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Liberale L, Carbone F, Bonaventura A, Kraler S, Bertolotto M, Artom N, Pontremoli R, Viazzi FC, Pende A, Pisciotta L, Montecucco F. Adiponectin/leptin ratio predicts the remission of metabolic syndrome: A pilot study. Int J Cardiol 2024; 400:131791. [PMID: 38244890 DOI: 10.1016/j.ijcard.2024.131791] [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: 07/18/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Adipokines are key mediators of inflammation in metabolic syndrome perpetuating the effect of excess nutrient intake by setting a self-maintaining vicious circle. Here, we assess levels of adiponectin and leptin in a cohort of individuals with MetS undergoing dietary and behavioral counselling. Specifically, we investigate their role as predictors of metabolic syndrome remission after 1 year. METHODS Patients with MetS (n = 127) received behavioral and dietary recommendations and were followed-up for 1 year. Serum was available for 108 individuals, levels of adiponectin and leptin were tested at baseline, at 6 months (t1) and after 1 year (t2). Adiponectin/leptin (A/L) ratio was also calculated and tested for predictive ability. RESULT At the end of the follow-up period, 59 patients did not show enough criteria to define MetS anymore. When considered alone, adiponectin and leptin levels did not show difference over follow-up. Their ratio instead was significantly reduced at t1 and t2 with respect to baseline. Remitters also showed lowers level of leptin and A/L ratio as compared to non-remitters at t1. At this timepoint, A/L ratio independently predicted MetS remission at 1 year [OR 9.082 95%CI (1.394-59.160), p = 0.021]. Bootstrap resampling analysis internally validated our findings. CONCLUSIONS Preliminary results from our pilot study suggest that MetS remission after counselling associates with changes in adipokine balance. A/L ratio decreases overtime and its value at 6 months can independently predict MetS remission.
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Affiliation(s)
- Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy.
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
| | - Aldo Bonaventura
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Maria Bertolotto
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Nathan Artom
- Department of Internal Medicine, Ospedale S. Paolo di Savona, 30 via Genova, 17110 Savona, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Francesca C Viazzi
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Aldo Pende
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
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Ruhnau J, Heuer C, Witt C, Ceesay S, Schulze J, Gross S, Waize M, Kromrey ML, Kühn JP, Langner S, Grunwald U, Bröker BM, Petersmann A, Steveling A, Dressel A, Vogelgesang A. Effects of body mass index on the immune response within the first days after major stroke in humans. Neurol Res Pract 2023; 5:42. [PMID: 37587512 PMCID: PMC10433619 DOI: 10.1186/s42466-023-00269-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Immunological alterations associated with increased susceptibility to infection are an essential aspect of stroke pathophysiology. Several immunological functions of adipose tissue are altered by obesity and are accompanied by chronic immune activation. The purpose of this study was to examine immune function (monocytes, granulocytes, cytokines) as a function of body mass index (BMI: 1st group: 25; 2nd group: 25 BMI 30; 3rd group: 30) and changes in body weight post stroke. METHOD Fat status was assessed using standardized weight measurements on days 1, 2, 3, 4, 5, and 7 after ischemic stroke in a cohort of 40 stroke patients and 16 control patients. Liver fat and visceral fat were assessed by MRI on day 1 or 2 [I] and on day 5 or 7 [II]. Leukocyte subpopulations in peripheral blood, cytokines, chemokines, and adipokine concentrations in sera were quantified. In a second cohort (stroke and control group, n = 17), multiple regression analysis was used to identify correlations between BMI and monocyte and granulocyte subpopulations. RESULTS Weight and fat loss occurred from the day of admission to day 1 after stroke without further reduction in the postischemic course. No significant changes in liver or visceral fat were observed between MRI I and MRI II. BMI was inversely associated with IL-6 levels, while proinflammatory cytokines such as eotaxin, IFN-β, IFN -γ and TNF-α were upregulated when BMI increased. The numbers of anti-inflammatory CD14+CD16+ monocytes and CD16+CD62L- granulocytes were reduced in patients with higher BMI values, while that of proinflammatory CD16dimCD62L+ granulocytes was increased. CONCLUSION A small weight loss in stroke patients was detectable. The data demonstrate a positive correlation between BMI and a proinflammatory poststroke immune response. This provides a potential link to how obesity may affect the clinical outcome of stroke patients.
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Affiliation(s)
- Johanna Ruhnau
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany.
| | - Christin Heuer
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Carl Witt
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Sonya Ceesay
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Juliane Schulze
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Stefan Gross
- Partner site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Maria Waize
- Department of Mathematics and Informatics, University Medicine Greifswald, Greifswald, Germany
| | - Marie-Luise Kromrey
- Department of Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Department of Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
- Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Sönke Langner
- Department of Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Uwe Grunwald
- Internal Medicine C, Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Barbara M Bröker
- Department of Immunology, University Medicine Greifswald, Greifswald, Germany
| | - Astrid Petersmann
- Department of Clinical Diagnostics, University Oldenburg, Oldenburg, Germany
| | - Antje Steveling
- Department of Endocrinology, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Dressel
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
- Department of Neurology, Carl-Thiem Klinikum, Cottbus, Germany
| | - Antje Vogelgesang
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany.
