Ischemia-Modified Albumin: Origins and Clinical Implications

Evaluation of the therapeutic potential of novel nanoparticle formulations of glutathione and virgin coconut oil in an experimental model of carbon tetrachloride-induced liver failure

BACKGROUND

Acute liver failure (ALF) is a critical condition characterized by rapid liver dysfunction, leading to high mortality rates. Current treatments are limited, primarily supportive, and often require liver transplantation. This study investigates the potential of a novel nanoparticle formulation of glutathione (GSH) and virgin coconut oil (VCO) alone and in combination to enhance therapeutic outcomes in a rat model of ALF induced by orogastric carbon tetrachloride (CCl4).

METHODS

The study employed adult male Albino rats divided into ten groups, with ALF induced via a single oral dose of CCl4. Various treatment regimens were administered over seven days, including conventional and nanoparticle forms of GSH and VCO and their combinations. The efficacy of treatments was evaluated through biochemical analysis of liver function markers, oxidative stress indicators, inflammatory biomarkers, and histopathological examinations. Nanoparticles were synthesized using established methods, and characterization techniques were employed to ensure their quality and properties.

RESULTS

The nanoparticle formulations significantly improved liver function, as indicated by reduced serum levels of alanine aminotransferase and aspartate aminotransferase, alongside decreased oxidative stress markers such as malondialdehyde. Furthermore, they reduced tumor necrosis factor alpha and interleukin-1 beta inflammatory markers. Histological analysis revealed reduced hepatocellular necrosis and inflammation in treated groups compared to controls. Also, decreased nuclear factor-kappa B was detected by immunohistochemical analysis.

CONCLUSION

The findings show that the nanoparticle mixture of GSH and VCO effectively reduces liver damage in ALF. This suggests a promising drug-based approach for improving liver regeneration and protection. This innovative strategy may pave the way for new therapeutic interventions in the management of ALF.

Analytical Insights into Methods for Measuring Ischemia-Modified Albumin

Ischemia-modified albumin (IMA) has emerged as a pivotal biomarker for the early detection of ischemic conditions, particularly myocardial ischemia, where timely diagnosis is crucial for effective intervention. This review provides an overview of the analytical methods for assessment of IMA, including Albumin Cobalt Binding (ACB), Albumin Copper Binding (ACuB), Enzyme-Linked Immunosorbent Assay (ELISA), new techniques such as liquid crystal biosensors (LCB), quantum dot coupled X-ray fluorescence spectroscopy (Q-XRF), mass spectrometry (MS), and electron paramagnetic resonance (EPR) spectroscopy. Each method was thoroughly examined for its analytical performance in terms of sensitivity, specificity, and feasibility. The ACB assay is the most readily implementable method in clinical laboratories for its cost-effectiveness and operational simplicity. On the other hand, the ACuB assay exhibits enhanced sensitivity and specificity, driven by the superior binding affinity of copper to IMA. Furthermore, nanoparticle-enhanced immunoassays and liquid crystal biosensors, while more resource-intensive, significantly improve the analytical sensitivity and specificity of IMA detection, enabling earlier and more accurate identification of ischemic events. Additionally, different biological matrices, such as serum, saliva, and urine, were reviewed to identify the most suitable for accurate measurements in clinical application. Although serum was considered the gold standard, non-invasive matrices such as saliva and urine are becoming increasingly feasible due to advances in technology. This review underscores the role of IMA in clinical diagnostics and suggests how advanced analytical techniques have the potential to significantly enhance patient outcomes in ischemic disease management.

A systematic review and meta-analysis of ischemia-modified albumin in diabetes mellitus

Aim

There is an ongoing search for novel biomarkers of diabetes. We conducted a systematic review and meta-analysis of the serum concentrations of ischemia-modified albumin (IMA), a candidate biomarker of oxidative stress, acidosis, and ischemia, in patients with pre-diabetes, different types of diabetes mellitus (type 1, T1DM, type 2, T2DM, and gestational, GDM), and healthy controls.

Methods

We searched for case-control studies published in PubMed, Web of Science, and Scopus from inception to December 31, 2023. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively.

Results

In 29 studies, T2DM patients had significantly higher IMA concentrations when compared to controls (standard mean difference, SMD = 1.83, 95 % CI 1.46 to 2.21, p˂0.001; I2 = 95.7 %, p < 0.001; low certainty of evidence). Significant associations were observed between the SMD and glycated hemoglobin (p = 0.007), creatinine (p = 0.003), triglycerides (p = 0.029), and the presence of diabetes complications (p = 0.003). Similar trends, albeit in a smaller number of studies, were observed in T1DM (two studies; SMD = 1.59, 95 % CI -0.09 to 3.26, p˂0.063; I2 = 95.8 %, p < 0.001), GDM (three studies; SMD = 3.41, 95 % CI 1.14 to 5.67, p = 0.003; I2 = 97.0 %, p < 0.001) and pre-diabetes (three studies; SMD = 15.25, 95 % CI 9.86 to 20.65, p˂0.001; I2 = 99.3 %, p < 0.001).

Conclusion

Our study suggests that IMA is a promising biomarker for determining the presence of oxidative stress, acidosis, and ischemia in pre-diabetes and T1DM, T2DM, and GDM. However, the utility of measuring circulating IMA warrants confirmation in prospective studies investigating clinical endpoints in pre-diabetes and in different types of diabetes (PROSPERO registration number: CRD42024504690).

Predictors and markers of the cardiovascular impact of obstructive sleep apnoea

PURPOSE OF REVIEW

Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing and has been linked to cardiovascular health. However, some of the findings supporting this are controversial. These discrepancies might be a result of heterogeneity among OSA patients, and thus, additional information would be required to better stratify OSA patients according to cardiovascular risk. In this review, we aim to discuss the potential of biomarkers to fulfil this role.

RECENT FINDINGS

Randomized controlled trials have been unable to confirm whether OSA treatment with continuous positive airway pressure (CPAP) has a positive effect on cardiovascular outcomes. Emerging physiology-based metrics of OSA seem to be more suitable for identifying patients at higher risk of cardiovascular disease and predicting the effects of CPAP outcomes on cardiovascular health. Similarly, blood-based molecular markers have gained attention in this context over the last few years.

SUMMARY

Accurate cardiovascular risk stratification and appropriate treatment allocation for OSA patients remain challenging. However, significant efforts are being made to develop novel tools to address these important issues.

Ischemia-modified albumin: is it a promising marker in acute coronary syndrome?

BACKGROUND

Acute coronary syndrome (ACS) is a type of coronary heart disease (CHD), which is responsible for one-third of total deaths in people older than 35 years. Even though cardiac troponin is the gold standard for myocardial necrosis it is blind for ischemia without necrosis. Studies demonstrate that Ischaemia Modified Albumin (IMA) is more sensitive in diagnosing ischemic chest pain compared to cardiac troponin T and electrocardiogram, and its combination with these tests significantly increases the sensitivity for diagnosing unstable angina, non-ST-elevation myocardial infarction (NSTEMI), or ST-elevation myocardial infarction (STEMI), with high positive and negative predictive values, making it a valuable tool for ruling out ACS in patients with inconclusive diagnoses in the emergency department.

METHODS

This prospective cohort study, conducted at the Teaching Hospital, Peradeniya, Sri Lanka, from 2015 to 2019, investigated ischemia-modified albumin (IMA) levels in 330 acute coronary syndrome (ACS) patients. Excluding those with various chronic conditions and those on specific medications, serum IMA was analyzed using a colorimetric assay based on cobalt (II) binding to human serum albumin affected by myocardial ischemia. Serum IMA levels were measured, and statistical analyses, including non-parametric tests and correlation analyses, were conducted to evaluate the association between IMA levels and various demographic and clinical factors.

RESULTS

IMA concentrations were found to be non-normally distributed, with an average concentration of 0.252 ± 0.123 AU. No overall significant gender-based difference in IMA levels was observed, though within the younger age group (< 59 years), males exhibited higher IMA concentrations than females. Significant gender differences were observed in the younger age group, with males showing higher IMA levels than females (p = 0.033). No significant differences in IMA levels were found across different ethnicities (p = 0.217) or BMI categories (p = 0.056). A significant increase in IMA levels was noted in ACS patients compared to control subjects (p < 0.001). Correlation analysis revealed significant associations between IMA levels and total cholesterol (r = 0.262, p = 0.009) and low-density lipoprotein (LDL) levels (r = 0.280, p = 0.006). Notably, a significant gender difference in IMA levels was found in obese patients, suggesting physiological differences in response to obesity. The study also revealed higher IMA concentrations in NSTEMI and STEMI patients compared to those with unstable angina.

CONCLUSION

The study confirms elevated IMA levels in ACS patients, supporting its diagnostic potential. It reveals demographic influences, such as higher IMA levels in younger males and significant gender-specific differences in obese patients. Personalized approaches considering demographics and lipid management are essential for ACS risk reduction and IMA's role in management.

The Effects of Colchicum Dispert and Bone Marrow-Derived Mesenchymal Stem Cell Therapy on Skeletal Muscle Injury in a Rat Aortic Ischemia-Reperfusion Model

BACKGROUND

Abdominal aortic aneurysms and peripheral artery disease pose significant health risks, ranking third after heart attacks and cerebral strokes. Surgical interventions often involve temporary aortic clamping, leading to ischemia-reperfusion injury and tissue damage. Colchicine and mesenchymal stem cells have shown promise, individually, in mitigating ischemia-reperfusion injury, but their combined effects remain understudied.

