Macrophage Migration Inhibitory Factor and Malondialdehyde as Potential Predictors of Vascular Risk Complications in Type 2 Diabetes Mellitus: Cross-Sectional Case Control Study in Saudi Arabia

Impact of Polyphenols on Inflammatory and Oxidative Stress Factors in Diabetes Mellitus: Nutritional Antioxidants and Their Application in Improving Antidiabetic Therapy

Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycaemia and oxidative stress. Oxidative stress plays a crucial role in the development and progression of diabetes and its complications. Nutritional antioxidants derived from dietary sources have gained significant attention due to their potential to improve antidiabetic therapy. This review will delve into the world of polyphenols, investigating their origins in plants, metabolism in the human body, and relevance to the antioxidant mechanism in the context of improving antidiabetic therapy by attenuating oxidative stress, improving insulin sensitivity, and preserving β-cell function. The potential mechanisms of, clinical evidence for, and future perspectives on nutritional antioxidants as adjuvant therapy in diabetes management are discussed.

Urinary Malondialdehyde as a Biomarker of Type 2 Diabetes Mellitus Treatment in the Primary Care Unit of a Tertiary Care Hospital

INTRODUCTION/OBJECTIVES

The examination of Urinary Malondialdehyde (UMDA) as a biomarker in the involvement of inflammatory response and oxidative stress, as a mechanism underlying the development of diabetes; in addition to complications in followed-up patients at a primary healthcare unit. The level of UMDA and its related factors in T2DM patients, between good and poor glycemic control was investigated.

METHODS

This analytical cross-sectional study was conducted at the primary care unit, of Songklanagarind Hospital; from May 2020 to August 2020. The voluntary patients were divided into 2 groups, by using a percentage of HbA1c ≤7% as a good control T2DM group, and higher than 7% as a poor control T2DM group. The comparison statistics and logistic regression analysis were performed by using R Program.

RESULTS

A total of 71 patients voluntarily participated in this study, and consisted of: 38 patients with poor glycemic control and 33 patients with good glycemic control. There were no significant differences between the patients; with the exception of smoking habits. The average levels of UMDA of the good control group (2.43 ± 0.91 μg/mL) were slightly lower than the poor control group (2.60 ± 0.96 μg/mL): P-value >.05. Patients who had underlying diseases, smoking, or drinking habits displayed significantly different levels of UMDA. Being a non-smoking patients, and having a higher level of HDL-C with significant protective factors, while having increased level of FBS and triglyceride were pointedly negative factors of oxidative stress status.

CONCLUSION

Patients who had good control of T2DM produced better health outcomes than the poor control group. UMDA, FBS, HDL-C, and triglyceride levels could be applied as follow-up criteria in T2DM patients within a primary healthcare setting.

Elevated Serum Levels of Ischemia Modified Albumin and Malondialdehyde are Related to Atherogenic Index of Plasma in a Cohort of Prediabetes

BACKGROUND

Prediabetes, defined as impaired glucose tolerance and/or impaired fasting glucose, is a risk factor for future type 2 diabetes, dyslipidemia, cardiovascular disease and all-cause mortality. High serum levels of ischemia modified albumin (IMA) and malondialdehyde (MDA) as oxidative stress markers were determined in diabetes, however, no studies have investigated these markers together in prediabetes. The aim of the present study was to investigate the circulating levels of both IMA and MDA in a cohort of prediabetic adults. The possible associations between both markers and the atherogenic index of plasma (AIP) were also evaluated.

METHODS

This study enrolled 100 adults with prediabetes and 50 healthy controls matched for age and sex. Anthropometric measurements, fasting and 2-hour post load glucose, glycosylated hemoglobin (A1c), lipids profile, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high sensitivity C-reactive protein (hs-CRP), AIP, IMA and MDA were assessed.

RESULTS

IMA, MDA, hs-CRP and AIP were significantly higher in adults with prediabetes than in healthy controls. Male gender, fasting and post load glucose, A1c, fasting insulin, TGs, HDL-C, hs- CRP, AIP and MDA were independent predictor variables of IMA, whereas male gender, WC, fasting and post load glucose, A1c, fasting insulin, TC, TGs, LDL-C, HDL-C, hs-CRP and AIP were independent predictor variables of MDA.

