P873Plasma PCSK9 levels and atherosclerosis burden in the coronary arteries of patients undergoing coronary angiography

Background

Plasma PCSK9 levels, a novel and effective therapeutic target for CVD prevention, have been associated with CVD events irrespective of traditional risk factors. Whether PCSK9 levels predict coronary artery disease (CAD) burden and severity is a matter of dispute.

Purpose

To investigate the association between plasma PCSK9 levels and CAD characteristics, including number of major diseased vessels, severity of coronary stenosis, and the burden of coronary calcifications.

Methods

One hundred and one patients undergoing coronary angiography were recruited for this cross-sectional study. The number of major coronary diseased vessels was defined as the presence of ≥1 stenoses ≥50% in diameter of at least one major coronary artery. CAD severity was defined as either the absence of coronary stenosis (no-CAD), CAD<50% or CAD≥50% in one or more coronary arteries. The burden of coronary calcifications was estimated by angiography visual inspection and classified as absent, mild, moderate or severe.

Results

Coronary angiography showed single, double and triple vessel disease in 26 (25.7%), 23 (22.8%) and 21 (20.8%) patients, respectively; 20 (19.8%) and 11 (10.9%) pts had either minimal CAD (<50%) or normal angiographic findings. Also, calcifications were absent in 65 patients (64.4%), and mild, moderate and severe in 23 (22.8%), 11 (10.9%) and 2 (2%) patients, respectively. Plasma PCSK9 levels were significantly associated with age (rho=0.22, p=0.025) and SBP (rho=0.21, p=0.034), and were almost doubled in patients with chronic kidney disease (CKD) as compared to those without CKD [164.6 ng/mL (104.6–187.0) vs 94.8 ng/mL (86.8–114.9), p=0.006]. Among patients without CKD, those with CAD≥50% had higher plasma PCSK9 levels than those without [97.1 ng/mL (87.8–143.0) vs 83.2 ng/mL (73.4–102.6), p=0.04]. In the overall population, higher plasma PCSK9 levels were found in pts with triple vessel disease [165.7 ng/mL (121.3–180.5)] than in those with double/single vessel involvement [97.9 ng/mL (87.6–99.8) and 88.4 ng/mL (87.3–97.4), p<0.001 for both comparisons] or without CAD [87.5 ng/mL (74.3–114.9), p<0.001]. Also, a trend toward an increase of plasma PCSK9 levels was found with higher CAD severity [no-CAD: 87.5 ng/mL (74.3–114.9), CAD<50%: 89.1 ng/mL (78.9–105.3), CAD≥50%: 97.6 ng/mL (87.9–155.3), p=0.051], which turned significant after exclusion of CKD patients (p=0.042). Adjustment for age, sex, plasma LDL-cholesterol levels, statin use and CKD abolished the association between PCSK9 and CAD severity but not with the number of significantly diseased vessels and the burden of coronary calcifications.

Conclusions

Circulating PCSK9, whose plasma levels are significantly influenced by the presence of CKD, discriminates patients with significant coronary artery stenosis from those without CAD. In addition, both the number of diseased coronary vessels and total coronary calcifications are independently predicted by an elevated plasma PCSK9 level.

Acknowledgement/Funding

None

PCSK9 and atherosclerosis burden in the coronary arteries of patients undergoing coronary angiography

AIMS

To investigate the association between plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) concentrations, current acute coronary syndrome (ACS), coronary artery disease (CAD) presence, severity and extension and the burden of coronary calcifications in patients with suspected CAD.

