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Terzo C, Gembillo G, Cernaro V, Longhitano E, Calabrese V, Casuscelli C, Peritore L, Santoro D. Investigational new drugs for the treatment of chronic renal failure: an overview of the literature. Expert Opin Investig Drugs 2024; 33:319-334. [PMID: 38429874 DOI: 10.1080/13543784.2024.2326624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/29/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is widespread throughout the world, with a high social and health impact. It is considered a 'silent killer' for its sudden onset without symptoms in the early stages of the disease. The main goal of nephrologists is to slow the progression of kidney disease and treat the associated symptoms with a range of new medications. AREAS COVERED The aim of this systematic review is to analyze the new investigational drugs for the treatment of chronic renal failure. Data were obtained from the available scientific literature and from the ClinicalTrials.gov website. EXPERT OPINION Among the drugs currently being researched, SGLT2 inhibitors appear to be the most promising drugs for the treatment of CKD, has they have slower progression of CKD and protection of cardiorenal function. An important role in the future of CKD treatment is played by autologous cell-therapy, which appears to be a new frontier in the treatment of CKD. Other therapeutic strategies are currently being investigated and have been shown to slow the progression of CKD. However, further studies are needed to determine whether these approaches may offer benefits in slowing the progression of CKD in the near future.
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Affiliation(s)
- Chiara Terzo
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD B, Messina, Italy
| | - Guido Gembillo
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD B, Messina, Italy
| | - Valeria Cernaro
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD B, Messina, Italy
| | - Elisa Longhitano
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD B, Messina, Italy
| | - Vincenzo Calabrese
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD B, Messina, Italy
| | - Chiara Casuscelli
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD B, Messina, Italy
| | - Luigi Peritore
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD B, Messina, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD B, Messina, Italy
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Klonoff DC, Aaron RE, Tian T, DuNova AY, Pandey A, Rhee C, Fleming GA, Sacks DB, Pop-Busui R, Kerr D. Advanced Glycation Endproducts: A Marker of Long-term Exposure to Glycemia. J Diabetes Sci Technol 2024:19322968241240436. [PMID: 38525944 DOI: 10.1177/19322968241240436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
This article examines the importance of advanced glycation endproducts (AGEs) and summarizes the structure of AGEs, pathological changes associated with AGEs, the contribution of AGEs to metabolic memory, and the value of AGEs as a predictor of diabetic complications and cardiovascular disease in people with and without diabetes. As a practical focus, skin autofluorescence (SAF) is examined as an attractive approach for estimating AGE burden. The measurement of AGEs may be of significant value to specific individuals and groups, including Black and Hispanic/Latino Americans, as they appear to have higher concentrations of hemoglobin A1c (HbA1c) than would be predicted by other metrics of mean glycemia. We hypothesize that if the amount of glycation of HbA1c is greater than expected from measured glucose levels, and if AGEs are accumulating, then this accumulation of AGEs might account for the increased rate of complications of diabetes in populations with high rates of vascular disease and other complications. Thus, identifying and modifying the burden of AGEs based on measurement of AGEs by SAF may turn out to be a worthwhile metric to determine individuals who are at high risk for the complications of diabetes as well as others without diabetes at risk of vascular disease. We conclude that available evidence supports SAF as both a clinical measurement and as a means of evaluating interventions aimed at reducing the risks of vascular disease and diabetic complications.
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Affiliation(s)
- David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | | | - Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Connie Rhee
- VA Greater Los Angeles Healthcare System, UCLA, Los Angeles, CA, USA
| | | | | | | | - David Kerr
- Sutter Health Center for Health Systems Research, Santa Barbara, CA, USA
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Cavero-Redondo I, Saz-Lara A, Martínez-García I, Otero-Luis I, Martínez-Rodrigo A. Validation of an early vascular aging construct model for comprehensive cardiovascular risk assessment using external risk indicators for improved clinical utility: data from the EVasCu study. Cardiovasc Diabetol 2024; 23:33. [PMID: 38218806 PMCID: PMC10787504 DOI: 10.1186/s12933-023-02104-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/27/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) remain a major global health concern, necessitating advanced risk assessment beyond traditional factors. Early vascular aging (EVA), characterized by accelerated vascular changes, has gained importance in cardiovascular risk assessment. METHODS The EVasCu study in Spain examined 390 healthy participants using noninvasive measurements. A construct of four variables (Pulse Pressure, Pulse Wave Velocity, Glycated Hemoglobin, Advanced Glycation End Products) was used for clustering. K-means clustering with principal component analysis revealed two clusters, healthy vascular aging (HVA) and early vascular aging (EVA). External validation variables included sociodemographic, adiposity, glycemic, inflammatory, lipid profile, vascular, and blood pressure factors. RESULTS EVA cluster participants were older and exhibited higher adiposity, poorer glycemic control, dyslipidemia, altered vascular properties, and higher blood pressure. Significant differences were observed for age, smoking status, body mass index, waist circumference, fat percentage, glucose, insulin, C-reactive protein, diabetes prevalence, lipid profiles, arterial stiffness, and blood pressure levels. These findings demonstrate the association between traditional cardiovascular risk factors and EVA. CONCLUSIONS This study validates a clustering model for EVA and highlights its association with established risk factors. EVA assessment can be integrated into clinical practice, allowing early intervention and personalized cardiovascular risk management.
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Affiliation(s)
- Iván Cavero-Redondo
- Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Alicia Saz-Lara
- Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain.
| | | | - Iris Otero-Luis
- Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
| | - Arturo Martínez-Rodrigo
- Research Group in Electronic, Biomedical, and Telecommunication Engineering, University of Castilla-La Mancha, Cuenca, Spain
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Abstract
Bone metabolism in the healthy, young adult is identified as a relatively stable process. Normal bone turnover is a dynamic state, which is conferred through intracellular signaling and complex cellular pathways. It has been well described in the literature that Charcot neuro-osteoarthropathy is a disease state, which is marked by intense bone turnover leading to structural collapse and dissolution of skeletal features of the foot and ankle. Within the last two decades, extensive interest has been placed in characterizing the metabolic pathogenesis of Charcot bone metabolism. Despite this work, there remains an incomplete understanding of this devastating disorder. In this article, we review bone histology, physiologic bone metabolism, biomarkers of bone metabolism, pathologic bone metabolism in Charcot diabetics, and potential avenues for intervention.
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Affiliation(s)
- Lisa Grant-McDonald
- Tidewater Foot and Ankle, 760 Independence Boulevard, Virginia Beach, VA 23455, USA.
| | - William Grant
- Tidewater Foot and Ankle, 760 Independence Boulevard, Virginia Beach, VA 23455, USA
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Papachristou S, Rizzo M, Papanas N. Advanced Glycation End Products: Do They Impair Bone Health in Diabetes? Exp Clin Endocrinol Diabetes 2022; 130:636-637. [PMID: 35977693 DOI: 10.1055/a-1903-1752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In diabetes mellitus (DM), there is increased formation and accumulation of advanced glycation end products (AGEs), which represent a heterogeneous class of molecules produced by non-enzymatic glycation of various molecules during long-term hyperglycaemia. Several studies have examined the role of AGEs in DM complications. Accumulating evidence suggests that AGEs affect bone metabolism. New knowledge indicates that they may play a role in bone disease among DM subjects. More data are now needed to clarify their role and to explore new AGEs-based therapeutic options for optimal bone health in DM.
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Affiliation(s)
- Stella Papachristou
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Manfredi Rizzo
- Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Italy
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
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Advanced Glycation End Products (AGEs) and Chronic Kidney Disease: Does the Modern Diet AGE the Kidney? Nutrients 2022; 14:nu14132675. [PMID: 35807857 PMCID: PMC9268915 DOI: 10.3390/nu14132675] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/13/2022] Open
Abstract
Since the 1980s, chronic kidney disease (CKD) affecting all ages has increased by almost 25%. This increase may be partially attributable to lifestyle changes and increased global consumption of a “western” diet, which is typically energy dense, low in fruits and vegetables, and high in animal protein and ultra-processed foods. These modern food trends have led to an increase in the consumption of advanced glycation end products (AGEs) in conjunction with increased metabolic dysfunction, obesity and diabetes, which facilitates production of endogenous AGEs within the body. When in excess, AGEs can be pathological via both receptor-mediated and non-receptor-mediated pathways. The kidney, as a major site for AGE clearance, is particularly vulnerable to AGE-mediated damage and increases in circulating AGEs align with risk of CKD and all-cause mortality. Furthermore, individuals with significant loss of renal function show increased AGE burden, particularly with uraemia, and there is some evidence that AGE lowering via diet or pharmacological inhibition may be beneficial for CKD. This review discusses the pathways that drive AGE formation and regulation within the body. This includes AGE receptor interactions and pathways of AGE-mediated pathology with a focus on the contribution of diet on endogenous AGE production and dietary AGE consumption to these processes. We then analyse the contribution of AGEs to kidney disease, the evidence for dietary AGEs and endogenously produced AGEs in driving pathogenesis in diabetic and non-diabetic kidney disease and the potential for AGE targeted therapies in kidney disease.
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Skin accumulation of advanced glycation end products and cardiovascular risk in Korean patients with type 2 diabetes mellitus. Heliyon 2022; 8:e09571. [PMID: 35711980 PMCID: PMC9192809 DOI: 10.1016/j.heliyon.2022.e09571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/01/2022] [Accepted: 05/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background The formation of advanced glycation end products (AGEs) takes place during normal aging; however, their production is faster in people having diabetes. The accumulated AGEs reportedly play a role in the occurrence of various age-related disorders. Furthermore, the skin autofluorescence (SAF) technique can be used to detect accumulated AGEs levels. There are few reports on the association between skin accumulation of AGEs and risk of complications in type 2 diabetes mellitus. Methods In this study, we aimed to describe the association between the skin accumulation of AGEs and cardiovascular risk factors in Korean patients with type 2 diabetes. A total of 310 Korean patients with diabetes were enrolled, and the levels of AGEs were measured using SAP. Levels of fasting blood glucose (FBS), triglycerides, total cholesterol, low- and high-density lipoprotein cholesterol, proteinuria, arterial pulse wave velocity (PWV), and blood vessel age were measured using an automatic waveform analyzer. General linear models were used to identify the independent effect of AGEs after adjusting for covariates (age, weight, and duration of diabetes). Results The skin levels of AGEs were strongly correlated with the diabetes duration. Significant independent associations were observed for AGEs with FBS (P < 0.01), proteinuria (P < 0.001), and PWV (P < 0.001). The advanced glycated product was independently associated to the arterial pulse wave conduction velocity that is used as a representative method for measuring arteriosclerosis by analysis early cardiovascular risk factors. Conclusion Our results show that an increase in SAF levels in Korean patients with type 2 diabetes is associated with PWV and vein age, and thereby with arterial stiffness. Therefore, our results suggest that AGEs are associated with cardiovascular risk factors. The level of AGEs can thus be used as an indicator of cardiovascular diseases in the clinical diagnosis of patients with type 2 diabetes. Unclear association between skin accumulation of AGEs and T2DM complication risk. Study Population: Korean patients with T2DM. Strong correlation between skin levels of AGEs and diabetes duration. Independent association between AGEs and arterial pulse wave conduction velocity. Association between increased SAF levels in with PWV, vein age, arterial stiffness.
