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Wasserstein MP, Lachmann R, Hollak C, Barbato A, Gallagher RC, Giugliani R, Guelbert NB, Hennermann JB, Ikezoe T, Lidove O, Mabe P, Mengel E, Scarpa M, Senates E, Tchan M, Villarrubia J, Thurberg BL, Yarramaneni A, Armstrong NM, Kim Y, Kumar M. Continued improvement in disease manifestations of acid sphingomyelinase deficiency for adults with up to 2 years of olipudase alfa treatment: open-label extension of the ASCEND trial. Orphanet J Rare Dis 2023; 18:378. [PMID: 38042851 PMCID: PMC10693698 DOI: 10.1186/s13023-023-02983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Olipudase alfa is a recombinant human acid sphingomyelinase enzyme replacement therapy for non-central-nervous-system manifestations of acid sphingomyelinase deficiency (ASMD). The ASCEND randomized placebo-controlled trial in adults with ASMD demonstrated reductions in sphingomyelin storage, organomegaly, interstitial lung disease and impaired diffusion capacity of the lung (DLCO), during the first year of olipudase alfa treatment. In an ongoing open-label extension of the ASCEND trial, individuals in the placebo group crossed over to olipudase alfa, and those in the olipudase alfa group continued treatment. RESULTS Thirty-five of 36 participants continued in the extension trial, and 33 completed year 2. Change-from-baseline results are presented as least-square mean percent change ± SEM. Improvements in the cross-over group after 1 year of treatment paralleled those of the olipudase alfa group from the primary analysis, while clinical improvement continued for those receiving olipudase alfa for 2 years. In the cross-over group, percent-predicted DLCO increased by 28.0 ± 6.2%, spleen volume decreased by 36.0 ± 3.0% and liver volume decreased by 30.7 ± 2.5%. For those with 2 years of olipudase alfa treatment, the percent predicted DLCO increased by 28.5 ± 6.2%, spleen volume decreased by 47.0 ± 2.7%, and liver volume decreased by 33.4 ± 2.2%. Lipid profiles and elevated liver transaminase levels improved or normalized by 1 year and remained stable through 2 years of treatment. Overall, 99% of treatment-emergent adverse events were mild or moderate, with one treatment-related serious adverse event (extrasystoles; previously documented cardiomyopathy). No individual discontinued due to an adverse event. CONCLUSION Treatment with olipudase alfa is well tolerated and reduces manifestations of chronic ASMD with sustained efficacy. Trial registration NCT02004691 registered 9 December 2013, https://clinicaltrials.gov/ct2/show/NCT02004691.
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Affiliation(s)
- Melissa P Wasserstein
- Children's Hospital at Montefiore and the Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA.
| | - Robin Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Carla Hollak
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Antonio Barbato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Renata C Gallagher
- Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - Roberto Giugliani
- Postgraduate Program in Genetics and Molecular Biology, Med Genet Serv & DR Brasil, HCPA, INAGEMP, DASA, and Casa Dos Raros, UFRGS, Porto Alegre, Brazil
| | | | - Julia B Hennermann
- Villa Metabolica, Center for Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University, Fukushima, Japan
| | - Olivier Lidove
- Department of Internal Medicine, La Croix St Simon Hospital, Paris, France
| | | | - Eugen Mengel
- Clinical Science for LSD, SpinCS, Hochheim, Germany
| | - Maurizio Scarpa
- Regional Coordinator Centre for Rare Diseases, University Hospital of Udine, 33100, Udine, Italy
| | | | - Michel Tchan
- Department of Genetic Medicine, Westmead Hospital, Sydney, Australia
| | - Jesus Villarrubia
- Hematology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Wasserstein M, Barbato A, Gallagher R, Giugliani R, Guelbert N, Hennermann J, Hollak C, Ikezoe T, Lachmann R, Lidove O, Mabe P, Mengel E, Scarpa M, Senates E, Tchan M, Villarrubia J, Thurberg B, Yarramaneni A, Rawlings A, Kim Y, Kumar M. eP280: Continued improvement in adults with acid sphingomyelinase deficiency after 2 years of olipudase alfa in the ASCEND placebo-controlled trial. Genet Med 2022. [DOI: 10.1016/j.gim.2022.01.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Colak Y, Coskunpinar EM, Senates E, Oltulu YM, Yaylim I, Gomleksiz OK, Ozan Tiryakioglu N, Hasturk B, Ekmekci CG, Aydogan HY. Assessment of the rs2645424 C/T single nucleotide polymorphisms in the FDFT1 gene, hepatic expression, and serum concentration of the FDFT in patients with nonalcoholic fatty liver disease. Meta Gene 2018. [DOI: 10.1016/j.mgene.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kilinc F, Senates E, Demircan F, Pekkolay Z, Gozel N, Guven M, Bahcecioglu IH, Tuzcu AK. Are There Differences in the Management of Acute Pancreatitis Cases Due to Severe Hypertriglyceridemia in Pregnant Women? Med Sci Monit 2018; 24:5619-5623. [PMID: 30100601 PMCID: PMC6104549 DOI: 10.12659/msm.910343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The aim of this study was to determine the prognosis of severe disease and treatment approaches of both normal and pregnant, especially in patients with severe pancreatitis due to hypertriglyceridemia. Material/Methods We included 30 patients (20 females and 10 males) in this study whose follow-ups and treatments were performed after a diagnosis of hypertriglyceridemia-induced acute pancreatitis between January 2011 and May 2017. Patient personal information, such as age, sex, pre-treatment and post-treatment triglyceride levels, receipt of anti-hyperlipidemic treatments or plasmapheresis, and family history, were collected from hospital records and patient files. Patients with severe pancreatitis history, score, and prognosis were included to increase the value of our study. Mild and moderate cases were excluded. Results The mean age of the patients was 35±6 years. Twenty-four patients (80%) received an anti-hyperlipidemic treatment before their pancreatitis attacks. Plasmapheresis was performed on 8 patients before their pancreatitis attacks. Eighteen patients (60%) had a family history suggesting familial hypertriglyceridemia. Twelve patients (40%) were pregnant. Conclusions The treatment of hypertriglyceridemia-induced acute pancreatitis was mostly confined to supportive, palliative treatments. However, plasmapheresis is a possible treatment option and should be used in the early stages of this disease. The response to medical treatment and support treatment was better in pregnant patients than in the other patient group, and pregnant patients did not require plasmapheresis.
