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Groenen AG, Halmos B, van Zeventer IA, Salzbrunn JB, Mayer ML, La Rose ND, Nolte IM, Schuringa JJ, Huls G, Westerterp M. Skin autofluorescence, a measure for accumulation of advanced glycation end products, positively associates with blood neutrophil and monocyte counts in the general population, and particularly in men with prediabetes. Atherosclerosis 2024; 395:117609. [PMID: 38878675 DOI: 10.1016/j.atherosclerosis.2024.117609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/06/2024] [Accepted: 05/30/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND AND AIMS Previous studies have shown that skin autofluorescence (SAF), measured with an advanced glycation end product (AGE) reader, estimates the accumulation of AGEs in tissues. SAF is predictive of incident type 2 diabetes, cardiovascular disease (CVD), and CV mortality in the general population. Studies in diabetic mice have shown that activation of the receptor for AGEs in hematopoietic progenitor cells increases blood neutrophils and monocytes, impairing atherosclerosis regression. We asked whether SAF is associated with blood neutrophil and monocyte counts in the general population, and whether this was moderated by prediabetes, diabetes, and sex. METHODS We examined the associations between SAF and blood neutrophil/monocyte counts in participants of the Lifelines cohort (n = 58,923: n = 24,382 men, and n = 34,541 women), a prospective population-based cohort from the North of the Netherlands, employing multivariable regression analyses. RESULTS SAF positively associated with blood neutrophil and monocyte counts in the whole cohort. The positive association between SAF and monocyte, but not neutrophil, counts was moderated by prediabetes and diabetes. Positive associations between SAF and blood neutrophil and monocyte counts were moderated by male sex. Moreover, three-way interaction analyses revealed that the positive associations between SAF and neutrophil and monocyte counts were moderated by prediabetes, but not diabetes, in male sex. CONCLUSIONS SAF is positively associated with blood neutrophil and monocyte counts in the general population, especially in men with prediabetes. This may contribute to the increased CV risk in men with prediabetes.
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Affiliation(s)
- Anouk G Groenen
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Benedek Halmos
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Isabelle A van Zeventer
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jonas B Salzbrunn
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marianne L Mayer
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nikita D La Rose
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Jacob Schuringa
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerwin Huls
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marit Westerterp
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Barreto J, Sano RY, Borges C, Nadruz W, Quadros K, Sposito AC, de Oliveira RB. Reference values of skin autofluorescence advanced glycation end-products in healthy and chronic kidney disease individuals: a propensity score matching analysis. J Nephrol 2024; 37:239-240. [PMID: 37486570 DOI: 10.1007/s40620-023-01705-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Joaquim Barreto
- Laboratory of Atherosclerosis and Vascular Biology, Division of Cardiology, Unicamp, Rua Tessalia Vieira Camargo, 126 - Cidade Universitária-Campinas, Sao Paulo, SP, Brazil.
| | - Rafael Y Sano
- Laboratory for Evaluation of Mineral and Bone Disorders in Nephrology (LEMON), Division of Nephrology, Unicamp, Sao Paulo, Brazil
| | - Cynthia Borges
- Laboratory for Evaluation of Mineral and Bone Disorders in Nephrology (LEMON), Division of Nephrology, Unicamp, Sao Paulo, Brazil
| | - Wilson Nadruz
- Division of Cardiology, Clinic Hospital, Unicamp, Sao Paulo, Brazil
| | - Kelcia Quadros
- Laboratory for Evaluation of Mineral and Bone Disorders in Nephrology (LEMON), Division of Nephrology, Unicamp, Sao Paulo, Brazil
| | - Andrei C Sposito
- Laboratory of Atherosclerosis and Vascular Biology, Division of Cardiology, Unicamp, Rua Tessalia Vieira Camargo, 126 - Cidade Universitária-Campinas, Sao Paulo, SP, Brazil
| | - Rodrigo Bueno de Oliveira
- Laboratory for Evaluation of Mineral and Bone Disorders in Nephrology (LEMON), Division of Nephrology, Unicamp, Sao Paulo, Brazil
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Fujiwara R, Anzai N, Ishikawa M, Takahashi A. Usefulness of Skin Autofluorescence as a Biomarker of Acute Oxidative Stress in Young Male Japanese Long-Distance Runners: A Cross-Sectional Study. Sports (Basel) 2022; 10:sports10110180. [PMID: 36422949 PMCID: PMC9699520 DOI: 10.3390/sports10110180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Chronic oxidative stress in long-distance runners adversely affects conditioning. It is important to objectively assess and monitor oxidative stress, but measuring oxidative stress can be invasive or require skill to measure. Therefore, this study aimed to verify whether skin autofluorescence (SAF), a non-invasive, rapid, and easily calculable metric for calculating advanced glycation end products (AGEs), is useful as an oxidative stress biomarker. The subjects were 50 young Japanese male long-distance runners (aged 20.2 ± 1.2 years); 35 average-sized male university students (aged 19.8 ± 1.1 years) served as controls. The interactions and relationships between SAF and plasma pentosidine and oxidative stress markers (reactive oxygen metabolite-derived compounds [d-ROMs], biological antioxidant potential [BAP], and the BAP/d-ROMs ratio) in runners were examined, and SAF in the runners and controls was compared. The results suggest that plasma pentosidine in runners is associated with oxidative stress markers and that it can assess oxidative stress. However, as SAF was not associated with oxidative stress markers, it was not validated as one. In future, clarifying the factors affecting SAF may also clarify the relationship between SAF, plasma pentosidine, and oxidative stress markers.
