Thyroid Function and its Implications in Oxidative Stress Influencing the Pathogenesis of Osteoporosis in Adults with Down Syndrome: A Cohort Study

People with Down syndrome (DS) show lower bone mass density (BMD) and a higher prevalence of hypothyroidism compared to general population. Furthermore, DS is a well-known high oxidative stress (OS) condition because genes involved in OS map on chromosome 21. Thyroid function too is involved in OS. Since both thyroid function and OS lead to lower BMD and osteoporotic fractures, we have explored correlations among BMD, thyroid hormones, and parameters of OS in DS adults. A total of 105 DS patients (48 males; 21-71 years; mean BMI 28.88±7.12 kg/m(2)) were enrolled in a cohort study, 48 of them undergoing thyroid replacement therapy. We evaluated thyroid function, BMD, and total antioxidant capacity (TAC) in blood plasma. TAC was assayed by H2O2-metmyoglobin system, as source of radicals, and by the chromogenous ABTS, with a latency time (LAG) in the appearance of its cation ABTS+proportional to antioxidant concentration. BMD was evaluated with DEXA, using WHO criteria to classify osteoporosis. Low BMD was found in 83.78% of patients. TSH and LAG did not correlate with BMD. Nevertheless, LAG significantly correlates to Z-scores estimated at the lumbar spine (r(2)=0.558; p=0.03) in hypothyroid patients. Our data show that low TAC could be more associated with reduced BMD rather than TSH itself in DS patients and that the OS could have a role in the pathogenesis of osteoporosis regarding the hypothyroid subgroup.

Global Survey of the Frequency of Atrial Fibrillation–Associated Stroke

Background and Purpose—

Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.

Methods—

Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.

Results—

Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P <0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF ( r =0.76; P =0.0002).

Conclusions—

This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.

Effects of long-term football training on the expression profile of genes involved in muscle oxidative metabolism

We investigated whether long-term recreational football training affects the expression of health-related biochemical and molecular markers in healthy untrained subjects. Five untrained healthy men trained for 1 h 2.4 times/week for 12 weeks and 1.3 times/week for another 52 weeks. Blood samples and a muscle biopsy from the vastus lateralis were collected at T0 (pre intervention) and at T1 (post intervention). Gene expression was measured by RTqPCR on RNA extracted from muscle biopsies. The expression levels of the genes principally involved in energy metabolism (PPARγ, adiponectin, AMPKα1/α2, TFAM, NAMPT, PGC1α and SIRT1) were measured at T0 and T1. Up-regulation of PPARγ (p < 0.0005), AMPKα1 (p < 0.01), AMPKα2 (p < 0.0005) and adiponectin was observed at T1 vs T0. Increases were also found in the expression of TFAM (p < 0.001), NAMPT (p < 0.01), PGC1α (p < 0.01) and SIRT1 (p < 0.01), which are directly or indirectly involved in the glucose and lipid oxidative metabolism. Multiple linear regression analysis revealed that fat percentage was independently associated with NAMPT, PPARγ and adiponectin expression. In conclusion, long-term recreational football training could be a useful tool to improve the expression of muscle molecular biomarkers that are correlated to oxidative metabolism in healthy males.

Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

BACKGROUND

Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient's ability, but the temporal evolution of motion related to motor control is disregarded.

OBJECTIVE

To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function.

METHODS

Twenty-five healthy individuals performed the Armeo®Spring device "Vertical Capture" task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided.

RESULTS

4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness.

CONCLUSIONS

We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.

Serum level of testosterone, dihydrotestosterone and IGF-1 during an acute exacerbation of COPD and their relationships with inflammatory and prognostic indices: a pilot study

AIM

Acute exacerbations (AECOPD) of negatively influence the natural history of chronic obstructive pulmonary (COPD) and they are related to muscle dysfunction. In this pathway hypogonadism could play a pivotal role. Our study wants to evaluate possible relationships among prognostic indexes of AECOPD, represented by Acute Physiology and Chronic Health Evaluation (APACHE) II, inflammation (serum amyloid A, SSA) and anabolic hormones, especially less studied steroids, like dihydrotestosterone (DHT) e free-testosterone (f-T).

