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Ray S, Saikia D, Vashisht Y, Sharma S, Meena RK, Kumar M. Dyslipidemia and atherogenic indexes in children with transfusion-dependent thalassemia. Hematol Transfus Cell Ther 2023:S2531-1379(23)00075-5. [PMID: 37147168 DOI: 10.1016/j.htct.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE This study endeavored to assess the lipid profile and atherogenic lipid indexes in children with transfusion-dependent thalassemia (TDT) and to compare them with matched healthy children. METHOD The study group consisted of a total of 72 TDT patients aged 3 to14 years, while the control group had 83 age- and sex-matched healthy children. The fasting lipid profile and lipid indexes were estimated and the atherogenic index of plasma (AIP), Castelli's risk indexes I and II, atherogenic coefficient were calculated and compared between the two groups. RESULT Compared to the control group, the mean LDL, HDL and cholesterol levels were significantly lower among the case group (p-value < 0.001). The mean VLDL and triglycerides were significantly higher in the case group (p-value < 0.001). Lipid indexes, including the atherogenic index of plasma (AIP), Castelli's risk indexes I and II and atherogenic coefficients were significantly higher in TDT children. CONCLUSION Dyslipidemia and increased risk of atherosclerosis were found in TDT children, as they had elevated atherogenic lipid indexes. Our study underlines the importance of the routine use of these indexes in TDT children. Future studies should focus on lipid indexes in this high-lipid group of children so that preventive strategies can be planned accordingly.
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Affiliation(s)
| | - Diganta Saikia
- Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | | | - Shikha Sharma
- Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | | | - Manish Kumar
- Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
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Atmakusuma TD, Nasution IR, Sutandyo N. Oxidative Stress (Malondialdehyde) in Adults Beta-Thalassemia Major and Intermedia: Comparison Between Before and After Blood Transfusion and Its Correlation with Iron Overload. Int J Gen Med 2021; 14:6455-6462. [PMID: 34675613 PMCID: PMC8504476 DOI: 10.2147/ijgm.s336805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 01/19/2023] Open
Abstract
Background Iron overload is a major problem in both transfusion-dependent (TDT) and non-transfusion-dependent thalassemia (NTDT). It has been known to increase oxidative stress. Meanwhile, blood transfusion as main therapy for thalassemia increases iron overload. One of the markers of oxidative stress is malondialdehyde (MDA). This study aims to provide data on MDA levels in adult thalassemia patients, and to compare the levels before and after transfusion in patients with TDT and NTDT. Methods This is a cross-sectional, pre-post study in adult patients with thalassemia major and intermedia that received blood transfusion with or without iron-chelating agents in Cipto Mangunkusumo Hospital. Blood samples were taken immediately before the transfusion and one day after. Serum ferritin (SF) assays were conducted by electrochemiluminescence immunoassay method, while transferrin saturation (TS) was calculated by dividing serum iron by the binding capacity. Subsequently, plasma MDA levels assays were performed using the Wills method, and data analysis was conducted using the t-test/Mann-Whitney and Pearson/Spearman correlation test, depending on the data distribution. Results The 63 respondents recruited consist of 51 TDT and 12 NTDT patients, and their median plasma MDA level before and after transfusion was 0.49 µmol/L and 0.45 µmol/L, respectively. Before transfusion, there was no correlation between SF and MDA, and TS and MDA levels. After the transfusion, there was no correlation between, SF and MDA, or TS and MDA levels. Conclusion There is no significant difference in MDA levels before and after transfusion. Although blood transfusion increases the iron load in thalassemia patients, there was no increase in median MDA level after transfusion. Meanwhile, there was no correlation between markers of iron overload and MDA level in thalassemia patients both before and after transfusion.
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Affiliation(s)
- Tubagus Djumhana Atmakusuma
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Intan Russiana Nasution
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Gatot Soebroto Army Hospital Jakarta/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Noorwati Sutandyo
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Dharmais National Cancer Hospital Jakarta/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Liaska A, Petrou P, Georgakopoulos CD, Diamanti R, Papaconstantinou D, Kanakis MG, Georgalas I. β-Thalassemia and ocular implications: a systematic review. BMC Ophthalmol 2016; 16:102. [PMID: 27390837 PMCID: PMC4938965 DOI: 10.1186/s12886-016-0285-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background Beta-thalassemia is a severe genetic blood disorder caused by a mutation in the gene encoding for the beta chains of hemoglobin. Individuals with beta-thalassemia major require regular lifelong Red Blood Cell transfusions to survive. Ocular involvement is quite common and may have serious implications. Methods Extensive review of observational studies on beta-thalassemia, to determine the prevalence and spectrum of ocular abnormalities, by clinical examination and multimodal imaging, and to investigate risk factors for their development. Results Frequency of ocular involvement differs among various studies (41.3–85 %, three studies). Ocular findings in beta-thalassemia may correlate to the disease itself, iron overload or the chelating agents used. Beta-thalassemia ocular manifestations include ocular surface disease, as demonstrated by tear function parameters (two studies). Lens opacities are present in 9.3–44 % (five studies). Lenticular opacities and RPE degeneration correlated positively with use of desferrioxamine and deferriprone respectively (two studies). Ocular fundus abnormalities characteristic of pseudoxanthoma elasticum (PXE), including peau d’orange, angioid streaks, pattern dystrophy-like changes, and optic disc drusen are a consistent finding in seven studies. Patients with PXE-like fundus changes were older than patients without these fundus changes (two studies). Age (two studies) and splenectomy (one study) had the strongest association with presence of PXE-like fundus changes. Increased retinal vascular tortuosity independently of the PXE-like fundus changes was found in 11–17.9 % (three studies), which was associated with aspartate amino transferase, hemoglobin and ferritin levels (two studies). Fundus autofluorescence and electrophysiological testing (ERG and EOG) may indicate initial stages or more widespread injury than is suggested by fundus examination (two studies). Conclusions Beta-thalassemia may present with various signs, both structural and functional. Pseudoxanthoma elasticum like fundus changes are a frequent finding in patients with b-thalassemia. These changes increase with duration or severity of the disease. Retinal vascular tortuosity may be an additional disease manifestation related to the severity and duration of anemia and independent of the PXE-like syndrome. Patients with long-standing disease need regular ophthalmic checkups because they are at risk of developing PXE-like fundus changes and potentially of subsequent choroidal neovascularization.
