1
|
Gauer JS, Ajanel A, Kaselampao LM, Candir I, MacCannell AD, Roberts LD, Campbell RA, Ariëns RA. Plant-derived compounds normalize platelet bioenergetics and function in hyperglycemia. Res Pract Thromb Haemost 2024; 8:102548. [PMID: 39309231 PMCID: PMC11416496 DOI: 10.1016/j.rpth.2024.102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/16/2024] [Accepted: 08/08/2024] [Indexed: 09/25/2024] Open
Abstract
Background Polyphenols have been shown to decrease oxidative stress and modulate glycemic response. Nevertheless, their effect on platelet bioenergetics and clot structure in diabetes and hyperglycemia is unknown. Objectives To investigate the effect of polyphenols on human platelet bioenergetics and its subsequent effect on clot structure in normoglycemia vs acute hyperglycemia in vitro. Methods Four polyphenols (resveratrol, hesperetin, epigallocatechin gallate [EGCG], and quercetin) were selected for initial analysis. Healthy volunteers' isolated platelets/platelet-rich plasma were treated with 5 or 25 mM glucose to represent normoglycemia and acute hyperglycemia, respectively. Platelet-derived reactive oxygen species (ROS), citrate synthase activity (mitochondrial density), mitochondrial calcium flux, and mitochondrial respiration were performed following exposure to polyphenols (20 µM, 1 hour) to determine their effects on platelet bioenergetics. Procoagulant platelets (annexin V) and fibrin fiber density (Alexa Fluor-488 fibrinogen; Invitrogen) were analyzed by laser scanning confocal microscopy, while clot porosity was determined using platelet-rich plasma following exposure to polyphenols (20 µM, 20 minutes). Results Acute hyperglycemia increased ROS, mitochondrial calcium flux, maximal respiration, and procoagulant platelet number. Resveratrol, quercetin, and EGCG reduced platelet ROS in normoglycemic and acute hyperglycemic conditions. Mitochondrial density was decreased by quercetin and EGCG in normoglycemia. Resveratrol and EGCG reduced mitochondrial calcium flux in acute hyperglycemia. Resveratrol also decreased procoagulant platelet number and attenuated oxygen consumption rate in normoglycemia and acute hyperglycemia. No effect of hyperglycemia or polyphenols was observed on fibrin fiber density or clot pore size. Conclusion Our results suggest polyphenols attenuate increased platelet activity stemming from hyperglycemia and may benefit thrombosis-preventative strategies in patients with diabetes.
Collapse
Affiliation(s)
- Julia S. Gauer
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Abigail Ajanel
- Molecular Medicine Program, University of Utah, Salt Lake City, UT 84112, USA
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Lutale M. Kaselampao
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Isabel Candir
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Amanda D.V. MacCannell
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Lee D. Roberts
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Robert A. Campbell
- Molecular Medicine Program, University of Utah, Salt Lake City, UT 84112, USA
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA
- Department of Emergency, Washington University, Saint Louis, MO 63110, USA
| | - Robert A.S. Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
2
|
Zajda A, Sikora J, Hynninen M, Tampio J, Huttunen KM, Markowicz-Piasecka M. Substituent effects of sulfonamide derivatives of metformin that can dually improve cellular glucose utilization and anti-coagulation. Chem Biol Interact 2023; 373:110381. [PMID: 36746201 DOI: 10.1016/j.cbi.2023.110381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 02/07/2023]
Abstract
Metformin, the most frequently prescribed medicine for the management of type 2 diabetes, has been shown to reduce cardiovascular events in diabetic patients in pre-clinical and clinical studies. The present work reports the design, synthesis, and biological assessment of the impact of six benzenesulfonamide biguanides on various aspects of hemostasis, cell function, red blood cell integrity (RBC), and their ability to uptake glucose in human umbilical endothelial cells (HUVECs). It was found that all synthesized o- and m-benzenesulfonamides, particularly derivatives with nitro (3) and amino groups (4), are characterized by a good safety profile in HUVECs, which was further confirmed in the cellular integrity studies. The biguanide analogues with methoxy group (1, 2) and an amino substituent (5, 6) significantly increased glucose utilization in HUVECs, similarly to the parent drug. Intriguingly, compounds 1, 3, and 6 favourably influenced some of the coagulation parameters. Furthermore, derivative 3 also slowed the process of fibrin polymerization, indicating more beneficial anti-coagulant properties than metformin. None of the novel metformin analogues interact strongly with the erythrocyte lipid-protein bilayer. Our findings indicate that derivative 3 has highly desirable anti-coagulant properties, and compounds 1 and 6 have potential dual-action activity, including anti-hyperglycaemic properties and anti-coagulant activity. As such, these derivatives can be used as lead molecules for further development of anti-diabetic agents with a beneficial effect on hypercoagulability.