CONCLUSION

The elevation of IMA concomitantly with MDA reflecting the antioxidant status in prediabetes, and their associations with hs-CRP and AIP should reinforce the idea of screening and treatment of prediabetes.

Phthalate metabolites and biomarkers of oxidative stress in the follicular fluid of women undergoing in vitro fertilization

Epidemiological studies have suggested that phthalate exposures were associated with adverse reproductive outcomes, such as low oocyte yield and reduced embryo quality, but the underlying mechanisms remained largely unknown. Oxidative stress may be a potential contributor to phthalate-induced adverse reproductive outcomes. To explore the associations between phthalate exposure and levels of oxidative stress among women seeking in vitro fertilization (IVF), we measured the concentrations of eight phthalate metabolites and biomarkers of oxidative stress, including 8-hydroxy-2'-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and total antioxidant capacity (TAC), in follicular fluid (FF) samples collected from 332 women. Multivariable linear regression models were used to assess the associations between phthalate metabolites and biomarkers of oxidative stress in FF samples. The concentrations of most tested phthalate metabolites were positively associated with the 8-OHdG levels. The metabolites of di-(2-ethylhexyl) phthalate (DEHP) were inversely associated with the TAC levels. The concentrations of mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) were positively associated with the MDA levels. Our results revealed a positive association between phthalate metabolites and oxidative stress levels in FF, while more toxicological and epidemiological studies are required to confirm our findings.

Effect of Dipeptidyl-Peptidase 4 Inhibitors on Circulating Oxidative Stress Biomarkers in Patients with Type 2 Diabetes Mellitus

Pre-clinical studies suggested potential cardiovascular benefits of dipeptidyl peptidase-4 inhibitors (DPP4i), however, clinical trials showed neither beneficial nor detrimental effects in patients with type 2 diabetes mellitus (T2DM). We examined the effects of DPP4i on several circulating oxidative stress markers in a cohort of 32 T2DM patients (21 males and 11 post-menopausal females), who were already on routine antidiabetic treatment. Propensity score matching was used to adjust demographic and clinical characteristics between patients who received and who did not receive DPP4i. Whole-blood reactive oxygen species (ROS), plasma advanced glycation end products (AGEs), advanced oxidation protein products (AOPP), carbonyl residues, as well as ferric reducing ability of plasma (FRAP) and leukocyte DNA oxidative damage (Fpg sites), were evaluated. With the exception of Fpg sites, that showed a borderline increase in DPP4i users compared to non-users (p = 0.0507), none of the biomarkers measured was affected by DPP4i treatment. An inverse correlation between estimated glomerular filtration rate and AGEs (p < 0.0001) and Fpg sites (p < 0.05) was also observed. This study does not show any major effect of DPP4i on oxidative stress, assessed by several circulating biomarkers of oxidative damage, in propensity score-matched cohorts of T2DM patients.

Circulating Oxidative Stress Biomarkers in Clinical Studies on Type 2 Diabetes and Its Complications

Type 2 diabetes (T2DM) and its complications constitute a major worldwide public health problem, with high rates of morbidity and mortality. Biomarkers for predicting the occurrence and development of the disease may therefore offer benefits in terms of early diagnosis and intervention. This review provides an overview of human studies on circulating biomarkers of oxidative stress and antioxidant defence systems and discusses their usefulness from a clinical perspective. Most case-control studies documented an increase in biomarkers of oxidative lipid, protein, and nucleic acid damage in patients with prediabetes and in those with a diagnosis of T2DM compared to controls, and similar findings were reported in T2DM with micro- and macrovascular complications compared to those without. The inconsistence of the results regarding antioxidant defence systems renders difficulty to draw a general conclusion. The clinical relevance of biomarkers of oxidative lipid and protein damage for T2DM progression is uncertain, but prospective studies suggest that markers of oxidative nucleic acid damage such as 8-hydroxy-2'-deoxyguanosine and 8-hydroxyguanosine are promising for predicting macrovascular complications of T2DM. Emerging evidence also points out the relationship between serum PON1 and serum HO1 in T2DM and its complications. Overall, enhanced oxidative damage represents an underlying mechanism of glucose toxicity in T2DM and its related micro- and macrovascular complications suggesting that it may be considered as a potential additional target for pharmacotherapy. Therefore, further studies are needed to understand whether targeting oxidative stress may yield clinical benefits. In this view, the measurement of oxidative stress biomarkers in clinical trials deserves to be considered as an additional tool to currently used parameters to facilitate a more individualized treatment of T2DM in terms of drug choice and patient selection.

