Comparison of glycosylated fibrinogen, albumin, and haemoglobin as indices of blood glucose control in diabetic patients

In silico prediction of protein binding affinities onto core-shell PEGylated noble metal nanoparticles for rational design of drug nanocarriers

Polymer-coated nanoparticles (NP) are commonly used as drug carriers or theranostic agents. Their uptake rates are modulated by the interactions with essential serum proteins such as transferrin and albumin. Understanding the control parameters of these interactions is crucial for improving the efficiency of these nanoscale devices. In this work, we perform a multiscale computational study of protein adsorption onto polyethylene glycol (PEG) coated gold and silver NPs, producing protein-NP adsorption rankings as a function of PEG grafting density, which are validated against previously reported experimental protein-NP binding constants. Furthermore, the applied nano-docking method provides information on the preferred orientation of proteins immobilised on the surface of NPs. We propose a method of construction of model core-shell NPs in silico. The presented protocol can provide molecular level insights for the experimental development of biosensors, nanocarriers, or other nanoplatforms where information on the preferred orientation of protein at the bio-nano interface is crucial, and enables fast in silico prescreening of assays of various nanocarriers, i.e., combinations of proteins, NPs, and coatings.

Hypofibrinolysis in diabetes: a therapeutic target for the reduction of cardiovascular risk

An enhanced thrombotic environment and premature atherosclerosis are key factors for the increased cardiovascular risk in diabetes. The occlusive vascular thrombus, formed secondary to interactions between platelets and coagulation proteins, is composed of a skeleton of fibrin fibres with cellular elements embedded in this network. Diabetes is characterised by quantitative and qualitative changes in coagulation proteins, which collectively increase resistance to fibrinolysis, consequently augmenting thrombosis risk. Current long-term therapies to prevent arterial occlusion in diabetes are focussed on anti-platelet agents, a strategy that fails to address the contribution of coagulation proteins to the enhanced thrombotic milieu. Moreover, antiplatelet treatment is associated with bleeding complications, particularly with newer agents and more aggressive combination therapies, questioning the safety of this approach. Therefore, to safely control thrombosis risk in diabetes, an alternative approach is required with the fibrin network representing a credible therapeutic target. In the current review, we address diabetes-specific mechanistic pathways responsible for hypofibrinolysis including the role of clot structure, defects in the fibrinolytic system and increased incorporation of anti-fibrinolytic proteins into the clot. Future anti-thrombotic therapeutic options are discussed with special emphasis on the potential advantages of modulating incorporation of the anti-fibrinolytic proteins into fibrin networks. This latter approach carries theoretical advantages, including specificity for diabetes, ability to target a particular protein with a possible favourable risk of bleeding. The development of alternative treatment strategies to better control residual thrombosis risk in diabetes will help to reduce vascular events, which remain the main cause of mortality in this condition.

High-dose aspirin is required to influence plasma fibrin network structure in patients with type 1 diabetes

OBJECTIVE

Patients with type 1 diabetes form a less permeable fibrin network, which could contribute to their increased risk of cardiovascular disease (CVD). Low-dose aspirin treatment is the standard in the management of CVD; however, the effect seems reduced in patients with diabetes. We investigated the effects of low- and high-dose aspirin treatment on fibrin network formation in patients with type 1 diabetes (primary aim) and the possible interaction between the treatment effects of aspirin on fibrin network permeability and glycemic control in these patients (secondary aim).

RESEARCH DESIGN AND METHODS

Forty-eight patients (24 subjects with good [HbA(1c) <7.4%] and 24 subjects with poor [HbA(1c) >8.4%] glycemic control) were randomly assigned to treatment with 75 or 320 mg/day aspirin during 4 weeks in a crossover fashion. A 4-week washout period separated the treatment periods. The plasma fibrin network was assessed by determination of the permeability coefficient (K(s)).

RESULTS

Treatment with 75 mg aspirin did not influence fibrin network permeability (K(s)). However, K(s) increased significantly during treatment with 320 mg aspirin (P = 0.004), and a significant treatment effect was seen compared with treatment with 75 mg aspirin (P = 0.009). The increase in K(s) during high-dose aspirin treatment was significant in patients with poor glycemic control (P = 0.02), whereas K(s) only tended to increase in patients with good glycemic control (P = 0.06).

CONCLUSIONS

A high dose of aspirin is required to influence fibrin network permeability in patients with type 1 diabetes. The observed lack of effect with low-dose aspirin may contribute to aspirin treatment failure in diabetes.

Glycation of fibrinogen in uncontrolled diabetic patients and the effects of glycaemic control on fibrinogen glycation

INTRODUCTION

Evidence exists for a relationship between glycaemic control and macrovascular disease. Non-enzymatic glycation of proteins may explain this relationship in part. We investigated the effect of blood glucose control, under out-patient conditions, on fibrinogen glycation as well as the relationship between glycated fibrinogen and glycaemic control using a new sensitive method for the measurement of glycated fibrinogen.

MATERIALS AND METHODS

Blood samples were taken from twenty subjects with uncontrolled Type 2 diabetes (HbA1c>7%) to determine the levels of glycation. The subjects were then treated with insulin in order to control blood glucose. Twenty age and BMI matched non-diabetic subjects were included as a reference group.

RESULTS

The subjects with diabetes had significantly higher mean fibrinogen glycation at baseline than the non-diabetic subjects (7.84 vs 3.89 mol glucose/mol fibrinogen; p<0.001). After control of blood glucose, fibrinogen glycation was reduced significantly in the subjects with diabetes (7.84 to 5.24 mol glucose/mol fibrinogen; p<0.0002). The change in glycation during the intervention correlated significantly with the change in capillary glucose in the diabetic group (r=0.6, p=0.005). Fibrinogen glycation was comparable to HbA1c in predicting glycaemic control (p=0.54). Fibrinogen glycation correlated best with the average fasting capillary glucose of the preceding 5-8 days (r=0.54, p=0.014).

CONCLUSION

We conclude that glucose control under out-patient conditions decreases fibrinogen glycation in subjects with Type 2 diabetes and that glycated fibrinogen compares well with HbA1c in its relation to glycaemic control.

Fructosamine in obese normal subjects and type 2 diabetes

The effect of various grades of obesity on serum fructosamine concentrations was studied in Type 2 diabetic (n = 105) and non-diabetic (n = 128) subjects. In obese diabetic and non-diabetic subjects (body mass index > or = 30 kg m-2), the concentration of fructosamine was markedly lower than that obtained for lean diabetic and non-diabetic subjects with similar glycaemic control. Stepwise multiple-regression analysis showed that fructosamine was associated with glycaemic control (as indicated by fasting plasma glucose and glycated haemoglobin), fasting triglycerides, and body mass index in both diabetic and non-diabetic subjects. In vitro studies showed marked decreases in both the extent of [14C]-glucose incorporation into plasma proteins and fructosamine production by incubated sera of obese patients whether diabetic or non-diabetic, with obese subjects with body mass index > 40 kg m-2 exhibiting the greatest decrease. In conclusion, serum fructosamine concentrations are shown to decrease in obese diabetic and non-diabetic subjects with body mass index > or = 30 kg m-2 giving rise to the underestimation of glycaemic control as indicated by fructosamine measurement. A change in the glycation reaction itself may be partly responsible for such decrease.