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Wood A, Ismail I. Wünderlich's syndrome in a haemodialysis patient. BMJ Case Rep 2023; 16:e255985. [PMID: 37816578 PMCID: PMC10565273 DOI: 10.1136/bcr-2023-255985] [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] [Indexed: 10/12/2023] Open
Abstract
Wünderlich's syndrome, or spontaneous renal haemorrhages, are rare, atraumatic, intraparenchymal and perirenal haemorrhages, which are difficult to diagnose and can be potentially fatal.Patients who are dialysis-dependent are at an increased risk of bleeding, due to an association between uraemia and platelet dysfunction; for this reason, the use of double antiplatelets is avoided in this cohort. Case studies exist demonstrating spontaneous bleeds in these patients.Fish oil is used increasingly within medicine: however, it is known to interfere with platelet aggregation, therefore, theoretically increasing the tendency to bleed. The topic remains under debate, with systemic reviews refuting a correlation between intraoperative and postoperative bleeding and fish oil consumption. There is, however, an absence of literature on the adverse effects of fish oil when taken in large quantities.This case study explores the case of a patient who had a spontaneous renal bleed following a large, self-medicated dose of fish oil.
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Affiliation(s)
- Anna Wood
- Nephrology, Cairns Hospital, Cairns North, Queensland, Australia
| | - Ibrahim Ismail
- Nephrology, Cairns Hospital, Cairns, Queensland, Australia
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2
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Bonutti PM, Sodhi N, Patel YH, Sultan AA, Khlopas A, Chughtai M, Kolisek FR, Williams N, Mont MA. Novel venous thromboembolic disease (VTED) prophylaxis for total knee arthroplasty-aspirin and fish oil. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:S30. [PMID: 29299477 DOI: 10.21037/atm.2017.11.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Despite the demonstrated success of multiple anticoagulation therapies for post-operative prophylaxis of thromboembolic disease in lower extremity arthroplasties, each modality comes with a unique set of limitations. Thus, the ideal anticoagulation medication which provides adequate therapy with minimal cost, complications, or added patient work is yet to be defined. One promising novel thrombophylactic supplement is fish oil, as many preliminary clinical trials have demonstrated a protective effect of fish oil against thrombosis in multiple clinical settings. In addition, others have demonstrated synergistic effect when combined with aspirin. However, there are paucity of studies that compared combined aspirin and fish oil therapy for venous thromboembolism prophylaxis with other pharmacological agents, especially in the field of orthopaedics. Therefore, this study evaluated: (I) risk of post-operative deep vein thrombosis (DVT) and pulmonary embolism (PE), and (II) bleeding complications; among patients who had primary total knee arthroplasty (TKA) and received one of the following regimens: (i) 325 mg aspirin and mechanical pulsatile stocking; (ii) rivaroxaban; or (iii) 325 mg aspirin and 1,000 mg fish oil. Methods This was a 6-year prospective study analyzing the postoperative thromboembolic prophylaxis received by patients who underwent primary TKA. Patients who had a previous history of thromboembolic disease were excluded from the study due to an increased risk of recurrent clot formation. A total of 850 patients were enrolled. A total of 300 patients enrolled between October 2011 and June 2013 received 325 mg aspirin and mechanical pulsatile stocking, while 250 patients enrolled between June 2013 and December 2014 received rivaroxaban. A total of 300 patients enrolled between January 2015 and July 2017 received 325 mg aspirin and 1,000 mg fish oil. Major venous thromboembolic events (VTEs) and bleeding complications within the first 90 days post-operatively were recorded in each cohort. The odds ratios (ORs) and 95% confidence intervals (CIs), for thromboembolic and bleeding events were calculated and compared between the aspirin and fish oil cohort vs. aspirin and pulsatile stocking cohort, and aspirin and fish oil cohort vs. rivaroxaban cohort. A P value of <0.05 was used to determine statistical significance. Results A total of 25 DVT events were recorded including 1 of 300 (0.33%) in the aspirin and fish oil cohort, 22 of 300 (7.33%) in the aspirin and pulsatile stocking cohort and 2 of 250 (0.8%) in the rivaroxaban cohort. When comparing ORs, patients who received aspirin and fish oil demonstrated significantly lower risk for thromboembolic events when compared to the aspirin and pulsatile stocking group (OR: 0.045; 95% CI: 0.0061-0.3394; P<0.05). When compared to the rivaroxaban cohort the ORs did not differ significantly (OR: 0.416; 95% CI: 0.0376-4.6223; P>0.05). In addition, no PE events were recorded in any of the cohorts. When compared to rivaroxaban, the fish oil and aspirin cohort demonstrated significantly lower incidence of bleeding episodes (1 of 300, 0.33% vs. 30 of 250 patients, 12%; OR: 0.0278; 95% CI: 0.0038-0.2051; P<0.05). No bleeding events were recorded in the aspirin and pulsatile stocking cohort. Conclusions This study demonstrated the potentially synergistic anti-thromboembolic effect of aspirin and fish oil in the prevention of post-operative venous thromboembolism in primary TKA patients. Based on the results from this study, the authors conclude that the combination of aspirin and fish oil maybe an excellent thromboprophylactic modality for patients to use after TKA. These results warrant further, larger prospective studies analyzing the use of fish oil supplements in VTE prophylaxis.