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Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus. J Clin Med 2022; 11:jcm11061625. [PMID: 35329949 PMCID: PMC8955850 DOI: 10.3390/jcm11061625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Patients with diabetes mellitus (DM) are known to show poor recovery after stroke. This specific burden might be due to acute and chronic hyperglycemic effects. Meanwhile, the underlying mechanisms are a cause of discussion, and the best measure to predict the outcome is unclear. Skin autofluorescence (SAF) reflects the in-patient load of so-called advanced glycation end products (AGEs) beyond HbA1c and represents a valid and quickly accessible marker of chronic hyperglycemia. We investigated the predictive potential of SAF in comparison to HbA1c and acute hyperglycemia on the functional outcome at 90 days after ischemic stroke in a cohort of patients with DM. Methods: We prospectively included 113 patients with DM type 2 hospitalized for acute ischemic stroke. SAF was measured on each patient’s forearm by a mobile AGE-Reader mu© in arbitrary units. HbA1c and the area under the curve (AUC) of the blood sugar profile after admission were assessed. Functional outcome was assessed via phone interview after 90 days. A poor outcome was defined as a deterioration to a modified Rankin Scale score ≥ 3. A good outcome was defined as a modified Rankin Scale score < 3 or as no deterioration from premorbid level. Results: Patients with a poor outcome presented with higher values of SAF (mean 3.38 (SD 0.55)) than patients with a good outcome (mean 3.13 (SD 0.61), p = 0.023), but did not differ in HbA1c and acute glycemia. In logistic regression analysis, age (p = 0.021, OR 1.24 [1.12−1.37]) and SAF (p = 0.021, OR 2.74 [1.16−6.46]) significantly predicted a poor outcome, whereas HbA1c and acute glycemia did not. Patients with a poor 90-day outcome and higher SAF experienced more infections (4.2% vs. 33.3% (p < 0.01)) and other various in-hospital complications (21.0% vs. 66.7% (p < 0.01)) than patients with a good outcome and lower SAF levels. Conclusions: SAF offers an insight into glycemic memory and appears to be a significant predictor of poor stroke outcomes in patients with DM exceeding HbA1c and acute glycemia. Measuring SAF could be useful to identify specifically vulnerable patients at high risk of complications and poor outcomes.
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Filipov A, Fuchshuber H, Kraus J, Ebert AD, Sandikci V, Alonso A. Skin Autofluorescence is an Independent Predictor of Post Stroke Infection in Diabetes. J Stroke Cerebrovasc Dis 2021; 30:105949. [PMID: 34186287 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 01/11/2023] Open
Abstract
Post stroke infection occurs in 15-20% of acute stroke patients and is associated with a poor longterm outcome. In a prospective study on 113 acute ischemic stroke patients with diabetes mellitus 15.9% suffered nosocomial infection. We found chronic hyperglycemia measured by skin autofluorescence in arbitrary units to be an independent predictor of a nosocomial infection post stroke (OR = 3.24 [CI 95%: 1.13; 9.26], p = 0.029). Skin autofluorescence represents the glycemic memory beyond HbA1c. Potential mechanisms leading from increased skin autofluorescence to vulnerability for infectious complications include more severe strokes due to preexisting vasculopathy and exacerbated post stroke immunosuppression.
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Affiliation(s)
- Alexandra Filipov
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Germany.
| | - Heike Fuchshuber
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Josephine Kraus
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Anne D Ebert
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Vesile Sandikci
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
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Pehlivanoğlu S, Bayraktar Z, Karakaya M, Albayrak S, Bayraktar Ş. Assessment of lens autofluorescence in patients with well-controlled essential hypertension and those with renal failure secondary to hypertension undergoing hemodialysis. Photodiagnosis Photodyn Ther 2021; 34:102268. [PMID: 33785443 DOI: 10.1016/j.pdpdt.2021.102268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the lens autofluorescence (AF) levels among patients with end-stage renal failure and undergoing hemodialysis secondary to hypertension, patients with well-controlled hypertension, and healthy controls. METHOD This study was a prospective, cross-sectional, comparative study conducted between February and April 2018. Two groups of patients and a group of healthy individuals were included in the study. The first group of patients included individuals with a renal insufficiency due to essential hypertension who underwent regular hemodialysis treatment (dialysis group). The second group included patients with well-controlled essential hypertension (hypertension group). Lens autofluorescence was measured via a scanning confocal lens fluorescence biomicroscope optical system for all participants. The measurement of fluorescence ratio is given as a numerical data. The AF results were compared in all groups. RESULTS The study included 87 individuals. There were 29 individuals (33.3 %) in the dialysis group, 30 (34.5 %) in the hypertension group, and 28 (32.2 %) in the healthy group. The mean fluorescence ratio(FR) was 0.20 ± 0.06, 0.20 ± 0.04, and 0.17 ± 0.04 in the dialysis, hypertension, and healthy groups respectively. There was a significant difference in the mean FR measurements between the three groups (p = .004). As a result of a binary comparison, mean FR values for patients in the dialysis group were higher (0.20 ± 0.06) than for healthy individuals (0.17 ± 0.04), which was statistically significant (p = .025). Mean FR measurements of hypertensive patients were higher (0.20 ± 0.04) than healthy individuals (0.17 ± 0.04), which was also statistically significant (p = .02). However, there was no statistically significant difference among the mean FR measurements between the hypertension and dialysis groups (p = .63). CONCLUSION We demonstrated that lens autofluorescence increased in patients with renal failure undergoing hemodialysis and those with well-controlled hypertension. The mean lens autofluorescence levels were significantly higher in both patient groups than the healthy control group.
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Affiliation(s)
- Seren Pehlivanoğlu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Zerrin Bayraktar
- Yeni Yüzyıl University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey.
| | - Muharrem Karakaya
- Yeni Yüzyıl University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey.
| | - Sinan Albayrak
- Yeni Yüzyıl University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey.
| | - Şükrü Bayraktar
- Yeni Yüzyıl University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey.
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Abstract
Advanced glycation end-products (AGEs) are heterogeneous molecules produced by the non-enzymatic glycation of proteins, lipids, or nucleic acids during hyperglycaemia. Accumulation of AGEs in the peripheral nerves has recently been proposed as an additional risk factor for the development of diabetic neuropathy (DN). The gold standard for measurement of tissue-bound AGEs is tissue biopsy. However, their assessment with the newer, fast and simple method of skin autofluorescence (sAF) has recently gained special interest by virtue of its non-invasive, highly reproducible nature and its acceptable correlation with the reference method of skin biopsy. Accumulation of tissue AGEs evaluated by sAF has been shown to independently correlate with DN. Importantly, increasing evidence underscores their potential value as early biomarkers of the latter. Further important associations include diabetic nephropathy, diabetic retinopathy and cardiovascular autonomic neuropathy. However, the value of the implementation of screening with skin AGEs for DN remains unclear. The aim of the present review is to critically summarise current evidence on the association between skin AGEs and diabetic microvascular complications, with a particular emphasis on diabetic neuropathy, and to note the most important limitations of existing knowledge. Longer follow-up studies are also highly anticipated to clarify its role and provide data on patient selection and cost-effectiveness.
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Affiliation(s)
- Stella Papachristou
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, G. Kondyli 22c, 68100, Alexandroupolis, Greece
| | - Kalliopi Pafili
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, G. Kondyli 22c, 68100, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, G. Kondyli 22c, 68100, Alexandroupolis, Greece.
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Zhang Y, Jiang T, Liu C, Hu H, Dai F, Xia L, Zhang Q. Effectiveness of Early Advanced Glycation End Product Accumulation Testing in the Diagnosis of Diabetes: A Health Risk Factor Analysis Using the Body Mass Index as a Moderator. Front Endocrinol (Lausanne) 2021; 12:766778. [PMID: 35370932 PMCID: PMC8967381 DOI: 10.3389/fendo.2021.766778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/08/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To evaluate the value of non-invasive detection of advanced glycation end products (AGEs) in the early screening of type 2 diabetes mellitus (T2DM) in the community of China. METHODS From January 2018 to January 2019, a total of 912 patients with community health physical examination and no history of T2DM were selected, excluding the results of missing value > 5%. Finally, 906 samples were included in the study, with a response rate of 99.3%. Non-invasive diabetic detection technology was used to detect AGEs in the upper arm skin of all participants, AGE accumulations were classified as ≤P25, P25∼P50, P50∼P75, and >P75; HbA1c, insulin, C-peptide, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), creatinine, urea, and other indicators were measured at the same time. Univariate analysis of variance was used to compare the differences in general data, biochemical indexes, skin AGE levels, and blood glucose among groups, and logistic regression analysis and latent category analysis were performed. RESULTS In univariate analysis, SBP, FBG, HbA1c, and age were correlated with higher AGE (p < 0.01); TG, TC, HDL, UA, and gender were not positively correlated with AGE (p < 0.01). After controlling for covariates (waist circumference, hip circumference), AGE accumulation was interacted with other variables. The results of latent category analysis (LCA) showed that the health risk factors (HRFs), including age, systolic blood pressure, HbA1c, FBG, triglyceride, total cholesterol, HDL-C, and uric acid, were divided as three groups, and AGE is divided into four categories according to the quartile method, which were low risk (≤P25), low to medium risk (P25∼P50), medium to high (P50∼P75), and high risk (>P75), respectively. The association between the quartile AGE and risk factors of the OR values was 1.09 (95% CI: 1.42, 2.86), 2.61 (95% CI: 1.11, 6.14), and 5.41 (95% CI: 2.42, 12.07), respectively. The moderation analysis using the PROCESS program was used to analyze whether BMI moderated the link between risk factors and AGE accumulation. There was also a significant three-way interaction among HRFs, BMI, and gender for AGE accumulation in the total sample (β = -0.30). CONCLUSION Non-invasive skin detection of AGEs has a certain application value for the assessment of T2DM risk and is related to a variety of risk factors.
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Affiliation(s)
- Yi Zhang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Tian Jiang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chao Liu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Honglin Hu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fang Dai
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Xia
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qiu Zhang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Qiu Zhang,
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Zharkikh E, Dremin V, Zherebtsov E, Dunaev A, Meglinski I. Biophotonics methods for functional monitoring of complications of diabetes mellitus. JOURNAL OF BIOPHOTONICS 2020; 13:e202000203. [PMID: 32654427 DOI: 10.1002/jbio.202000203] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 06/11/2023]
Abstract
The prevalence of diabetes complications is a significant public health problem with a considerable economic cost. Thus, the timely diagnosis of complications and prevention of their development will contribute to increasing the length and quality of patient life, and reducing the economic costs of their treatment. This article aims to review the current state-of-the-art biophotonics technologies used to identify the complications of diabetes mellitus and assess the quality of their treatment. Additionally, these technologies assess the structural and functional properties of biological tissues, and they include capillaroscopy, laser Doppler flowmetry and hyperspectral imaging, laser speckle contrast imaging, diffuse reflectance spectroscopy and imaging, fluorescence spectroscopy and imaging, optical coherence tomography, optoacoustic imaging and confocal microscopy. Recent advances in the field of optical noninvasive diagnosis suggest a wider introduction of biophotonics technologies into clinical practice and, in particular, in diabetes care units.