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Tirandi A, Sgura C, Carbone F, Montecucco F, Liberale L. Inflammatory biomarkers of ischemic stroke. Intern Emerg Med 2023; 18:723-732. [PMID: 36745280 PMCID: PMC10082112 DOI: 10.1007/s11739-023-03201-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/09/2023] [Indexed: 02/07/2023]
Abstract
Ischemic stroke remains the second leading cause of death and among the major causes of morbidity worldwide. Therapeutic options are currently limited to early reperfusion strategies, while pharmacological neuroprotective strategies despite showing promising results in the experimental setting constantly failed to enter the clinical arena. Inflammation plays an important role in the pathophysiology of ischemic stroke and mediators of inflammation have been longtime investigated as possible prognostic marker and therapeutic target for stroke patients. Here, we summarized available evidence on the role of cytokines, soluble adhesion molecules and adipokines in the pathophysiology, prognosis and therapy of ischemic stroke.
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Affiliation(s)
- Amedeo Tirandi
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Cosimo Sgura
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Luca Liberale
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Largo Rosanna Benzi 10, 16132, Genoa, Italy
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Zhang JJ, Sánchez Vidaña DI, Chan JNM, Hui ESK, Lau KK, Wang X, Lau BWM, Fong KNK. Biomarkers for prognostic functional recovery poststroke: A narrative review. Front Cell Dev Biol 2023; 10:1062807. [PMID: 36699006 PMCID: PMC9868572 DOI: 10.3389/fcell.2022.1062807] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background and objective: Prediction of poststroke recovery can be expressed by prognostic biomarkers that are related to the pathophysiology of stroke at the cellular and molecular level as well as to the brain structural and functional reserve after stroke at the systems neuroscience level. This study aimed to review potential biomarkers that can predict poststroke functional recovery. Methods: A narrative review was conducted to qualitatively summarize the current evidence on biomarkers used to predict poststroke functional recovery. Results: Neurophysiological measurements and neuroimaging of the brain and a wide diversity of molecules had been used as prognostic biomarkers to predict stroke recovery. Neurophysiological studies using resting-state electroencephalography (EEG) revealed an interhemispheric asymmetry, driven by an increase in low-frequency oscillation and a decrease in high-frequency oscillation in the ipsilesional hemisphere relative to the contralesional side, which was indicative of individual recovery potential. The magnitude of somatosensory evoked potentials and event-related desynchronization elicited by movement in task-related EEG was positively associated with the quantity of recovery. Besides, transcranial magnetic stimulation (TMS) studies revealed the potential values of using motor-evoked potentials (MEP) and TMS-evoked EEG potentials from the ipsilesional motor cortex as prognostic biomarkers. Brain structures measured using magnetic resonance imaging (MRI) have been implicated in stroke outcome prediction. Specifically, the damage to the corticospinal tract (CST) and anatomical motor connections disrupted by stroke lesion predicted motor recovery. In addition, a wide variety of molecular, genetic, and epigenetic biomarkers, including hemostasis, inflammation, tissue remodeling, apoptosis, oxidative stress, infection, metabolism, brain-derived, neuroendocrine, and cardiac biomarkers, etc., were associated with poor functional outcomes after stroke. However, challenges such as mixed evidence and analytical concerns such as specificity and sensitivity have to be addressed before including molecular biomarkers in routine clinical practice. Conclusion: Potential biomarkers with prognostic values for the prediction of functional recovery after stroke have been identified; however, a multimodal approach of biomarkers for prognostic prediction has rarely been studied in the literature. Future studies may incorporate a combination of multiple biomarkers from big data and develop algorithms using data mining methods to predict the recovery potential of patients after stroke in a more precise way.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | | | - Jackie Ngai-Man Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Edward S. K. Hui
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Xin Wang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Benson W. M. Lau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis. World Neurosurg 2021; 163:e1-e42. [PMID: 34728391 DOI: 10.1016/j.wneu.2021.10.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The goal of this study was to systematically review the utility of serum biomarkers in the setting of ischemic stroke (IS) to predict long-term outcome. METHODS A systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986-2018. All studies assessing long-term functional outcome (defined as 30 days or greater) following IS with respect to serum biomarkers were included. Data were extracted and pooled using a meta-analysis of odds ratios. RESULTS Of the total 2928 articles in the original literature search, 183 studies were ultimately selected. A total of 127 serum biomarkers were included. Biomarkers were grouped into several categories: inflammatory (32), peptide/enzymatic (30), oxidative/metabolic (28), hormone/steroid based (23), and hematologic/vascular (14). The most commonly studied biomarkers in each category were found to be CRP, S100β, albumin, copeptin, and D-dimer. With the exception of S100β, all were found to be statistically associated with >30-day outcome after ischemic stroke. CONCLUSIONS Serum-based biomarkers have the potential to predict functional outcome in IS patients. This meta-analysis has identified CRP, albumin, copeptin, and D-dimer to be significantly associated with long-term outcome after IS. These biomarkers have the potential to serve as a platform for prognosticating stroke outcomes after 30 days. These serum biomarkers, some of which are routinely ordered, can be combined with imaging biomarkers and used in artificial intelligence algorithms to provide refined predictive outcomes after injury. Ultimately these tools will assist physicians in providing guidance to families with regards to long-term independence of patients.