METHODS

This study utilized 42 male Wistar rats, divided into six groups: Control, Sham, Ischemia-Reperfusion, Colchicine, Mesenchymal stem cell, and Mix (colchicine and mesenchymal stem cell). The ischemia-reperfusion model involved clamping the abdominal aorta for 60 min, followed by 120 min of reperfusion. Colchicine and mesenchymal stem cell treatments were administered as pre- and post-ischemia interventions, respectively. Mesenchymal stem cells were cultured, characterized by flow cytometry, and verified for specific surface antigens. Blood and tissue samples were analyzed for oxidative stress markers, nitric oxide metabolites, and apoptosis using TUNEL.

RESULTS

There were significant differences between the groups in terms of the serum total antioxidant capacity (p < 0.001) and inflammation markers (ischemia-modified albumin, p = 0.020). The combined therapy group (Mix) exhibited the lowest inflammation levels. Arginine levels also showed significant variation (p = 0.028), confirming the ischemia-reperfusion injury model. In muscle tissues, the total antioxidant capacity (p = 0.022), symmetric dimethylarginine, and citrulline levels (p < 0.05) indicated nitric oxide metabolism. Apoptosis was notably high in the ischemia-reperfusion injury group as anticipated. It appeared to be reduced by colchicine, mesenchymal stem cells, and their combination, with the most significant decrease observed in the Mix group (p < 0.001).

CONCLUSIONS

This study highlights the potential of using combined colchicine and mesenchymal stem cell therapy to reduce muscle damage caused by ischemia-reperfusion injury. Further research is needed to understand the underlying mechanisms and confirm the clinical significance of this approach in treating extremity ischemia-reperfusion injuries.

Evaluation of diagnostic potential of maternal serum ischemia modified albumin in cases of pre-eclampsia

OBJECTIVES

The underlying causes and mechanisms of pre-eclampsia (PE), its exact etiology remains unclear and poorly understood. Hypoxia, ischemia, and oxidative stress induced by free radicals have been associated with development of PE. Ischemia-modified albumin (IMA) is a chemically modified albumin due to oxidative stress. IMA, a serum biomarker of hypoxia, ischemia, and oxidative free radicals is a potential biomarker for PE. The aim of the current proposal was to study serum IMA as a diagnostic biomarker of pre-eclampsia (PE) in pregnant females and to evaluate the correlation between serum IMA and different markers of pre-eclampsia (BP, urinary protein, LFT, KFT, serum total protein & uric acid).

METHODS

A total of 60 pregnant women aged between 21 and 35 years were recruited (30 PE cases and 30 normal pregnancy). Serum IMA was measured by spectrophotometric method developed by Bar-Or D. BP and biochemical parameters (urinary protein, LFT, KFT, serum total protein & uric acid) were also assayed and compared between two groups. Correlation analysis was done for analyzing the relationship between serum IMA and biochemical parameters.

RESULTS

The mean serum IMA was significantly higher in normotensive pregnant females (0.93 ABSU) than PE cases (0.71 ABSU). Kidney function and liver function parameters were more deranged in PE cases than in controls. Serum IMA was positively correlated with serum creatinine (r=0.322), serum uric acid (r=0.54) and urinary protein (0.376) whereas negatively correlated with total serum bilirubin (r=-0.515) and serum albumin (r=-0.380).

CONCLUSIONS

Elevated serum IMA concentrations in normotensive pregnant controls as compared to PE cases suggest that apart from ongoing ischemia and oxidative stress in placenta IMA values are influenced by many other mechanisms in pregnancy.

Peripheral blood diagnostic markers of chronic cerebral hypoperfusion

OBJECTIVE

To investigate the efficacy of ischemia-modified albumin (IMA), lipoprotein-associated phospholipase A2 (Lp-PLA2), brain-derived neurotrophic factor (BDNF), and visinin-like protein-1 (VILIP-1) in diagnosing chronic cerebral hypoperfusion (CCH).

METHODS

This retrospective study included 84 patients with suspected chronic cerebral ischemia admitted to Sichuan Provincial People's Hospital between February 2021 and April 2022. Arterial spin labeling (ASL) imaging and biological examinations were performed. According to the ASL perfusion imaging patterns, the patients were divided into a CCH group (n = 55) and a non-CCH group (n = 29). Serum markers of the two groups were compared, and correlation analysis was conducted between ischemic marker levels and cerebral blood flow (CBF) in the ischemic region, as measured by ASL. Receiver operating characteristic (ROC) curve analysis was used to evaluate the efficacy of each marker for diagnosing chronic cerebral ischemia. The Delong test was used to compare AUC size between groups.

RESULTS

Compared to the non-CCH group, the CCH group exhibited higher IMA levels and lower BDNF concentrations (P < 0.05). However, VILIP-1 and Lp-PLA2 concentrations were not significantly different between the two groups (P > 0.05). Moreover, IMA and BDNF levels were not correlated with CBF in the hypoperfused area. ROC curve analysis demonstrated that the cut-off values of 24.2915 U/mL and 6.714 ng/L for IMA and BDNF achieved a sensitivity of 83.6% and 41.8% and a specificity of 62.1% and 93.1%, respectively. Lastly, the areas under the curve for IMA and BDNF were 0.738 (95% confidence interval [CI], 0.627-0.848) and 0.631 (95% CI, 0.512-0.751), respectively.

CONCLUSION

IMA and BDNF may have clinical value in the diagnosis of CCH.

Serum Erythropoietin and Ischemic-Modified Albumin Levels in Adolescents with Obsessive-Compulsive Disorder

Erythropoietin (EPO) has neuroprotective effects by increasing oxidative stress resistance and stabilizing redox balance. Ischemic-modified albumin (IMA) is a product of protein oxidation, and recent evidence suggests that IMA can be used as an indicator of oxidative damage. This study aimed to investigate serum EPO and IMA levels in obsessive-compulsive disorder (OCD) patients and to investigate the relationship between EPO and IMA levels and clinical variables such as disease duration and disease severity. A total of 68 adolescents (11-18 years old), including 35 OCD patients (18 males/17 females) and 33 healthy controls (14 males/19 females) without comorbid disorders matched for age, gender, and BMI, were included in the study. The enzyme-amplified chemiluminescence technique determined serum EPO levels, and serum IMA levels were determined by the spectrophotometric method. Serum EPO levels were lower in OCD patients compared to healthy controls (p = 0.002; Z =  - 3.123), and serum IMA levels (ABSU) were significantly higher in the OCD group (p = 0.005). A significant positive correlation was found between IMA levels and the duration of OCD symptoms (p = 0.015, r = 0.409). The study's findings contribute to the growing body of evidence implicating inflammatory and oxidative processes in the pathogenesis of OCD. The potential of EPO and IMA levels as diagnostic biomarkers for OCD aligns with the ongoing efforts to identify reliable biological markers for the disorder. The positive correlation of IMA levels with the duration of OCD shows the importance of early detection of oxidative damage.

Serum Thiols and Ischemia-Modified Albumin Levels in Children With Major Depressive Disorder: A Cross-Sectional Study

Introduction This cross-sectional study aimed to investigate potential biomarkers of oxidative stress by analyzing serum thiol-disulfide homeostasis (TDH) and ischemia-modified albumin (IMA) levels in children who have been diagnosed with major depressive disorder (MDD). Methods The study included 24 medication-naive children aged seven to 17 years diagnosed with MDD and 19 healthy controls matched for age, gender, and body mass index. Clinical interviews were conducted using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL-DSM-5), and diagnoses were made according to DSM-5. The Child Depression Inventory (CDI) and the Clinical Global Impression Scale-Severity (CGI-S) were also administered to the participants. Venous blood samples were taken from all subjects to assess TDH and IMA levels, considered potential oxidative stress indicators. Results The study showed no significant difference in TDH and IMA levels between the MDD and the control groups. Although not statistically significant, it was observed that native thiol and total thiol levels were higher in the MDD group. No direct relationship was found between disease severity and either TDH or IMA levels. Conclusion In conclusion, while there were no significant differences in the levels of TDH and IMA, higher levels of both native and total thiols were found in the MDD group.

Ischemia-Modified Albumin, Lactate, and Combination for Predicting Mortality in Patients with Septic Shock in the Emergency Department

Ischemia-modified albumin (IMA) is produced during ischemia and reactive oxygen species production. This study aimed to evaluate the association between IMA and mortality in a larger population and the prognostic value of the combination of IMA and lactate for predicting mortality in septic shock patients in the emergency department. This retrospective observational study included adult septic shock patients between October 2019 and December 2021. A multivariable Cox proportional hazards model was performed. IMA was significantly higher in the non-surviving group than in the surviving group (89.1 ± 7.2 vs. 83.8 ± 6.2 U/mL, p < 0.001). IMA was independently associated with 28-day mortality after adjustments (adjusted hazard ratio [aHR]: 1.075, 95% confidence interval [CI]: 1.016-1.138, p = 0.012). The area under the ROC curve (AUROC) of IMA was 0.712 (95% CI: 0.648-0.775, p < 0.001) and was comparable to that of lactate. The AUROC of the combination of IMA and lactate was 0.838 (95% CI: 0.786-0.889, p < 0.001). The group with both high lactate and high IMA levels showed an extremely high risk of mortality than other groups (86.1%; aHR 8.956, 95% CI 4.071-19.70, p < 0.001). The elevation of IMA was associated with mortality in septic shock patients. The combination of IMA and lactate can be a helpful tool for early risk stratification of septic shock patients.

