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Luo Z, Fu C, Li T, Gao Q, Miao D, Xu J, Zhao Y. Hypoglycemic Effects of Licochalcone A on the Streptozotocin-Induced Diabetic Mice and Its Mechanism Study. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:2444-2456. [PMID: 33605141 DOI: 10.1021/acs.jafc.0c07630] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is a type of metabolic illness based on relatively insufficient insulin secretion and insulin resistance (IR) as pathophysiological bases. Currently, it is the main type of diabetes. Hypoglycemic and hypolipidemic effects of licochalcone A (LicA) on high-fat diet and streptozocin-caused T2DM were studied. LicA can remarkably decline the IR index and blood glucose and serum lipid levels. Also, the treatment of LicA can improve the "three more and one less" phenomenon in T2DM mice, such as excessive drinking, eating, urine, and weight loss. In addition, LicA can improve oral glucose tolerance, pancreatic injury, and liver enlargement in T2DM mice. Network pharmacology analysis demonstrated that the observed pharmacological effects were mediated by regulating the insulin signal transduction pathway. Therefore, the PI3K/Akt-signaling pathway was selected for verification; it was demonstrated that LicA could improve the insulin-signaling pathway, protect islet cells, improve IR, reduce blood glucose levels, and alleviate lipid metabolism disorder. Its mechanism of influence may be closely related to LicA up-regulating the liver and pancreas IRS-2/PI3K/AKT-signaling pathway. Among them, the high-dose group of LicA had the best effect, which provided an idea for the use of LicA as a nutritional agent in the cure of T2DM.
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Affiliation(s)
- Zhonghua Luo
- Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Chaofan Fu
- Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Tao Li
- Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Qingqing Gao
- Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Dongyu Miao
- Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Jing Xu
- Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Yuqing Zhao
- Shenyang Pharmaceutical University, Shenyang 110016, China
- Key Laboratory of Structure-based Drug Design and Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China
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Zhou AM, Xiang YJ, Liu EQ, Cai CH, Wu YH, Yang LB, Zeng CL. Salvianolic acid a inhibits platelet activation and aggregation in patients with type 2 diabetes mellitus. BMC Cardiovasc Disord 2020; 20:15. [PMID: 31931718 PMCID: PMC6956554 DOI: 10.1186/s12872-019-01316-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Platelets in patients with type 2 diabetes mellitus (DM2) are characterized by increased activation and aggregation, which tends to be associated with a high morbidity and mortality due to cardiovascular disease (CVD). Moreover, a large proportion of DM2 patients show an inadequate response to standard antiplatelet treatments, contributing to recurrent cardiovascular events. In our previous study, we indicated that Salvianolic acid A (SAA) presents an antiplatelet effect in healthy volunteers. However, whether it can inhibit “activated platelets” with a pathologic status has not been explored. Therefore, this study was designed to investigate the antiplatelet effect of SAA and its diabetic complication-related difference in DM2. Methods Forty patients diagnosed with DM2 from January 2018 to April 2018 were recruited. Fibrinogen-binding (PAC-1) and P-selectin (CD62p) flow cytometry reagents were measured under resting and stimulated conditions by flow cytometry, while agonist-induced platelet aggregation was conducted by light transmission aggregometry. Before all these measurements were conducted, all platelet samples were preincubated with a vehicle or SAA for 10 min. Additionally, the diabetic complication-related difference in the antiplatelet effect of SAA was further studied in enrolled patients. Results The expressions of PAC-1 and CD62p were elevated in DM2, as well as the maximal platelet aggregation. In addition, SAA decreased the expressions of PAC-1 and CD62p, which were enhanced by ADP and thrombin (all P < 0.01). It also reduced the platelet aggregation induced by ADP (P < 0.001) and thrombin (P < 0.05). Comparing the antiplatelet effect of SAA on DM2, with and without diabetic complications, no statistically significant difference was found (all P > 0.05). Conclusions The present study demonstrated that SAA can inhibit platelet activation and aggregation in patients with DM2, and the inhibition did not abate for the existence of diabetic complications.
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Affiliation(s)
- Ai-Ming Zhou
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yi-Jia Xiang
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, Zhejiang, China
| | - En-Qian Liu
- Zhejiang University School of Medicine, Hangzhou, 310029, Zhejiang, China
| | - Chang-Hong Cai
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Yong-Hui Wu
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Le-Bing Yang
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Chun-Lai Zeng
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, Zhejiang, China.