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Affiliation(s)
- Rei Fujiwara
- Department of Food and Nutrition, Junior College, Nihon University, 2-31-145 Bunkyo-Cho, Mishima 411-8555, Shizuoka, Japan
| | - Natsume Anzai
- Department of Philosophy, Division of Humanities, Graduate School of Humanities, Osaka University, 1-5 Machikaneyama-Cho, Toyonaka 560-8532, Osaka, Japan
| | - Motoyasu Ishikawa
- Department of Food and Nutrition, Junior College, Nihon University, 2-31-145 Bunkyo-Cho, Mishima 411-8555, Shizuoka, Japan
| | - Atsuhiko Takahashi
- Department of Food and Nutrition, Junior College, Nihon University, 2-31-145 Bunkyo-Cho, Mishima 411-8555, Shizuoka, Japan
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Matsumoto S, Ochi M, Akechi Y, Takei S, Senzaki K, Okada Y, Miura S, Ochi H, Igase M, Ohyagi Y. Dermal advanced glycation end-product accumulation is associated with sarcopenia-related measures in middle-aged and older men. Arch Gerontol Geriatr 2022; 101:104704. [DOI: 10.1016/j.archger.2022.104704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/02/2022]
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Rodriguez AJ, Boonya-Ananta MT, Gonzalez M, Le VND, Fine J, Palacios C, McShane MJ, Coté GL, Ramella-Roman JC. Skin optical properties in the obese and their relation to body mass index: a review. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:030902. [PMID: 35352513 PMCID: PMC8963797 DOI: 10.1117/1.jbo.27.3.030902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Obesity is a worldwide epidemic contributing directly to several cardiovascular risk factors including hypertension and type 2 diabetes. Wearable devices are becoming better at quantifying biomarkers relevant for the management of health and fitness. Unfortunately, both anecdotal evidence and recent studies indicate that some wearables have higher levels of error when utilized by populations with darker skin tones and high body mass index (BMI). There is an urgent need for a better evaluation of the limits of wearable health technologies when used by obese individuals. AIMS (1) To review the current know-how on changes due to obesity in the skin epidermis, dermis, and subcutis that could affect the skin optical properties; (2) for the green wavelength range, to evaluate the difference in absorption and scattering coefficients from the abdominal skin between individuals with and without elevated BMI. The changes include alterations in layer thickness and cell size, as well as significant differences in chromophores and scatterer content, e.g., water, hemoglobin, collagen, and lipids. APPROACH We have summarized literature pertaining to changes in skin and its components in obesity and report the results of our search using articles published between years 1971 and 2020. A linear model was used to demonstrate the absorption and reduced scattering coefficient of the abdominal skin of individuals with and without elevated BMI in the green wavelength range (530 to 550 nm) that is typically found in most wearables. RESULTS The general trends indicate a decrease in absorption for both dermis and subcutis and an increase in reduced scattering for both epidermis and dermis. At 544-nm wavelength, a typical wavelength used for photoplethysmography (PPG), the absorption coefficient's relative percentage difference between high and low BMI skin, was 49% in the subcutis, 19% in the dermis, and negligible in the epidermis, whereas the reduced scattering coefficient relative difference was 21%, 29%, and 165% respectively. CONCLUSIONS These findings suggest that there could be significant errors in the output of optical devices used for monitoring health and fitness if changes due to obesity are not accounted for in their design.
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Affiliation(s)
- Andres J. Rodriguez
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | | | - Mariacarla Gonzalez
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Vinh Nguyen Du Le
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Jesse Fine
- Texas A&M University, Department of Biomedical Engineering, College Station, Texas, United States
| | - Cristina Palacios
- Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, United States
| | - Mike J. McShane
- Texas A&M University, Department of Biomedical Engineering, College Station, Texas, United States
- Texas A&M University, TEES Center for Remote Health Technologies and Systems, College Station, Texas, United States
- Texas A&M University, Department of Material Science and Engineering, College Station, Texas, United States
| | - Gerard L. Coté
- Texas A&M University, Department of Biomedical Engineering, College Station, Texas, United States
- Texas A&M University, TEES Center for Remote Health Technologies and Systems, College Station, Texas, United States
| | - Jessica C. Ramella-Roman
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States
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Hosseini MS, Razavi Z, Ehsani AH, Firooz A, Afazeli S. Clinical Significance of Non-invasive Skin Autofluorescence Measurement in Patients with Diabetes: A Systematic Review and Meta-analysis. EClinicalMedicine 2021; 42:101194. [PMID: 34841236 PMCID: PMC8605318 DOI: 10.1016/j.eclinm.2021.101194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Advanced glycation end products (AGE), one of the main factors causing diabetic end-organ damage, accumulate in long half-life proteins, such as skin and cartilage collagen. AGE measurement may offer additional evidence to predict diabetic vascular complications. Skin autofluorescence (SAF) is suggested as a non-invasive, quick, and reliable method to measure tissue AGE level. The aim of this study was to review and evaluate evidence on the clinical validation of SAF measurement in diabetes mellitus (DM) patients. METHODS In this systematic review and meta-analysis, we searched "PubMed" (MEDLINE) and "Cochrane" databases from their inception to 10 August 2021 for observational studies concerning SAF measurement in diabetic patients. The following key terms were used in advanced searching: "Diabetes", "Diabetes Mellitus"," DM", "Glycation ", "Advanced Glycation End product", "AGE", "skin autofluorescence", "SAF". Published studies that included DM patients and estimated their AGE using SAF were considered eligible for meta-analysis. Articles that were editorials, study proposals, congress posters, or case reports and were not on human subjects were excluded. We used a random-effect models for meta-analyzing the clinical