Association between serum neurofilament light chain and periodontitis

OBJECTIVES

The association between serum neurofilament light chain (sNfL) and periodontitis remains unclear, and there is a need to examine the contribution of serum albumin (SA) in this association. The objective of the study is to investigate the correlation between sNfLand periodontitis, while examining the potential mediator role of SA in this association.

METHODS

The study, which included 1218 participants from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), aimed to evaluate the association between sNfL and periodontitis through weighted multivariable logistic regression analysis, restricted cubic spline (RCS) models, and stratified models. In addition, mediation analysis was used to investigate the role of SA in mediating this association.

RESULTS

The multivariable logistic regression models revealed that sNfL was significantly linked to periodontitis (model 1: odds ratio [OR], 3.08, 95% confidence interval [CI], 1.48 to 6.39, model 2: OR, 3.69; 95% CI, 1.73 to 7.90, model 3: OR, 3.58, 95% CI, 1.52 to 8.43). The RCS models suggested a linear relationship between sNfL and periodontitis. The stratified analysis revealed no significant moderating effects (p-value > 0.05). The mediation analysis demonstrated that SA mediated the correlation between sNfL and periodontitis, with a mediation proportion of 10.62%.

CONCLUSIONS

The results point to sNfL being a factor in the heightened risk of periodontitis. Additionally, SA may mediate the changes in periodontitis that are associated with sNfL.

CLINICAL RELEVANCE

sNfL may contribute to the development of periodontitis by mediating changes in SA in humans.

Evaluation of the relationship between adjusted ischemia-modified albumin and the presence and severity of peripheral artery disease

OBJECTIVES

Albumin undergoes structural changes under ischemia and oxidative stress, turning into ischemia-modified albumin (IMA). It has been proposed as an early biomarker for various diseases associated with ischemia. We aimed to investigate the relationship between serum IMA and peripheral artery disease (PAD) and whether it is a risk marker for the severity of PAD.

METHODS

This prospective case-control study included 100 patients with lower extremity PAD and 50 volunteers without. Patients with resting pain, ulcer, and gangrene were excluded from the study. Patients with PAD included in the study were divided into two groups as mild claudication and moderate-severe claudication. Adjusted-IMA levels were calculated according to the median albumin values of the groups. The basic clinical features and laboratory findings of the participants were recorded and compared. Possible risk factors for presence and severity of PAD and IMA levels were examined by logistic regression and receiver-operating characteristic (ROC) curve analyses.

RESULTS

IMA and adjusted-IMA levels were significantly higher in the PAD group (p < 0.001, p < 0.001, respectively). IMA and adjusted-IMA levels were significantly higher in PAD group 2, which had moderate-to-severe claudication and more pronounced ischemic symptoms (p < 0.001, p < 0.001, respectively). Advanced age, presence of hypertension, smoking, low albumin levels, and high adjusted-IMA levels were independent predictors of PAD. There was a negative high correlation between adjusted-IMA levels and ABI (r: -0.666, p < 0.001, Spearman's correlation). ROC curve analysis demonstrated that adjusted-IMA cut-off values of 0.802 or above could predict presence and severity of peripheral artery disease with 70% sensitivity and 78% specificity (AUC: 0.825, 95% CI: 0.758-0.893, log rank p: 0.000).

CONCLUSION

We determinated that increased adjusted-IMA levels were a predictors of the presence and severity of PAD. In addition, adjusted-IMA values can be a valuable marker in the follow-up of clinical severity of PAD.

Ischemia-modified albumin in rheumatic diseases: A systematic review and meta-analysis

INTRODUCTION

The identification of novel, easily measurable disease biomarkers might enhance the diagnosis and management of patients with rheumatic diseases (RDs). We conducted a systematic review and meta-analysis of ischemia-modified albumin (IMA), a marker of oxidative stress, acidosis, and ischemia, in RD patients and healthy controls.

METHODS

We searched PubMed, Web of Science, and Scopus from inception to January 15, 2024. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively.

RESULTS

In 20 studies investigating a total of 1188 RD patients (mean age 45 years, 64% females) and 981 healthy controls (mean age 44 years, 66% females), RD patients had significantly higher IMA concentrations when compared to controls (standard mean difference, SMD = 0.50, 95% CI: 0.18-0.83, p = .003; I2 = 92.4%, p < .001; low certainty of evidence). In subgroup analysis, the pooled SMD was significantly different in studies investigating ankylosing spondylitis (p < .001), Behçet's disease (p < .001), and rheumatoid arthritis (p = .033), but not familial Mediterranean fever (p = .48). Further associations were observed between the pooled SMD and the broad classification of autoimmune and/or autoinflammatory diseases, the study country, and the method used to measure IMA.

CONCLUSION

Our study suggests that IMA is a promising biomarker of oxidative stress, acidosis, and ischemia, as it can effectively discriminate between patients with different types of RDs and healthy controls. Our results warrant confirmation in longitudinal studies of patients with different types of RDs and different ethnicities (PROSPERO registration number: CRD42024509126).

An auxiliary strategy of partial least squares regression in pharmacokinetic/pharmacodynamic studies: A case of application of guhong injection in myocardial ischemia/reperfusion rats

Guhong injection (GHI) has been applied in the therapy of cardio-cerebrovascular disease in clinic, but there is no report about the pharmacokinetic/pharmacodynamic (PK/PD) research on GHI treating myocardial ischemia/reperfusion (MI/R) injury in rats. In this study, eight compounds of GHI in plasma, including N-acetyl-L-glutamine (NAG), chlorogenic acid (CGA), hydroxysafflor yellow A (HSYA), p-coumaric acid ( pCA), rutin, hyperoside, kaempferol-3-O-rutinoside, and kaempferol-3-O-glucoside, were quantified by LC-MS/MS. We discovered that the values of t1/2β, k12, V2, and CL2 were larger than those of t1/2α, k21, V1, and CL1 for all compounds. The levels of four biomarkers, creatine kinase-MB (CK-MB), cardiac troponin I (cTn I), ischemia-modified albumin (IMA), and alpha-hydroxybutyrate dehydrogenase (α-HBDH) in plasma were determined by ELISA. The elevated level of these biomarkers induced by MI/R was declined to different degrees via administrating GHI and verapamil hydrochloride (positive control). The weighted regression coefficients of NAG, HSYA, CGA, and pCA in PLSR equations generated from The Unscrambler X software (version 11) were mostly minus, suggesting these four ingredients were positively correlated to the diminution of the level of four biomarkers. Emax and ED50, two parameters in PK/PD equations that were obtained by adopting Drug and Statistics software (version 3.2.6), were almost enlarged with the rise of GHI dosage. Obviously, all analytes were dominantly distributed and eliminated in the peripheral compartment with features of rapid distribution and slow elimination. With the enhancement of GHI dosage, the ingredients only filled in the central compartment if the peripheral compartment was replete. Meanwhile, high-dose of GHI generated the optimum intrinsic activity, but the affinity of compounds with receptors was the worst, which may be caused by the saturation of receptors. Among the eight analytes, NAG, HSYA, CGA, and pCA exhibited superior cardioprotection, which probably served as the pharmacodynamic substance basis of GHI in treating MI/R injury.

Effect of Adrenocorticotropic Hormone Stimulation on Ischemiamodified Albumin Levels in vivo

Objective

Ischemia-modified albumin (IMA) formation is associated with increased reactive oxygen species (ROS) production, while increased cortisol leads to decreased ROS levels. We aimed to evaluate the effect of adrenocorticotropic hormone (ACTH) stimulation on IMA levels and whether the effect was dose-dependent or not.

Methods

A total of 99 subjects with normal ACTH test results were included in the study. Of these, 80 had standard-dose ACTH test while 19 had low-dose ACTH test. Blood samples were collected to determine cortisol and IMA levels; at minutes 0, 30, and 60 following the standard-dose ACTH test and at minutes 0 and 30 following the low-dose ACTH test.

Results

IMA levels decreased significantly within 30 minutes and the decrease continued up to the sixtieth minute (p=0.002) after standard-dose ACTH stimulation. After ACTH stimulation, a weak negative correlation was found between peak cortisol and IMA levels at the thirtieth minute (r=0.233, p=0.02). There was no significant difference in IMA levels after low-dose ACTH stimulation, despite an increase in cortisol (p=0.161).

Conclusion

IMA levels decreased rapidly after standard-dose ACTH stimulation, while a decrease in IMA levels was not observed after low-dose ACTH stimulation. The lack of decrease in IMA levels after low-dose ACTH stimulation suggests a possible dose-dependent relationship between ACTH and IMA. The moderate increase in cortisol with no reduction in IMA levels after low-dose ACTH stimulation and the weak correlation between peak cortisol and 30-minute IMA levels after standard-dose ACTH stimulation suggest that ACTH may have a direct effect on IMA.

