Acute-phase proteins and other systemic responses to inflammation

AA amyloidosis in vertebrates: epidemiology, pathology and molecular aspects

AA amyloidosis is a prototypic example of systemic amyloidosis: it results from the prolonged overproduction of SAA protein produced in response to chronic inflammation. AA amyloidosis primarily affects the kidneys, liver, spleen, gastrointestinal tract, leading to a variety of symptoms. First, this review examines AA amyloidosis in humans, focusing on pathogenesis, clinical presentation, and diagnosis and then in animals. In fact AA amyloidosis is the only systemic amyloidosis that has been largely documented in a remarkable number of vertebrate species: mammals, birds, and fishes, especially in individuals with comorbidities, chronic stress, or held in captivity. Secondly, here, we summarise independent sets of evidence obtained on different animal species, exploring the possible transmissibility of AA amyloidosis especially in crowded or confined populations. Finally, biochemical and structural data on native SAA and on AA amyloid fibrils from human, murine, and cat ex vivo samples are discussed. The available structural data depict a complex scenario, where SAA can misfold forming highly different amyloid assemblies. This review highlights the complexity of AA amyloidosis, emphasising the need for further research into its spread in the animal kingdom, its structural aspects, and pathogenetic mechanisms to evaluate its impact on human and animal health.

Porcine serum amyloid A3 promotes the adhesion, invasion, and proliferation of Actinobacillus pleuropneumoniae

The spread of Porcine contagious pleuropneumonia (PCP), a severe disease that occurs in pigs caused by Actinobacillus pleuropneumoniae (APP), remains a threat to the porcine farms and has been known to cause severe economic losses. Serum amyloid A (SAA) is an acute-phase protein rapidly expressed in response to infection and inflammation in vertebrates. This study aimed to investigate the function of SAA3 in bacterial infections. Here, APP was used to infect porcine alveolar macrophages (3D4/21), pigs, and mice. The results showed that the expression level of SAA3 was significantly up-regulated in APP-infected 3D4/21 cells, as well as pigs and mice infected with APP. In SAA3-overexpressing (SAA3-OE) cells, the expression of IL-1β, IL-6, and TNF-α were also up-regulated, while silencing of SAA3 reversed these effects. Furthermore, the levels of APP were substantially up-regulated in the culture supernatant of SAA3-OE cells, with significant down-regulation in siRNA-SAA3 cells culture supernatants. Also, SAA3-OE enhanced the adhesion and invasion of APP-infected target cells. These findings suggest that porcine SAA3 up-regulated cytokine expression, with increased SAA3 expression exacerbating inflammation. Notably, SAA3 promoted the growth of APP during the logarithmic growth phase. This created favorable conditions for APP growth and promoted its proliferation, adhesion, and invasion. These findings provide insights into the role of porcine SAA3 in the course of bacterial infection.

Clinical Gestalt to Predict Bacterial Infection and Mortality in Emergency Department Patients: A Prospective Observational Study

BACKGROUND

Time to treatment is a significant predictor of mortality in emergency department (ED) patients with bacterial sepsis. Strategies for the early detection of bacterial infection and sepsis are lacking. Clinical gestalt is a tool for assessing and synthesizing the entire clinical picture, focusing on the first clinical impression at presentation.

OBJECTIVE

This study aimed to assess ED physicians' clinical gestalt for the prediction of bacterial infection and mortality in ED patients presenting with signs and symptoms of infection.

DESIGN

Prospective, observational study with a 30-day follow-up.

PARTICIPANTS

Patients aged 18 or older presenting to the ED with signs and symptoms compatible with an infection and abnormal vital signs were included.

MAIN MEASURES

ED physicians recorded their clinical gestalt using a visual analog scale (VAS) to assess the likelihood of bacterial infection and responded to a dichotomous question regarding the probability of a patient's death. The main outcome was the confirmed diagnosis of an acute bacterial infection. Final diagnoses, based on laboratory and follow-up information, were adjudicated by an expert panel.

KEY RESULTS

In total, 444 patients were included. Median age was 68 years [IQR 51, 80] and median National Early Warning Score (NEWS) was 5 [IQR 3, 7]. Median VAS for physicians' clinical gestalt regarding bacterial infection likelihood was 8.2 [IQR 6.7, 9.0] of 10 in patients with bacterial infection, 2.3 [IQR 1.2, 4.3] in patients with viral infection, 4.6 [IQR 4.0, 7.3] in patients with an infection due to another pathogen, and 2.3 [IQR 1.1 6.2] in patients with no acute infection (p-value = <0.001). Clinical gestalt's sensitivity regarding 30-day mortality was 57.1% [95%CI 37.2 to 75.5] with a specificity of 83.4% [95%CI 79.7 to 86.9].

CONCLUSION

In this study of ED patients presenting with signs and symptoms of infection, clinical gestalt was shown to be useful differentiating between bacterial and infections of other causes. Antibiotic prescription rate increased with the likelihood of bacterial infection according to physician gestalt. Lastly, simple heuristic prognostication of mortality (likely vs. unlikely) carried some, but limited, prognostic value.

Inflammation in cancer: therapeutic opportunities from new insights

As one part of the innate immune response to external stimuli, chronic inflammation increases the risk of various cancers, and tumor-promoting inflammation is considered one of the enabling characteristics of cancer development. Recently, there has been growing evidence on the role of anti-inflammation therapy in cancer prevention and treatment. And researchers have already achieved several noteworthy outcomes. In the review, we explored the underlying mechanisms by which inflammation affects the occurrence and development of cancer. The pro- or anti-tumor effects of these inflammatory factors such as interleukin, interferon, chemokine, inflammasome, and extracellular matrix are discussed. Since FDA-approved anti-inflammation drugs like aspirin show obvious anti-tumor effects, these drugs have unique advantages due to their relatively fewer side effects with long-term use compared to chemotherapy drugs. The characteristics make them promising candidates for cancer chemoprevention. Overall, this review discusses the role of these inflammatory molecules in carcinogenesis of cancer and new inflammation molecules-directed therapeutic opportunities, ranging from cytokine inhibitors/agonists, inflammasome inhibitors, some inhibitors that have already been or are expected to be applied in clinical practice, as well as recent discoveries of the anti-tumor effect of non-steroidal anti-inflammatory drugs and steroidal anti-inflammatory drugs. The advantages and disadvantages of their application in cancer chemoprevention are also discussed.

IL-6 mediates defense against influenza virus by promoting protective antibody responses but not innate inflammation

Influenza virus infection is a leading cause of morbidity and mortality worldwide, posing a significant public health problem. The pro-inflammatory cytokine interleukin-6 (IL-6) has been shown to promote defense against respiratory viral infection, while excessive IL-6 responses have been associated with severe pneumonia. Heterogenous expression of IL-6R and the IL-6-signal transducer subunit (gp130) across many cell types and different signaling modalities have made it difficult to define the precise role of the IL-6/IL-6R pathway in vivo. We generated multiple cell lineage-specific Il6ra-deficient mice and compared them to global Il6ra-/- and Il-6-/- mice to dissect the systemic and cell-intrinsic mechanisms for pneumonitis and control of influenza A virus (IAV) infection. Delayed viral clearance and severe morbidity in the global IL-6 knockouts were associated with reduced antibody responses, complement C3 and C5 production, and impaired T follicular helper (Tfh) cell generation. Mice lacking IL-6R exclusively in T cells phenocopied a defect in Tfh cell differentiation and antibody production, although susceptibility to IAV was only mildly affected. Mice lacking IL-6R specifically in B cells mounted normal antibody responses. Moreover, innate pro-inflammatory cytokine responses, myeloid cell infiltration, and adaptive immunity in the lung remained unaffected in Il6rafl/flLysMCre mice. Our results suggest that IL-6 mediates defense against IAV mainly by generating Tfh cells and promoting local C3 production, which together are required for eliciting protective antibody responses by B cells.

Translating Biomarker Research into Clinical Practice in Orthopaedic Trauma: A Systematic Review

Background/Objectives: Orthopaedic trauma management in polytrauma patients presents challenges, particularly in selecting between damage control orthopaedics (DCO) and early appropriate care (EAC). This systematic review evaluates these approaches and explores the role of biomarkers in optimising surgical timing. The primary objective of this review was to evaluate the potential clinical utility of biomarkers in guiding surgical timing and predicting perioperative complications. The secondary objective was to compare the effectiveness of DCO and EAC approaches, focusing on their impact on patient outcomes when controlled for Injury Severity Scores (ISSs). Methods: A systematic search of PubMed, MEDLINE, and Google Scholar identified studies focusing on fracture management (DCO versus EAC), timing protocols, and biomarkers in polytrauma patients. Twenty-seven studies met inclusion criteria. Results: Among the 27 studies, 12 evaluated biomarkers and 15 compared DCO and EAC. Point-of-care (POC) biomarkers, including lactate (p < 0.001; OR 1.305), monocyte L-selectin (p = 0.001; OR 1.5), and neutrophil L-selectin (p = 0.005; OR 1.56), demonstrated predictive value for sepsis, infection, and morbidity. CD16bright/CD62Ldim neutrophils were significant predictors of infection (p = 0.002). Advanced biomarkers, such as IL-6, IL-10, RNA IL-7R, HMGB1, and leptin offered prognostic insights but required longer processing times. No clear superiority was identified between DCO and EAC, with comparable outcomes when injury severity scores (ISS) were controlled. Conclusions: This systematic review highlights the challenge of translating biomarker research into clinical practice, identifying several point-of-care and advanced laboratory biomarkers with significant potential to predict complications like sepsis, infection, and MODS. Future efforts should focus on refining biomarker thresholds, advancing point-of-care technologies, and validating their role in improving surgical timing and trauma care outcomes.