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Affiliation(s)
- Faruk Kilinc
- Department of Endocrinology, Medical Faculty, Firat University, Elazig, Turkey
| | - Ebubekir Senates
- Department of Gastroenterology, Medical Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatih Demircan
- Department of Internal Diseases, Private Etik Life Medical Center, Istanbul, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Nevzat Gozel
- Department of Internal Medicine, Medical Faculty, Firat University, Elazig, Turkey
| | - Mehmet Guven
- Department of Endocrinology, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | | | - Alpaslan Kemal Tuzcu
- Department of Endocrinology, Medical Faculty, Dicle University, Diyarbakir, Turkey
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Yalvac ESD, Aldag M, Kocaaslan C, Senates E, Oztekin A, Bademci MS, Aydin E. Acute Pancreatitis After Coronary Artery Bypass Surgery Treated by Plasmapheresis. Am J Cardiol 2018. [DOI: 10.1016/j.amjcard.2018.03.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yilmaz Y, Colak Y, Kurt R, Senates E, Eren F. Linking Nonalcoholic Fatty Liver Disease to Hepatocellular Carcinoma: From Bedside to Bench and Back. Tumori 2018; 99:10-6. [DOI: 10.1177/030089161309900102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims and background Nonalcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC) are two major causes of liver disease worldwide. Epidemiological and clinical data have clearly demonstrated that NAFLD and its associated metabolic abnormalities are a risk factor for HCC. Traditionally, the mechanisms whereby NAFLD acts as a risk for HCC are believed to include replicative senescence of steatotic hepatocytes and compensatory hyperplasia of progenitor cells as a reaction to chronic hepatic injury. Recent years have witnessed significant advances in our understanding of the mechanisms underlying the link between NAFLD and HCC. Methods In the present review, we provide an update on the pathophysiological pathways linking NAFLD and its associated metabolic derangements to malignant hepatic transformation, with a special focus on insulin resistance, adipokines, inflammation, and angiogenesis. We will also discuss the potential therapeutic implications that such molecular links carry. Results Although treating NAFLD could reduce the risk of malignant hepatic transformation, no long-term studies focusing on this issue have been conducted thus far. Insulin resistance, inflammation as well as derangements in adipokines and angiogenic factors associated with NAFLD are closely intertwined with the risk of developing HCC. Conclusions Traditional therapeutic approaches in NAFLD including metformin and statins may theoretically reduce the risk of HCC by acting on common pathophysiological pathways shared by NAFLD and HCC.
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Affiliation(s)
- Yusuf Yilmaz
- Institute of Gastroenterology, School
of Medicine, Marmara University, Istanbul
- Department of Gastroenterology, School
of Medicine, Marmara University, Istanbul
| | - Yasar Colak
- Department of Gastroenterology,
Faculty of Medicine, Istanbul Medeniyet University, Istanbul
| | - Ramazan Kurt
- Department of Gastroenterology, School
of Medicine, Marmara University, Istanbul
| | - Ebubekir Senates
- Department of Gastroenterology, School
of Medicine, Dicle University, Diyarbakir
| | - Fatih Eren
- Institute of Gastroenterology, School
of Medicine, Marmara University, Istanbul
- Department of Medical Biology and
Genetics, School of Medicine, Marmara University, Istanbul, Turkey
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Colak Y, Bozbey G, Erim T, Caklili OT, Ulasoglu C, Senates E, Mutlu HH, Mesci B, Doğan MS, Tasan G, Enc FY, Tuncer I. Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease. J Neurogastroenterol Motil 2016; 22:470-6. [PMID: 26932908 PMCID: PMC4930302 DOI: 10.5056/jnm15159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/22/2015] [Accepted: 01/29/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIMS Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Along with the increase in the incidence of NAFLD and associated obesity, an increase in gallbladder disease (GD) has been noted. This has led to the identification of a new disease entity called fatty GD. There is a gap in the literature on the dynamics of gallbladder function in patients with NAFLD. METHODS An observational case-control study, a total of 50 patients with biopsy proven NAFLD without gallbladder stone/sludge and 38 healthy comparison subjects were enrolled. Fasting, postprandial gallbladder volumes (PGV), gallbladder ejection fraction (GEF), and fasting gallbladder wall thickness (FGWT) were measured by real-time 2-dimensional ultrasonography. RESULTS Fasting gallbladder wall thickness, fasting gallbladder volumes and PGV were significantly higher in patients with NAFLD than control subjects (P < 0.001, P = 0.006, and P < 0.001, respectively). Gallbladder ejection fraction was significantly lower in the NAFLD group than the controls (P = 0.008). The presence of NAFLD was an independent predictor for GEF, PGV, and FGWT. Also, steatosis grade was an independent predictor for GEF, and GEF was significantly lower in the nonalcoholic steatohepatitis (NASH) subgroup than the controls. CONCLUSIONS Gallbladder dysfunction and increase in gallbladder wall thickness exists in asymptomatic (without stone/sludge and related symptoms) patients with NAFLD and are useful in identifying fatty GD. Measurement of these variables in NAFLD patients may be useful in identifying those at higher risk for GD.
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Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey.,Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL, USA
| | - Gulcin Bozbey
- Department of Radiology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Tolga Erim
- Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL, USA
| | - Ozge Telci Caklili
- Department of Internal Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Celal Ulasoglu
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ebubekir Senates
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Hasan Huseyin Mutlu
- Department of Family of Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Banu Mesci
- Department of Internal Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Mehmet Sait Doğan
- Department of Radiology, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Guralp Tasan
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Feruze Yilmaz Enc
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ilyas Tuncer
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
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Sargin F, Yildiz D, Aydin OA, Mete B, Gunduz A, Karaosmanoglu HK, Yemisen M, Yazici S, Bolukcu S, Durdu B, Senates E, Ozaras R, Dokmetas I, Tabak F. Changes in HIV demographic patterns in a low prevalence population: no evidence of a shift towards men who have sex with men. Int J Infect Dis 2016; 48:52-6. [PMID: 27173075 DOI: 10.1016/j.ijid.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to examine the changes in HIV demographics over time in an exceptionally low prevalence population, with particular emphasis on men who have sex with men (MSM). METHODS A total of 1292 newly diagnosed HIV-positive patients registered in the ACTHIV-IST Study Group database between 2000 and 2014 were included. The changes occurring over time in the characteristics of patients at the time of initial admission were examined retrospectively. RESULTS A gradual increase in the total number of newly diagnosed patients was evident during the study period; however, it was not possible to show an increase in the proportion of MSM within the study population (p=0.63). There was a male predominance throughout the study (85% vs. 15%), with further increases in the proportion of males in recent years. The mean age was lower at the end of the study (p<0.05) and there was an increase in the number of unmarried patients (p<0.05). CONCLUSIONS Sexual preference patterns of HIV patients in extremely low prevalence populations may be different, possibly due to an early phase of the epidemic. Nevertheless, MSM still represent a target subgroup for interventions, since they account for a substantial proportion of cases and a resurgent epidemic may be expected among this group in later phases of the epidemic.