Biosensing Platforms for Cardiac Biomarker Detection

Myocardial infarction (MI) is a cardiovascular disease that occurs when there is an elevated demand for myocardial oxygen as a result of the rupture or erosion of atherosclerotic plaques. Globally, the mortality rates associated with MI are steadily on the rise. Traditional diagnostic biomarkers employed in clinical settings for MI diagnosis have various drawbacks, prompting researchers to investigate fast, precise, and highly sensitive biosensor platforms and technologies. Biosensors are analytical devices that combine biological elements with physicochemical transducers to detect and quantify specific compounds or analytes. These devices play a crucial role in various fields including healthcare, environmental monitoring, food safety, and biotechnology. Biosensors developed for the detection of cardiac biomarkers are typically electrochemical, mass, and optical biosensors. Nanomaterials have emerged as revolutionary components in the field of biosensing, offering unique properties that significantly enhance the sensitivity and specificity of the detection systems. This review provides a comprehensive overview of the advancements and applications of nanomaterial-based biosensing systems. Beginning with an exploration of the fundamental principles governing nanomaterials, we delve into their diverse properties, including but not limited to electrical, optical, magnetic, and thermal characteristics. The integration of these nanomaterials as transducers in biosensors has paved the way for unprecedented developments in analytical techniques. Moreover, the principles and types of biosensors and their applications in cardiovascular disease diagnosis are explained in detail. The current biosensors for cardiac biomarker detection are also discussed, with an elaboration of the pros and cons of existing platforms and concluding with future perspectives.

Association between ischemia-modified albumin (IMA) and peripheral endothelial dysfunction in rheumatoid arthritis patients

The identification of circulating biomarkers of endothelial dysfunction (ED), a precursor to atherosclerosis, in rheumatoid arthritis (RA) would facilitate early risk stratification and prevention strategies. Ischemia-modified albumin (IMA) has emerged as a potential biomarker of oxidative stress, ischemia, and ED. However, studies examining the relationship between IMA and ED in RA patients are lacking. We measured serum IMA concentrations by using an albumin cobalt binding test and peripheral vasodilatory capacity by EndoPAT in 113 RA patients without previous cardiovascular events enrolled in the EDRA study (ClinicalTrials.gov: NCT02341066). The mean peripheral vasodilatory capacity, expressed by the log of reactive hyperemia index (logRHI), was 0.82, corresponding to 27% RA patients having ED. The mean plasma concentrations of IMA were 0.478 absorbance units. We observed a significant and inverse association between peripheral vasodilatory capacity and serum IMA concentrations (rho =  - 0.22, p = 0.02). In univariate logistic regression, ED was significantly associated with serum IMA concentrations [OR 1173 (95% CI 1.3568 to 101,364), p = 0.040) and higher disease activity. In multivariate logistic regression, the independent association between ED and IMA remained significant after correction for disease activity and other RA-confounders [OR 2252 (95% CI 1.0596 to 4,787,505), p = 0.048 in Model 1; OR 7221 (95% CI 4.1539 to 12,552,859), p = 0.02 in Model 2]. Conclusions: This study suggests that IMA is a promising biomarker of ED in RA. Further research is needed to confirm our findings and determine the clinical utility of IMA in detecting and managing early atherosclerosis in RA patients.

Photodynamic Therapy for Atherosclerosis

Atherosclerosis, which currently contributes to 31% of deaths globally, is of critical cardiovascular concern. Current diagnostic tools and biomarkers are limited, emphasizing the need for early detection. Lifestyle modifications and medications form the basis of treatment, and emerging therapies such as photodynamic therapy are being developed. Photodynamic therapy involves a photosensitizer selectively targeting components of atherosclerotic plaques. When activated by specific light wavelengths, it induces localized oxidative stress aiming to stabilize plaques and reduce inflammation. The key advantage lies in its selective targeting, sparing healthy tissues. While preclinical studies are encouraging, ongoing research and clinical trials are crucial for optimizing protocols and ensuring long-term safety and efficacy. The potential combination with other therapies makes photodynamic therapy a versatile and promising avenue for addressing atherosclerosis and associated cardiovascular disease. The investigations underscore the possibility of utilizing photodynamic therapy as a valuable treatment choice for atherosclerosis. As advancements in research continue, photodynamic therapy might become more seamlessly incorporated into clinical approaches for managing atherosclerosis, providing a blend of efficacy and limited invasiveness.

Impact of human serum albumin level on symptomatic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

OBJECTIVE

To investigate the impact of human serum albumin (HSA) levels on symptomatic cerebral vasospasm (SCVS) in patients with aneurysmal subarachnoid hemorrhage (aSAH).

METHODS

We retrospectively reviewed the medical records. SCVS was defined as the development of a new neurological deterioration when the cause was considered to be ischemia attributable to vasospasm after other possible causes of worsening had been excluded. The aSAH patients were divided into two groups: those with SCVS (group 1) and those without SCVS (group 2). The HSA level data on the 1st, 2nd, and 3rd day after admission was collected. Multivariate logistical regression and receiver operating characteristic (ROC) analysis were performed to evaluate the ability of HSA level to predict the development of SCVS.

RESULTS

A total of 270 patients were included in our study, of which 74 (27.4%) developed SCVS. The average and lowest HSA levels were lower in group 1 (P < 0.001). In univariate logistic regression, white blood cell count, neutrophil count, and average and lowest HSA levels were associated with SCVS. After adjustment for age, CT Fisher grade, Hunt-Hess grade, and WFNS grade, both the average and lowest HSA levels remained independent predictors of SCVS (P < 0.001). The CT Fisher grade was confirmed to be an independent predictor of SCVS across each model. ROC analysis revealed that the lowest HSA level was a better predictor for SCVS than average HSA level and CT Fisher grade.

CONCLUSION

Clinicians are encouraged to measure HSA levels for the first 3 days after admission to predict the occurrence of SCVS after aSAH.

Ischemia-modified albumin: a novel blood marker of endoscopic mucosal healing in inflammatory bowel disease

BACKGROUND/AIMS

The achievement of endoscopic remission is an important therapeutic goal in the treatment of inflammatory bowel diseases (IBD). We aimed to evaluate the role of fecal calprotectin (FCP) and ischemia-modified albumin (IMA) as biomarkers for evaluating IBD disease activity.

METHODS

A total of 48 patients with IBD (20 with ulcerative colitis and 28 with Crohn's disease) were included in this study. FCP and serum C-reactive protein levels, erythrocyte sedimentation rate, and IMA were measured in patients with IBD and compared with endoscopic findings.

RESULTS

Elevated FCP and serum IMA levels were significantly associated with endoscopic non-mucosal healing. The correlation between FCP and IMA was not significant. Analysis of the receiver operating characteristic curve showed that both FCP and IMA had diagnostic value in predicting non-mucosal healing. When the Ln(FCP)+IMA/10 value was calculated using both factors, the predictive value for non-mucosal healing increased; however, no significant difference was observed.

CONCLUSIONS

IMA could be a candidate serum biomarker for predicting endoscopic mucosal healing in IBD.

Association of Ischemia-Modified Albumin (IMA) in Saliva, Serum, and Urine with Diagnosis of Chronic Kidney Disease (CKD) in Children: A Case-Control Study

BACKGROUND Ischemia-modified albumin (IMA) is a secreted biomarker for ischemic oxidative stress. This case-control study aimed to evaluate the association of ischemia-modified albumin (IMA) in saliva, serum, and urine with diagnosis of chronic kidney disease (CKD) in 24 children. MATERIAL AND METHODS The study involved 24 children with CKD. CKD was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) diagnostic criteria. The control group consisted of 24 healthy children who were matched for age and gender to the experimental group. The concentration of IMA was determined by the colorimetric method in non-stimulated whole saliva (NWS), stimulated whole saliva (SWS), serum, and urine of children with CKD. The Mann-Whitney U test was used for inter-group comparisons. RESULTS IMA levels were significantly higher in NWS (P=0.0082) and SWS (P=0.0014) of children with CKD than in the control group. The concentration of IMA in NWS was correlated with standard indicators of kidney function, including the estimated glomerular filtration rate (r=-0.798, P≤0.0001), stage of CKD (r=0.814, P≤0.0001), and serum creatinine (r=0.711, P≤0.0001) and urea levels (r=0.738, P≤0.0001). CONCLUSIONS Salivary IMA concentration depends on renal function in children. Salivary IMA discriminates children with end-stage kidney disease from children with mild and moderate CKD and healthy children with high sensitivity and specificity. Further research is required, including assessment of the diagnostic usefulness and validation of the biomarker in a clinical diagnostic study.

Serum oxidative stress factors predict myocardial ischemia reperfusion injury after percutaneous coronary intervention in patients with acute myocardial infarction and type 2 diabetes mellitus

Introduction

Serum oxidative stress factors may be considered to be essential parameters for indicating cell oxidative damage.

Aim

We designed this study to investigate the clinical diagnostic value of serum oxidative stress factors (superoxide dismutase (SOD), malondialdehyde (MDA), and myeloperoxidase (MPO)) combined with ischemia-modified albumin (IMA) and heat shock protein 70 (HSP70) for myocardial ischemia-reperfusion injury (MIRI) after percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM).

Material and methods

From November 2020 to August 2021, 94 patients with AMI + T2DM and 86 patients with AMI were enrolled in the study; they were sub-grouped into the MIRI and non-MIRI groups following the occurrence of MIRI within 48 h after PCI. SOD, MDA, MPO, IMA, and HSP70 levels were determined. The clinical values of the combined serum oxidative stress factors, IMA, and HSP70 levels to predict MIRI events were analyzed.

Results

There was a higher probability of MIRI events in the AMI + T2DM group than the AMI group (p < 0.05). The ROC curve for the combined prediction of SOD, MDA, MPO, IMA, and HSP70 for the occurrence of MIRI events was higher in both the AMI and the AMI + T2DM groups than for predictive factors alone (all p < 0.05).

Conclusions

Combined prediction of SOD, MDA, MPO, IMA, and HSP70 has the highest diagnostic value for predicting MIRI events after PCI in AMI patients, especially in patients with AMI combined with T2DM.