Collapse
Affiliation(s)
- Agnieszka Zajda
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego1, 90-151, Lodz, Poland.
| | - Joanna Sikora
- Department of Bioinorganic Chemistry, Medical University of Lodz, ul. Muszyńskiego1, 90-151, Lodz, Poland.
| | - Mira Hynninen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Janne Tampio
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Kristiina M Huttunen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Magdalena Markowicz-Piasecka
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego1, 90-151, Lodz, Poland.
| |
Collapse
|
3
|
Valproic acid influences the expression of genes implicated with hyperglycaemia-induced complement and coagulation pathways. Sci Rep 2021; 11:2163. [PMID: 33495488 PMCID: PMC7835211 DOI: 10.1038/s41598-021-81794-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023] Open
Abstract
Because the liver plays a major role in metabolic homeostasis and secretion of clotting factors and inflammatory innate immune proteins, there is interest in understanding the mechanisms of hepatic cell activation under hyperglycaemia and whether this can be attenuated pharmacologically. We have previously shown that hyperglycaemia stimulates major changes in chromatin organization and metabolism in hepatocytes, and that the histone deacetylase inhibitor valproic acid (VPA) is able to reverse some of these metabolic changes. In this study, we have used RNA-sequencing (RNA-seq) to investigate how VPA influences gene expression in hepatocytes. Interesting, we observed that VPA attenuates hyperglycaemia-induced activation of complement and coagulation cascade genes. We also observe that many of the gene activation events coincide with changes to histone acetylation at the promoter of these genes indicating that epigenetic regulation is involved in VPA action.
Collapse
|
4
|
Markowicz-Piasecka M, Huttunen KM, Broncel M, Sikora J. Sulfenamide and Sulfonamide Derivatives of Metformin - A New Option to Improve Endothelial Function and Plasma Haemostasis. Sci Rep 2019; 9:6573. [PMID: 31024058 PMCID: PMC6484023 DOI: 10.1038/s41598-019-43083-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/16/2019] [Indexed: 12/30/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a multi-factorial disease which can cause multiple organ dysfunction, including that of the vascular endothelium. The aim of the present study was to evaluate the effects of metformin, and its sulfenamide and sulfonamide derivatives (compounds 1–8) on the selected markers of endothelial function and blood coagulation. The integrity of endothelial cells(ECs) was examined using the real-time cell electric impedance system. Tissue Factor(TF) production, the release of von Willebrand Factor (vWF) and tissue plasminogen activator(t-PA) from ECs were determined using immunoenzymatic assays, while the process of platelet thrombus formation using the Total Thrombus-Formation Analysis System. Sulfenamide with n-butyl alkyl chain(3) does not interfere with ECs integrity, and viability (nCI(24h) = 1.03 ± 0.03 vs. 1.06 ± 0.11 for control), but possesses anticoagulation properties manifested by prolonged platelet-dependent thrombus formation (Occlusion Time 370.3 ± 77.0 s vs. 286.7 ± 65.5 s for control) in semi-physiological conditions. Both p- and o-nitro-benzenesulfonamides (compounds7,8) exhibit anti-coagulant properties demonstrated by decreased vWF release and prolonged parameters of platelet thrombus formation and total blood thrombogenicity. In conclusion, chemical modification of metformin scaffold into sulfenamides or sulfonamides might be regarded as a good starting point for the design and synthesis of novel biguanide-based compounds with anticoagulant properties and valuable features regarding endothelial function.
Collapse
Affiliation(s)
- Magdalena Markowicz-Piasecka
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego1, 90-151, Lodz, Poland.
| | - Kristiina M Huttunen
- School Of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1C, POB 1627, 70211, Kuopio, Finland
| | - Marlena Broncel
- Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, Kniaziewicza 1/5, 91-347, Lodz, Poland
| | - Joanna Sikora
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego1, 90-151, Lodz, Poland
| |
Collapse
|
5
|
Abstract
Major known effects of the metabolic derangements of diabetes in haemostasis are induction of platelet-vascular activation by hyperglycaemia, the increase in fibrinogen, modification of fibrin substrate by glucose and hypofibrinolysis related to insulin resistance. The platelet effects are specifically expressed during high shear stress and may be relevant in particular for developing of micro-angiopathy. Hypofibrinolysis, increased fibrinogen and modifications of fibrin may aggravate microthrombosis and organ damage and contribute to precipitation of coronary and cerebral infarction. In addition to specific anti-diabetic medication to reduce the haemostatic effects, specific antiplatelet and profibrinolytic treatments may be relevant for reducing further the morbidity and mortality in diabetics for both micro- and macro-angiopathy.