Increased malondialdehyde vs. reduced sirtuin 1 in relation with adiposity, atherogenicity and hematological indices in metabolic syndrome patients with and without prediabetes

BACKGROUND

Sirtuin 1 (SIRT 1) and malondialdehyde (MDA) were implicated in metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) pathophysiology.

AIMS AND METHODS

This cross-sectional study aimed to investigate both SIRT 1 and MDA in 30 lean healthy control, 31 normoglycemic MetS subjects and 30 MetS-Pre/T2DM drug naïve. C orrelation studies were established for both biomarkers with adiposity indices [conicity index (CI), waist circumference (WC), weight-to-height (WHtR) ratio, weight-to-hip (WHR) ratio, hip circumference (HC), and body adiposity index (BAI)], hematological indices [red cell distribution width (RDW), mean platelet volume (MPV), platelet-to-lymphcyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR)] and atherogenicity indices (atherogenicity index of plasma (AIP = log₁₀TG/HDL-C ratio), TC/HDL-C and LDL-C/HDL-C ratios].

RESULTS

SIRT1 levels (ng/mL) were markedly lower in both MetS groups (2.12 ± 0.06 and 2.32 ± 0.19, respectively, vs. controls 4.73 ± 0.15; P < 0.05). Conversely, a gradual increase in MDA levels (μM) was attained (MetS 72 ± 3.3 and MetS pre-T2DM 81 ± 6.1 vs. controls 62 ± 3.5; P > 0.05). A significant inverse MDA-SIRT1 relationship was observed (P = 0.006). SIRT1 correlated inversely with all the studied adiposity (WC: P < 0.001, HC: P < 0.001, WHR: P < 0.001, C-index: P < 0.001, BAI: P < 0.001) and atherogenicity indices (AIP: P < 0.001, TC/HDL-C: P < 0.001, LDL-C/HDL-C: P < 0.001) as well as MPV (P < 0.01). Whereas MDA directly with WHtR, CI and BAI (WC: P < 0.01, HC: P < 0.05, BMI: P < 001, WHtR: P < 0.001, C-index: P < 0.005, BAI: P < 0.01).

CONCLUSION

The substantial variations and correlations emphasize a potential molecular role of SIRT1 and MDA in the pathophysiology of MetS and pre/T2DM.

Cross-sectional correlates of paraoxonase 1 and soluble intercellular adhesion molecule-1 in metabolic syndrome patients with and without diabetes

BACKGROUND

Paraoxonase 1 (PON1) and soluble intercellular adhesion molecule-1(sICAM-1) are intricately involved in metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) pathophysiology. This study aimed to investigate PON1 and sICAM-1 plasma levels in addition to correlating them with adiposity, atherogenicity and hematological indices in T2DM and MetS.

METHODS

This cross-sectional study composed of 28 healthy lean subjects (control), 29 normoglycemic MetS subjects and 30 MetS-Pre/T2DM.

RESULTS

The sICAM-1 levels (ng/ml) were markedly higher in the pre/diabetic MetS group (828 ± 250.37 versus controls' 608.62 ± 184; p < 0.05). Conversely, PON1 levels (mlU/ml) were markedly lower in the pre/diabetic MetS group [252,700 (163,950, 362,800) versus controls' 394,900 (212,550, 469,350); p < 0.05]. sICAM-1 correlated directly with all adiposity indices [conicity index (CI), waist circumference (WC), waist-hip ratio (WHR) waist-to-height (WHtR) ratio, hip circumference (HC) and body adiposity index (BAI)] in addition to the atherogenicity index of plasma (AIP). PON1 correlated negatively and significantly with CI, WC, WHR, WHtR and HC but directly with lymphocyte. Significantly, a reciprocal sICAM-1-PON1 relationship was observed in the total population (r = -0.262, p = 0.015).

CONCLUSION

Utility of sICAM-1 and PON1 as surrogate prognostic biomarkers and putative therapeutic targets in the management of diabetes and MetS is strongly suggested.