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Andone S, Bajko Z, Motataianu A, Mosora O, Balasa R. The Role of Biomarkers in Atherothrombotic Stroke-A Systematic Review. Int J Mol Sci 2021; 22:ijms22169032. [PMID: 34445740 PMCID: PMC8396595 DOI: 10.3390/ijms22169032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/26/2022] Open
Abstract
Stroke represents the primary debilitating disease in adults and is the second-highest cause of death worldwide. Atherosclerosis, the most prevalent etiology for vascular conditions, is a continuous process that gradually creates and develops endothelial lesions known as atherosclerotic plaques. These lesions lead to the appearance of atherothrombotic stroke. In the last decades, the role of biological biomarkers has emerged as either diagnostic, prognostic, or therapeutic targets. This article aims to create a list of potential biomarkers related to atherothrombotic stroke by reviewing the currently available literature. We identified 23 biomarkers and assessed their roles as risk factors, detection markers, prognostic predictors, and therapeutic targets. The central aspect of these biomarkers is related to risk stratification, especially for patients who have not yet suffered a stroke. Other valuable data are focused on the predictive capabilities for stroke patients regarding short-term and long-term prognosis, including their influence over the acute phase treatment, such as rt-PA thrombolysis. Although the role of biomarkers is anticipated to be of extreme value in the future, they cannot yet compete with traditional stroke neuroimaging markers but could be used as additional tools for etiological diagnosis.
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Affiliation(s)
- Sebastian Andone
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (S.A.); (R.B.)
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
| | - Zoltan Bajko
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, 540136 Targu Mures, Romania
- Correspondence:
| | - Anca Motataianu
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, 540136 Targu Mures, Romania
| | - Oana Mosora
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
| | - Rodica Balasa
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (S.A.); (R.B.)
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, 540136 Targu Mures, Romania
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Li J, Hao M, Yang B, Shi T, Zhang Y, Feng J, Chen J. Long non-coding RNAs expression profile and functional analysis of acute ischemic stroke. Medicine (Baltimore) 2020; 99:e22964. [PMID: 33327229 PMCID: PMC7738114 DOI: 10.1097/md.0000000000022964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) have been evidenced to be associated with the development of multiple diseases. However, the expression pattern and function of lncRNAs in acute ischemic stroke remain unclear. To determine the differential expression of lncRNAs in acute ischemic stroke, we analyzed the expression profile of lncRNAs by high-throughput sequencing analysis. Gene Ontology (GO) and pathway analyses were employed to analyze the gene function and identify enriched pathways of the differentially expressed lncRNAs. We also built an lncRNA-mRNA expression correlation network and verified the interactions of selected lncRNAs in acute ischemic stroke. To further confirm the results of the expression profile, 6 differentially expressed lncRNAs were randomly selected and quantitative RT-PCR (qRT-PCR) performed. We identified 44,578 aberrantly expressed lncRNAs, including 228 upregulated and 16 downregulated lncRNAs. The qRT-PCR results showed that ENSG00000269900, ENSG00000196559, ENSG00000202198, ENSG00000226482, ENSG00000260539 (up), and XLOC_013994_2 (down) were abnormally expressed, which was consistent with the sequencing results. The upregulated expression of lncRNA ENSG00000226482 may activate the adipocytokine signaling pathway, resulting in acute ischemia stroke. In summary, we analyzed the lncRNAs expression profile in acute ischemic stroke patients and identified the functions and enriched metabolic pathways, proposing new insights into the diagnostic and therapeutic biomarkers for this disease.