Thiol-disulphide homeostasis, ischemia-modified albumin, complete blood count-derived inflammatory markers and C-reactive protein from acute mania to early remission in bipolar disorder

OBJECTIVES

There is much recent evidence that inflammation contributes to the pathophysiology of acute mania in bipolar disorder (BD). However, no study was evaluated in which the change in thiol-disulphide homeostasis, ischemia-modified albumin (IMA), complete blood count-derived inflammatory markers (CBC-IMs) and C-reactive protein (CRP) levels in bipolar patients was followed-up from acute mania to early remission.

METHODS

Seventy-seven bipolar patients in acute mania and ninety-one HC were enrolled. We measured levels of thiol-disulphide parameters, IMA, and CBC-IMs such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red-cell-distribution-width (RDW)-to-platelet ratio (RPR), systemic immune-inflammatory index (SII), and systemic inflammatory response index (SIRI), CRP and platelet-to-albumin ratio (PAR), after adjusting for age, gender, body-mass index (BMI) and smoking status, during acute mania to subsequent early remission. The results were compared with HC.

RESULTS

The levels or ratios of all thiol-disulphide parameters except for disulphide, IMA and CRP of bipolar patients in both acute mania and early remission were significantly different from HC, after adjusting for confounders. The NLR, SII, CRP and PAR values of bipolar patients were significantly higher in only acute mania compared to HC. Significant changes in thiol-disulphide parameters and IMA levels were not found in early remission after acute mania.

LIMITATIONS

Short follow-up period and lack of drug-naive patients.

CONCLUSIONS

Our results suggest that thiol-disulphide parameters, IMA level and SIRI value might be a trait biomarkers of inflammation in BD. In addition, NLR, SII and PAR values and CRP level might be a state biomarker of inflammation in bipolar patients in a manic phase.

Effects of the real-life metal(oid)s mixture on female reproductive function: Less is different

The current study aimed to examine the effect of toxic metal(oid) mixtures (lead (Pb), cadmium (Cd), arsenic (As), mercury (Hg), cadmium (Cd), chromium (Cr), and nickel (Ni)) on female reproductive function in Wistar rats after the 28- and 90-day exposure to dose levels calculated on the basis of the previously conducted human study. Experimental groups included: 2 controls (28- and 90-day), treated groups - doses based on: median- F2 (28) and F2(90) and 95th percentile concentrations in the general human population - F3(28) and F3(90); calculated lower Benchmark dose confidence limit (BMDL) for effects on hormone levels - F1(28) and F1(90) and a group given the doses calculated on the basis of the reference values from the literature (F4(28)). Blood and ovarian samples were collected for sex hormones and ovary redox status analysis. After 28-day exposure, changes were present both in prooxidants and antioxidants. However, after the 90-day exposure redox status imbalance was majorly caused by the disturbance of antioxidants. Changes in some parameters were observed even after exposure to the lowest doses. After 28-day exposure, the strongest dose-response relationship was found between hormones: LH and FSH and toxic metal(oid)s and, after 90-day exposure, between investigated redox status parameters: sulfhydryl groups, ischemia-modified albumin and nuclear factor erythroid 2-related factor 2 (Nrf2) and toxic metal(oid)s. Low obtained BMDLs and narrow Benchmark intervals for toxic metal(oid)s and some of the parameters might confirm the "no-threshold" paradigm. This study indicates possible detrimental effects of prolonged exposure to real-life mixtures of toxic metal(oid) on female reproductive function.

Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice

Serum albumin (ALB), one of the most important proteins in human physiology, has the main functions of maintaining plasma oncotic pressure and plasma volume, transporting hormones, vitamins, oligominerals and drugs, and exerting a powerful antioxidant-anti-inflammatory role. Its prognostic value in liver and malabsorption syndromes is well known. In this narrative review, an analysis of the most important studies evaluating the prognostic significance of low serum ALB levels in hospitalized patients was performed. Specifically, the risk in emergency medicine, cardiovascular diseases, Coronavirus Disease 19 (COVID-19) infection, nephrology, oncology, and autoimmune rheumatic diseases has been examined to fully explore its clinical value. ALB is a negative acute-phase reactant and the reduction in its serum levels represents a threatening parameter for long-term survival in several clinical settings, and a strong biomarker for a poor prognosis in most diseases. Therefore, clinicians should consider serum ALB as a valuable tool to assess the efficacy of specific therapies, both in hospitalized patients and in chronic follow-up.

Utility of Ischemia-Modified Albumin as a Biomarker for Acute Appendicitis: A Systematic Review and Meta-Analysis

BACKGROUND

Acute appendicitis is a frequently encountered surgical emergency. Despite several scoring systems, the possibility of delayed diagnosis persists. In addition, a delayed diagnosis leads to an increased risk of complicated appendicitis. Hence, there is a need to identify biological markers to help clinicians rapidly and accurately diagnose and prognosticate acute appendicitis with a high sensitivity and specificity. Although several markers have been evaluated, the pressing concern is still the low specificity of these markers. One such marker is serum ischemia-modified albumin (IMA), which can be a novel biomarker for accurately diagnosing and prognosticating acute appendicitis.

METHODS

The authors conducted a systematic search of the PubMed, EMBASE, Web of Science, and Scopus databases through February 2023 as per the PRISMA guidelines. The difference in the levels of IMA between patients with acute appendicitis vs. healthy controls, and the difference in the levels of IMA between patients with complicated vs. non-complicated acute appendicitis were taken as the outcome measures. Statistical analysis was performed using a random effects model and mean difference (MD) was calculated. The methodological quality of the studies was assessed by utilizing the Newcastle-Ottawa scale.

RESULTS

A total of six prospective comparative studies were included in the meta-analysis. The analysis revealed that the mean level of serum IMA was significantly raised in the acute appendicitis group (MD 0.21, 95% CI 0.05 to 0.37, p = 0.01). Similarly, the mean serum IMA levels were also raised in the complicated appendicitis group compared to the non-complicated appendicitis group (MD 0.05, 95% CI 0.01 to 0.10, p = 0.02). Three of the studies included were, however, of poor methodological quality.

CONCLUSIONS

Serum IMA is a viable potential marker for diagnosing and prognosticating acute appendicitis. However, due to the limited methodological quality of available studies, further prospectively designed and adequately powered studies are needed.

Serum Oxidative and Nitrosative Stress Markers in Clear Cell Renal Cell Carcinoma

Oxidative stress is believed to be a factor in the development and progression of renal cell carcinoma (RCC). The identification of the oxidative and nitrosative modification of proteins and the definition of their roles in clear cell RCC (ccRCC) may be helpful in the elaboration of targeted therapeutic approaches to mitigate protein damage. This study aimed to investigate the status of oxidative/nitrosative stress and to explore its role in the development and progression. The studied group consisted of 48 newly diagnosed ccRCC and 30 healthy controls. Serum levels of oxidative stress markers-advanced oxidation protein products (AOPP), thiol groups, Amadori reaction products, 3-nitrotyrosine, nitrate/nitrite, malondialdehyde (MDA), 4-hydroxy-2-nonenal and total antioxidant capacity (TAC)-were determined. Additionally, associations between tumour stage assessed according to TNM classification, histological grade, and the effect of the presence of angioinvasion on the level of stress markers were evaluated. The levels of Amadori products, 3-nitrotyrosine, and nitrate/nitrite were elevated, while the levels of thiol groups and TAC decreased in the ccRCC group. The levels of AOPP, Amadori, and 3-nitrotyrosine increased, and thiol groups and TAC levels decreased with the increasing pathological stage of the tumour. In the case of advanced histological assessment of the tumour, we found decreasing levels of thiol groups and increasing levels of MDA. In patients with angioinvasion, nitrate/nitrite and MDA levels were significantly elevated compared to those in patients without angioinvasion. Oxidative stress increased with the progression of the disease assessed according to the TNM and histological grade. These results demonstrate systemic oxidative stress in ccRCC, suggesting the therapeutic application of antioxidants.

Diagnostic values of ischemia modified albumin in diabetes-related complications: a narrative review

Purpose

Oxidative stress (OS) plays a critical role in the onset and progression of macro and microvascular complications of diabetes mellitus (DM). Ischemia-modified albumin (IMA) is a novel and simple test for evaluating OS. In the present study, we reviewed the available information on the alteration of circulating IMA in DM and its possible prognostic and diagnostic value in DM-related complications.

Methods

Relevant studies regarding IMA alteration in DM published until May 30, 2022 were extracted from Google Scholar, PubMed, Scopus, and Science Direct databases. The following key words were used: IMA, DM, diabetes complications, retinopathy, nephropathy, diabetic foot, and vascular complications.

Results

This review revealed increased circulating IMA levels in the patients with type 1, type 2, and gestational DM. Furthermore, IMA showed a close relationship with the severity of DM complications including hyperglycemia, dyslipidemia, diabetic retinopathy, diabetic nephropathy, peripheral arterial disease, and diabetic foot ulcer. However, lack of assay standardization and low specificity are major obstacles to the use of IMA as a promising biomarker.

Conclusion

IMA levels are associated with DM complications and can be applied as a practical test for evaluating the risk and predicting the severity of DM complications.