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Bairy S, Rao MR, Edla SR, Manthena SR, Tatavarti NVGD. Effect of an Integrated Naturopathy and Yoga Program on Long-Term Glycemic Control in Type 2 Diabetes Mellitus Patients: A Prospective Cohort Study. Int J Yoga 2020; 13:42-49. [PMID: 32030020 PMCID: PMC6937879 DOI: 10.4103/ijoy.ijoy_32_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/31/2019] [Accepted: 09/11/2019] [Indexed: 11/04/2022] Open
Abstract
AIM Lifestyle is an important risk factor for increasing the prevalence of diabetes in the Indian population. In this study, we evaluate the effects of naturopathy treatment, salt-restricted low-calorie diets, and yoga in long-term glycemic control in patients with type 2 diabetes mellitus. METHODS In this prospective, longitudinal, two-arm cohort study, patients with type 2 diabetes mellitus referred from a tertiary care center undergoing a 3-month residential naturopathy treatment were compared with those undergoing only conventional management on glycemic control. Both fasting and postprandial blood glucose (PPBG) levels were assessed at baseline, 3 months following intervention, at 6 months, and 12 months from the study start. Data were analyzed using repeated-measures ANOVA with post hoc Bonferroni correction. RESULTS Naturopathy and yoga intervention significantly reduced PPBG levels (P < 0.001), glycated hemoglobin levels (P < 0.001), and reduced requirement for antidiabetic medications (P < 0.008) in the intervention group compared to controls. The effects were more profound immediately following intervention and lasted up to 6 months from the start of the study. CONCLUSION The results suggest benefit with an intensive residential naturopathy-based lifestyle intervention program. Randomized controlled trials are needed to further validate the findings.
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Affiliation(s)
- Srinivas Bairy
- Manthena Satyanarayana Raju Arogylayam, Guntur, Andhra Pradesh, India
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Barreira E, Novo A, Vaz JA, Pereira AMG. Dietary program and physical activity impact on biochemical markers in patients with type 2 diabetes: A systematic review. Aten Primaria 2018; 50:590-610. [PMID: 29061310 PMCID: PMC6836882 DOI: 10.1016/j.aprim.2017.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/26/2017] [Accepted: 06/13/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Evaluate the effectiveness of the implementation of independently or combined dietary and physical activity programs on the blood glucose values and lipid profile in patients with type 2 diabetes, including participants aged 60 years and over. DESIGN Systematic review. DATA SOURCE PubMed/Medline database, with language restrictions. Papers published between 2010 and 2016 were included. STUDY SELECTION A total of 30 randomised controlled trials were included that focused on physical activity and dietary interventions in patients with type 2 diabetes mellitus and include participants aged 60 years and over. RESULTS The selected articles have shown that the implementation of physical activity programs (aerobic, resistance, flexibility and combined exercises), and programs based on a higher intake of vegetables, grains, legumes, fruits, unsaturated fatty acids, as well as consumption of foods with low glycaemic index, calorie restriction, intake of probiotics, vitamin D supplementation and educational sessions about diabetes improves blood glucose levels, as well as the lipid profile, in patients with type 2 diabetes. CONCLUSIONS Physical activity and dietary programs are fundamental in the treatment and metabolic control of type 2 diabetes mellitus.
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Affiliation(s)
- Eduarda Barreira
- Health School, Polytechnic Institute of Bragança, Bragança, Portugal.
| | - André Novo
- Health School, Polytechnic Institute of Bragança, Bragança, Portugal; CINTESIS-Research Center on Health Technologies and Services, Porto, Portugal
| | - Josiana A Vaz
- Health School, Polytechnic Institute of Bragança, Bragança, Portugal; CIMO-Mountain Research Centre, Polytechnic Institute of Bragança, Campus de Santa Apolónia, Bragança, Portugal
| | - Ana M G Pereira
- Health School, Polytechnic Institute of Bragança, Bragança, Portugal
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Gaiz A, Mosawy S, Colson N, Singh I. Thrombotic and cardiovascular risks in type two diabetes; Role of platelet hyperactivity. Biomed Pharmacother 2017; 94:679-686. [PMID: 28787703 DOI: 10.1016/j.biopha.2017.07.121] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/20/2022] Open
Abstract
One of the most commonly identified chronic illnesses in many countries is type 2 diabetes mellitus (T2DM). T2DM denotes an independent risk factor for cardiovascular disease (CVD). Heart disease is one of the causes of mortality in patients with diabetes, mainly due to the macrovascular complications. One of these macrovascular complications in diabetes is atherosclerosis, which involves a complicated pathophysiological process. Besides hyperglycemia, oxidative stress plays a significant role in the pathogenesis of diabetes and its associated risk of CVD. There are many other factors including molecular, metabolic, lipid, fibrinolytic, and platelet function disorders precipitate to thrombotic and CVD risks in T2DM. Also, Platelets have an increased response to procoagulants in patients with diabetes. Platelet hyperactivity, in the presence of oxidative stress, has a major effect on the progression of thrombotic and CVD events. This review will discuss the impact of the above factors and the potential effects of platelet hyperactivity on thrombotic and cardiovascular risks.