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Affiliation(s)
- Peter M Bonutti
- Department of Orthopaedic Surgery, Bonutti Clinic, Effingham, Illinois, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yatindra H Patel
- School of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Frank R Kolisek
- Department of Orthopaedic Surgery, OrthoIndy, Greenwood, IN, USA
| | - Nick Williams
- Department of Orthopaedic Surgery, Bonutti Clinic, Effingham, Illinois, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Viecelli AK, Mori TA, Roy-Chaudhury P, Polkinghorne KR, Hawley CM, Johnson DW, Pascoe EM, Irish AB. The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled. Semin Dial 2017; 31:244-257. [DOI: 10.1111/sdi.12658] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Qld Australia
- Australasian Kidney Trials Network; School of Medicine; University of Queensland; Brisbane Qld Australia
| | - Trevor A Mori
- Medical School; University of Western Australia; Perth WA Australia
| | - Prabir Roy-Chaudhury
- Department of Medicine; University of Arizona College of Medicine and Southern Arizona VA Healthcare System; Tucson AZ USA
| | - Kevan R Polkinghorne
- Department of Nephrology; Monash Medical Centre; Melbourne Vic. Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Vic. Australia
- Department of Medicine; Monash University; Melbourne Vic. Australia
| | - Carmel M Hawley
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Qld Australia
- Australasian Kidney Trials Network; School of Medicine; University of Queensland; Brisbane Qld Australia
- Translational Research Institute; Brisbane Qld Australia
| | - David W Johnson
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Qld Australia
- Australasian Kidney Trials Network; School of Medicine; University of Queensland; Brisbane Qld Australia
- Translational Research Institute; Brisbane Qld Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network; School of Medicine; University of Queensland; Brisbane Qld Australia
| | - Ashley B Irish
- Australasian Kidney Trials Network; School of Medicine; University of Queensland; Brisbane Qld Australia
- Department of Nephrology; Fiona Stanley Hospital; Perth WA Australia
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4
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Viecelli AK, Pascoe EM, Polkinghorne KR, Hawley CM, Paul-Brent PA, Badve SV, Cass A, Johnson DW, Kerr PG, Mori TA, Scaria A, Hooi SL, Ong ML, Irish AB. Baseline characteristics of the omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study. Nephrology (Carlton) 2016. [PMID: 26205903 DOI: 10.1111/nep.12573] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The Fish oils and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial investigated whether 3 months of omega-3 polyunsaturated fatty acids, either alone or in combination with aspirin, will effectively reduce primary access failure of de novo arteriovenous fistulae. This report presents the baseline characteristics of all study participants, examines whether study protocol amendments successfully increased recruitment of a broader and more representative haemodialysis cohort, including patients already receiving aspirin, and contrasts Malaysian participants with those from Australia, New Zealand and the United Kingdom (UK). METHOD This international, randomized, double-blind, placebo-controlled trial included patients older than 19 years with stage 4 or 5 chronic kidney disease currently receiving, or planned within 12 months to receive haemodialysis. RESULTS Participants (n = 568) were overweight (28.6 ± 7.3 kg/m(2) ), relatively young (54.8 ± 14.3 years), and predominantly male (63%) with a high prevalence of diabetes mellitus (46%) but low rate of ischaemic heart disease (8%). Sixty one percent were planned for lower arm arteriovenous fistula creation. Malaysian participants (n = 156) were younger (51.8 ± 13.6 years vs 57.1 ± 14.2 years, P < 0.001) with a higher prevalence of diabetes mellitus (65% vs 43%, P < 0.001), but less ischaemic heart disease (5% vs 14%, P < 0.01) compared with the combined Australian, New Zealand and UK cohort (n = 228). Protocol modifications allowing for inclusion of patients receiving aspirin increased the prevalence of co-morbidities compared with the original cohort. CONCLUSIONS The FAVOURED study participants, while mostly similar to patients in contemporary national registry reports and comparable recent clinical trials, were on average younger and had less ischaemic heart disease. These differences were reduced as a consequence of including patients already receiving aspirin.
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peta-Anne Paul-Brent
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sunil V Badve
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, St George Hospital, Sydney, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Trevor A Mori
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Anish Scaria
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Seong L Hooi
- Department of Medicine and Haemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Meng L Ong
- Department of Nephrology, Penang Hospital, Georgetown, Malaysia
| | - Ashley B Irish
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Nephrology, Fiona Stanley Hospital, Perth, Western Australia, Australia
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5
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Viecelli AK, Pascoe E, Polkinghorne KR, Hawley C, Paul-Brent PA, Badve SV, Cass A, Heritier S, Kerr PG, Mori TA, Robertson A, Seong HL, Irish AB. The Omega-3 fatty acids (Fish Oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study: the updated final trial protocol and rationale of post-initiation trial modifications. BMC Nephrol 2015; 16:89. [PMID: 26116581 PMCID: PMC4482267 DOI: 10.1186/s12882-015-0089-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 06/16/2015] [Indexed: 12/20/2022] Open
Abstract
Background The FAVOURED study is an international multicentre, double-blind, placebo-controlled trial which commenced recruitment in 2008 and examines whether omega-3 polyunsaturated fatty acids (omega-3 PUFAs) either alone or in combination with aspirin will effectively reduce primary access failure of de novo arteriovenous fistulae (AVF) in patients with stage 4 and 5 chronic kidney disease. Publication of new evidence derived from additional studies of clopidogrel and a high screen failure rate due to prevalent aspirin usage prompted an updated trial design. Methods/design The original trial protocol published in 2009 has undergone two major amendments, which were implemented in 2011. Firstly, the primary outcome ‘early thrombosis’ at 3 months following AVF creation was broadened to a more clinically relevant outcome of ‘AVF access failure’; a composite of thrombosis, AVF abandonment and cannulation failure at 12 months. Secondly, participants unable to cease using aspirin were allowed to be enrolled and randomised to omega-3 PUFAs or placebo. The revised primary aim of the FAVOURED study is to test the hypothesis that omega-3 PUFAs will reduce rates of AVF access failure within 12 months following AVF surgery. The secondary aims are to examine the effect of omega-3 PUFAs and aspirin on the individual components of the primary end-point, to examine the safety of study interventions and assess central venous catheter requirement as a result of access failure. Discussion This multicentre international clinical trial was amended to address the clinically relevant question of whether the usability of de novo AVF at 12 months can be improved by the early use of omega-3 PUFAs and to a lesser extent aspirin. This study protocol amendment was made in response to a large trial demonstrating that clopidogrel is effective in safely preventing primary AVF thrombosis, but ineffective at increasing functional patency. Secondly, including patients taking aspirin will enrol a more representative cohort of haemodialysis patients, who are significantly older with a higher prevalence of cardiovascular disease and diabetes which may increase event rates and the power of the study. Trial registration Australia & New Zealand Clinical Trial Register (ACTRN12607000569404)
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Elaine Pascoe
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia. .,Departments of Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia. .,Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Peta-Anne Paul-Brent
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Sunil V Badve
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia. .,Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - Stephane Heritier
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Peter G Kerr
- Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia. .,Department of Medicine, Monash University, Melbourne, VIC, Australia.