validation of SAF in DM with particular emphasis on chronic diabetes complications. FINDINGS We identified 881 records and twenty-nine records fulfilled our eligibility criteria and were included in the systematic review and meta-analysis. A statistically significant correlation was found between SAF and diabetes last HbA1c 0.21(0.13,0.28) in studies with substantial heterogeneity (I2=77.99%, p<0.05). Nevertheless, a significant positive association between SAF level and diabetic retinopathy (DR) [(OR= 1.05, 95% CI=1.03,1.08), (I2=63.78%, p<0.05)], diabetic peripheral neuropathy (DPN) [(OR= 1.11, 95%CI= 1.06,1.16), (I2=79.17%, p<0.05)], diabetic nephropathy (DNP) [(OR= 1.08, 95%CI: 1.05,1.11), (I 2 =65.36%, p<0.05)] and diabetic macrovascular events (D-MVE) [(OR=1.08, 95%CI=1.05,1.11) (I2=67.32, p<0.05)] were found. INTERPRETATION Our study confirmed the significance of SAF measurement as a non-invasive surrogate marker of DM micro and macrovascular complications. Skin AGE estimation may be a useful factor for the prediction and early detection of irreversible DM complications. More studies with larger populations and longer follow-up periods are required.
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Affiliation(s)
- Mahboobeh sadat Hosseini
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Zahra Razavi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Amir Houshang Ehsani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Science, Tehran, Iran
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Januszewski AS, Xu D, Cho YH, Benitez-Aguirre PZ, O'Neal DN, Craig ME, Donaghue KC, Jenkins AJ. Skin autofluorescence in people with type 1 diabetes and people without diabetes: An eight-decade cross-sectional study with evidence of accelerated aging and associations with complications. Diabet Med 2021; 38:e14432. [PMID: 33078416 DOI: 10.1111/dme.14432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 02/03/2023]
Abstract
AIM To measure skin autofluorescence in youth (<18 y.o.) and adults (≥18 y.o.) and to assess its relationship with type 1 diabetes, chronic complications and smoking. METHODS In a cross-sectional study (n = 383) skin autofluorescence was measured in 269 people with type 1 diabetes (67 with vascular complications) and 114 people without diabetes, covering eight decades of age. Associations of skin autofluorescence with demographics and traditional risk factors were assessed. RESULTS Skin autofluorescence increased with age in people with diabetes: for those with complications it increased by a mean ± se of 0.029 ± 0.003 arbitrary units per year (r = 0.76) and, for those without complications, it increased by 0.028 ± 0.002 arbitrary units (r = 0.77). These increases were higher than for people without diabetes, whose skin autofluorescence increased by 0.022 ± 0.002 arbitrary units (r = 0.78) per year (p = 0.004). Mean ±se age-adjusted skin autofluorescence was higher in people with diabetes complications vs people without diabetes complications (1.85 ± 0.04 vs 1.66 ± 0.02 arbitrary units) and people without diabetes (1.48 ± 0.03 arbitrary units; all P < 0.0001). Age-adjusted skin autofluorescence was higher in current smokers and recent ex-smokers vs non-smokers and longer-term ex-smokers (1.86 ± 0.06 vs 1.63 ± 0.02 arbitrary units; P = 0.0005). Skin autofluorescence area under the receiver-operating characteristic curve was 0.89 (95% CI 0.85-0.94) for retinopathy and 0.56 (95% CI 0.47-0.65) for nephropathy. CONCLUSIONS Skin autofluorescence increases with age, but faster in people with diabetes, particularly in those with complications and in smokers, consistent with accelerated aging. Skin autofluorescence may facilitate complication screening and prediction. Longitudinal studies are merited.
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Affiliation(s)
- A S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Medicine, University of Melbourne, Fitzroy, NSW, Australia
| | - D Xu
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Engineering Science, University of Oxford, Visual Geometry Group, Oxford, UK
| | - Y H Cho
- Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | - D N O'Neal
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Medicine, University of Melbourne, Fitzroy, NSW, Australia
| | - M E Craig
- Children's Hospital at Westmead, Sydney, NSW, Australia
| | - K C Donaghue
- Children's Hospital at Westmead, Sydney, NSW, Australia
| | - A J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Medicine, University of Melbourne, Fitzroy, NSW, Australia
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Korpijaakko C, Wasenius N, Teramo K, Klemetti MM, Kautiainen H, Eriksson JG, Laine MK. Skin Autofluorescence in Young Adult Offspring of Women with Type 1 Diabetes: A Cross-Sectional Case-Control Study. Diabetes Ther 2021; 12:669-677. [PMID: 33484434 PMCID: PMC7947119 DOI: 10.1007/s13300-021-01001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/09/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Offspring born to women with type 1 diabetes pregnancies have an elevated risk for early-onset obesity and type 2 diabetes compared with offspring born to women without diabetes. Skin autofluorescence (SAF) is a marker of accumulated advanced glycation end products (AGEs) and it has been shown to predict type 2 diabetes, cardiovascular disease, and mortality in the general population. The aim of this study was to evaluate whether maternal type 1 diabetes influences the SAF value in young adult offspring. METHODS This cross-sectional case-control study included 78 offspring of women with type 1 diabetes (cases) and 85 control participants (controls). All study participants, aged 18-23 years, were invited to participate in a clinical assessment including laboratory tests and questionnaires. SAF was assessed using the AGE reader from the dominant forearm of each participant. RESULTS The mean SAF value did not differ between the cases (1.61 [standard deviation (SD) 0.37]) arbitrary units [AU]) and the controls (1.64 [SD 0.41] AU) (p = 0.69). After adjusting for glycated hemoglobin A1c, body fat percentage, smoking, and season the mean SAF value did not differ between the cases and the controls (p = 0.49) but differed between men and women (p = 0.008), without any interaction observed (p = 0.78). CONCLUSION SAF values did not differ between the young adult offspring of women with type 1 diabetes and offspring born to mothers without diabetes. Surprisingly, young adult women showed higher SAF values than men in both case and control groups.