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Affiliation(s)
- Almottesembellah Gaiz
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parkland Drive, Southport, Queensland, 4222, Australia; National Centre of Hematology, Almustansiriah University, Alyarmook, Baghdad, Iraq.
| | - Sapha Mosawy
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parkland Drive, Southport, Queensland, 4222, Australia
| | - Natalie Colson
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parkland Drive, Southport, Queensland, 4222, Australia
| | - Indu Singh
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parkland Drive, Southport, Queensland, 4222, Australia
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Tissue factor levels in type 2 diabetes mellitus. Inflamm Res 2017; 66:365-368. [PMID: 28246677 DOI: 10.1007/s00011-017-1030-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus is a pandemic associated with disturbance in haemostasis that could contribute to the development of diabetic vascular disease and accelerated atherosclerosis. In this population, hypercoagulation is prevalent, as well as pathological changes to erythrocytes. This is mainly due to upregulated circulating inflammatory markers. MATERIALS AND METHODS Here we looked at tissue factor (TF) levels using ELISA, in a sample of diabetics, with and without cardiovascular complications. Diabetic subjects were recruited from the diabetic clinic at Steve Biko Academic Hospital, Pretoria, South Africa. 20 diabetics with cardiovascular disease and 22 without were enrolled to participate. RESULTS AND CONCLUSION TF levels were significantly elevated in both diabetic groups when compared to the controls. We suggest that pathologic plasma TF activity, as marker of increased propensity of clot pathology, should be investigated. Agents that might lower TF levels might also possibly lower thrombotic complications.
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Soma P, Swanepoel AC, du Plooy JN, Mqoco T, Pretorius E. Flow cytometric analysis of platelets type 2 diabetes mellitus reveals 'angry' platelets. Cardiovasc Diabetol 2016; 15:52. [PMID: 27036108 PMCID: PMC4818425 DOI: 10.1186/s12933-016-0373-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/23/2016] [Indexed: 12/26/2022] Open
Abstract
Background The function of platelets have extended way beyond the horizon of haemostasis and thrombosis, and are recognised as active participants in vascular inflammation, as well as in prothrombotic complications of cardiovascular diseases. We describe and compare platelet function in type II diabetes (with and without cardiovascular manifestation) and healthy individuals using scanning electron microscopy and flow cytometry. Methods Thirty subjects were recruited per group and informed consent was obtained from all participants. Diabetic patients were recruited from the diabetic clinic of the Steve Biko Academic Hospital (South Africa). Blood samples were drawn from all participants so that platelet specific antigens were analyzed in citrated whole blood. The platelet parameters used in the study were platelet identifiers (CD41 and CD42) and markers of platelet activation (CD62 and CD63). Results Results show that, compared to healthy individuals, both diabetic groups showed a significant difference in both platelet identifiers (CD41-PE, CD42b-PE) as well as markers indicating platelet activation (CD62P-PE and CD63-PE). Interpretation The flow cytometric data shows that the platelet surface receptors and platelet activation are statistically elevated. This is suggestive of enhanced platelet activation and it appears as if platelets are displaying ‘angry’ behaviour. The lysosomal granules may play a significant role in diabetes with cardiovascular complications. These results were confirmed by ultrastructural analysis.
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Affiliation(s)
- Prashilla Soma
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia, Pretoria, 0007, South Africa
| | - Albe Carina Swanepoel
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia, Pretoria, 0007, South Africa
| | - Jeanette Noel du Plooy
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia, Pretoria, 0007, South Africa
| | - Thandi Mqoco
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia, Pretoria, 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia, Pretoria, 0007, South Africa.
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Vichova T, Knot J, Ulman J, Maly M, Motovska Z. The impact of stage of chronic kidney disease on the outcomes of diabetics with acute myocardial infarction treated with percutaneous coronary intervention. Int Urol Nephrol 2016; 48:1137-43. [PMID: 26995007 DOI: 10.1007/s11255-016-1260-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/02/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of acute myocardial infarction and recurrent cardiovascular events. According to the previous studies, the combination of the two conditions may have a synergistic impact on prognosis. The aim of this study was to assess the impact of stage of CKD on the outcomes of patients with DM and ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). METHODS Study population consisted of 946 consecutive patients with STEMI who underwent PCI from January 2009 to December 2012 and were followed up until the end of 2013. The all-cause mortality during this period was evaluated in relation to DM and severe or moderate reduction in glomerular filtration rate (GFR categories G4-5, or G3; KDIGO classification). Cox regression analysis adjusted for possible confounding factors was used in statistics. RESULTS Out of the study population (mean age 63 years, 69.6 % males), 217 (22.9 %) patients had DM. Of them, 10.6 % were in GFR category G4-5 and 32.7 % in G3. The in-hospital mortality rates in patients with DM were 34.8 % for G4-5, 18.3 % for G3, and 4.1 % in G1-2 groups. The all-cause mortality at the end of the follow-up period for diabetics within G4-5 was 2.27 -times higher compared to mortality of diabetics in G1-2 (p = 0.047, Cox regression analysis), and there was a trend toward higher mortality for G3 versus G1-2 (HR 1.64, p = 0.12). CONCLUSION Severe chronic kidney disease (GFR category 4-5) was significantly associated with all-cause mortality of diabetics with STEMI treated with PCI; the association with severe CKD was stronger compared to moderate CKD.
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Affiliation(s)
- Teodora Vichova
- Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic
| | - Jiri Knot
- Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic
| | - Jaroslav Ulman
- Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic
| | - Marek Maly
- Department of Biostatistics and Informatics, National Institute of Public Health, Srobarova 48, 10042, Prague, Czech Republic
| | - Zuzana Motovska
- Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic.