| | - Trevor A Mori
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
| | - Amanda Robertson
- Department of Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Hooi L Seong
- Hospital Sultanah Aminah, Johor Bahru, Malaysia.
| | - Ashley B Irish
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia. .,Department of Renal Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA, 6150, Australia.
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DeFilippis AP, Rai SN, Cambon A, Miles RJ, Jaffe AS, Moser AB, Jones RO, Bolli R, Schulman SP. Fatty acids and TxA(2) generation, in the absence of platelet-COX-1 activity. Nutr Metab Cardiovasc Dis 2014; 24:428-433. [PMID: 24370448 PMCID: PMC4409424 DOI: 10.1016/j.numecd.2013.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/09/2013] [Accepted: 08/26/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS Omega-3 fatty acids suppress Thromboxane A(2) (TxA(2)) generation via mechanisms independent to that of aspirin therapy. We sought to evaluate whether baseline omega-3 fatty acid levels influence arachidonic acid proven platelet-cyclooxygenase-1 (COX-1) independent TxA(2) generation (TxA(2) generation despite adequate aspirin use). METHODS AND RESULTS Subjects with acute myocardial infarction, stable CVD or at high risk for CVD, on adequate aspirin therapy were included in this study. Adequate aspirin action was defined as complete inhibition of platelet-COX-1 activity as assessed by <10% change in light transmission aggregometry to ≥1 mmol/L arachidonic acid. TxA(2) production was measured via liquid chromatography-tandem mass spectrometry for the stable TxA(2) metabolite 11-dehydro-thromboxane B2 (UTxB2) in urine. The relationship between baseline fatty acids, demographics and UTxB(2) were evaluated. Baseline omega-3 fatty acid levels were not associated with UTxB(2) concentration. However, smoking was associated with UTxB(2) in this study. CONCLUSION Baseline omega-3 fatty acid levels do not influence TxA(2) generation in patients with or at high risk for CVD receiving adequate aspirin therapy. The association of smoking and TxA(2) generation, in the absence of platelet COX-1 activity, among aspirin treated patients warrants further study.
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Affiliation(s)
- A P DeFilippis
- University of Louisville, Rudd Heart & Lung Center/Kentucky One Health, Louisville, KY, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - S N Rai
- Biostatistics Shared Facility, JG Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - A Cambon
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - R J Miles
- University of Louisville School of Medicine, Louisville, KY, USA
| | - A S Jaffe
- Cardiovascular division, Mayo Clinic, Rochester, MN, USA
| | - A B Moser
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R O Jones
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Bolli
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA
| | - S P Schulman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Grossi P, Bertoni G, Cappelli FP, Trevisi E. Effects of the precalving administration of omega-3 fatty acids alone or in combination with acetylsalicylic acid in periparturient dairy cows1. J Anim Sci 2013; 91:2657-66. [DOI: 10.2527/jas.2012-5661] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | - G. Bertoni
- Istituto di Zootecnica, Università Cattolica del Sacro Cuore, 29122 Piacenza, Italy
| | - F. Piccioli Cappelli
- Istituto di Zootecnica, Università Cattolica del Sacro Cuore, 29122 Piacenza, Italy
| | - E. Trevisi
- Istituto di Zootecnica, Università Cattolica del Sacro Cuore, 29122 Piacenza, Italy
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Banderó CRR, Salvadori MGSS, Gomes AT, Dal Ri NMK, Furian AF, Oliveira MS, Rambo LM, Scorza FA, Cysneiros RM, Emanuelli T, Mello CF. Fish oil attenuates methylmalonate-induced seizures. Epilepsy Res 2013; 105:69-76. [PMID: 23375884 DOI: 10.1016/j.eplepsyres.2013.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 12/21/2012] [Accepted: 01/03/2013] [Indexed: 12/20/2022]
Abstract
Methylmalonic acidemias are inherited metabolic disorders characterized by methylmalonate (MMA) accumulation and neurological dysfunction, including seizures. Dietary fatty acids are known as an important energy source and reduce seizure activity in selected acute animal models. This study investigated whether chronic treatment with fish oil or with oleic acid attenuates MMA-induced seizures and whether maintenance of Na(+),K(+)-ATPase activity was involved in such an effect. Adult male Wistar rats were given fish oil (85 mg/kg), oleic acid (85 mg/kg) or vehicle (0.42% aqueous Cremophor EL™, 4 mL/kg/body weight/day), p.o., for 75 days. On the 73th day a cannula was implanted in the right lateral ventricle with electrodes over the parietal cortex for EEG recording. On the 76th day the animals were injected with NaCl (2.5 μmol/2.5 μL, i.c.v.), or with MMA (2.5 μmol/2.5 μL, i.c.v.), and seizure activity was measured by electroencephagraphic (EEG) recording with concomitant behavior monitoring. The effect of prostaglandin E2 (PGE2) on Na(+),K(+)-ATPase activity of slices of cerebral cortex from NaCl-injected animals was determined. Fish oil increased the latency to MMA-induced tonic-clonic seizures, reduced the mean amplitude of ictal EEG recordings, and prevented PGE2-induced decrease of Na(+),K(+)-ATPase activity in cortical slices in vitro. Oleic acid decreased mean amplitude of ictal EEG recordings. The results support that fish oil decreases MMA-induced seizures. The decreased sensitivity of Na(+),K(+)-ATPase to the inhibitory effect of PGE2 in fish oil-treated animals may be related to the currently reported anticonvulsant activity.
