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Djite M, Chao de la Barca JM, Bocca C, Gaye NM, Barry NOK, Mbacke MN, Cissé O, Kandji PM, Thioune NM, Coly-Gueye NF, Ndour EHM, Gueye-Tall F, Diop AG, Simard G, Mirebeau-Prunier D, Gueye PM, Reynier P. A Metabolomic Signature of Ischemic Stroke Showing Acute Oxidative and Energetic Stress. Antioxidants (Basel) 2023; 13:60. [PMID: 38247484 PMCID: PMC10812657 DOI: 10.3390/antiox13010060] [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: 10/26/2023] [Revised: 11/28/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Metabolomics is a powerful data-driven tool for in-depth biological phenotyping that could help identify the specific metabolic profile of cryptogenic strokes, for which no precise cause has been identified. We performed a targeted quantitative metabolomics study in West African patients who had recently suffered an ischemic stroke, which was either cryptogenic (n = 40) or had a clearly identified cause (n = 39), compared to a healthy control group (n = 40). Four hundred fifty-six metabolites were accurately measured. Multivariate analyses failed to reveal any metabolic profile discriminating between cryptogenic ischemic strokes and those with an identified cause but did show superimposable metabolic profiles in both groups, which were clearly distinct from those of healthy controls. The blood concentrations of 234 metabolites were significantly affected in stroke patients compared to controls after the Benjamini-Hochberg correction. Increased methionine sulfoxide and homocysteine concentrations, as well as an overall increase in saturation of fatty acids, were indicative of acute oxidative stress. This signature also showed alterations in energetic metabolism, cell membrane integrity, monocarbon metabolism, and neurotransmission, with reduced concentrations of several metabolites known to be neuroprotective. Overall, our results show that cryptogenic strokes are not pathophysiologically distinct from ischemic strokes of established origin, and that stroke leads to intense metabolic remodeling with marked oxidative and energetic stresses.
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Affiliation(s)
- Moustapha Djite
- Laboratoire de Biochimie Pharmaceutique, Faculté de Médecine, Pharmacie, Université Cheikh Anta Diop, Dakar 2238, Senegal; (N.O.K.B.); (E.H.M.N.); (F.G.-T.); (P.M.G.)
- Laboratoire de Biochimie, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (M.N.M.); (P.M.K.); (N.M.T.)
| | - Juan Manuel Chao de la Barca
- Département de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire (CHU), 49933 Angers, France; (J.M.C.d.l.B.); (C.B.); (G.S.); (D.M.-P.); (P.R.)
- Unité Mixte de Recherche (UMR) MITOVASC, Institut National de la Santé et de la Recherche Médicale (INSERM U-1083), Centre National de la Recherche Scientifique (CNRS 6015), Université d’Angers, 49933 Angers, France
| | - Cinzia Bocca
- Département de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire (CHU), 49933 Angers, France; (J.M.C.d.l.B.); (C.B.); (G.S.); (D.M.-P.); (P.R.)
- Unité Mixte de Recherche (UMR) MITOVASC, Institut National de la Santé et de la Recherche Médicale (INSERM U-1083), Centre National de la Recherche Scientifique (CNRS 6015), Université d’Angers, 49933 Angers, France
| | - Ndiaga Matar Gaye
- Clinique Neurologique, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (N.M.G.); (O.C.); (A.G.D.)
| | - Néné Oumou Kesso Barry
- Laboratoire de Biochimie Pharmaceutique, Faculté de Médecine, Pharmacie, Université Cheikh Anta Diop, Dakar 2238, Senegal; (N.O.K.B.); (E.H.M.N.); (F.G.-T.); (P.M.G.)
- Laboratoire de Biochimie, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (M.N.M.); (P.M.K.); (N.M.T.)
| | - Mame Ndoumbé Mbacke
- Laboratoire de Biochimie, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (M.N.M.); (P.M.K.); (N.M.T.)
| | - Ousmane Cissé
- Clinique Neurologique, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (N.M.G.); (O.C.); (A.G.D.)
| | - Pape Matar Kandji
- Laboratoire de Biochimie, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (M.N.M.); (P.M.K.); (N.M.T.)
| | - Ndèye Marème Thioune
- Laboratoire de Biochimie, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (M.N.M.); (P.M.K.); (N.M.T.)