Serum Amyloid A Binding to Glycosaminoglycans is Synergistic with Amyloid Formation: Therapeutic Targeting in the Inflammation-linked Amyloidosis

Serum amyloid A (SAA), a small lipophilic plasma protein elevated in inflammation, is a precursor of amyloid A (AA) amyloidosis, the major life-threatening complication of chronic inflammation in animals and humans. Although heparan sulfate (HS) is a potent amyloid agonist, particularly in AA amyloidosis, therapeutic targeting of SAA-HS interactions using a small-molecule HS/heparin decoy was unsuccessful. To understand molecular underpinnings, we used recombinant lipid-free human and murine SAA1 and human SAA2 to explore their interactions with various glycosaminoglycans at pH 5.5-7.4 during amyloid formation, from native protein to amyloid oligomers and fibrils. Effects of pH and glycosaminoglycan sulfation/charge supported by prior computational studies indicate electrostatic origin of SAA-glycosaminoglycan interactions. HS/heparin can promote amyloidogenesis by inducing non-native β-sheet and apparently causing liquid droplet formation in SAA in solution. Structural and binding studies by spectroscopy and ELISA reveal previously unknown synergy between amyloid formation and heparin/HS binding by SAA. We propose that this synergy potentially extends to other protein amyloids and stems from longitudinal binding of HS polyanions to basic residue arrays on amyloid oligomers or fibrils. This binding mode explains our finding that a minimal heparin chain length exceeding 20 monosaccharides is necessary to compete with HS for binding to amyloid oligomers. The results help explain prior failure of a small-molecule drug in targeting of SAA-HS interactions and consider alternative HS-targeting approaches for AA and, potentially, other amyloid diseases.

Beyond nutritional immunity: immune-stressing challenges basic paradigms of immunometabolism and immunology

Pathogens have the well-known advantage of rapid evolution due to short generation times and large populations. However, pathogens have the rarely noted disadvantage of the vulnerability to stress involved in proliferation as well as being localized. Presented here are numerous new paradigms in immunology, and especially immunometabolism, which are derived from examining how hosts capitalize on pathogen vulnerabilities to stress. Universally, proliferation requires both resources and synthesis, which are vulnerable to resource-limiting stress and damaging/noxious stress, respectively. Pathogens are particularly vulnerable to stress at the time when they are most threatening-when they are proliferating. Since immune cells actively controlling pathogens (effector cells) typically do not proliferate at infected sites, there is a "stress vulnerability gap" wherein proliferating pathogens are more vulnerable to any type of stress than are the attacking effector cells. Hosts actively stress vulnerable proliferating pathogens by restricting resources (resource-limiting stress) and generating noxious waste products (damaging/disruptive stress) in a fundamental defense here-in termed "immune-stressing." While nutritional immunity emphasizes denying pathogens micronutrients, immune-stressing extends the concept to restricting all resources, especially glucose and oxygen, coupled with the generation of noxious metabolic products such as lactic acid, reactive oxygen species (ROS), and heat to further harm or stress the pathogens. At present much of the field of immunometabolism centers on how nutrition and metabolism regulate immune function, a central feature being the inefficient use of glucose via aerobic glycolysis (with much lactate/lactic acid production) by effector immune cells. In contrast, immune-stressing emphasizes how the immune system uses nutrition and metabolism to control infections. Immune-stressing addresses effector cell glycolysis at the infected site by noting that the high uptake of glucose linked with high output of lactic acid is an ideal double-pronged stressor targeting proliferating pathogens. Once the basic vulnerability of pathogen proliferation is recognized, numerous other paradigms of immunometabolism, and immunology as a whole, are challenged.

Changes of leucine-rich alpha 2 glycoprotein could be a marker of changes of endoscopic and histologic activity of ulcerative colitis

Leucine-rich alpha 2 glycoprotein (LRG) is one of the serum biomarkers for disease activity of ulcerative colitis (UC). We focused on the correlation between the changes of LRG and the changes of endoscopic and histologic activity of UC, in comparison to the changes of fecal calprotectin (Fcal), fecal immunochemical test (FIT), and C-reactive protein (CRP). Seventy-nine patients with two or more colonoscopies were enrolled, and 123 paired colonoscopies and 121 paired biopsies were examined. With regard to the change of endoscopic/histologic activity between the preceding and subsequent colonoscopy, there was improvement (n = 29/45), unchanging (n = 63/36), and worsening (n = 31/40). The correlations between the changes of marker levels and endoscopic/histologic activity were Fcal; r = 0.50/0.39 and FIT; r = 0.41/0.40, LRG; r = 0.42/0.40 and CRP; r = 0.22/0.17. Furthermore, when the correlation between the changes of LRG levels and the changes of endoscopic/histological activity was compared with those of other markers, the correlation of LRG tended to be superior to those of CRP (CRP vs. LRG; p = 0.08/0.01). LRG is equivalent to fecal markers and superior to CRP, when inferring changes in disease activity of UC based on changes in its level.

Inverse association between CALLY index and angina pectoris in US adults: a population-based study

BACKGROUND

The C-reactive protein-albumin-lymphocyte (CALLY) index is a significant marker that reflects both inflammatory and nutritional states and has proven to be a valuable tool for assessing prognosis in various medical conditions. However, the connection between it and angina pectoris has not yet been fully examined. This research sought to thoroughly investigate the possible link between the CALLY index and angina pectoris.

METHODS

This research utilized a cross-sectional approach, drawing data from the 2003-2010 National Health and Nutrition Examination Survey (NHANES), which included 16,291 adults from the U.S. The CALLY index was calculated based on lymphocyte counts, serum albumin concentrations, and C-reactive protein (CRP) levels. The relationship between the CALLY index and angina pectoris was analyzed using multivariate logistic regression and restricted cubic spline (RCS) methods. Subgroup and interaction analyses were also performed.

RESULTS

Elevated ln CALLY was inversely correlated with the prevalence of angina (OR: 0.88, 95% CI: 0.82, 0.95). Those in the highest quartile of the ln CALLY (Q4) were 38% less likely to experience angina than those in the lowest quartile (Q1) (OR: 0.62, 95% CI: 0.46, 0.84). RCS analysis revealed an L-shaped curve linking the CALLY index to angina, with a cutoff at 14. The consistency of this relationship was substantiated through subgroup analyses across different population groups.

CONCLUSIONS

This research highlights a notable inverse relationship between the CALLY index and angina in U.S. adults, suggesting its potential as an innovative tool for evaluating angina.

Association of fibrinogen-to-albumin ratio with all-cause and cardiovascular mortality in patients on dialysis with acute coronary syndrome

PURPOSE

This study aimed to investigate the association of the fibrinogen-to-albumin ratio (FAR) and all-cause mortality as well as cardiovascular mortality in patients on dialysis with acute coronary syndrome (ACS). Furthermore, we explored the incremental prognostic value of incorporating the FAR into the Global Registry of Acute Coronary Events (GRACE) score.

METHODS

We retrospectively enrolled 1035 patients on dialysis with ACS between January 2015 and June 2021. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. Multivariate Cox regression model, restricted cubic spline analysis, and C-statistic were performed to evaluate the prognostic value of FAR on outcomes.

RESULTS

After a median follow-up of 21.8 months, 369 (35.7%) patients died, including 250 cardiovascular deaths. Patients with the highest FAR tertile had significantly increased risks of all-cause mortality (46.1% vs 27.8%; adjusted hazard ratio [HR], 1.790; 95% confidence interval [CI], 1.372-2.336) and cardiovascular mortality (33.0% vs 16.5%; adjusted HR, 2.086; 95% CI, 1.496-2.908) compared to those in the lowest tertile. Restricted cubic spline analysis revealed a J-shaped association between the FAR and all-cause mortality and cardiovascular mortality, with HRs increasing significantly when the FAR exceeded 94.15. Furthermore, integrating the FAR into the GRACE score significantly improved its predictive accuracy for all-cause mortality and cardiovascular mortality, as measured by C-statistic, continuous net reclassification index, and integrated discriminatory index.

CONCLUSIONS

In patients on dialysis with ACS, the FAR was independently associated with increased risks of all-cause mortality and cardiovascular mortality. Incorporating the FAR might improve the predictive accuracy of the GRACE score in patients on dialysis with ACS.

Can Galectin-3 Be Used as a Predictor of Obstructive Sleep Apnea Severity: Insights from High-Volume Patient Single Center

Background/Objectives: Obstructive sleep apnea (OSA) is a condition characterized by intermittent airway obstructions, leading to reduced oxygen levels and increased sympathetic nervous system activity. OSA can cause a range of health problems, including an increased risk of cardiovascular diseases and mortality. Galectin-3, a member of the galectin family, plays a significant role in inflammation and fibrosis, and studies show that it is elevated in various conditions, including heart and lung diseases. The aim of this study was to determine whether galectin-3 levels are related to the severity of sleep apnea. Methods: A total of 191 participants from the University Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia, between January 2023 and May 2024, were included in the analyses. All patients were hospitalized under suspicion of OSA, and they all underwent a polysomnography test. Various demographic, respiratory, laboratory, and clinical parameters were obtained. Correlations between numerical variables and galectin-3 were assessed by the Pearson or Spearman correlation coefficients. Univariate and multivariate linear regression models were used to assess the predictors of galectin-3 values. In all analyses, the significance level was set at 0.05. Results: The mean age of the study participants was 56.2 years, mostly male (68.9%). Of the comorbidities, two-thirds of patients had hypertension (66.1%), 46.8% had hyperlipoproteinemia, and 21.1% had diabetes mellitus. Patients who had an AHI of more than fifteen events per hour more often had higher values of galectin-3. OSA severity had a significant positive correlation with galectin-3 (p = 0.014). In multivariate linear regression analysis, significant independent predictors of higher galectin-3 values were older age, presence of coronary disease, hypoventilation syndrome, higher BMI, NTproBNP, lactate, creatinine, lower LDL, and lower FEV1 (p < 0.05). Conclusions: The present study demonstrated that galectin-3 is linked to the severity of OSA and plays a crucial role in inflammation induced by intermittent hypoxia in OSA. Further screening and interventions targeting galectin-3 could aid in preventing inflammatory diseases related to sleep disturbances.