Antioxidative Effects of Black Currant and Cornelian Cherry Juices in Different Tissues of an Experimental Model of Metabolic Syndrome in Rats

A Western-style diet, rich in fat and simple sugars, is the main risk factor for a significant number of chronic diseases and disorders, as well as for a progression of metabolic syndrome (MetS). One of the key mechanisms involved in MetS development is increased oxidative stress caused by the accumulation of body fat. Some dietary polyphenols have shown a protective role in preventing oxidative-stress-induced damage. We investigated the difference in the oxidative response of plasma, liver, and visceral adipose tissue in rats fed with a high-fat high-fructose (HFF) diet for ten weeks, and the effectiveness of polyphenol-rich juices (black currant (BC) and cornelian cherry (CC)) in HFF-diet-induced oxidative stress prevention. The most prominent impact of the HFF diet on redox parameters was recorded in the liver, whereas adipose tissue showed the most potent protection mechanisms against oxidative stress. Consumption of both juices decreased advanced oxidation protein product (AOPP) level in plasma, increased paraoxonase1 (PON1) activity in the liver, and significantly decreased total oxidative status (TOS) in adipose tissue. BC exerted stronger antioxidative potential than CC and decreased the superoxide anion radical (O₂^•-) level in the liver. It also reduced TOS, total antioxidative status (TAS), and malondialdehyde (MDA) concentration in adipose tissue. The multiple linear regression analysis has shown that the best predictors of MetS development, estimated through the increase in visceral adiposity, were superoxide dismutase (SOD), AOPP, TOS, and TAS. The consumption of polyphenol-rich juices may provide a convenient approach for the systemic reduction of oxidative stress parameters.

Analysis of the Ischemia-Modified Albumin as a Potential Biomarker for Cardiovascular Damage in Obstructive Sleep Apnea Patients with Acute Coronary Syndrome

Obstructive sleep apnea (OSA) has been identified as a cardiovascular (CV) risk factor. The potential of OSA promoting the synthesis of CV biomarkers in acute coronary syndrome (ACS) is unknown. Ischemia-modified albumin (IMA) has been identified as a specific CV biomarker. The aim of this study was to evaluate the role of IMA as a potential biomarker for determining the impact of OSA in ACS patients. A total of 925 patients (15.5% women, age: 59 years, body mass index: 28.8 kg/m²) from the ISAACC study (NCT01335087) were included. During hospitalization for ACS, a sleep study for OSA diagnosis was performed and blood samples extraction for IMA determination were obtained. IMA values were significantly higher in severe OSA (median (IQR), 33.7 (17.2-60.3) U/L) and moderate (32.8 (16.9-58.8) U/L) than in mild/no OSA (27.7 (11.8-48.6) U/L) (p = 0.002). IMA levels were very weakly related to apnea-hypopnea index (AHI) as well as hospital and intensive care unit stay, although they only maintained a significant relationship with days of hospital stay after adjusting for sex, age and BMI (ß = 0.410, p = 0.013). The results of the present study would suggest a potentially weaker role of OSA in the synthesis of the CV risk biomarker IMA in patients with ACS than in primary prevention.

The Role of Potential Oxidative Biomarkers in the Prognosis of Acute Ischemic Stroke and the Exploration of Antioxidants as Possible Preventive and Treatment Options

Ischemic strokes occur when the blood supply to a part of the brain is interrupted or reduced due to arterial blockage, and it often leads to damage to brain cells or death. According to a myriad of experimental studies, oxidative stress is an important pathophysiological mechanism of ischemic stroke. In this narrative review, we aimed to identify how the alterations of oxidative stress biomarkers could suggest a severity-reflecting diagnosis of ischemic stroke and how these interactions may provide new molecular targets for neuroprotective therapies. We performed an eligibility criteria-based search on three main scientific databases. We found that patients with acute ischemic stroke are characterized by increased oxidative stress markers levels, such as the total antioxidant capacity, F2-isoprostanes, hydroxynonenal, total and perchloric acid oxygen radical absorbance capacity (ORACTOT and ORACPCA), malondialdehyde (MDA), myeloperoxidase, and urinary 8-oxo-7,8-dihydro-2′-deoxyguanosine. Thus, acute ischemic stroke is causing significant oxidative stress and associated molecular and cellular damage. The assessment of these molecular markers could be useful in diagnosing ischemic stroke, finding its causes, predicting its severity and outcomes, reducing its impact on the cellular structures of the brain, and guiding preventive treatment towards antioxidant-based therapy as novel therapeutic alternatives.

Application of effective albumin concentration in treatment of chronic liver disease

Albumin is a non-glycosylated plasma protein. Besides the role of increasing blood volume and maintaining plasma colloid osmotic pressure, albumin also has multiple biological functions such as transport, antioxidant and anti-inflammatory effects, immune regulation, etc. In-depth studies on the structure and function of albumin have revealed that the post-transcriptional modification of albumin reduces the effective albumin concentration in patients with chronic liver disease, so the clinically effective albumin concentration rather than total albumin concentration can more accurately reflect the disease progression and prognosis, and more effectively guide exogenous albumin treatment in such patients. This article summarizes the clinical correlation between post-transcriptional modification of albumin and the liver and its related diseases, as well as the studies on effective albumin, in order to provide evidence-based information on effective albumin concentration and to better guide the clinical treatment of chronic liver disease.

Dynamic thiol-disulphide homeostasis as a biomarker for predicting the development of contrast medium-associated acute kidney injury in the endovascular treatment of peripheral arterial disease: should intravenous N-acetylcysteine be given before the procedure?

AIM

To determine the predictive ability of serum thiol-disulphide levels for contrast medium-associated acute kidney injury (CA-AKI) after endovascular treatment (EVT) of peripheral arterial disease (PAD) and evaluate the efficacy of intravenous N-acetylcysteine (NAC) in preventing CA-AKI.

MATERIAL AND METHODS

This double-blind, randomised controlled study included 85 consecutive adult patients who underwent EVT for PAD. Patients were divided into NAC negative (NAC-) and positive (NAC+) groups. While the NAC- group received only 500 ml saline, the NAC + group received 500 ml saline plus intravenous 600 mg NAC before the procedure. Intra- and intergroup patient characteristics, procedural details, preoperative thiol-disulphide levels, and ischaemia-modified albumin (IMA) levels were recorded.

RESULTS

There was a significant difference between NAC- and NAC + groups regarding native thiol, total thiol, disulphide/native thiol ratio (D/NT), and disulphide/total thiol ratio (D/TT). There was also a significant difference between the NAC- (33.3%) and NAC+ (13%) groups in CA-AKI development. Logistic regression analysis showed that the D/TT (OR 2.463) and D/NT (OR 2.121) were the most influential parameters for CA-AKI development. In the receiver operating characteristic (ROC) curve analysis, the sensitivity of native thiol to detect the development of CA-AKI was 89.1%. The negative predictive values of native thiol and total thiol were 95.6% and 94.1%, respectively.

CONCLUSION

The serum thiol-disulphide level can be used as a biomarker to detect CA-AKI development and reveal patients with a low risk for CA-AKI development before EVT of PAD. Furthermore, thiol-disulphide levels allow for the indirect quantitative monitoring of NAC. Preprocedural intravenous NAC administration significantly inhibits CA-AKI development.

Incidence and Severity of Acute Myocardial Injury after Thoracic Surgery: Effects of Nicorandil

Aim. To study the perioperative dynamics of myocardial injury biomarkers high-sensitivity cardiac troponin I (hs-cTnI), ischemia-modified albumin (IMA) and soluble ST2 (sST2) when taking nicorandil in lung cancer patients with concomitant coronary heart disease (CHD) undergoing surgical lung resection.

Material and methods. The study included 54 patients (11 women and 43 men) with non-small cell lung cancer and concomitant stable CHD who underwent lung resection in the volume of lobectomy or pneumonectomy. Patients were randomly assigned to the nicorandil group (oral administration 10 mg BID for 7 days before and 3 days after surgery; n=27) and the control group (n=27). In the study groups, the perioperative dynamics of hscTnI, IMA and sST2, determined in the blood before and 24 and 48h after surgery, were compared. We calculated the incidence of acute myocardial injury in the groups, which was diagnosed in cases of postoperative hs-cTnI increase of more than one 99th percentile of the upper reference limit. The associations of nicorandil intake and acute myocardial injury were evaluated.

Results. The groups were comparable in gender, age, basic clinical characteristics, as well as baseline levels of myocardial injury biomarkers. After the intervention, both samples showed an increase in the hs-cTnI and sST2 levels and a decrease in IMA concentration (all p<0.02 for related group differences). In the nicorandil group, in comparison with the control one, 48h after surgery, we found lower mean levels of hs-cTnI [16.7 (11.9;39.7) vs 44.3 (15.0;130.7) ng/l; p<0.05) and sST2 [62.8 (43.6;70.1) vs 76.5 (50.2;87.1) ng/ml; p<0.05), concentration increase rates of hs-cTnI [14.8 (0.7;42.2) vs 32.5 (14.0;125.0) ng/l; p<0.01) and sST2 [24.4 (10.3;42.4) vs 47.4 (17.5;65.3) ng/ml; p<0.05), as well as highest concentrations for the entire postoperative period of hs-cTnI [30.7 (12.0;53.7) vs 79.0 (20.3;203.3) ng/L, p<0.01] and sST2 [99.8 (73.6;162.5) vs 147.8 (87.8;207.7) ng/mL; p<0.05]. The serum IMA decreased when taking nicorandil to a greater extent [-8.0 (-12.6; -2.0) vs -2.7 (-6.0; +5.5) ng/ ml; p<0.01] 24h after surgery. Acute myocardial injury was diagnosed in 7 people in the nicorandil group (25.9%) and in 15 in the control one (55.6%; pχ2=0.027). The adjusted odds ratio of acute myocardial injury when taking nicorandil was 0.35 (95% confidence interval 0.15-0.83, p=0.017).