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Affiliation(s)
- Aliki Liaska
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | - Petros Petrou
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | | | - Ramza Diamanti
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | | | - Menelaos G Kanakis
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | - Ilias Georgalas
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece.
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Endocrine and bone complications in β-thalassemia intermedia: current understanding and treatment. BIOMED RESEARCH INTERNATIONAL 2015; 2015:813098. [PMID: 25834825 PMCID: PMC4365366 DOI: 10.1155/2015/813098] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/15/2014] [Accepted: 10/07/2014] [Indexed: 01/19/2023]
Abstract
Thalassemia intermedia (TI), also known as nontransfusion dependent thalassemia (NTDT), is a type of thalassemia where affected patients do not require lifelong regular transfusions for survival but may require occasional or even frequent transfusions in certain clinical settings and for defined periods of time. NTDT encompasses three distinct clinical forms: β-thalassemia intermedia (β-TI), Hb E/β-thalassemia, and α-thalassemia intermedia (Hb H disease). Over the past decade, our understanding of the molecular features, pathophysiology, and complications of NTDT particularly β-TI has increased tremendously but data on optimal treatment of disease and its various complications are still lacking. In this paper, we shall review a group of commonly encountered complications in β-TI, mainly endocrine and bone complications.
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Kotsis T, Pappas E, Sarmas G, Basilopoulou S, Hatzioannou A, Theodoraki K, Mylonas S, Speggos K. Carotid endarterectomy in a young symptomatic patient with B-thalassemia major. Ann Vasc Surg 2015; 29:838.e1-5. [PMID: 25681635 DOI: 10.1016/j.avsg.2014.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/09/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
β-Thalassemia major promotes atherosclerotic process, although the debating literature concerning the lipidic profile of young patients; it is well accepted that there is early vascular destruction in these homozygous patients either as a direct consequence of the genetic disorder per se or because of the repeated transfusions and the iron overload. Despite the potential of the disease for local brain thrombotic events, accelerated atheromatosis can lead to early thromboembolic events. We present an interesting case of a 36-year-old man with unilateral embolic infarcts (repeated transient ischemic attacks) originated from a near occlusion right carotid stenosis with additional peripheral thrombus. The patient underwent a successful carotid endarterectomy with primary arterial closure with uneventful postoperative course, confirmed by a clear postoperative angiography; he remains asymptomatic 18 months later. To the best of our knowledge, this is the first case of a young symptomatic patient with β-thalassemia major who underwent carotid repair.
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Affiliation(s)
- Thomas Kotsis
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital Medical School, University of Athens, Greece.
| | - Evangelos Pappas
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital Medical School, University of Athens, Greece
| | - Georgios Sarmas
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital Medical School, University of Athens, Greece
| | | | - Achilles Hatzioannou
- 1st Laboratory of Radiology, Aretaieion Hospital, Medical School, University of Athens, Greece
| | - Kassiani Theodoraki
- 1st Clinic of Anaesthesiology, Aretaieion Hospital, Medical School, University of Athens, Greece
| | - Spyridon Mylonas
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital Medical School, University of Athens, Greece
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何 慧. Structures, Antioxidation Mechanism, and Antioxidation Test of the Common Natural Antioxidants in Plants. Biophysics (Nagoya-shi) 2015. [DOI: 10.12677/biphy.2015.31004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Ozdemir ZC, Koc A, Aycicek A, Kocyigit A. N-Acetylcysteine Supplementation Reduces Oxidative Stress and DNA Damage in Children with β-Thalassemia. Hemoglobin 2014; 38:359-64. [DOI: 10.3109/03630269.2014.951890] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Association of Iron Overload with Oxidative Stress, Hepatic Damage and Dyslipidemia in Transfusion-Dependent β-Thalassemia/HbE Patients. Indian J Clin Biochem 2013; 29:298-305. [PMID: 24966477 DOI: 10.1007/s12291-013-0376-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
Blood transfusion can be a life-saving therapy for β-thalassemia major and β-thalassemia/HbE (β-TM) patients with chronic anemia, major caused severe iron overload particularly in β-TM patients received only blood transfusion therapy. We aim to evaluate the association of iron overload with oxidative stress, liver damage, and elevated very low density lipoprotein cholesterol (VLDL-C) in transfusion-dependent β-TM patients. Serum ferritin, malondialdehyde (MDA), liver profiles, triglycerides levels, and VLDL-C were significantly higher while total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol and total antioxidant capacity were lower in β-TM than controls. Serum ferritin was significantly correlated with MDA, liver enzymes and lipid profiles (p < 0.05). Multiple forward stepwise linear regression analyses of the significant variables showed that in these β-TM patients, independent predictors of iron overload were MDA (β = 0.410, r (2) = 0.671, p < 0.001), ALT (β = 0.493, r (2) = 0.578, p < 0.001), and VLDL-C (β = 0.253, r (2) = 0.711, p < 0.001). In conclusion, iron overload associated with increased oxidative stress, lipid peroxidation, liver damage, decreased TC, LDL-C, HDL-C and over production of VLDL-C, is significantly problem in transfusion-dependent β-TM patients. These appeared the major cause of future morbidity and mortality in β-TM patients.