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Affiliation(s)
- Elena Zharkikh
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
| | - Viktor Dremin
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- School of Engineering and Applied Science, Aston University, Birmingham, UK
| | - Evgeny Zherebtsov
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- Optoelectronics and Measurement Techniques unit, University of Oulu, Oulu, Finland
| | - Andrey Dunaev
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
| | - Igor Meglinski
- School of Engineering and Applied Science, Aston University, Birmingham, UK
- Optoelectronics and Measurement Techniques unit, University of Oulu, Oulu, Finland
- Interdisciplinary Laboratory of Biophotonics, National Research Tomsk State University, Tomsk, Russia
- Institute of Engineering Physics for Biomedicine (PhysBio), National Research Nuclear University-MEPhI, Moscow, Russia
- School of Life and Health Sciences, Aston University, Birmingham, UK
- Department of Histology, Cytology and Embryology, Institute of Clinical Medicine N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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14
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Saz-Lara A, Álvarez-Bueno C, Martínez-Vizcaíno V, Notario-Pacheco B, Sequí-Dominguez I, Cavero-Redondo I. Are Advanced Glycation End Products in Skin Associated with Vascular Dysfunction Markers? A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186936. [PMID: 32972023 PMCID: PMC7559442 DOI: 10.3390/ijerph17186936] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022]
Abstract
Evidence exists regarding the association between advanced glycation end products and different cardiovascular disease subclinical processes, such as arterial stiffness and atherosclerosis. With this systematic review and meta-analysis, we aimed to provide a synthesis of the evidence regarding the association of arterial stiffness measured by pulse wave velocity and atherosclerosis measured by carotid intima media thickness with skin autofluorescence. A systematic search was performed using: MEDLINE (PubMed), SCOPUS, and Web of Science, until 30 March 2020. Cross-sectional studies or baseline data from prospective longitudinal studies were considered. The DerSimonian and Laird method was used to calculate the pooled estimates of correlation coefficients and the corresponding 95% confidence intervals (CI) for the association of pulse wave velocity and carotid intima media thickness with skin autofluorescence. Twenty-five studies were included in the systematic review and meta-analysis, including 6306 subjects. The pooled correlation coefficient was 0.25 (95% CI: 0.18, 0.31) for pulse wave velocity and skin autofluorescence, and 0.31 (95% CI: 0.25, 0.38) for carotid intima media thickness and skin autofluorescence. This systematic review and meta-analysis provide a synthesis of the evidence showing a positive weak association of pulse wave velocity and carotid intima media thickness with skin autofluorescence.
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Affiliation(s)
- Alicia Saz-Lara
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16171 Cuenca, Spain; (A.S.-L.); (V.M.-V.); (B.N.-P.); (I.S.-D.); (I.C.-R.)
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16171 Cuenca, Spain; (A.S.-L.); (V.M.-V.); (B.N.-P.); (I.S.-D.); (I.C.-R.)
- Universidad Politécnica y Artística del Paraguay, 001518 Asuncion, Paraguay
- Correspondence:
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16171 Cuenca, Spain; (A.S.-L.); (V.M.-V.); (B.N.-P.); (I.S.-D.); (I.C.-R.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, 3460000 Talca, Chile
| | - Blanca Notario-Pacheco
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16171 Cuenca, Spain; (A.S.-L.); (V.M.-V.); (B.N.-P.); (I.S.-D.); (I.C.-R.)
| | - Irene Sequí-Dominguez
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16171 Cuenca, Spain; (A.S.-L.); (V.M.-V.); (B.N.-P.); (I.S.-D.); (I.C.-R.)
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16171 Cuenca, Spain; (A.S.-L.); (V.M.-V.); (B.N.-P.); (I.S.-D.); (I.C.-R.)
- Universidad Politécnica y Artística del Paraguay, 001518 Asuncion, Paraguay
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15
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Advanced Glycation End Products (AGEs): Biochemistry, Signaling, Analytical Methods, and Epigenetic Effects. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:3818196. [PMID: 32256950 PMCID: PMC7104326 DOI: 10.1155/2020/3818196] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 02/08/2023]
Abstract
The advanced glycation end products (AGEs) are organic molecules formed in any living organisms with a great variety of structural and functional properties. They are considered organic markers of the glycation process. Due to their great heterogeneity, there is no specific test for their operational measurement. In this review, we have updated the most common chromatographic, colorimetric, spectroscopic, mass spectrometric, and serological methods, typically used for the determination of AGEs in biological samples. We have described their signaling and signal transduction mechanisms and cell epigenetic effects. Although mass spectrometric analysis is not widespread in the detection of AGEs at the clinical level, this technique is highly promising for the early diagnosis and therapeutics of diseases caused by AGEs. Protocols are available for high-resolution mass spectrometry of glycated proteins although they are characterized by complex machine management. Simpler procedures are available although much less precise than mass spectrometry. Among them, immunochemical tests are very common since they are able to detect AGEs in a simple and immediate way. In these years, new methodologies have been developed using an in vivo novel and noninvasive spectroscopic methods. These methods are based on the measurement of autofluorescence of AGEs. Another method consists of detecting AGEs in the human skin to detect chronic exposure, without the inconvenience of invasive methods. The aim of this review is to compare the different approaches of measuring AGEs at a clinical perspective due to their strict association with oxidative stress and inflammation.
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16
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Honda T, Hirakawa Y, Nangaku M. The role of oxidative stress and hypoxia in renal disease. Kidney Res Clin Pract 2019; 38:414-426. [PMID: 31558011 PMCID: PMC6913586 DOI: 10.23876/j.krcp.19.063] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022] Open
Abstract
Oxygen is required to sustain aerobic organisms. Reactive oxygen species (ROS) are constantly released during mitochondrial oxygen consumption for energy production. Any imbalance between ROS production and its scavenger system induces oxidative stress. Oxidative stress, a critical contributor to tissue damage, is well-known to be associated with various diseases. The kidney is susceptible to hypoxia, and renal hypoxia is a common final pathway to end stage kidney disease, regardless of the underlying cause. Renal hypoxia aggravates oxidative stress, and elevated oxidative stress, in turn, exacerbates renal hypoxia. Oxidative stress is also enhanced in chronic kidney disease, especially diabetic kidney disease, through various mechanisms. Thus, the vicious cycle between oxidative stress and renal hypoxia critically contributes to the progression of renal injury. This review examines recent evidence connecting chronic hypoxia and oxidative stress in renal disease and subsequently describes several promising therapeutic approaches against oxidative stress.
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Affiliation(s)
- Tomoko Honda
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Hirakawa
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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17
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Fernando ME, Crowther RG, Lazzarini PA, Sangla KS, Wearing S, Buttner P, Golledge J. Within- and Between-Body-Site Agreement of Skin Autofluorescence Measurements in People With and Without Diabetes-Related Foot Disease. J Diabetes Sci Technol 2019; 13:836-846. [PMID: 31204497 PMCID: PMC6955457 DOI: 10.1177/1932296819853555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Skin autofluorescence has been used to assess longer term glycemic control and risk of complications. There is however no agreed site at which autofluorescence should be measured. This study evaluated the within- and between-site agreement in measurement of skin autofluorescence using a noninvasive advanced glycation end product (AGE) reader. METHODS Overall, 132 participants were included: 16 with diabetes-related foot ulcers (DFU), 63 with diabetes but without foot ulcers (DMC), 53 without diabetes or foot ulcers (HC). Skin autofluorescence was measured using the AGE Reader (DiagnOptics technologies BV, the Netherlands). Three consecutive skin autofluorescence measurements were each performed at six different body sites: the volar surfaces of both forearms (arms), dorsal surfaces of both calves (legs), and plantar surfaces of both feet (feet). Within- and between-site agreements were analyzed with concordance correlation coefficients (CCC) and 95% confidence intervals (95% CI), absolute mean differences (±standard deviation), and Bland-Altman limits of agreement. RESULTS The agreement between repeat assessments at the same site was almost perfect (CCC [95% CI] ranging from 0.94 [0.91-0.96] for assessments in the right foot to 0.99 [0.99-0.99] for assessments in the left arm). The limits of agreement were narrow within ±0.5 arbitrary units for all sites. The between-site agreement in measurements was poor (CCC < 0.65) with large maximum absolute mean differences (±SD) in arbitrary units (DFU = 3.40 [±2.04]; DMC = 3.15 [±2.45]; HC = 2.72 [±1.83]) and wide limits of agreement. CONCLUSIONS Skin autofluorescence measurements can be repeated at the same site with adequate repeatability but measurements at different sites in the same patient have marked differences. The reason for this variation across sites and whether this has any role in diabetes-related complications needs further investigation.
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Affiliation(s)
- Malindu E. Fernando
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Jonathan Golledge, M Chir, Director, Queensland Research Centre for Peripheral Vascular Disease, 100 Angus Smith Dr, Douglas QLD 4814, Australia.
| | - Robert G. Crowther
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Australia
| | - Kunwarjit S. Sangla
- Department of Diabetes and Endocrinology, Townsville Hospital, Queensland, Australia
| | - Scott Wearing
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Petra Buttner
- Centre for Chronic Disease Prevention, James Cook University, Cairns, Australia
| | - Jonathan Golledge
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Queensland, Australia
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18
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Oude Voshaar RC, Dhondt TDF, Fluiter M, Naarding P, Wassink S, Smeets MMJ, Pelzers LPRM, Lugtenburg A, Veenstra M, Marijnissen RM, Hendriks GJ, Verlinde LA, Schoevers RA, van den Brink RHS. Study design of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) project; a cohort study of older patients with affective disorders referred for specialised geriatric mental health care. BMC Psychiatry 2019; 19:182. [PMID: 31208389 PMCID: PMC6580500 DOI: 10.1186/s12888-019-2176-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Affective disorders, encompassing depressive-, anxiety-, and somatic symptom disorders, are the most prevalent mental disorders in later life. Treatment protocols and guidelines largely rely on evidence from RCTs conducted in younger age samples and ignore comorbidity between these disorders. Moreover, studies in geriatric psychiatry are often limited to the "younger old" and rarely include the most frail. Therefore, the effectiveness of treatment in routine clinical care for older patients and impact of ageing characteristics is largely unknown. OBJECTIVE The primary aim of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) - project is to examine the impact of ageing characteristics on the effectiveness of treatment for affective disorders in specialised geriatric mental health care. METHODS ROM-GPS is a two-stage, multicentre project. In stage one, all patients aged ≥60 years referred to participating outpatient clinics for specialised geriatric mental health care will be routinely screened with a semi-structured psychiatric interview, the Mini International Neuropsychiatric Interview and self-report symptom severity scales assessing depression, generalized anxiety, hypochondria, and alcohol use. Patients with a unipolar depressive, anxiety or somatic symptom disorder will be asked informed consent to participate in a second (research) stage to be extensively phenotyped at baseline and closely monitored during their first year of treatment with remission at one-year follow-up as the primary outcome parameter. In addition to a large test battery of potential confounders, specific attention is paid to cognitive functioning (including computerized tests with the Cogstate test battery as well as paper and pencil tests) and physical functioning (including multimorbidity, polypharmacy, and different frailty indicators). The study is designed as an ongoing project, enabling minor adaptations once a year (change of instruments). DISCUSSION Although effectiveness studies using observational data can easily be biased, potential selection bias can be quantified and potentially corrected (e.g. by propensity scoring). Knowledge of age-related determinants of treatment effectiveness, may stimulate the development of new interventions. Moreover, studying late-life depressive, anxiety and somatic symptom disorders jointly enables data-driven studies for more optimal classification of these disorders in later life. TRIAL REGISTRATION Dutch Trial Register: NL6704 ( www.trialregister.nl ). Retrospectively registered on 2017-12-05.