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Affiliation(s)
- Cristina Ruedell Reschke Banderó
- Programa de Pós-graduação em Farmacologia, CCS, Universidade Federal de Santa Maria, Av. Roraima, 1000-Camobi, CEP: 97105-900, Santa Maria, RS, Brazil
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Influence of omega-3 polyunsaturated fatty acid-supplementation on platelet aggregation in humans: a meta-analysis of randomized controlled trials. Atherosclerosis 2012; 226:328-34. [PMID: 23153623 DOI: 10.1016/j.atherosclerosis.2012.10.056] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/10/2012] [Accepted: 10/22/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Increased platelet activity predicts adverse cardiovascular events. The objective was to assess the effects of long-chain omega-3 polyunsaturated fatty acid (n-3 PUFA)-supplementation on platelet aggregation. METHODS AND RESULTS We conducted a meta-analysis of randomized controlled trials identified using PubMed, Embase and the Cochrane Library. Fifteen studies were included. In comparison to placebo using the random-effect model, n-3 PUFA-supplementation significantly reduced adenosine diphosphate-induced platelet aggregation (standard mean difference [SMD] = -1.23 with 95% confidence interval [CI] -2.24 to -0.23, p = 0.02) and platelet aggregation units, determined using the VerifyNow(®) rapid platelet-function assay system (SMD = -6.78 with 95% CI -12.58 to -0.98, p = 0.02). There was a trend toward decreased collagen-induced (SMD = -0.70 with 95% CI -0.72 to 0.33, p = 0.18) and arachidonic acid-induced platelet aggregation (SMD = -0.43 with 95% CI -2.26 to 1.40, p = 0.64) compared with controls; however, statistical significance was not reached. CONCLUSIONS Our meta-analysis demonstrates that n-3 PUFA-supplementation is associated with a significant reduction in platelet aggregation when the participants were at poor health status, but not in healthy persons. High-risk patients with cardiovascular disease and even diabetics may potentially benefit from n-3 PUFAs therapy. However, n-3 PUFAs may not be effective in primary prevention. Larger trials need to be carried out to confirm the present findings.
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10
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Berliner AR, Fine DM. There's something fishy about this bleeding. NDT Plus 2011; 4:270-2. [PMID: 25949500 PMCID: PMC4421441 DOI: 10.1093/ndtplus/sfr046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/07/2011] [Indexed: 11/14/2022] Open
Affiliation(s)
- Adam R Berliner
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Nephrology Center of Maryland, Baltimore, MD, USA
| | - Derek M Fine
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Basselin M, Ramadan E, Chen M, Rapoport SI. Anti-inflammatory effects of chronic aspirin on brain arachidonic acid metabolites. Neurochem Res 2011; 36:139-45. [PMID: 20981485 PMCID: PMC3011042 DOI: 10.1007/s11064-010-0282-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2010] [Indexed: 12/22/2022]
Abstract
Pro-inflammatory and anti-inflammatory mediators derived from arachidonic acid (AA) modulate peripheral inflammation and its resolution. Aspirin (ASA) is a unique non-steroidal anti-inflammatory drug, which switches AA metabolism from prostaglandin E₂ (PGE₂) and thromboxane B₂ (TXB₂) to lipoxin A₄ (LXA₄) and 15-epi-LXA₄. However, it is unknown whether chronic therapeutic doses of ASA are anti-inflammatory in the brain. We hypothesized that ASA would dampen increases in brain concentrations of AA metabolites in a rat model of neuroinflammation, produced by a 6-day intracerebroventricular infusion of bacterial lipopolysaccharide (LPS). In rats infused with LPS (0.5 ng/h) and given ASA-free water to drink, concentrations in high-energy microwaved brain of PGE₂, TXB₂ and leukotriene B₄ (LTB₄) were elevated. In rats infused with artificial cerebrospinal fluid, 6 weeks of treatment with a low (10 mg/kg/day) or high (100 mg/kg/day) ASA dose in drinking water decreased brain PGE₂, but increased LTB₄, LXA₄ and 15-epi-LXA₄ concentrations. Both doses attenuated the LPS effects on PGE₂, and TXB₂. The increments in LXA₄ and 15-epi-LXA₄ caused by high-dose ASA were significantly greater in LPS-infused rats. The ability of ASA to increase anti-inflammatory LXA₄ and 15-epi-LXA₄ and reduce pro-inflammatory PGE₂ and TXB₂ suggests considering aspirin further for treating clinical neuroinflammation.