METHODS AND RESULTS

One hundred and one patients, with or without current ACS, were recruited for this cross-sectional study. CAD presence was defined based on either the presence or absence of at least one significant (≥50%) CAD lesion (SCAD). CAD severity was classified according to the absence of coronary lesions, the presence of non-significant (<50%) CAD (MCAD) or SCAD in at least one major coronary artery. Patients with one, two or three significantly diseased major coronary arteries were defined as 1-SCAD, 2-SCAD and 3-SCAD, respectively. The cumulative length of SCAD lesions and the amount of calcifications in coronary arteries were estimated. Plasma PCSK9 concentrations were higher in patients with SCAD as compared to those without (p = .012). A significant increase in plasma PCSK9 concentrations was observed with greater CAD severity (p = .042). Higher plasma PCSK9 concentrations were found in 3-SCAD patients as compared to either 2-SCAD or 1-SCAD (p < .001). PCSK9 increased with the cumulative length of SCAD lesions and the burden of calcifications (p < .05 for both comparisons). Multivariable adjustment abolished the association between PCSK9 and either CAD presence or severity, but not the association between PCSK9 and the number of significantly diseased vessels, SCAD lesion length and the burden of coronary calcifications. ACS was associated with a borderline significant increase of plasma PCSK9 concentrations among patients not taking statins (p = .05).

CONCLUSION

Circulating PCSK9 concentrations discriminate patients with greater coronary atherosclerotic lesion extension and calcification, and are increased in patients with current ACS.

Efficacy of curcumin on prevention of drug-induced nephrotoxicity: A review of animal studies

Drug-induced nephrotoxicity is a frequent serious adverse effect, contributing to morbidity and increased healthcare utilization. Prevention or reversal is key. Curcumin has useful biological features that include antioxidant, anti-inflammatory, and anticancer properties. This review covers aspects of curcumin in relation to prevention of drug-induced nephrotoxicity: dosage and schedule, effect on kidney biomarkers and histological changes, and mechanisms of curcumin's protective effects. Despite success in some animal models, human studies and clinical administration of curcumin for nephroprotection remains limited due to difficulty in achieving therapeutic levels following oral administration and in determining the optimal dosing schedule. Lack of sufficient evidence from animal studies, coupled with low systemic bioavailability, continues to limit the utilization of curcumin in addressing and controlling drug-induced nephrotoxicity. Therefore, human studies are required to fully assess and validate the therapeutic potential of curcumin.

Efficacy of phospholipidated curcumin in nonalcoholic fatty liver disease: a clinical study

Curcumin is a safe and dietary phytochemical that can improve different pathophysiologic features of non-alcoholic fatty liver disease (NAFLD). Here, we investigated the efficacy of phospholipidated curcumin supplementation in NAFLD patients. In this single-arm study, 36 patients were recruited. Each patient received three capsules a day (each containing 500 mg of phospholipidated curcumin [overall content of curcuminoids per capsule: 100 mg]) for a period of 8 weeks. The results indicated that phospholipidated curcumin supplementation reduced NAFLD severity and ameliorated ultrasonographic and biochemical measures (including liver transaminases and lipid profile) associated with disease progression.

The Underlying Role of Oxidative Stress in Neurodegeneration: A Mechanistic Review

BACKGROUND

Neurodegeneration is a condition in which progressive loss of function and structure of neurons occurs. Several lines of evidence suggest that oxidative stress has a central role in neurodegenerative diseases.

OBJECTIVE

The aim was to survey molecular mechanisms underlying the involvement of oxidative stress in developing different neurodegenerative diseases.

METHODS

Original and review articles were retrieved through a PubMed and Google scholar search (from 1989 to 2015) using the following key words: "oxidative stress", "nerve degeneration" and "neurodegenerative diseases".

RESULTS

A comprehensive analysis of the obtained articles confirmed strong involvement of oxidative stress in the pathophysiology of neurodegenerative diseases through a variety of mechanisms including induction of oxidation of nucleic acids, proteins and lipids, formation of advanced glycation end products, mitochondrial dysfunction, glial cell activation, amyloid β deposition and plaque formation, apoptosis, cytokine production and inflammatory responses, and proteasome dysfunction.

CONCLUSION

Regarding the pivotal role of oxidative stress in neurodegeneration, modulation of free radical production or alleviating their harmful effects can be considered as a potential therapeutic strategy for preventing and controlling neurodegenerative diseases. Accordingly; boosting endogenous antioxidant capacity besides providing exogenous sources of antioxidants merits future research in order to discover new therapeutic agents.