Collapse
Affiliation(s)
- Cornelis Kluft
- Gaubius Laboratory, TNO-PG, Leiden, The Netherlands, Thrombosis Institute, University of Southern Denmark, Esbjerg, Denmark,
| | - Jorgen Jespersen
- Thrombosis Institute, University of Southern Denmark, Esbjerg, Denmark
| |
Collapse
|
6
|
Miller WM, Nori Janosz KE, Yanez J, McCullough PA. Effects of weight loss and pharmacotherapy on inflammatory markers of cardiovascular disease. Expert Rev Cardiovasc Ther 2014; 3:743-59. [PMID: 16076283 DOI: 10.1586/14779072.3.4.743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Obesity is currently an epidemic, and the prevalence of cardiovascular risk factors is increasing dramatically as a result. Visceral adiposity is correlated with a proinflammatory and prothrombotic state that is believed to promote atherosclerosis and acute coronary syndromes. This article will review clinical trials on the effects of weight loss and pharmacotherapy on obesity associated inflammatory and thrombotic markers linked with cardiovascular disease.
Collapse
Affiliation(s)
- Wendy M Miller
- Beaumont Health Center, Weight Control Center, Division of Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, 4949 Coolidge Highway, Royal Oak, MI 48078, USA.
| | | | | | | |
Collapse
|
7
|
Rojas E, Velasco M, Bermúdez V, Israili Z, Bolli P. Targeting hypertension in patients with cardiorenal metabolic syndrome. Curr Hypertens Rep 2012; 14:397-402. [PMID: 22846983 DOI: 10.1007/s11906-012-0292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Diabetes mellitus coexisting with hypertension is greater than chance alone would predict. Hypertensive patients have been shown to have altered composition of skeletal muscle tissue, decreased blood flow to skeletal muscle and post-receptor signaling alterations in the IRS insulin pathway, all inducing insulin resistance states, which partially explains why blood pressure goals in DM patients are lower than in normoglycemic patients. Although optimal first-step antihypertensive drug therapy in type 2 DM or impaired fasting glucose levels (IFG) should be individualized for each patient, converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have been demonstrated in some but not all studies to decrease the rate of development of proteinuria and diabetic renal disease. According to the ACCF/AHA 2011 Expert Consensus, elderly persons with diabetes, hypertension, and nephropathy should be initially treated with ACEIs or ARBs, although the choice of a specific antihypertensive may also depend on other associated comorbidities.
Collapse
Affiliation(s)
- Edward Rojas
- Endocrine and Metabolic Diseases Research Centre "Dr. Felix Gomez", University of Zulia, Maracaibo, Venezuela.
| | | | | | | | | |
Collapse
|
8
|
Adiponectin, Non-Esterified Fatty Acids and Antiphospholipid Antibodies in Type II Diabetes Mellitus. J Med Biochem 2012. [DOI: 10.2478/v10011-012-0009-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adiponectin, Non-Esterified Fatty Acids and Antiphospholipid Antibodies in Type II Diabetes MellitusThe importance of the association of antiphospholipid antibodies (aPL Abs) with the features of type II diabetes mellitus has not yet been elucidated. The aim of this work was to investigate the association of aPL Abs with adiponectin and non-esterified fatty acids (NEFA) in type II diabetes mellitus patients without micro and/or macrovascular complications, and to analyze the differences between the male and female patients with regard to the abovementioned parameters. Male patients with type II diabetes mellitus showed a positive correlation between NEFA concentrations and anti-oxLDL antibodies (r=0.334, p=0.019). A weak, but statistically significant correlation between adiponectin concentrations and the IgM isotype of anti-annexin A5 antibodies was found in type II diabetes mellitus patients (r=0.285, p=0.011). The presence of a positive correlation between NEFA and anti-oxLDL antibodies might be useful in the detection of patients with premature atherosclerosis in type II diabetes mellitus patients without any micro and/or macrovascular complications among type II diabetes mellitus patients.