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Affiliation(s)
| | | | - Ben Yang
- Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, P.R. China
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Zou Y, Hu L, Zou W, Li H. Association of Low Leptin with Poor 3-Month Prognosis in Ischemic Stroke Patients with Type 2 Diabetes. Clin Interv Aging 2020; 15:2353-2361. [PMID: 33328729 PMCID: PMC7734075 DOI: 10.2147/cia.s279535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Leptin, an adipokine, has effects on the cardiovascular system with both protective and harmful role. This study aimed to assess the relationship between leptin and 3-month prognosis in ischemic stroke patients with type 2 diabetes. Patients and Methods As a prospective single-center observational study, we collected consecutive first-ever acute ischemia stroke with type 2 diabetes mellitus from February 2019 to February 2020. Serum samples were obtained at admission, and leptin serum levels were tested by the ELISA method. Logistic regression models were used to assess leptin's prognostic value to predict the functional outcome and mortality within three months. Results Finally, two hundred and eleven patients were included, and the mean leptin serum level was 16.8 (SD. 6.9) ng/mL. At admission, 53.6% of those included patients (N=113) were defined as severe stroke (NIH Stroke Scale [NIHSS]>5). In multivariable models adjusted for other factors, leptin levels<11.6ng/mL (lowest quartile, Q1) related to severe stroke and the risk increased 175% (odds ratios [OR] =2.75; 95% confidence interval [CI]=2.13-3.38; P=0.002). Serum leptin levels on admission in patients with poor outcomes and nonsurvivors were significantly reduced (P<0.001 and P<0.001). Leptin levels <11.6ng/mL (lowest quartile, Q1) related to a higher risk of poor functional impairment (OR=5.13; 95% CI =3.25-6.86; P<0.001) and mortality (OR=3.19; 95% CI =2.03-4.25; P<0.001). Conclusion The data shows that leptin serum level is a useful prognostic biomarker in ischemic stroke patients with type 2 diabetes, and this relationship is negative.
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Affiliation(s)
- Yi Zou
- Department of Endocrinology, The Third Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Ling Hu
- Department of Endocrinology, The Third Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Wenjun Zou
- General Surgery, Nanchang Third Hospital, Nanchang, People's Republic of China
| | - Honglin Li
- Department of Biochemistry, Medical College of Georgia, Augusta, GA, USA
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Tu WJ, Qiu HC, Liu YK, Liu Q, Zeng X, Zhao J. Elevated levels of adiponectin associated with major adverse cardiovascular and cerebrovascular events and mortality risk in ischemic stroke. Cardiovasc Diabetol 2020; 19:125. [PMID: 32771014 PMCID: PMC7415178 DOI: 10.1186/s12933-020-01096-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adiponectin plays role in multiple metabolic pathways. Previous studies in cardiovascular disease evaluated the association between adiponectin and clinical outcomes, yielding conflicting results. The aim of this study was to investigate the association of adiponectin with major adverse cardiovascular and cerebrovascular events (MACCE) and mortality in Chinese patients with first-ever acute ischemic stroke (AIS). METHODS This was a prospective, multicenter cohort study. From September 2009 through October 2015, all patients with AIS from 3 stroke centers in Shandong were included. Serum levels of adiponectin at admission were tested. The prognostic role of adiponectin to predict the MACCE and mortality within 3 years was evaluated by multivariable-adjusted Cox proportional hazards models. RESULTS This study included 4274 patients (median age 68 years [interquartile ranges {IQR}: 61-76]; 53.2% men). There were 794 deaths and 899 MACCE events. Higher serum levels of adiponectin on admission were found in patients with MACCE events and nonsurvivors (P < 0.001 and P < 0.001). In multivariable models adjusted for factors that confirmed in the univariate model, elevated serum levels of adiponectin were associated with a higher risk of MACCE (Quartile[Q]4 vs. Q1, Hazard ratio[HR] = 4.95 [95% confidence interval {CI}: 3.03-7.06]) and mortality (Q4 vs. Q1, HR = 5.63 [95% CI 3.15-7.99]). Adiponectin improved the prognostic value of the National Institutes of Health Stroke Scale (NIHSS) to predict MACCE (combined areas under the curve [AUC], 0.76; 95% CI 0.68-0.88; P = 0.001) and mortality (0.78[0.69-0.91]; P < 0.01). Subgroups analysis indicated that the prognostic role of adiponectin was more pronounced in women and patients with high levels of N-terminal-pro B-type natriuretic peptide(NT-pro BNP) (P < 0.001 and P < 0.001). CONCLUSIONS Elevated serum levels of adiponectin were associated with a higher risk of MACCE and mortality independent of traditional risk factors in ischemic stroke patients.