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Affiliation(s)
- Richard C. Oude Voshaar
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ton D. F. Dhondt
- Mental Health Center GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Mario Fluiter
- Mental Health Center GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Paul Naarding
- GGNet Mental Health, Division of Old Age Psychiatry, Warnsveld & Apeldoorn, The Netherlands
| | - Sanne Wassink
- GGNet Mental Health, Division of Old Age Psychiatry, Warnsveld & Apeldoorn, The Netherlands
| | - Maureen M. J. Smeets
- 0000 0004 0468 1456grid.491215.aMental Health Center GGZ Centraal, Ermelo, The Netherlands
| | - Loeki P. R. M. Pelzers
- 0000 0004 0468 1456grid.491215.aMental Health Center GGZ Centraal, Ermelo, The Netherlands
| | - Astrid Lugtenburg
- 0000 0004 0465 6592grid.468637.8Mental Health Center GGZ Drenthe, Assen, The Netherlands
| | - Martine Veenstra
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,0000 0004 0465 6592grid.468637.8Mental Health Center GGZ Drenthe, Assen, The Netherlands
| | - Radboud M. Marijnissen
- 0000 0004 0466 1666grid.491369.0Mental health Center Pro Persona, Arnhem/Nijmegen, The Netherlands
| | - Gert-Jan Hendriks
- 0000 0004 0466 1666grid.491369.0Mental health Center Pro Persona, Arnhem/Nijmegen, The Netherlands
| | | | - Robert A. Schoevers
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob H. S. van den Brink
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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Shi L, Li YJ, Dai GC, Lin YC, Li G, Wang C, Chen H, Rui YF. Impaired function of tendon-derived stem cells in experimental diabetes mellitus rat tendons: implications for cellular mechanism of diabetic tendon disorder. Stem Cell Res Ther 2019; 10:27. [PMID: 30646947 PMCID: PMC6332703 DOI: 10.1186/s13287-018-1108-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 12/20/2022] Open
Abstract
Background Patients with diabetes mellitus (DM) often suffered with many musculoskeletal disorders, such as tendon rupture and tendinopathy. However, the understanding of the pathogenesis of these alternations is limited. This study was designed to investigate the role of tendon-derived stem cells (TDSCs) in histopathological alterations of DM tendons. Methods Forty-two SD rats were randomly and equally divided into a diabetes group (DG) and control group (CG). DM was induced by streptozotocin (65 mg/kg). The patellar tendons were isolated at weeks 1, 2, and 4 for histological analysis. TDSCs were isolated at week 2 for osteo-chondrogenic differentiation analysis. Mann-Whitney U test was used with SPSS. p < 0.050 was statistically significant. Results Micro-tears of collagen fibers and altered appearance of tendon cells were observed in DG tendons. DG tendons exhibited significantly higher expression of OPN, OCN, SOX9, and Col II and decreased expression of Col I and tenomodulin (TNMD) at week 2. Diabetic TDSCs (dTDSCs) demonstrated significantly decreased proliferation ability and increased osteogenic and chondrogenic differentiation ability. Osteo-chondrogenic markers BMP2, ALP, OPN, OCN, Col II, and SOX9 were also significantly increased while tenogenic markers Col I and TNMD were decreased in dTDSCs. Conclusion These results suggested the erroneous differentiation of dTDSCs might account for the structural and non-tenogenic alternations in DM tendons, which provided new cues for the pathogenesis of tendon disorders in DM. Electronic supplementary material The online version of this article (10.1186/s13287-018-1108-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China
| | - Ying-Juan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, 87 Ding Jia Qiao, Nanjing, 210009, People's Republic of China
| | - Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China
| | - Yu-Cheng Lin
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China
| | - Gang Li
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chen Wang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Department of Orthopaedics, Xishan People's Hospital, 588 Guang Rui Road, Wuxi, 214011, Jiangsu, People's Republic of China
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China. .,Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China. .,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China. .,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China. .,School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China. .,Department of Orthopaedics, Xishan People's Hospital, 588 Guang Rui Road, Wuxi, 214011, Jiangsu, People's Republic of China. .,China Orthopedic Regenerative Medicine Group, Hangzhou, 310000, Zhejiang, People's Republic of China.
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20
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Kuiper D, Hoek A, la Bastide-van Gemert S, Seggers J, Mulder DJ, Haadsma M, Heineman MJ, Hadders-Algra M. Cardiovascular health of 9-year-old IVF offspring: no association with ovarian hyperstimulation and the in vitro procedure. Hum Reprod 2018; 32:2540-2548. [PMID: 29087467 DOI: 10.1093/humrep/dex323] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/03/2017] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Are the in vitro procedure, ovarian hyperstimulation or a combination of these two associated with blood pressure (BP) of 9-year-old IVF children born to subfertile couples? SUMMARY ANSWER Our study demonstrates that ovarian hyperstimulation and the in vitro procedure are not associated with BP values in 9-year-old children born to subfertile couples. WHAT IS KNOWN ALREADY Possible long-term effects of IVF on child health and development have been studied relatively little. This is surprising, as it is known that environmental conditions may influence embryonic and foetal development which may result in health related problems in later life. Some studies suggested that IVF is associated with higher BP at pre-school age. Yet, it is unclear whether this may be also true for older children and if so, which component of IVF, i.e. the ovarian hyperstimulation, the embryo culture or a combination of these, attributes to this potentially less favourable BP. STUDY DESIGN, SIZE, DURATION The Groningen Assisted Reproductive Technology cohort-study is a prospective assessor-blinded study of children followed from before birth onwards. In total, 170 children were assessed at the age of 9 years. The attrition rate up until the 9-year-old assessment was 21%. PARTICIPANTS/MATERIALS, SETTING, METHODS We evaluated cardiovascular health, focusing on BP (in mmHg and the internationally recognized percentiles of the US National High BP Education Program), heart rate and anthropometrics of 57 children born following controlled ovarian hyperstimulation-IVF/ICSI (COH-IVF/ICSI); 47 children born after modified natural cycle-IVF/ICSI (MNC-IVF/ICSI); and 66 children who were conceived naturally by subfertile couples (Sub-NC). Cardiovascular parameters were measured multiple times on one day. In addition, anthropometric data, including BMI and skinfold thickness, were collected. MAIN RESULTS AND THE ROLE OF CHANCE Systolic BP in mmHg did not differ between the COH-IVF/ICSI (mean 106.9, SD 6.7), MNC-IVF/ICSI (mean 104.8, SD 5.9) and Sub-NC (mean 106.3, SD 5.3) groups. In addition, systolic BP percentiles did not differ between the groups: COH-IVF/ICSI (mean 62.4, SD 20.2); MNC-IVF/ICSI (mean 56.3, SD 19.3); and Sub-NC (mean 62.3, SD17.8). Also, after adjustment for confounders BP in the three groups was similar. Heart rate and anthropometric values in the three groups did not differ. For instance, BMI values in the COH-IVF/ICSI-children were 16.3 (median value, range 13.0-24.7), in MNC-IVF/ICSI-children 16.1 (range 12.7-22.5) and in Sub-NC children 16.3 (range 12.7-24.0). LIMITATIONS, REASONS FOR CAUTION The size of our study groups does not allow for pertinent conclusions on the effect of ovarian hyperstimulation and the in vitro procedure. The lack of a fertile control group may be regarded as another limitation. WIDER IMPLICATIONS OF THE FINDINGS Our study suggests that ovarian hyperstimulation and in vitro procedures are not associated with cardiovascular health in 9-year-old. Yet, BP percentiles of the three groups were higher than the expected 50th percentile. This might indicate that children of subfertile couples have a higher BP than naturally conceived children. STUDY FUNDING/COMPETING INTEREST(S) The study was financially supported by the University Medical Center Groningen (UMCG), the two graduate schools of the UMCG, BCN, SHARE and the Cornelia Stichting. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The authors have no conflicts of interest to declare.
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Affiliation(s)
- Derk Kuiper
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division Developmental Neurology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Annemieke Hoek
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynaecology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Sacha la Bastide-van Gemert
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Jorien Seggers
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division Developmental Neurology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Douwe J Mulder
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Vascular Medicine, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Maaike Haadsma
- University of Groningen, University Medical Center Groningen, Department of Genetics, Division of Clinical Genetics, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Maas Jan Heineman
- University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam AZ 1105, The Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division Developmental Neurology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
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Skin Autofluorescence, as a Measure of AGE Accumulation in Individuals Suffering from Chronic Plaque Psoriasis. Mediators Inflamm 2018; 2018:4016939. [PMID: 30363704 PMCID: PMC6180958 DOI: 10.1155/2018/4016939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/26/2018] [Indexed: 02/08/2023] Open
Abstract
Background Psoriasis is currently regarded as a chronic systemic inflammatory disease associated with increased cardiovascular risk. Advanced glycation end products (AGEs) contribute to the development of atherosclerosis. Objectives The aim of the study was the assessment of skin autofluorescence (SAF), as a measure of AGE accumulation, in individuals suffering from chronic plaque psoriasis without any comorbid conditions. Methods A study group consisted of 70 patients with chronic plaque psoriasis without any comorbid conditions and 59 healthy controls, matched by age and gender. AGE accumulation was assessed by SAF (AGE Reader, DiagnOptics BV) which is a validated and noninvasive technique. Relations between SAF and some clinical and laboratory data were assessed. Results SAF was positively correlated with age both in patients with psoriasis and controls (R = 0.722, p < 0.00001 and R = 0.613, p < 0.00001, respectively). There was significantly increased SAF in patients with psoriasis with elevated levels of C-reactive protein (CRP) and increased erythrocyte sedimentation rate (ESR) compared to controls (p < 0.00001; p < 0.00001, respectively, after adjustment to age). Increased SAF was found in psoriatic patients with prediabetes (HbA1c 5.7–6.4%) compared to controls (p < 0.0012, after adjustment to age). Conclusion Systemic inflammation (increased CRP level), prediabetes, and aging may influence enhanced AGE accumulation in patients with psoriasis without any comorbidities. SAF may be considered as a useful, noninvasive method to identify patients with psoriasis at increased cardiovascular risk.
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Advanced glycation end products (AGEs) estimated by skin autofluorescence are related with cardiovascular risk in renal transplant. PLoS One 2018; 13:e0201118. [PMID: 30067789 PMCID: PMC6070236 DOI: 10.1371/journal.pone.0201118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Advanced glycation end products (AGEs) accumulation, a measure of cumulative metabolic stress, constitute a novel pathogenic mechanism involved in aging, diabetes, cardiovascular (CVD) and chronic kidney disease (CKD). Despite removal of uremic toxins and AGEs after a successful renal transplant (RT), CVD remains the leading cause of mortality. We hypothesized that AGEs measurement by Skin Autofluorescence (SAF) might be useful even after a successful RT and thus reflect the high cardiovascular risk burden of these patients. Methods 189 stable RT (61% men, aged 56±13.0 years), CKD stages 1–4 and >12 months since RT were enrolled. Variables collected comprised comorbid history, medication use, smoking habit, routine biochemistry, subclinical atheromatosis by ankle-brachial-index (ABI) and allograft resistivity index (RI), 24-h ABPM, anthropometry and handgrip strength. AGEs were measured by SAF and expressed in arbitrary units (AU). Vascular age was estimated by Koetsier´s formula (SAF-0.83/0.024) and expected 10-years cardiovascular death risk was calculated with the REGICOR score. Results Mean SAF was 3.00±0.83 AU and estimated vascular age 90±34.7 years (30 years above biological age). SAF was higher among men (3.10±0.91 vs 2.81±0.66), diabetic nephropathy (3.49±0.75 vs 2.96±0.83) and steroid users (3.14±0.86 vs 2.71±0.69). We observed a positive correlation of SAF with night-systolic blood pressure (r = 0.25, p = 0.001), parathormone (r = 0.20, p<0.01), phosphate (r = 0.28, p<0.001) and negative with hemoglobin (r = -0.29, p<0.001), CKD-EPI (r = -0.32, p<0.001), albumin (r = -0.17, p<0.05), and dynamometry (r = -0.20, p<0.01). Subclinical vascular atheromatosis (ABI and RI) as well as the REGICOR scale (r = 0.35 p<0.001) were also correlated with SAF. In multivariable analysis age, gender, steroid use, serum phosphate and handgrip strength remained independently associated with SAF. Conclusions SAF levels are elevated in RT patients and correlate with CVD risk. Besides age and male sex, our results suggest that phosphate overload, steroid use and nutritional status are important factors linking to AGEs accumulation.