METHODS

Twenty-four patients (17 males; age 75 ± 13 yrs) were studied. On admission and at discharge a blood sample for total testosterone (T), DHT, insulin like grow factor 1 (IGF-1) and Serum Amyloid A (SSA) was obtained. f-T was calculated using Vermeulen's formula.

RESULTS

Descriptive statistical analysis shows reduced of T values (1.85 ± 2.28 ng/mL), f-T (0.028 ± 0.030 ng/mL), DHT (0.18 ± 0.19 ng/mL) and IGF-1 (91.840 ± 74.19 pg/mL). Calculating tertile for Apache II and SSA and using them as cut off point, three categories were made and used in the analysis (SSA< 10 mg/mL; 10-160 mg/mL; > 160 mg/mL); (APACHE II ≤ 10; 11-12; > 12). Using this classification, an inverse correlation between SAA and T (P = 0.01), f-T (0.01), DHT (0.001) and IGF-1 (P = 0.05) was found. Data show the same inverse relationship between APACHE II tertiles on one hand and T (P = 0.01) and f-T (P = 0.02) on the other hand.

CONCLUSION

Our data confirm systemic effects of AECOPD and the role of endocrinological derangements, suggesting a possible mechanism explaining them.

The kidney in Fabry's disease

Fabry disease (FD) is an X-linked disease in which mutations of the GLA gene result in a deficiency of the enzyme α-galactosidase A and subsequent progressive, intralysosomal deposition of undegraded glycosphingolipid products, primarily globotriaosylceramide, in multiple organs. Progressive nephropathy is one of the main features of FD and is marked by an insidious development, with an overall rate of progression of chronic kidney disease (CKD) very similar to diabetic nephropathy. Untreated patients usually develop end stage renal disease in their 50s. The decline in renal function in FD is adversely affected by male gender, advanced CKD, hypertension and, in particular, severe proteinuria. Enzyme replacement therapy (ERT) has been shown to slow the progression of Fabry nephropathy. The current consensus is that ERT should be started in all men and women with signs of renal involvement.

Comparison of plasma antioxidant levels in middle-aged and old male with idiopatic osteoporosis: preliminary data

OBJECTIVES

With the purpose of evaluating the role of oxidative stress (OS) in male idiopatic osteoporosis, we have evaluated plasma total antioxidant capacity (TAC) in patients classified according to age (< 65 or ≥ 65 yrs), with normal hormone values and in age-matched healthy control subjects.

PATIENTS AND METHODS

TAC was evaluated with a colorimetric method, using the system metamyoglobin-H2O2 and the chromogen ABTS; the latency time (LAG, sec) in the appearance of ABTS radical species is proportional to antioxidant content of the system.

RESULTS

We found slightly increased LAG values in middle-aged patients, compared with age-matched controls, probably expression of a compensatory mechanism to OS; on the contrary aged patients showed significantly lower LAG values in comparison with age-matched controls, suggesting a defective compensatory mechanism and, therefore, a risk for oxidative damage.

CONCLUSIONS

OS could be a possible mechanism underlying male osteoporosis, both in middle-aged and aged patients, but compensatory mechanisms seem to be defective in the last group.