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Affiliation(s)
- Fatma Sargin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Dilek Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Altuntas Aydin
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Alper Gunduz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hayat Kumbasar Karaosmanoglu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Mucahit Yemisen
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Saadet Yazici
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Bulent Durdu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ebubekir Senates
- Department of Gastroenterology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Ilyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
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Yilmaz B, Can G, Ucmak F, Arslan AO, Solmaz I, Unlu O, Düzenli S, Korkmaz U, Kurt M, Senates E. Polymorphisms in the IL28B gene (rs12979860, rs8099917) and the virological response to pegylated interferon therapy in hepatitis D virus patients. Acta Gastroenterol Belg 2016; 79:206-10. [PMID: 27382939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM Few data are available regarding the effects of interleukin 28B (IL28B) polymorphisms in chronic hepatitis D (CHD) patients. This study investigated the relationship between IL28B poly-morphisms and the response of patients with CHD infections to pegylated interferon (PEG-IFN) therapy. MATERIALS AND METHODS A total of 101 CHD patients were -selected, 80 of whom (46 males ; median age 41 years) satisfied the inclusion criteria and were enrolled in the study. Thirty-seven patients were treated with peg-IFNα for at least 12 months and were followed for a median of 18 months (range, 12-30 months). The primary treatment endpoint was the suppression of HDV replication, as documented by the loss of detectable HDV RNA in serum. Genotyping was used to analyse the IL28B polymorphisms rs12979860 and rs8099917 according to the virological response. RESULTS After treatment, a sustained viral response (SVR) was achieved in 19 (51%) of the patients treated with PEG-INF. The IL28B genotypes in the 80 patients were as follows : CC in 36 (45%), CT in 33 (41%) and TT in 11 (14%) for rs12979860, and GG in 4 (5%), GT in 27 (34%) and TT in 49 (61%) for rs8099917. SVR was achieved in 5 (26%), 10 (53%) and 4 (21%) patients with CC, CT and TT at rs12979860, respectively, and one (5%), nine (47%) and nine (47%) patients with GG, GT and TT at rs8099917, respectively. There were differences in the SVR among genotypes (rs12979860 and rs8099917 ; chi-squared test, p = 0.047). CONCLUSION IL28B predicts the PEG-IFN response in patients with CHD infection.
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Ozturk O, Colak Y, Senates E, Yilmaz Y, Ulasoglu C, Doganay L, Ozkanli S, Oltulu YM, Coskunpinar E, Tuncer I. Increased serum soluble lectin-like oxidized low-density lipoprotein receptor-1 levels in patients with biopsy-proven nonalcoholic fatty liver disease. World J Gastroenterol 2015; 21:8096-8102. [PMID: 26185381 PMCID: PMC4499352 DOI: 10.3748/wjg.v21.i26.8096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/02/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the relationship between the serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) levels and clinical and histopathological features of biopsy-confirmed nonalcoholic fatty liver disease (NAFLD) patients.
METHODS: Fifty-three consecutive, biopsy-proven NAFLD patients (31 males and 22 females, mean age 42.5 ± 9.6 years) and 26 age- and gender-matched, healthy controls (14 males and 12 females, mean age 39 ± 10.7 years) were included. The patients with NAFLD were consecutive patients who had been admitted to the hepatology outpatient clinic within the last year and had been diagnosed with NAFLD as the result of liver biopsy. The healthy controls were individuals who attended the outpatient clinic for routine health control and had no known chronic illnesses. The histological evaluation was conducted according to the NAFLD activity scoring system recommended by The National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. The serum LOX-1 levels were measured using an ELISA kit (Life Science Inc. USCN. Wuhan, Catalog No. E1859Hu) in both patients and healthy controls. A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff value of LOX-1 and thereby distinguish between patients with nonalcoholic steatohepatitis (NASH) and healthy controls. A P-value < 0.05 was considered statistically significant.
RESULTS: NAFLD and healthy control groups were similar in terms of age and sex. NAFLD patients consisted of 8 patients with simple steatosis (15%), 27 with borderline NASH (51%) and 18 with definitive NASH (34%). Metabolic syndrome was found in 62.2% of the patients with NAFLD. The mean serum LOX-1 level in biopsy-proven NAFLD patients was 8.49 ± 6.43 ng/mL compared to 4.08 ± 4.32 ng/mL in healthy controls (P = 0.001). The LOX-1 levels were significantly different between controls, simple steatosis and NASH (borderline+definite) cases (4.08 ± 4.32 ng/mL, 6.1 ± 6.16 ng/mL, 8.92 ± 6.45 ng/mL, respectively, P = 0.004). When the cut-off value for the serum LOX-1 level was set at 5.35 ng/mL, and a ROC curve analysis was performed to distinguish between steatohepatitis patients and controls; the sensitivity and specificity of the serum LOX-1 level were 69.8% and 69.2%, respectively.
CONCLUSION: The serum LOX-1 levels were significantly higher in NAFLD patients than in healthy controls. Additionally, the serum LOX-1 levels could differentiate between steatohepatitis patients and healthy controls.
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Colak Y, Yesil A, Mutlu HH, Caklili OT, Ulasoglu C, Senates E, Takir M, Kostek O, Yilmaz Y, Yilmaz Enc F, Tasan G, Tuncer I. A potential treatment of non-alcoholic fatty liver disease with SIRT1 activators. J Gastrointestin Liver Dis 2015; 23:311-9. [PMID: 25267960 DOI: 10.15403/jgld.2014.1121.233.yck] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sirtuins (SIRTs) are members of the silent information regulator-2 family and act as nicotinamide adenine dinucleotide (NAD+)-dependent histone/protein deacetylases. The de-acetylation of proteins and histones results in an up- or down-regulation of gene transcription and protein function. In recent years, the regulatory action of the deacetylation activity of SIRT1 has been shown to have a positive impact on the pathophysiological mechanisms of nonalcoholic fatty liver disease (NAFLD). Among the effects of SIRT1 are: its healing activity on insulin sensitivity, thereby ameliorating glycemic regulation; its mimetic activity on calorie restriction; its antihyperlipidemic activity on lipid homeostasis via the liver, adipose tissues and skeletal muscles; its anti-inflammatory activities; its protective effects against cardiovascular events and endothelial dysfunction; its positive influence on autophagy, apoptosis and cancer; and finally, its anti-aging activity. The current approach for the treatment of NAFLD involves the treatment of etiological factors and recommendation of life-style changes including more physical activity and a low-calorie diet. However, there is no specific medical treatments for NAFLD. The therapeutic potential of SIRT1 activity in the treatment of NAFLD discovered in humans has been presented in this article. In this review, the potential effects of SIRT1 activation on NAFLD-related pathophysiological mechanisms and on the treatment of NAFLD are discussed.