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Affiliation(s)
- Cedric Korpijaakko
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Niko Wasenius
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Kari Teramo
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Miira M Klemetti
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Human Potential Translational Research Programme and Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
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The AGE Reader: A non-invasive method to assess long-term tissue damage. Methods 2021; 203:533-541. [PMID: 33636313 DOI: 10.1016/j.ymeth.2021.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/16/2020] [Accepted: 02/21/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Advanced glycation endproducts (AGEs) are sugar-modified adducts which arise during non-enzymatic glycoxidative stress. These compounds may become systemically elevated in disease states, and accumulate in tissue, especially on long-lived proteins. AGEs have been implicated in various acute, and chronic diseases, stressing the need for reliable and comprehensive measuring techniques. Measurement of AGEs in tissue such as skin requires invasive skin biopsies. The AGE Reader has been developed to assess skin autofluorescence (SAF) non-invasively using the fluorescent properties of several AGEs. RESULTS/CONCLUSION Various studies have shown that SAF is a useful marker of disease processes associated with oxidative stress. It is prospectively associated with the development of cardiovascular events in patients with diabetes, renal or cardiovascular disease, and it predicts diabetes, cardiovascular disease, and mortality in the general population. However, when measuring SAF in individual subjects, several factors may limit the reliability of the measurement. These include endogenous factors present in the skin that absorb emission light such as melanin in dark-skinned subjects, but also factors that lead to temporal changes in SAF such as acute diseases and strenuous physical exercise associated with glycoxidative stress. Also, exogenous factors could potentially influence SAF levels inadvertently such as nutrition, and for example the application of skin care products. This review will address the AGE Reader functionality and the endogenous, and exogenous factors which potentially influence the SAF assessment in individual subjects.
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Tomaszewski EL, Orchard TJ, Hawkins M, Conway BN, Buchanich JM, Maynard J, Songer T, Costacou T. Skin intrinsic fluorescence scores are a predictor of all-cause mortality risk in type 1 diabetes: The Epidemiology of Diabetes Complications study. J Diabetes Complications 2021; 35:107770. [PMID: 33168396 PMCID: PMC7855847 DOI: 10.1016/j.jdiacomp.2020.107770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 01/13/2023]
Abstract
AIMS We assessed the association of skin intrinsic fluorescence (SIF) scores, as a measure of advanced glycation end-products (AGE), with all-cause mortality in type 1 diabetes (T1D). METHODS This is an observational retrospective study of a convenience sample from the Epidemiology of Diabetes Complications (EDC) study. AGEs were measured with a SIF score between 2007 and 2014; vital status was assessed in 2020. RESULTS Among 245 participants, mean age was 48.6 ± 7.4 years, median diabetes duration was 39.5 years (IQR: 34.2, 44.9), and 53.5% were female. Compared to survivors, the deceased (n = 20) were older, with higher SIF scores, longer diabetes duration, lower body mass index (BMI), and an adverse risk factor profile (all p≤0.05). Univariate Cox regression showed a marginal association between SIF score and mortality (HR: 1.1, 95% CI 0.9-1.2, p = 0.06), which persisted after adjustment for multiple daily insulin shots/pump (MDI) use (HR: 1.1, 95% CI 1.0-1.2, p = 0.04). This association was attenuated after adjustment for T1D duration, A1c months, or estimated glomerular filtration rate (eGFR). CONCLUSIONS In individuals with long duration T1D, SIF scores adjusted for MDI predicted all-cause mortality, although this association was attenuated after adjustments. Given the nature of sampling and small number of events, our findings require replication.