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Lilje C, Cronan JC, Schwartzenburg EJ, Owers EM, Clesi P, Gomez R, Stender S, Hempe J, Chalew SA, Cardinale JP. Intima-media thickness at different arterial segments in pediatric type 1 diabetes patients and its relationship with advanced glycation end products. Pediatr Diabetes 2018; 19:450-456. [PMID: 28664608 DOI: 10.1111/pedi.12557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/09/2017] [Accepted: 06/06/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with type 1 diabetes mellitus (T1DM) are at risk for premature atherosclerosis (AS), which has its origin in childhood. Carotid intima-media thickness (IMT) is an established surrogate marker for subclinical AS in adults. The first macroscopically detectable AS changes, however, begin in the abdominal aorta. Advanced glycation end products (AGE) predict microvascular complications in diabetes. OBJECTIVES To assess the sensitivity for early macrovascular changes of brachial, femoral, and aortic IMT compared to conventional carotid IMT in pediatric T1DM patients ; and the relationship of IMT with AGE. METHODS Using high-resolution external ultrasound, carotid, brachial, femoral, and aortic IMT were prospectively analyzed in children and adolescents with established T1DM and in controls (Ctrls). AGE were estimated by skin intrinsic fluorescence (SIF). Other established cardiovascular risk factors were excluded. RESULTS Seventy-six subjects (T1DM = 38; Ctrls = 38) with a mean age of 13.1 ± 4.0 years (6-19, median 13) qualified for analysis. Carotid, brachial, femoral, and aortic IMT analyses were feasible in 100%, 74%, 84%, and 92% of subjects, respectively. Aortic and femoral IMT were increased in T1DM patients (0.60 ± 0.11 vs 0.52 ± 0.10 mm, P < .001; and 0.41 ± 0.07 vs 0.36 ± 0.07 mm, P < .01, respectively) while carotid and brachial IMT were not. AGE levels were elevated in T1DM patients and correlated with aortic IMT only. The influence of AGE on aIMT did not remain significant after adjusting for T1DM and age in our small population. CONCLUSION We found aortic IMT-and to a lesser degree femoral IMT-to be more sensitive than carotid and brachial IMT for detecting early macrovascular changes in pediatric T1DM patients.
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Affiliation(s)
- Christian Lilje
- Department of Pediatrics (Cardiology), Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
| | - Julie C Cronan
- School of Medicine, Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
| | - Elridge J Schwartzenburg
- School of Medicine, Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
| | - Elizabeth M Owers
- School of Medicine, Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
| | - Patrice Clesi
- Clinical Trials Center, Children's Hospital, New Orleans, Louisiana
| | - Ricardo Gomez
- Department of Pediatrics (Endocrinology), Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
| | - Sarah Stender
- Department of Pediatrics (Endocrinology), Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
| | - James Hempe
- Department of Pediatrics (Endocrinology), Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
| | - Stuart A Chalew
- Department of Pediatrics (Endocrinology), Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
| | - Jeffrey P Cardinale
- School of Medicine, Louisiana State University Health Sciences Center, Children's Hospital, New Orleans, Louisiana
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Isami F, West BJ, Nakajima S, Yamagishi SI. Association of advanced glycation end products, evaluated by skin autofluorescence, with lifestyle habits in a general Japanese population. J Int Med Res 2018; 46:1043-1051. [PMID: 29322837 PMCID: PMC5972252 DOI: 10.1177/0300060517736914] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective Accumulation of advanced glycation end products (AGEs) occurs during normal aging but markedly accelerates in people with diabetes. AGEs may play a role in various age-related disorders. Several studies have demonstrated that skin autofluorescence (SAF) reflects accumulated tissue levels of AGEs. However, very few studies have investigated SAF in the general population. The purpose of the present study was to more thoroughly evaluate the potential association among SAF, chronological age, and lifestyle habits in the general population. Methods A large cross-sectional survey of 10,946 Japanese volunteers aged 20 to 79 years was conducted. Volunteers completed a self-administered questionnaire and underwent SAF measurement on their dominant forearms. The associations of SAF with age and lifestyle habits were analyzed using a multiple stepwise regression analysis. Results Age was independently correlated with SAF. Lifestyle habits such as physical activity, nonsmoking, adequate sleep, low mental stress level, eating breakfast, and abstaining from sugary food were each independently associated with lower SAF. Conclusions SAF was associated with age and healthy lifestyle habits in this general Japanese population. The present study suggests that SAF measurement is a convenient tool for evaluating habitual lifestyle behaviors and may have potential for preventative health education.
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Affiliation(s)
| | - Brett J West
- 2 Research and Development, Morinda Inc., American Fork, UT, USA
| | - Sanae Nakajima
- 3 Department of Language and Literature, Kyoritsu Women's Junior College, Tokyo, Japan
| | - Sho-Ichi Yamagishi
- 4 Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications, Kurume University School of Medicine, Kurume, Japan
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25
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Fokkens BT, van Waateringe RP, Mulder DJ, Wolffenbuttel BHR, Smit AJ. Skin autofluorescence improves the Finnish Diabetes Risk Score in the detection of diabetes in a large population-based cohort: The LifeLines Cohort Study. DIABETES & METABOLISM 2017; 44:424-430. [PMID: 29097003 DOI: 10.1016/j.diabet.2017.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 12/15/2022]
Abstract
AIM The aim of the present study was to investigate whether skin autofluorescence would improve the Finnish Diabetes Risk Score (FINDRISC) in detecting undiagnosed diabetes in a large population-based cohort. METHODS Included were participants from the Dutch LifeLines Cohort Study. Skin autofluorescence was assessed in an unselected subset of participants using the AGE Reader. After the exclusion of participants with previously diagnosed diabetes (n=1635), pregnant women (n=58) and those using corticosteroids (n=345), 79,248 subjects were eligible for analysis. Diabetes was defined as fasting plasma glucose ≥7.0mmol/L, non-fasting plasma glucose ≥11.1mmol/L or HbA1c ≥6.5% (48mmol/mol). RESULTS Diabetes was detected in 1042 participants (aged 55±12 years; 54% male). Skin autofluorescence improved the area under the receiver operating characteristic (AUROC) curve of the FINDRISC model from 0.802 to 0.811 (P<0.001). Furthermore, the addition of skin autofluorescence to FINDRISC reclassified 8-15% of all participants into more accurate risk categories (NRI: 0.080, 95% CI: 0.052-0.110). The proportion of reclassified participants was especially high (>30%) in the intermediate (1% to <5% and 5% to<10%) risk categories. When skin autofluorescence was added to a simplified model (age+body mass index), its discriminatory performance was similar to the full model+skin autofluorescence (AUROC: 0.806, P=0.062). CONCLUSION Skin autofluorescence is a non-invasive tool that can be used to further improve the FINDRISC for diabetes detection. The new resultant model is especially useful for reclassifying people in the intermediate-risk categories, where additional blood glucose testing is needed to confirm the presence of diabetes.
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Affiliation(s)
- B T Fokkens
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ Groningen, Netherlands.
| | - R P van Waateringe
- Department of Endocrinology, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - D J Mulder
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - B H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - A J Smit
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ Groningen, Netherlands
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Kellow NJ, Coughlan MT, Reid CM. Association between habitual dietary and lifestyle behaviours and skin autofluorescence (SAF), a marker of tissue accumulation of advanced glycation endproducts (AGEs), in healthy adults. Eur J Nutr 2017; 57:2209-2216. [DOI: 10.1007/s00394-017-1495-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 06/25/2017] [Indexed: 01/11/2023]
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Federico G, Gori M, Randazzo E, Vierucci F. Skin advanced glycation end-products evaluation in infants according to the type of feeding and mother's smoking habits. SAGE Open Med 2016; 4:2050312116682126. [PMID: 28210490 PMCID: PMC5302171 DOI: 10.1177/2050312116682126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/20/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study was conducted to assess whether formula-fed infants had increased skin advanced glycation end-products compared with breastfed ones. We also evaluated the effect of maternal smoke during pregnancy and lactation on infant skin advanced glycation end-products accumulation. METHODS Advanced glycation end-product-linked skin autofluorescence was measured in 101 infants. RESULTS In infants born from non-smoking mothers, advanced glycation end-products were higher in formula-fed subjects than in breastfed subjects (0.80 (0.65-0.90) vs 1.00 (0.85-1.05), p < 0.001). Advanced glycation end-products in breastfed infants from smoking mothers were higher than in those from non-smoking mothers (0.80 (0.65-0.90) vs 1.00 (0.90-1.17), p = 0.009). CONCLUSION Formula-fed infants had increased amounts of advanced glycation end-products compared with the breastfed ones, confirming that breast milk represents the best food for infants. Breastfed infants from mothers smoking during pregnancy and lactation had increased skin advanced glycation end-products, suggesting that smoke-related advanced glycation end-products transfer throughout breast milk. Moreover, advanced glycation end-products may already increase during gestation, possibly affecting fetal development. Thus, we reinforced that smoking must be stopped during pregnancy and lactation.
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Affiliation(s)
- Giovanni Federico
- Unit of Pediatric Endocrinology & Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Gori
- Unit of Pediatric Endocrinology & Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emioli Randazzo
- Unit of Pediatric Endocrinology & Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Schutte E, de Vos LC, Lutgers HL, Lambers Heerspink HJ, Wolffenbuttel BH, Vart P, Zeebregts CJ, Gansevoort RT, Lefrandt JD. Association of Skin Autofluorescence Levels With Kidney Function Decline in Patients With Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2016; 36:1709-14. [DOI: 10.1161/atvbaha.116.307771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022]
Abstract
Objective—
Skin autofluorescence (SAF), a measure of advanced glycation end product accumulation, is associated with kidney function. We investigated the association of SAF with rate of kidney function decline in a cohort of patients with peripheral artery disease.