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Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul,
| | - Atakan Yesil
- Department of Gastroenterology, Haydarpasa Training and Research Hospital, Istanbul, Turkey
| | - Hasan Huseyin Mutlu
- Department of Family Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ozge Telci Caklili
- Department of Internal Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Celal Ulasoglu
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ebubekir Senates
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Mumtaz Takir
- Department of Endocrinology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Osman Kostek
- Department of Internal Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Yusuf Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Feruze Yilmaz Enc
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Guralp Tasan
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ilyas Tuncer
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
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Abstract
Background/Aims We sought to examine whether the presence of gallstone disease (GD) in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) is associated with liver fibrosis and histological nonalcoholic steatohepatitis (NASH) score. Methods We included 441 Turkish patients with biopsy-proven NAFLD. GD was diagnosed in the presence of sonographic evidence of gallstones, echogenic material within the gallbladder with constant shadowing and little or no visualization of the gallbladder or absence of gallbladder at ultrasonography, coupled with a history of cholecystectomy. Results Fifty-four patients (12.2%) had GD (GD+ subjects). Compared with the GD- subjects, GD+ patients were older, had a higher body mass index and were more likely to be female and have metabolic syndrome. However, GD+ patients did not have a higher risk of advanced fibrosis or definite NASH on histology. After adjustment for potential confounding variables, the prevalence of GD in NAFLD patients was not associated with significant fibrosis (≥2) (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.53 to 2.21; p=0.68) or definite NASH (OR, 1.03; 95% CI, 0.495 to 2.12; p=0.84). Conclusions The presence of GD is not independently associated with advanced fibrosis and definite NASH in adult Turkish patients with biopsy-proven NAFLD.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Talat Ayyildiz
- Department of Gastroenterology, Uludag University Medical School, Bursa, Turkey
| | - Hakan Akin
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasar Colak
- Department of Gastroenterology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Oguzhan Ozturk
- Department of Gastroenterology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Ebubekir Senates
- Department of Gastroenterology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Ilyas Tuncer
- Department of Gastroenterology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Enver Dolar
- Department of Gastroenterology, Uludag University Medical School, Bursa, Turkey
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Yilmaz Y, Senates E, Yesil A, Ergelen R, Colak Y. Not only type 2 diabetes but also prediabetes is associated with portal inflammation and fibrosis in patients with non-alcoholic fatty liver disease. J Diabetes Complications 2014; 28:328-31. [PMID: 24602757 DOI: 10.1016/j.jdiacomp.2014.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 02/06/2023]
Abstract
AIMS Growing evidence suggests that not only type 2 diabetes (T2D) but also prediabetes (PD) is common in patients with non-alcoholic fatty liver disease (NAFLD). However, few data exist on how PD impacts the histological characteristics of NAFLD patients. In this exploratory study, we sought to investigate the associations of PD and T2D with the severity of the histological features in patients with NAFLD. METHODS The population consisted of 280 patients with biopsy-proven NAFLD. The associations of PD and T2D with the severity of histological features of NAFLD were analyzed using multiple logistic (or ordinal logistic) regression models after adjustment for confounding factors. RESULTS PD and T2D was noted in 102 (36.4%) and 92 (32.8%) of patients, respectively. Of the 92 patients with T2D, ten (10.9%) were diagnosed de novo after the OGTT. PD and T2D were significantly associated with more severe portal inflammation (P<0.01); the adjusted odds ratios (ORs) of PD and T2D for having a higher grade of portal inflammation were 1.8 [95% CI, 1.1, 3.2] and 2.6 [95% CI, 1.3, 5.8]), respectively. A similar relationship was observed for liver fibrosis (P<0.001); specifically, the adjusted ORs of PD and T2D for having a higher grade of hepatic fibrosis were 2.4 [95% CI, 1.3, 3.7] and 3.8 [95% CI, 1.9, 6.1]), respectively. CONCLUSION Not only T2D but also PD is independently associated with portal inflammation and fibrosis in NAFLD patients. PD may be useful as a clinical indicator of patients who are likely to have already more severe histological findings.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey; Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
| | - Ebubekir Senates
- Department of Gastroenterology, Dicle University, School of Medicine, Diyarbakir, Turkey
| | - Atakan Yesil
- Department of Gastroenterology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Rabia Ergelen
- Department of Radiology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Yasar Colak
- Department of Gastroenterology, Istanbul Medeniyet University, Medical Faculty, Istanbul, Turkey
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14
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Kiziltas S, Ata P, Colak Y, Mesçi B, Senates E, Enc F, Ulasoglu C, Tuncer I, Oguz A. TLR4 gene polymorphism in patients with nonalcoholic fatty liver disease in comparison to healthy controls. Metab Syndr Relat Disord 2014; 12:165-70. [PMID: 24443993 DOI: 10.1089/met.2013.0120] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Recent studies have suggested that bacterial overgrowth and endotoxemia along with its receptor, Toll-like receptor 4 (TLR-4), play a role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). The present study was designed to test and evaluate the TLR4 gene polymorphism in patients with NAFLD in comparison to healthy controls. METHODS A total of 119 patients [mean (standard deviation, SD) age 43.4 (11.5) years, 55.5% were males] with NAFLD and 80 healthy controls [mean (SD) age 40.9 (8.1) years, 67.5% were females)] were evaluated in terms of patient demographics, anthropometrics, blood biochemistry, liver histology, and ultrasonographic (USG) findings. Histological evaluation was performed in 111 patients, and blood samples were collected from 119 patients with NAFLD and 80 healthy persons. Allelic variants of TLR4 (Asp299Gly and Thr399Ile) were assayed by real-time PCR. Genomic DNA was amplified using FAM/VIC primers specific for allelic variants of TLR4 Asp299Gly and Thr399Ile with real-time PCR. Amplicons were analyzed with high-resolution melting on a Light Cycler 480 for detecting different melting patterns of polymorphic and wild-type alleles. RESULTS The number of the subjects with heterozygous mutation at genotype 299 (Asp299Gly) was significantly lower in the NAFLD than in the control group (23.8 vs. 10.9%, P=0.027). Logistic regression analysis revealed that female gender [odds ratio (OR)=2.984, 95% confidence interval (CI) 1.561-5.360, P=0.001] and heterozygous (Asp299Gly) mutation at codon 299 (OR=2.998, 95% CI 1.325-6.783, P=0.008) were the significant predictors of higher likelihood of TRL4 gene polymorphism-related prevention of NAFLD. CONCLUSIONS As the first-time-in-humans controlled study related to investigation of TLR4 gene polymorphism in NAFLD, our findings contribute to the available data that TLR-4 signaling is pivotal for the pathogenesis of NASH and indicate that the TLR4 codon 299 heterozygous gene mutation (Asp299Gly) in humans may have a preventive role against the genesis of NAFLD.
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Affiliation(s)
- Safak Kiziltas
- 1 Department of Gastroenterology, Goztepe Training and Research Hospital , Istanbul, Turkey
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15
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Ozkara S, Aker F, Yesil A, Senates E, Canbey C, Yitik A, Gonen C. Re-evaluation of cases with gastroenteropancreatic neuroendocrine tumors between 2004 and 2012 according to the 2010 criteria. Hepatogastroenterology 2013; 60:1665-1672. [PMID: 24627925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIMS We re-evaluated the clinical, histopathological and immunohistochemical features of neuroendocrine tumors (NETs) diagnosed in our pathology laboratory between 2004 and 2012 and re-classified them according to the WHO-2000 and WHO-2010 criteria. METHODOLOGY The study included NET samples of 106 patients having gastroenteropancreatic and hepatobiliary tumors. The histopathological findings were re-assessed. The cases were re-appraised based on the WHO-2000 and WHO-2010 criteria. The association between survival and Ki-67 index was analysed. RESULTS The most frequent localization was the stomach. The average tumor size was 3.0±4.1 cm. Differentiation was poor in 17 cases (16.0%). Lymphovascular invasion was detected in 16.1% (n = 17) and necrosis was identified in 15.1% (n = 16). The average number of Ki-67 was 9.1±19.9. Ki-67 measurements were significantly higher in patients who died compared to those who survived (p <0.01). In ROC analysis, the cut-off point for Ki-67 was 5. CONCLUSIONS Our study is a single-center study comprising patients from Turkey for a period of 8 years. We found that the most frequent localization is the stomach. This ratio is associated with common use of endoscopy in our center. The specimens were re-evaluated according to the WHO-2000 and WHO-2010 classification systems the data and terminology have been updated.