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Gullu H, Caliskan M, Caliskan Z, Unler GK, Ermisler E, Ciftci O, Guven A, Muderrisoglu H. Coronary Microvascular function, Peripheral Endothelial Function and Carotid IMT in beta-thalassemia minor. Thromb Res 2013; 131:e247-52. [DOI: 10.1016/j.thromres.2013.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/19/2013] [Accepted: 03/14/2013] [Indexed: 01/08/2023]
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Abstract
It is common knowledge that thalassemic patients are under significant oxidative stress. Chronic hemolysis, frequent blood transfusion, and increased intestinal absorption of iron are the main factors that result in iron overload with its subsequent pathophysiologic complications. Iron overload frequently associates with the generation of redox-reactive labile iron, which in turn promotes the production of other reactive oxygen species (ROS). If not neutralized, uncontrolled production of ROS often leads to damage of various intra- and extracellular components such as DNA, proteins, lipids, and small antioxidant molecules among others. A number of endogenous and exogenous defense mechanisms can neutralize and counteract the damaging effects of labile iron and the reactive substances associated with it. Endogenous antioxidant enzymes, such as superoxide dismutase, catalase, glutathione peroxidase, and ferroxidase, may directly or sequentially terminate the activities of ROS. Nonenzymatic endogenous defense mechanisms include metal binding proteins (ceruloplasmin, haptoglobin, albumin, and others) and endogenously produced free radical scavengers (glutathione (GSH), ubiquinols, and uric acid). Exogenous agents that are known to function as antioxidants (vitamins C and E, selenium, and zinc) are mostly diet-derived. In this review, we explore recent findings related to various antioxidative mechanisms operative in thalassemic patients with special emphasis on protein antioxidants.
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Affiliation(s)
- Samir Awadallah
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
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11
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Olalla-Saad ST. Fermented papaya preparation for β-thalassemia? Expert Rev Hematol 2010; 3:265-8. [PMID: 21082979 DOI: 10.1586/ehm.10.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article comments on the results obtained by Fibach et al., which showed reduction of oxidative status in red blood cells of patients with β- and E-β-thalassemia (β-thal) treated with fermented papaya preparation. The study was a three-center, prospective study, including eight patients with β-thal intermedia, four β-thal major and seven E-β-thal patients. The patients received 3 g of fermented papaya preparation (FPP) two- to three-times a day after meals, respectively, for 3 months. A marked decrease in reactive oxygen species, lipid peroxidation and phosphatidylserine externalization and an increase in GSH were detected in both groups of patients, indicating that FPP is efficient in reducing the oxidative stress of these red blood cells. The results are very encouraging as all parameters analyzed indicated the reduction of red blood cells oxidative stress by the action of a natural and inexpensive product.
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Affiliation(s)
- Sara T Olalla-Saad
- Hemocentro-Unicamp, Cidade Universitária Zeferino Vaz, CEP 13083-970, Campinas, SP, Brazil.
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Unchern S, Laohareungpanya N, Sanvarinda Y, Pattanapanyasat K, Tanratana P, Chantharaksri U, Sibmooh N. Oxidative modification and poor protective activity of HDL on LDL oxidation in thalassemia. Lipids 2010; 45:627-33. [PMID: 20532993 DOI: 10.1007/s11745-010-3435-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 05/15/2010] [Indexed: 10/19/2022]
Abstract
Oxidative modification of low-density lipoprotein (LDL) has been reported in thalassemia, which is a consequence of oxidative stress. However, the levels of oxidized high-density lipoprotein (HDL) in thalassemia have not been evaluated and it is unclear whether HDL oxidation may be linked to LDL oxidation. In this study, the levels of total cholesterol, iron, protein, conjugated diene (CD), lipid hydroperoxide (LOOH), and thiobarbituric acid reactive substances (TBARs) were determined in HDL from healthy volunteers and patients with beta-thalassemia intermedia with hemoglobin E (beta-thal/Hb E). The protective activity of thalassemic HDL on LDL oxidation was also investigated. The iron content of HDL(2) and HDL(3) from beta-thal/HbE patients was higher while the cholesterol content was lower than those in healthy volunteers. Thalassemic HDL(2) and HDL(3) had increased levels of lipid peroxidation markers i.e., conjugated diene, LOOH, and TBARs. Thalassemic HDL had lower peroxidase activity than control HDL and was unable to protect LDL from oxidation induced by CuSO(4). Our findings highlight the oxidative modification and poor protective activity of thalassemic HDL on LDL oxidation which may contribute to cardiovascular complications in thalassemia.
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Affiliation(s)
- Supeenun Unchern
- Department of Pharmacology, Faculty of Science, Mahidol University, Rama 6 Rd, Bangkok, 10400, Thailand
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Cakmak A, Soker M, Koc A, Aksoy N. Prolidase activity and oxidative status in patients with thalassemia major. J Clin Lab Anal 2010; 24:6-11. [PMID: 20087956 DOI: 10.1002/jcla.20361] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIM Prolidase is a specific imidodipeptidase involved in collagen degradation. The increase in the enzyme activity is believed to be correlated with the increased intensity of collagen degradation. The study aimed to evaluate the relationship between prolidase activity and oxidative status in patients with thalassemia major. METHODS Comparison was made between 87 patients diagnosed with thalassemia major and 33 healthy children of similar age and gender. Mean age of the subjects was 7.5+/-4.3 years in the group of patients with thalassemia major and 8.9+/-3.1 years in the control group. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) measurement. RESULTS Prolidase activity was significantly increased in patients with thalassemia major (53.7+/-8.7 U/l) compared to the control group (49.2+/-7.2 U/l, P<0.001). TOS was significantly increased in the patient group (5.31+/-3.14 mmol H2O2 equiv./l) compared to the control group (3.49+/-2.98 mumol H2O2 equiv./l) and the OSI was also significantly increased in the patient group (3.86+/-3.28 arbitrary unit) compared to the control group (2.53+/-2.70 arbitrary unit) (P<0.0001 and P<0.001, respectively), while there were no significant differences between the patient (1.61+/-0.30 mumol Trolox equiv./l) and control (1.64+/-0.33 mumol Trolox equiv./l) groups with respect to TAC. CONCLUSION Significant increases in prolidase activity in patients with thalassemia major may constitute a key parameter in demonstrating a disorder of the collagen metabolism.