Collapse
|
9
|
Becarevic M, Seferovic J, Ignjatovic S, Singh S, Majkic-Singh N. Significant association of antiphospholipid antibodies and TNF-alpha: marker of severe atherogenic profile of patients with type II diabetes mellitus without micro and/or macrovascular complications. Cytokine 2011; 55:301-6. [PMID: 21621418 DOI: 10.1016/j.cyto.2011.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 04/19/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In vitro, stimulation of monocytes with antiphospholipid (aPL) antibodies resulted in increased secretion of TNF-alpha, but association of aPL with features of diabetes mellitus is not clarified yet. Therefore, we investigated the distribution of anticardiolipin (aCL), anti-β2gpI (aβ2gpI), anti-annexin A5 (aannxA5), and anti-oxLDL (aoxLDL) antibodies, and TNF-alpha in well-formed group of 78 patients with type II diabetes mellitus without vascular complications. METHODS Investigated antibodies and TNF-alpha concentrations were measured by ELISA. RESULTS Antiphospholipid antibodies were in positive correlation with TNF-alpha concentrations: aCL IgG (r=0.303, p=0.007), aCL IgM (r=0.386, p=0.000), aβ2gpI IgG (r=0.499, p=0.000), aβ2gpI IgM (r=0.462, p=0.000), aanxA5 IgG (r=0.479, p=0.000), aanxA5 IgM (r=0.641, p=0.000), aoxLDL (IgG+IgM, r=0.279, p=0.000). Anticardiolipin-positive and aCL-negative subgroups differed in TNF-alpha concentrations (Mann-Whitney, p=0.032). Significantly elevated LDL concentrations were noticed in aCL-positive patients with disease duration 10-15 years (χ(2)=15.000, p=0.000) and apoB concentrations were elevated in aoxLDL-positive patients with disease duration 7-10 years (χ(2)=3.938, p=0.047). CONCLUSION Significant association of antiphospholipid antibodies and TNF-alpha might be a marker of severe atherogenic profile (suggested by increased levels of lipids in aPL-positive subgroups) and should be used for the stratification of patients with an increased risk for future deterioration of the disease.
Collapse
|
10
|
Abstract
INTRODUCTION Type 2 diabetes mellitus is one of the most important cardiovascular risk factors. Insulin-resistance represents the common mechanism that leads to type 2 diabetes in obese subjects. Pioglitazone is an insulin-sensitizing agent available for treatment of type 2 diabetes. Large clinical trials have demonstrated the effectiveness of pioglitazone in achieving metabolic control and reducing cardiovascular morbidity and mortality. AIM The purpose of this article is to review the effectiveness and tolerability of pioglitazone in the prevention and management of atherosclerosis in patients with type 2 diabetes. EVIDENCE REVIEW We reviewed the main monotherapy and comparative studies of pioglitazone, and particularly the recent evidence in the field of atherosclerosis and cardiovascular prevention. PLACE IN THERAPY The current evidence shows that pioglitazone is an effective option in the treatment of type 2 diabetes. More studies are needed to establish a role for pioglitazone in atherosclerosis prevention beyond glycemic control.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Sibilla AT Salvadeo
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| |
Collapse
|
11
|
Carrizo E, Fernández V, Quintero J, Connell L, Rodríguez Z, Mosquera M, Acosta A, Baptista T. Coagulation and inflammation markers during atypical or typical antipsychotic treatment in schizophrenia patients and drug-free first-degree relatives. Schizophr Res 2008; 103:83-93. [PMID: 18436434 DOI: 10.1016/j.schres.2008.03.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/02/2008] [Accepted: 03/05/2008] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clinical studies suggest that the second generation antipsychotics (APs) clozapine and olanzapine and to a lesser extent the typical antipsychotics may be associated with a procoagulant and proinflammatory state that promotes venous thromboembolism. We evaluated here several blood factors associated with coagulation and inflammation in AP-treated schizophrenia patients and their first-degree relatives. METHODS Procoagulant factors (fibrinogen and plasminogen activator inhibitor [PAI-1]), the anticoagulant factor antithrombin III [AT-III], and inflammation-related factors (C-reactive protein [CRP] and leptin) were assessed in patients chronically treated with clozapine (n=29), olanzapine (n=29), typical APs (n=30) and first degree relatives of clozapine (n=23) and olanzapine subjects (n=11). RESULTS The typical AP group had the highest CRP level (p=0.013) in spite of having the lowest body mass index (BMI). Patients as a single group had higher CRP levels than relatives (p=0.003). The typical AP group also had the highest AT-III levels (p=0.021). Fibrinogen levels did not differ between the groups (p=0.13). Olanzapine patients displayed the highest PAI-1 and leptin levels among the drug-treated subjects, but values were similar to those observed in their relatives, and were significantly correlated with the BMI. CONCLUSIONS A homogeneous negative profile of high inflammation and procoagulant factors along with low levels of anticoagulants was not detected in any group. While preliminary, our results suggest that the observed abnormalities were not related to a direct drug effect, but to elevated BMI (high PAI-1 and leptin in olanzapine-treated patients). We speculate that the high CRP in the typical AP group might be related to poor lifestyle habits, but this must we confirmed in future studies.