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Calhan T, Kahraman R, Sahin A, Senates E, Doganay HL, Kanat E, Ozdil K, Sokmen HM. Efficacy of two levofloxacin-containing second-line therapies for Helicobacter pylori: a pilot study. Helicobacter 2013; 18:378-83. [PMID: 23601026 DOI: 10.1111/hel.12056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND An ideal second-line therapeutic regimen for the treatment of patients who do not respond to standard triple therapy is currently being investigated. In this study, we aimed to investigate the efficacy of two levofloxacin-containing second-line therapies for Helicobacter pylori (H. pylori). MATERIALS AND METHODS One hundred and forty eight consecutive H. pylori -positive patients who did not respond to the standard triple therapy (77 female, 71 male) were enrolled in the study. The patients were randomized consecutively to two-second-line therapy groups; 73 to the levofloxacin-containing sequential (LCS) and 75 to the levofloxacin-containing quadruple (LCQ) therapy group. The LCS therapy group received pantoprazole 40 mg and amoxicillin 1,000 mg twice daily for 5 days followed by pantoprazole 40 mg twice daily and metronidazole 500 mg three times daily and levofloxacin 500 mg one time daily for 7 days. The LCQ therapy group received pantoprazole 40 mg twice daily, tetracycline 500 mg four times daily, bismuth subcitrate 300 mg four times daily and levofloxacin 500 mg one time daily for 10 days. H. pylori eradication was confirmed by stool antigen testing at least 6 weeks after cessation of therapy. Side-effects and compliance were assessed by a questionnaire. RESULTS Intention-to-treat cure rates were: 82.2% (95%CI; 73-91) and 90.6% (95%CI; 79-95) in the LCS and LCQ therapy, respectively. Per protocol cure rates were: 85.7% (95%CI; 75-92) and 93.1% (95%CI; 85-98) in the LCS and LCQ therapy, respectively. No statistically significant difference was found between two groups (p = .1). No differences in compliance or adverse effects were demonstrated between two groups. CONCLUSIONS This prospective trial demonstrates that both levofloxacin-containing sequential therapy and levofloxacin-containing quadruple therapy regimens have higher H. pylori eradication rates and are well tolerated. The levofloxacin-containing quadruple therapy is likely the best treatment option for a second-line therapy, at least in the Turkish population.
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Affiliation(s)
- Turan Calhan
- Department of Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey
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17
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Ceylan B, Mete B, Fincanci M, Aslan T, Akkoyunlu Y, Ozguneş N, Colak O, Gunduz A, Senates E, Ozaras R, Inci A, Tabak F. A new model using platelet indices to predict liver fibrosis in patients with chronic hepatitis B infection. Wien Klin Wochenschr 2013; 125:453-60. [PMID: 23860694 DOI: 10.1007/s00508-013-0394-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 06/16/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND We aimed to investigate whether mean platelet volume (MPV) and platelet distribution width (PDW) are variables determining the severity of liver fibrosis in patients with chronic HBV infection. METHODS Patients were divided into two groups with fibrosis scores of 0-2 and 3-6 (according to Ishac scoring system). Whether MPV and PDW were independent variables determining the severity of liver fibrosis score or not was investigated by comparing these groups. RESULTS Of the 111 cases, 74 (66.7 %) were male (mean age 37.7 ± 11.6 years). Twenty-two of the cases (19.8 %) were HBeAg-positive. Fibrosis scores of 42 cases (37.8 %) were ≥ 3 and the remaining 69 cases had fibrosis scores < 3 (62.2 %). Independent variables determining the severity of fibrosis score were low levels of albumin and mean platelet volume, and high levels of prothrombin time and PDW (Odds ratio (95 % confidence interval) and p values were 0.105 (0.018-0.605) and 0.012 for albumin, 0.402 (0.234-0.692) and 0.001 for mean platelet volume, 1.529 (1.183-1.975) and 0.001 for PDW, and 0.924 (0.875-0.976) and 0.005 for prothrombin time, respectively). The sensitivity, specificity, positive predictive value and negative predictive value of regression model that is established using above mentioned parameters were 88.1, 75.3, 68.5, and 91.7 %, respectively (AUC = 0.886, p = 0.0001). CONCLUSIONS MPV and PDW are independent variables determining the severity of liver fibrosis, and the regression model that is established using these parameters along with other markers, may give more information about the severity of liver fibrosis.
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Affiliation(s)
- Bahadir Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Vatan Caddesi, Fatih İlçesi, Istanbul, Turkey.
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18
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Colak Y, Senates E, Yesil A, Yilmaz Y, Ozturk O, Doganay L, Coskunpinar E, Kahraman OT, Mesci B, Ulasoglu C, Tuncer I. Assessment of endothelial function in patients with nonalcoholic fatty liver disease. Endocrine 2013; 43:100-7. [PMID: 22661277 DOI: 10.1007/s12020-012-9712-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/21/2012] [Indexed: 02/07/2023]
Abstract
In this study, we aimed to evaluate the endothelial functions in patients with nonalcoholic fatty liver disease (NAFLD). In this observational case-control study, a total of 51 patients with NAFLD in study group and a total of 21 with age- and sex-equivalent individuals in control group were enrolled. In both patients and control groups, levels of asymmetric dimethylarginine (ADMA), systemic endothelial function (brachial artery flow-mediated dilation) (FMD) and carotid artery intima-media thickness (C-IMT) were measured. FMD and C-IMT were evaluated by vascular ultrasound. Plasma levels of ADMA were measured by ELISA. C-IMT was significantly higher in patients with NAFLD group than control group (0.67 ± 0.09 vs. 0.52 ± 0.11 mm, P < 0.001). The average C-IMT measurements were found in groups of control, simple steatosis, and NAFLD with (borderline and definite) NASH as 0.52 ± 0.11, 0.63 ± 0.07, and 0.68 ± 0.1 mm, respectively. The differences between groups were significant (P < 0.001). Measurement of brachial artery FMD was significantly lower in patients with NAFLD group compared to control group (7.3 ± 4.8 vs. 12.5 ± 7.1 %, P < 0.001). FMD measurements in groups of control, the simple steatosis, and NAFLD with NASH as 12.5 ± 7.1, 9.64 ± 6.63, and 7.03 ± 4.57 %, respectively, and the differences were statistically significant (P < 0.001). The increase in C-IMT and decrease in FMD was independent from metabolic syndrome and it was also more evident in patients with simple steatosis and NASH compared to control group. There was no significant difference between the control and NAFLD groups in terms of plasma ADMA levels (0.61 ± 0.11 vs. 0.69 ± 0.37 μmol/L, P = 0.209). Our data suggested that NAFLD is associated with endothelial dysfunction and increased earlier in patients with atherosclerosis compared to control subjects.
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Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, Istanbul Medeniyet Universty Medical Faculty, Istanbul Goztepe Education and Research Hospital, 34730, Istanbul, Turkey.