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Affiliation(s)
- Alpay Cakmak
- Department of Pediatrics, Harran University School of Medicine, Sanliurfa, Turkey.
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Abstract
PURPOSE The aim of this study was to study paraoxonase and arylesterase activities along with oxidative status parameters, and to find out whether there is any increased susceptibility to atherogenesis, which might be reflected with increased oxidative stress and decreased serum paraoxonase/arylesterase activity in beta-thalassemia major (BTM) patients. PATIENTS AND METHODS Eighty-seven patients with BTM and 33 healthy individuals were enrolled in the study. RESULTS Paraoxonase and arylesterase activities were significantly lower in BTM patients than controls (for all P<0.0001), whereas total oxidant status, total peroxide concentration levels, and oxidative stress index were significantly higher (P<0.0001, <0.0001, and <0.001, respectively). Correlations were found between serum iron and ferritin and levels of total oxidant status in BTM patients. Significant correlation was found with serum total peroxide concentration levels and paraoxonase and arylesterase activities in patients with BTM. CONCLUSIONS It was seen that oxidative stress increases, while serum paraoxonase activity is decreased in BTM patients. Decrease in paraoxonase activity seems to be associated with both the degree of oxidative stress and anemia. BTM patients may be more prone to development of atherogenesis because of low serum paraoxonase/arylesterase activity.
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Stakos DA, Tavridou A, Margaritis D, Tziakas DN, Kotsianidis I, Chalikias GK, Tsatalas K, Bourikas G, Manolopoulos VG, Boudoulas H. Oxidised low-density lipoprotein and arterial function in β-thalassemia major. Eur J Haematol 2009; 82:477-83. [DOI: 10.1111/j.1600-0609.2009.01236.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The term thalassaemia intermedia includes a large spectrum of conditions of varying severity. Blood transfusion and chelation are necessary in some patients, especially during childhood, in order to promote growth and prevent bone deformities. Alloimunisation, however, is frequent and can be difficult to control. Splenectomy is usually needed at some time because of hypersplenism and mechanical encumbrance. Reactivation of HbF is possible only in a small proportion of patients: hydroxycarbamide (also known as hydroxyurea) appears to be the most effective drug for this purpose. Antioxidant agents, although theoretically useful, do not improve haemoglobin levels. Stem cell transplantation is an option limited to the severe forms. Gene therapy and other molecular approaches are subjects of intense study. Numerous complications, including pulmonary hypertension, thrombotic events, pseudoxanthoma elasticum and osteoporosis, have been described and all contribute to complicate the treatment of a disease that represents a significant burden for the patients and their families.
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Amendola G, Danise P, Todisco N, D'Urzo G, Di Palma A, Di Concilio R. Lipid profile in ?-thalassemia intermedia patients: correlation with erythroid bone marrow activity. Int J Lab Hematol 2007; 29:172-6. [PMID: 17474893 DOI: 10.1111/j.1751-553x.2006.00862.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lipid abnormalities, including low levels of all fractions of serum lipids, have been repeatedly reported in all phenotypes of beta-thalassemia. Unexpectedly, in more recent studies, the concentration of total cholesterol (TC) and high- and/or low-density lipoprotein cholesterol (HDL-C and LDL-C) has been found in beta-thalassemia intermedia (TI) patients even lower than in thalassemia major, without a clear explanation of pathophysiology of these findings. This lack of information prompted us to evaluate the plasma lipids and lipoproteins pattern in the TI patients followed in our department; the data were compared with those found in hereditary spherocytosis patients. Furthermore, in both groups of patients, the erythroid bone marrow activity was evaluated, utilizing the level of soluble transferrin receptors (sTfR) in the plasma. Both groups of patients showed similar lipid abnormalities (low-TC, HDL-C and LDL-C) and the same increase of sTfR, with significantly lower hemoglobin levels in TI patients. Data analysis of our study shows that the lipid profile in TI patients is not influenced by age, sex, liver injury, hemoglobin or ferritin levels; the higher erythroid bone marrow activity with the enhanced cholesterol consumption could be the dominant mechanism implicated in the lipid abnormalities of TI patients.
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Affiliation(s)
- G Amendola
- Pediatric Hematology and Oncology Section, Department of Neonatology and Pediatrics, Ospedale Umberto I, Nocera Inferiore, Salerno, Italy
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Selek S, Aslan M, Horoz M, Gur M, Erel O. Oxidative status and serum PON1 activity in beta-thalassemia minor. Clin Biochem 2007; 40:287-91. [PMID: 17296173 DOI: 10.1016/j.clinbiochem.2006.10.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 10/15/2006] [Accepted: 10/19/2006] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Paraoxonase-1 (PON1) deficiency is related to increased susceptibility to low density lipoprotein oxidation and development of atherosclerosis. The aim of this study was to investigate paraoxonase and arylesterase activities along with oxidative status parameters, and to find out if there is any increased susceptibility to atherogenesis, which might be reflected with increased oxidative stress and decreased serum PON1 activity in beta-thalassemia minor (BTM) subjects. DESIGN AND METHODS Thirty-two subjects with BTM and 28 healthy subjects as control were enrolled in the study. Serum paraoxonase and arylesterase activities, lipid hydroperoxide (LOOH) levels, total antioxidant capacity (TAC), total oxidant status (TOS) and oxidative stress index (OSI) were determined. RESULTS Serum TAC, paraoxonase and arylesterase activities were significantly lower in BTM subjects than controls (for all p<0.001), while TOS, LOOH levels and OSI were significantly higher (p<0.001, p<0.05 and p<0.001; respectively). In BTM subjects, OSI, TOS, LOOH levels and TAC were significantly correlated with serum paraoxonase (r=-0.245, p<0.05; r=-0.231, p<0.05; r=-0.264, p<0.05 and, r=0.342, p<0.05, respectively) and arylesterase activities (r=-0.332, p<0.05, r=-0.308, p<0.05; r=-0.320, p<0.05 and r=0.443, p<0.05). Additionally, hemoglobin level was also correlated with serum paraoxonase (r=0.501, p<0.001) and arylesterase activities (r=0.501, p<0.001), TAC (r=0.402, p<0.05), TOS (r=-0.274, p<0.05) and OSI (r=-0.352, p<0.05). CONCLUSIONS Oxidative stress is increased, while serum PON1 activity is decreased in BTM subjects. Decrease in PON1 activity seems to be associated with both the degree of oxidative stress and anemia. BTM subjects may be more prone to development of atherogenesis due to low serum PON1 activity.