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Affiliation(s)
- Erin L Tomaszewski
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, School of Public Health, 130 De Soto Street, Pittsburgh, PA 15231, USA.
| | - Trevor J Orchard
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, School of Public Health, 130 De Soto Street, Pittsburgh, PA 15231, USA
| | - Marquis Hawkins
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, School of Public Health, 130 De Soto Street, Pittsburgh, PA 15231, USA
| | - Baqiyyah N Conway
- University of Texas Health Science Center at Tyler, School of Rural and Community Health, Department of Community Health, 11937 US Highway 271, suite H250, Tyler, TX 75701, USA
| | - Jeanine M Buchanich
- University of Pittsburgh, Graduate School of Public Health, Department of Biostatistics, 130 De Soto Street, Pittsburgh, PA 15231, USA
| | - John Maynard
- Medical Device and Diagnostics Consultant, 185 Montag Circle NE, #453, Atlanta, GA 30307, USA
| | - Thomas Songer
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, School of Public Health, 130 De Soto Street, Pittsburgh, PA 15231, USA
| | - Tina Costacou
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, School of Public Health, 130 De Soto Street, Pittsburgh, PA 15231, USA
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Shirakami T, Yamanaka M, Fujihara J, Matsuoka Y, Gohto Y, Obana A, Tanito M. Advanced Glycation End Product Accumulation in Subjects with Open-Angle Glaucoma with and without Exfoliation. Antioxidants (Basel) 2020; 9:E755. [PMID: 32824189 PMCID: PMC7465686 DOI: 10.3390/antiox9080755] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
Advanced glycation end products (AGEs), which are the products of a non-enzymatic reaction between reducing sugars and other macromolecules, are critical in aging, as well as metabolic and degenerative diseases. To assess the involvement of AGEs in glaucoma, skin autofluorescence (sAF) level, which is a measurement of AGEs' accumulation, was compared among Japanese patients with glaucoma (316 with primary open-angle glaucoma (PG) and 127 exfoliation syndrome and glaucoma (EG)) and controls (133 nonglaucomatous controls) (mean age 71.6 ± 12.8 years, 254 men and 322 women). The sAF values were estimated from the middle fingertip using a 365 nm light-emitting diode for excitation and detection at 440 nm emission light. The estimated AGE values (arbitrary unit) were 0.56 ± 0.15, 0.56 ± 0.11, and 0.61 ± 0.11 in the control, PG, and EG groups, respectively (p < 0.0001, analysis of variance); and were significantly higher in the EG group than the control (p = 0.0007) and PG (p < 0.0001) groups. After adjustment for various demographic parameters by multivariate analyses, male sex (standard β = 0.23), EG (0.19), and diabetes (0.09) were associated with higher AGE levels; PG (-0.18) and smoking (-0.19) were associated with lower AGE levels. Age, visual acuity, intraocular pressure, glaucoma medications, lens status, and systemic hypertension were not associated with AGEs. The high AGE level in EG suggested that specific oxidation and glycation mechanisms underlie the glaucoma pathogenesis associated with pseudoexfoliation syndrome.
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Affiliation(s)
- Tomoki Shirakami
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan;
| | - Mikihiro Yamanaka
- Laboratory of Food and Regulation Biology, School of Agriculture, Tokai University, Kumamoto 862-8652, Japan;
| | - Jo Fujihara
- Division of Ophthalmology, Matsue Red Cross Hospital, Matsue 690-8506, Japan; (J.F.); (Y.M.)
| | - Yotaro Matsuoka
- Division of Ophthalmology, Matsue Red Cross Hospital, Matsue 690-8506, Japan; (J.F.); (Y.M.)
| | - Yuko Gohto
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (Y.G.); (A.O.)
| | - Akira Obana
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (Y.G.); (A.O.)
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan;
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12
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Vaes AW, Spruit MA, Reynaert NL, Franssen FME, Wouters EFM, Theunis J, De Boever P. Skin auto-fluorescence as a measure of advanced glycation end-products is associated with microvascular health in patients with COPD. Microvasc Res 2020; 132:104053. [PMID: 32763256 DOI: 10.1016/j.mvr.2020.104053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic obstructive pulmonary disease (COPD) is associated with systemic inflammation and oxidative stress. These physiological processes can lead to increased formation and accumulation of advanced glycation end-products (AGEs), that can play a role in vascular complications. In this cross-sectional study, we determined the association between skin AGEs and microvascular health in patients with COPD. METHODS Clinical characteristics and cardiovascular parameters, including pulmonary function, metabolic and inflammatory parameters, and blood pressure, were obtained in this observational study with patients with COPD. Skin concentrations of AGEs were assessed non-invasively by measuring skin autofluorescence (AF). Retinal vessel analysis was used as a marker of microvascular health. RESULTS 62 patients with COPD (52% males; mean age: 64.4 ± 8.4 years; mean FEV1: 45.0 ± 20.7%pred.) were analysed. Mean skin AF was 2.75 ± 0.64 arbitrary units. Skin AF in patients with COPD was negatively associated with retinal arteriolar diameter (β -0.021, 95% CI -0.040 to -0.002; p = 0.031) and arteriole-to-venular ratio (β -7.233, 95% CI -9.732 to -4.734; p < 0.001) and positively associated with retinal venular diameter (β 0.029, 95% CI 0.019 to 0.038; p < 0.001) after adjustment for sex, age, lung function, pack-years of smoking and conventional cardiovascular risk factors. CONCLUSION We document for the first time that skin AF in patients with COPD is independently associated with retinal arteriolar and venular vessel diameters, biological indicators for microvascular health. This adds to the evidence that AGEs are an accessible marker of microvascular health.