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Yilmaz Y, Eren F, Colak Y, Senates E, Celikel CA, Imeryuz N. Hepatic expression and serum levels of syndecan 1 (CD138) in patients with nonalcoholic fatty liver disease. Scand J Gastroenterol 2012; 47:1488-93. [PMID: 23137022 DOI: 10.3109/00365521.2012.725093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Syndecan-1 (CD138) is a transmembrane heparan sulfate proteoglycan expressed in the liver which may exert metabolic effects by mediating the hepatic clearance of triglyceride-rich lipoproteins. In the present study, we assayed serum levels and the hepatic expression of syndecan-1 and examined their association with clinical, biochemical, and histologic phenotypes in patients with histology-proven nonalcoholic fatty liver disease (NAFLD). METHODS A total of 59 patients with biopsy-proven NAFLD and 54 matched controls were enrolled. The analysis of syndecan-1 expression in liver biopsies was performed by immunohistochemistry on formalin-fixed, paraffin-embedded samples. Serum syndecan-1 levels were measured by ELISA. RESULTS NAFLD patients had significantly higher serum syndecan-1 levels [median: 61 ng/mL (interquartile range: 36-97 ng/mL)] than controls [median: 37 ng/mL (interquartile range: 25-59 ng/mL, Mann-Whitney U test, p < 0.001]. However, we did not find any significant association between serum syndecan-1 and the mean syndecan-1 immunohistochemical score (n = 59, r = 0.064, p = 0.63). Interestingly, the syndecan-1 immunohistochemical score was an independent predictor of HDL cholesterol in NAFLD patients (β = 0.27; t = 1.99, p < 0.05). CONCLUSIONS Our data suggest that serum syndecan-1 levels are raised in patients with NAFLD. Moreover, the syndecan-1 immunohistochemical score in the liver is independently associated with HDL cholesterol in this group of patients. These pilot results support further investigation of this molecule in metabolic liver diseases.
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Affiliation(s)
- Yusuf Yilmaz
- Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
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20
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Colak Y, Senates E, Coskunpinar E, Oltulu YM, Zemheri E, Ozturk O, Doganay L, Mesci B, Yilmaz Y, Enc FY, Kiziltas S, Ulasoglu C, Tuncer I. Concentrations of connective tissue growth factor in patients with nonalcoholic fatty liver disease: association with liver fibrosis. Dis Markers 2012; 33:77-83. [PMID: 22846210 PMCID: PMC3810787 DOI: 10.3233/dma-2012-0907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM In this study, we aimed to investigate the relationship between the histological fibrosis stage of nonalcoholic fatty liver disease (NAFLD) and serum connective tissue growth factor (CTGF) to determine the usefulness of this relationship in clinical practice. METHODS Serum samples were collected from 51 patients with biopsy-proven NAFLD and 28 healthy controls, and serum levels of CTGF were assayed by ELISA. RESULTS Levels of CTGF were significantly higher in patients with NAFLD compared with controls (P=0.001). The serum CTGF levels were significantly increased, that correlated with histological fibrosis stage, in patients with NAFLD [in patients with no fibrosis (stage 0) 308.2 ± 142.9, with mild fibrosis (stage 1-2) 519.9 ± 375.2 and with advanced fibrosis (stage 3-4) 1353.2 ± 610 ng/l, P < 0.001]. Also serum level of CTGF was found as an independent predictor of histological fibrosis stage in patients with NAFLD (β = 0.662, t=5.6, P <0.001). The area under the ROC curve was estimated 0.931 to separate patients with severe fibrosis from patients with other fibrotic stages. CONCLUSION Serum levels of CTGF may be a clinical utility for distinguishing NAFLD patients with and without advanced fibrosis.
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Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, Istanbul Medeniyet University, Medical Faculty, Istanbul, Turkey.
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Colak Y, Tuncer I, Senates E, Ozturk O, Doganay L, Yilmaz Y. Nonalcoholic Fatty Liver Disease: A Nutritional Approach. Metab Syndr Relat Disord 2012; 10:161-6. [DOI: 10.1089/met.2011.0145] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Ilyas Tuncer
- Department of Gastroenterology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Ebubekir Senates
- Department of Gastroenterology, S.B. Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Oguzhan Ozturk
- Department of Gastroenterology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Levent Doganay
- Department of Gastroenterology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Yusuf Yilmaz
- Department of Gastroenterology, Marmara Universty School of Medicine, and Institute of Gastroenterology, Marmara University, Istanbul, Turkey
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Yilmaz Y, Senates E, Ayyildiz T, Colak Y, Tuncer I, Ovunc AOK, Dolar E, Kalayci C. Characterization of nonalcoholic fatty liver disease unrelated to the metabolic syndrome. Eur J Clin Invest 2012; 42:411-8. [PMID: 21913918 DOI: 10.1111/j.1365-2362.2011.02597.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome (MS). However, not all patients with the MS will develop NAFLD and not all patients with NAFLD have the MS. We sought to investigate the differences between patients with biopsy-proven NAFLD with and without the MS. METHODS A total of 357 consecutive patients with biopsy-proven NAFLD were analysed. Of them, 216 patients had nonalcoholic steatohepatitis (NASH) and 96 a fibrosis score ≥ 2. The MS was defined as ≥ 3 of the ATP III criteria. RESULTS A total of 214 patients with NAFLD met the criteria for the MS, while the remaining 143 did not. In NAFLD patients with the MS, homeostasis model of insulin resistance (P = 0·03; OR, 1·06; 95% CI, 1·023-1·25 per unit increase) and diabetes (P = 0·01; OR, 1·2; 95% CI, 1·1-2·4) were independent predictors of NASH. In NAFLD patients without the MS, the only variable independently associated with NASH was haemoglobin (P = 0·007; OR, 1·9; 95% CI, 1·4-3·6 per 50 g/L increase). Alanine aminotransferase (P = 0·03; OR, 1·04; 95% CI, 1·006-1·11 per 10 U/L increase) was an independent predictor of fibrosis ≥ 2 in NAFLD patients with the MS, while haemoglobin (P = 0·02; OR, 1·4; 95% CI, 1·2-1·9 per 50 g/L increase) was the only variable significantly associated with fibrosis ≥ 2 in NAFLD patients without the MS. CONCLUSIONS Increased haemoglobin in NAFLD subjects without MS should be considered in the selection of cases for histological assessment.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Pendik, Istanbul, Turkey.
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Colak Y, Senates E, Ozturk O, Yilmaz Y, Coskunpinar E, Kahraman OT, Sahin O, Zemheri E, Enc FY, Ulasoglu C, Kiziltas S, Kurdas OO, Tuncer I. Plasma fibrinogen-like protein 2 levels in patients with non-alcoholic fatty liver disease. ACTA ACUST UNITED AC 2012; 58:2087-90. [PMID: 22024080 DOI: 10.5754/hge11248] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS Fibrinogen-like protein 2 (fgl2), has recently been identified as a new member of the fibrinogen-like family of proteins. In this study we assayed plasma levels of fgl2 in patients with biopsy proven non-alcoholic fatty liver disease (NAFLD) and examined their association with clinical, biochemical and histological phenotypes. METHODOLOGY Levels of plasma fgl2 were measured by enzyme linked immunosorbent assay and compared between the study groups. Moreover, concentrations of fgl2 were assessed in relation to the general characteristics of the study participants and the results of the liver biopsy. RESULTS Levels of fgl2 were significantly higher in patients with definite non-alcoholic steatohepatitis (NASH) (788±190pg/mL, p<0.001) and borderline NASH (710 ± 140pg/mL, p<0.001) compared with controls (515±174pg/mL). No significant differences were found in patients with simple steatosis (649 ± 162pg/mL) as compared with controls. There were no associations between the plasma fgl2 levels with the fibrosis stage and steatosis grade. CONCLUSIONS Although subject to future confirmation, our data suggest that fgl2 levels are elevated in the more severe forms of NAFLD.