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Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Four Ring West Road, Beijing, 100070, People's Republic of China.,Department of Neurosurgery, Qilu Hospital of Shandong University, No. 107 Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.,Institute of Radiation Medicine, China Academy of Medical Science & Peking Union Medical College, Tianjin, China
| | - Han-Cheng Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Four Ring West Road, Beijing, 100070, People's Republic of China
| | - Ya-Kun Liu
- Department of Neurosurgery, Qilu Hospital of Shandong University, No. 107 Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China
| | - Qiang Liu
- Institute of Radiation Medicine, China Academy of Medical Science & Peking Union Medical College, Tianjin, China
| | - Xianwei Zeng
- Department of Neurosurgery, Qilu Hospital of Shandong University, No. 107 Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Four Ring West Road, Beijing, 100070, People's Republic of China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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10
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Liberale L, Montecucco F. Adipocytokines and cardiovascular diseases: Putative role of Neuregulin 4. Eur J Clin Invest 2020; 50:e13306. [PMID: 32511758 DOI: 10.1111/eci.13306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/30/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, Genoa, Italy
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11
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Bonaventura A, Liberale L, Carbone F, Vecchié A, Montecucco F. Plaque vulnerability and adverse outcomes: The long road to fight atherosclerosis. Eur J Clin Invest 2020; 50:e13253. [PMID: 32329065 DOI: 10.1111/eci.13253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/07/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Aldo Bonaventura
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, Genoa, Italy
| | - Alessandra Vecchié
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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12
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Kamtchum-Tatuene J, Jickling GC. Blood Biomarkers for Stroke Diagnosis and Management. Neuromolecular Med 2019; 21:344-368. [PMID: 30830566 PMCID: PMC6722038 DOI: 10.1007/s12017-019-08530-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
Abstract
Biomarkers are objective indicators used to assess normal or pathological processes, evaluate responses to treatment and predict outcomes. Many blood biomarkers already guide decision-making in clinical practice. In stroke, the number of candidate biomarkers is constantly increasing. These biomarkers include proteins, ribonucleic acids, lipids or metabolites. Although biomarkers have the potential to improve the diagnosis and the management of patients with stroke, there is currently no marker that has demonstrated sufficient sensitivity, specificity, rapidity, precision, and cost-effectiveness to be used in the routine management of stroke, thus highlighting the need for additional work. A better standardization of clinical, laboratory and statistical procedures between centers is indispensable to optimize biomarker performance. This review focuses on blood biomarkers that have shown promise for translation into clinical practice and describes some newly reported markers that could add to routine stroke care. Avenues for the discovery of new stroke biomarkers and future research are discussed. The description of the biomarkers is organized according to their expected application in clinical practice: diagnosis, treatment decision, and outcome prediction.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-120 Katz Building, 114 Street & 87 Avenue, Edmonton, AB, T6G 2E1, Canada.
| | - Glen C Jickling
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-120 Katz Building, 114 Street & 87 Avenue, Edmonton, AB, T6G 2E1, Canada
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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13
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Wang Z, Li B, Wang Y, Maimaitili A, Qin H, Dangmurenjiafu G, Wang S. The association between serum adiponectin and 3-month outcome after ischemic stroke. Cardiovasc Diabetol 2019; 18:105. [PMID: 31412946 PMCID: PMC6694580 DOI: 10.1186/s12933-019-0908-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/07/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although adiponectin is a major adipocytokine that affects the pathogenesis of various cardiovascular diseases, its clinical significance in stroke remains controversial. The purpose of this study was to assess the impact of serum adiponectin levels on functional prognosis in patients with ischemic stroke. METHODS This was a prospective, observational cohort study. Consecutive first-ever ischemic stroke patients without any pre-morbid handicap admitted to our hospital were identified from December 2017 to December 2018. Serum concentration of adiponectin was routinely measured within the first 24 h after admission by a commercially available sandwich ELISA. Associations between adiponectin and either clinical severity at admission, poor outcomes or mortality at 3-month after admission were analyzed using logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI). RESULTS The serum level of adiponectin was obtained in 227 patients with a median value of 7.0 μg/ml, which was significantly higher (P < 0.001) than in those heathy control. Adiponectin levels were associated with moderate-to-high stroke, and risk increased by 12% (OR = 1.12; 95% CI 1.03-1.25; P = 0.002). Patients with a poor outcome and nonsurvivors had significantly increased adiponectin levels on admission (P < 0.001, all). In multivariate logistic regression analysis, adiponectin was an independent predictor of functional outcome and mortality, and risk increased by 24% (OR = 1.24, 95% CI 1.13-1.37; P < 0.001) and 31% (1.31 [1.18-1.46], P < 0.001), respectively. Kaplan-Meier analysis suggested that the patients with high serum adiponectin levels had a higher risk of death than those patients with low levels (log-rank test P < 0.001). CONCLUSIONS Our results show that high adiponectin is associated with stroke severity and support the hypothesis that adiponectin can be serve as a biomarker of poor outcome after stroke, independent of baseline variables. Trial registration ChiCTR-OPC-17013501. Retrospectively Registered 21 September 2017.
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Affiliation(s)
- Zengliang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fanyang Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Bo Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fanyang Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Yongxin Wang
- Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Aisha Maimaitili
- Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Hu Qin
- Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Geng Dangmurenjiafu
- Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fanyang Road, Fengtai District, Beijing, 100070, People's Republic of China.
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14
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Katsiki N, Mikhailidis DP, Banach M. Leptin, cardiovascular diseases and type 2 diabetes mellitus. Acta Pharmacol Sin 2018; 39:1176-1188. [PMID: 29877321 PMCID: PMC6289384 DOI: 10.1038/aps.2018.40] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/02/2018] [Indexed: 02/07/2023] Open
Abstract
Leptin, an adipokine that is implicated in the control of food intake via appetite suppression, may also stimulate oxidative stress, inflammation, thrombosis, arterial stiffness, angiogenesis and atherogenesis. These leptin-induced effects may predispose to the development of cardiovascular diseases. In the present review we discuss the evidence linking leptin levels with the presence, severity and/or prognosis of both coronary artery disease and non-cardiac vascular diseases such as stroke, carotid artery disease, peripheral artery disease (PAD) and abdominal aortic aneurysms (AAA) as well as with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Leptin levels have been positively associated with the presence, severity, extent and lesion complexity of coronary atherosclerosis as well as with the presence, severity and poor clinical outcomes of both ischemic and hemorrhagic strokes. But conflicting results also exist. Furthermore, leptin was reported to independently predict common carotid intima-media thickness and carotid plaque instability. A link between hyperleptinemia and PAD has been reported, whereas limited data were available on the potential association between leptin and AAA. Elevated leptin concentrations have also been related to CKD incidence and progression as well as with insulin resistance, T2DM, micro- and macrovascular diabetic complications. Statins and antidiabetic drugs (including sitagliptin, metformin, pioglitazone, liraglutide and empagliflozin) may affect leptin levels. Further research is needed to establish the potential use (if any) of leptin as a therapeutic target in these diseases.
