Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses

Development of the Gut Microbiome in Children, and Lifetime Implications for Obesity and Cardiometabolic Disease

Emerging evidence suggests that microbiome composition and function is associated with development of obesity and metabolic disease. Microbial colonization expands rapidly following birth, and microbiome composition is particularly variable during infancy. Factors that influence the formation of the gut microbiome during infancy and childhood may have a significant impact on development of obesity and metabolic dysfunction, with life-long consequences. In this review, we examine the determinants of gut microbiome composition during infancy and childhood, and evaluate the potential impact on obesity and cardiometabolic risk.

Inflammation, adiposity, and progression of arterial stiffness in adolescents with type 1 diabetes: The SEARCH CVD Study

AIMS

We examined the association between inflammation and progression of arterial stiffness in a population of youth with type 1 diabetes (T1D).

METHODS

A total of 287 youth with T1D (median age 13 years) from SEARCH CVD, an ancillary study to the SEARCH for Diabetes in Youth, were included. Markers of inflammation (CRP, IL-6, fibrinogen, leptin, and adiponectin) and measures of pulse wave velocity (PWV) of the arm (PWV-R), trunk (PWV-T), and lower extremity (PWV-LE) were measured at baseline. Measures of PWV were repeated approximately five years later.

RESULTS

PWV-R (0.50 m/s), PWV-T (0.65 m/s), and PWV-LE (1.0 m/s) significantly increased over the follow-up (p < 0.001 for each). A significant interaction was found between waist circumference and fibrinogen (p = 0.036) on the progression of PWV-T, suggesting that fibrinogen is more strongly associated with PWV progression in lean participants.

CONCLUSIONS

Improved understanding of adiposity, inflammation, and functional changes in the vascular system in patients with T1D is crucial.

Health promoting properties of blueberries: a review

With the strengthening of the link between diet and health, several foodstuffs have emerged as possessing potential health benefits such as phenolic rich fruits and vegetables. Blueberries, along with other berries, given their flavonoid and antioxidant content have long since been considered as a particularly interesting health promoting fruit. Therefore, the present work aimed to compile the existing evidences regarding the various potential benefits of blueberry and blueberry based products consumption, giving particular relevance to in vivo works and epidemiological studies whenever available. Overall, the results demonstrate that, while the evidences that support a beneficial role of blueberry and blueberry extracts consumption, further human based studies are still needed.

The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES

BACKGROUND/OBJECTIVE

Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders.

METHODS

Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance.

RESULTS

Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls.

CONCLUSION

Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.

Markers of Atherosclerosis: Part 1 - Serological Markers

Atherosclerosis is a major contributor to morbidity and mortality worldwide. With therapeutic consequences in mind, several risk scores are being used to differentiate individuals with low, intermediate or high cardiovascular (CV) event risk. The most appropriate management of intermediate risk individuals is still not known, therefore, novel biomarkers are being sought to help re-stratify them as low or high risk. This narrative review is presented in two parts. Here, in Part 1, we summarise current knowledge on serum (serological) biomarkers of atherosclerosis. Among novel biomarkers, high sensitivity C-reactive protein (hsCRP) has emerged as the most promising in chronic situations, others need further clinical studies. However, it seems that a combination of serum biomarkers offers more to risk stratification than either biomarker alone. In Part 2, we address genetic and imaging markers of atherosclerosis, as well as other developments relevant to risk prediction.

Obesity is an independent determinant of elevated C-reactive protein in healthy women but not men

BACKGROUND AND AIMS

High-sensitivity C-reactive protein (hs CRP) has emerged as an inflammatory biomarker to predict metabolic syndrome. Here, we investigate the association of hs CRP with metabolic variables and determine the risks for elevated hs CRP levels in healthy Singaporean adults.

METHODS

We conducted a cross-sectional study of 225 participants (104 men). The levels of hs CRP and fasting lipid parameters were analyzed by COBAS. Body composition was determined with dual-energy X-ray absorptiometry.

RESULTS

Twenty-one (9 %) participants had elevated hs CRP levels (>3 mg/mL). The levels of hs CRP had significant correlations (p <0.05) with obesity and metabolic variables among women. Stepwise multivariate regression analysis identified FM (%) (accounted for 22.5% of the variability in hs CRP levels) as a major determinant of hs CRP levels. On multivariate regression, FM (%) was the independent determinant of intermediate and elevated hs CRP in women after adjustment for the potential confounders.

CONCLUSIONS

Obesity may play a direct role in the elevated hs CRP levels in women, but not men living in Singapore. This is probably due to different body composition or different effects of sex hormones on adipose tissue between men and women.

Role of vasodilator-stimulated phosphoprotein in human cytomegalovirus-induced hyperpermeability of human endothelial cells

Atherosclerosis (AS) is a common chronic vascular disease and epidemiological evidence demonstrates that infection is closely associated with the occurrence of AS, including infection by human cytomegalovirus (HCMV) and Chlamydophila pneumoniae. The aim of the present study was to investigate the effect of HCMV AD169 infection on the barrier function of human umbilical vein endothelial cells (HUVECs) and to understand the role of vasodilator-stimulated phosphoprotein (VASP) during this process. In cultured HUVEC-CRL-1730 cells, knockdown of VASP expression with small interfering (si)RNA-VASP resulted in impaired cellular barrier function. Furthermore, knockdown of Ras-related C3 botulinum toxin substrate 1 (Rac1) using siRNA-Rac1 could induce downregulation of VASP expression in HUVEC-CRL-1730 cells. Additionally, following the infection of the cells by HCMV, cellular morphological alterations could be observed under an inverted microscope, the mRNA and protein levels of Rac1 and VASP were transiently reduced, and what appeared to be a time-dependent impairment of the barrier function was observed. Finally, transfection of siRNA-VASP or siRNA-Rac1 into HCMV-infected HUVEC-CRL-1730 cells resulted in increased impairment of the cellular barrier function. Taken together, these data demonstrated that HCMV infection could induce impairment of the barrier function in monolayer HUVEC-CRL-1730 cells via interference with Rac1/VASP expression.

Inflammatory milieu in contrast-induced nephropathy: a prospective single-center study

Background

Acute kidney injury (AKI) caused by contrast exposure is a common problem, which may cause a significant increase in patients in-hospital stay and therefore the cost of treatment. This study was conducted to evaluate the role of inflammation, inflammatory markers in predicting contrast induced nephropathy (CIN). This is a prospective study that was carried out in a major tertiary referral hospital in Jordan.

Methods

Clinical data, blood and urine samples were collected from all patients admitted to the cardiology unit. All patients who agreed to participate in the study had creatinine level analysis 48-72 hours after the procedure. The CIN was defined as an increase in serum creatinine by 25% or 44 μmol/L from the baseline within 48-72 hours after the contrast administration. Patients with stage 4, 5 renal failure, patients on dialysis, and patients with recent intravenous contrast use, active infection or cancer were excluded from the study.