Collapse
Affiliation(s)
- Edgardo Carrizo
- Institute of Clinical Research Dr. Américo Negrette, Zulia University Medical School, and University Psychiatric Hospital, Maracaibo, Venezuela
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Lee KW, Blann AD, Jolly K, Lip GYH. Plasma haemostatic markers, endothelial function and ambulatory blood pressure changes with home versus hospital cardiac rehabilitation: the Birmingham Rehabilitation Uptake Maximisation Study. Heart 2006; 92:1732-8. [PMID: 16807272 PMCID: PMC1861270 DOI: 10.1136/hrt.2006.092163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation is an accepted therapeutic intervention in patients after myocardial infarction or coronary revascularisation. The effects of cardiac rehabilitation programmes, whether home based or hospital based, on haemostatic indices (as reflected by fibrinogen, plasma viscosity, fibrin D-dimer (an index of thrombogenesis), von Willebrand factor (vWf, an index of endothelial damage/dysfunction), soluble P-selectin (an index of platelet activation)), vasomotor function (using flow-mediated dilatation (FMD)) and ambulatory blood pressure (ABP) in patients with coronary heart disease are unknown. METHODS 81 patients (66 men, mean (SD) 59 (11) years) after myocardial infarction or coronary revascularisation were randomised to comprehensive hospital-based (n = 40) or home-based (n = 41) cardiac rehabilitation. Plasma levels of vWf, D-dimer, fibrinogen, soluble P-selectin and plasma viscosity, as well as FMD and 24-h ABP, were measured at baseline and after 3 months of cardiac rehabilitation. RESULTS In patients who completed cardiac rehabilitation, levels of vWf, fibrinogen and D-dimer were significantly lower and FMD improved (all p<or=0.001), whereas levels were unchanged in controls. Significant reductions were also observed in 24-h mean systolic blood pressure, diastolic blood pressure and mean aortic pressure after completion of cardiac rehabilitation (all p<0.05). No significant differences were observed between the hospital-based and home-based cardiac rehabilitation programmes on these indices. CONCLUSIONS Cardiac rehabilitation improves haemostasis, endothelial function and ABP in patients with coronary heart disease, with no significant differences between home-based and hospital-based cardiac rehabilitation programmes. These effects may contribute to the beneficial effects of cardiac rehabilitation programmes on CV outcomes.
Collapse
Affiliation(s)
- K W Lee
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK
| | | | | | | |
Collapse
|
13
|
Tarkun I, Hacihanefioğlu A, Tarkun P, Cetinarslan B, Cantürk Z. Anticardiolipin and anti-beta2 glycoprotein I antibody concentrations in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2005; 68:181-7. [PMID: 15936458 DOI: 10.1016/j.diabres.2004.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Revised: 09/03/2004] [Accepted: 09/13/2004] [Indexed: 10/26/2022]
Abstract
Anticardiolipin and anti-beta2 glycoprotein I antibodies are associated with an increased tendency to thrombosis by various mechanisms. This study aimed to evaluate the association between micro and macrovascular complications of diabetes and anticardiolipin and anti-beta2 glycoprotein I antibodies. Forty-six patients with type 2 diabetes mellitus (T2DM) were studied. Twenty-one patients had coronary artery disease as a macrovascular complication. Twenty-five age and sex matched healthy subjects formed a control group. Anticardiolipin IgM, IgG, anti-beta2 glycoprotein IgM and IgG antibody levels were studied in both patient and control groups. Diabetic patients with ischaemic heart disease had significantly higher titres of anticardiolipin IgG antibody than patients without ischaemic heart disease (P < 0.001). However, none of these patients had an anticardiolipin IgG antibody level higher than 20 GPL, which is accepted as a clinically significant value, so this association may not be clinically important. There was no association with the microvascular complications. There was also no significant association between anti-beta2 glycoprotein I antibodies in type 2 diabetic patients and micro and macrovascular complications. Anticardiolipin and anti-beta2 glycoprotein I antibodies do not have a major role in the pathogenesis of diabetic complications in type 2 diabetic patients. Prospective studies of large populations are needed to explore this association further.
Collapse
Affiliation(s)
- Ilhan Tarkun
- Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey.