DHT and IGF-1 in peripheral blood lymphocytes: new markers for the biological passport of athletes

We performed a pilot study using human peripheral blood lymphocytes (PBL) as a novel system to identify new biomarkers of dihydrotestosterone (DHT) and insulin-like growth factor-1 (IGF-1) abuse in sport. First, to obtain a gene signature, we treated cultures of lymphocytes from sedentary males with three doses of 0.237 microg/ml DHT, each of which is 80-fold the physiological concentration in young adult male serum, at days 0, 2 and 4, or with a single dose of 1.25 microg/ml IGF-1, which is 5-fold the physiological concentration in young adult male serum. We then used the Human Genome U133 Plus 2.0 microarray to identify a gene signature related to DHT or IGF-1 administration. Gene expression was evaluated after 7 and 21 days of DHT treatment, and after 24 h, 72 h and 7 days of IGF-1 treatment. Microarray analysis yielded a list of genes whose expression was altered after DHT or IGF-1 treatment. Among these we selected the genes that are most representative of the pathways associated with skeletal and muscular disorders using the IPA bioinformatics tool. We identified six (IDO1, CXCL13, CCL1, GZMB, VDR and IL2RA) and two (FN1 and RAB31) genes that were up-regulated in lymphocytes from sedentary subjects after 7 days of DHT and IGF-1 treatment, respectively. The expression of these genes in lymphocytes from differently trained athletes was either down-regulated or similar to that in lymphocytes from sedentary subjects. This finding suggests that up-regulation was due to the drug and not to physical exercise. In conclusion, we demonstrate that PBL can be useful in anti-doping checks, and we describe new biomarkers of DHT and IGF-1 abuse which can be included in the Athlete's Biological Passport.

Estrogens as antioxidant modulators in human fertility

Among treatments proposed for idiopathic male infertility, antiestrogens, like tamoxifen, play a possible role. On the other hand, oxidative stress is a mechanism well recognized for deleterious effects on spermatozoa function. After reviewing the literature on the effects of estrogens in modulation of antioxidant systems, in both sexes, and in different in vivo and in vitro models, we suggest, also on the basis of personal data, that a tamoxifen treatment could be active via an increase in seminal antioxidants.

Relationship between plasma antioxidants and thyroid hormones in chronic obstructive pulmonary disease

BACKGROUND

A low-T₃ syndrome is observed in chronic diseases, but its treatment is still debated. Chronic obstructive pulmonary disease (COPD) has not been conclusively studied under this aspect. COPD is a complex condition, which cannot be considered a lung-related disorder, but rather a systemic disease also associated to increased oxidative stress. We evaluated thyroid hormones and antioxidant systems, the lipophilic Coenzyme Q10 (CoQ₁₀) and total antioxidant capacity (TAC) in COPD patients to reveal the presence of a low-T₃ syndrome in COPD and investigate the correlation between thyroid hormones, lung function parameters and antioxidants.

METHODS

We studied: 32 COPD patients and 45 controls, evaluating thyrotropin (TSH), free-triiodotyronine (fT₃), free-tetraiodotyronine (fT₄), CoQ₁₀ (also corrected for cholesterol) and TAC. CoQ₁₀ was assayed by HPLC; TAC by the metmyoglobin-ABTS method and expressed as latency time (LAG) in radical species appearance.

RESULTS

We found significantly lower LAG values, fT₃ and fT₄ levels and significantly higher TSH in COPD patients vs. controls. LAG values significantly correlated with fT₃ concentration. 12 out of 32 patients exhibited fT₃ levels lower than normal range. So we divided COPD patients in 2 groups on the basis of the fT₃ concentration (normal fT₃ COPD and low fT₃ COPD). We observed lower LAG values in normal fT₃-COPD, compared to healthy subjects, with a further significant reduction in low fT₃-COPD patients. Moreover higher TSH concentration was present in normal fT₃-COPD, compared to healthy subjects, with a further significant increase in low fT₃-COPD patients. CoQ₁₀/cholesterol ratio was higher in low fT₃-COPD vs. normal fT₃-COPD, with a nearly significant difference.

CONCLUSIONS

These data seem to indicate an increased oxidative stress in low fT₃-COPD and a role of fT₃ in modulating antioxidant systems. However low fT₃ levels are joined to metabolic indexes of true hypothyroidism, suggesting that elevated CoQ₁₀ expresses a reduced tissue utilization. These data might suggest the need of thyroid replacement therapy in such a condition.