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Shehata M, Fayez G, Nassar A. Intensive Statin Therapy in NSTE-ACS Patients Undergoing PCI: Clinical and Biochemical Effects. Tex Heart Inst J 2015; 42:528-36. [PMID: 26664304 DOI: 10.14503/thij-14-4891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Early initiation of statin therapy in acute coronary syndrome patients has a favorable prognostic impact because of its anti-inflammatory and antithrombotic properties. In this study, we explored the effect of atorvastatin-loading, followed by intensive atorvastatin therapy, on clinical and biochemical outcomes in non-ST-segment-elevation acute coronary syndrome patients who were scheduled for percutaneous coronary intervention. We prospectively enrolled 140 patients (mean age, 56 ± 9 years, 68% men). Once eligible, patients were randomly assigned to receive either a moderate 20-mg daily dose of atorvastatin (Group A) or a 160-mg loading dose followed by an intensified 80-mg daily dose (Group B). High-sensitivity C-reactive protein (hs-CRP) levels were recorded before and after intervention. Evaluation after 6 months included hs-CRP levels, left ventricular systolic function, and major adverse cardiac events. We found no significant difference between the 2 groups in regard to the interventional data. However, blood sampling after coronary intervention, and again 6 months later, revealed a significant decline in mean hs-CRP level among Group B patients (P < 0.001). Moreover, patients in Group B manifested a higher left ventricular ejection fraction than did patients in Group A (P < 0.05). After 6 months, we found no significant difference between groups in the incidence of major adverse cardiac events. We conclude that intensive atorvastatin therapy in non-ST-segment-elevation acute coronary syndrome patients is associated with lower hs-CRP levels and with higher left ventricular ejection fraction after 6 months, with no significant impact on adverse cardiac events.
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Effect of acetylsalicylic acid on platelet activation and oxidative profile in a set of Brazilian patients with type 2 diabetes mellitus. Blood Coagul Fibrinolysis 2015; 26:123-30. [PMID: 25325344 DOI: 10.1097/mbc.0000000000000199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Type 2 diabetes mellitus (DM2) is a metabolic disorder associated with hyperactivation of platelets, increased formation of platelet microparticles (PMPs) and oxidative stress that are related to cardiovascular complications. Acetylsalicylic acid (ASA) is an antiplatelet agent used in the prevention of atherothrombosis. The aim of this study was to evaluate the effect of ASA by means of platelet activation and oxidative profile. We collected blood samples of 81 patients with DM2 before and during ASA treatment. These samples were analyzed to determine the levels of 2,3-dinor thromboxane-B2 (2,3-dinor-TXB2), PMPs, thiobarbituric acid reactive species (TBARS) and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT). Moreover, the relationship between the levels of 2,3-dinor-TXB2 with some clinical and laboratory variables such as glycated hemoglobin, platelet count, D dimer, low-density lipoprotein cholesterol and glycoprotein IIb/IIIa and cyclooxygenase-1 polymorphisms was evaluated. ASA intake did not change the levels of PMP, TBARS and MTT. Although a significant decrease in the levels of 2,3 dinorTXB2 (P < 0.001) in patients under ASA has been observed, an equal and satisfactory response to this drug was not found. However, the presence of PIA2 allele in GPIIIa gene may be associated with a better response to ASA intake in these patients, whereas other clinical and laboratory variables showed no association with this drug use. These findings are consistent with previous reports in the literature that patients with DM2 do not benefit in an equal way from the use of ASA for primary prevention of atherothrombotic events.
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Soma P, Pretorius E. Interplay between ultrastructural findings and atherothrombotic complications in type 2 diabetes mellitus. Cardiovasc Diabetol 2015; 14:96. [PMID: 26228646 PMCID: PMC4521497 DOI: 10.1186/s12933-015-0261-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/19/2015] [Indexed: 12/27/2022] Open
Abstract
Accelerated atherosclerosis is the main underlying factor contributing to the high risk of atherothrombotic events in patients with diabetes mellitus and atherothrombotic complications are the main cause of mortality. Like with many bodily systems, pathology is observed when the normal processes are exaggerated or uncontrolled. This applies to the processes of coagulation and thrombosis as well. In diabetes, in fact, the balance between prothrombotic and fibrinolytic factors is impaired and thus the scale is tipped towards a prothrombotic and hypofibrinolytic milieu, which in association with the vascular changes accompanying plaque formation and ruptures, increases the prevalence of ischaemic events such as angina and myocardial infarction. Apart from traditional, modifiable risk factors for cardiovascular disease like hypertension, smoking, elevated cholesterol; rheological properties, endogenous fibrinolysis and impaired platelet activity are rapidly gaining significance in the pathogenesis of atherosclerosis especially in diabetic subjects. Blood clot formation represents the last step in the athero-thrombotic process, and the structure of the fibrin network has a role in determining predisposition to cardiovascular disease. It is no surprise that just like platelets and fibrin networks, erythrocytes have been shown to play a role in coagulation as well. This is in striking contrast to their traditional physiological role of oxygen transport. In fact, emerging evidence suggests that erythrocytes enhance functional coagulation properties and platelet aggregation. Among the spectrum of haematological abnormalities in diabetes, erythrocyte aggregation and decreased deformability of erythrocytes predominate. More importantly, they are implicated in the pathogenesis of microvascular complications of diabetes. The morphology of platelets, fibrin networks and erythrocytes are thus essential role players in unravelling the pathogenesis of cardiovascular complications in diabetic subjects.