Does Turmeric/curcumin Supplementation Change Anthropometric Indices in Patients with Non-alcoholic Fatty Liver Disease? A Systematic Review and Meta-analysis of Randomized Controlled Trials

Curcumin is the principal polylphenol of turmeric that has been used to treat various disorders. However, its anti-obesity effects in patients with non-alcoholic fatty liver disease (NAFLD) remain controversial. Therefore, we aimed to perform a meta-analysis on the effects of supplementation with turmeric/curcumin on body weight, body mass index (BMI) and waist circumference (WC) in these patients. PubMed, Scopus, Cochrane Library, and ISI Web of Science were searched until January 2019, without any restrictions. Clinical trials that reported body weight, BMI and WC in patients with NAFLD were included. Weighted mean differences (WMDs) were pooled using a random-effects model. Eight studies (449 participants) fulfilled the eligibility criteria of the present meta-analysis. Overall, meta-analysis could not show any beneficial effect of turmeric/curcumin supplementation on body weight (WMD, -0.54 kg; 95% confidence interval [CI], -2.40, 1.31; p = 0.56; I2 = 0.0%), BMI (WMD, -0.21 kg/m2; 95% CI, -0.71, 0.28; p = 0.39; I2 = 0.0%) and WC (WMD, -0.88 cm; 95% CI, -3.76, 2.00; p = 0.54; I2 = 0.0%). Subgroup analysis based on participants' baseline BMI, type of intervention, and study duration did not show any significant association in all subgroups. The results showed that turmeric/curcumin supplementation had no significant effect on body weight, BMI and WC in patients with NAFLD. Further studies with large-scale are needed to find out possible anti-obesity effects of turmeric/curcumin.

Curcuminoids plus piperine improve nonalcoholic fatty liver disease: A clinical trial

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) as a prevalent hepatic disease is associated with an increased risk of morbidity and mortality related to the liver and cardiovascular disease (CVD). Lifestyle modification and good metabolic control is the first line of treatment, but not always efficacious in reversing NAFLD pathogenesis. Curcumin is a dietary phytochemical with hepatoprotective activities, though its low bioavailability is considered as a major challenge for clinical applications. Therefore, in this study, in order to improve the bioavailability of curcumin, it was coadministered with piperine and we investigated the effects of this bioavailability-enhanced curcumin on serum hepatic enzymes, lipid profile, and glycemic indices in patients with NAFLD.

METHODS

In this randomized controlled parallel-group trial, 70 subjects with ultrasound-determined NAFLD were randomized to either 500 mg curcuminoids coadministered with 5 mg piperine daily or placebo for 12 weeks. NAFLD severity (on the basis of sonography) and hepatic function was assessed at baseline and at the study end.

RESULTS

Seventy subjects completed the study. Supplementation with curcuminoids plus piperine significantly reduced the hematocrit (P = 0.027), erythrocyte sedimentation rate (P = 0.048) and the serum concentrations of alanine aminotransferase (P = 0.035), aspartate aminotransferase (P = 0.042), alkaline phosphatase (P = 0.004), cholesterol (P < 0.016), low-density lipoprotein cholesterol (P < 0.017), Iron (P = 0.026), and Hemoglobin (P = 0.025) and increased total iron-binding capacity (P = 0.003). However, except albumin, changes in other parameters were not statistically different between groups. In addition, administration of curcuminoids plus piperine significantly improved NAFLD severity (P < 0.001), which was statistically different compared with the placebo group (P = 0.022). Also, the percentage of improved patients was marginally higher in the curcuminoids plus piperine group when compared with the placebo group (P = 0.058).

CONCLUSION

This study suggested beneficial effects of combined curcuminoids and piperine supplementation on disease severity in patients with NAFLD.