Results

Of the total 202 patients, 30 (14.8%) developed CIN. The incidence rate was 21.1% among females and 12.4% among males. In the multivariate analysis, beside eGFR, diuretics, and alkaline phosphatase, IL-33 was significantly associated with CIN, while the other cytokines did not to show this an association.

Conclusion

Serum level of IL-33 was a significant predictor for development of CIN. Good clinical judgment and high serum levels of IL-33 may stratify patients into low and high risk for CIN.

Perceived discrimination and cardiovascular health disparities: a multisystem review and health neuroscience perspective

There are distinct racial disparities in cardiovascular disease (CVD) risk, with Black individuals at much greater risk than White individuals. Although many factors contribute to these disparities, recent attention has focused on the role of discrimination as a stress-related factor that contributes to racial disparities in CVD. As such, it is important to understand the mechanisms by which discrimination might affect CVD. Recent studies have examined these mechanisms by focusing on neurobiological mediators of CVD risk. Given this increase in studies, a systematic review of perceived discrimination and neurobiological mediators of CVD risk is warranted. Our review uses a multisystem approach to review studies on the relationship between perceived discrimination and (1) cardiovascular responses to stress, (2) hypothalamic-pituitary-adrenocortical axis function, and (3) the immune system, as well as (4) the brain systems thought to regulate these parameters of peripheral physiology. In addition to summarizing existing evidence, our review integrates these findings into a conceptual model describing multidirectional pathways linking perceived discrimination with a CVD risk.

Impact of cigarette smoking cessation on plasma α-klotho levels

Smoking cessation reduces the risk of cardiovascular disease and improves clinical outcomes. We studied the effect of smoking cessation on plasma levels of α-klotho, which is an antiaging protein. We treated 28 smokers (male:female = 23:5, 46 ± 12 years) with varenicline (n = 14) or a transdermal nicotine patch (n = 14) as part of a 12-week smoking cessation program (the VN-SEESAW Study). Pulse rate, blood pressure, plasma levels of α-klotho, fibroblast growth factor (FGF)-19, FGF-21, hemoglobin (Hb), and expiratory carbon monoxide (CO) concentration were measured before and after the antismoking intervention. Smoking cessation significantly decreased pulse rate, α-klotho, Hb, and CO concentration, but not FGF-19 or FGF-21 in all subjects. On the contrary, body mass index significantly increased after the intervention. Changes in α-klotho levels (values at week 12 - values at week 0) were negatively associated with α-klotho levels at week 0 and positively associated with changes in Hb levels. In addition, the successful smoking cessation group (n = 21) showed significant reductions in pulse rate, systolic blood pressure, α-klotho, Hb, and CO concentration. In conclusion, smoking cessation significantly decreased serum levels of the antiaging molecule α-klotho. Our results are consistent with a previous report that an increase in α-klotho might be a compensatory response to smoking stress.

Decline in lung function is associated with elevated lipoprotein (a) in individuals without clinically apparent disease: A cross-sectional study

BACKGROUND AND OBJECTIVE

Reduced lung function and high lipoprotein (a) (Lp(a)) levels are both recognized risk factors for cardiovascular disease. Few studies have investigated the association between serum Lp(a) and lung function in the general population. We evaluated the association between reduced lung function and high Lp(a) levels in healthy individuals without known medical disease diagnoses.

METHODS

We performed a cross-sectional study on 64 082 Korean health screening examinees (33 049 males, 38 ± 7 years) who underwent a health examination in 2015.

RESULTS

The median Lp(a) level was 12 (6-25)mg/dL. The prevalence of high Lp(a) (defined as >30 mg/dL) was 19.5%. Subjects with a high Lp(a) had both lower values of measured forced expiratory volume in 1 s (FEV₁ ) and forced vital capacity (FVC; L) than those with a low Lp(a) (P < 0.001). However, FEV₁ /FVC ratio was not significantly different between groups (P = 0.112). Comparison of the second, third and fourth measured FVC (L) quartiles with that of the lowest quartile (1Q) group (reference) on regression analysis revealed adjusted odd ratios (OR) for a high Lp(a) of 0.928 (95% CI: 0.876-0.982), 0.860 (0.808-0.916) and 0.895 (0.839-0.954), respectively (P for trend < 0.001). In addition, adjusted OR for high Lp(a) compared with reference was 0.894 (0.844-0.947), 0.857 (0.806-0.912) and 0.882 (0.8727-0.940) across the measured FEV₁ (L) quartiles in increasing order (P for trend < 0.001).

CONCLUSION

High Lp(a) levels were associated with reduced lung function in this cross-sectional population study. Longitudinal follow-up studies will be required to validate our findings.

Association between a guided meditation practice, sleep and psychological well-being in type 2 diabetes mellitus patients

Background Type 2 diabetes mellitus [T2DM] is one of the leading causes for mortality. This study examined the role of an self-awareness based guided meditation practice, Cyclic Meditation [CM] on perceived stress, anxiety, depression, sleep and quality of life in T2DM patients. Design A single arm pre-post design was used for the study. Setting The study was conducted in an auditorium for general public diagnosed with T2DM in Ernakulam, Kerala, India. Subjects Subjects were 30 T2DM patients, both male and female of age 50.12 ± 11.15 years and BMI 25.14 ± 4.37 Kg/m2 and not having a history of hospitalisation were randomly recruited for the study following advertisements in national dailies. Intervention Participants completed a supervised CM programs in the evenings, 5 days a week for 4 weeks, in addition to their regular medication. Measures Perceived stress, anxiety and depression were assessed with Perceived Stress Scale, State Anxiety Inventory and Beck's depression inventory, respectively. Sleep and quality of life were assessed with Pittsburgh Sleep Quality Index and WHO-Quality of Life - BREF respectively. Analysis Changes in the outcome measures from baseline to 4 weeks were compared using paired "t" test. Results After 4 weeks, the quality of life and sleep scores increased 7.1% [p = 0.001] and 32.7% [p = 0.001], respectively. The perceived stress, anxiety and depression reduced 26.1% [p = 0.001], 16.01% [p = 0.003] and 37.63% [p = 0.006] as compared to their baseline reports. The CM practice also reduced daytime dysfunction. Conclusions A guided self-awareness based meditation program was safe and effective in improving depression, anxiety, perceived stress and enhance sleep and quality of life in T2DM patients, which could be helpful in reducing the future complications of T2DM. Mind management is essential along with medical management to achieve better clinical results.

Protein Biomarkers of Cardiovascular Disease and Mortality in the Community

BACKGROUND

The discovery of novel and highly predictive biomarkers of cardiovascular disease (CVD) has the potential to improve risk-stratification methods and may be informative regarding biological pathways contributing to disease.