Approach and Results—
We performed a post hoc analysis of an observational longitudinal cohort study. We included 471 patients with peripheral artery disease, and SAF was measured at baseline. Primary end point was rate of estimated glomerular filtration rate (eGFR) decline. Secondary end points were incidence of eGFR <60 and <45 mL/min/1.73 m
2
and rapid eGFR decline, defined as a decrease in eGFR of >5 mL/min/1.73 m
2
/y. During a median follow-up of 3 years, the mean change in eGFR per year was −1.8±4.4 mL/min/1.73 m
2
/y. No significant difference in rate of eGFR decline was observed per 1 arbitrary unit increase in SAF (−0.1 mL/min/1.73 m
2
/y; 95% confidence interval, −0.7 to 0.5;
P
=0.8). Analyses of the secondary end points showed that there was an association of SAF with incidence of eGFR <60 and <45 mL/min/1.73 m
2
(hazard ratio, 1.54; 95% confidence interval, 1.13–2.10;
P
=0.006 and hazard ratio, 1.76; 95% confidence interval, 1.20–2.59;
P
=0.004, respectively), but after adjustment for age and sex, significance was lost. There was no association of SAF with rapid eGFR decline.
Conclusions—
In conclusion, in this cohort of patients with peripheral artery disease, elevated SAF was associated with lower baseline eGFR. Although SAF has previously been established as a predictor for cardiovascular disease and mortality, it did not predict the rate of kidney function decline during follow-up in this study.
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Affiliation(s)
- Elise Schutte
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisanne C. de Vos
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Helen L. Lutgers
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hiddo J. Lambers Heerspink
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bruce H.R. Wolffenbuttel
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Priya Vart
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J. Zeebregts
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T. Gansevoort
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joop D. Lefrandt
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Fokkens BT, Smit AJ. Skin fluorescence as a clinical tool for non-invasive assessment of advanced glycation and long-term complications of diabetes. Glycoconj J 2016; 33:527-35. [PMID: 27287226 PMCID: PMC4975757 DOI: 10.1007/s10719-016-9683-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
Glycation is important in the development of complications of diabetes mellitus and may have a central role in the well-described glycaemic memory effect in developing these complications. Skin fluorescence has emerged over the last decade as a non-invasive method for assessing accumulation of advanced glycation endproducts. Skin fluorescence is independently related to micro- and macrovascular complications in both type 1 and type 2 diabetes mellitus and is associated with mortality in type 2 diabetes. The relation between skin fluorescence and cardiovascular disease also extends to other conditions with increased tissue AGE levels, such as renal failure. Besides cardiovascular complications, skin fluorescence has been associated, more recently, with other prevalent conditions in diabetes, such as brain atrophy and depression. Furthermore, skin fluorescence is related to past long-term glycaemic control and clinical markers of cardiovascular disease. This review will discuss the technique of skin fluorescence, its validation as a marker of tissue AGE accumulation, and its use as a clinical tool for the prediction of long-term complications in diabetes mellitus.
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Affiliation(s)
- Bernardina T Fokkens
- Department of Internal Medicine, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ, Groningen, the Netherlands. .,Research Institute GUIDE, Graduate School of Medical Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
| | - Andries J Smit
- Department of Internal Medicine, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.,Research Institute GUIDE, Graduate School of Medical Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
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Renart I. La mano diabética. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2015. [DOI: 10.1016/j.ricma.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
La diabetes es una de las enfermedades con mayor prevalencia y repercusión sociosanitaria, no solo por su elevada frecuencia, sino también por el impacto de las complicaciones crónicas de la enfermedad y el papel que desempeña como factor de riesgo en la afección cardiovascular. Sin embargo, la diabetes también puede involucrar al sistema musculoesquelético y a los tejidos blandos de forma muy diversa, siendo la mano una de las regiones más afectadas. De hecho, se estima que el 40% de los pacientes diabéticos tienen problemas significativos de la mano que requieren una atención médica.En el presente artículo se revisan las principales enfermedades de la mano que van asociadas a la diabetes, haciendo especial hincapié en el tratamiento y el pronóstico de cada una de ellas.
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Hofmann B, Jacobs K, Navarrete Santos A, Wienke A, Silber R, Simm A. Relationship between cardiac tissue glycation and skin autofluorescence in patients with coronary artery disease. DIABETES & METABOLISM 2015; 41:410-5. [DOI: 10.1016/j.diabet.2014.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 11/27/2014] [Accepted: 12/02/2014] [Indexed: 12/22/2022]
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Shi L, Rui YF, Li G, Wang C. Alterations of tendons in diabetes mellitus: what are the current findings? INTERNATIONAL ORTHOPAEDICS 2015; 39:1465-73. [PMID: 25944078 DOI: 10.1007/s00264-015-2775-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/23/2015] [Indexed: 12/13/2022]
Abstract
As a connective tissue, tendon connects the muscle and bone, and plays the key role in the locomotor system. Some previous studies have shown the pathological alternations in diabetic tendons, which might result in the structural and functional changes, and even accelerate the process of diabetic foot. In this review, we examined the current findings of the diabetic tendons in the form of various aspects, and summarized the clinical presentation, imaging, biomechanical, histopathological, cellular and molecular abnormalities in the diabetic tendons. The progress of diabetic tendon damage is complicated and the main hypotheses include the excessive accumulation of AGEs, the altered inflammatory response, neovascularization and insensitive neuropathy. However, the cellular and molecular mechanisms of these alterations are still ambiguous. Tendon stem/progenitor cells (TSPCs) have been discovered to play important roles in both tendon physiology and tendon pathology. Recently, we identified TSPCs from patellar tendons in our well-established diabetic rat model and found impaired tenogenic differentiation potential of these cells. We proposed a new hypothesis that the impaired cell functions of diabetic TSPCs might be the underlying cellular and molecular mechanism of the diabetic tendon alternations. These findings should be helpful to establish a better therapeutic strategy for diabetic tendon repair and regeneration.
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Affiliation(s)
- Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China
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Hanssen NMJ, Russell N, Cooper ME. Recent advances in glucose-lowering treatment to reduce diabetic kidney disease. Expert Opin Pharmacother 2015; 16:1325-33. [PMID: 25912195 DOI: 10.1517/14656566.2015.1041502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The epidemic of diabetes has now taken on epic proportions and therefore reducing the impact of diabetic complications represents one of the major global challenges in improving health and well-being worldwide. Preventing the development of diabetic kidney disease (DKD) is particularly important, as diabetes is one of the main risk factors for the development of chronic kidney disease, which in turn is strongly linked to development of cardiovascular disease, end-stage renal failure, hospitalization and premature death. Intensive glucose-lowering treatment has been shown to prevent and slow progression of DKD, yet to date, only certain populations have benefited from this intervention. AREAS COVERED We review the evidence for existing glucose-lowering treatments in the prevention of DKD, and research into techniques to better target individuals who will benefit from these therapies. EXPERT OPINION Diabetic patients with established kidney disease may benefit from glucose-lowering treatment, particularly if a safer side-effect profile of these treatments is achieved. Better understanding of glucose homeostasis and evaluation of compounds inhibiting its downstream effects are required in order to improve the outlook for individuals with DKD. An additional approach to improve the success rate of glucose-lowering treatment is to improve the selection of individuals who may benefit from treatment. A potential means to identify such subjects could involve the use of biomarkers.
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Affiliation(s)
- Nordin M J Hanssen
- Maastricht University, CARIM School of Cardiovascular Diseases, Department of Internal Medicine , Maastricht , The Netherlands
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Gugliucci A, Menini T. The axis AGE-RAGE-soluble RAGE and oxidative stress in chronic kidney disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 824:191-208. [PMID: 25039001 DOI: 10.1007/978-3-319-07320-0_14] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic kidney disease (CKD) has been shown to be associated with high oxidative stress and cardiovascular disease. In this chapter our focus will be on the role of advanced glycation end products (AGE) and their receptor, RAGE in CKD progression and their role on cardiovascular complications. We provide a succinct, yet comprehensive summary of the current knowledge, the challenges and the future therapeutic avenues that are stemming out from novel recent findings. We first briefly review glycation and AGE formation and the role of the kidney in their metabolism. Next, we focus on the RAGE, its signaling and role in oxidative stress. We address the possible role of soluble RAGEs as decoys and the controversy regarding this issue. We then provide the latest information on the specific role of both AGE and RAGE in inflammation and perpetuation of kidney damage in diabetes and in CKD without diabetes, which is the main purpose of the review. Finally, we offer an update on new avenues to target the AGE-RAGE axis in CKD.
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Affiliation(s)
- Alejandro Gugliucci
- Glycation, Oxidation and Disease Laboratory, Department of Research, College of Osteopathic Medicine, Touro University-California, 1310 Club Drive, 94592, Vallejo, CA, USA,
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Stirban A, Heinemann L. Skin Autofluorescence - A Non-invasive Measurement for Assessing Cardiovascular Risk and Risk of Diabetes. EUROPEAN ENDOCRINOLOGY 2014; 10:106-110. [PMID: 29872473 DOI: 10.17925/ee.2014.10.02.106] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/28/2014] [Indexed: 01/13/2023]
Abstract
The results of the Diabetes Control and Complications Trial-Epidemiology of Diabetes Interventions and Complications (DCCT-EDIC) study have strengthened the 'glycaemic memory' concept, postulating that the quality of metabolic control over several years predicts the development of diabetic complications. To mirror long-term metabolic control, the degree of glycated haemoglobin (HbA1c) might not represent the optimal biomarker. Other substances with a longer persistence, like the so-called advanced glycation end-products (AGEs), which probably form the substrate of the glycaemic memory, might perform better. Newly developed methods such as the assessment of skin autofluorescence (SAF), enable fast, uncomplicated and non-invasive AGEs assessment. SAF was validated for diabetes screening and shows a good predictive value for the development of diabetic and cardiovascular complications. This article deals with the theoretical background and with available clinical data on this new variable.