Impact of Cultivation Condition and Media Content onChlorella vulgaris Composition

Microalgae are a source material in food, pharmacy, and cosmetics industries for producing various products including high-protein nutritional supplements, synthetic pharmaceuticals, and natural colors. A promising algal source for such productions is Chlorella vulgaris which contains a considerable protein content. Similar to other microalgae, its desirability is minimal nutrient requirements since they are unicellular, photosynthetic, and fast-growing microorganisms. Another propitious option to be produced by C. vulgaris is biodiesel, since it is rich in oil too. Besides, algal well thriving in presence of increased amount of carbon dioxide makes them a practicable alternative biofuel resource without some problems of the traditional ones. At the same time, C. vulgaris is also a promising source for nutraceuticals such as amino acids, vitamins, and antioxidants. This review aims to discuss the conditions need to be observed for achieving a favorable growth efficiency of the C. vulgaris, as well as targeted productions such as biomass, antioxidant, and biofuel. Additionally, different approaches to induce any specific production are also considered comprehensively.

Biological properties of metal complexes of curcumin

Curcumin, a naturally occurring phenolic compound isolated from Curcuma longa, has different pharmacological effects, including antiinflammatory, antimicrobial, antioxidant, and anticancer properties. However, curcumin has been found to have a limited bioavailability because of its hydrophobic nature, low-intestinal absorption, and rapid metabolism. Therefore, there is a need for enhancing the bioavailability and its solubility in water in order to increase the pharmacological effects of this bioactive compound. One strategy is curcumin complexation with transition metals to circumvent the abovementioned problems. Curcumin can undergo chelation with various metal ions to form metallo-complexes of curcumin, which may show greater effects as compared with curcumin alone. Promising results with metal curcumin complexes have been observed with regard to antioxidant, anticancer, and antimicrobial activity, as well as in treatment of Alzheimer's disease. The present review provides a concise summary of the characterization and biological properties of curcumin-metal complexes. © 2019 BioFactors, 45(3):304-317, 2019.

Curcuminoids Plus Piperine Modulate Adipokines in Type 2 Diabetes Mellitus

OBJECTIVE

Curcumin is a naturally occurring polyphenol derived from tumeric that has been reported to have anti-inflammatory properties with effects on adipokine and ghrelin levels. Adiponectin, leptin and ghrelin modulate energy homeostasis but each has modulatory effects on inflammatory cytokines and the immune system. Therefore, this analysis was performed to investigate the effect of curcumin on adiponectin, leptin and ghrelin.

METHOD

A double blind randomised control trial comparing curcumin 1000mg with 10mg of piperine daily to placebo over a 12 week period. 118 patients with type 2 diabetes were recruited out of which 50 control and 50 active subjects completed the trial. Adiponectin, leptin, ghrelin and tumor necrosis factor-α (TNF-α) were measured at baseline and 12 weeks.

RESULTS

Between group comparison of the magnitude of changes showed serum levels of leptin (p<0.001), TNF-α (p<0.001) and leptin:adiponectin ratio (p<0.001) to be significantly reduced while serum adiponectin levels were elevated in the curcuminoids versus placebo group (p=0.032). Changes in serum ghrelin levels did not differ between the study groups (p=0.135).

CONCLUSION

Curcumin supplementation increased adiponectin, whilst the the leptin:adiponectin ratio (a measure of atherosclerosis) and leptin levels were decreased independent of weight change and reflected a decrease in the inflammatory TNF-α levels.

Stomach-Specific Drug Delivery of Clarithromycin Using a Semi Interpenetrating Polymeric Network Hydrogel Made of Montmorillonite and Chitosan: Synthesis, Characterization and In Vitro Drug Release Study