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Affiliation(s)
- Mireille Basselin
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bldg. 9, Room 1S126, 9000 Rockville Pike, Bethesda, MD 20892, USA
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12
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Gajos G, Rostoff P, Undas A, Piwowarska W. Effects of polyunsaturated omega-3 fatty acids on responsiveness to dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: the OMEGA-PCI (OMEGA-3 fatty acids after pci to modify responsiveness to dual antiplatelet therapy) study. J Am Coll Cardiol 2010; 55:1671-8. [PMID: 20394870 DOI: 10.1016/j.jacc.2009.11.080] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/19/2009] [Accepted: 11/02/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate whether omega-3 polyunsaturated fatty acids (PUFAs) are able to modify platelet responsiveness to dual antiplatelet therapy in stable coronary artery disease patients undergoing percutaneous coronary intervention (PCI). BACKGROUND Although previous studies have suggested antiplatelet properties of omega-3 polyunsaturated fatty acids, it is unknown whether they can enhance platelet inhibition on standard aspirin and clopidogrel treatment. METHODS The OMEGA-PCI (OMEGA-3 Fatty Acids After PCI to Modify Responsiveness to Dual Antiplatelet Therapy) study was an investigator-initiated, prospective, single-center, double-blind, placebo-controlled, randomized study. Patients receiving standard dual antiplatelet therapy (aspirin 75 mg/day and clopidogrel 600 mg loading dose followed by 75 mg/day) were randomly assigned to receive the addition of 1 g of omega-3 ethyl esters (n = 33) or placebo (n = 30) for 1 month. Platelet function was measured serially by light transmission aggregometry (adenosine diphosphate and arachidonic acid [AA] were used as agonists) and assessment of the phosphorylation status of the vasodilator-stimulated phosphoprotein at baseline, 12 h, 3 to 5 days, and 30 days after randomization. RESULTS The P2Y(12) reactivity index was significantly lower, by 22.2%, after 1 month of treatment with omega-3 polyunsaturated fatty acids compared with placebo when used in addition to dual antiplatelet therapy (p = 0.020). Maximal platelet aggregation induced by 5 and 20 micromol/l adenosine diphosphate was lower by 13.3% (p = 0.026) and 9.8% (p = 0.029), respectively, after 1 month of treatment with omega-3 polyunsaturated fatty acids compared with placebo. Platelet aggregation after AA stimulation was low and did not change significantly throughout the study. There were no cases of aspirin resistance during follow-up that was suggestive of good compliance with the medication. CONCLUSIONS The addition of omega-3 ethyl esters to the combination of aspirin and clopidogrel significantly potentiates platelet response to clopidogrel after percutaneous coronary intervention.
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Affiliation(s)
- Grzegorz Gajos
- Department of Coronary Disease, John Paul II Hospital, Cracow, Poland.
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Lev EI, Solodky A, Harel N, Mager A, Brosh D, Assali A, Roller M, Battler A, Kleiman NS, Kornowski R. Treatment of aspirin-resistant patients with omega-3 fatty acids versus aspirin dose escalation. J Am Coll Cardiol 2010; 55:114-21. [PMID: 20117379 DOI: 10.1016/j.jacc.2009.08.039] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 08/10/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether addition of omega-3 fatty acids or increase in aspirin dose improves response to low-dose aspirin among patients who are aspirin resistant. BACKGROUND Low response to aspirin has been associated with adverse cardiovascular events. However, there is no established therapeutic approach to overcome aspirin resistance. Omega-3 fatty acids decrease the availability of platelet arachidonic acid (AA) and indirectly thromboxane A2 formation. METHODS Patients (n = 485) with stable coronary artery disease taking low-dose aspirin (75 to 162 mg) for at least 1 week were screened for aspirin response with the VerifyNow Aspirin assay (Accumetrics, San Diego, California). Further testing was performed by platelet aggregation. Aspirin resistance was defined by > or =2 of 3 criteria: VerifyNow score > or =550, 0.5-mg/ml AA-induced aggregation > or =20%, and 10-micromol/l adenosine diphosphate (ADP)-induced aggregation > or =70%. Thirty patients (6.2%) were found to be aspirin resistant and randomized to receive either low-dose aspirin + omega-3 fatty acids (4 capsules daily) or aspirin 325 mg daily. After 30 days of treatment patients were re-tested. RESULTS Both groups (n = 15 each) had similar clinical characteristics. After treatment significant reductions in AA- and ADP-induced aggregation and the VerifyNow score were observed in both groups. Plasma levels of thromboxane B2 were also reduced in both groups (56.8% reduction in the omega-3 fatty acids group, and 39.6% decrease in the aspirin group). Twelve patients (80%) who received omega-3 fatty acids and 11 patients (73%) who received aspirin 325 mg were no longer aspirin resistant after treatment. CONCLUSIONS Treatment of aspirin-resistant patients by adding omega-3 fatty acids or increasing the aspirin dose seems to improve response to aspirin and effectively reduces platelet reactivity.
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Affiliation(s)
- Eli I Lev
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel.