METHODS AND RESULTS

We used a discovery proteomic platform that targeted high-value proteins for CVD to ascertain 85 circulating protein biomarkers in 3523 Framingham Heart Study participants (mean age, 62 years; 53% women). Using multivariable-adjusted Cox models to account for clinical variables, we found 8 biomarkers associated with incident atherosclerotic CVD, 18 with incident heart failure, 38 with all-cause mortality, and 35 with CVD death (false discovery rate, q<0.05 for all; P-value ranges, 9.8×10-34 to 3.6×10-2). Notably, a number of regulators of metabolic and adipocyte homeostasis were associated with cardiovascular events, including insulin-like growth factor 1 (IGF1), insulin-like growth factor binding protein 1 (IGFBP1), insulin-like growth factor binding protein 2 (IGFBP2), leptin, and adipsin. In a multimarker approach that accounted for clinical factors, growth differentiation factor 15 (GDF15) was associated with all outcomes. In addition, N-terminal pro-b-type natriuretic peptide, C-reactive protein, and leptin were associated with incident heart failure, and C-type lectin domain family 3 member B (CLEC3B; tetranectin), N-terminal pro-b-type natriuretic peptide, arabinogalactan protein 1 (AGP1), soluble receptor for advanced glycation end products (sRAGE), peripheral myelin protein 2 (PMP2), uncarboxylated matrix Gla protein (UCMGP), kallikrein B1 (KLKB1), IGFBP2, IGF1, leptin receptor, and cystatin-C were associated with all-cause mortality in a multimarker model.

CONCLUSIONS

We identified numerous protein biomarkers that predicted cardiovascular outcomes and all-cause mortality, including biomarkers representing regulators of metabolic homeostasis and inflammatory pathways. Further studies are needed to validate our findings and define clinical utility, with the ultimate goal of improving strategies for CVD prevention.

OxInflammation: From Subclinical Condition to Pathological Biomarker

Inflammation is a complex systemic response evolved to cope with cellular injury, either due to infectious agents or, in general, with sporadic events challenging tissue integrity and function. Researchers involved in different fields have the tendency to look at the inflammatory response with different angles, according to their specific interest. Established its complexity, one of the most evident features of the inflammatory response is the generation of a pro-oxidative environment due to the production of high fluxes of pro-oxidant species. This production begins locally, close to the sites of tissue damage or infection, but eventually becomes a chronic challenge for the organism, if the inflammatory response is not properly controlled. In this review, we focus on this specific aspect of chronic, low-level sub-clinical inflammatory response. We propose the term "OxInflammation" as a novel operative term describing a permanent pro-oxidative feature that interact, in a positive feed-back manner, to a not yet clinically detectable inflammatory process, leading in a long run (chronically) to a systemic/local damage, as a consequence of the cross talk between inflammatory, and oxidative stress mediators. Therefore, it could be useful to analyze inflammatory markers in pathologies where there is an alteration of the redox homeostasis, although an inflammatory status is not clinically evident.

Microbiome-Mediated Effects of the Mediterranean Diet on Inflammation

The Mediterranean diet pattern is increasingly associated with improved metabolic health. Two mechanisms by which consuming a Mediterranean diet pattern may contribute to improved metabolic health are modulation of the gastrointestinal (GI) microbiota and reduction of metabolic endotoxemia. Metabolic endotoxemia, defined as a 2- to 3-fold increase in circulating levels of bacterial endotoxin, has been proposed as a cause of inflammation during metabolic dysfunction. As the largest source of endotoxins in the human body, the GI microbiota represents a crucial area for research on strategies for reducing endotoxemia. Diets high in saturated fat and low in fiber contribute to metabolic endotoxemia through several mechanisms, including changes in the GI microbiome and bacterial fermentation end products, intestinal physiology and barrier function, and enterohepatic circulation of bile acids. Thus, the Mediterranean diet pattern, rich in unsaturated fats and fiber, may be one dietary strategy to reduce metabolic endotoxemia. Preclinical studies have demonstrated the differential effects of dietary saturated and unsaturated fats on the microbiota and metabolic health, but human studies are lacking. The role of dietary fiber and the GI microbiome in metabolic endotoxemia is underinvestigated. Clinical research on the effects of different types of dietary fat and fiber on the GI microbiota and GI and systemic inflammation is necessary to determine efficacious dietary strategies for reducing metabolic endotoxemia, inflammation, and subsequent metabolic disease.

Association between Helicobacter pylori eradication and the risk of coronary heart diseases

The evidences on the association of Helicobacter pylori (H. pylori) to coronary heart diseases (CHD) are conflicting. In order to answer this important but yet unanswered clinical health issue, a large cohort study such as big data from the Taiwan National Health Insurance Research Database should be more convincing. Therefore, we aimed to make use of these big data source to analyze and clarify the relevance of H. pylori eradication and CHD risks. We looked through a total of 208196 patients with peptic ulcer diseases (PUD) from the years of 2000 to 2011. First, 3713 patients who received H. pylori eradication within 365 days of the index date were defined as the group A. We randomly selected the same number of patients as cohort A from 55249 non-eradication patients to be the comparison group B using propensity scores (including age, gender and comorbidity) so that we could control the confounding variables of CHD and mortality. Importantly, we perform sensitivity analysis for the time-dependent association between H. pylori eradication and risk of CHD, interactions between patient demographic characteristics and therapy by age (≥ or < 65 years old). The results showed that a trend of decreased association of CHD in patients with early eradication was observed compared to those without eradication (2.58% vs. 3.35%, p = 0.0905). The mortality rate was lower in early eradication subgroup compared to cohort B (2.86% vs. 4.43%, p = 0.0033). Interestingly, there was also significant difference observed in composite end-points for CHD and death in the early eradication subgroup (0.16% vs.0.57%, p = 0.0133). Further, the cumulative CHD rate was significantly lower in younger patients (< 65 years old) with H. pylori eradication therapy started < 1 year compared to those patients without eradication at all (p = 0.0384); the treatment did not appear to have an effect in older patients (≥ 65 years old) (p = 0.1963). Multivariate analysis showed that hypertension and renal diseases were risk factors for CHD in patients without eradication whilst younger age (< 65 years old) initiated with H. pylori therapy was a protective factor. In conclusion, the trend of decrease in CHD occurrence after early H. pylori eradication in addition to the significant decrease in composite end points for CHD and death, the significantly lower cumulative CHD rate in younger patients < 65 years old with H. pylori treated within 365 days suggested that there was positive association between H. pylori eradication and CHD.

The link between insulin resistance parameters and serum uric acid is mediated by adiposity

BACKGROUND AND AIMS

Conflicting results suggest a link between serum uric acid (SUA), inflammation and glucose/insulin homeostasis; however, the role of adiposity in this relationship is not clear. Therefore, we evaluated the role of different adiposity factors, including central body mass index (BMI), peripheral waist circumference (WC), and visceral adiposity [visceral adipose tissue (apVAT)], on the association between SUA, inflammation and glucose/insulin homeostasis among US adults.

METHODS

Data were extracted from the 2005-2010 US National Health and Nutrition Examination Surveys. Overall, 16,502 participants were included in the analysis (mean age = 47.1 years, 48.2% men). Analysis of co-variance and "conceptus causal mediation" models were applied, while accounting for survey design.