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Affiliation(s)
- Prashilla Soma
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
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12
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Zheng Y, Wang L, Zhu Z, Yan X, Zhang L, Xu P, Luo D. Altered platelet calsequestrin abundance, Na⁺/Ca²⁺ exchange and Ca²⁺ signaling responses with the progression of diabetes mellitus. Thromb Res 2014; 134:674-81. [PMID: 25084748 DOI: 10.1016/j.thromres.2014.03.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/11/2014] [Accepted: 03/24/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Downregulation of calsequestrin (CSQ), a major Ca(2+) storage protein, may contribute significantly to the hyperactivity of internal Ca(2+) ([Ca(2+)]i) in diabetic platelets. Here, we investigated changes in CSQ-1 abundance, Ca(2+) signaling and aggregation responses to stimulation with the progression of diabetes, especially the mechanism(s) underlying the exaggerated Ca(2+) influx in diabetic platelets. MATERIALS AND METHODS Type 1 diabetes was induced by streptozotocin in rats. Platelet [Ca(2+)]i and aggregation responses upon ADP stimulation were assessed by fluorescence spectrophotometry and aggregometry, respectively. CSQ-1 expression was evaluated using western blotting. RESULTS During the 12-week course of diabetes, the abundance of CSQ-1, basal [Ca(2+)]i and ADP-induced Ca(2+) release were progressively altered in diabetic platelets, while the elevated Ca(2+) influx and platelet aggregation were not correlated with diabetes development. 2-Aminoethoxydiphenyl borate, the store-operated Ca(2+) channel blocker, almost completely abolished ADP-induced Ca(2+) influx in normal and diabetic platelets, whereas nifedipine, an inhibitor of the nicotinic acid adenine dinucleotide phosphate receptor, showed no effect. Additionally, inhibition of Na(+)/Ca(2+) exchange induced much slower Ca(2+) extrusion and more Ca(2+) influx in normal platelets than in diabetic platelets. Furthermore, under the condition of Ca(2+)-ATPase inhibition, ionomycin caused greater Ca(2+) mobilization and Ca(2+) influx in diabetic platelets than in normal platelets. CONCLUSIONS These data demonstrate that platelet hyperactivity in diabetes is caused by several integrated factors. Besides the downregulation of CSQ-1 that mainly disrupts basal Ca(2+) homeostasis, insufficient Na(+)/Ca(2+) exchange also contributes, at least in part, to the hyperactive Ca(2+) response to stimulation in diabetic platelets.
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Affiliation(s)
- Yuanyuan Zheng
- Department of Pharmacology, Capital Medical University, Beijing 100069, P.R. China; Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Diseases, Beijing 100069, P.R. China
| | - Limin Wang
- Department of Pharmacology, Capital Medical University, Beijing 100069, P.R. China; Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Diseases, Beijing 100069, P.R. China
| | - Zhixiang Zhu
- Department of Pharmacology, Capital Medical University, Beijing 100069, P.R. China; Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Diseases, Beijing 100069, P.R. China
| | - Xinxin Yan
- Department of Pharmacology, Capital Medical University, Beijing 100069, P.R. China; Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Diseases, Beijing 100069, P.R. China
| | - Lane Zhang
- Department of Pharmacology, Capital Medical University, Beijing 100069, P.R. China; Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Diseases, Beijing 100069, P.R. China
| | - Pingxiang Xu
- Department of Pharmacology, Capital Medical University, Beijing 100069, P.R. China; Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Diseases, Beijing 100069, P.R. China
| | - Dali Luo
- Department of Pharmacology, Capital Medical University, Beijing 100069, P.R. China; Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Diseases, Beijing 100069, P.R. China.
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Mosawy S, Jackson DE, Woodman OL, Linden MD. The flavonols quercetin and 3',4'-dihydroxyflavonol reduce platelet function and delay thrombus formation in a model of type 1 diabetes. Diab Vasc Dis Res 2014; 11:174-81. [PMID: 24623318 DOI: 10.1177/1479164114524234] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diabetes is associated with increased cardiovascular risk. We have recently shown that the naturally occurring flavonol quercetin (Que) or the synthetic flavonol 3',4'-dihydroxyflavonol (DiOHF) inhibits platelet function and delays thrombus formation in healthy mice. Therefore, the aim of this study was to investigate the effect of Que or DiOHF treatment on platelet function and ferric chloride-induced carotid artery thrombosis in a mouse model of type 1 diabetes. Diabetic mice treated with Que or DiOHF maintained blood flow at a significantly higher level than untreated diabetic mice at the end of the recording period. In addition, treatment with Que or DiOHF significantly reduced diabetes-induced platelet hyper-aggregability in response to platelet agonist stimulation. Furthermore, treatment with Que or DiOHF significantly inhibited dense, but not alpha, granule exocytosis in diabetic and control mice. Our demonstration that flavonols delay thrombus formation in diabetes suggests a potential clinical role for these compounds in anti-platelet therapy.