Conclusion. Taking  nicorandil  in patients with lung cancer and concomitant CHD  who underwent  surgical  lung resection is associated  with a lower postoperative  increase in hs-cTnI  and sST2  and a reduced risk of acute myocardial  injury, which may indicate the cardioprotective effect of nicorandil under acute surgical stress conditions.

Biomarkers of oxidative stress and reproductive complications

Oxidative stress is the result of an imbalance between the formation of reactive oxygen species (ROS) and the levels of enzymatic and non-enzymatic antioxidants. The assessment of biological redox status is performed by the use of oxidative stress biomarkers. An oxidative stress biomarker is defined as any physical structure or process or chemical compound that can be assessed in a living being (in vivo) or in solid or fluid parts thereof (in vitro), the determination of which is a reproducible and reliable indicator of oxidative stress. The use of oxidative stress biomarkers allows early identification of the risk of developing diseases associated with this process and also opens up possibilities for new treatments. At the end of the last century, interest in oxidative stress biomarkers began to grow, due to evidence of the association between the generation of free radicals and various pathologies. Up to now, a significant number of studies have been carried out to identify and apply different oxidative stress biomarkers in clinical practice. Among the most important oxidative stress biomarkers, it can be mentioned the products of oxidative modifications of lipids, proteins, nucleic acids, and uric acid as well as the measurement of the total antioxidant capacity of fluids in the human body. In this review, we aim to present recent advances and current knowledge on the main biomarkers of oxidative stress, including the discovery of new biomarkers, with emphasis on the various reproductive complications associated with variations in oxidative stress levels.

Ischemia modified albumin can act as an independent predictor of inhospital mortality in patients with acute aortic dissection

Acute aortic dissection (AAD) is a serious disease characterized by high mortality. However, there are no accurate indicators to predict in-hospital mortality. The objective of this study was to identify the potential value of ischemia modified albumin (IMA) in prediction of in-hospital mortality of AAD patients. This was a single-center, prospective study involved 314 patients undergoing AAD, including 197 males and 117 females, aged 26-87 (57.14 ± 21.71) years old, 116 cases of TAAD and 198 cases of TBAD (37 cases of complicated, 114 cases of high risk, and 47 cases of uncomplicated), 228 cases were underwent surgery/intervention treatment (77 cases of TAAD,151 cases of TBAD) and 86 cases were underwent conservative therapy (39 cases of TAAD, 47 cases of TBAD). The basic data, on-admission IMA level, and the all-cause in-hospital mortality was recorded. IMA in the non-survivor group and TAAD group was found to be significantly higher than that in the survivor group and TBAD group (P < 0.001). Multivariate logistic regression analysis results revealed that age (OR = 1.923, 95%CI: 1.102-4.481, P = 0.020), conservative therapy (OR = 17.892, 95%CI: 7.641-24.748, P < 0.001), D-dimer level (OR = 3.517, 95%CI: 1.874-7.667, P = 0.011) and IMA level (OR = 5.406, 95%CI: 2.951-10.395, P = 0.004) served as independent risk factors for in-hospital mortality of TAAD patients. And D-dimer level (OR = 2.241, 95%CI: 1.475-5.663, P = 0.018), IMA level (OR = 3.115, 95%CI: 1.792-6.925, P = 0.009) also served as independent risk factors for in-hospital mortality of TBAD patients, whereas surgery (OR = 0.110, 95%CI: 0.075-0.269, P < 0.001) was the protective factor of in-hospital mortality of TAAD patients. After IMA prediction, the AUC, optimal cut-off value, sensitivity, and the specificity of in-hospital mortality of AAD patients were observed to be 0.801 (95%CI: 0.744-0.858), 86.55 U/mL, 79.1%, and 73.2%, respectively. In addition, it was found that AUC was 0.799 (95%CI: 0.719-0.880) in TAAD and 0.753 (95% CI: 0.641-0.866) in TBAD. Overall, it was concluded that on-admission IMA level acted as an independent prediction index for in-hospital mortality of AAD patients.

Effects of edaravone on oxidative protein modification and activity of gelatinases after intracerebral hemorrhage in rats with nicotinamide-streptozotocin induced diabetes

Stroke, especially hemorrhagic form, is one of the most serious comorbidity disease of diabetes mellitus, often associated with high mortality, particularly in type 2 DM (T2DM). Therefore, it is relevant the search for drugs with a metabolically justified protective effect. Edaravone (Eda) is widely used for treating ischemic stroke but its biochemical effects in intracerebral hemorrhage (ICH) associated with T2DM is not still confirmed. The aim of the study was to assess the impact of Eda on the markers of oxidative modification of proteins (OMP), such as advanced oxidation protein products (AOPP), neutral and basic carbonyls (PC370 and PC430), advanced glycation end products (AGE) and ischemia modified albumin (IMA) as well as on the activity of matrix metalloproteinases MMP2/MMP9 (gelatinases) in rats with experimental T2DM after collagenase-induced ICH. Metformin was used as a comparative drug. The data obtained indicate that ICH in diabetic rats is accompanied by an increase in AOPP, PC370, AGE, and mature forms of both gelatinases. On the contrary, IMA and proMMP9 were below normal level after ICH. Both studied drugs decreased the OMP markers to the levels of intact rats or lower, and Eda show a more potent effect. Besides, Eda significantly decreased the activity of MMP9 and changed progelatinases activity. We conclude that Eda has a perspective to be useful in the treatment of comorbid brain hemorrhage in T2DM due to inhibiting of oxidative stress and modulation of gelatinases activity.

Zinc in Prostate Health and Disease: A Mini Review

Introduction-With the high global prevalence of prostate cancer and associated mortalities, it is important to enhance current clinical practices for better prostate cancer outcomes. The current review is towards understanding the value of Zn towards this mission. Method-General information on Zn in biology and multiple aspects of Zn involvement in prostate health and disease were referred to in PubMed. Results-The most influential feature of Zn towards prostate health is its ability to retain sufficient citrate levels for a healthy prostate. Zn deficiencies were recorded in serum, hair, and prostate tissue of men with prostate cancer compared to non-cancer controls. Zn gut absorption, albumin binding, and storage compete with various factors. There are multiple associations of Zn cellular influx and efflux transporters, Zn finger proteins, matrix metalloproteinases, and Zn signaling with prostate cancer outcomes. Such Zn marker variations associated with prostate cancer recorded from biological matrices may improve algorithms for prostate cancer screening, prognosis, and management when coupled with standard clinical practices. Discussion-The influence of Zn in prostatic health and disease is multidimensional, therefore more personalized Zn requirements may be beneficial. Several opportunities exist to utilize and improve understanding of Zn associations with prostate health and disease.

Hypoxia-inducible factor-1α and ischemia-modified albumin levels in intensive care COVID-19 Patients

OBJECTIVES

In this study, it was aimed to evaluate the hypoxia-inducible factor-1α (HIF-1α) and ischemia-modified albumin (IMA) levels of patients diagnosed with COVID-19 in the intensive care unit (ICU) and healthy controls. To our knowledge, this is the first study investigate HIF-1α and IMA levels in COVID-19 patients in ICUs and comparing them with a healthy control group. For this reason, our study is original and will contribute to the literature.

METHODS

A total of 70 intensive care patients diagnosed with COVID-19, and 72 healthy controls were included in the study.

RESULTS

When we compared the patient and healthy control group; there were no statistically significant differences between the groups in terms of age and gender (p>0.05). No exitus was observed in the patient group. We found weak correlation between HIF-1α and IMA (r: 0.320). However, there were statistically significant differences in HIF-1α and IMA levels in the patient group. The receiver operating characteristic (ROC) curve demonstrated an area under curve (AUC) value of 0.651 for HIF-1α and 0.937 for IMA.

CONCLUSIONS

The HIF-1α and IMA levels were significantly higher among COVID-19 patients in ICU compared with healthy controls. HIF-1α and IMA levels can be used as reliable markers for the prognosis of COVID-19.

The importance of a sepsis layered early warning system for critical patients

Critical illness, particularly sepsis, is associated with high mortality, so prevention is more important than effective therapy. Advances in medical science have provided more opportunities for early warning and early intervention to avoid the development of critical illness. Existing early warning systems (EWS) have the advantages of high efficiency and convenience. However, with the development of medical technology, they do not completely meet clinical needs. EWS should contain elements that meet many dimensions of clinical requirements, including risk warning, response warning, injury warning, critical warning, and death warning. By summarizing previous studies, we outlined a layered EWS that follows RISK bundles. RISK represents different warning sign categories: R: host response, I: organ injury, S: changes in vital signs, and K: gradual appearance of "killed" organs. We plan to construct a complete layered EWS to guide clinical activities and subsequent clinical studies in the near future.