RESULTS

Corrected models showed that subjects with higher SUA levels have a less favorable profile of inflammation and glucose/insulin homeostasis parameters (all p < 0.001). We found that all our potential mediators (BMI, WC and apVAT) had an impact (to various extents) on the link between variables, including serum C-reactive protein (CRP), apolipoprotein-B (apoB), insulin resistance markers, 2-h blood glucose (2hG) and triglyceride, and fasting blood glucose (FBG) (TyG) index (all p < .001), while none of the potential mediators (BMI, apVAT, WC) had an impact on the link between FBG and glycated hemoglobin with SUA (all p > 0.05). We have found that all of our mediators partially mediated the link between inflammation and glucose/insulin homeostasis parameters and SUA. Of note, apVAT fully mediated the association between SUA and 2hG.

CONCLUSIONS

By applying advanced statistical techniques, we shed light on the complex link of SUA with inflammation and glucose/insulin homeostasis and quantify the role of adiposity factors in that link.

Sodium tanshinone IIA sulfate adjunct therapy reduces high-sensitivity C-reactive protein level in coronary artery disease patients: a randomized controlled trial

High-sensitivity C-reactive protein (hs-CRP) is independently associated with cardiovascular events in coronary artery disease (CAD) patients and reducing the hs-CRP level may further benefit this population. We conduct this parallel design, randomized-controlled trial to assess the effectiveness of adjunct sodium tanshinone IIA sulfate (STS) therapy on circulating inflammation markers in CAD patients. Unstable angina or non-ST-elevation myocardial infarction patients with increased hs-CRP level were randomly assigned to atorvastatin-based standard medical therapy or standard therapy plus STS injection (80 mg, once daily for 14 consecutive days). The primary outcome was hs-CRP level. After the 14-day treatment, the experimental group (n = 35) exhibited significantly lower levels of hs-CRP than the control group (n = 35) (1.72 vs 3.20 mg/L, p = 0.0191). Lower levels of interleukin-6, monocyte chemotactic protein-1 (MCP-1), and soluble CD40 ligand were also observed in the experimental group. Angina symptoms were also better controlled in the experimental group. At 30 days after treatment completion, MCP-1 levels remained lower in the experimental group than in the control group (313.88 vs 337.91 pg/mL, p = 0.0078). No serious adverse events occurred. Our study demonstrates that on the basis of standard medical therapy, STS further reduce elevated hs-CRP and other circulating inflammation markers in CAD patients. (Chictr.org number: ChiCTR-TRC-12002361).

The temporal expression of adipokines during spinal fusion

BACKGROUND CONTEXT

Adipokines are secreted by white adipose tissue and have been associated with fracture healing. Our goal was to report the temporal expression of adipokines during spinal fusion in an established rabbit model.

PURPOSE

Our goal was to report the temporal expression of adipokines during spinal fusion in an established rabbit model.

STUDY DESIGN

The study design included a laboratory animal model.

METHODS

New Zealand white rabbits were assigned to either sham surgery (n=2), unilateral posterior spinal fusion (n=14), or bilateral posterior spinal fusion (n=14). Rabbits were euthanized 1-6 and 10 weeks out from surgery. Fusion was evaluated by radiographs, manual palpation, and histology. Reverse transcription-polymerase chain reaction on the bone fusion mass catalogued the gene expression of leptin, adiponectin, resistin, and vascular endothelial growth factor (VEGF) at each time point. Results were normalized to the internal control gene, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) (2^ΔCt), and control bone sites (2^ΔΔCt). Quantitative data were analyzed by two-factor analysis of variance (p<.05).

RESULTS

Manual palpation scores, radiograph scores, and histologic findings showed progression of boney fusion over time (p<.0003). The frequency of fusion by palpation after 4 weeks was 68.75%. Leptin expression in decortication and bone graft sites peaked at 5 weeks after the fusion procedure (p=.0143), adiponectin expression was greatest 1 week after surgery (p<.001), VEGF expression peaked at 4 weeks just after initial increases in leptin expression (p<.001), and resistin decreased precipitously 1 week after the fusion procedure (p<.001).

CONCLUSIONS

Leptin expression is likely associated with the maturation phase of bone fusion. Adiponectin and resistin may play a role early on during the fusion process. Our results suggest that leptin expression may be upstream of VEGF expression during spinal fusion, and both appear to play an important role in bone spinal fusion.

Knee Osteoarthritis and Risk of Hypertension: A Longitudinal Cohort Study

Although previous research has indicated an association between osteoarthritis (OA) and cardiovascular disease, it remains unclear whether people with OA are at greater risk of developing hypertension. The aim of this study was to answer this uncertainity. We used the data of the Osteoarthritis Initiative, an ongoing public and private longitudinal study including people at higher risk of OA or having knee OA. Knee OA was defined through radiological and clinical assessment. Incident hypertension was defined as a systolic blood pressure ≥140 mmHg and/or a diastolic value ≥90 mmHg. Multivariate Cox's regression analyses were constructed considering the presence of knee OA as the exposure and incident hypertension as the outcome during a 96-month follow-up interval. A total of 3558 people with normative blood pressure values at baseline were analyzed (1930 OA/1628 controls). Incidence of hypertension within the follow-up interval was significantly higher in people with knee OA than in those without (60/[1000 person-years] vs. 55/[1000 person-years]; p < 0.0001). After adjusting for 13 confounders, people with knee OA had a 13% higher chance of developing hypertension (hazard ratio = 1.13; 95% confidence interval: 1.01-1.26; p = 0.03). Propensity score analysis did not alter these conclusions. In conclusion, this is the first longitudinal data analysis to demonstrate that people with knee OA have a higher chance of developing hypertension than those without OA. Our data suggest that monitoring blood pressure and prescribing health promotion interventions may be warranted among people with OA to mitigate the potential onset and adverse consequences of hypertension.

Impact of blood urea nitrogen to creatinine ratio on mortality and morbidity in hemodialysis patients: The Q-Cohort Study

The association between blood urea nitrogen to creatinine ratio (UCR) and survival is uncertain in hemodialysis patients. We examined the influence of UCR on mortality and morbidity in hemodialysis patients. A total of 3,401 hemodialysis patients were prospectively followed for 4 years. The association between UCR with overall survival was analyzed using a Cox regression model. During a 4-year follow-up period, 545 patients died from any cause and 582 experienced MACE, 392 with coronary heart disease (CHD), 114 with infection-related death, 77 with hemorrhagic stroke, 141 with ischemic stroke, and 107 with cancer death. Every 1 increase in UCR level was significantly associated with an increased risk for all-cause mortality (hazard ratio [HR] 1.07; 95% confidence interval [CI] 1.03–1.12), CHD (HR 1.08; 95% CI 1.02–1.14), and infection-related death (HR 1.11; 95% CI 1.02–1.21). There was no evidence of a significant association between UCR and death from cancer, and incidence of stroke. A high UCR was significantly associated with an increased risk for all-cause mortality, infection-related death and incidence of CHD in hemodialysis patients.