Purpose: In this study, we aimed to prepare an extended drug delivery formulation of clarithromycin (CAM) based on a semi-interpenetrating polymer network (semi-IPN) hydrogel. Methods: Synthesis of semi-IPN hydrogel nanocomposite made of chitosan (CS), acrylic acid (AA), acrylamide (AAm), polyvinylpyrrolidone (PVP), and montmorillonite (MMT) was performed by free radical graft copolymerization method. Swelling kinetic studies were done in acidic buffer solutions of hydrochloric acid (pH = 1.2), acetate (pH = 4), and also distilled water. Also, the effects of MMT on the swelling kinetic, thermal stability, and mechanical strength of the hydrogels were evaluated. Moreover, in vitro release behavior of CAM and its release kinetics from hydrogels were studied in a hydrochloric acid buffer solution. Results: Fourier transform infrared spectroscopy (FTIR) results revealed that synthesis of semi- IPN superabsorbent nanocomposite and CAM incorporation into hydrogel was performed, successfully. Introducing MMT into hydrogel network not only improved its thermal stability but also increased mechanical strength of the final hydrogel product. Also, in comparison with neat hydrogel (1270 g/g), hydrogel nanocomposite containing 13 wt% MMT exhibited greater equilibrium swelling capacity (1568 g/g) with lower swelling rate. In vitro drug release experiments showed that CS-g-poly(AA-co-AAm)/PVP/MMT/CAM formulation possesses a sustained release character over extended period of time compared with CS-g-poly(AA-co- AAm)/PVP/CAM formulation. Conclusion: In the presence of MMT, the effective life time of drug is prolonged, demonstrating a sustained release property. The reason is that interlinked porous channels within superabsorbent nanocomposite network hinder penetration of aqueous solutions into hydrogel and subsequently cause a slower drug release.

Neuroprotective effects of antioxidants in the management of neurodegenerative disorders: A literature review

It is proven that oxidative stress has a pivotal role in the process of neurodegeneration. The use of antioxidants is an attractive method to prevent the incidence of neurodegenerative diseases. We searched major databases (PubMed, Medline, and Google Scholar) using the keywords of neurodegeneration, oxidative stress, and antioxidant for both review and original studies, which have reported the various beneficial effects of antioxidants. About 70 studies were identified for this review. Among various antioxidants, nine antioxidants with the most applications in research investigations were selected and the major findings concerning their protective effects were reviewed. It is concluded that antioxidants can modify and readjust the oxidative stress in the biological milieu, elicit neuroprotective effects, and positively impact the management of neurodegenerative processes.

Neuroprotective Agents in the Intensive Care Unit: -Neuroprotective Agents in ICU

Neuroprotection or prevention of neuronal loss is a complicated molecular process that is mediated by various cellular pathways. Use of different pharmacological agents as neuroprotectants has been reported especially in the last decades. These neuroprotective agents act through inhibition of inflammatory processes and apoptosis, attenuation of oxidative stress and reduction of free radicals. Control of this injurious molecular process is essential to the reduction of neuronal injuries and is associated with improved functional outcomes and recovery of the patients admitted to the intensive care unit. This study reviews neuroprotective agents and their mechanisms of action against central nervous system damages.

Evaluation of corneal biomechanical properties in mustard gas keratopathy

Background

Degenerative biomechanical factors and immunologic processes with effect on collagen and corneal reparative process are known as the main cause of ocular surface dysfunction in mustard gas keratopathy (MGK) and may cause changes in the corneal biomechanical values. Therefore, we evaluate corneal biomechanical properties of these patients.

Methods and materials

This case-control study includes 61 chemical warfare victims with MGK. After omission according to our exclusion criteria, 88 eyes of patients with MGK were enrolled as the case group and also a group of 88 normal eyes, which were matched regarding their age and sex in the control group, were enrolled. Measurements of corneal biomechanical properties which reported by ORA and Corvis ST (CST) devices were compared. The SPSS software version 23.0 was used in the statistical analysis. For comparisons between groups, if the data had a normal distribution, were analyzed by Student’s t-test and ANOVA, and if the data didn’t have a normal distribution, Mann–Whitney U test, and Kruskal-Wallis were used. Furthermore, to identify a relationship between two groups of data Spearman's rank Correlation test was used. P value < 0.05 were considered statistically significant.

Results

In the MGK group, A1 length (A1L), A1 velocity (A1V), A2 velocity (A2V), deformation amplitude (DA) and peak distance (PD) were higher than the control group (P < 0.001). However, the corneal hysteresis (CH) (P = 0.003), corneal resistant factor (CRF), non-corrected IOP (IOPnct), corrected IOP based on corneal thickness (IOPpachy), and central corneal thickness (CCT) were lower than the control group (P < 0.001). The visual acuity according to the LogMAR scale and severity of MGK was positively associated with IOPpachy and negatively associated with CH, CRF, CCT and highest concavity radius (Radius).