| | | | | | | | | |
Collapse
|
14
|
Tentolouris N, Boutati E, Karambakalis N, Perrea D, Tselepis AD, Tsoukala C, Kyriaki D, Lourida E, Anastasopoulou I, Karafoullidou A, Raptis SA, Katsilambros N. Acute nateglinide administration in subjects with type 2 diabetes: effects on postprandial metabolism, coagulation, and fibrinolysis. Nutr Metab Cardiovasc Dis 2005; 15:6-12. [PMID: 15871845 DOI: 10.1016/j.numecd.2004.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Revised: 06/18/2004] [Accepted: 06/18/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Postprandial glycaemia and lipaemia are known risk factors for atherosclerosis in type 2 diabetes. Coagulation activation in the postprandial state also contributes to acceleration of atherosclerosis. Nateglinide is effective in reducing postprandial glycaemia. Its effect on glycaemia may also be beneficial in postprandial lipaemia and coagulation. The aim of this study was to examine the potential effect of a single dose of nateglinide on postprandial triglyceridaemia, coagulation, and fibrinolysis in patients with type 2 diabetes. METHODS AND RESULTS Ten subjects with type 2 diabetes, treated with diet alone were recruited in a crossover randomized study. In the morning, after a 12- to 14-h fast, each subject received a standard mixed meal (total energy 783 kcal), preceded by one tablet of 120 mg nateglinide or placebo. Venous blood samples were drawn prior to meal consumption and 6h afterwards for the measurement of plasma glucose, insulin, and C-peptide, lipids, coagulation, and fibrinolysis factors. As expected, there was a significant reduction in postprandial glycaemia after nateglinide administration compared to placebo (P<0.001). Plasma insulin levels were significantly higher after nateglinide than after placebo (P=0.002). Nateglinide administration resulted in a lower overall postprandial reduction of tissue-plasminogen activator than placebo (-2.9+/-1.3 vs. -8.3+/-3.7 ng/ml h, P=0.003). In addition, a significant reduction of postprandial plasminogen activator inhibitor-1 was observed in comparison with the baseline values after nateglinide (P=0.001), although the overall response was not significantly different after nateglinide and placebo (P=0.31). Plasma concentrations of C-peptide, lipids and the remaining coagulation parameters studied were not different between nateglinide and placebo. CONCLUSIONS Acute nateglinide administration improves postprandial glycaemia and fibrinolytic activity in patients with type 2 diabetes. This combined effect, if confirmed by a long-treatment study, might reduce cardiovascular risk in type 2 diabetes.
Collapse
Affiliation(s)
- N Tentolouris
- First Department of Propaedeutic Medicine, Laiko Hospital, Athens University Medical School, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Sommeijer DW, Florquin S, Hoedemaker I, Timmerman JJ, Reitsma PH, Ten Cate H. Renal Tissue Factor Expression Is Increased in Streptozotocin-Induced Diabetic Mice. ACTA ACUST UNITED AC 2005; 101:e86-94. [PMID: 15990447 DOI: 10.1159/000086646] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 04/04/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tissue factor (TF) is the key initiator of the coagulation cascade. Recent evidence suggests that TF plays a role in renal fibrin formation and renal failure in experimental kidney disease. We hypothesized that hyperglycemia is an important stimulus of TF expression in the kidney. METHODS Mice were injected with streptozotocin (STZ) (200 mg/kg) or with control buffer. Three or 10 weeks after injection, fibrin, thrombin and TF staining and TF activity were evaluated in the kidney. The effect of hyperglycemia on TF expression and secretion by tubular epithelial cells was measured in vitro. RESULTS Kidneys of STZ-treated mice showed a marked increase in thrombin staining (3.0 +/- 0.5 vs. 1.2 +/- 0.11) (p = 0.002) and an increase in TF clotting activity 10 weeks after STZ injection (33.9 +/- 1.3 vs. 25.4 +/- 1.0 s) (p < 0.0001). Increased glomerular fibrin deposition was present in 3 out of 6 diabetic mice. Tubular cells incubated with D-glucose (25 mmol/l) for 48 h displayed increased cellular TF (p = 0.05). However, soluble TF levels and TF activity in supernatant of cells incubated with D- or L-glucose were not different. CONCLUSIONS These data suggest that hyperglycemia is a causal factor in procoagulant activity associated with diabetic nephropathy.
Collapse
Affiliation(s)
- Dirkje W Sommeijer
- Laboratory for Experimental Internal Medicine, AMC, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
16
|
Affiliation(s)
- Susan J Appel
- Graduate Division, School of Nursing, University of Alabama at Birmingham, Birmingham, USA
| | | | | |
Collapse
|
17
|
Baptista T, De Mendoza S, Beaulieu S, Bermúdez A, Martinez M. The Metabolic Syndrome During Atypical Antipsychotic Drug Treatment: Mechanisms and Management. Metab Syndr Relat Disord 2004; 2:290-307. [DOI: 10.1089/met.2004.2.290] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Trino Baptista
- Department of Physiology, Los Andes University Medical School, Mérida, Venezuela
| | | | - Serge Beaulieu
- Douglas Hospital Research Center, McGill University, Verdun, Quebec, Canada
| | - Andrés Bermúdez
- Department of Endocrinology, Los Andes University, Mérida, Venezuela
| | - Maritza Martinez
- Department of Psychiatry, Los Andes University, Mérida, Venezuela
| |
Collapse
|
18
|
Affiliation(s)
- Juhana Karha
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | | |
Collapse
|
19
|
Baptista T, Kin NMKNY, Beaulieu S. Treatment of the metabolic disturbances caused by antipsychotic drugs: focus on potential drug interactions. Clin Pharmacokinet 2004; 43:1-15. [PMID: 14715048 DOI: 10.2165/00003088-200443010-00001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The risk of excessive bodyweight gain, glucose dysregulation and hyperlipidaemia is differentially increased by conventional and atypical antipsychotic drugs. Switching or combining agents may be sufficient in some cases, but in many instances additional drug treatment will be required. This includes oral antidiabetics, insulin and agents to treat hyperlipidaemia, hypertension and platelet dysfunction, among others. Numerous pharmacokinetic and pharmacodynamic interactions with the antipsychotics are possible, although few have been tested in formal studies. After reviewing the literature, the authors provide preliminary guidelines to assist clinicians in drug selection for this complex and fragile clinical population.