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Affiliation(s)
- Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
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15
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Kang K, Lee WW, Lee JJ, Park JM, Kwon O, Kim BK. Association of higher waist circumference with milder stroke severity in acute ischaemic stroke. Neurol Res 2018; 40:785-794. [PMID: 29856277 DOI: 10.1080/01616412.2018.1479346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Although higher body mass index (BMI) was reported to be associated with increased stroke incidence, having a higher BMI is known to be associated with better clinical outcomes after stroke. However, BMI has shown conflicting associations with baseline stroke severity. The aim of our study was to assess the relationship between waist circumference (WC) at admission and baseline stroke severity among patients with ischaemic stroke. METHODS The WC of acute stroke patients was divided into sex-specific quartiles. Baseline stroke severity was categorised as mild [National Institutes of Health Stroke Scale (NIHSS) score 0-4], moderate (NIHSS score 5-10), and severe (NIHSS score ≥11). Multinomial logistic regression was used and reference categories were men or women in the lowest sex-specific WC quartiles who had experienced a mild stroke. RESULTS A total of 637 female and 766 male patients were included. The adjusted OR of severe stroke were 1.3 (95% CI, 0.7-2.4) for male patients in the third WC quartile, 0.7 (95% CI, 0.3-1.5) for male patients in the second WC quartile, and 0.4 (95% CI, 0.2-0.8) for male patients in the top WC quartile. The adjusted OR of severe stroke for female patients in the third WC quartile, the second WC quartile, and the top WC quartile were 0.8 (95% CI, 0.4-1.5), 0.4 (95% CI, 0.2-0.9), and 0.7 (95% CI, 0.3-1.3), respectively. DISCUSSION Higher WC at admission is associated with milder baseline stroke severity among patients with acute ischaemic stroke. ABBREVIATIONS BMI: body mass index; CE: cardioembolism; CI: confidence interval; LAA: large-artery atherosclerosis; NIHSS: National Institutes of Health Stroke Scale; OR: odds ratio; SAO: small-artery occlusion; WC: waist circumference.
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Affiliation(s)
- Kyusik Kang
- a Department of Neurology , Nowon Eulji Medical Center, Eulji University , Seoul , Republic of Korea
| | - Wong-Woo Lee
- a Department of Neurology , Nowon Eulji Medical Center, Eulji University , Seoul , Republic of Korea
| | - Jung-Ju Lee
- a Department of Neurology , Nowon Eulji Medical Center, Eulji University , Seoul , Republic of Korea
| | - Jong-Moo Park
- a Department of Neurology , Nowon Eulji Medical Center, Eulji University , Seoul , Republic of Korea
| | - Ohyun Kwon
- a Department of Neurology , Nowon Eulji Medical Center, Eulji University , Seoul , Republic of Korea
| | - Byung Kun Kim
- a Department of Neurology , Nowon Eulji Medical Center, Eulji University , Seoul , Republic of Korea
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16
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Meadows KL. Ischemic stroke and select adipose-derived and sex hormones: a review. Hormones (Athens) 2018; 17:167-182. [PMID: 29876798 DOI: 10.1007/s42000-018-0034-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/27/2018] [Indexed: 02/03/2023]
Abstract
Ischemic stroke is the fifth leading cause of death in the USA and is the leading cause of serious, long-term disability worldwide. The principle sex hormones (estrogen, progesterone, and testosterone), both endogenous and exogenous, have profound effects on various stroke outcomes and have become the focus of a number of studies evaluating risk factors and treatment options for ischemic stroke. In addition, the expression of other hormones that may influence stroke outcome, including select adipose-derived hormones (adiponectin, leptin, and ghrelin), can be regulated by sex hormones and are also the focus of several ischemic stroke studies. This review aims to summarize some of the preclinical and clinical studies investigating the principle sex hormones, as well as select adipose-derived hormones, as risk factors or potential treatments for ischemic stroke. In addition, the potential for relaxin, a lesser studied sex hormone, as a novel treatment option for ischemic stroke is explored.
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Affiliation(s)
- Kristy L Meadows
- Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Rd., North Grafton, MA, 01536, USA.