Discrete Barker Frailty and Warped Mortality Dynamics at Older Ages

We develop a discrete variant of a general model for adult mortality influenced by the delayed impact of early conditions on adult health and mortality. The discrete variant of the model builds on an intuitively appealing interpretation of conditions that induce delayed effects and is an extension of the discrete form of the standard frailty model with distinct implications. We show that introducing delayed effects is equivalent to perturbing adult mortality patterns with a particular class of time-/age-varying frailty. We emphasize two main results. First, populations with delayed effects could experience unchanging or increasing adult mortality even when background mortality has been declining for long periods of time. Although this phenomenon also occurs in a regime with standard frailty, the distortions can be more severe under a regime with Barker frailty. As a consequence, conventional interpretations of the observed rates of adult mortality decline in societies that experience Barker frailty may be inappropriate. Second, the observed rate of senescence (slope of adult mortality rates) in populations with delayed effects could increase, decrease, or remain steady over time and across adult ages even though the rate of senescence of the background age pattern of mortality is time- and age-invariant. This second result implies that standard interpretations of empirical estimates of the slope of adult mortality rates in populations with delayed effects may be misleading because they can reflect mechanisms other than those inducing senescence as conventionally understood in the literature.

Poor sleep moderates the relationship between daytime napping and inflammation in Black and White men

OBJECTIVES

To test whether napping was associated with 2 inflammatory markers with known relationships to cardiovascular disease: high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Because IL-6 is known to impact central inflammatory processes that relate to sleep regulation, including subjective fatigue, we tested whether this relationship was moderated by sleep duration, sleep efficiency, and self-reported sleep quality.

DESIGN

Cross-sectional.

PARTICIPANTS

A community sample of Black and White men (N=253) completed a week of actigraphy and diary measures of sleep and napping and provided a fasting blood sample.

MEASUREMENTS/ANALYSIS

Napping was measured as the proportion of days with at least 30 minutes napped and the average minutes napped per day. Linear regressions adjusted for race, socioeconomic status, employment, body mass index, smoking, medications that affect sleep or inflammation, working the nightshift, and day-sleeping status, followed by interaction terms between napping and sleep duration, efficiency, and quality, respectively.

RESULTS

There were no significant main effects of actigraphy- or diary-measured napping on IL-6 or hsCRP. Moderation analyses indicated elevated IL-6 values among men who napped more days (by actigraphy) and demonstrated short sleep duration (P=.03). Moderation analyses also indicated elevated IL-6 among men who demonstrated greater average minutes napped (by actigraphy) and short sleep duration (P<.001), low efficiency (P=.03), and poor quality (P=.03). Moderation analyses involving diary napping or hsCRP were not significant.

CONCLUSIONS

Actigraphy-assessed daytime napping is related to higher IL-6 in men who demonstrate worse sleep characteristics. Daytime napping may pose additional risk for inflammation beyond the known risk conferred by short sleep.

Association of SAA gene polymorphism with ischemic stroke in northern Chinese Han population

BACKGROUND

Serum amyloid A protein (SAA) is known as an inflammatory factor and an apolipoprotein that can replace apolipoprotein A-I/II components as the major apolipoprotein of high-density lipoprotein (HDL), which is related to atherosclerosis. The present study is aimed to evaluate whether the SAA gene polymorphism is involved in ischemic stroke in northern Chinese Han population.

METHODS

In a case-control study, the participants included 396 patients (239 males, 157 females) with ischemic stroke and 360 healthy subjects (211 males, 149 females). The rs12218 polymorphism of the SAA gene was analyzed by polymerase chain reaction and restriction fragment length polymorphism, while the rs2468844 polymorphism of the SAA gene was analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

RESULTS

The frequencies of the CC genotype and the C allele of rs12218 were higher in participants with ischemic stroke than in the control group (P=0.020 in males, P=0.001 in large-artery atherosclerosis group, LAA). The frequencies of the AG genotype and the G allele of rs2468844 were higher in participants with ischemic stroke than in the control group (P=0.040 in males, P=0.011 in large-artery atherosclerosis group). Multiple logistic regression analysis revealed the significance of the rs12218 in males and in large-artery atherosclerosis group after adjustment for confounding factors.

CONCLUSION

The rs12218 polymorphism of the SAA gene was associated with ischemic stroke in males and in patients with large-artery atherosclerosis group in northern Chinese Han population.

Mathematical modelling as a proof of concept for MPNs as a human inflammation model for cancer development

The chronic Philadelphia-negative myeloproliferative neoplasms (MPNs) are acquired stem cell neoplasms which ultimately may transform to acute myelogenous leukemia. Most recently, chronic inflammation has been described as an important factor for the development and progression of MPNs in the biological continuum from early cancer stage to the advanced myelofibrosis stage, the MPNs being described as "A Human Inflammation Model for Cancer Development". This novel concept has been built upon clinical, experimental, genomic, immunological and not least epidemiological studies. Only a few studies have described the development of MPNs by mathematical models, and none have addressed the role of inflammation for clonal evolution and disease progression. Herein, we aim at using mathematical modelling to substantiate the concept of chronic inflammation as an important trigger and driver of MPNs.The basics of the model describe the proliferation from stem cells to mature cells including mutations of healthy stem cells to become malignant stem cells. We include a simple inflammatory coupling coping with cell death and affecting the basic model beneath. First, we describe the system without feedbacks or regulatory interactions. Next, we introduce inflammatory feedback into the system. Finally, we include other feedbacks and regulatory interactions forming the inflammatory-MPN model. Using mathematical modeling, we add further proof to the concept that chronic inflammation may be both a trigger of clonal evolution and an important driving force for MPN disease progression. Our findings support intervention at the earliest stage of cancer development to target the malignant clone and dampen concomitant inflammation.

Tryptophan breakdown and cognition in bipolar disorder

INTRODUCTION

It has been demonstrated that bipolar disorder (BD) is often accompanied by cognitive deficits across all subdomains including verbal memory, attention and executive functioning. Cognitive deficits are observed both during episodes of mania or depression, as well as during the euthymic phase. It has been proposed that chronic immune-mediated inflammation in the central nervous system results in alterations in neural structures that subserve cognitive function. Kynurenine is an intermediate in the inflammatory cascade and can be peripherally measured to proxy inflammatory activity. Herein, we sought to determine whether serum levels of kynurenine and/or its metabolites were associated with cognitive function in BD.

METHODS

In this investigation 68 euthymic individuals with BD according to DSM-IV completed a cognitive test battery to asses premorbid intelligence (Multiple Choice Word Test; MWT-B), verbal memory (California Verbal Learning Test; CVLT), attention (d2 Test of Attention; d2 test, Trail Making Test-A; TMT-A, Stroop word reading/Stroop color naming) and executive functioning (TMT-B, Stroop interference). In addition, fasting blood samples were taken and serum levels of kynurenine and its metabolites 3-hydroxykynurenine and kynurenic acid were analyzed. Subsequently ratios were formed from individual parameters. Patient data were compared with those of a mentally healthy control group (n=93).

