial level. Such changes of NADH during reperfusion in patients with SLE could be associated with their possible lower sensitivity to hypoxia and possibly with endothelial dysfunction.
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Majewski S, Szewczyk K, Białas AJ, Miłkowska-Dymanowska J, Kurmanowska Z, Górski P. Assessment of microvascular function in vivo using flow mediated skin fluorescence (FMSF) in patients with obstructive lung diseases: A preliminary study. Microvasc Res 2019; 127:103914. [PMID: 31472204 DOI: 10.1016/j.mvr.2019.103914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cardiovascular diseases play an important role in the morbidity and mortality of patients with obstructive lung diseases. Impaired vascular endothelial function seems to be a key element linking obstructive lung disease and cardiovascular disease. Recently developed technique named flow mediated skin fluorescence (FMSF) is a novel, non-invasive tool to study microvascular function. METHODS Total of 69 volunteers including 26 patients with chronic obstructive pulmonary disease (COPD), 23 patients with asthma and 20 healthy subjects underwent microvascular function assessments using FMSF. FMSF assessments were composed of measurements of reduced form of nicotinamide adenine dinucleotide (NADH) fluorescence intensity signal during brachial artery occlusion - ischemic response (IRmax) and immediately after release of occlusion - hyperemic response (HRmax). Associations of microvascular function with clinical and biochemical characteristics of studied subjects were also evaluated. RESULTS The median value of IRmax was significantly lower in COPD subjects (2.4 [1.0-6.7] %) compared with healthy subjects (9.6 [3.7-13.5] %; p < 0.01). The mean value of HRmax was also significantly reduced in COPD subjects (9.7 (4.5) %) compared with both asthma subjects (12.1 (3.5) %; p < 0.05) and healthy control subjects (13.4 (2.9) %; p < 0.01). CONCLUSIONS The FMSF technique makes it possible to identify impairments of the microvascular function in patients with COPD, but not in asthma patients. These exploratory findings require further validation in a larger patients cohort.
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Affiliation(s)
- Sebastian Majewski
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland.
| | - Karolina Szewczyk
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Adam Jerzy Białas
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Zofia Kurmanowska
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Paweł Górski
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland
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Katarzynska J, Borkowska A, Czajkowski P, Los A, Szczerbinski L, Milewska-Kranc A, Marcinek A, Kretowski A, Cypryk K, Gebicki J. Flow Mediated Skin Fluorescence technique reveals remarkable effect of age on microcirculation and metabolic regulation in type 1 diabetes. Microvasc Res 2019; 124:19-24. [PMID: 30807771 DOI: 10.1016/j.mvr.2019.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
STUDY DESCRIPTION Flow Mediated Skin Fluorescence (FMSF) is a novel technique for non-invasive evaluation of the microcirculation and metabolic regulation. This study describes the diagnostic potential of FMSF for type 1 diabetes (DM1). STUDY POPULATION All study participants, in both the control (n = 31) and DM1 (n = 40) groups, were between the ages of 30-49 y. The patients in the DM1 group had all been suffering from diabetes for at least 10 y. RESULTS The parameters HRindex, HRmax and MR inversely correlate with age and BMI. An unidentified compensatory effect was observed among the younger members of the DM1 group. The majority of DM1 patients with HRindex < 8% showed signs of dysfunctional metabolic regulation. CONCLUSION FMSF appears to be an extremely useful technique for monitoring diabetic patients over time, enabling early diagnosis of potentially dysfunctional microcirculation and metabolic regulation.
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Affiliation(s)
| | - Anna Borkowska
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Lodz, Poland
| | | | - Agnieszka Los
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Lukasz Szczerbinski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | | | - Andrzej Marcinek
- Angionica Ltd., Lodz, Poland; Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, Poland
| | - Adam Kretowski
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland; Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Cypryk
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Jerzy Gebicki
- Angionica Ltd., Lodz, Poland; Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, Poland.
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