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Affiliation(s)
- Anouk W Vaes
- Research and Development, CIRO, Horn, the Netherlands; Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.
| | - Martijn A Spruit
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Niki L Reynaert
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Frits M E Franssen
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Emiel F M Wouters
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Jan Theunis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium; Department of Biology, University of Antwerp, Wilrijk, Belgium; Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
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13
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Lentferink YE, van Teeseling L, Knibbe CAJ, van der Vorst MMJ. Skin autofluorescence in children with and without obesity. J Pediatr Endocrinol Metab 2019; 32:41-47. [PMID: 30530882 DOI: 10.1515/jpem-2018-0237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/14/2018] [Indexed: 11/15/2022]
Abstract
Background Obesity is associated with oxidative stress, which is related to increased advanced glycation end product (AGE) formation. AGEs accumulated in skin collagen can be measured with skin autofluorescence (sAF). There are conflicting reports on the influence of obesity on sAF in adults and no data in children. Therefore, this study evaluated sAF in pediatric patients with and without obesity. Methods In this cross-sectional study, participants aged 4-18 years were included: patients with obesity (body mass index standard deviation score [BMI-SDS] >2.3) and lean controls (BMI-SDS >-1.1 to <1.1). sAF was measured using the AGE Reader®. Participants were stratified according to age (<10, ≥10 to <13, ≥13 to <15, ≥15 to <17 and ≥17 years) and skin type (I-VI). Results In total, 143 patients and 428 controls were included. In patients, there was no influence of age on sAF (p=0.09). In controls, sAF was higher in children aged <10 years compared to ≥10 to <13 and ≥13 to <15 years (p=0.02; p=0.04). Stratified by age, sAF was higher in patients compared to controls in all age categories, except <10 years of age (p<0.01), while this was not observed when stratified by skin type (p>0.05). Skin type and BMI were significant covariates for sAF. Conclusions BMI was a covariate for sAF; however, no difference in sAF was observed between children with and without obesity, stratified by skin type. Duration of obesity as well as accuracy of the AGE Reader® might explain this difference. Further research is warranted, in which patients should be matched for age and skin type.
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Affiliation(s)
- Yvette E Lentferink
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Lisa van Teeseling
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Catherijne A J Knibbe
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands.,LACDR, Leiden University, Leiden, The Netherlands
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14
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Hermsmeier M, Jeong S, Yamamoto A, Chen X, Nagavarapu U, Evans CL, Chan KF. Characterization of human cutaneous tissue autofluorescence: implications in topical drug delivery studies with fluorescence microscopy. BIOMEDICAL OPTICS EXPRESS 2018; 9:5400-5418. [PMID: 30460136 PMCID: PMC6238944 DOI: 10.1364/boe.9.005400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/27/2018] [Accepted: 10/05/2018] [Indexed: 05/04/2023]
Abstract
In pharmacokinetic studies of topical drugs, fluorescence microscopy methods can enable the direct visualization and quantification of fluorescent drugs within the skin. One potential limitation of this approach, however, is the strong endogenous fluorescence of skin tissues that makes straightforward identification of specific drug molecules challenging. To study this effect and quantify endogenous skin fluorescence in the context of topical pharmacokinetics, an integrating sphere-based screening tool was designed to collect fluorescence yield data from human skin specimens. Such information could be utilized to select specific donors in the investigation of drug uptake and distribution. Results indicated human facial skin specimens from a group of more than 35 individuals exhibited an at least 6-fold difference in endogenous fluorescence. In visualizing drug distributions, the negative impact of autofluorescence could be exacerbated in cases where there are overlapping spatial distributions or spectral emission profiles between endogenous fluorophores and the exogenous fluorophore of interest. We demonstrated the feasibility of this approach in measuring the range of tissue endogenous fluorescence and selecting specimens for the study of drug pharmacokinetics with fluorescence microscopy.
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Affiliation(s)
- Maiko Hermsmeier
- BioPharmX, Inc., 1505 Adams Drive Suite D, Menlo Park, CA 94025, USA
| | - Sinyoung Jeong
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Akira Yamamoto
- BioPharmX, Inc., 1505 Adams Drive Suite D, Menlo Park, CA 94025, USA
| | - Xin Chen
- BioPharmX, Inc., 1505 Adams Drive Suite D, Menlo Park, CA 94025, USA
| | - Usha Nagavarapu
- BioPharmX, Inc., 1505 Adams Drive Suite D, Menlo Park, CA 94025, USA
| | - Conor L. Evans
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Kin F. Chan
- BioPharmX, Inc., 1505 Adams Drive Suite D, Menlo Park, CA 94025, USA
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15
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Association of skin autofluorescence with plaque vulnerability evaluated by optical coherence tomography in patients with cardiovascular disease. Atherosclerosis 2018; 274:47-53. [DOI: 10.1016/j.atherosclerosis.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/12/2018] [Accepted: 03/01/2018] [Indexed: 12/23/2022]
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16
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Morvová M, Jeczko P, Šikurová L. Gender differences in the fluorescence of human skin in young healthy adults. Skin Res Technol 2018; 24:599-605. [PMID: 29700858 DOI: 10.1111/srt.12471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human skin naturally contains many endogenous fluorophores; therefore, fluorescence techniques can be used for monitoring of the human skin even in in vivo mode. The aim of this work was to study skin autofluorescence in vivo regarding the possible effect of gender. MATERIALS AND METHODS Fluorescence emission spectra of young healthy Caucasian adults in 3 anatomical regions (forehead, hand, and inner upper arm) were taken with excitation at 280, 325, or 400 nm. RESULTS Three emission bands were found in the spectra for both men and women: (1) an intensive band peaked at 340/280 nm (peak emission/excitation wavelength), corresponding to aromatic amino acids of proteins in epidermis; (2) a broad band with emission between 360 nm and 480 nm (excitation 325 nm) with a base peak around 390 nm and 2 side peaks at 420 and 450 nm, mainly due to collagen cross-links in dermis with a possible weak contribution of elastin and mitochondrial NADPH; (3) a weak but distinct peak at 600/400 nm corresponding presumably to skin unmetalled porphyrins. CONCLUSION The intensity of skin autofluorescence showed differences between genders and among anatomical regions. The 340 nm intensity was 1.4 times higher in the male group in all 3 anatomical regions studied. The highest intensity of skin autofluorescence for the peaks at 340/280 nm and 600/400 nm was found on the forehead, whereas the 390/325 nm band was most intensive on the inner upper arm in both genders.