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Kidson-Gerber G, Weaver J, Gemmell R, Prasan AM, Chong BH. Serum thromboxane B2 compared to five other platelet function tests for the evaluation of aspirin effect in stable cardiovascular disease. Heart Lung Circ 2010; 19:234-42. [PMID: 20144559 DOI: 10.1016/j.hlc.2009.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 11/09/2009] [Accepted: 11/11/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND To assess the role of serum thromboxane B(2) (TXB(2)) measurements and the correlation between platelet function studies, in patients with stable cardiovascular disease on aspirin or clopidogrel. METHODS 76 patients (47 on aspirin, 16 clopidogrel, 13 both) underwent assessment of TXB(2), whole blood aggregometry (WBA) after stimulation with (i) arachidonic acid (0.5mM), (ii) ADP (5 microM), (iii) collagen (1 and 5 microg/ml), PFA-100, and Cone and Plate Analyzer. Clopidogrel patients were additionally assessed by the VerifyNow System. RESULTS TXB(2) values ranged between 0.2 and 56.2 ng/ml, with significant separation between those taking aspirin, clopidogrel and controls (0.45 ng/ml vs 6.85 ng/ml vs 12.97 ng/ml, p<0.001). There was moderate correlation between WBA-AA and TXB(2) (r=0.487, p<0.001), PFA-100((R)) (r=0.599, p<0.001), WBA-Col1 (r=0.424, p<0.001), WBA-Col1:5 (r=0.417, p<0.001), and between TXB(2) and PFA-100((R)) (r=0.509, p<0.001). The prevalence of aspirin non-responders for WBA-AA, TXB(2), PFA-100((R)), CPA and Coll1:5 was 13.1%, 8.2%, 14.8%, 9.7% and 16.4% respectively. Individual patients were not consistently classified as aspirin non-responders in all tests. Those with inadequate aspirin response on > or =3 tests had higher TXB(2) levels (mean 1.57+/-1.66, range 0.553-4.45 vs mean 0.45+/-0.18, range 0.23-1.50) (p=0.001). Clopidogrel suppressed TXB(2) (p=0.02), WBA-AA (p<0.001), WBA-Col1 (p=0.012) and WBA-ADP (p<0.001) compared to controls. TXB(2) in patients ingesting fish oil tablets was lower compared to those without (0.4 ng/ml vs 0.52 ng/ml, p=0.004). Obesity was associated with higher TXB(2) values (0.61 vs 0.41, p=0.01). CONCLUSION Serum TXB(2) measurements are a direct measure of the pharmacological effect of aspirin, are easily performed and correlate with other measures of platelet function. Serum TXB(2) measurements could be a useful sole measure of aspirin non-response, and may be even more predictive when performed in tandem with a global measure of platelet function. Aspirin and clopidogrel both suppressed several platelet pathways.
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Affiliation(s)
- Giselle Kidson-Gerber
- South Eastern Area Laboratory Services, Department of Haematology, Prince of Wales Hospital, Sydney, Australia.
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Irish A, Dogra G, Mori T, Beller E, Heritier S, Hawley C, Kerr P, Robertson A, Rosman J, Paul-Brent PA, Starfield M, Polkinghorne K, Cass A. Preventing AVF thrombosis: the rationale and design of the Omega-3 fatty acids (Fish Oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study. BMC Nephrol 2009; 10:1. [PMID: 19159453 PMCID: PMC2637871 DOI: 10.1186/1471-2369-10-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 01/21/2009] [Indexed: 12/05/2022] Open
Abstract
Background Haemodialysis (HD) is critically dependent on the availability of adequate access to the systemic circulation, ideally via a native arteriovenous fistula (AVF). The Primary failure rate of an AVF ranges between 20–54%, due to thrombosis or failure of maturation. There remains limited evidence for the use of anti-platelet agents and uncertainty as to choice of agent(s) for the prevention of AVF thrombosis. We present the study protocol for a randomised, double-blind, placebo-controlled, clinical trial examining whether the use of the anti-platelet agents, aspirin and omega-3 fatty acids, either alone or in combination, will effectively reduce the risk of early thrombosis in de novo AVF. Methods/Design The study population is adult patients with stage IV or V chronic kidney disease (CKD) currently on HD or where HD is planned to start within 6 months in whom a planned upper or lower arm AVF is to be the primary HD access. Using a factorial-design trial, patients will be randomised to aspirin or matching placebo, and also to omega-3 fatty acids or matching placebo, resulting in four treatment groups (aspirin placebo/omega-3 fatty acid placebo, aspirin/omega-3 fatty acid placebo, aspirin placebo/omega-3 fatty acid, aspirin/omega-3 fatty acid). Randomisation will be achieved using a dynamic balancing method over the two stratification factors of study site and upper versus lower arm AVF. The medication will be commenced pre-operatively and continued for 3 months post surgery. The primary outcome is patency of the AVF at three months after randomisation. Secondary outcome measures will include functional patency at six and twelve months, primary patency time, secondary (assisted) patency time, and adverse events, particularly bleeding. Discussion This multicentre Australian and New Zealand study has been designed to determine whether the outcome of surgery to create de novo AVF can be improved by the use of aspirin and/or omega-3 fatty acids. Recently a placebo-controlled trial has shown that clopidogrel is effective in safely preventing primary AVF thrombosis, but ineffective at increasing functional patency. Our study presents significant differences in the anti-platelet agents used, the study design, and surgical and patient demographics that should contribute further evidence regarding the efficacy of anti-platelet agents. Trial Registration Australia & New Zealand Clinical Trials Register (ACTRN12607000569404).
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Affiliation(s)
- Ashley Irish
- Renal Unit, Royal Perth Hospital, Perth, WA, Australia.