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Affiliation(s)
- Sapha Mosawy
- School of Medical Sciences, RMIT University, Melbourne, VIC, Australia
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Ulutas KT, Dokuyucu R, Sefil F, Yengil E, Sumbul AT, Rizaoglu H, Ustun I, Yula E, Sabuncu T, Gokce C. Evaluation of mean platelet volume in patients with type 2 diabetes mellitus and blood glucose regulation: a marker for atherosclerosis? Int J Clin Exp Med 2014; 7:955-961. [PMID: 24955167 PMCID: PMC4057846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Platelets have an important role in atherosclerosis and arterial thrombosis. Cardiovascular complication prevalence of type 2 diabetes mellitus (type 2 DM) may be associated with glycosylated hemoglobin (HbA1c) and mean platelet volume (MPV). The aim of the study was to investigate if platelets were activated in diabetes and its associated vascular complications by measuring the MPV in the diabetics compared to the non-diabetics, and to determine the correlation of MPV with fasting serum glucose (FSG), HbA1c and duration of diabetes in the diabetic patients, respectively. MATERIALS AND METHODS The study carried out in 65 patients with type 2 DM and 40 non-diabetic subjects. In addition to non-diabetic patients, all diabetic patients were divided into two groups according to their HbA1c levels: group A consisted of patients with HbA1c levels ≤7% and group B consisted of patients with HbA1c levels >7%. RESULTS MPV was significantly higher in Group B as compared to both non-diabetics and Group A. MPV had a high positive correlation with HbA1c and FSG, as with diabetes duration. It is found that MPV was increased in type 2 DM. CONCLUSION Our findings suggested an association between MPV and HbA1c. Therefore, MPV would be a beneficial prognostic marker of cardio-vascular complications in patients with type 2 DM.
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Affiliation(s)
| | - Recep Dokuyucu
- Department of Medical Physiology, Medical Faculty, Mustafa Kemal UniversityHatay, Turkey
| | - Fatih Sefil
- Department of Medical Physiology, Medical Faculty, Mustafa Kemal UniversityHatay, Turkey
| | - Erhan Yengil
- Department of Family Medicine, Medical Faculty, Mustafa Kemal UniversityHatay, Turkey
| | - Ahmet Taner Sumbul
- Department of Medical Oncology, Medical Faculty, Mustafa Kemal UniversityHatay, Turkey
| | - Hatice Rizaoglu
- Department of Internal Medicine, Medical Faculty, Mustafa Kemal UniversityHatay, Turkey
| | - Ihsan Ustun
- Department of Endocrinology and Metabolism, Mustafa Kemal UniversityHatay, Turkey
| | - Erkan Yula
- Department of Medical Microbiology, Medical Faculty, Mustafa Kemal UniversityHatay, Turkey
| | - Tevfik Sabuncu
- Department of Endocrinology and Metabolism, Medical Faculty, Harran UniversitySanliurfa, Turkey
| | - Cumali Gokce
- Department of Endocrinology and Metabolism, Mustafa Kemal UniversityHatay, Turkey
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15
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Aiello A, Anichini R, Brocco E, Caravaggi C, Chiavetta A, Cioni R, Da Ros R, De Feo ME, Ferraresi R, Florio F, Gargiulo M, Galzerano G, Gandini R, Giurato L, Graziani L, Mancini L, Manzi M, Modugno P, Setacci C, Uccioli L. Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE). Nutr Metab Cardiovasc Dis 2014; 24:355-369. [PMID: 24486336 DOI: 10.1016/j.numecd.2013.12.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/31/2013] [Accepted: 12/01/2013] [Indexed: 02/07/2023]
Abstract
Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot. Italy has one of the lowest prevalence rates of major amputations in Europe, and has a long tradition in the field of limb salvage by means of an aggressive approach in debridement, antibiotic therapy and distal revascularisation. Therefore, we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community.