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Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, Istanbul Goztepe Education and Research Hospital, Istanbul, Turkey.
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Güzelbulut F, Ovünç AOK, Oetinkaya ZA, Senates E, Gökden Y, Saltürk AGD, Sezikli M, Ozkara S, Cetinkaya F. Comparison of the efficacy of entecavir and tenofovir in chronic hepatitis B. Hepatogastroenterology 2012; 59:477-480. [PMID: 21940383 DOI: 10.5754/hge11426] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIMS This study aimed to compare the efficacy of entecavir and tenofovir in nucleos(t)ide-naive chronic hepatitis B patients after 48 weeks of therapy. METHODOLOGY We retrospectively reviewed our data of chronic hepatitis B patients. Nucleos(t)ide-naive patients who had received entecavir or tenofovir for at least 48 weeks were included. We compared entecavir and tenofovir after 48 weeks of therapy with respect to virological, biochemical, serological and histological responses. RESULTS Of the 44 patients, 24 received entecavir and 20 received tenofovir. Pretreatment characteristics of the patients were similar. After 48 weeks, serum HBV DNA levels decreased by 6.93±1.54log copy/ mL in the entecavir group and 6.89±1.22log copy/mL in the tenofovir group (p=0.65). A similar proportion of patients in entecavir and tenofovir groups achieved undetectable serum HBV DNA (87.5% vs. 95%, p=0.39) and serum ALT normalization (79.2% vs. 85%, p=0.62). The mean histological activity index score improved by 3.83±3.51 points in the entecavir group and 2.20±1.91 points in the tenofovir group (p=0.07), and the mean fibrosis scores improved by 0.38±1.61 points in the entecavir group and 0.70±1.17 points in the tenofovir group after 48 weeks (p=0.44). CONCLUSIONS Entecavir and tenofovir are similarly effective in nucleos(t)ide-naive chronic hepatitis B patients with high viral load and/or high fibrosis scores after 48 weeks of therapy.
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Affiliation(s)
- Fatih Güzelbulut
- Department of Gastroenterology, Haysarpasa Numune Education and Research Hospital, Istanbul, Turkey.
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25
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Ozdil K, Calhan T, Sahin A, Senates E, Kahraman R, Yüzbasioglu B, Demirdag H, Demirsoy H, Sökmen MH. Levofloxacin based sequential and triple therapy compared with standard plus probiotic combination for Helicobacter pylori eradication. ACTA ACUST UNITED AC 2012; 58:1148-52. [PMID: 21937367 DOI: 10.5754/hge11075] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS Development of resistance to standard therapy for Helicobacter pylori (H. pylori) eradication is rapid. The aim of this study is to compare the efficacy of alternative treatment modalities for H. pylori. Compared treatments were standard triple treatment plus probiotic, sequential therapy with levofloxacin, and a 14-day regimen of PPI (proton pump inhibitor) and levofloxacin/amoxicillin combination. METHODOLOGY Overall 285 patients were enrolled in the study and allocated into three groups. Group I (n=98) received lansoprazole, clarithromycin, amoxicillin and saccharomyces boulardii (probiotic) and group II (n=95) received esomeprazole, levofloxacin and amoxicillin for 14 days. Finally, group III (n=92) received esomeprazole and amoxicillin for five days, followed by esomeprazole, levofloxacin and metronidazole for seven days. Testing for H. pylori infection post-treatment was done using a stool antigen test five weeks after the completion of therapy. RESULTS Patients in all three groups were treatment-naive. Response to treatment (Per Protocol/ITT analysis) was 77.1/72.4% in Group I, 89.1/86.3% in Group II, and 95.5% in Group III. Response to treatment was significantly higher in Groups II and III compared to Group I (p=0.03 and p<0.001, respectively). There was no difference between Groups II and III in terms of response to treatment (p=0.1). CONCLUSIONS Levofloxacin-based sequential therapy and levofloxacin based triple therapy were significantly superior to standard triple therapy plus probiotic.
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Affiliation(s)
- Kamil Ozdil
- Department of Gstroenterology, Umraniye Education and Research Hospital, Istanbul, Turkey
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Colak Y, Senates E, Ozturk O, Doganay HL, Coskunpinar E, Oltulu YM, Eren A, Sahin O, Ozkanli S, Enc FY, Ulasoglu C, Tuncer I. Association of serum lipoprotein-associated phospholipase A2 level with nonalcoholic fatty liver disease. Metab Syndr Relat Disord 2011; 10:103-9. [PMID: 22112193 DOI: 10.1089/met.2011.0111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is one of the most common causes of chronic liver disease, worldwide. Lipoprotein-associated phospholipase A2 (Lp-PLA2) was recently characterized as a novel inflammatory biomarker that is correlated with several components constituting the metabolic syndrome. METHODS In this study, we determined the serum levels of Lp-PLA2 in patients with definite nonalcoholic steatohepatitis (NASH, n=25), borderline NASH (n=22), simple fatty liver (n=10), and healthy controls without evidence of liver disease (n=38). The levels of Lp-PLA2 were measured by enzyme-linked immunosorbent assay and compared in the four study groups. Moreover, concentrations of Lp-PLA2 were assessed in relation to the general characteristics of the study participants and the results of liver biopsy. RESULTS Concentrations of Lp-PLA2 were significantly higher in patients with definite NASH (161.8±0.9 μg/L, P<0.001), borderline NASH (135.4±47.7 μg/L, P=0.001), and simple fatty liver (132.4±46.2 μg/L, P=0.042) compared with healthy controls (86.2±40.7 μg/L). Furthermore, the serum Lp-PLA2 level was strongly associated to histological steatosis scores in patients with NAFLD (β=0.32, t=2.50, P=0.016). CONCLUSION Although subject to future confirmation, our data suggest that Lp-PLA2 levels are elevated in NAFLD.
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Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, Istanbul Goztepe Education and Research Hospital, Istanbul, Turkey.