Conclusion

Measurement of corneal biomechanical properties may be, have a useful role in the classification, monitoring or diagnosis of MGK.

Effects of statins on the chemoresistance-The antagonistic drug-drug interactions versus the anti-cancer effects

There has been growing interest in the potential anti-cancer activity of statins based on evidence of their anti-proliferative, pro-apoptotic, and radiosensitizing properties, but no studies have focused on the effects of statins on the chemoresistance. In spite of their direct cytostatic/cytotoxic effects on the cancer cells, statins via drug interactions may affect therapeutic effects of the chemotherapy agents and so cause chemoresistance in cancer cells. Here, we aim to present the molecular mechanisms underlying cytotoxic effects of statins on the cancer cells against those mechanisms by which statins may lead to chemoresistance, in order to clarify whether the positive effects of the co-treatment of statins on the efficiency of chemotherapeutic agents is due to the natural anti-cancer effects of statins or it is due to increasing the cellular concentrations of chemotherapy drugs in cancer cells.

Systematic Review and Meta-analysis of Flibanserin's Effects and Adverse Events in Women with Hypoactive Sexual Desire Disorder

OBJECTIVE

The efficacy and safety of flibanserin in the treatment of Hypoactive Sexual Desire Disorder (HSDD) is controversial. We reviewed existing evidence on the efficacy and safety of flibanserin in treating HSDD, and performed a meta-analysis of reported effects.

METHOD

Literature search was performed in PubMed, Scopus, and Cochrane library to find all trials on the efficacy of flibanserin in HSDD. Meta-analysis was performed using fixed- and random-effects models. Egger's test and "trim and fill" methods were used for the assessment of publication bias and imputation of potentially missing studies, respectively.

RESULTS

Among 105 studies that were initially found, only ten related documents (six published and four nonpublished studies) were included in the final analysis, comprising 8345 subjects (6113 and 2232 subjects in the flibanserin and placebo groups, respectively). Incomplete outcome data bias was probable in the included studies. Most studies had an acceptable validity and quality. There was no significant difference between flibanserin and placebo groups in most of the HSDD-assessed indices. Our results showed that although SSE, DSDS, FSFID and FSFI are significantly improved with flibanserin, this change did not reach statistical significance compared with placebo. For FSDSR-item 13 score and FSDSR total score, no significant difference was observed between flibanserin and placebo. The most common side effect of flibanserin was somnolence. The most common causes of heterogeneity were black ethnicity, duration of therapy, age of participants and duration of marital relationship.

CONCLUSION

the efficacy of flibanserin in women with HSDD was not found to be significantly different compared with placebo. Additional trials are required to clarify the efficacy of flibanserin for the treatment of HSDD.

An analytical enrichment-based review of structural genetic studies on keratoconus

Keratoconus is a progressive bilateral corneal protrusion that leads to irregular astigmatism and impairment of vision. Keratoconus is an etiologically heterogeneous corneal dystrophy and both environmental and genetic factors play a role in its etiopathogenesis. In this analytical review, we have studied all the genes that are structurally associated with keratoconus and have tried to explain the function of each gene and its association with other eye disorders in a concise way. In addition, using gene set enrichment analysis, it was attempted to find the most important impaired metabolic pathways in keratoconus. Several genetic studies have been carried out on keratoconus and several genes have been identified as risk factors involved in the etiology of the disease. In the current study, 16 studies, including nine association studies, five genome-wide association studies, one linkage study, and one meta-analysis, were reviewed and based on the 19 genes found, enrichment was performed and the most important metabolic pathways involved in the disease were identified. The enrichment results indicated that the two pathways, interleukin 1 processing and assembly of collagen fibrils, are significantly associated with the disease. Obviously, the results of this study, in addition to providing information about the genes involved in the disease, can provide an integrated insight into the gene-based etiology of keratoconus and therapeutic opportunities thereof.