RESULTS

In male participants with BD only we found a significant negative correlation between the 3-hydroxykynurenine to kynurenic acid ratio and performance on the CVLT. Additionally, the kynurenine to 3-hydroxykynurenine ratio was associated with performance on a sub-score of the CVLT. Those associations were neither present in female individuals with BD nor in the control group.

DISCUSSION

Our findings suggest that a shift towards the hydroxykynurenine arm of the kynurenine pathway may be associated with poorer memory performance due to its effects on neuronal functioning and neurogenesis in the hippocampus. Our results implicate a mechanistic role of central inflammatory processes in cognitive functions in adults with bipolar disorder.

Persistent Depressive Symptoms are Independent Predictors of Low-Grade Inflammation Onset Among Healthy Individuals

Background

Depressive symptoms are independently associated with an increased risk of cardiovascular disease (CVD) among individuals with non-diagnosed CVD. The mechanisms underlying this association, however, remain unclear. Inflammation has been indicated as a possible mechanistic link between depression and CVD.

Objectives

This study evaluated the association between persistent depressive symptoms and the onset of low-grade inflammation.

Methods

From a database of 1,508 young (mean age: 41 years) individuals with no CVD diagnosis who underwent at least two routine health evaluations, 134 had persistent depressive symptoms (Beck Depression Inventory - BDI ≥ 10, BDI+) and 1,374 had negative symptoms at both time points (BDI-). All participants had been submitted to repeated clinical and laboratory evaluations at a regular follow-up with an average of 26 months from baseline. Low-grade inflammation was defined as plasma high-sensitivity C-Reactive Protein (CRP) concentrations > 3 mg/L. The outcome was the incidence of low-grade inflammation evaluated by the time of the second clinical evaluation.

Results

The incidence of low-grade inflammation was more frequently observed in the BDI+ group compared to the BDI- group (20.9% vs. 11.4%; p = 0.001). After adjusting for sex, age, waist circumference, body mass index, levels of physical activity, smoking, and prevalence of metabolic syndrome, persistent depressive symptoms remained an independent predictor of low-grade inflammation onset (OR = 1.76; 95% CI: 1.03-3.02; p = 0.04).

Conclusions

Persistent depressive symptoms were independently associated with low-grade inflammation onset among healthy individuals.

Association of asthma with coronary heart disease: A meta analysis of 11 trials

PURPOSE

While the relationship of asthma and coronary heart disease (CHD) (a specific manifestation of cardiovascular disease) has not been described consistently, we tried to defined this relation and explore the influence of gender and asthma status (child- and adult-onset asthma) on this issue.

METHODS

We searched published reports that described the relationship of asthma and CHD.

RESULTS

Eleven trials were identified, covering 666,355 subjects. Asthma overall was significantly associated with CHD both for prospective trials (HR 1.34 [1.09,1.64], P = 0.005) and for retrospective trials(OR 1.29 [1.13,1.46], P = 0.001), when compared to individuals without asthma. Subgroup analysis split by gender indicated that females with asthma were significantly associated with CHD (HR 1.40 [1.20,1.62], P<0.001), but males with asthma were not significantly related with CHD (HR 1.19 [0.98,1.44], P = 0.07). For the four subgroups (Females with adult-onset asthma,males with adult-onset asthma,females with child-onset asthma,and males with child-onset asthma), pooled analysis of two trials indicated that only females with adult-onset asthma were significantly associated with CHD (HR 2.06 [1.32,3.19], P<0.001).

CONCLUSIONS

Our data indicated that asthma was associated with CHD, and the relationship between them seemed to derived mostly from females with adult-onset asthma. Considering the limits of our study, these findings should be taken with caution.

Adverse effects of consuming high fat–sugar diets on cognition: implications for understanding obesity

There is increasing evidence for important roles of key cognitive processes, including attention, memory and learning, in the short-term decision making about eating. There is parallel evidence that people who are overweight or obese tend to perform worse on a variety of cognitive tasks. In this review, the evidence for these two ideas is summarised and then the idea that overconsumption of Western-style high-fat (HF)–high-sugar diets may underlie the association between obesity and poorer cognitive performance is explored. In particular, evidence in animals and human subjects that repeated consumption of HF or HF and sugar (HFS) diets leads to specific impairments in the functioning of the hippocampus, which underpin the consequent changes in cognition is summarised. These findings lead into the vicious cycle model (VCM), which suggests that these cognitive changes have knock-on negative effects for future appetite control, and evidence that altered hippocampal function is also associated with impaired appetite control is explored. The review concludes that there is consistent evidence in the animal literature and emerging evidence from human studies that supports this VCM. It is also noted, however, that to date studies lack the nutritional specificity needed to be able to translate these basic research findings into clear nutritional effects, and concludes that there is an urgent need for additional research to clarify the precise nature of the apparent effects of consuming HFS diets on cognition.

Oral health and cardiovascular disease risk in a cohort of periodontitis patients

BACKGROUND AND AIMS

The aim of this study was to determine whether oral health is uniformly associated with three different cardiovascular diseases (CVDs), including myocardial infarction (MI), stroke, and heart failure (HF), which has not been studied previously.

METHODS

A full mouth investigation was performed in 8999 individuals referred to a specialized periodontology clinic between 1979 and 2012. The number of deepened pockets (NDP), number of teeth (NT), and bleeding on probing (BOP) were investigated. Incident CVD diagnosis was obtained from the Swedish cause of death and the hospital discharge registers.

RESULTS

During a median follow-up time of 15.8 years (153,103 person years at risk), 1338 incident cases of fatal/non-fatal CVD occurred (672 fatal/non-fatal MI, 545 stroke and 302 HF). When NT, BOP and NDP were all included in the same model with age, sex, smoking, calendar time, and education level, NT and NDP, but not BOP, were significantly related to future CVD (combined end-point, p = 0.0003 for NT and p = 0.007 for NDP). In similar analyses of 3 separate CVD outcomes, NT was significantly related to MI, with an incidence rate ratio (IRR) for a given interquartile range change of 0.90 (95% CI 0.82-0.99) and to HF, with an IRR of 0.87 (95% CI 0.77-0.99). However, NT was not significantly related to stroke. BOP and NDP were not significantly related to any of the three separate CVD outcomes.

CONCLUSION

Oral health, mainly represented by NT, was related to incident MI and HF, but not to incident stroke. Therefore, oral health does not seem to relate to all major CV disorders in a similar fashion.

Mora‐Faife E, García‐García G, del Valle‐Infante I, Gómez‐Marrero L, Britton J, Fogarty AW, HINASIC (Historia Natural de la Sibilancia en Cuba/Natural History of Wheezing in Cuba) Study Group. The association of low birth weight with serum C reactive protein in 3-year-old children living in Cuba: A population-based prospective study

OBJECTIVE

Low birthweight is associated with a decreased risk of childhood leukemia and an increased risk of both cardiovascular disease and all-cause mortality in adult life. Possible biological mediators include systemic innate immunity and inflammation. We tested the hypothesis that birthweight was inversely associated with serum high sensitivity C reactive protein assay (hsCRP), a measure of both innate immunity and systemic inflammation.