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Yilmaz Y, Eren F, Ayyildiz T, Colak Y, Kurt R, Senates E, Tuncer I, Dolar E, Imeryuz N. Serum pigment epithelium-derived factor levels are increased in patients with biopsy-proven nonalcoholic fatty liver disease and independently associated with liver steatosis. Clin Chim Acta 2011; 412:2296-9. [DOI: 10.1016/j.cca.2011.08.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 08/08/2011] [Accepted: 08/18/2011] [Indexed: 12/28/2022]
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Colak Y, Ozturk O, Senates E, Tuncer I, Yorulmaz E, Adali G, Doganay L, Enc FY. SIRT1 as a potential therapeutic target for treatment of nonalcoholic fatty liver disease. Med Sci Monit 2011; 17:HY5-9. [PMID: 21525818 PMCID: PMC3539588 DOI: 10.12659/msm.881749] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sirtuins are members of the silent information regulator 2 (Sir2) family, a group of Class III histone/protein deacetylases. There are 7 different sirtuins in mammals (SIRT1-7), of which SIRT1 is the best known and most studied. SIRT1 is responsible for the regulation of protein activation by means of deacetylating a variety of proteins that play important roles in the pathophysiology of metabolic diseases. Recently, it has been shown that SIRT1 plays key roles in the regulation of lipid and glucose homeostasis, control of insulin secretion and sensitivity, antiinflammatory effects, control of oxidative stress and the improvements in endothelial function that result due to increased mitochondrial biogenesis and β-oxidation capacity. Nonalcoholic fatty liver disease (NAFLD) is currently the most common liver disease, and it has been accepted as the hepatic component of metabolic syndrome. Recent studies have shown that SIRT expression in the liver is significantly decreased in an NAFLD model of rats fed a high-fat diet, and moderate SIRT1 overexpression protects mice from developing NAFLD. In addition to resveratrol, a natural SIRT1 activator, small-molecule pharmacologic SIRT1 activators have positive effects on metabolic diseases. These effects are particularly promising in the case of diabetes mellitus, for which phase studies are currently being performed. With this information, we hypothesized that the pharmacologic activation of SIRT1, which has been implicated in the pathogenesis of NAFLD, will be a potential therapeutic target for treating NAFLD. In this paper, we review the metabolic effects of SIRT1 and its association with the pathophysiology of NAFLD.
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Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, S. B. Goztepe Education and Research Hospital, Istanbul, Turkey.
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Senates E, Yilmaz Y, Colak Y, Ozturk O, Altunoz ME, Kurt R, Ozkara S, Aksaray S, Tuncer I, Ovunc AOK. Serum Levels of Hepcidin in Patients with Biopsy-Proven Nonalcoholic Fatty Liver Disease. Metab Syndr Relat Disord 2011; 9:287-90. [DOI: 10.1089/met.2010.0121] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ebubekir Senates
- Department of Gastroenterology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Yusuf Yilmaz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasar Colak
- Department of Gastroenterology, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Oguzhan Ozturk
- Department of Gastroenterology, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Erhan Altunoz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ramazan Kurt
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Selvinaz Ozkara
- Department of Pathology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Sebahat Aksaray
- Department of Microbiology and Clinical Microbiology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Ilyas Tuncer
- Department of Gastroenterology, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Ayse Oya Kurdas Ovunc
- Department of Gastroenterology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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Yilmaz Y, Eren F, Kurt R, Yonal O, Polat Z, Senates E, Bacha M, Imeryuz N. Serum galectin-3 levels in patients with nonalcoholic fatty liver disease. Clin Biochem 2011; 44:955-8. [DOI: 10.1016/j.clinbiochem.2011.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 05/13/2011] [Accepted: 05/15/2011] [Indexed: 01/14/2023]
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Yilmaz Y, Kurt R, Gurdal A, Alahdab YO, Yonal O, Senates E, Polat N, Eren F, Imeryuz N, Oflaz H. Circulating vaspin levels and epicardial adipose tissue thickness are associated with impaired coronary flow reserve in patients with nonalcoholic fatty liver disease. Atherosclerosis 2011; 217:125-9. [PMID: 21513939 DOI: 10.1016/j.atherosclerosis.2011.03.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 03/18/2011] [Accepted: 03/20/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with nonalcoholic fatty liver disease (NAFLD) have a reduced coronary flow reserve (CFR) and an increased risk of cardiovascular disease. The fat cells that surround coronary arteries may play a central and underrecognized role in development of cardiovascular disease through the systemic secretion of adipokines. We therefore evaluated the relation of epicardial fat thickness, serum levels of epicardial fat-related adipokines (chemerin and vaspin), and CFR in patients with NAFLD. METHODS We investigated 54 patients with biopsy-proven NAFLD and 56 age- and sex-matched controls. CFR and epicardial fat thickness (EFT) were measured by transthoracic echocardiography. Serum levels of chemerin and vaspin were measured by ELISA. RESULTS EFT was significantly higher (0.64 ± 0.13 vs. 0.54 ± 0.10 cm, P<0.001) and CFR significantly lower (2.11 ± 0.45 vs. 2.52 ± 0.62, P < 0.001) in patients with NAFLD than in controls. Serum levels of vaspin and chemerin were both significantly increased in patients with NAFLD compared with controls. Stepwise regression analysis showed that EFT (β=-0.53, t=-3.7, P<0.001), serum vaspin levels (β=-0.30, t=-2.5, P=0.014), and liver fibrosis (β=-0.31, t=-2.11, P=0.041), in the order they entered into the model, were independent predictors of CFR in NAFLD patients. CONCLUSION Our data suggest the presence of a complex interplay between EFT, serum vaspin, and liver histology in promoting an impaired hyperemic stimulation of coronary blood flow in patients with NAFLD.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Pendik, 34899 Istanbul, Turkey.
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Masatlioglu S, Seyahi E, Tahir Turanli E, Fresko I, Gogus F, Senates E, Oguz Savran F, Yazici H. A twin study in Behçet's syndrome. Clin Exp Rheumatol 2010; 28:S62-S66. [PMID: 20868573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 07/30/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Case reports on monozygotic (MZ) twins with Behçet's syndrome (BS) have been few and we are not aware of formal twin studies. We sought the frequency of MZ and dizygotic (DZ) twin births in BS and compared it to a healthy population sample from the same geography. We also looked for the concordance rate among the MZ and DZ twins. METHODS 1705 (1039M/666F) patients attending a dedicated BS outpatient clinic and 7761 (3848M/3913F) medical school students were asked about having a MZ or DZ twin sibling. MZ and DZ twins thus identified among both patients and controls were individually seen at the clinic. In addition, HLA, DNA microsatellite markers and blood groups were typed to further confirm twin- ship. All twins were contacted 8 years later for new emergence of disease. RESULTS There were 14 (0.82%) patients with BS and 120 (1.55%) controls who had a twin sibling (p=0.022). Of these, 8 (0.47%) patients with BS and 92 (1.19%) controls had a DZ twin sibling (p=0.009). MZ twin frequency was similar between BS patients (6/1705; 0.35%) and control population (28/7761; 0.36%). The pairwise concordance rate for BS was 2/6 (95% CI: -0.21-0.88) for MZ and 1/8 (95% CI: -0.17-0.42) for DZ twins (p=0.538). Genetic effects accounted for 41% of the phenotypic variance for BS among twins. After 8 years of follow-up, 4 of 6 MZ and 6 of 7 DZ twin pairs were still discordant. CONCLUSIONS The frequency of MZ twin births in BS is not different than that in the general population while the DZ twins were seen less frequently among the BS patients. The concordances for BS were higher in MZ compared with DZ twins, suggesting genetic predisposition. On the other hand, the persistence of discordance after 8 years of follow up among the remaining MZ twins demands further research to understand non- genetic factors in causation of BS.
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Affiliation(s)
- Seval Masatlioglu
- Division of Rheumatology, Haydarpaşa Numune Research and Education Hospital, Istanbul, Turkey.
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