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Affiliation(s)
- Sahbettin Selek
- Harran University, School of Medicine, Department of Biochemistry, Sanliurfa, Turkey
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AMENDOLA G, DANISE P, TODISCO N, D'URZO G, DI PALMA A, DI CONCILIO R. Lipid profile in ?-thalassemia intermedia patients: correlation with erythroid bone marrow activity. Int J Lab Hematol 2007. [DOI: 10.1111/j.1365-2257.2006.00862.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chung KY, Lee SJ, Chung SM, Lee MY, Bae ON, Chung JH. Generation of free radical by interaction of iron with thiols in human plasma and its possible significance. Thromb Res 2005; 116:157-64. [PMID: 15907531 DOI: 10.1016/j.thromres.2004.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2004] [Revised: 11/22/2004] [Accepted: 11/25/2004] [Indexed: 12/17/2022]
Abstract
It has been reported that iron can generate reactive oxygen species (ROS) with thiols. In this study, we examined the interaction of iron with thiols in plasma and the generation of ROS. In human plasma, unlike with Fe(3+), treatment with Fe(2+) increased lucigenin-enhanced chemiluminescence in a concentration-dependent manner, and this was inhibited by superoxide dismutase. Boiling of plasma did not affect chemiluminescence generation induced by Fe(2+). Thiol depletion in plasma by pretreatment with N-ethylmaleimide (NEM) decreased chemiluminescence significantly. Consistent with these findings, albumin, the major thiol contributor in plasma, also generated ROS with Fe(2+). Treatment with Fe(2+) resulted in significant reduction of oxygen radical absorbance capacity (ORAC value) in plasma followed by an increase in low-density lipoprotein (LDL) oxidation. These results suggest that generation of ROS by nonenzymatic reaction of Fe(2+) with plasma thiols could lead to reduction of total antioxidant capacity in plasma, thereby enhancing susceptibility of plasma LDL to oxidation under iron overload conditions.
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Affiliation(s)
- Ka-Young Chung
- Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul 151-742, South Korea
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21
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Cheng ML, Ho HY, Tseng HC, Lee CH, Shih LY, Chiu DTY. Antioxidant deficit and enhanced susceptibility to oxidative damage in individuals with different forms ofα-thalassaemia. Br J Haematol 2005; 128:119-27. [PMID: 15606558 DOI: 10.1111/j.1365-2141.2004.05257.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
alpha-Thalassaemia is a common red cell disorder in Taiwan, affecting 6-8% of Taiwanese. Previous studies have shown that reactive oxygen species are generated in increased amounts in thalassaemic red cells. This implies the possible alteration of redox status in thalassaemic patients, which may adversely affect their health. In the present study, the redox status of patients with alpha-thalassaemia trait and haemoglobin H (Hb H) disease was investigated. Lipid peroxidation, as measured by the level of plasma thiobarbituric acid reactive substances (TBARS), was increased in alpha-thalassaemic patients, with the highest level of TBARS in Hb H disease patient. The plasma levels of vitamin A, C, and E were significantly lower in alpha-thalassaemic patients than in controls. The overall antioxidant capacity in plasma was inversely correlated with the severity of alpha-globin gene defect: the more severe the form of alpha-thalassaemia, the lower the overall antioxidant capacity in plasma. Erythrocytes isolated from alpha-thalassaemia patients had lower levels of vitamin E, glutathione, catalase and superoxide dismutase. In addition, these alpha-thalassaemic red cells were more susceptible to hydrogen peroxide-induced lipid peroxidation and decrease in deformability. All these data suggest that the alpha-thalassaemic patients suffer from increased oxidative stress and antioxidant deficit, which may complicate the pathophysiology of alpha-thalassaemia.
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Affiliation(s)
- Mei-Ling Cheng
- Graduate Institute of Medical Biotechnology & Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Kwei-san, Tao-yuan, Taiwan
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Brizzi P, Tonolo G, Bertrand G, Carusillo F, Severino C, Maioli M, Malaguarnera L, Musumeci S. Autoantibodies against oxidized low-density lipoprotein (ox-LDL) and LDL oxidation status. ACTA ACUST UNITED AC 2004; 42:164-70. [PMID: 15061355 DOI: 10.1515/cclm.2004.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractOxidized low-density lipoproteins (ox-LDLs) and their autoantibodies (OLAB) are involved in the development of atherosclerosis in animal models, but their role in humans is still not clear. For this reason we studied 54 patients with β-thalassemia major (TM), as a model of chronically low circulating LDLs with a high level of oxidation; 44 patients with primary hypercholesterolemia, as model of chronically high circulating LDLs; 24 type 2 diabetic mellitus patients (T2DM) before and after 3 months of atorvastatin treatment (20 mg/day), as a model of acute changes in circulating LDLs; and 41 normolipidemic subjects as a control group. ox-LDLs were measured by the determination of baseline diene concentration in the plasma LDL lipidic fraction after 12 hours fasting and were expressed as the amount of conjugated dienes/liter (BDC/l) or BDC/LDL-cholesterol (LDL-C), which indicate respectively LDL oxidation degree and status. OLABwere determined using an enzyme immunoassay and related to LDL oxidation degree (BDC/l). In TM, BDC/l was lower, while BDC/LDL-C was significantly higher, compared to both hypercholesterolemia and normolipidemic subjects. Patients with hypercholesterolemia had higher BDC/l, but lower BDC/LDL-C and OLAB/BDC-l, than normolipidemic subjects. In T2DM patients at diet, BDC/LDL-C and OLAB/BDC-l were lower than in normolipidemic subjects. After 3 months of atorvastatin treatment, BDC/LDL-C and OLAB/BDC-l ratios increased. When all patients were evaluated together, a significant inverse correlation was evident between OLABand either LDL or BDC/l. Our findings suggest that a relationship between OLABtiter and oxidation indices (BDC/l and BDC/LDL-C) does exist and we may speculate that an increase in OLAB/BDC-l ratio might be protective against the risk of atherosclerosis.