METHODS

Data on birthweight and current anthropometric measures along with a range of exposures were collected at 1 and 3 years of age in a population-based cohort study of young children living in Havana, Cuba. A total of 986 children aged 3-years-old provided blood samples that were analyzed for serum hsCRP levels.

RESULTS

Nearly 49% of children had detectable hsCRP levels in their serum. Lower birthweight was linearly associated with the natural log of hsCRP levels (beta coefficient -0.70 mg L-1 per kg increase in birthweight, 95% CI: -1.34 to -0.06). This was attenuated but still present after adjustment for the child's sex and municipality (-0.65 mg L-1 per kg birthweight; 95% CI: -1.38 to +0.08). There were no associations between growth from birth or anthropometric measures at 3 years and systemic inflammation.

CONCLUSIONS

Birthweight was inversely associated with serum hsCRP levels in children aged 3 years living in Cuba. These observations provide a potential mechanism that is present at the age of 3 years to explain the association between low birthweight and both decreased childhood leukemia and increased cardiovascular disease in adults.

Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review and Meta-Analysis

An increasing evidence base suggests that low bone mineral density (BMD) and fractures are associated with cardiovascular disease (CVD). We conducted a systematic review and meta-analysis summarizing the evidence of low BMD and fractures as risk factors for future CVD. Two independent authors searched major databases from inception to August 1, 2016, for longitudinal studies reporting data on CVD incidence (overall and specific CVD) and BMD status and fractures. The association between low BMD, fractures, and CVD across longitudinal studies was explored by calculating pooled adjusted hazard ratios (HRs) ±95% confidence intervals (CIs) with a random-effects meta-analysis. Twenty-eight studies (18 regarding BMD and 10 fractures) followed a total of 1,107,885 participants for a median of 5 years. Taking those with higher BMD as the reference, people with low BMD were at increased risk of developing CVD during follow-up (11 studies; HR = 1.33; 95%CI, 1.27 to 1.38; I2  = 53%), after adjusting for a median of eight confounders. This finding was confirmed using a decrease in one standard deviation of baseline BMD (9 studies; HR = 1.16; 95% CI, 1.09 to 1.24; I2  = 69%). The presence of fractures at baseline was associated with an increased risk of developing CVD (HR = 1.20; 95% CI, 1.06 to 1.37; I2  = 91%). Regarding specific CVDs, low BMD was associated with an increased risk of developing coronary artery disease, cerebrovascular conditions, and CVD-associated death. Fractures at baseline was associated with an increased risk of cerebrovascular conditions and death due to CVD. In conclusion, low BMD and fractures are associated with a small, but significant increased risk of CVD risk and possibly death. © 2017 American Society for Bone and Mineral Research.

Inflammatory status and uricaemia determine HDL-cholesterol levels in hypertensive adults over 65: an analysis of the FAPRES register

In inflammatory disease, the levels of high-density lipoprotein cholesterol (HDL-C) decrease, and the composition of HLD-C changes. Data from the "non-inflammatory" general population indicate the presence of the same phenomenon, albeit to a smaller extent. Levels of uricaemia contribute to the overall inflammatory state of patients. The aim of this study was to analyse the association between inflammatory state, levels of uricaemia, and levels of HLD-C in a hypertensive Spanish population aged 65 or older. This was a retrospective analysis of the FAPRES database. We compared lipid levels [HDL-C, low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides] in terciles of patients according to their leukocyte counts and uricaemia. When we observed statistically significant differences at a 95% confidence level, we constructed a multivariable linear regression model to adjust for possible confounders. We analysed 860 patients (52.7% women) with a mean age of 72.9 years (±5.8). Participants in the highest tercile for leukocytes or uricaemia presented with significantly lower levels of HDL-C and higher levels of triglycerides, but there was no difference in total cholesterol or LDL-C. The multivariable analysis confirmed an independent and inverse association between HDL-C and both leukocytes (β = -0.001, p = 0.025) and uricaemia (β = -1.054, p = 0037) as well as an independent, direct association between triglycerides and both leukocytes (β = 0.004, p = 0.049), and uricaemia (β = 8.411, p = 0.003). In hypertensive adults aged 65 or older, inflammatory state, and uricaemia independently operate to decrease HDL-C-these findings confirm those described in studies in people with inflammatory disease. This phenomenon could help to define a proatherogenic profile in people without inflammatory disease.

HIV Infection and Compromised Mucosal Immunity: Oral Manifestations and Systemic Inflammation

Mucosal surfaces account for the vast majority of HIV transmission. In adults, HIV transmission occurs mainly by vaginal and rectal routes but rarely via oral route. By contrast, pediatric HIV infections could be as the result of oral route by breastfeeding. As such mucosal surfaces play a crucial role in HIV acquisition, and spread of the virus depends on its ability to cross a mucosal barrier. HIV selectively infects, depletes, and/or dysregulates multiple arms of the human immune system particularly at the mucosal sites and causes substantial irreversible damage to the mucosal barriers. This leads to microbial products translocation and subsequently hyper-immune activation. Although introduction of antiretroviral therapy (ART) has led to significant reduction in morbidity and mortality of HIV-infected patients, viral replication persists. As a result, antigen presence and immune activation are linked to “inflammaging” that attributes to a pro-inflammatory environment and the accelerated aging process in HIV patients. HIV infection is also associated with the prevalence of oral mucosal infections and dysregulation of oral microbiota, both of which may compromise the oral mucosal immunity of HIV-infected individuals. In addition, impaired oral immunity in HIV infection may predispose the patients to periodontal diseases that are associated with systemic inflammation and increased risk of cardiovascular diseases. The purpose of this review is to examine existing evidence regarding the role of innate and cellular components of the oral cavity in HIV infection and how HIV infection may drive systemic hyper-immune activation in these patients. We will also discuss current knowledge on HIV oral transmission, HIV immunosenescence in relation to the oral mucosal alterations during the course of HIV infection and periodontal disease. Finally, we discuss oral manifestations associated with HIV infection and how HIV infection and ART influence the oral microbiome. Therefore, unraveling how HIV compromises the integrity of the oral mucosal tissues and innate immune components of the oral cavity and its association with induction of chronic inflammation are critical for the development of effective preventive interventions and therapeutic strategies.