Evaluating serum proteinogram methodologies for the diagnosis of inflammation in fish: Acute and chronic patterns in gilthead seabream (Sparus aurata) injected with λ-carrageenan

Proteinogram is a semiquantitative method specially used in clinic to separate the serum proteins from patients for use in the diagnosis of diseases. However, this methodology has only been applied very recently with this approach in farmed fish. Thus, the aim of this study was to explore the changes in the serum proteinogram of gilthead seabream (Sparus aurata), after triggering an acute or chronic sterile inflammation. For this, two experiments were carried out: i) Acute inflammation experiment: seabream specimens were injected intramuscularly with 50 μL of λ-carrageenan (0.5 mg fish-1) or buffer (control) and blood samples were collected at 3, 6 and 24 h post-injection; ii) Chronic inflammation experiment: specimens were injected at 0, 7 and 14 days with 500, 250 and 250 μL of λ-carrageenan, respectively (20 mg fish-1) or buffer, and blood samples were collected at 15 days post-injection. In both cases, serum was obtained and processed by electropherograms and HPLC-mass spectrometry. Results of electropherograms of control fish revealed four major proteins of 19.5, 76.3, 104.4, and 156.7 kDa in the serum. These four proteins were correlated with apolipoprotein A-II (II (the counterpart of mammalian albumin, Apo fraction), serotransferrin (β fraction), inter-α-trypsin inhibitor heavy chain H3-like (α1 fraction) and α-2-macroglobulin-like (α2 fraction) according to the results obtained with HPLC-mass spectrometry. In a statistical view (p < 0.05), no variations were detected in the four major serum protein bands between the control and the acutely inflamed groups. However, in chronically inflamed fish, the Apo fraction decreased statistically compared to the control group. In contrast, the α1 and α2 fractions were statistically increased in the serum of fish sampled 15 days after λ-carrageenan injection, compared to those found in the control fish. α1 and α2 protein fractions are recognized indicators of inflammation in mammals. Consequently, our study presents a novel method for assessing both acute and chronic λ-carrageenan-induced sterile inflammation in gilthead seabream, which could be applicable to other marine species for diagnostic purposes.

Receptor-independent regulation of Gα13 by alpha-1-antitrypsin C-terminal peptides

Alpha-1-antitrypsin (AAT), a circulating serine protease inhibitor, is an acute inflammatory response protein with anti-inflammatory functions. The C-terminal peptides of AAT are found in various tissues and have been proposed as putative bioactive peptides with multiple functions, but its mechanism of action remains unclear. We previously reported that a mouse AAT C-terminal peptide of 35 amino acids (mAAT-C1-35) penetrates plasma membrane and associates guanine nucleotide-binding protein subunit alpha 13 (Gα13). Here, we show that mAAT-C1-35 binds directly to the guanosine diphosphate (GDP)-bound form of Gα13 through the N-terminal region (mAAT-C1-17), thereby facilitating the interaction of Gα13・GDP with its effector proteins. The minimal sequence (mAAT-C3-16) and essential amino acid residue (Phe11) of mAAT-C1-17 were identified as being necessary for this effect. A molecular dynamics simulation for the Gα13・GDP-mAAT-C1-17 complex model showed that binding of mAAT-C1-17 to the region surrounded by switch regions of Gα13 stabilizes the flexible switch II and III regions, thereby maintaining their active conformation. In addition, mAAT-C1-35 activates the Gα13 signaling pathway in cells where Phe11 is required. Our study reveals the structure-based mechanism of action of AAT-C peptides in the regulation of Gα13 and demonstrates that AAT-C peptides represent a biological peptide capable of activating G protein signals in a manner that is independent of G-protein-coupled receptors.

Nomograms for the prediction of decannulation in patients with neurological injury: a study based on clinical practice

BACKGROUND

Rational prediction of the probability of decannulation in tracheotomy patients is of great importance to clinicians and patients' families. This study aimed to develop a prediction model for decannulation in tracheotomized patients with neurological injury using routine clinical data and blood tests.

METHODS

We developed a prediction model based on 186 tracheotomized patients, and data were collected from January 2018 to March 2021. The least absolute shrinkage and selection operator (LASSO) regression model was used to optimize feature selection for the decannulation risk model. The performance of the prediction model was evaluated in terms of discrimination, calibration, and clinical utility using measures such as C-index, calibration plot, and decision curve analysis (DCA). Internal validation was performed through bootstrapping validation.

RESULTS

A total of 66.13% (123/186) of patients were decannulated. Predictors included in the prediction nomogram were age, gender, subtype of neurological injury, Glasgow Coma Scale (GCS) score, swallowing function, duration of tracheotomy, procalcitonin (PCT) level, white blood cell (WBC) count, and serum albumin (ALB) level. The predictive model showed good discrimination, with a C-index of 0.755 (95% confidence interval: 0.68-0.83). Internal validation also confirmed a satisfactory C-index of 0.690. The DCA indicated that the nomogram added substantial value in predicting decannulation risk for patients with threshold probabilities falling between >21% and <98% compared to the existing scheme.

CONCLUSIONS

This predictive model serves as a valuable instrument for clinicians to quantitatively assess the probability of decannulation in patients with neurological injury, aiding in informed decision-making and patient management.

A systematic review of the role of systemic inflammation-based prognostic scores in patients with abdominal aortic aneurysm

BACKGROUND AND AIMS

Activation of the systemic inflammatory response (SIR) is associated with inferior outcomes across a spectrum of disease. Routinely available measures of the SIR (neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory grade (SIG)) have been shown to provide prognostic value in patients undergoing surgical intervention. The present study aimed to review the literature describing the prognostic association of NLR, PLR, SII and SIG in patients undergoing intervention for abdominal aortic aneurysm (AAA).

METHODS

This PRISMA guidelines were followed. The MEDLINE database was interrogated for relevant studies investigating the effect of peri-operative systemic inflammation-based prognostic systems on all-cause mortality in patients undergoing OSR and EVAR for AAA. Inter-study heterogeneity precluded meaningful meta-analysis; qualitative analysis was instead performed.

RESULTS

There were 9 studies included in the final review reporting outcomes on a total of 4571 patients; 1256 (27 %) patients underwent OSR, and 3315 (73 %) patients underwent EVAR. 4356 (95 %) patients underwent a procedure for unruptured AAA, 215 (5 %) patients underwent an emergency procedure for ruptured AAA0.5 studies reported early (inpatient or 30-day) mortality; 2 of these found that elevated NLR predicted inferior survival, however PLR did not provide prognostic value. 6 studies reported long-term mortality; elevated NLR (5 studies), PLR (1 study), and SIG (1 study) predicted inferior survival.

CONCLUSIONS

It appears that activation of the SIR is associated with inferior prognosis in patients undergoing intervention for AAA, however the evidence is limited by heterogenous methodology and lack of consensus regarding optimal cutoff.

PROSPERO DATABASE REGISTRATION NUMBER

CRD42022363765.

Pulmonary exposure to renewable diesel exhaust particles alters protein expression and toxicity profiles in bronchoalveolar lavage fluid and plasma of mice

Exposure to diesel exhaust is associated with increased risk of cardiovascular and lung disease. Substituting petroleum diesel with renewable diesel can alter emission properties but the potential health effects remain unclear. This study aimed to explore toxicity and underlying mechanisms of diesel exhaust from renewable fuels. Using proximity extension assay (Olink), 92 proteins linked to inflammation, cardiovascular function, and cancer were analyzed in bronchoalveolar lavage fluid (BALF) and plasma in mice 1 day after pulmonary exposure to exhaust particles at doses of 6, 18, and 54 µg/mouse. Particles were generated from combustion of renewable (rapeseed methyl ester, RME13, hydrogen-treated vegetable oil, HVO13; both at 13% O2 engine intake) and petroleum diesel (MK1 ultra-low-sulfur diesel at 13% and 17% O2 intake; DEP13 and DEP17). We identified positive dose-response relationships between exposure and proteins in BALF using linear models: 33 proteins for HVO13, 24 for DEP17, 22 for DEP13, and 12 for RME13 (p value < 0.05). In BALF, 11 proteins indicating cytokine signaling and inflammation (CCL2, CXCL1, CCL3L3, CSF2, IL1A, CCL20, TPP1, GDNF, LGMN, ITGB6, PDGFB) were common for all exposures. Several proteins in BALF (e.g., CCL2, CXCL1, CCL3L3, CSF2, IL1A) correlated (rs ≥ 0.5) with neutrophil cell count and DNA damage in BAL cells. Interestingly, plasma protein profiles were only affected by RME13 and, to lesser extent, by DEP13. Overall, we identified inflammation-related changes in the BALF as a common toxic mechanism for the combustion particles. Our protein-based approach enables sensitive detection of inflammatory protein changes across different matrices enhancing understanding of exhaust particle toxicity.

Association between the C-reactive protein-albumin-lymphocyte index and metabolic syndrome: evidence from the 2003-2010 national health and nutrition examination survey

BACKGROUND

Metabolic syndrome (MetS) is a global public health problem that significantly impacts human health and quality of life. The relationship between MetS and the C-reactive protein-albumin-lymphocyte (CALLY) index is uncertain.