Serum Concentrations of Ischaemia-Modified Albumin in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

The identification of novel circulating biomarkers of acute coronary syndrome (ACS) may improve diagnosis and management. We conducted a systematic review and meta-analysis of ischaemia-modified albumin (IMA), an emerging biomarker of ischaemia and oxidative stress, in ACS. We searched PubMed, Web of Science, and Scopus from inception to March 2022, and assessed the risk of bias and certainty of evidence with the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 18 studies (1654 ACS patients and 1023 healthy controls), IMA concentrations were significantly higher in ACS (standard mean difference, SMD = 2.38, 95% CI 1.88 to 2.88; p < 0.001; low certainty of evidence). The effect size was not associated with pre-defined study or patient characteristics, barring the country where the study was conducted. There were no significant differences in effect size between acute myocardial infarction (MI) and unstable angina (UA), and between ST-elevation (STEMI) and non-ST-elevation MI (NSTEMI). However, the effect size was progressively larger in UA (SMD = 1.63), NSTEMI (SMD = 1.91), and STEMI (3.26). Our meta-analysis suggests that IMA might be useful to diagnose ACS. Further studies are warranted to compare the diagnostic performance of IMA vs. established markers, e.g., troponin, and to determine its potential utility in discriminating between UA, NSTEMI, and STEMI (PROSPERO registration number: CRD42021324603).

Serum albumin, prealbumin, and ischemia-modified albumin levels in patients with ANCA-associated vasculitis: A prospective cohort study

Objectives

Acute phase reactants (APRs) are proteins altered by inflammation and are regarded as surrogate markers representing inflammatory status. This study evaluated changes of albumin (Alb), prealbumin (Palb), and ischemia-modified albumin (IMA) in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in response to alterations in disease activity and the correlation between disease activity and Alb, Palb, and IMA.

Methods

Fifty-nine patients with AAV registered in the prospective SHAVE cohort, who had available serial blood samples at least three months apart were included (indicated as pre and post). Correlation analysis and linear regression were carried out to determine the relationship between continuous variables. Alb, Palb, and IMA levels in 40 healthy controls (HCs) were compared with patients with AAV.

Results

Comparison of Alb, Palb, and IMA levels in HCs and in patients at initial (pre) and follow-up (post) time points revealed that Alb levels significantly increased following the improvement of disease activity and were comparable between HCs and patients at follow-up (post). Meanwhile, there was no significant difference noted in Palb and IMA levels after the decrease of disease activity. While initial (pre) Alb and Palb were significantly associated with BVAS, a subgroup analysis of patients with new-onset disease showed Palb was no longer significantly associated with Birmingham Vasculitis Activity Score (BVAS). Multivariate linear regression showed Alb level (standardized β = -0.377; 95% confidence interval: -5.623, -1.260; p = 0.003) was an independent predictor of BVAS at baseline.

Conclusions

Among Alb, Palb, and IMA, we found that Alb could be a useful marker indicating disease activity in patients with AAV.

The diagnostic potential of oxidative stress biomarkers for preeclampsia: systematic review and meta-analysis

BACKGROUND

Preeclampsia is a multifactorial cardiovascular disorder of pregnancy. If left untreated, it can lead to severe maternal and fetal outcomes. Hence, timely diagnosis and management of preeclampsia are extremely important. Biomarkers of oxidative stress are associated with the pathogenesis of preeclampsia and therefore could be indicative of evolving preeclampsia and utilized for timely diagnosis. In this study, we conducted a systematic review and meta-analysis to determine the most reliable oxidative stress biomarkers in preeclampsia, based on their diagnostic sensitivities and specificities as well as their positive and negative predictive values.

METHODS

A systematic search using PubMed, ScienceDirect, ResearchGate, and PLOS databases (1900 to March 2021) identified nine relevant studies including a total of 343 women with preeclampsia and 354 normotensive controls.

RESULTS

Ischemia-modified albumin (IMA), uric acid (UA), and malondialdehyde (MDA) were associated with 3.38 (95% CI 2.23, 4.53), 3.05 (95% CI 2.39, 3.71), and 2.37 (95% CI 1.03, 3.70) odds ratios for preeclampsia diagnosis, respectively. The IMA showed the most promising diagnostic potential with the positive predictive ratio (PPV) of 0.852 (95% CI 0.728, 0.929) and negative predictive ratio (NPV) of 0.811 (95% CI 0.683, 0.890) for preeclampsia. Minor between-study heterogeneity was reported for these biomarkers (Higgins' I2 = 0-15.879%).

CONCLUSIONS

This systematic review and meta-analysis identified IMA, UA, and MDA as the most promising oxidative stress biomarkers associated with established preeclampsia. IMA as a biomarker of tissue damage exhibited the best diagnostic test accuracy. Thus, these oxidative stress biomarkers should be further explored in larger cohorts for preeclampsia diagnosis.

Ischemia-Modified Albumin—A Potential New Marker of Oxidative Stress in Dermatological Diseases

There is growing evidence that oxidative stress is involved in the pathogenesis of numerous conditions, including dermatological diseases. Various markers are available to assess oxidative stress, but none of these can be considered the ideal marker. Recent studies have shown that ischemia-modified albumin (IMA) is not only an indicator of ischemia, but also a marker of oxidative stress. We have conducted a narrative review to evaluate the role of IMA in dermatological diseases. We have identified 24 original articles that evaluated IMA in skin disorders (psoriasis, acne vulgaris, hidradenitis suppurativa, urticaria, vitiligo and Behcet’s disease) and hair disorders (alopecia areata, androgenetic alopecia and telogen effluvium). The results of the studies analyzed reveal that IMA may be considered a new marker of oxidative stress in dermatological diseases and offer new insights into the pathogenesis of these disorders and the theoretical basis for the development of new, effective, targeted therapies. To the best of our knowledge, this is the first review that gathers up data on the role of IMA in dermatological diseases.

A Systematic Review and Meta-Analysis of Serum Concentrations of Ischaemia-Modified Albumin in Acute Ischaemic Stroke, Intracerebral Haemorrhage, and Subarachnoid Haemorrhage

The identification of robust circulating biomarkers of stroke may improve outcomes. We conducted a systematic review and meta-analysis of serum concentrations of ischaemia-modified albumin (IMA) in subjects with or without acute ischaemic stroke (AIS), intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH). We searched PubMed, Web of Science, Scopus, and Google Scholar from inception to March 2022. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 17 studies, IMA concentrations were significantly higher in patients with AIS (standard mean difference, SMD = 2.52, 95% CI 1.92 to 3.12; p < 0.001), ICH (SMD = 3.13, 95% CI 1.00 to 5.25; p = 0.004), and SAH (SMD = 4.50, 95% CI 0.91 to 7.01; p = 0.014) vs. controls (very low certainty of evidence). In AIS, the effect size was associated with the male gender, and was relatively larger in studies conducted in Egypt and India and those using enzyme-linked immunosorbent assays. IMA concentrations were progressively higher, by direct comparison, in SAH, ICH, and AIS. In sensitivity analysis, the pooled SMDs were not altered when individual studies were sequentially removed. Our meta-analysis suggests that IMA concentrations might be useful to diagnose stroke and discriminate between AIS, ICH, and SAH (PROSPERO registration number: CRD42021320535).

Value of IMA, IMAR, the IMA Index, and Other Hematological Features in Predicting AIS Caused by MCA Stenosis/Occlusion

OBJECTIVE

In this study, we investigated the relationship between serum ischemic modified albumin (IMA) levels and other hematologic features and middle cerebral artery (MCA) severe stenosis/occlusion in acute ischemic stroke (AIS) patients.

METHODS

The levels of serum IMA and Albumin (ALB) of 169 AIS patients were measured, and the ratio of IMA to albumin (IMAR) and the albumin-adjusted ischemia-modified albumin index (IMA index) were calculated. Different combinations of other hematologic changes and clinical features of the patients were analyzed.

RESULTS

The results indicated that the levels of blood IMA and IMAR were significantly higher in the group with severe intracranial stenosis/occlusion than in the group with non-severe stenosis/ occlusion in AIS patients, while the CHE levels were significantly lower than those in the other groups. In the MCA severe stenosis/occlusion group, the levels of blood IMA and IMAR were significantly higher than that in the other vascular severe stenosis/occlusion groups, while the IMA index, ALB, and CHE were significantly lower than that in the other groups. Multiple linear regression analysis showed a significant negative correlation between IMA and albumin. A combined diagnostic ROC curve analysis showed that among AIS patients, the best combination for determining severe stenosis/occlusion of the great intracranial arteries was the admission NIHSS score + CHE (AUC = 0.783). The best combination for determining severe stenosis or occlusion of the MCA in AIS patients was IMAR combined with the admission NIHSS score and CHE (AUC = 0.827).

CONCLUSION

The combined use of IMA, IMAR, and the IMA index has some diagnostic value in AIS caused by severe stenosis or occlusion of the MCA. IMAR, CHE, and the admission NIHSS scores are the best combinations to determine whether an AIS patient has severe stenosis or occlusion of the MCA.

The Relationship between Ozone and Human Blood in the Course of a Well-Controlled, Mild, and Transitory Oxidative Eustress

In the last twenty years there has been a proliferation of articles on the therapeutic use of ozone. As it is well-known, the term ozone therapy is very broad. It ranges from either systemic or loco-regional administration of unstable gaseous oxygen/ozone mixtures to the topical application of stable ozonated derivatives. Anyway, in relation to the absence of specific receptors and the extreme reactivity with the biological liquids with which it comes into contact, gaseous ozone cannot be classified as either a drug or a pro-drug. When the gaseous ozone impacts a biological matrix, both reactive oxygen species (ROS) and lipid oxidation products (LOPs) are formed. They represent the effector molecules responsible for modulating the therapeutic activity in the body. Apart from the merits of the action mechanisms resulting from the use of ozone, this article seeks to validate the practice of ozone therapy as an adjuvant treatment in full compliance with the physiology of the whole organism.