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Affiliation(s)
- Patrizia Brizzi
- Diabetes Service, Department of Medicine, University of Sassari, Sassari, Italy.
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23
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Gartaganis SP, Georgakopoulos CD, Exarchou A, Mela EK, Psachoulia C, Eliopoulou MI, Kourakli A, Gotsis SS, Tripathi RC. Alterations in conjunctival cytology and tear film dysfunction in patients with beta-thalassemia. Cornea 2003; 22:591-7. [PMID: 14508254 DOI: 10.1097/00003226-200310000-00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients with beta-thalassemia (beta-tha) represent a group with lifelong transfusion-dependent anemias. This study aimed to describe the conjunctival changes and tear film parameters in these patients. METHODS A total of 52 patients (104 eyes) with beta-tha major and 22 normal control subjects (44 eyes) were studied during 1999 through 2000. Tear film break-up time (BUT), Schirmer test, rose Bengal staining, and cytologic evaluation of the conjunctival epithelium were performed in all subjects. The Papanicolaou and May-Grümwald-Giemsa staining procedures were performed on all smears. Patients and control subjects were compared for tear function parameters and conjunctival changes. RESULTS The BUT, Schirmer test, and rose Bengal staining values were significantly lower (P < 0.001) in beta-tha patients than in control subjects. Keratinized cells were observed in conjunctival samples in 41% of patients, with a decrease in the number of goblet cells per slide in 64% of patients. In 9% of beta-tha patients, there were a slightly greater number of inflammatory cells than in control eyes. CONCLUSION Ocular surface disorder of these patients was characterized by goblet cell loss and conjunctival squamous metaplasia. Our findings were correlated positively with the variable age. Epithelial damage by toxic reaction and disorder of tear quality and quantity are implicated as important factors in the pathogenesis of the ocular surface disease in beta-tha patients.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmmology, University of Patras Medical School, Patras, Grece.
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24
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Brizzi P, Isaja T, D'Agata A, Malaguarnera L, Malaguarnera M, Musumeci S. Oxidized LDL antibodies (OLAB) in patients with beta-thalassemia major. J Atheroscler Thromb 2003; 9:139-44. [PMID: 12226555 DOI: 10.5551/jat.9.139] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Thalassemic (TM) patients are subjected to peroxidative tissue injury because of continuous blood transfusions. It has been documented that circulating LDL from TM patients show marked oxidative modification, that could represent an event leading to atherogenesis. We investigated in 75 beta-TM patients the levels of oxidized LDL antibody (OLAB) to asses their correlation with total cholesterol, LDL and HDL cholesterol, triglycerides Apo A-1 and Apo B. OLAB/mg chol-LDL is greater in TM patients than healthy controls (p<0.001). No correlation was found between OLAB and age, sex of patients, mean blood consumption, mean serum ferritin, mean transaminases, PT, PTT, and fibrinogen. A significant positive correlation was found between OLAB and triglycerides in TM patients (p<0.001). Also a significant correlation was found between OLAB/mg chol-LDL and level of triglycerides in TM patients, but not with total cholesterol, LDL and HDL chols, Apo A-1 and Apo B. On the contrary in the healthy controls this correlation between OLAB and OLAB/mg chol-LDL versus triglycerides was negative and not significant. High levels of OLAB/mg chol-LDL in patients with beta-thalassemia, in absence of evident signs of atherosclerosis, suggest some regulatory mechanisms on the lipid peroxidation which modulate the deposition of ox-LDL in the macrophages and support the hypothesis that both serum iron and triglycerides are involved in the pathogenesis of LDL oxidation.
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Affiliation(s)
- Patrizia Brizzi
- Department of Internal Medicine, University of Sassari, Sassari, Italy
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25
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Brizzi P, Tonolo G, Carusillo F, Malaguarnera M, Maioli M, Musumeci S. Plasma lipid composition and LDL oxidation. Clin Chem Lab Med 2003; 41:56-60. [PMID: 12636050 DOI: 10.1515/cclm.2003.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Low-density lipoprotein (LDL) oxidation in vivo depends on lipid composition and on plasma antioxidant status. The aim of our study was to investigate the relationship between plasma lipid composition and LDL oxidation and, in particular, to explore whether LDL-cholesterol/triglycerides ratio (LDL-C/TG) and LDL-cholesterol/high-density lipoprotein (HDL)-cholesterol ratio (LDL-C/HDL-C) can be used as predictive parameters of LDL oxidation in vivo. In 87 volunteers over a wide range of age plasma lipids and LDL oxidation were studied. Blood was collected after 12 h overnight fast. LDL oxidation was estimated by the level of conjugated diene (BDC) in the lipid fraction isolated from plasma after gradient ultra-centrifugation. The results were expressed as micromol/l (BDC/l) to evaluate the level of oxidized LDL, and as nmol of BDC for mg of LDL-cholesterol (BDC/LDL-C) for the evaluation of LDL oxidation degree. BDC/l correlated significantly with age, total and LDL-C, apolipoprotein B and TG, while BDC/LDL-C negatively correlated with total cholesterol, apolipoprotein B, LDL/TG and LDL/HDL ratios. Age of subjects significantly correlated with total and LDL-C and apolipoprotein B. TG have a significant inverse correlation with HDL-C. Our results support the hypothesis that among the several factors involved in LDL oxidation the most important determinants are LDL/TG. Plasma triglycerides appear to be very important even when circulating cholesterol levels are within normal limits. Moreover, we found that the LDL/HDL ratio is also very important with regard to the putative protective role of HDL against LDL oxidation in vivo. In conclusion, plasma lipid parameters must be evaluated not only for their absolute values but also for their mutual ratios as expression of plasma lipid homeostasis. Both LDL/TG and LDL/HDL ratios can be used as predictive parameters of in vivo LDL oxidation.