METHODS

This study analyzed the data of 7,534 individuals from the National Health and Nutrition Examination Survey cycles (2003-2010 cycles). Weighted logistic regression and weighted restricted cubic spline (RCS) curve analyses were used to identify the relationships between the CALLY index and MetS, as well as its components.

RESULTS

Of the 7,534 participants, 2,086 were diagnosed with MetS. The estimated prevalence of MetS decreased with an increase in the CALLY index (P < 0.001). Multivariable logistic regression analysis showed that the odds ratio of MetS was 0.25 (95% confidence interval 0.20-0.32, P < 0.001) in the highest CALLY index quartile compared with the lowest quartile after adjusting for confounding variables. The RCS curve analysis revealed non-linear relationships between the CALLY index and MetS or its components.

CONCLUSIONS

This study revealed an inverse relationship between the CALLY index and MetS risk. The CALLY index might be valuable for identifying individuals who are at a high risk of MetS.

CLINICAL TRIAL NUMBER

Not applicable.

Recent Advances in Studies of Serum Amyloid A: Implications in Inflammation, Immunity and Tumor Metastasis

Research on serum amyloid A (SAA) has seen major advancement in recent years with combined approaches of structural analysis and genetically altered mice. Initially identified as an acute-phase reactant, SAA is now recognized as a major player in host defense, inflammation, lipid metabolism and tumor metastasis. SAA binding and the neutralization of LPS attenuate sepsis in mouse models. SAA also displays immunomodulatory functions in Th17 differentiation and macrophage polarization, contributing to a pro-metastatic tumor microenvironment. In spite of the progress, the regulatory mechanisms for these diverse functions of SAA remain unclear. This review provides a brief summary of recent advances in SAA research on immunity, inflammation, tumor microenvironment and in vivo models.

Sequential transcriptome profiling: comparative analysis of normal and canine lymphoma preceding detailed T-cell and B-cell subtype comparison

Introduction

As the lifespan of companion animals extends, the incidence of tumor also increases. Among these tumors, lymphoma is reported as the most prevalent hematopoietic tumor with a 80-90% prevalence rate. Ongoing research spans multiple domains, aiming to uncover novel therapeutic targets, including small molecular weight inhibitors, antibody treatments, and subtype-specific selective agents.

Methods

Transcriptional profiling was performed on canine lymphoma samples to identify genes and functional pathways associated with pathogenesis, treatment response, and prognosis. Additionally, genes with potential relevance to the clinical characteristics of T-cell lymphoma (TCL), which is characterized by a low treatment response and poor prognosis, were identified through a comparative analysis of different lymphoma subtypes.

Results

Within the canine lymphoma group, HERC5 showed consistent upregulation, a gene similarly implicated in human acute myeloid leukemia but previously no reports exist. Additionally, noteworthy genes, including IKZF2, CCL4, SAA1, and CD40, exhibited differential expression in the TCL group compared to the B-cell lymphoma (BCL) group.

Discussion

The upregulation of HERC5 may impact on canine lymphoma pathogenicity. Furthermore, the upregulation of IKZF2, CCL4, and SAA1, along with the downregulation of CD40, may contribute to adverse clinical characteristics of TCL in dogs.

No difference in outcomes with early vs late antibiotic prophylaxis for term premature rupture of membranes: a multicenter analysis

BACKGROUND

Although guidelines suggest administering antibiotics 12 to 18 hours after the rupture of membranes in women with term premature rupture of membranes, in practice, clinicians tend to initiate prophylactic antibiotics as soon as possible to avoid risk of infection.

OBJECTIVE

This study aimed to assess whether early administration of prophylactic antibiotics for term premature rupture of membranes reduces the incidence of maternal and neonatal infections.

STUDY DESIGN

This multicenter prospective cohort study included women with term premature rupture of membranes. The participants were divided into early and late administration groups according to the duration between rupture of membranes and antibiotic use. The effectiveness outcomes included the incidence of puerperal infection, the incidence of total maternal infection, and the rate of neonatal sepsis, whereas the safety outcomes included the incidence of adverse reactions. Antibiotic use density was used to assess antibiotic consumption. The propensity score matching method was used to control for confounding factors.

RESULTS

A total of 1099 women with term premature rupture of membranes were enrolled: 459 in the early 6-hour group (antibiotic administration within 6 hours) and 640 in the late 6-hour group (antibiotic administration after 6 hours) and 707 in the early 12-hour group (antibiotic administration within 12 hours) and 392 in the late 12-hour group (antibiotics administration after 12 hours). After propensity score matching, there were 300 women in each 6-hour group and 230 women in each 12-hour group. The baseline characteristics showed no significant difference between the matched groups (P>.05). The early 6-hour and 12-hour groups had lower maternal C-reactive protein levels than the late 6-hour and 12-hour groups (P<.05). However, no significant difference was observed in other maternal and neonatal outcomes (P<.05). Adverse reactions showed no statistically significant difference between the early and late treatment groups (P=1.000). Antibiotic use density was higher in the early treatment groups by 10.1 defined daily doses (6-hour groups) and 11.7 defined daily doses (12-hour groups).

CONCLUSION

There was no substantial difference in the efficacy and safety of antibiotics administered within 6 to 12 hours after rupture of membranes compared with that administered after 6 to 12 hours in women with term premature rupture of membranes. Delayed antibiotic use substantially reduced antibiotic consumption.

Oxy-inflammation in hyperbaric oxygen therapy applications

Hyperbaric oxygen therapy (HBOT) is a non-invasive method of O2 delivery that induces systemic hyperoxia. Hyperbaric chamber consists of a pressure vessel and a compressed breathing gas supply, which can regulate internal pressure. The chamber delivers 100% O2 to patients according to predetermined protocols and is monitored by trained personnel. HBOT relies on increasing the inspired O2 fraction (fiO2) and elevating the partial pressure of O2 (pO2). O2 is typically administered at pressures between 1.5 and 3.0 ATA for 60 to 120 minutes, depending on the clinical presentation. Currently, there are 15 indications for HBOT approved by the Undersea and Hyperbaric Medicine Society, categorized into three groups: emergency medicine, wound healing acceleration, and antimicrobial effects. The present narrative review aims to elucidate the mechanisms action underlying HBOT, particularly oxy-inflammation, in various pathologies within these categories.

Development and validation of a prognostic nomogram incorporating neutrophil-to-albumin ratio for predicting overall survival in patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy

Background

Recent research suggests that the emerging neutrophil-albumin ratio (NAR) has a significant correlation with the survival outcomes across a range of tumors, yet its predictive significance for nasopharyngeal carcinoma (NPC) remains insufficiently investigated. This study aimed to evaluate the relationship between the neutrophil-to-albumin ratio (NAR) and overall survival (OS) in patients with NPC, as well as to develop a corresponding prognostic model.

Methods

This retrospective analysis included 861 NPC patients treated with concurrent chemoradiotherapy (CCRT), who were randomly divided into a training group (n = 605) and a validation group (n = 256). To identify factors associated with OS and construct a prognostic nomogram, both univariate and multivariate Cox regression analyses were performed. The nomogram's prognostic accuracy was evaluated and independently validated.

Results

The NAR score successfully segregated NPC patients into two categories with significantly different OS (HR = 0.536; 95 % CI: 0.296-0.972, P = 0.040). Through multivariate analysis, factors such as age, T stage, N stage, and NAR score were identified as independent predictors of OS, leading to the creation of a prognostic nomogram. This nomogram demonstrated superior predictive capability for OS [C-index = 0.702 (95 % CI: 0.636-0.768)], surpassing that of the conventional staging system [C-index = 0.651 (95 % CI: 0.549-0.752)]. The findings underwent internal validation within an independent cohort.

Conclusions

The NAR, an emergent biomarker combining nutritional and inflammatory status, offers a practical, low-cost, and non-invasive prognostic measure for NPC patients treated with CCRT. Additionally, the prognostic nomogram derived from NAR surpasses traditional staging systems in predictive accuracy.

Associations between human blood metabolome and vascular dementia

BACKGROUND

Effective and specific biomarkers are warranted for the management of vascular dementia. We aimed to systematically screen the human blood metabolome to identify potential mediators of vascular dementia via a two-sample Mendelian randomization (MR) design.

METHODS

We selected 93 unique blood metabolites from 3 metabolome genome-wide association studies (GWASs) with a total of 147,827 participants of European ancestry. Summary statistics for vascular dementia originated from a European-descent GWAS dataset released by the FinnGen Study, involving 859 cases and 211,300 controls. We applied the inverse-variance weighted MR method in the main analysis to examine the causal roles of blood metabolites in vascular dementia, followed by several sensitivity analyses for robustness validation.

RESULTS

Genetically determined glycoproteins (OR per 1-SD increase, 0.75; 95 % CI, 0.68-0.83, P = 1.08 × 10-8) and O-methylascorbate (OR per 1-SD increase, 0.08; 95 % CI, 0.02-0.32; P = 3.74 × 10-4) levels had negative associations with the risk of vascular dementia, whereas genetically determined total cholesterol (OR per 1-SD increase, 1.77; 95 % CI, 1.32-2.38; P = 1.39 × 10-4) and low-density lipoprotein (LDL) cholesterol (OR per 1-SD increase, 1.94; 95 % CI, 1.48-2.55; P = 1.61 × 10-6) levels had positive associations with the risk of vascular dementia. MR-Egger regression suggested no directional pleiotropy for the identified associations, and sensitivity analyses with different MR models further confirmed these findings.