| | | | - El Hadji Malick Ndour
- Laboratoire de Biochimie Pharmaceutique, Faculté de Médecine, Pharmacie, Université Cheikh Anta Diop, Dakar 2238, Senegal; (N.O.K.B.); (E.H.M.N.); (F.G.-T.); (P.M.G.)
| | - Fatou Gueye-Tall
- Laboratoire de Biochimie Pharmaceutique, Faculté de Médecine, Pharmacie, Université Cheikh Anta Diop, Dakar 2238, Senegal; (N.O.K.B.); (E.H.M.N.); (F.G.-T.); (P.M.G.)
| | - Amadou Gallo Diop
- Clinique Neurologique, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (N.M.G.); (O.C.); (A.G.D.)
| | - Gilles Simard
- Département de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire (CHU), 49933 Angers, France; (J.M.C.d.l.B.); (C.B.); (G.S.); (D.M.-P.); (P.R.)
| | - Delphine Mirebeau-Prunier
- Département de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire (CHU), 49933 Angers, France; (J.M.C.d.l.B.); (C.B.); (G.S.); (D.M.-P.); (P.R.)
- Unité Mixte de Recherche (UMR) MITOVASC, Institut National de la Santé et de la Recherche Médicale (INSERM U-1083), Centre National de la Recherche Scientifique (CNRS 6015), Université d’Angers, 49933 Angers, France
| | - Papa Madieye Gueye
- Laboratoire de Biochimie Pharmaceutique, Faculté de Médecine, Pharmacie, Université Cheikh Anta Diop, Dakar 2238, Senegal; (N.O.K.B.); (E.H.M.N.); (F.G.-T.); (P.M.G.)
- Laboratoire de Biochimie, Centre Hospitalier National Universitaire (CHNU) de FANN, Dakar 45701, Senegal; (M.N.M.); (P.M.K.); (N.M.T.)
| | - Pascal Reynier
- Département de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire (CHU), 49933 Angers, France; (J.M.C.d.l.B.); (C.B.); (G.S.); (D.M.-P.); (P.R.)
- Unité Mixte de Recherche (UMR) MITOVASC, Institut National de la Santé et de la Recherche Médicale (INSERM U-1083), Centre National de la Recherche Scientifique (CNRS 6015), Université d’Angers, 49933 Angers, France
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Ren X, Lin F, Tang C, Liu Y, Liao G, Liang J, Luo W, Zhang L, Chen W. Identification of cholest-4-ene-3,6-dione as a Novel Neuroprotectant in Ischemic Stroke and Its Lipidomics. Drug Des Devel Ther 2023; 17:3709-3722. [PMID: 38107659 PMCID: PMC10722991 DOI: 10.2147/dddt.s412743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Stroke is a leading cause of disability and death globally. However, there are few clinical drugs for stroke therapy. Novel and effective neuroprotectants are called on the way. Methods In this study, 93 steroids from a constructed steroidal library were randomly numbered and blindly evaluated in an L-glutamate-induced HT-22 oxidative stress model. The neuroprotective effects of 5 candidates were further investigated in potassium deprivation-induced apoptosis of cerebellar granule neurons (CGNs), D-glutamate-induced excitotoxicity of CGNs, and cortical neuron (CN) models. Results Interestingly, unblinding revealed that cholest-4-ene-3,6-dione (78), a cholesterol derivative, was first found to have comprehensive neuroprotective effects in all cell models. 78 administration also decreased the infarction volume and improved motor function in middle cerebral artery occlusion (MCAO) model rats. Additionally, 78 treatment decreased intercellular reactive oxygen species (ROS) and NO production in the HT-22 cell model. Finally, lipidomics and molecular docking results showed that 78 may exert its neuroprotective effects by increasing platelet-activating factor (PAF) analog 1-(9Z-pentadecenoyl)-glycero-3-phosphocholine production. Conclusion This study indicates that 78, a novel neuroprotectant, is a promising therapeutic candidate with comprehensive neuroprotective effects for the treatment of ischemic stroke by decreasing ROS/reactive nitrogen species (RNS) levels and increasing 1-(9Z-pentadecenoyl)-glycero-3-phospho-choline production.