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Affiliation(s)
- Patrizia Brizzi
- Diabetes Service, Department of Medicine, University of Sassari, Italy.
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26
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Lin KY, Chen YL, Shih CC, Pan JP, Chan WE, Chiang AN. Contribution of HDL-apolipoproteins to the inhibition of low density lipoprotein oxidation and lipid accumulation in macrophages. J Cell Biochem 2002; 86:258-67. [PMID: 12111995 DOI: 10.1002/jcb.10210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
High-density lipoprotein (HDL) is known as a protective factor against atherosclerosis. However, whether HDL-apolipoproteins (apo-HDL) contribute to the protection in arterial cells remains unclear. The localization patterns of human apolipoproteins in atherosclerotic arteries were determined using immunohistochemical examination. The results indicate that several apolipoproteins are retained in component cells of the coronary artery walls. To elucidate the possible roles of apo-HDL in the protection of atherosclerotic lesion formation, we investigated the effects of apo-HDL on the formation of conjugated diene (CD) in a cell-free system and thiobarbituric acid-reactive substances (TBARS) in the medium of a macrophage-mediated LDL oxidation system. The results showed that apo-HDL significantly exerted an inhibitory effect on LDL lipid oxidation in vitro. In addition, apo-HDL decreased cholesterol influx but enhanced cholesterol efflux from J774 macrophages in a dose-dependent manner. These results are consistent with the notion that there is reduced intracellular lipid accumulation in apo-HDL treated macrophages. These data provide a direct evidence for apo-HDL in protecting LDL from oxidative modification and in reducing the accumulation of cholesterol and lipid droplets by J774 macrophages.
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Affiliation(s)
- Kae-Yuan Lin
- Institute of Biochemistry, National Yang-Ming University, Taipei 112, Taiwan, Republic of China
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27
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Hartman C, Tamary H, Tamir A, Shabad E, Levine C, Koren A, Shamir R. Hypocholesterolemia in children and adolescents with beta-thalassemia intermedia. J Pediatr 2002; 141:543-7. [PMID: 12378195 DOI: 10.1067/mpd.2002.127498] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To conduct a prospective study to evaluate the lipid profile in children and adolescents with beta-thalassemia intermedia and major, and to examine the contribution of different factors to hypocholesterolemia observed in these patients. STUDY DESIGN Demographic, clinical, and laboratory data were prospectively obtained from patients with beta-thalassemia intermedia (n = 9) and major (n = 47). Lipid profiles were also determined in a control group of healthy children (n = 18). Lipid values of beta-thalassemics and controls were compared and the relationships between lipid levels and different covariates were determined. RESULTS beta-thalassemia intermedia patients had significantly lower total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) compared with beta-thalassemia major and controls (P <.001). With regression analysis, serum lipid levels (TC, HDL-C, and triglycerides) correlated with diagnosis (beta-thalassemia major or intermedia) but not with age, sex, hemoglobin, or ferritin. LDL-C was influenced by both diagnosis and ferritin levels. CONCLUSIONS Children and adolescents with beta-thalassemia intermedia have significantly lower cholesterol levels than patients with beta-thalassemia major. This is related to their disorder and not influenced by age, sex, hemoglobin, or ferritin levels. In these patients, needless investigations for hypolipidemia should be avoided.
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Affiliation(s)
- Corina Hartman
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Rambam Medical Center, Haifa, Israel
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28
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Zhao SP, Xu DY. Oxidized lipoprotein(a) enhanced the expression of P-selectin in cultured human umbilical vein endothelial cells. Thromb Res 2000; 100:501-10. [PMID: 11152930 DOI: 10.1016/s0049-3848(00)00363-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lipoprotein(a) [Lp(a)] has been demonstrated to be an independent risk factor for coronary heart disease. However, the precise mechanism by which it contributes to the development of atherosclerosis remains unclear. P-selectin is one of the major adhesion molecules to mediate the interaction between monocytes, platelets and endothelial cells. Increased expression of P-selectin has been frequently found in atherosclerotic lesions. The present study assessed the effects of native and oxidized LDL (n-LDL and ox-LDL) and Lp(a) (n-Lp(a) and ox-Lp(a)) on the expression of P-selectin in cultured human umbilical vein endothelial cells (HUVECs). Cell ELISA was used to measure the expression of P-selectin in HUVECs and monocyte adhesion assay was used to detect whether the P-selectin expressed in HUVECs was functional. P-selectin mRNA expression in HUVECs was determined by Northern blot. Results showed that P-selectin protein expression was not influenced by n-LDL, but was moderately increased by ox-LDL and n-Lp(a). ox-Lp(a) was the most potent stimulus for P-selectin expression, increasing it in HUVECs by 144 +/- 10% at 10 nmol/l and 202 +/- 22% at 20 nmol/l. In addition, it showed that dose dependency induced monocyte adherence to endothelial cells after incubation of HUVECs with ox-Lp(a). Northern blot analysis demonstrated that the amount of P-selectin mRNA was markedly increased after treatment with ox-Lp(a) but not with n-LDL, ox-LDL and n-Lp(a). These results demonstrate that ox-Lp(a) can induce P-selectin expression in HUVECs, which may thereby influence the pathogenesis of athersclerosis.