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Affiliation(s)
- Alin Stirban
- Director Endocrinology and Diabetes Complications
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Wang AYM, Wong CK, Yau YY, Wong S, Chan IHS, Lam CWK. Skin Autofluorescence Associates With Vascular Calcification in Chronic Kidney Disease. Arterioscler Thromb Vasc Biol 2014; 34:1784-90. [PMID: 24876353 DOI: 10.1161/atvbaha.114.303378] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Angela Yee-Moon Wang
- From the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (A.Y.-M.W., S.W.); Department of Chemical Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (C.-K.W.); Biomedical Imaging Center, Central, Hong Kong, China (Y.-Y.Y.); Department of Pathology, United Christian Hospital, Hong Kong, China (I.H.-S.C.); and Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Chun-Kwok Wong
- From the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (A.Y.-M.W., S.W.); Department of Chemical Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (C.-K.W.); Biomedical Imaging Center, Central, Hong Kong, China (Y.-Y.Y.); Department of Pathology, United Christian Hospital, Hong Kong, China (I.H.-S.C.); and Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Yat-Yin Yau
- From the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (A.Y.-M.W., S.W.); Department of Chemical Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (C.-K.W.); Biomedical Imaging Center, Central, Hong Kong, China (Y.-Y.Y.); Department of Pathology, United Christian Hospital, Hong Kong, China (I.H.-S.C.); and Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Sharon Wong
- From the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (A.Y.-M.W., S.W.); Department of Chemical Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (C.-K.W.); Biomedical Imaging Center, Central, Hong Kong, China (Y.-Y.Y.); Department of Pathology, United Christian Hospital, Hong Kong, China (I.H.-S.C.); and Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Iris Hiu-Shuen Chan
- From the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (A.Y.-M.W., S.W.); Department of Chemical Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (C.-K.W.); Biomedical Imaging Center, Central, Hong Kong, China (Y.-Y.Y.); Department of Pathology, United Christian Hospital, Hong Kong, China (I.H.-S.C.); and Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Christopher Wai-Kei Lam
- From the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (A.Y.-M.W., S.W.); Department of Chemical Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (C.-K.W.); Biomedical Imaging Center, Central, Hong Kong, China (Y.-Y.Y.); Department of Pathology, United Christian Hospital, Hong Kong, China (I.H.-S.C.); and Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
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Simon Klenovics K, Kollárová R, Hodosy J, Celec P, Sebeková K. Reference values of skin autofluorescence as an estimation of tissue accumulation of advanced glycation end products in a general Slovak population. Diabet Med 2014; 31:581-5. [PMID: 24111899 DOI: 10.1111/dme.12326] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/21/2013] [Accepted: 09/19/2013] [Indexed: 01/11/2023]
Abstract
AIMS For decades, Slovakia has maintained a prominent place in mortality rates from cardiovascular diseases among European Union (EU-27) countries. Determination of skin autofluorescence serves as an estimate of tissue accumulation of advanced glycation end products--substances accumulating in tissues and body fluids that play a pathophysiological role in age-related diseases and their complications, such as diabetes. METHODS In 1385 apparently healthy Slovakian subjects aged from a few days old to 77 years, skin autofluorescence was determined using an advanced glycation end product reader and compared with reference data from Dutch Caucasians. The impact of the weekly frequency of recreational physical exercise on skin autofluorescence was investigated in the adults, and the impact of feeding regimen in the infants. RESULTS With the exception of 10- to 19-year-olds, Slovaks had lower skin autofluorescence values in comparison with the Dutch Caucasians. In healthy non-smokers, physical exercise for > 30 min/day performed ≥ 3 times/week was associated with lower skin autofluorescence levels. In infants, breastfeeding (advanced glycation end product-poor diet) was associated with lower skin autofluorescence levels in comparison with consumption of infant formulas (advanced glycation end product-rich diet). CONCLUSIONS Reference ranges of skin autofluorescence in Slovak Caucasians, detailed for paediatric age groups, are provided. Our data show that, in healthy adults, regular physical exercise associates with lower skin autofluorescence. Infants fed or weaned from infant formulas (advanced glycation end product-rich diet) have higher skin autofluorescence than their breast milk-consuming counterparts. It is unclear why Slovaks have lower skin autofluorescence compared with a Dutch population with lower cardiovascular mortality rates. Reference data on skin autofluorescence from diverse populations are needed for the precise clinical interpretation of skin autofluorescence measurements.
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Affiliation(s)
- K Simon Klenovics
- Institute of Physiology, Comenius University Medical Faculty, Bratislava, Slovakia
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de Vos LC, Mulder DJ, Smit AJ, Dullaart RPF, Kleefstra N, Lijfering WM, Kamphuisen PW, Zeebregts CJ, Lefrandt JD. Skin autofluorescence is associated with 5-year mortality and cardiovascular events in patients with peripheral artery disease. Arterioscler Thromb Vasc Biol 2014; 34:933-8. [PMID: 24526694 DOI: 10.1161/atvbaha.113.302731] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Advanced glycation end products play a pivotal role in atherosclerosis. Recently, we showed that tissue advanced glycation end products deposition, noninvasively assessed by skin autofluorescence (SAF), is increased in patients with peripheral artery disease. The aim of the present study was to establish whether SAF is associated with all-cause mortality and with fatal or nonfatal major adverse cardiovascular events (MACE) in patients with peripheral artery disease. APPROACH AND RESULTS We performed a single-center prospective cohort study of 252 patients with peripheral artery disease (mean age, 66±11 years), recruited from the outpatient clinic (October 2007 to June 2008) who were followed until June 2013. SAF was measured with the AGE Reader. The primary end point was all-cause mortality, and the secondary end point was fatal or nonfatal MACE, defined as cardiovascular death and nonfatal myocardial infarction or stroke. During a median follow-up of 5.1 (interquartile range, 5.0-5.3) years, 62 (25%) patients died. Fatal or nonfatal MACE occurred in 62 (25%) patients. A higher SAF was associated with increased risk for all-cause mortality (hazard ratio per unit increase, 2.01; 95% confidence interval, 1.40-2.88; P=0.0002) and fatal or nonfatal MACE (hazard ratio, 1.82; 95% confidence interval, 1.28-2.60; P=0.001), also after adjustment for cardiovascular risk factors and the use of lipid-lowering drugs (hazard ratio, 1.63; 95% confidence interval, 1.13-2.34; P=0.009 and hazard ratio, 1.50; 95% confidence interval, 1.04-2.17; P=0.03, for all-cause mortality and fatal and nonfatal MACE, respectively). CONCLUSIONS SAF as a measure of advanced glycation end products deposition is independently associated with all-cause mortality and fatal or nonfatal MACE in patients with peripheral artery disease after a 5-year follow-up.
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Affiliation(s)
- Lisanne C de Vos
- From the Department of Internal Medicine, Division of Vascular Medicine (L.C.d.V., D.J.M., A.J.S., P.W.K., J.D.L.), Division of Endocrinology (R.P.F.D.), and Department of Surgery, Division of Vascular Medicine (C.J.Z.), The Diabetes Centre, Isala, Zwolle (N.K.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands (W.M.L.)
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den Dekker MAM, Zwiers M, van den Heuvel ER, de Vos LC, Smit AJ, Zeebregts CJ, Oudkerk M, Vliegenthart R, Lefrandt JD, Mulder DJ. Skin autofluorescence, a non-invasive marker for AGE accumulation, is associated with the degree of atherosclerosis. PLoS One 2013; 8:e83084. [PMID: 24376641 PMCID: PMC3871581 DOI: 10.1371/journal.pone.0083084] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/25/2013] [Indexed: 12/17/2022] Open
Abstract
Introduction Advanced glycation endproducts (AGEs) may be involved in the development of atherosclerosis, beyond diabetes and renal disease. Skin autofluorescence (AF) is a non-invasive marker for AGEs. We examined whether skin AF is increased in (subclinical) atherosclerosis and associated with the degree of atherosclerosis independent of diabetes and renal function. Methods A cross-sectional study of 223 patients referred for primary (n = 163) or secondary (n = 60) prevention between 2006 and 2012 was performed. Skin AF was measured using the AGE-Reader. Ultrasonography was used to assess plaques in carotid and femoral arteries and computed tomography for the calculation of the coronary artery calcium score (CACS; in primary prevention only). Primary prevention patients were divided into a group with subclinical atherosclerosis defined as >1 plaque or CACS>100 (n = 67; age 53 year [interquartile range 48–56]; 49% male) and without (controls; 96; 43 [38–51]; 55%). Secondary prevention were patients with peripheral arterial disease (60; 64 [58–70]; 73%). Results Skin AF was higher in subclinical and clinical atherosclerosis compared with controls (skin AF 2.11 [interquartile range 1.83–2.46] and 2.71 [2.15–3.27] vs. 1.87 [1.68–2.12] respectively; P = 0.005 and <0.001). In a multivariate analysis, the association of skin AF with the atherosclerosis categories was independent of age, sex, diabetes, presence of the metabolic syndrome, Framingham Risk Score, and renal function. Skin AF correlated with most cardiovascular risk factors, Framingham risk score, and IMT and CACS. Conclusions Skin AF is increased in documented subclinical and clinical atherosclerosis, independent of known risk factors such as diabetes and renal disease. These data suggest that AGEs may be associated with the burden of atherosclerosis and warrant a prospective study to investigate its clinical usability as a risk assessment tool for primary prevention.
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Affiliation(s)
- Martijn A. M. den Dekker
- Center for Medical Imaging – North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Zwiers
- Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edwin R. van den Heuvel
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisanne C. de Vos
- Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andries J. Smit
- Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Clark J. Zeebregts
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging – North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Center for Medical Imaging – North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joop D. Lefrandt
- Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Douwe J. Mulder
- Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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Stirban A, Gawlowski T, Roden M. Vascular effects of advanced glycation endproducts: Clinical effects and molecular mechanisms. Mol Metab 2013; 3:94-108. [PMID: 24634815 DOI: 10.1016/j.molmet.2013.11.006] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 12/17/2022] Open
Abstract
The enhanced generation and accumulation of advanced glycation endproducts (AGEs) have been linked to increased risk for macrovascular and microvascular complications associated with diabetes mellitus. AGEs result from the nonenzymatic reaction of reducing sugars with proteins, lipids, and nucleic acids, potentially altering their function by disrupting molecular conformation, promoting cross-linking, altering enzyme activity, reducing their clearance, and impairing receptor recognition. AGEs may also activate specific receptors, like the receptor for AGEs (RAGE), which is present on the surface of all cells relevant to atherosclerotic processes, triggering oxidative stress, inflammation and apoptosis. Understanding the pathogenic mechanisms of AGEs is paramount to develop strategies against diabetic and cardiovascular complications.
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Affiliation(s)
- Alin Stirban
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstrasse 9, 41460 Neuss, Germany
| | - Thomas Gawlowski
- University of Paderborn, Warburger Str. 100, 33098 Paderborn, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany ; Division of Endocrinology and Diabetology, University Clinics Düsseldorf, 40225 Düsseldorf, Germany
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Graaff R, Arsov S, Ramsauer B, Koetsier M, Sundvall N, Engels GE, Sikole A, Lundberg L, Rakhorst G, Stegmayr B. Skin and Plasma Autofluorescence During Hemodialysis: A Pilot Study. Artif Organs 2013; 38:515-8. [DOI: 10.1111/aor.12205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Reindert Graaff
- Department of UMC Staff; Universities of Groningen; Groningen The Netherlands
| | - Stefan Arsov
- Department of Biomedical Engineering; Universities of Groningen; Groningen The Netherlands
| | - Bernd Ramsauer
- Department Public Health and Medicine; Umea University; Umea Sweden
| | - Marten Koetsier
- Department of Biomedical Engineering; Universities of Groningen; Groningen The Netherlands
| | - Nils Sundvall
- Department Public Health and Medicine; Umea University; Umea Sweden
| | | | - Aleksandar Sikole
- Department of Nephrology; Universities of Groningen; Groningen The Netherlands
| | - Lennart Lundberg
- Department Public Health and Medicine; Umea University; Umea Sweden
| | - Gerhard Rakhorst
- Department of Surgery; Universities of Groningen; Groningen The Netherlands
| | - Bernd Stegmayr
- Department Public Health and Medicine; Umea University; Umea Sweden
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Stirban A, Pop A, Fischer A, Heckermann S, Tschoepe D. Variability of skin autofluorescence measurement over 6 and 12 weeks and the influence of benfotiamine treatment. Diabetes Technol Ther 2013; 15:733-7. [PMID: 23964994 DOI: 10.1089/dia.2013.0103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Measurements of skin autofluorescence (SAF) allow for a simple and noninvasive quantification of tissue advanced glycation end-products (AGEs), a marker linked to the risk of diabetes complications. The aim of this study was to test the repeatability of SAF over 6 and 12 weeks and to test whether benfotiamine, a thiamine prodrug suggested to reduce AGEs formation under hyperglycemic conditions, is able to attenuate SAF when administered over 6 weeks. PATIENTS AND METHODS In a double-blind, placebo-controlled, randomized, crossover study, 22 patients with type 2 diabetes mellitus (T2DM) received 900 mg/day benfotiamine or placebo for 6 weeks (washout period of 6 weeks between). At the beginning and at the end of each treatment period, SAF was assessed in the fasting state, as well as 2, 4, and 6 h following a mixed test meal. RESULTS The respective intra-individual and inter-individual variability of fasting SAF was 6.9% and 24.5% within 6 weeks and 10.9% and 23.1% within 12 weeks. The respective variability calculated for triplicate comparisons was 9.9% and 27.7%. A short-term therapy with benfotiamine did not influence SAF significantly, nor did we find a significant postprandial SAF increase. CONCLUSIONS In patients with T2DM, repeated, timely spaced SAF measurements have an intra-subject variability of below 11%. Using these data, sample sizes were calculated for interventional studies aiming at reducing SAF. Benfotiamine treatment for 6 weeks did not significantly influence SAF; for this, a longer-term therapy is probably needed.