Glycated LDL-C and glycated HDL-C in association with adiposity, blood and atherogenicity indices in metabolic syndrome patients with and without prediabetes

BACKGROUND

The aim of the study was to compare and correlate glycated high-density lipoprotein (GHDL-C) and glycated low-density lipoprotein (GLDL-C) plasma levels with adiposity indices [weight/hip ratio (WHR) and body adiposity index (BAI)], lipid ratios and hematological indices [platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR)].

METHODS

This was a cross-sectional study of 30 nondiabetic metabolic syndrome (MetS) patients, 30 prediabetic or type 2 diabetes mellitus (T2DM) patients and 30 normoglycemic controls.

RESULTS

Remarkably both GHDL-C and GLDL-C levels lacked any intergroup statistically significant discrepancy in either MetS or MetS-pre/T2DM versus control (p > 0.05). Unlike GLDL-C/LDL-C ratios for either MetS groups; there were highly significant intergroup differences in the means of GHDL-C/HDL-C ratios when comparing both nondiabetic MetS and MetS-pre/T2DM groups versus controls (p = 0.001). In MetS patients; GHDL-C and GLDL-C proportionally correlated with WHR (p < 0.05). Also, MetS GHDL-C correlated inversely with MLR and monocytes (p < 0.05). In MetS-pre/T2DM; GLDL-C directly correlated with BAI, platelet count and PLR (p < 0.05).

CONCLUSION

GLDL-C and GHDL-C are dysfunctional glucolipotoxicity lipoproteins and may present putatively surrogate biomarkers for prediction/prevention of metabolic disturbances.

Exposure to phthalates in patients with diabetes and its association with oxidative stress, adiponectin, and inflammatory cytokines

Epidemiologic studies have revealed higher concentrations of the metabolites of phthalic acid esters (mPAEs) in patients with type 2 diabetes. On the other hand, oxidative stress, adiponectin, and inflammatory cytokines play important roles in the pathogenesis of diabetes and its complications. However, little information is known about the association between exposure to PAEs and these physiological parameters. Hence, paired urine and blood samples were collected from a total of 329 volunteers, and 11 main mPAEs and malondialdehyde (MDA), as a biomarker of oxidative stress, were measured in the urine samples. Serum adiponectin and tumor necrosis factor-α (TNF-α), a biomarker of inflammation, were also measured. Multivariable linear regression was used to assess the association between urinary mPAEs and these physiological parameters in the total subjects and subjects stratified by age, sex, and body mass index (BMI) to elucidate their possible interactions. All 11 mPAEs were detected in the urine with detection rates of 42.9%-100% and geometric means of 0.30-54.52ng/mL (0.44-79.93μg/g creatinine). The mPAEs were all positively associated with MDA levels. There were significant positive associations between monomethyl phthalate (mMP) and TNF-α, and inverse associations between mMP and adiponectin levels. In the stratified analysis, there were age-, sex-, and BMI-specific differences for these associations. The positive associations between mPAEs and MDA were insignificant in some subgroups, especially in the larger age group. However, in the larger BMI group, summed metabolites of di-(2-ethylhexyl) phthalate (∑DEHP) and mono(2-ethylhexyl) phthalate were positively associated with TNF-α, and the concentrations of ∑DEHP were negatively associated with adiponectin. Our findings suggested that PAE exposure is associated with oxidative stress, adiponectin, and inflammatory cytokines in diabetic patients; further studies on toxicology and a comparison with general population are needed.

Serum macrophage migration inhibitory factor is correlated with atrial fibrillation

OBJECTIVE

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine secreted by macrophages. This study is performed to investigate whether serum MIF is correlated with atrial fibrillation (AF).

METHODS

Totally, 186 AF patients and 103 healthy controls were enrolled in this study. AF patients were then divided into paroxysmal AF, persistent AF, and permanent AF subgroups.

RESULTS

There were higher serum MIF concentrations in AF patients than in healthy subjects. Logistic regression analysis demonstrated that serum MIF was associated with AF. Permanent AF patients exhibited higher serum MIF concentrations than persistent and paroxysmal AF subgroups. Elevated serum MIF concentrations were found in persistent AF patients compared with paroxysmal AF patients. Moreover, serum MIF concentrations were associated with left atrial diameter after Spearman correlation analysis.