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Affiliation(s)
- Xiaoshuai Ren
- Department of Clinical Laboratory, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Feng Lin
- Department of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Chaogang Tang
- Department of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Yao Liu
- Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Guolei Liao
- Department of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Jiabi Liang
- Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Wenji Luo
- Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Lei Zhang
- Department of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Wenli Chen
- Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, People’s Republic of China
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Liverpool L. 'In case I die, I need to publish this paper': scientist who left the lab to fight in Ukraine. Nature 2023; 622:442-443. [PMID: 37798452 DOI: 10.1038/d41586-023-03044-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
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Guo G, Fan L, Yan Y, Xu Y, Deng Z, Tian M, Geng Y, Xia Z, Xu Y. Shared metabolic shifts in endothelial cells in stroke and Alzheimer's disease revealed by integrated analysis. Sci Data 2023; 10:666. [PMID: 37775708 PMCID: PMC10542331 DOI: 10.1038/s41597-023-02512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
Since metabolic dysregulation is a hallmark of both stroke and Alzheimer's disease (AD), mining shared metabolic patterns in these diseases will help to identify their possible pathogenic mechanisms and potential intervention targets. However, a systematic integration analysis of the metabolic networks of the these diseases is still lacking. In this study, we integrated single-cell RNA sequencing datasets of ischemic stroke (IS), hemorrhagic stroke (HS) and AD models to construct metabolic flux profiles at the single-cell level. We discovered that the three disorders cause shared metabolic shifts in endothelial cells. These altered metabolic modules were mainly enriched in the transporter-related pathways and were predicted to potentially lead to a decrease in metabolites such as pyruvate and fumarate. We further found that Lef1, Elk3 and Fosl1 may be upstream transcriptional regulators causing metabolic shifts and may be possible targets for interventions that halt the course of neurodegeneration.
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Affiliation(s)
- Guangyu Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, China
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liyuan Fan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, China
| | - Yingxue Yan
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, China
| | - Yunhao Xu
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, China
| | - Zhifen Deng
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Miaomiao Tian
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaoqi Geng
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zongping Xia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, China.
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, China.
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Kopach O, Sylantyev S, Bard L, Michaluk P, Heller JP, Gutierrez del Arroyo A, Ackland GL, Gourine AV, Rusakov DA. Human neutrophils communicate remotely via calcium-dependent glutamate-induced glutamate release. iScience 2023; 26:107236. [PMID: 37496680 PMCID: PMC10366500 DOI: 10.1016/j.isci.2023.107236] [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: 03/01/2023] [Revised: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
Neutrophils are white blood cells that are critical to acute inflammatory and adaptive immune responses. Their swarming-pattern behavior is controlled by multiple cellular cascades involving calcium-dependent release of various signaling molecules. Previous studies have reported that neutrophils express glutamate receptors and can release glutamate but evidence of direct neutrophil-neutrophil communication has been elusive. Here, we hold semi-suspended cultured human neutrophils in patch-clamp whole-cell mode to find that calcium mobilization induced by stimulating one neutrophil can trigger an N-methyl-D-aspartate (NMDA) receptor-driven membrane current and calcium signal in neighboring neutrophils. We employ an enzymatic-based imaging assay to image, in real time, glutamate release from neutrophils induced by glutamate released from their neighbors. These observations provide direct evidence for a positive-feedback inter-neutrophil communication that could contribute to mechanisms regulating communal neutrophil behavior.
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Affiliation(s)
- Olga Kopach
- Queen Square Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Sergyi Sylantyev
- Queen Square Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
- Rowett Institute, University of Aberdeen, Ashgrove Road West, Aberdeen AB25 2ZD, UK
| | - Lucie Bard
- Queen Square Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Piotr Michaluk
- Queen Square Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
- BRAINCITY, Laboratory of Neurobiology, Nencki Institute of Experimental Biology PAS, 3 Pasteur Street, 02-093 Warsaw, Poland
| | - Janosch P. Heller
- Queen Square Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
- School of Biotechnology, Dublin City University, Dublin 9, Ireland
| | - Ana Gutierrez del Arroyo
- Translational Medicine and Therapeutics, Queen Mary University of London, Mile End Road, London E1 4NS, UK
| | - Gareth L. Ackland
- Translational Medicine and Therapeutics, Queen Mary University of London, Mile End Road, London E1 4NS, UK
| | - Alexander V. Gourine
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
| | - Dmitri A. Rusakov
- Queen Square Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
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Yang S, Li J, Meng R, Yu T, Wang Z, Xiong P, Gao Z. Screening and identification of genes involved in β-alanine biosynthesis in Bacillus subtilis. Arch Biochem Biophys 2023:109664. [PMID: 37301357 DOI: 10.1016/j.abb.2023.109664] [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: 05/01/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
β-alanine is the only naturally occurring β-amino acid, which is widely used in medicine, food, and feed fields, and generally produced through synthetic biological methods based on engineered strains of Escherichia coli or Corynebacterium glutamicum. However, the β-alanine biosynthesis in Bacillus subtilis, a traditional industrial model microorganism of food safety grade, has not been thoroughly explored. In this study, the native l-aspartate-α-decarboxylase was overexpressed in B. subtilis 168 to obtain an increase of 842% in β-alanine production. A total of 16 single-gene knockout strains were constructed to block the competitive consumption pathways to identify a total of 6 genes (i.e., ptsG, fbp, ydaP, yhfS, mmgA, and pckA) involved in β-alanine synthesis, while the multigene knockout of these 6 genes obtained an increased β-alanine production by 40.1%. Ten single-gene suppression strains with the competitive metabolic pathways inhibited revealed that the inhibited expressions of genes glmS, accB, and accA enhanced the β-alanine production. The introduction of heterologous phosphoenolpyruvate carboxylase increased the β-alanine production by 81.7%, which was 17-fold higher than that of the original strain. This was the first study using multiple molecular strategies to investigate the biosynthetic pathway of β-alanine in B. subtilis and to identify the genetic factors limiting the excessive synthesis of β-alanine by microorganisms.