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Affiliation(s)
- M Morvová
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia
| | - P Jeczko
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia
| | - L Šikurová
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia
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17
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Niihata K, Takahashi S, Kurita N, Yajima N, Omae K, Fukuma S, Okano T, Nomoto Y, Omori K, Fukuhara S. Association Between Accumulation of Advanced Glycation End-Products and Hearing Impairment in Community-Dwelling Older People: A Cross-Sectional Sukagawa Study. J Am Med Dir Assoc 2017; 19:235-239.e1. [PMID: 29079032 DOI: 10.1016/j.jamda.2017.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The experimental studies suggested the hypothesis that the accumulation of advanced glycation end-products (AGEs) could induce hearing impairment. The purpose of this study is to examine the hypothesis among elderly people using an epidemiologic approach. DESIGN Cross-sectional study. SETTING Sukagawa City, Fukushima, Japan. PARTICIPANTS A total of 270 residents aged 75 years or over without dementia, who participated in a health check-up conducted in 2015. MEASUREMENTS The exposure variable was AGEs, which was assessed using skin autofluorescence (AF) as a proxy measure. The primary outcome was moderate hearing impairment or worse, which was defined as a pure tone average of thresholds ≥41 decibel hearing level at 0.5, 1, 2, and 4 kHz in the better-hearing ear. The secondary outcome was the pure tone average of thresholds as a continuous variable. We estimated the odds ratio using a logistic regression model for the primary outcome and a general linear model for the mean difference in the pure tone average of thresholds for the secondary outcome. Both models were adjusted for relevant confounding factors: age, sex, smoking, diabetes, hypertension, and history of cerebrovascular diseases. RESULTS The median (interquartile range) AF was 2.2 (2.0, 2.5) arbitrary units (AU). Moderate hearing impairment was reported in 88 participants (32.6%). For the primary outcome, we found significant associations between moderate hearing impairment and AF (adjusted odds ratio per 1 AU, 2.60; 95% confidence interval 1.26-5.35). For the secondary outcome, we also found a significant association between a 1-AU increase in AF and increased pure tone average, with a difference (6.52 dB per 1 AU; 95% confidence interval 2.18-10.86) comparable in magnitude to the increase in pure tone average observed for a 6-year increase in age in our population. CONCLUSIONS Our study indicated that high levels of AGEs were independently associated with hearing impairment. Modifying levels of AGEs may prevent hearing impairment.
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Affiliation(s)
- Kakuya Niihata
- Department of Clinical Epidemiology, Fukushima Medical University, Fukushima City, Fukushima, Japan; Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Sei Takahashi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University, Fukushima City, Fukushima, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Noriaki Kurita
- Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University, Fukushima City, Fukushima, Japan; Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan.
| | - Nobuyuki Yajima
- Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University, Fukushima City, Fukushima, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan; Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kenji Omae
- Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University, Fukushima City, Fukushima, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan; Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Shingo Fukuma
- Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University, Fukushima City, Fukushima, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Takayuki Okano
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto-city, Japan
| | - Yukio Nomoto
- Department of Otolaryngology, Ohara General Hospital, Fukushima City, Fukushima, Japan
| | - Koichi Omori
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto-city, Japan; Department of General Medicine, Shirakawa Satellite Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University, Fukushima City, Fukushima, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan; Department of General Medicine, Shirakawa Satellite Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
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18
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Ahmad MS, Kimhofer T, Ahmad S, AlAma MN, Mosli HH, Hindawi SI, Mook-Kanamori DO, Šebeková K, Damanhouri ZA, Holmes E. Ethnicity and skin autofluorescence-based risk-engines for cardiovascular disease and diabetes mellitus. PLoS One 2017; 12:e0185175. [PMID: 28931094 PMCID: PMC5607192 DOI: 10.1371/journal.pone.0185175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 09/07/2017] [Indexed: 02/03/2023] Open
Abstract
Skin auto fluorescence (SAF) is used as a proxy for the accumulation of advanced glycation end products (AGEs) and has been proposed to stratify patients into cardiovascular disease (CVD) and diabetes mellitus (DM) risk groups. This study evaluates the effects of seven different ethnicities (Arab, Central-East African, Eastern Mediterranean, European, North African, South Asian and Southeast Asian) and gender on SAF as well as validating SAF assessment as a risk estimation tool for CVD and DM in an Arabian cohort. SAF data from self-reported healthy 2,780 individuals, collated from three independent studies, has been linear modelled using age and gender as a covariate. A cross-study harmonized effect size (Cohens’d) is provided for each ethnicity. Furthermore, new data has been collected from a clinically well-defined patient group of 235 individuals, to evaluate SAF as a clinical tool for DM and CVD-risk estimation in an Arab cohort. In an Arab population, SAF-based CVD and/or DM risk-estimation can be improved by referencing to ethnicity and gender-specific SAF values. Highest SAF values were observed for the North African population, followed by East Mediterranean, Arab, South Asian and European populations. The South Asian population had a slightly steeper slope in SAF values with age compared to other ethnic groups. All ethnic groups except Europeans showed a significant gender effect. When compared with a European group, effect size was highest for Eastern Mediterranean group and lowest for South Asian group. The Central-East African and Southeast Asian ethnicity matched closest to the Arab and Eastern Mediterranean ethnicities, respectively. Ethnic and gender-specific data improves performance in SAF-based CVD and DM risk estimation. The provided harmonized effect size allows a direct comparison of SAF in different ethnicities. For the first time, gender differences in SAF are described for North African and East Mediterranean populations.