CONCLUSION

Glycoproteins, O-methylascorbate, total cholesterol, and LDL cholesterol might be promising blood markers of vascular dementia, which may provide novel insights into the prevention of vascular dementia. Further studies are warranted to replicate our findings and elucidate the potential mechanistic pathways.

Exploring sedentary behavior, neutrophil-to-lymphocyte ratio, and depression: Mediation analysis in NHANES

BACKGROUND

Sedentary behavior and depression have been linked to inflammation. However, the specific role of inflammation in the relationship between sedentary behavior and depression remains unclear.

METHOD

We examined associations among the inflammatory marker (neutrophil-to-lymphocyte ratio [NLR]), sedentary behavior, and depression in a robust, ethnically diverse sample (n = 29,769) from the National Health and Nutrition Examination Survey (NHANES).

RESULT

Our findings indicate that individuals experiencing depression and/or engaging in sedentary behavior show elevated levels of the NLR. Even after adjusting for confounding variables such as age, sex, and body mass index, sedentary behavior remains significantly associated with both depression and NLR levels. Additionally, our analysis reveals a non-linear relationship between NLR levels and depression, suggesting a complex interaction. Importantly, NLR partially mediates a modest yet statistically significant portion (1.920 %, p = 0.014) of the association between sedentary behavior and depression.

CONCLUSION

This study highlights the intricate interplay among sedentary behavior, inflammation, and depression, providing insights into potential avenues for intervention and management.

Infective Complications of Endobronchial Ultrasound-Transbronchial Needle Aspiration (EBUS-TBNA) and Clinical Biomarkers: A Concise Review

EBUS-TBNA is the most common interventional pulmonology procedure performed globally and remains the cornerstone of the diagnosis and staging not only of lung cancer but also for other neoplastic, inflammatory, and infective pathologies of the mediastinum. Infective complications of EBUS-TBNA are underreported in the literature, but the constantly rising incidence of lung cancer is leading to an increasing number of EBUS-TBNA procedures and, therefore, to a significant number of infective complications, even 4 weeks following the procedure. In this review we attempt to summarize the risk factors related to these infective complications, along with useful biomarkers that can be used to identify patients that might develop infective complications, to facilitate the prediction or even prompt treatment of these.

Caffeic Acid Phenethyl Ester Protects Neurons Against Oxidative Stress and Neurodegeneration During Traumatic Brain Injury

Traumatic brain injury (TBI) is an inflammatory disease causing neurodegeneration. One of the consequences of inflammation is an elevated blood level of fibrinogen (Fg). Earlier we found that extravasated Fg induced an increased expression of neuronal nuclear factor kappa B (NF-κB) p65. In the present study, we aimed to evaluate the effect of caffeic acid phenethyl ester (CAPE), an inhibitor of NF-κB, on Fg-induced neurodegeneration in vitro and in mice with mild-to-moderate TBI. Primary mouse brain cortical neurons were treated with Fg (0.5 or 1 mg/mL) in the presence or absence of CAPE. A cortical contusion injury -induced model of TBI in C57BL/6 mice was used. Mice were treated with CAPE for two weeks. The generation of reactive oxygen species (ROS) and neuronal viability were assessed. Mice memory was assessed using novel object recognition and contextual fear conditioning tests. The generation of ROS and viability of neurons in vitro and in the brain samples were assessed. Data showed that CAPE attenuated the Fg-induced generation of ROS and neuronal death. CAPE improved the cognitive function of the mice with TBI. The results suggest that Fg-induced generation of ROS could be a mechanism involved in cognitive impairment and that CAPE can offer protection against oxidative damage and neurodegeneration.

Relationship between albumin-globulin ratio and prostate-specific antigen: a cross-sectional study based on NHANES 2003-2010

PURPOSE

The albumin-globulin ratio (AGR) influences the development of prostate cancer; however, the relationship between AGR and prostate-specific antigen (PSA) has not been reported.

METHODS

This cross-sectional investigation used comprehensive AGR versus PSA data from men with 40 years of age and older, who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2010, spanning 4 investigation cycles, as only these cycles contained complete PSA data. To evaluate the nonlinear relationship between the ARG and PSA level, a regression utilizing smoothed curve fitting (penalized spline approach) and a generalized additive model (GAM) were employed. A two-segment linear regression model was used to conduct threshold effect evaluations. Lastly, subgroup analyses were carried out along with interaction tests.

RESULTS

This study included 5,376 subjects, whose total serum PSA (mean ± standard deviation) was 1.83 ± 3.34, and its level decreased roughly with increasing quartiles of AGR. In the fully-adjusted model, AGR was negatively correlated with the likelihood of PSA, and this relationship persisted across subgroups (trend > 0.05). The PSA was characterized by an "L"-shaped curve with an inflection point. On the left side of the inflection point (K = 1.32), there was a negative relationship between AGR and PSA.

CONCLUSION

In the United States, among men over 40 years of age without prostate diseases, AGR demonstrated a nonlinear relationship with PSA, negatively correlating when AGR was below 1.32.

CLINICAL TRIAL NUMBER

Not applicable.

International Symposium on Ruminant Physiology: The immunometabolism of transition dairy cows from dry-off to early lactation: lights and shadows

The mismatch between the nutrient intake from the diet and the output by the mammary gland causes a negative energy balance in transition dairy cows, that, if excessive, can promote several metabolic disorders. Other relevant phenomena occur during transition, such as inflammation at calving and changes in immunocompetence, redox balance, and mineral metabolism. Despite the efforts, some aspects of the adaptive mechanisms observed in the transition period still need to be clarified. For instance, alterations of physiological responses even before the dry-off or during the dry period can affect the success of the whole transition period in certain cows. In this context, the mechanism regulating the inflammatory response around calving may play a pivotal role, as suggested by the variety of factors influencing it and its consequences, particularly feed intake depression, that can amplify and anticipate the negative energy balance. When this mechanism derails is still unclear, but detecting the triggers of diverted or abnormal physiological responses and where they stem (e.g., liver, rumen and gut epithelia, uterus, or mammary gland) will help to discover the weak points in the immune system and the possible ways of restoring it. Furthermore, the postpartum healthy cow appears to have an acute phase response at the liver level, despite a decrease in circulating proinflammatory cytokines. What is physiological and what is pathological in this context? To understand the latter, finding markers of an unsuccessful transition period that go beyond the energy deficit would be advisable. Future efforts should be dedicated to clarifying the causes of the acute phase response at calving, exploiting the potential of the system biology. Moreover, it would be helpful, for both basic and applied research, to define biomarkers associated with pathological responses (i.e., cytokines and acute phase proteins) and to introduce in the genetic selection phenotypes related to the ability of cows to adapt to the immunometabolic stress typical of the transition period.

Factor associated with and risk of cardiovascular disease in people with uncontrolled hypertension

We aimed to identify and validate factors related to uncontrolled hypertension. Participants treated with at least one antihypertensive drug from the prospective contemporaneous CoLaus|PsyCoLaus study were enrolled. We investigated the association between hypertension status (uncontrolled, defined as systolic blood pressure [SBP] ≥ 140 mm Hg and/or diastolic blood pressure [DBP] ≥ 90 mm Hg, versus controlled hypertension [SBP/DBP < 140/90 mm Hg]) and potential risk factors. Additionally, the prospective association of uncontrolled hypertension with cardiovascular disease and all-cause mortality was evaluated. 1040 participants recruited between 2003 and 2006 with a mean follow-up of 12.3 years (SD ± 3.4) were included in the analyses. Heavy alcohol consumption, increased BMI, increased ferritin and albuminuria were positively associated with uncontrolled hypertension. Factors inversely associated with uncontrolled hypertension were university degree, current smoker, and high potassium urinary excretion. Uncontrolled hypertension status was not associated with incident ASCVD nor all-cause mortality in our study. In conclusion, uncontrolled hypertension was associated with modifiable factors, such as heavy drinking, obesity and level of education. Further studies should investigate whether including biological markers in clinical practice, such as potassium excretion, ferritin levels, or albuminuria, would help identify individuals who may develop uncontrolled hypertension.

Data-driven cluster analysis of lipids, inflammation, and aging in relation to new-onset type 2 diabetes mellitus

PURPOSE

Early detection and intervention are vital for managing type 2 diabetes mellitus (T2DM) effectively. However, it's still unclear which risk factors for T2DM onset are most significant. This study aimed to use cluster analysis to categorize individuals based on six known risk factors, helping to identify high-risk groups requiring early intervention to prevent T2DM onset.

METHODS

This study comprised 7402 Korean Genome and Epidemiology Study individuals aged 40 to 69 years. The hybrid hierarchical k-means clustering algorithm was employed on six variables normalized by Z-score-age, triglycerides, total cholesterol, non-high-density lipoprotein cholesterol, high-density lipoprotein cholesterol and C-reactive protein. Multivariable Cox proportional hazard regression analyses were conducted to assess T2DM incidence.

RESULTS

Four distinct clusters with significantly different characteristics and varying risks of new-onset T2DM were identified. Cluster 4 (insulin resistance) had the highest T2DM incidence, followed by Cluster 3 (inflammation and aging). Clusters 3 and 4 exhibited significantly higher T2DM incidence rates compared to Clusters 1 (healthy metabolism) and 2 (young age), even after adjusting for covariates. However, no significant difference was found between Clusters 3 and 4 after covariate adjustment.

CONCLUSION

Clusters 3 and 4 showed notably higher T2DM incidence rates, emphasizing the distinct risks associated with insulin resistance and inflammation-aging clusters.