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Affiliation(s)
- A Aiello
- P.O. Campobasso - ASReM, Campobasso, Italy
| | - R Anichini
- Servizi di Diabetologia, USL 3, Pistoia, Italy
| | - E Brocco
- Policlinico Abano Terme, Presidio Ospedaliero ULSS 16, Veneto, Italy
| | - C Caravaggi
- Istituto Clinico "Città Studi", Milan, Italy
| | | | - R Cioni
- Dipartimento Radiologia Diagnostica, interventistica e medicina nucleare, Azienda Ospedaliera Universitaria Pisana, Pisa, italy
| | - R Da Ros
- Centro Diabetologico Monfalcone (GO) - Ass2, Gorizia, Italy
| | - M E De Feo
- U.O.S. Diabetologia A.O.R.N. "A. Cardarelli", Naples, Italy
| | - R Ferraresi
- Emodinamica Interventistica Cardiovascolare, Istituto Clinico Città Studi, Milan, Italy
| | - F Florio
- IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - M Gargiulo
- Chirurgia Vascolare, Azienda Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - G Galzerano
- Department of Surgery Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - R Gandini
- Dipartimento Diagnostica per immagini, Imaging molecolare, radioterapia e radiologia interventistica, Policlinico Universitario Tor Vergata, Rome, Italy
| | - L Giurato
- Diabetic Foot Unit, Dept of Internal Medicine, Policlinico Universitario Tor Vergata, Rome, Italy
| | - L Graziani
- Unità Operativa di Cardiologia Invasiva, Istituto Clinico "Città di Brescia", Brescia, Italy
| | - L Mancini
- Istituto Dermatologico Immacolata IRCCS, Rome, Italy
| | - M Manzi
- Radiologia Interventistica, Policlinico Abano Terme, Presidio Ospedaliero ULSS 16, Veneto, Italy
| | - P Modugno
- Dipartimento Malattie Cardiovascolari Fondazione Giovanni Paolo II, Università Cattolica Sacro Cuore, Campobasso, Italy
| | - C Setacci
- Department of Surgery Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - L Uccioli
- Diabetic Foot Unit, Dept of Internal Medicine, Policlinico Universitario Tor Vergata, Rome, Italy.
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16
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Viswanathan GN, Marshall SM, Balasubramaniam K, Badimon JJ, Zaman AG. Differences in thrombus structure and kinetics in patients with type 2 diabetes mellitus after non ST elevation acute coronary syndrome. Thromb Res 2014; 133:880-5. [PMID: 24582462 PMCID: PMC4018991 DOI: 10.1016/j.thromres.2014.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/27/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Despite optimal secondary prevention therapy following non-ST elevation acute coronary syndrome (NSTE-ACS), recurrent thrombotic events are more frequent in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This exploratory study was aimed to evaluate quantitative and qualitative aspects of thrombus. In 28 patients with and without T2DM treated with aspirin and clopidogrel we assessed thrombus quantity using an ex-vivo chamber, platelet reactivity, thrombus ultrastructure and thrombus kinetics one week after NSTE-ACS. RESULTS T2DM was associated with increased thrombus [14861 (8003 to 30161) vs 8908 (6812 to 11996), μ(2)/mm, median (IQR), p=0.045] and platelet reactivity. In addition, diabetic thrombus showed lower visco-elastic tensile strength [(-0.2(-1.7 to 0.7) vs 1.0(-0.9 to 3.3), p=0.044)] and was more resistant to autolysis [(27.8(11.7 to 70.7) vs 78.8(68.5 to109.6) mm/min, p=0.002)]. On SEM, fibrin fibres in diabetes were thinner, with higher lateral interlinkage and mesh-like organisation. Thrombus quantity correlated inversely with thrombus retraction (r=-0.450 p=0.016) but not with platelet reactivity (r=0.153, p=0.544). CONCLUSIONS Despite optimal antiplatelet therapy, T2DM patients after NSTE-ACS developed increased thrombus of lower tensile strength and slower retraction. SEM revealed loosely arranged fibrin fibres. Our data showed significant differences in the magnitude as well as structural and mechanistic characteristics of thrombus in patients with T2DM.
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Affiliation(s)
| | - Sally M Marshall
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | | | | | - Azfar G Zaman
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Freeman Hospital, Newcastle upon Tyne, UK.
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17
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Identification of chicoric acid as a hypoglycemic agent from Ocimum gratissimum leaf extract in a biomonitoring in vivo study. Fitoterapia 2014; 93:132-41. [PMID: 24418658 DOI: 10.1016/j.fitote.2013.12.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/29/2013] [Accepted: 12/31/2013] [Indexed: 11/20/2022]
Abstract
Ocimum gratissimum L. is popularly used to treat diabetes mellitus. The hypoglycemic activity of this medicinal species has been confirmed by in vivo studies. The present study conducted a chemical investigation of a leaf decoction (10% p/v) of O. gratissimum monitored by in vivo hypoglycemic activity assays. Four phenolic substances were identified: L-caftaric acid (1), L-chicoric acid (2), eugenyl-β-D-glucopyranoside (3) and vicenin-2 (4). The acute hypoglycemic activity of the O. gratissimum decoction fractions Og1-S (300 mg/kg), Og1-A (240 mg/kg) and Og1-B (80 mg/kg) was evaluated intraperitoneally in normal and streptozotocin-induced diabetic mice. They reduced glycemia by 63%, 76% and 60% (in 120 min), respectively, in the diabetic mice. Subfractions of Og1-A were also evaluated under the same conditions: Og1-AS (200 mg/kg) and Og1-AP (40 mg/kg) produced a decrease of only 37% and 39%, respectively. Among the major phenolic substances, only chicoric acid (2; 3 mg/kg) reduced significantly the glycemic levels of diabetic mice by 53%, 120 min after treatment. This is the first study describing the hypoglycemic activity of chicoric acid in an animal model of diabetes mellitus. In addition, we suggest that there may be other substances contributing to this activity. Thus, for the first time, a correlation is established between the hypoglycemic activity of O. gratissimum and its chemical composition.