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Affiliation(s)
- S P Zhao
- Department of Cardiology, the Second Affiliated Hospital, Hunan Medical University, 410011, Changsha, China.
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Belcher JD, Marker PH, Geiger P, Girotti AW, Steinberg MH, Hebbel RP, Vercellotti GM. Low-density lipoprotein susceptibility to oxidation and cytotoxicity to endothelium in sickle cell anemia. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 1999; 133:605-12. [PMID: 10360636 DOI: 10.1016/s0022-2143(99)90191-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with sickle-cell anemia exhibit pro-oxidative metabolic perturbations. We hypothesize that because of chronic oxidative stress, plasma low-density lipoprotein (LDL) from patients with sickle-cell anemia is more susceptible to oxidation. To test this hypothesis, LDL susceptibility to copper-mediated oxidation was measured in 24 patients with sickle-cell anemia and 48 control subjects. Sickle-cell LDL was more susceptible to oxidation than control LDL, measured by a 22% shorter mean lag time between LDL exposure to CuSO4 and conjugated diene formation (97 vs 124 minutes; P = .023). LDL vitamin E, iron, heme, and cholesterol ester hydroperoxide (CEOOH) levels were also measured. LDL vitamin E levels were significantly lower in patients with sickle-cell anemia compared with control subjects (1.8 vs 2.9 mol/mol LDL; P = .025), but there was no correlation with lag time. Pro-oxidant heme and iron levels were the same in sickle-cell and control LDL. LDL CEOOHs were not significantly different in sickle and control LDL (3.1 vs 1.2 mmol/mol of LDL unesterified cholesterol, P = .15), but LDL CEOOH levels were inversely correlated with lag times in patients with sickle-cell anemia (r2 = 0.38; P = .018). The cytotoxicity of partially oxidized LDL to porcine aortic endothelial cells was inversely correlated with lag times (r2 = 0.48; P = .001). These preliminary data suggest that increased LDL susceptibility to oxidation could be a marker of oxidant stress and vasculopathy in patients with sickle-cell anemia.
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Affiliation(s)
- J D Belcher
- Department of Medicine, University of Minnesota, Minneapolis 55455, USA
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30
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Abstract
We investigated the oxidative state of low-density lipoprotein (LDL) in patients with β-thalassemia to determine whether there was an association with atherogenesis. Conjugated diene lipid hydroperoxides (CD) and the level of major lipid antioxidants in LDL, as well as modified LDL protein, were evaluated in 35 β-thalassemia intermedia patients, aged 10 to 60, and compared with age-matched healthy controls. Vitamin E and β-carotene levels in LDL from patients were 45% and 24% of that observed in healthy controls, respectively. In contrast, the mean amount of LDL-CD was threefold higher and lysil residues of apo B-100 were decreased by 17%. LDL-CD in thalassemia patients showed a strong inverse correlation with LDL vitamin E (r = −0.784; P < .0001), while a negative trend was observed with LDL-β–carotene (r = −0.443; P = .149). In the plasma of thalassemia patients, malondialdehyde (MDA), a byproduct of lipid peroxidation, was increased by about twofold, while vitamin E showed a 52% decrease versus healthy controls. LDL-CD were inversely correlated with plasma vitamin E (r = −0.659; P < .0001) and correlated positively with plasma MDA (r = 0.621; P < .0001). Plasma ferritin was positively correlated with LDL-CD (r = 0.583; P =.0002). No correlation was found between the age of the patients and plasma MDA or LDL-CD. The LDL from thalassemia patients was cytotoxic to cultured human fibroblasts and cytotoxicity increased with the content of lipid peroxidation products. Clinical evidence of mild to severe vascular complications in nine of the patients was then matched with levels of LDL-CD, which were 36% to 118% higher than the mean levels of the patients. Our results could account for the incidence of atherogenic vascular diseases often reported in β-thalassemia patients. We suggest that the level of plasma MDA in β-thalassemia patients may represent a sensitive index of the oxidative status of LDL in vivo and of its potential atherogenicity.
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Abstract
AbstractWe investigated the oxidative state of low-density lipoprotein (LDL) in patients with β-thalassemia to determine whether there was an association with atherogenesis. Conjugated diene lipid hydroperoxides (CD) and the level of major lipid antioxidants in LDL, as well as modified LDL protein, were evaluated in 35 β-thalassemia intermedia patients, aged 10 to 60, and compared with age-matched healthy controls. Vitamin E and β-carotene levels in LDL from patients were 45% and 24% of that observed in healthy controls, respectively. In contrast, the mean amount of LDL-CD was threefold higher and lysil residues of apo B-100 were decreased by 17%. LDL-CD in thalassemia patients showed a strong inverse correlation with LDL vitamin E (r = −0.784; P < .0001), while a negative trend was observed with LDL-β–carotene (r = −0.443; P = .149). In the plasma of thalassemia patients, malondialdehyde (MDA), a byproduct of lipid peroxidation, was increased by about twofold, while vitamin E showed a 52% decrease versus healthy controls. LDL-CD were inversely correlated with plasma vitamin E (r = −0.659; P < .0001) and correlated positively with plasma MDA (r = 0.621; P < .0001). Plasma ferritin was positively correlated with LDL-CD (r = 0.583; P =.0002). No correlation was found between the age of the patients and plasma MDA or LDL-CD. The LDL from thalassemia patients was cytotoxic to cultured human fibroblasts and cytotoxicity increased with the content of lipid peroxidation products. Clinical evidence of mild to severe vascular complications in nine of the patients was then matched with levels of LDL-CD, which were 36% to 118% higher than the mean levels of the patients. Our results could account for the incidence of atherogenic vascular diseases often reported in β-thalassemia patients. We suggest that the level of plasma MDA in β-thalassemia patients may represent a sensitive index of the oxidative status of LDL in vivo and of its potential atherogenicity.
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