A [18F]FDG PET based nomogram to predict cancer-associated cachexia and survival outcome: A multi-center study

OBJECTIVES

Cancer patients with cachexia face poor prognosis and shortened survival. Early diagnosis and accurate prognosis prediction remain challenging. This multi-center study aims to develop and externally validate a nomogram integrating [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET findings and routine clinical biochemistry tests for predicting cancer-associated cachexia, while also assessing its potential prognostic value.

RESEARCH METHODS & PROCEDURES

A retrospective analysis of 658 cancer patients (390 in the development cohort, 268 in the validation cohort) utilized [18F]FDG PET/CT data from two centers. Logistic regression identified organ-specific standardized uptake values (SUVs) and clinical variables associated with cancer-associated cachexia. Diagnostic accuracy, discriminative ability, and clinical effectiveness were assessed using area under the curve (AUC), calibration curve, and decision curve. Nomogram predictability for overall survival was evaluated through Cox regression and Kaplan-Meier curves.

RESULTS

The combined nomogram incorporating age (odds ratio [OR] = 1.893; P = 0.012), hemoglobin (OR = 2.591; P < 0.001), maximum SUV of the liver (OR = 3.646; P < 0.001), and minimum SUV of the subcutaneous fat (OR = 5.060; P < 0.001) achieved good performance in predicting cancer-associated cachexia (AUC = 0.807/0.726, development/validation). Calibration and decision curve analyses confirmed its clinical effectiveness. Kaplan-Meier curves analysis showed that overall survival can be categorized using the combined nomogram (P < 0.001).

CONCLUSION

Combining radiological information from clinical standard [18F]FDG PET data from cancer patients with biochemical results in their routine clinical blood tests through a well-constructed nomogram enables predicting cachexia and its effect on the prognosis of cancer patients.

Hypoalbuminemia in status epilepticus is a biomarker of short- and long-term mortality: A 9-year cohort study

BACKGROUND

Outcome prediction in Status epilepticus (SE) aids in clinical decision-making, yet existing scores have limitations due to SE heterogeneity. Serum albumin is emerging as a readily available prognostic biomarker in various clinical conditions. This study evaluates hypoalbuminemia in predicting short- and long-term mortality.

METHODS

Observational cohort study including non-hypoxic SE adult patients admitted to the University Hospital of Geneva (Switzerland) between 2015 and 2023. Primary outcomes were in-hospital and 6-month mortality.

RESULTS

Four hundred and ninety-six patients were included, 46 (9.3%) died in hospital; 6-month outcome was available for 364 patients, 86 (23.6%) were not alive at follow-up. Hypoalbuminemia was associated with older age and patients' comorbidities. Binomial regression showed an independent correlation between hypoalbuminemia and short- (p = 0.005, OR = 3.35, 95% CI = 1.43-7.86) and long-term mortality (p = 0.001, OR = 3.59,95% CI = 1.75-7.35). The Status Epilepticus Severity Score (STESS) had an overall AUC of 0.754 (95% CI = 0.656-0.836) for predicting in-hospital mortality and of 0.684 (95% CI = 0.613-0.755) for 6-month mortality. Through an exploratory analysis, we replaced age with hypoalbuminemia in the STESS, creating the Albumin-STESS (A-STESS) score (0-6). The global A-STESS AUC significantly improved for both in-hospital (0.837, 95% CI = 0.760-0.916, p = 0.002) and 6-month (0.739, 95% CI = 0.688-0.826; p = 0.033) mortality prediction. A-STESS-3 cutoff demonstrated a strong sensitivity-specificity balance for both in-hospital (sensitivity = 0.88, specificity = 0.68, accuracy = 0.70) and 6-month (sensitivity = 0.67, specificity = 0.73, accuracy = 0.72) mortality.

CONCLUSIONS

Hypoalbuminemia is an easily measurable biomarker reflecting the overall patient's condition and is independently related to short- and long-term SE mortality. Integrating hypoalbuminemia into the STESS (A-STESS) significantly enhances mortality prediction. Future studies are needed to externally validate the A-STESS and evaluate the benefits of albumin supplementation in SE patient prognosis.

Use and utility of C-reactive protein (CRP) in neonatal early-onset sepsis: a secondary analysis of a prospective surveillance study

OBJECTIVE

Characterize C-reactive protein (CRP) within 72 postnatal hours in early-onset sepsis (EOS).

STUDY DESIGN

Secondary analysis of a prospective surveillance study of neonates with EOS 2015-2017. We examined CRP use by center and neonatal characteristics, and CRP levels by time, neonatal characteristics, clinical signs, and pathogen.

RESULTS

CRP was obtained for 96/235 neonates with EOS, which varied by center (p < 0.001). 71/95 had CRP > 10 mg/L (1 missing). Neonatal characteristics with and without CRP did not differ. There was no relationship between CRP level and timing (p = 0.41) or neonate characteristics. Median CRP was higher with ≥5 vs <5 clinical signs (56, 23 mg/L; p = 0.002), and was not different in Gram-positive vs Gram-negative sepsis (43, 51 mg/L; p = 0.37) or preterm neonates who died vs survived (38, 28 mg/L; p = 0.37).

CONCLUSIONS

Among neonates with EOS, CRP use varied by center. CRP levels did not differ by time, neonate characteristics, pathogen, or death.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov ID Early-Onset Sepsis an NICHD/CDC Surveillance Study (EOSII): NCT02410486.

Liver damage and immune responses

Chronic liver disease (CLD) has massive systemic repercussions including major impacts on the body's immune system. Abnormalities in phenotype, function and numbers of various immune cell subsets have been established by a large number of clinical and pre-clinical studies. The loss of essential immune functions renders CLD-patients exceptionally susceptible to bacterial and viral infections and also impairs the efficacy of vaccination. Consequently, infections represent a major clinical issue causing significant morbidity and mortality in these patients. Mechanistically, the immune dysfunction associated with CLD results from the increased translocation of bacteria and bacterial cues from the intestine. These trigger a signaling axis around the cytokines IFN I and IL-10 in hepatic myeloid cells, which aside from impairing the function of the myeloid cells themselves, also has notable negative impacts on the functionality of other immune cells. T cells in CLD-patients and -models are especially affected by this signaling axis and display a variety of quantitative and qualitative defects. Due to the high clinical relevance, understanding the mechanisms underlaying CED-associated immune dysfunction is of critical importance to discover and develop new therapeutic targets.

Clinical Implications of Inflammation in Patients With Cirrhosis

Cirrhosis-associated immune dysfunction refers to the concurrent systemic inflammation and immunoparesis evident across the disease spectrum of chronic liver disease, ranging from the low-grade inflammatory plasma milieu that accompanies compensated disease to the intense high-grade inflammatory state with coexistent severe immune paralysis that defines acute decompensation and acute-on-chronic liver failure. Systemic inflammation plays a crucial role in the disease course of cirrhosis and is a key driver for acute decompensation and the progression from compensated to decompensated cirrhosis. Severe systemic inflammation is fundamental to the development of organ dysfunction and failure and, in its most extreme form, acute-on-chronic liver failure. Systemic inflammation propagates the development of hepatic encephalopathy and hepatorenal syndrome-acute kidney injury. It may also be involved in the pathogenesis of further complications such as hepatocellular carcinoma and mental illness. Those patients with the most profound systemic inflammation have the worst prognosis. Systemic inflammation exerts its negative clinical effects through a number of mechanisms including nitric oxide-mediated increased splanchnic vasodilation, immunopathology, and metabolic reallocation.

Loss of function in protein Z (PROZ) is associated with increased risk of ischemic stroke in the UK Biobank

BACKGROUND

The vitamin K-dependent coagulation factor protein Z (PZ), encoded by the PROZ gene, is canonically considered to have anticoagulant effects through negative regulation of factor Xa. Paradoxically, higher circulating PZ concentrations have repeatedly been associated with an elevated risk of acute ischemic stroke.

OBJECTIVES

We performed a large-scale genetic association study to examine the relationship between germline genetic variants in PROZ and the risk of ischemic stroke.

METHODS

Using whole-exome sequencing and clinical data for 416 711 participants in the UK Biobank (UKB), we identified individuals with rare (minor allele frequency ≤0.1%) putatively function-altering variants in PROZ. Using Firth's logistic regression and controlling for known stroke risk factors, we evaluated the association between variant carrier status and noncardioembolic ischemic stroke (NCEIS). Additionally, we evaluated differences in the plasma levels of 1472 proteins between PROZ variant carriers and noncarriers in a subset of 48 893 UKB participants.

RESULTS

After accounting for missing data, qualifying variants in PROZ were identified in 414 UKB participants (99.0% heterozygous). Variant carriers had a significantly increased risk of NCEIS (odds ratio, 2.34; 95% CI, 1.15-4.13; P = .02) but not of venous thromboembolism, myocardial infarction, or peripheral artery disease. Plasma proteomics analysis revealed that PROZ variant carriers had significantly elevated levels of 2 proteins related to the response to cerebral ischemia, peroxiredoxins 1 and 6 (PRDX1: fold change, 1.83; P = 1.3 × 10-5; PRDX6: fold change, 1.78; P = 9.6 × 10-10).

CONCLUSION

Lifelong exposure to decreased PZ levels confers a significantly increased risk of NCEIS, consistent with the role of PZ as an anticoagulant factor.