Collapse
Affiliation(s)
- Trino Baptista
- Department of Physiology, Los Andes University Medical School, Mérida, Venezuela.
| | | | | |
Collapse
|
20
|
Setter SM, Iltz JL, Thams J, Campbell RK. Metformin hydrochloride in the treatment of type 2 diabetes mellitus: a clinical review with a focus on dual therapy. Clin Ther 2004; 25:2991-3026. [PMID: 14749143 DOI: 10.1016/s0149-2918(03)90089-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus typically involves abnormal beta-cell function that results in relative insulin deficiency, insulin resistance accompanied by decreased glucose transport into muscle and fat cells, and increased hepatic glucose output, all of which contribute to hyperglycemia. OBJECTIVE This review examines the pharmacology, pharmacokinetics, drug-interaction potential, adverse effects, and dosing guidelines for metformin hydrochloride, a biguanide agent for the treatment of type 2 diabetes. Clinical trial data are reviewed, including efficacy and tolerability information, with a focus on studies of dual metformin therapy (metformin plus another oral agent or insulin) published from 1998 to the present. Pharmacoeconomic considerations are also discussed. METHODS Primary research and review articles were identified through a search of MEDLINE (1966-May 2003) and International Pharmaceutical Abstracts (1970-May 2003) using the terms metformin and/or Glucophage. Web of Science (1995-May 2003) was used to search for additional abstracts. The package inserts for metformin and metformin combination products were consulted. All identified articles and abstracts were assessed for relevance, and all relevant information was included. Priority was given to the primary medical literature and clinical trial reports. RESULTS Metformin is the only currently available oral antidiabetic/hypoglycemic agent that acts predominantly by inhibiting hepatic glucose release. Because patients with type 2 diabetes often have excess hepatic glucose output, use of metformin is effective in lowering glycosylated hemoglobin (HbA1c) by 1 to 2 percentage points when used as monotherapy or in combination with other blood glucose-lowering agents or insulin. Other metabolic variables (eg, dyslipidemia, fibrinolysis) may be improved with the use of metformin. Body weight is often maintained or slightly reduced from baseline. Metformin is well tolerated and is associated with few clinically deleterious adverse events. The most important and potentially life-threatening adverse event associated with its use is lactic acidosis, which occurs very rarely. CONCLUSIONS Metformin has multiple benefits in patients with type 2 diabetes. It can effectively lower HbA1c values, positively affect lipid profiles, and improve vascular and hemodynamic indices. Adverse effects are generally tolerable and self-limiting. The availability of products combining metformin with a sulfonylurea or rosiglitazone has expanded the array of therapies for the management of type 2 diabetes.
Collapse
Affiliation(s)
- Stephen M Setter
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane 99217-6131, USA.
| | | | | | | |
Collapse
|
21
|
Abstract
People with type 2 diabetes are disproportionately affected by cardiovascular disease (CVD), compared with those without diabetes. Traditional risk factors do not fully explain this excess risk, and other "nontraditional" risk factors may be important. This review will highlight the importance of nontraditional risk factors for CVD in the setting of type 2 diabetes and discuss their role in the pathogenesis of the excess CVD morbidity and mortality in these patients. We will also discuss the impact of various therapies used in patients with diabetes on nontraditional risk factors.
Collapse
Affiliation(s)
- V Fonseca
- Section of Endocrinology, Department of Medicine, Tulane University Medical Center, New Orleans, Louisiana 70112, USA.
| | | | | | | |
Collapse
|
22
|
Lyon CJ, Hsueh WA. Effect of plasminogen activator inhibitor-1 in diabetes mellitus and cardiovascular disease. Am J Med 2003; 115 Suppl 8A:62S-68S. [PMID: 14678868 DOI: 10.1016/j.amjmed.2003.08.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Concentrations of plasminogen activator inhibitor-1 (PAI-1) are elevated beginning at the stage of impaired glucose tolerance and continuing through the development of diabetes mellitus and the metabolic syndrome. Evolving evidence of the central role of PAI-1 in mediating fibrosis and thrombosis increasingly supports the theory that it is a significant risk factor for macrovascular complications and cardiovascular disease, particularly in patients with diabetes. Several clinical studies have demonstrated a strong correlation between circulating PAI-1 levels and cardiovascular events and mortality. With the potentially severe effects of elevated PAI-1 levels becoming evident, there is increased interest in developing therapies targeted at reducing PAI-1 expression or circulating concentrations. Thus far, weight loss, inhibitors of the renin-angiotensin system, and insulin sensitization through use of thiazolidinediones (TZDs) appear to be the most promising strategies for managing elevated PAI-1 levels. Of these, TZD therapy is the only one that provides the benefits of both long-term glycemic control and improved cardiovascular risk profile. This article reviews the regulation of PAI-1, its activity in various disease states, and available treatment options.