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Affiliation(s)
- Alin Stirban
- Diabetes Clinic, Heart and Diabetes Center NR, Ruhr University Bochum, Bad Oeynhausen, Germany.
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Abstract
The development of cost-effective, simple, and reproducible tests for diabetes screening represents a priority of modern medicine in light of the increasing prevalence of diabetes mellitus. Besides fasting plasma glucose, the oral glucose tolerance test, and glycated hemoglobin A1c, several tests have been proposed, among them the assessment of skin fluorescence spectroscopy (SFS). This article comments on the article by Olson and coauthors published in this issue of Journal of Diabetes Science and Technology and comprehensively reviews related available information. Overall, SFS seems to represent an easy-to-use, noninvasive tool that adds value to existing tests for diabetes screening.
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Affiliation(s)
- Alin Stirban
- Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
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Skin autofluorescence based decision tree in detection of impaired glucose tolerance and diabetes. PLoS One 2013; 8:e65592. [PMID: 23750268 PMCID: PMC3672176 DOI: 10.1371/journal.pone.0065592] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/29/2013] [Indexed: 11/21/2022] Open
Abstract
Aim Diabetes (DM) and impaired glucose tolerance (IGT) detection are conventionally based on glycemic criteria. Skin autofluorescence (SAF) is a noninvasive proxy of tissue accumulation of advanced glycation endproducts (AGE) which are considered to be a carrier of glycometabolic memory. We compared SAF and a SAF-based decision tree (SAF-DM) with fasting plasma glucose (FPG) and HbA1c, and additionally with the Finnish Diabetes Risk Score (FINDRISC) questionnaire±FPG for detection of oral glucose tolerance test (OGTT)- or HbA1c-defined IGT and diabetes in intermediate risk persons. Methods Participants had ≥1 metabolic syndrome criteria. They underwent an OGTT, HbA1c, SAF and FINDRISC, in adition to SAF-DM which includes SAF, age, BMI, and conditional questions on DM family history, antihypertensives, renal or cardiovascular disease events (CVE). Results 218 persons, age 56 yr, 128M/90F, 97 with previous CVE, participated. With OGTT 28 had DM, 46 IGT, 41 impaired fasting glucose, 103 normal glucose tolerance. SAF alone revealed 23 false positives (FP), 34 false negatives (FN) (sensitivity (S) 68%; specificity (SP) 86%). With SAF-DM, FP were reduced to 18, FN to 16 (5 with DM) (S 82%; SP 89%). HbA1c scored 48 FP, 18 FN (S 80%; SP 75%). Using HbA1c-defined DM-IGT/suspicion ≥6%/42 mmol/mol, SAF-DM scored 33 FP, 24 FN (4 DM) (S76%; SP72%), FPG 29 FP, 41 FN (S71%; SP80%). FINDRISC≥10 points as detection of HbA1c-based diabetes/suspicion scored 79 FP, 23 FN (S 69%; SP 45%). Conclusion SAF-DM is superior to FPG and non-inferior to HbA1c to detect diabetes/IGT in intermediate-risk persons. SAF-DM’s value for diabetes/IGT screening is further supported by its established performance in predicting diabetic complications.
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Abstract
The prevalence of heart failure (HF) is increasing. A distinction is made between diastolic HF (preserved left ventricular ejection fraction (LVEF)) and systolic HF (reduced LVEF). Advanced glycation end-products (AGEs) are crystallized proteins that accumulate during ageing, but are particularly increased in patients with diabetes mellitus and in patients with renal failure. Through the formation of collagen crosslinks, and by interaction with the AGE-receptor, which impairs calcium handling and increases fibrosis, AGE-accumulation has pathophysiologically been associated with the development of diastolic and renal dysfunction. Interestingly, diastolic dysfunction is a frequent finding in elderly patients, diabetic patients and in patients with renal failure. Taken together, this suggests that AGEs are related to the development and progression of diastolic HF and renal failure. In this review, the role of AGEs as a possible pathophysiological factor that link the development and progression of heart and renal failure, is discussed. Finally, the role of AGE intervention as a possible treatment in HF patients will be discussed.
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Gkogkolou P, Böhm M. Advanced glycation end products: Key players in skin aging? DERMATO-ENDOCRINOLOGY 2013; 4:259-70. [PMID: 23467327 PMCID: PMC3583887 DOI: 10.4161/derm.22028] [Citation(s) in RCA: 334] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aging is the progressive accumulation of damage to an organism over time leading to disease and death. Aging research has been very intensive in the last years aiming at characterizing the pathophysiology of aging and finding possibilities to fight age-related diseases. Various theories of aging have been proposed. In the last years advanced glycation end products (AGEs) have received particular attention in this context. AGEs are formed in high amounts in diabetes but also in the physiological organism during aging. They have been etiologically implicated in numerous diabetes- and age-related diseases. Strategies inhibiting AGE accumulation and signaling seem to possess a therapeutic potential in these pathologies. However, still little is known on the precise role of AGEs during skin aging. In this review the existing literature on AGEs and skin aging will be reviewed. In addition, existing and potential anti-AGE strategies that may be beneficial on skin aging will be discussed.
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Affiliation(s)
- Paraskevi Gkogkolou
- Department of Dermatology; Laboratory for Neuroendocrinology of the Skin and Interdisciplinary Endocrinology; University of Münster; Münster, Germany
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Makulska I, Szczepańska M, Drożdż D, Polak-Jonkisz D, Zwolińska D. Skin autofluorescence as a marker of cardiovascular risk in children with chronic kidney disease. Pediatr Nephrol 2013; 28:121-8. [PMID: 22976887 PMCID: PMC3505501 DOI: 10.1007/s00467-012-2280-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/13/2012] [Accepted: 07/13/2012] [Indexed: 01/20/2023]
Abstract
BACKGROUND We examined skin autofluorescence (sAF) in chronic kidney disease children (CKD) in relation to renal function and dialysis modality. METHODS Twenty children on hemodialysis (HD), 20 on peritoneal dialysis (PD), 36 treated conservatively, and 26 healthy subjects were enrolled into the study. In all children sAF, pulse-wave velocity indexed to height (PWV/ht), left ventricular mass index (LVMI), blood pressure (BP), serum lipid profile, phosphate (P), calcium (Ca), and homocysteine were measured. RESULTS sAF was significantly elevated in CKD groups vs. controls and was significantly associated with PWV/ht, LVMI, BP, P, Ca × P product and homocysteine. sAF in HD and PD groups was positively correlated with dialysis vintage, and in the predialysis group negatively correlated with glomerular filtration rate (eGFR). Multiple regression analysis showed significant association of sAF with LVMI and P in the CKD patient group, and with dialysis treatment duration and BP in dialyzed children. CONCLUSIONS In CKD children, tissue accumulation of advanced glycation end-products (AGEs) was observed. This was aggravated as eGFR declined and was related to early cardiovascular changes and some biochemical cardiovascular disease (CVD) risk markers. sAF as a non-invasive method may be a useful tool for identification of a clinical risk factors of cardiovascular disease in CKD children.
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Affiliation(s)
- Irena Makulska
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, Wrocław, Poland
| | - Maria Szczepańska
- Pediatric Dialysis Unit, Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dorota Drożdż
- Dialysis Unit, Jagiellonian University Medical College, Kraków, Poland
| | - Dorota Polak-Jonkisz
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, Wrocław, Poland
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, Wrocław, Poland
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48
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Jiang J, Chen P, Chen J, Yu X, Xie D, Mei C, Xiong F, Shi W, Zhou W, Liu X, Sun S, Zhang P, Yang X, Zhang Y, Zhang Y, Liang X, Zhang Z, Lin Q, Yu Y, Miyata T, Tian J, Liang M, Luo W, Xu X, Hou F. Accumulation of tissue advanced glycation end products correlated with glucose exposure dose and associated with cardiovascular morbidity in patients on peritoneal dialysis. Atherosclerosis 2012; 224:187-94. [PMID: 22857897 DOI: 10.1016/j.atherosclerosis.2012.06.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/08/2012] [Accepted: 06/12/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Accumulation of tissue advanced glycation end products (AGEs) is a marker of cumulative glycemic and/or oxidative stress. Cutaneous AGEs levels measured by skin autofluorescence correlate well with cardiovascular outcomes in diabetes and hemodialysis (HD) patients. The present study aimed to compare tissue AGEs levels with peritoneal dialysis (PD) and HD patients and to evaluate the relationship between skin autofluorescence and cardiovascular morbidity in patients on PD. METHODS A total of 2388 maintenance dialysis patients (613 PD and 1775 HD) were enrolled in this cross-sectional study. Skin autofluorescence was measured non-invasively with an autofluorescence reader. Cardiovascular morbidity was defined as clinically diagnosed ischemic heart disease, heart failure, stroke or peripheral vascular disease from initiation of dialysis. RESULTS More than 90% of patients on both PD and HD had met current dialysis adequacy targets. Compared to HD group, PD patients receiving conventional glucose-containing dialyzate had significantly higher skin autofluorescence values in each category of age and dialysis duration, irrespective of the presence or absence of diabetes. In PD patients, skin autofluorescence values were strongly correlated with the duration of PD and glucose exposure dose and independently associated with cardiovascular morbidity. Multivariate analysis revealed that glucose exposure dose and skin autofluorescence were the strongest risk factors for cardiovascular morbidity in PD patients after adjustment by age, gender, and other classic- or uremic-related risk factors. CONCLUSIONS Accumulation of tissue AGEs provides a potential link between PD exposure of metabolic stress and progression of cardiovascular disease in patients on PD.
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Affiliation(s)
- Jianping Jiang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
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49
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Spatial and temporal analysis of skin glycation by the use of multiphoton microscopy and spectroscopy. J Dermatol Sci 2012; 65:189-95. [DOI: 10.1016/j.jdermsci.2011.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/20/2011] [Accepted: 12/10/2011] [Indexed: 11/18/2022]
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50
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Law B, Fowlkes V, Goldsmith JG, Carver W, Goldsmith EC. Diabetes-induced alterations in the extracellular matrix and their impact on myocardial function. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2012; 18:22-34. [PMID: 22221857 PMCID: PMC4045476 DOI: 10.1017/s1431927611012256] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Diabetes is an increasing public health problem that is expected to escalate in the future due to the growing incidence of obesity in the western world. While this disease is well known for its devastating effects on the kidneys and vascular system, diabetic individuals can develop cardiac dysfunction, termed diabetic cardiomyopathy, in the absence of other cardiovascular risk factors such as hypertension or atherosclerosis. While much effort has gone into understanding the effects of elevated glucose or altered insulin sensitivity on cellular components within the heart, significant changes in the cardiac extracellular matrix (ECM) have also been noted. In this review article we highlight what is currently known regarding the effects diabetes has on both the expression and chemical modification of proteins within the ECM and how the fibrotic response often observed as a consequence of this disease can contribute to reduced cardiac function.
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