Comparison of clinical outcomes of bilateral and unilateral unicompartmental knee arthroplasty for the treatment of knee osteoarthritis

The risks and benefits associated with simultaneous bilateral unicompartmental knee arthroplasty (UKA) continue to engender contentious debate. The aim of this study was to compare the clinical outcomes of simultaneous bilateral and unilateral UKA. A retrospective review was performed between 2019 and 2022 on 280 patients (130 simultaneous bilateral vs. 150 unilateral Oxford UKA) who performed by two experienced surgeons. Patients in both groups underwent surgery according to the Microplasty instrumentation system, with congruent postoperative management and carefully standardized follow-up. This study performed a comparative analysis between the two groups of patients with regard to postoperative laboratory tests, knee functionality, postoperative discomfort, and incidence of complications. There was a significant difference in the duration of disease between the two groups (U-UKA:6.05 vs. SB-UKA:7.80, P < 0.05). When it comes to laboratory examinations, a notable disparity emerged in hemoglobin levels, erythrocyte pressure volume, D-dimer concentrations, albumin levels, as well as indicators of inflammation among the two groups of patients (P < 0.05). There was a significant difference in operative time and blood loss between the two groups (P < 0.05), with no significant difference in complications. There was no significant difference in radiographic and prosthetic survival between the two groups (U-UKA: 99.3% vs. 98.5%). The HSS score, VAS, and ROM showed remarkable disparities between the two groups in the initial postoperative phase, albeit these distinctions gradually attenuated with the passage of time. Simultaneous bilateral UKA reduces the number of procedures without increasing the risk of surgical complications, but results in a markedly enhanced physiological response and a suboptimal perioperative experience. We strongly encourage the surgeon to work with the patient to determine a surgical strategy.

Effects of Oral Nutritional Supplement on Postoperative Orthognathic Surgery Patients' Nutritional Status: A Randomised Clinical Trial

Purpose

Orthognathic surgery often leads to decreased nutrient intake and increased metabolic demands, potentially resulting in muscle mass loss and delayed recovery. The use of oral nutritional supplements (ONS) alongside nutritional counselling has been proposed to mitigate these effects. This study aimed to investigate the impact of ONS on the postoperative nutritional status of patients undergoing orthognathic surgery.

Patients and methods

A 12-week randomized controlled trial was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand. The recruitment period was extended from July to December 2022 due to unforeseen delays. Patients aged 18 or older, undergoing orthognathic surgery involving at least one jaw, and without metabolic diseases or allergies were included. The intervention group received nutritional counselling and ONS for one-month post-surgery, while the control group received only nutritional counselling. The primary outcome was nutritional status, assessed through anthropometric, biomarker, and muscle strength measurements at various time points.

Results

A total of 28 participants completed the study (control group: n=12, intervention group: n=16). Both groups experienced postoperative weight and muscle mass loss. While the intervention group showed a significantly lower weight loss at two- and four-weeks post-surgery, no significant differences were found in other nutritional status parameters or oral health-related quality of life between the groups after 12 weeks.

Conclusion

The addition of ONS to nutritional counselling did not significantly improve the overall nutritional status of orthognathic surgery patients in the long term. Further research is needed to explore more personalized and intensive nutritional interventions to enhance postoperative recovery in this population.

Trial Registration

Thai Clinical Trials Registry, TCTR20220624006. Registered 24 June 2022.

Preconception exposure to bisphenol A and its alternatives: Effects on female fecundity mediated by oxidative stress and ovarian reserve

BACKGROUND

Various 'Bisphenol A (BPA)-free' alternatives have emerged in numerous personal products in recent years. However, it remains unclear whether BPA analogs affect female fecundity and possible biological mechanisms.

OBJECTIVES

We aimed to evaluate the relationships of bisphenol analogs with female fecundability and infertility and whether oxidative stress, inflammation, and ovarian reserve may play a mediation role in such associations.

METHODS

This prospective preconception cohort study included 957 couples who attempted pregnancy. BPA and six alternatives were measured in women's urine samples. Bisphenol analogs-outcome associations were estimated using discrete-time Cox hazards and logistic regression models. A quantile g-computation (QGC) methodology was further applied to assess the joint effects of co-exposure to bisphenol analogs on fecundity. We also quantified three biomarkers, including malondialdehyde (MDA), C-reactive protein and Anti-Müllerian hormone (AMH), to explore possible biological pathways.

RESULTS

Using an integrated analytical approach consisting of both single-pollutant and mixture models, we found that BPA and bisphenol AP (BPAP) were significantly associated with decreased fecundability (adjusted fecundability ratio (aFR) = 0.87, 95%CI: 0.81, 0.94 for BPA; aFR = 0.64, 95%CI: 0.48, 0.84 for BPAP) and increased risk of infertility (adjusted odd ratio (aOR) = 1.23, 95%CI: 1.06, 1.44 for BPA; aOR = 2.27, 95%CI: 1.29, 3.99 for BPAP) after controlling for other bisphenol analogs. The link between BPA and prolonged time to pregnancy was more prominent in overweight or obese women and those who had regular menstrual cycles. Bisphenol AF was associated with impaired fecundity in women aged 35 years or older. The mixed effects of bisphenol analogs on fecundity were statistically non-significant. Mediation analysis revealed a significant indirect effect of urinary MDA and serum AMH in bisphenol analogs-induced impaired fecundity, with all average causal mediation effects (ACME) showing statistical significance (PACME < 0.05).

CONCLUSIONS

Our prospective preconception cohort study suggests that BPA and BPAP may be associated with impaired female fecundity. Increased oxidative stress and decreased ovarian reserve may be the underlying pathways.

Preliminary analyses of tryptophan, kynurenine, and the kynurenine: Tryptophan ratio in plasma, as potential biomarkers for systemic chlamydial infections in koalas

Chlamydiosis is the major infectious disease responsible for significant morbidity and mortality in free-living koalas. Recently, it was reported that 28.5% of koalas infected with chlamydiosis were presented with no overt clinical signs. Identification and quantification of changes in plasma biomarkers' fluctuations have the potential to enhance C. pecorum detection and facilitate the monitoring of therapeutic efficacy of antibiotics to treat this disease in koalas. Therefore, concentrations of the essential amino acid tryptophan, tryptophan's metabolite kynurenine, and the kynurenine:tryptophan ratio were quantified by high-performance liquid chromatography in the plasma of clinically normal koalas (n = 35), koalas identified with chlamydial disease (n = 35) and koalas that had other non-chlamydial co-morbidities (n = 10). Results showed that there was a significant difference between the clinically normal versus diseased, and clinically normal versus 'other' (both p < 0.001) in kynurenine plasma concentrations and kynurenine:tryptophan ratio; and also between the clinically normal and diseased in tryptophan plasma concentrations (p = 0.001). Proposed reference ranges of tryptophan, kynurenine, and kynurenine:tryptophan ratio in koalas are: 4.27-10.4 μg/mL, 0.34-1.23 μg/mL, and 0.05-0.22, respectively. Proposed optimal cut-off points to differentiate between clinically normal and diseased are: ≤ 4.75 μg/mL (tryptophan), ≥ 0.88 μg/mL (kynurenine), and ≥ 0.12 (kynurenine:tryptophan); and ≤ 7.67 μg/mL (tryptophan), ≥ 1.18 μg/mL (kynurenine), and ≥ 0.16 (kynurenine:tryptophan) to differentiate between released/recovered and euthanised of the diseased/'other' koalas. Significant differences in haematological and biochemical analytes were in the plasma globulins between the clinically normal and diseased koalas (p = 0.01), and in alkaline phosphatase between the clinically normal and 'other' koalas (p = 0.03). Although these potential biomarkers, especially tryptophan, may not be specific for detecting C. pecorum from the rest of the population, kynurenine and the kynurenine:tryptophan ratio may have a role in identifying unhealthy koalas from the clinically normal ones, irrespective of the underlying cause.

Correlation of preoperative fibrinogen/albumin ratio with morbidity following advanced-age hip fractures: an observational study

PURPOSE

Given the occurrence of comorbidities in geriatric patients, the postoperative period of hip fractures may progress with high morbidity and mortality. Recently, several inflammatory markers have been used to evaluate the treatment course. Herein, we prospectively followed-up and examined the relationship between preoperative fibrinogen/albumin ratio(FAR) and morbidity/mortality in elderly patients with hip fracture.

METHODS

Patients aged ≥ 85 years who underwent hip fracture surgery under unilateral spinal anesthesia were included in this prospective observational study. The patients' preoperative FAR, age-adjusted Charlson comorbidity index(AACCI) score, Nottingham Hip Fracture Score, and Clinical Frailty Scale score were calculated. In addition, data on patients' morbidity, 3-month mortality, and lengths of intensive care unit (ICU) and hospital stay were recorded. The patients were categorized into two groups based on the FAR cutoff value of 0.102. A total of 108 patients participated in the study, with 43 assigned to Group 1(FAR < 0.102) and 65 to Group 2(FAR ≥ 0.102).

RESULTS

A significant difference was found in the risk of death within 3-months between patients with high and low FAR scores(p = 0.018). Patients with higher FAR scores were more likely to die within 3 months. A significantly positive association was observed between the FAR and AACCI score, with the AACCI score of Group2 being significantly higher than that of Group 1(p = 0.029). The lengths of hospital(p = 0.044) and ICU(p = 0.013) stay were significantly higher in Group2 than in Group1.

CONCLUSION

Preoperative FAR, which is an inexpensive and readily available test, is a promising index for predicting mortality and complications in patients with hip fracture.