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Affiliation(s)
- Muhammad Saeed Ahmad
- Drug Metabolism Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Biomolecular Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, South Kensington, London, United Kingdom
- * E-mail: (MSA); (TK)
| | - Torben Kimhofer
- Biomolecular Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, South Kensington, London, United Kingdom
- * E-mail: (MSA); (TK)
| | - Sultan Ahmad
- Drug Metabolism Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Nabil AlAma
- Cardiology Unit, Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hala Hisham Mosli
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salwa Ibrahim Hindawi
- Department of Haematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Dennis O. Mook-Kanamori
- Department of Primary Care/Public Health and Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Katarína Šebeková
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zoheir Abdullah Damanhouri
- Drug Metabolism Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Elaine Holmes
- Drug Metabolism Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Biomolecular Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, South Kensington, London, United Kingdom
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19
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Da Moura Semedo C, Webb M, Waller H, Khunti K, Davies M. Skin autofluorescence, a non-invasive marker of advanced glycation end products: clinical relevance and limitations. Postgrad Med J 2017; 93:289-294. [PMID: 28143896 DOI: 10.1136/postgradmedj-2016-134579] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/20/2016] [Accepted: 01/08/2017] [Indexed: 11/03/2022]
Abstract
Advanced glycation end products (AGEs) are protein-bound compounds derived from glycaemic and oxidative stress that contain fluorescent properties, which can be non-invasively measured as skin autofluorescence (SAF) by the AGE Reader. SAF has been demonstrated to be a biomarker of cumulative skin AGEs and potentially may be a better predictor for the development of chronic complications and mortality in diabetes than glycated haemoglobin A1c. However, there are several confounding factors that should be assessed prior to its broader application: these include presence of other fluorescent compounds in the skin that might be measured (eg, fluorophores), skin pigmentation and use of skin creams. The aim of this article is to provide a theoretical background of this newly developed method, evaluate its clinical relevance and discuss the potential confounding factors that need further analysis.
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Affiliation(s)
- Cidila Da Moura Semedo
- The Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - M'Balu Webb
- The Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.,NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Helen Waller
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- The Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.,NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie Davies
- The Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.,NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
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20
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Liu CY, Huang QF, Cheng YB, Guo QH, Chen Q, Li Y, Wang JG. A Comparative Study on Skin and Plasma Advanced Glycation End Products and Their Associations with Arterial Stiffness. Pulse (Basel) 2016; 4:208-218. [PMID: 28229055 DOI: 10.1159/000453581] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/17/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We compared skin and plasma measurements of advanced glycation end products (AGEs), with particular focus on their levels in the presence of hypertension or diabetes and prediabetes and their associations with arterial stiffness in outpatients with suspected or diagnosed hypertension. METHODS Skin AGE accumulation was measured as autofluorescence on the left forearm using the skin autofluorescence Reader and expressed in arbitrary units in the range from 0 to 25. Plasma AGE concentration was measured by the enzyme-linked immunosorbent assay method and logarithmically transformed for statistical analysis. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor system (Sydney, Australia). RESULTS The 218 participants (96 [44.0%] men, mean age 51.9 years) had a mean skin autofluorescence of 1.89 arbitrary units, plasma AGE concentration of 4.47 μg/ml, and cfPWV of 8.0 m/s. Skin autofluorescence was significantly correlated with plasma AGEs in diabetic or prediabetic patients (n = 31, r = 0.37, p = 0.04) but not in subjects with normoglycemia (n = 187, r = -0.05, p = 0.48). Nonetheless, both measurements were significantly (p ≤ 0.001) higher in men (2.00 arbitrary units and 6.73 μg/ml, respectively) than women (1.81 arbitrary units and 3.60 μg/ml, respectively) and in diabetic or prediabetic (2.03 arbitrary units and 6.61 μg/ml, respectively) than normoglycemia subjects (1.87 arbitrary units and 4.17 μg/ml, respectively), but similar in hypertensive (n = 105) and normotensive subjects (n = 113, p ≥ 0.35). In adjusted multiple regression analyses, plasma AGE concentration, but not skin autofluorescence (p ≥ 0.37), was significantly associated with cfPWV in all subjects (β 0.44 m/s for each 10-fold increase; p = 0.04) and in subgroups of men and diabetes and prediabetes (β 0.12-0.55 m/s for each 10-fold increase; p ≤ 0.02). CONCLUSIONS Although skin and plasma AGEs were similarly associated with gender and diabetes or prediabetes, they might measure something different and have different clinical relevance, such as for arterial stiffness.
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Affiliation(s)
- Chang-Yuan Liu
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Chen
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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