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17
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Liberale L, Carbone F, Bertolotto M, Bonaventura A, Vecchié A, Mach F, Burger F, Pende A, Spinella G, Pane B, Palombo D, Dallegri F, Montecucco F. Serum adiponectin levels predict acute coronary syndrome (ACS) in patients with severe carotid stenosis. Vascul Pharmacol 2018; 102:37-43. [PMID: 29305337 DOI: 10.1016/j.vph.2017.12.066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/12/2017] [Accepted: 12/30/2017] [Indexed: 02/06/2023]
Abstract
As endocrine organ, adipose tissue may modulate inflammatory response by releasing a wide range of mediators, known as adipocytokines. Due to the complex balance between pro- and anti-inflammatory activity their pathophysiological and prognostic role in cardiovascular (CV) diseases still remains debated. Here, we consider the potential associations of circulating adipocytokines adiponectin, leptin and their ratio (LAR), with metabolic and inflammatory profiles in 217 patients with severe carotid stenosis. A prospective analysis investigating their predictive role toward acute coronary syndromes (ACS) was also drawn over a 12-month follow-up period. Serum leptin was positively associated with fasting insulinemia and HOMA-IR, but not with lipid profile and inflammation. Conversely, adiponectin was negatively associated with glucose, insulin, HOMA-IR, triglycerides and both systemic and intraplaque inflammatory markers whereas a positive association with high-density lipoprotein cholesterol (HDL-c) was observed. Accordingly, a significant association with metabolic profile was reported for LAR. According to the cut-off point identified by ROC curve, adiponectin values≤2.56μg/mL were correlated with a higher risk of ACS occurrence at 12months' follow-up (p-value for Log Rank test=0.0003). At Cox regression analysis the predictive ability of low serum adiponectin was confirmed also after adjustment for age, male gender and diabetes. In conclusion, adiponectin may be considered a biomarker of metabolic compensation, inversely associated with chronic low-grade inflammation. Circulating adiponectin is also associated with lower risk of adverse CV events in patients with severe carotid stenosis.
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Affiliation(s)
- Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland.
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Maria Bertolotto
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Alessandra Vecchié
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - François Mach
- Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva, 64 Avenue de la Roseraie, 1211 Geneva, Switzerland
| | - Fabienne Burger
- Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva, 64 Avenue de la Roseraie, 1211 Geneva, Switzerland
| | - Aldo Pende
- Clinic of Emergency Medicine, Department of Emergency Medicine, University of Genoa, 16132 Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132 Genoa, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, Department of Surgery, University of Genoa, 16132 Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132 Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, Department of Surgery, University of Genoa, 16132 Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132 Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, Department of Surgery, University of Genoa, 16132 Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132 Genoa, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132 Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy
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18
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Liberale L, Montecucco F, Casetta I, Seraceni S, Trentini A, Padroni M, Dallegri F, Mach F, Fainardi E, Carbone F. Decreased serum PCSK9 levels after ischaemic stroke predict worse outcomes. Eur J Clin Invest 2016; 46:1053-1062. [PMID: 27759884 DOI: 10.1111/eci.12692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/17/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Soluble mediators have been investigated to predict the prognosis of acute ischaemic stroke (AIS). Among them, proprotein convertase subtilisin/kexin type 9 (PCSK9) might have both clinical and pathophysiological relevance. MATERIALS AND METHODS All available serum samples from a cohort of patients with first AIS (n = 72) were tested for PCSK9 and included in this substudy analysis. The primary endpoint investigated the predictive value of early PCSK9 level variations (ΔPCSK9) from AIS onset to day 7 or from day 1 to day 7, towards a 90-day outcome by modified Rankin Scale (mRS). The secondary endpoint explored the association between ΔPCSK9 and the risk of major adverse cardiovascular events (MACEs). RESULTS Decreased serum PCSK9 levels at days 1 and 7 were associated with poor clinical outcomes at day 90. At the cut-off point identified by ROC curve analysis (-61·28 ng/mL), ΔPCSK9 day 7-day 1 predicted a poor mRS at day 90 after AIS. ΔPCSK9 day 7-day 1 ≤ -61·28 ng/mL was associated with an increased rate of MACEs. CONCLUSION A decrease in PCSK9 levels was a predictor for poor outcome and increased MACEs after AIS. Additional studies targeting post-AIS PCSK9 levels and activity are required to clarify the prognostic and pathophysiological relevance of PCSK9 after AIS.