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Santhakumar AB, Bulmer AC, Singh I. A review of the mechanisms and effectiveness of dietary polyphenols in reducing oxidative stress and thrombotic risk. J Hum Nutr Diet 2013; 27:1-21. [PMID: 24205990 DOI: 10.1111/jhn.12177] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Dietary sources of polyphenols, which are derivatives and/or isomers of flavones, isoflavones, flavonols, catechins and phenolic acids, possess antioxidant properties and therefore might be important in preventing oxidative-stress-induced platelet activation and attenuating adverse haemostatic function. Free radicals, including reactive oxygen and nitrogen species, promote oxidative stress, leading to platelet hyperactivation and the risk of thrombosis. The consumption of antioxidant/polyphenol rich foods might therefore impart anti-thrombotic and cardiovascular protective effects via their inhibition of platelet hyperactivation or aggregation. Most commonly-used anti-platelet drugs such as aspirin block the cyclooxygenase (COX)-1 pathway of platelet activation, similar to the action of antioxidants with respect to neutralising hydrogen peroxide (H2 O2 ), with a similar effect on thromboxane production via the COX-1 pathway. Polyphenols also target various additional platelet activation pathways (e.g. by blocking platelet-ADP, collagen receptors); thus alleviating fibrinogen binding to platelet surface (GPIIb-IIIa) receptors, reducing further platelet recruitment for aggregation and inhibiting platelet degranulation. As a result of the ability of polyphenols to target additional pathways of platelet activation, they may have the potential to substitute or complement currently used anti-platelet drugs in sedentary, obese, pre-diabetic or diabetic populations who can be resistant or sensitive to pharmacological anti-platelet therapy.
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Affiliation(s)
- A B Santhakumar
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast Campus, Qld, Australia
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Paradela-Dobarro B, Raposeiras-Roubín S, Rodiño-Janeiro BK, Grigorian-Shamagian L, García-Acuña JM, Aguiar-Souto P, Jacquet-Hervet M, Reino-Maceiras MV, González-Juanatey JR, Alvarez E. Statins modulate feedback regulation mechanisms between advanced glycation end-products and C-reactive protein: evidence in patients with acute myocardial infarction. Eur J Pharm Sci 2013; 49:512-8. [PMID: 23665412 DOI: 10.1016/j.ejps.2013.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/01/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE High sensitivity C-reactive protein (hsCRP) and advanced glycation end-products (AGEs) have been proposed as mediators in inflammation and atherosclerosis. Therefore, we studied the relation between AGE and hsCRP in patients with acute myocardial infarction (AMI). METHODS Patients with AMI diagnosis and satisfying our inclusion criteria were included during 2009-2011 in an unicentre registry of AMI patients for a cross-sectional study. The final cohort was composed of 156 patients (46.2% STEMI and 27.6% with type-2 diabetes). AGE and hsCRP were measured in plasma. RESULTS Diabetic patients were older than non-diabetics (68.6 ± 10.6 vs. 60.4 ± 13.9 years; p<0.05), presented more incidence of hypertension (62.8 vs. 36.3%; p<0.05) and were in a higher Killip class (p<0.05). The mean values of fluorescent AGE and hsCRP levels were 61.3 ± 49.8 AU and 2.4 ± 4.0 mg/L, respectively, and there were no differences in these parameters between diabetic and non-diabetic patients. A direct association between AGE and hsCRP levels was observed, mainly in diabetic patients (r=0.258; p=0.018). Importantly, this association disappeared in patients who had been treated with statins before their AMI (r=-0.055; p=0.845), but it was maintained in non-diabetic patients naïve for statins treatment (r=0.634; p<0.001), independently of other treatments and confounding parameters. CONCLUSIONS This is the first evidence in humans of a feedback regulation mechanism between CRP and the AGE-RAGE axis modulated by statins.
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Abstract
Diabetes mellitus is the most common etiology for end stage renal disease (ESRD) worldwide and in the United States. The incidence of morbidity and mortality is higher in diabetic patients with ESRD due to increased cardiovascular events. Patients with type 2 diabetes who receive a renal allograft have a higher survival rate compared with patients who are maintained on chronic hemodialysis therapy, but there is scarcity of data on long-term graft outcomes. Most recently the development of new onset diabetes after transplantation (NODAT) poses a serious threat to patient and allograft survival. Pre-emptive transplantation and the use of living donors have improved overall survival. In addition, critical management of glucose, blood pressure, and cholesterol are some of the factors that can help minimize adverse outcomes in both patients with pre-existing diabetes and patients who develop NODAT. Future clinical trials are warranted to improve therapeutic medical management of these patients thus influencing graft attrition.
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Affiliation(s)
- Giselle Guerra
- Division of Nephrology, Hypertension and Transplantation, Department of Medicine, Miller School of Medicine University of Miami, Miami, FL, USA.
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