Molecular characterization of the histopathological growth patterns of colorectal cancer liver metastases by RNA sequencing of targeted samples at the tumor-liver interface

The behaviour of metastases in patients with liver-metastatic colorectal cancer (CRC) is still not adequately considered during treatment planning. However, studies in large cohorts have shown that the disease course in these patients depends on the histopathological growth pattern (HGP) of the liver metastases, with the desmoplastic (or encapsulated) pattern responsible for a favourable outcome and the replacement pattern for an unfavourable course. To increase our knowledge of cancer biology in general as well as to design clinical trials that take into account the diverse behaviour of liver metastases, it is necessary to know the cellular and molecular determinants of these growth patterns. For that purpose, we compared the transcriptome of tumour tissue (prospective cohort; n = 57) sampled very precisely at the transition of metastasis and adjacent liver, between the desmoplastic and replacement HGP. In addition, the mutational profiles for 46 genes related to CRC were extracted from the RNA sequencing reads. First, we show that the genetic constitution of a liver metastasis from colorectal cancer does not determine its HGP. Second, we show clear differences between HGPs regarding the expression of genes belonging to the Molecular Signatures Database hallmark gene sets. Biological themes of the replacement HGP reflect cancer cell proliferation and glucose metabolism, while the desmoplastic HGP is characterized by inflammation and immune response, and angiogenesis. This study supports the view that HGPs are a reflection of the biology of CRC liver metastases and suggests the HGPs are driven epigenetically rather than by specific gene mutations.

Harnessing the host response for precision infectious disease diagnosis

SUMMARYDetection of the presence of infection and its etiology must be accurate and timely to facilitate appropriate antimicrobial use. Diagnostic strategies that rely solely on pathogen detection often are insufficient due to poor test characteristics, inability to differentiate colonization from infection, or protracted delay to result. Understanding the human response across different pathogens on a clinical and molecular level can provide more accurate, timely, and useful answers, especially in critical illness and diagnostic uncertainty. Improvements in understanding the human immune response including genomics, protein analysis, gene expression, and cellular morphology have led to rapid innovation of new host response-based diagnostic tests. This review describes the limitations of pathogen-focused technology and the benefits of examining the breadth of immune response to diagnose infection. It then explores biomarkers that have been studied for this purpose and scrutinizes the performance of host-based multianalyte testing. Currently cleared diagnostics and those in late-stage development are described in depth, with a focus on the purpose of testing and its utility for clinicians. Finally, it concludes by examining opportunities for further host response-derived diagnostic innovation.

Red Blood Cell-Related Parameters in Rheumatoid Arthritis: Clinical Value and Immunological Significance

Rheumatoid arthritis (RA) is characterized by chronic inflammation and autoimmunity. Moreover, the disease activity, co-morbidities, and prognosis of RA are closely associated with changes in red blood cell (RBC)-related parameters. The role of these parameters in RA has therefore been extensively studied. Accordingly, this article summarizes and analyzes the close relationship of RBC-related parameters such as RBC count, hemoglobin, and RBC distribution width with disease activity, co-morbidities, and prognosis in RA by reviewing the available literature. In addition, given the immunomodulatory functions of RBCs, their surface proteins, contents, and microparticles are involved in the immunomodulatory process during RA. Overall, this review aims to assess the important clinical value and immunological significance of RBCs and their related parameters in the monitoring and management of RA, thus providing a reference for the clinical diagnosis and treatment of RA and the direction for the research on RBC-related immunity.

Negative association of C-reactive protein-albumin-lymphocyte index (CALLY index) with all-cause and cause-specific mortality in patients with cancer: results from NHANES 1999-2018

BACKGROUND

The CALLY index, which is derived from C-reactive protein (CRP) content, serum albumin level, and total lymphocyte count, reflects the immune, nutritional, and inflammatory status of the body. Lack of sufficient evidence on the correlation between the CALLY index and the prognosis of cancer patients with various cancer forms. This study seeks to elucidate the association between the CALLY index and mortality from all causes as well as specific causes in cancer patients within a U.S.

POPULATION

METHODS

This investigation encompassed 3511 cancer-afflicted adults from the National Health and Nutritional Examination Surveys (NHANES) spanning 1999 to 2018. The CALLY index was measured at baseline only. The relationship between the CALLY index and mortality from both all causes and cancer specifically was examined using Cox proportional hazards models. Additionally, restricted cubic spline, piecewise linear regression, and various subgroup and sensitivity analyses were employed.

RESULTS

Over a median follow-up of 103 months, 1,355 deaths occurred, and the incidence of all-cause mortality for these participants was 38.34%. Our findings indicate that an elevated CALLY index correlates with a diminished risk of all-cause mortality. Upon applying a natural logarithmic transformation to the CALLY index, the comprehensively adjusted model revealed that each one-unit increment in ln CALLY corresponded to a 18% decrease in all-cause mortality risk among cancer patients (HR = 0.82, 95% CI:0.79-0.86). Analyses of mortality due to cardiac and cancer-related causes yielded consistent results, which were robust across various subgroup and sensitivity analyses.

CONCLUSION

The CALLY index demonstrated a linear and negative association with all-cause mortality, as well as mortality caused by cancer and cardiac conditions, highlighting its significant prognostic value in patients with oncological conditions.

Relationships Between Markers of Iron Status and Hematological Parameters in Patients With Sickle Cell Disease

Based on the relationship between the intracellular concentration of sickle hemoglobin S (HbS) and the delay that occurs prior to the onset of sickling following deoxygenation, targeting the intracellular HbS concentration is a recognized therapeutic approach for sickle cell disease (SCD). We and others have shown that restricting iron by dietary or pharmacologic means improves hematologic parameters, inflammation, and organ damage in mouse models of SCD. Clinical evidence corroborating these findings is confined to case reports and small case series studies, none of which account for treatment or α-thalassemia. We hypothesize that increased transferrin saturation is associated with increased mean cellular hemoglobin concentration (MCHC) which in turn is associated with decreased red cell counts and worsening anemia. To investigate this hypothesis, we examined the relationships between transferrin saturation and MCHC with each of the parameters that define MCHC in sickle patients (HbSS without α-thalassemia) and healthy volunteers (HVs). Results indicate that transferrin saturation and MCHC are positively correlated with each other in sickle patients and HV. In patients with SCD, MCHC and transferrin saturation are negatively correlated with RBC count and are not correlated with hemoglobin, whereas each is positively associated with HV. Transferrin saturation and MCHC are each positively correlated with the hemolysis marker, lactate dehydrogenase. These observations support a model where increased transferrin saturation contributes to higher intracellular HbS concentrations with subsequent increases in sickling and hemolysis in sickle patients, suggesting that pharmacologic approaches to decrease serum iron may provide a therapeutic approach for patients with SCD. Trial Registration: This study was registered with ClinicalTrials.gov identifiers: NCT00011648, NCT00081523, and NCT04817670.

Transcriptomic Analysis Reveals the Potential Mechanism of Cardamine circaeoides Hook.f. & Thomson in Lowering Serum Uric Acid by Reducing Inflammatory State Through CCR7 Target

Cardamine circaeoides Hook.f. & Thomson (CC) is a traditional medicinal herb with multiple biological activities. In previous studies, we have identified its serum uric acid (SUA) lowering effects and speculated that Cardamine circaeoides water extract (CCE) may exert anti-hyperuricemia effects related to its anti-inflammatory activity. This study aims to further investigate the molecular mechanism underlying these effects at the mRNA level through transcriptomic analysis, quantitative reverse transcription polymerase chain reaction (RT-qPCR), molecular docking, and Western blotting. CCE effectively reduced SUA and improved renal function in a dose-dependent manner in hyperuricemia rats. Cytokine-cytokine receptor interaction pathway was significantly altered by CCE. An additional study identified a number of genes (IL27, Inhbe, CCR7, CXCR3, IL12RB1, CXCR5, Mstn, and GDF5) as regulators of the inflammatory response. Meanwhile, three key targets (IL27, Inhbe, and CCR7) were found to be significantly expressed at the mRNA level and have strong binding affinity with 22 components, among which Kaempferol 3-sophoroside 7-glucoside, Kaempferol-3-O-sophoroside, and Quercetin 3-sophoroside 7-glucoside have strong binding activities. Following this, Western blotting showed a significant increase in CCR7 expression. Our findings indicated that CCE regulated the cytokine-cytokine receptor interaction pathway through CCR7 to reduce the inflammatory state and exert an SUA-lowering effect.

Bivariate genome-wide association study of circulating fibrinogen and C-reactive protein levels

BACKGROUND

Fibrinogen and C-reactive protein (CRP) play an important role in inflammatory pathways and share multiple genetic loci reported in previously published genome-wide association studies (GWAS), highlighting their common genetic background. Leveraging the shared biology may identify further loci pleiotropically associated with both fibrinogen and CRP.

OBJECTIVES

To identify novel genetic variants that are pleiotropic and associated with both fibrinogen and CRP, by integrating both phenotypes in a bivariate GWAS by using a multitrait GWAS.

METHODS

We performed a bivariate GWAS to identify further pleiotropic genetic loci, using summary statistics of previously published GWAS on fibrinogen (n = 120 246) from the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium, consisting of European ancestry samples and CRP (n = 363 228) from UK Biobank, including 5 different population groups. The main analysis was performed using metaUSAT and N-GWAMA. We conducted replication for novel CRP associations to test the robustness of the findings using an independent GWAS for CRP (n = 148 164). We also performed colocalization analysis to compare the associations in identified loci for the 2 traits and Genotype-Tissue Expression data.

RESULTS

We identified 87 pleiotropic loci that overlapped between metaUSAT and N-GWAMA, including 23 previously known for either fibrinogen or CRP, 58 novel loci for fibrinogen, and 6 novel loci for both fibrinogen and CRP. Overall, there were 30 pleiotropic and novel loci for both traits, and 7 of these showed evidence of colocalization, located in or near ZZZ3, NR1I2, RP11-72L22.1, MICU1, ARL14EP, SOCS2, and PGM5. Among these 30 loci, 13 replicated for CRP in an independent CRP GWAS.

CONCLUSION

Bivariate GWAS identified additional associated loci for fibrinogen and CRP. This analysis suggests fibrinogen and CRP share a common genetic architecture with many pleiotropic loci.