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Affiliation(s)
- Shaomei Yang
- School of Life Sciences and Medicine, Shandong University of Technology, 266 Xincun West Road, Zibo, 255000, China
| | - Jiachang Li
- School of Life Sciences and Medicine, Shandong University of Technology, 266 Xincun West Road, Zibo, 255000, China
| | - Rong Meng
- School of Life Sciences and Medicine, Shandong University of Technology, 266 Xincun West Road, Zibo, 255000, China
| | - Tingting Yu
- Key Laboratory of Molecular Epigenetics of the Ministry of Education, Northeast Normal University, Changchun, 130024, China
| | - Zengjian Wang
- School of Life Sciences and Medicine, Shandong University of Technology, 266 Xincun West Road, Zibo, 255000, China
| | - Peng Xiong
- School of Life Sciences and Medicine, Shandong University of Technology, 266 Xincun West Road, Zibo, 255000, China.
| | - Zhengquan Gao
- School of Pharmacy, Binzhou Medical University, 346 Guanhai Road, Yantai, 256603, China.
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Zhang Y, Liu D, Ma Z, Wang C, Gu S, Zhou Z, Zuo H. Plasma β-Alanine is Positively Associated With Risk of Ischemic Stroke: a Nested Case-Control Study. J Nutr 2023; 153:1162-1169. [PMID: 36854355 DOI: 10.1016/j.tjnut.2023.02.029] [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: 11/26/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Previous studies suggested that β-alanine as a neurotransmitter could affect the pathogenesis of ischemic damage. However, the association between circulating β-alanine and risk of ischemic stroke (IS) has not been evaluated in populations. OBJECTIVES We aimed to examine the association between β-alanine and IS risk in a nested case-control study. METHODS We performed a case-control study nested within a prospective community-based cohort (n = 16457; median follow-up time: 5.3 y), which included 321 incident IS cases and 321 controls matched by age and sex. Β-alanine and other metabolites were measured in plasma after overnight fasting by LC-MS/MS. The association of β-alanine with risk of IS was evaluated by conditional logistic regression. BMI, current smoking, educational attainment, physical activity, total energy intake, family history of stroke, hypertension, diabetes, hyperlipidemia, and estimated GFR were adjusted in multivariable models. RESULTS There was a significant Spearman partial correlation between β-alanine and 4-pyridoxic acid (ρ = 0.239; P < 0.001). Participants with elevated β-alanine levels were more likely to develop IS with an adjusted OR of 1.26 (95% CI: 1.06-1.51; P = 0.011) (per standard deviation increment). This association remained significant after excluding the first 2 y of follow-up, and after further adjustment for red meat intake, total protein intake, medication use, or vitamin B6 indicators. CONCLUSIONS Our novel findings revealed that plasma β-alanine at baseline were positively associated with risk of IS and may function as an early biomarker of IS risk.
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Affiliation(s)
- Ya Zhang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Dong Liu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Ze Ma
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Cuicui Wang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Shujun Gu
- Department of Chronic Disease Control and Prevention, Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Zhengyuan Zhou
- Department of Chronic Disease Control and Prevention, Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
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