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Browning LM, Krebs JD, Moore CS, Mishra GD, O'Connell MA, Jebb SA. The impact of long chain n-3 polyunsaturated fatty acid supplementation on inflammation, insulin sensitivity and CVD risk in a group of overweight women with an inflammatory phenotype. Diabetes Obes Metab 2007; 9:70-80. [PMID: 17199721 DOI: 10.1111/j.1463-1326.2006.00576.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inflammation is strongly related to obesity and the risk of cardiovascular disease (CVD). The metabolic benefits of long chain (LC) n-3 polyunsaturated fatty acid (PUFA) may be attributable to its anti-inflammatory properties. OBJECTIVE To investigate whether an individual's habitual inflammatory status influences the impact of a LC n-3 PUFA intervention on CVD risk. DESIGN The study was a randomized crossover design. Subjects received LC n-3 PUFA capsules or a placebo for 12 weeks, with 4-week washout between phases. Thirty women, in the top and bottom tertiles of baseline sialic acid concentration, formed raised inflammatory status (top, n = 12) and reference (bottom, n = 18) groups. Baseline data were analysed using one-way anova, differences between treatment phases were calculated at each timepoint and analysed using a random effects model. RESULTS At baseline, the raised inflammatory status group had significantly higher body mass index and area under the curve (AUC) insulin than the reference group. With LC n-3 PUFA supplementation, both groups showed significantly higher plasma eicosapentaenoic acid and docosahexaenoic acid at 4 and 12 weeks (p < 0.001), and lower triacylglycerols (4 weeks p < 0.01 and 12 weeks p < 0.05). The difference in AUC insulin between the two treatment phases at 12 weeks was significantly greater in the raised inflammatory status group compared to the reference group (p < 0.05). Inflammatory markers were significantly lower after 12 weeks LC n-3 PUFA supplementation compared to baseline (C-reactive protein p < 0.05 and interleukin-6 p < 0.01), but there was no significant group effect. CONCLUSIONS Habitual inflammatory status influences the impact of LC n-3 PUFA supplementation, but it is not clear whether the effect of LC n-3 PUFA on AUC insulin is mediated through inflammatory mechanisms.
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Affiliation(s)
- L M Browning
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK.
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Moore CS, Bryant SP, Mishra GD, Krebs JD, Browning LM, Miller GJ, Jebb SA. Oily fish reduces plasma triacylglycerols: a primary prevention study in overweight men and women. Nutrition 2006; 22:1012-24. [PMID: 17027436 DOI: 10.1016/j.nut.2006.07.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 07/18/2006] [Accepted: 07/28/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Previous studies have demonstrated benefits of high-dose long-chain omega-3 polyunsaturated fatty acid (LC omega-3 PUFA) supplements on metabolic risk. Effects of increased dietary omega-3 PUFA, via oily fish and/or plant-derived omega-3 PUFAs, are less clear and may be modulated by the omega-6:omega-3 PUFA of the habitual diet. This study examined the effect on cardiovascular disease risk markers of reducing dietary omega-6:omega-3 PUFA by changes in linoleic acid:alpha-linolenic acid (LA:LNA) and/or increasing LC omega-3 PUFA. It tested whether decreases in LA:LNA modulate effects of LC omega-3 PUFA. METHODS One hundred forty-two subjects, recruited to a 24-wk randomized study, were assigned to a control group or one of four interventions. Intervention groups received two portions of oily fish (4.5 g eicosapentaenoic acid + docosahexanoic acid) or white fish (0.7 g eicosapentaenoic acid + docosahexanoic acid) per week, and replaced habitual household fats with ones high in sunflower (high LA:LNA) or rapeseed (low LA:LNA) oil. RESULTS Modest dietary manipulations of omega-6 and omega-3 PUFAs resulted in significant group x time interactions for serum triacylglycerols (TAGs; P = 0.05); at 24 wk the control and two oily fish groups showed lower TAG than did the white fish/sunflower group (P = 0.05). Reductions in TAG, associated with increased oily fish intakes, were maximized when combined with lower dietary LA:LNA. There were no significant changes in several other cardiovascular disease risk markers. CONCLUSIONS Two portions of oily fish per week led to significant reductions in TAG relative to consumption of two portions of white fish per week. Changes in TAG were maximized when combined with lower LA:LNA.
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Affiliation(s)
- Carmel S Moore
- Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK.
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The Potential Hazards of Used and Abused Perioperative Drugs, Herbs, and Dietary Supplements. ACTA ACUST UNITED AC 2006. [DOI: 10.1097/00126869-200634010-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Desai D, Hasan A, Wesley R, Sunderland E, Pucino F, Csako G. Effects of dietary supplements on aspirin and other antiplatelet agents: an evidence-based approach. Thromb Res 2005; 117:87-101; discussion 113-5. [PMID: 16115664 DOI: 10.1016/j.thromres.2005.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2005] [Revised: 05/21/2005] [Accepted: 06/20/2005] [Indexed: 11/29/2022]
Affiliation(s)
- Ditina Desai
- Pharmacy Department, Clinical Center, National Institutes of Health, DHHS, Bldg 10, Room 1N-257, Bethesda, MD 20892-1196, USA.
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Clària J, Kent JD, López-Parra M, Escolar G, Ruiz-Del-Arbol L, Ginès P, Jiménez W, Vucelic B, Arroyo V. Effects of celecoxib and naproxen on renal function in nonazotemic patients with cirrhosis and ascites. Hepatology 2005; 41:579-87. [PMID: 15723448 DOI: 10.1002/hep.20595] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nonselective inhibition of cyclooxygenase (COX) by nonsteroidal anti-inflammatory drugs frequently induces renal failure in decompensated cirrhosis. Studies in experimental cirrhosis suggest that selective inhibitors of the inducible isoform COX-2 do not adversely affect renal function. However, very limited information is available on the effects of these compounds on renal function in human cirrhosis. This investigation consists of a double-blind, randomized, placebo-controlled trial aimed at comparing the effects of the selective COX-2 inhibitor celecoxib (200 mg every 12 hours for a total of 5 doses) on platelet and renal function and the renal response to furosemide (40 mg intravenously) with those of naproxen (500 mg every 12 hours for a total of 5 doses) and placebo in 28 patients with cirrhosis and ascites. A significant reduction (P < .05) in glomerular filtration rate (113 +/- 27 to 84 +/- 22 mL/min), renal plasma flow (592 +/- 158 to 429 +/- 106 mL/min) and urinary prostaglandin E(2) excretion (3430 +/- 430 to 2068 +/- 549 pg/min) and suppression of the diuretic (urine volume: 561 +/- 128 to 414 +/- 107 mL/h) and natriuretic (urine sodium: 53 +/- 13 to 34 +/- 10 mEq/h) responses to furosemide were observed in the group of patients treated with naproxen but not in the other two groups. Naproxen, but not celecoxib or placebo, significantly inhibited platelet aggregation (72% +/- 8% to 47% +/- 8%, P < .05) and thromboxane B(2) production (41 +/- 12 to 14 +/- 5 pg/mL, P < .05). In conclusion, our results indicate that short-term administration of celecoxib does not impair platelet and renal function and the response to diuretics in decompensated cirrhosis. Further studies are needed to evaluate the long-term safety of this drug in cirrhosis.