Collapse
Affiliation(s)
- Christopher J Lyon
- Division of Endocrinology, Diabetes and Hypertension, University of California at Los Angeles, Los Angeles, California 90095, USA
| | | |
Collapse
|
23
|
Klem I, Wehinger C, Schneider B, Hartl E, Finsterer J, Stöllberger C. Diabetic atrial fibrillation patients: mortality and risk for stroke or embolism during a 10-year follow-up. Diabetes Metab Res Rev 2003; 19:320-8. [PMID: 12879410 DOI: 10.1002/dmrr.386] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To compare in atrial fibrillation patients with and without diabetes, (1) baseline characteristics, (2) additional risk factors for stroke or peripheric or visceral embolism (hypertension, previous stroke, age >75 years), (3) mortality, (4) stroke or embolism, and (5) oral anticoagulation in the year 2000. METHODS Included were 409 outpatients with nonrheumatic atrial fibrillation (62 +/- 12 years, 36% female). All underwent transthoracic and transesophageal echocardiography. Patients with thrombi received oral anticoagulation; patients without thrombi received aspirin until the follow-up in 1995; afterwards, oral anticoagulation according to risk factors for stroke or embolism was recommended. Patients were contacted during the year 2000. RESULTS Type 2 diabetes was diagnosed in 73 patients (18%). Sixteen (22%) diabetic and 169 (50%) nondiabetic patients had no other risk factors for stroke or embolism (p < 0.0001). Diabetic patients were older, had more frequent heart failure, hypertension, myocardial infarction, left ventricular dysfunction, valvular abnormalities, left atrial or appendage thrombi, larger left atria, and left atrial appendages than nondiabetic patients. Mean follow-up was 115 months. Diabetic patients had a higher mortality than nondiabetic patients (7%/year versus 4%/year, p < 0.0001). The rate of stroke or embolism of diabetic (3%/year) and nondiabetic patients (2%/year) was similar. The rate of oral anticoagulation was higher in diabetic than in nondiabetic patients (p = 0.0066). CONCLUSIONS Diabetic patients with atrial fibrillation frequently have additional risk factors for stroke or embolism, and thus should be treated with oral anticoagulation. Whether in the rare cases of atrial fibrillation, in whom diabetes is the only clinical risk factor, oral anticoagulation is indicated cannot be answered by the present study.
Collapse
Affiliation(s)
- Igor Klem
- 2nd Medical Department, KA Rudolfstiftung, Juchgasse, Wien, Osterreich
| | | | | | | | | | | |
Collapse
|
24
|
Nowak SN, Jaber LA. Aspirin dose for prevention of cardiovascular disease in diabetics. Ann Pharmacother 2003; 37:116-21. [PMID: 12503945 DOI: 10.1345/aph.1c101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine whether a specific dose of aspirin can be recommended for prevention of cardiovascular disease in patients with diabetes. DATA SOURCE Biomedical literature was accessed through MEDLINE (1990-February 2002). Key terms included diabetes, cardiovascular protection, and aspirin. DATA SYNTHESIS Pharmacologic and clinical studies focusing on the dose-response relationship of aspirin therapy were reviewed. Evidence supports the benefit of low-dose aspirin therapy in reducing vascular events in secondary and primary prevention trials in various patient populations; however, some studies suggest larger doses of aspirin may be needed in certain patients. CONCLUSIONS Review of the evidence does not support a particular dose of aspirin for cardiovascular protection in diabetic patients. Clinical guidelines recommend aspirin therapy in the range of 81-325 mg/d. However, due to an increased prevalence of cardiovascular morbidity and disturbances in coagulation in diabetic patients, the dose of aspirin for prevention of cardiovascular disease in these individuals may be different from that in other populations and requires further evaluation.
Collapse
Affiliation(s)
- Sandra N Nowak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | | |
Collapse
|
25
|
Grundy SM, Garber A, Goldberg R, Havas S, Holman R, Lamendola C, Howard WJ, Savage P, Sowers J, Vega GL. Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group IV: lifestyle and medical management of risk factors. Circulation 2002; 105:e153-8. [PMID: 11994266 DOI: 10.1161/01.cir.0000014022.85836.96] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|