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Affiliation(s)
- Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS AOU San Martino - IST, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Ilaria Casetta
- Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | - Silva Seraceni
- Istitute for Maternal and Child Health 'IRCCS Burlo Garofolo', Trieste, Italy
| | - Alessandro Trentini
- Section of Medical Biochemistry, Molecular Biology and Genetics, Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Marina Padroni
- Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS AOU San Martino - IST, Genoa, Italy
| | - François Mach
- Division of Cardiology, Department of Medical Specialties, Foundation for Medical Researches, University of Geneva, Geneva, Switzerland
| | - Enrico Fainardi
- Neuroradiology Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
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19
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Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke. Int J Mol Sci 2016; 17:ijms17121967. [PMID: 27898011 PMCID: PMC5187767 DOI: 10.3390/ijms17121967] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 12/26/2022] Open
Abstract
After an acute ischemic stroke (AIS), inflammatory processes are able to concomitantly induce both beneficial and detrimental effects. In this narrative review, we updated evidence on the inflammatory pathways and mediators that are investigated as promising therapeutic targets. We searched for papers on PubMed and MEDLINE up to August 2016. The terms searched alone or in combination were: ischemic stroke, inflammation, oxidative stress, ischemia reperfusion, innate immunity, adaptive immunity, autoimmunity. Inflammation in AIS is characterized by a storm of cytokines, chemokines, and Damage-Associated Molecular Patterns (DAMPs) released by several cells contributing to exacerbate the tissue injury both in the acute and reparative phases. Interestingly, many biomarkers have been studied, but none of these reflected the complexity of systemic immune response. Reperfusion therapies showed a good efficacy in the recovery after an AIS. New therapies appear promising both in pre-clinical and clinical studies, but still need more detailed studies to be translated in the ordinary clinical practice. In spite of clinical progresses, no beneficial long-term interventions targeting inflammation are currently available. Our knowledge about cells, biomarkers, and inflammatory markers is growing and is hoped to better evaluate the impact of new treatments, such as monoclonal antibodies and cell-based therapies.
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20
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Carbone F, Satta N, Montecucco F, Virzi J, Burger F, Roth A, Roversi G, Tamborino C, Casetta I, Seraceni S, Trentini A, Padroni M, Dallegri F, Lalive PH, Mach F, Fainardi E, Vuilleumier N. Anti-ApoA-1 IgG serum levels predict worse poststroke outcomes. Eur J Clin Invest 2016; 46:805-17. [PMID: 27490973 DOI: 10.1111/eci.12664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/01/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Autoantibodies to apolipoprotein A-1 (anti-ApoA-1 IgG) were shown to predict major adverse cardiovascular events and promote atherogenesis. However, their potential relationship with clinical disability and ischaemic lesion volume after acute ischaemic stroke (AIS) remains unexplored. MATERIALS AND METHODS We included n = 76 patients admitted for AIS and we investigated whether baseline serum anti-ApoA-1 IgG levels could predict (i) AIS-induced clinical disability [assessed by the modified Rankin Scale (mRS)], and (ii) AIS-related ischaemic lesion volume [assessed by Computed Tomography (CT)]. We also evaluated the possible pro-apoptotic and pro-necrotic effects of anti-ApoA-1 IgG on human astrocytoma cell line (U251) using flow cytometry. RESULTS High levels of anti-ApoA-1 IgG were retrieved in 15·8% (12/76) of patients. Increased baseline levels of anti-ApoA-1 IgG were independently correlated with worse mRS [β = 0·364; P = 0·002; adjusted odds ratio (OR): 1·05 (95% CI 1·01-1·09); P = 0·017] and CT-assessed ischaemic lesion volume [β = 0·333; P < 0·001; adjusted OR: 1·06 (95% CI 1·01-1·12); P = 0·048] at 3 months. No difference in baseline clinical, biochemical and radiological characteristics was observed between patients with high vs. low levels of anti-ApoA-1 IgG. Incubating human astrocytoma cells with anti-ApoA-1 IgG dose dependently induced necrosis and apoptosis of U251 cells in vitro. CONCLUSION Anti-ApoA-1 IgG serum levels at AIS onset are associated with poorer clinical recovery and worse brain lesion volume 3 months after AIS. These observations could be partly explained by the deleterious effect of anti-ApoA-1 IgG on human brain cell survival in vitro and may have clinical implication in the prediction of poor outcome in AIS.
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Affiliation(s)
- Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, School of Medicine, University of Genoa, Genoa, Italy
| | - Nathalie Satta
- Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, School of Medicine, University of Genoa, Genoa, Italy.,IRCCS AOU San Martino - IST, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Julien Virzi
- Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Burger
- Division of Cardiology, Department of Medical Specialties, Foundation for Medical Researches, University of Geneva, Geneva, Switzerland
| | - Aline Roth
- Division of Cardiology, Department of Medical Specialties, Foundation for Medical Researches, University of Geneva, Geneva, Switzerland
| | - Gloria Roversi
- Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Carmine Tamborino
- Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Ilaria Casetta
- Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Silva Seraceni
- Institute for Maternal and Child Health 'IRCCS Burlo Garofolo', Trieste, Italy
| | - Alessandro Trentini
- Section of Medical Biochemistry, Molecular Biology and Genetics, Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Marina Padroni
- Section of Medical Biochemistry, Molecular Biology and Genetics, Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, School of Medicine, University of Genoa, Genoa, Italy.,IRCCS AOU San Martino - IST, Genoa, Italy
| | - Patrice H Lalive
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland
| | - François Mach
- Division of Cardiology, Department of Medical Specialties, Foundation for Medical Researches, University of Geneva, Geneva, Switzerland
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
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