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Affiliation(s)
- Joan Clària
- DNA Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Abstract
Beneficial effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) have been reported in recent epidemiologic studies and randomized clinical trials in a variety of cardiovascular and autoimmune diseases. Fish and marine oils are the most abundant and convenient sources of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the two major n-3 fatty acids that serve as substrates for cyclooxygenase and lipoxygenase pathways leading to less potent inflammatory mediators than those produced through the n-6 PUFA substrate, arachidonic acid. N-3 PUFA can also suppress inflammatory and/or immunologic responses through eicosanoid-independent mechanisms. Although the pathophysiology of IgA nephropathy is incompletely understood, it is likely that n-3 PUFA prevents renal disease progression by interfering with a number of effector pathways triggered by mesangial immune-complex deposition. In addition, potential targets of n-3 PUFA relevant to renal disease progression could be similar to those involved in preventing the development and progression of cardiovascular disease by lowering blood pressure, reducing serum lipid levels, decreasing vascular resistance, or preventing thrombosis. In IgA nephropathy, efficacy of n-3 PUFA contained in fish oil supplements has been tested with varying results. The largest randomized clinical trial performed by our collaborative group provided strong evidence that treatment for 2 years with a daily dose of 1.8 g of EPA and 1.2 g of DHA slowed the progression of renal disease in high-risk patients. These benefits persisted after 6.4 years of follow up. With safety, composition, and dosing convenience in mind, we can recommend two products that are available as pharmaceutical-grade fish-oil concentrates, Omacor (Pronova Biocare, Oslo, Norway) and Coromega (European Reference Botanical Laboratories, Carlsbad, CA).
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Affiliation(s)
- James V Donadio
- Division of Nephrology, the Department of Medicine, and the Department of Laboratory Medicine and Pathology, Mayo Clinic & Mayo Foundation, Rochester, MN, USA.
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Planagumà A, Titos E, López-Parra M, Gaya J, Pueyo G, Arroyo V, Clària J. Aspirin (ASA) regulates 5-lipoxygenase activity and peroxisome proliferator-activated receptor alpha-mediated CINC-1 release in rat liver cells: novel actions of lipoxin A4 (LXA4) and ASA-triggered 15-epi-LXA4. FASEB J 2002; 16:1937-9. [PMID: 12368230 DOI: 10.1096/fj.02-0224fje] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The mechanism of action of aspirin (ASA) is related to cyclooxygenase (COX) inhibition, but additional actions cannot be excluded for their antiinflammatory properties and antithrombotic activity. In the current investigation, we examined the effects of ASA on COX and 5-lipoxygenase (5-LO) pathways and its impact on peroxisome proliferator-activated receptor alpha (PPARalpha) and cytokine-induced neutrophil chemoattractant-1 (CINC-1) levels in rat liver cells. In Kupffer cells, the liver resident macrophages, ASA switched eicosanoid biosynthesis from prostaglandin E2 (PGE2) to leukotriene B4 (LTB4) and 15-epi-lipoxin A4 (15-epi-LXA4) formation. In hepatocytes, ASA significantly inhibited PPARalpha protein expression and CINC-1 secretion, effects that were also observed in hepatocytes exposed to the selective PPARalpha agonist Wy-14643. In contrast, treatment of hepatocytes with PGE2 in association with LTB4 had no significant effect on PPARalpha but stimulated CINC-1 release. Interestingly, the endogenous antiinflammatory eicosanoids LXA4 and ASA-triggered 15-epi-LXA4, in addition to inhibiting macrophage 5-LO activity to a similar extent as PGE2, significantly reduced PPARalpha and CINC-1 levels in hepatocytes. Taken together and because arachidonic acid-derived products, PPARalpha levels, and CINC-1 secretion are involved in the extent and duration of an inflammatory response, these findings provide additional molecular mechanisms for the pharmacological properties of ASA.
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Affiliation(s)
- Anna Planagumà
- DNA Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Spain
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Saldeen TGP, Mehta JL. Dietary modulations in the prevention of coronary artery disease: a special emphasis on vitamins and fish oil. Curr Opin Cardiol 2002; 17:559-67. [PMID: 12357135 DOI: 10.1097/00001573-200209000-00018] [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] [Indexed: 11/25/2022]
Abstract
Coronary artery disease (CAD) is the most common cause of death in most countries. The etiology of CAD is complex, and many risk factors have been described. Traditional risk factors for CAD can only explain about half of the clinical events; therefore, interest in nutritional factors, such as vitamins and fish oil, has been maintained.
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Affiliation(s)
- Tom G P Saldeen
- Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden.
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