HIV Infection and Compromised Mucosal Immunity: Oral Manifestations and Systemic Inflammation

Mucosal surfaces account for the vast majority of HIV transmission. In adults, HIV transmission occurs mainly by vaginal and rectal routes but rarely via oral route. By contrast, pediatric HIV infections could be as the result of oral route by breastfeeding. As such mucosal surfaces play a crucial role in HIV acquisition, and spread of the virus depends on its ability to cross a mucosal barrier. HIV selectively infects, depletes, and/or dysregulates multiple arms of the human immune system particularly at the mucosal sites and causes substantial irreversible damage to the mucosal barriers. This leads to microbial products translocation and subsequently hyper-immune activation. Although introduction of antiretroviral therapy (ART) has led to significant reduction in morbidity and mortality of HIV-infected patients, viral replication persists. As a result, antigen presence and immune activation are linked to "inflammaging" that attributes to a pro-inflammatory environment and the accelerated aging process in HIV patients. HIV infection is also associated with the prevalence of oral mucosal infections and dysregulation of oral microbiota, both of which may compromise the oral mucosal immunity of HIV-infected individuals. In addition, impaired oral immunity in HIV infection may predispose the patients to periodontal diseases that are associated with systemic inflammation and increased risk of cardiovascular diseases. The purpose of this review is to examine existing evidence regarding the role of innate and cellular components of the oral cavity in HIV infection and how HIV infection may drive systemic hyper-immune activation in these patients. We will also discuss current knowledge on HIV oral transmission, HIV immunosenescence in relation to the oral mucosal alterations during the course of HIV infection and periodontal disease. Finally, we discuss oral manifestations associated with HIV infection and how HIV infection and ART influence the oral microbiome. Therefore, unraveling how HIV compromises the integrity of the oral mucosal tissues and innate immune components of the oral cavity and its association with induction of chronic inflammation are critical for the development of effective preventive interventions and therapeutic strategies.

Increased breakdown of kynurenine towards its neurotoxic branch in bipolar disorder

INTRODUCTION

Bipolar disorder (BD) is a chronic psychiatric disease which can take most different and unpredictable courses. It is accompanied by unspecific brainstructural changes and cognitive decline. The neurobiological underpinnings of these processes are still unclear. Emerging evidence suggests that tryptophan catabolites (TRYCATs), which involve all metabolites of tryptophan towards the kynurenine (KYN) branch, are involved in the etiology as well as in the course of BD. They are proposed to be mediators of immune-inflammation and neurodegeneration. In this study we measured the levels of KYN and its main catabolites consisting of the neurotoxic hydroxykynurenine (3-HK), the more neuroprotective kynurenic acid (KYNA) and anthranilic acid (AA) and evaluated the ratios between end-products and substrates as proxies for the specific enzymatic activity (3-HK/KYN, KYNA/KYN, AA/KYN) as well as 3-HK/KYNA as a proxy for neurotoxic vs. neuroprotective end-product relation in individuals with BD compared to healthy controls (HC).

METHODS

We took peripheral TRYCAT blood levels of 143 euthymic to mild depressive BD patients and 101 HC. For statistical analyses MANCOVA's controlled for age, sex, body mass index, cardiovascular disease and smoking were performed.

RESULTS

The levels of KYNA (F = 5,579; p <.05) were reduced in BD compared to HC. The enzymatic activity of the kynurenine-3-monooxygenase (KMO) reflected by the 3-HK/KYN ratio was increased in BD individuals compared to HC (F = 5,394; p <.05). Additionally the ratio of 3-HK/KYNA was increased in individuals with BD compared to healthy controls (F = 11,357; p <.01).

DISCUSSION

In conclusion our findings subserve the concept of KYN -pathway alterations in the pathophysiology of BD. We present evidence of increased breakdown towards the neurotoxic branch in KYN metabolism even in a euthymic to mild depressive state in BD. From literature we know that depression and mania are accompanied by inflammatory states which should be capable to produce an even greater imbalance due to activation of key enzymes in the neurotoxic direction of KYN -conversion. These processes could finally be involved in the development of unspecific brain structural changes and cognitive deficits which are prevalent in BD. Further research should focus on state dependent changes in TRYCATs and its relation to cognition, brain structure and staging parameters.

C-reactive protein level predicts mortality in COPD: a systematic review and meta-analysis

The prognostic role of baseline C-reactive protein (CRP) in chronic obstructive pulmonary disease (COPD) is controversial. In order to clarify this issue, we performed a systematic review and meta-analysis to assess the predictive effect of baseline CRP level in COPD patients. 15 eligible articles focusing on late mortality in COPD were included in our study. We performed a random-effects meta-analysis, and assessed heterogeneity and publication bias. We pooled hazard ratio (HR) estimates and their 95% confidence intervals on mortality for the comparison between the study-specific highest category of CRP level versus the lowest category. In overall analysis, elevated baseline CRP levels were significantly associated with higher mortality (HR 1.53, 95% CI 1.32-1.77, I²=68.7%, p<0.001). Similar results were observed across subgroups. However, higher mortality risk was reported in studies using a cut-off value of 3 mg·L^-1 (HR 1.61, 95% CI 1.12-2.30) and in those enrolling an Asiatic population (HR 3.51, 95% CI 1.69-7.31). Our analysis indicates that baseline high CRP level is significantly associated with higher late mortality in patients with COPD. Further prospective controlled studies are needed to confirm these data.

Relative contribution of health-related behaviours and chronic diseases to the socioeconomic patterning of low-grade inflammation

OBJECTIVES

To test the association of low-grade inflammation with socioeconomic status (SES) and determine the relative contribution of prevalent chronic diseases and health-related behaviours in explaining such association.

METHODS

Cross-sectional analysis on 19,867 subjects (age ≥35, 48.1% men) recruited within the Moli-sani study from 2005 to 2010 (Italy). A score of low-grade inflammation, including platelet and leukocyte counts, the granulocyte-to-lymphocyte ratio, and C-reactive protein was applied. SES was measured by education, household income, and occupational social class.

RESULTS

Low SES was associated with elevated levels of low-grade inflammation. Health behaviours (including adiposity, smoking, physical activity, and Mediterranean diet adherence) explained 53.5, 53.9, and 84.9% of the association between social class, income, and education with low-grade inflammation, respectively. Adiposity and body mass index showed a prominent role, while prevalent chronic diseases and conditions only marginally attenuated SES inequalities in inflammation.

CONCLUSIONS

Low-grade inflammation was socioeconomically patterned in a large Mediterranean population. Potentially modifiable behavioural factors explained the greatest part of this association with a leading contribution of adiposity, body mass index, and physical activity.

The Inflammatory Heart Diseases: Causes, Symptoms, and Treatments

The inflammation of the heart muscles, such as myocarditis, the membrane sac which surrounds the heart called as pericarditis, and the inner lining of the heart or the myocardium, heart muscle as endocarditis are known as the inflammatory heart diseases. Inflammation of heart is caused by known infectious agents, viruses, bacteria, fungi or parasites, and by toxic materials from the environment, water, food, air, toxic gases, smoke, and pollution, or by an unknown origin. Myocarditis is induced by infection of heart muscle by virus like sarcoidosis and immune diseases. The symptoms include chest pain, angina, pain in heart muscle, and shortness of breath, edema, swelling of feet or ankles, and fatigue. The ECG, X-ray, and MRI can diagnose the disease; blood test and rise in enzymes levels provide abnormality in heart function. The treatment includes use of antibiotics for inflammation of heart muscle and medications. The ultrasound imaging indicates further damage to the heart muscle. In severe cases of infection heart failure can occur so long-term medications are necessary to control inflammation. The various biomarkers are reported for the inflammatory heart diseases. The causes, symptoms and treatments of inflammatory heart diseases are described.