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).

Investigation of serum endocan and serglycin levels in obstructive sleep apnea

BACKGROUND

Apnea-related hypoxia, hypercapnia, and blood pressure fluctuations cause production of various proinflammatory cytokines and trigger a vicious cycle that results in vascular endothelial damage and systemic inflammation in obstructive sleep apnea (OSA). Endothelial function is frequently impaired in OSA even in the absence of significant cardiac or vascular disorders.

AIMS

This study aimed to investigate the serum endocan and serglycin levels in OSA patients.

METHODS

This prospective study included 78 consecutive patients who admitted to the sleep laboratory of a tertiary referral center with the complaints of daytime sleepiness, witnessed sleep apnea, and/or snoring and who underwent all-night polysomnography (PSG). After PSG, the patients were divided into four groups in relation with their apnea-hypopnea indexes. The groups were compared for endocan and serglycin levels and their correlations with OSA severity. The correlations with demographic data and PSG findings were also investigated.

RESULTS

The OSA and the control groups had significantly different endocan and serglycin levels ([Formula: see text], for both). On univariate logistic regression analysis, it was found that serglycin and endocan levels and BMI were predictors of OSA. Multiple logistic regression analysis showed that endocan and serglycin levels were independent predictors for OSA ([Formula: see text] and [Formula: see text], respectively).

CONCLUSIONS

We have demonstrated that elevated endocan and serglycin levels are predictors for OSA. Furthermore, we have showed for the first time in literature that serglycin is correlated with OSA and is an independent predictor for OSA.

Effects of Niaoduqing granules on inflammatory response of diabetic kidney disease: A meta‑analysis

Diabetic kidney disease (DKD) is one of the most severe chronic microvascular complications of diabetes and the leading cause of end-stage kidney disease worldwide. The mechanism of inflammation underlying DKD has been attracting attention over recent years, but effective therapeutic strategies have remained elusive. Niaoduqing (NDQ) granules are one of the most commonly used drugs for the treatment of DKD in China, and it has therapeutic effects against inflammation in DKD. Therefore, the aim of the present analysis was to evaluate the inflammatory response outcomes and safety of NDQ granules for the treatment of DKD. The following databases were searched from their inception to 31st of May 2023 to obtain published accounts of relevant randomized controlled trials: China National Knowledge Infrastructure, China Science and Technology Journal, Wanfang, The Chinese Biomedicine, PubMed, Web of Science and Cochrane Library. The 'risk of bias' evaluation tool produced by the Cochrane Collaboration Handbook was used for evaluating the quality, whereas Revman software (version 5.3) was used for meta-analysis. In total, 16 studies were included into the present study according to criteria, with a total of 1,526 patients. Compared with those in the control group, the results of the meta-analysis revealed that the combination of conventional treatment and NDQ granules may further decrease C-reactive protein [standardized mean difference (SMD), -1.33; 95% confidence interval (CI), -1.76, -0.91; P<0.00001], TNF-α (SMD, -1.90; 95% CI, -2.35,-1.45; P<0.00001) and IL-6 (SMD, -1.72; 95% CI, -2.52,-0.91; P<0.0001) levels, whilst increasing the clinical effective rate (risk ratio, 1.22; 95% CI, 1.14,1.29; P<0.00001), in patients with DKD. In terms of safety, a total of 34 and 39 patients included in the intervention and in the control group, respectively, developed adverse reactions. Results from the present analysis suggest that NDQ granules may be beneficial in suppressing inflammation caused by DKD when used in combination with conventional treatment, potentially guiding future directions in clinical practice. However, further high-quality studies are needed to confirm the anti-inflammation response in the future.

Chronic Inflammation Plays a Role of a Bridge Between Cardiovascular Disease and Hyperglycemia

Background: Chronic inflammation is believed to play a key role in managing cardiovascular disease (CVD) and glycometabolism, but the specific effects remain unclear. The subclinical features of CVD events and hyperglycemia linked to inflammatory status were evaluated in this study. In addition, independent factors associated with inflammatory status were identified. Methods: Inflammatory status was measured by high-sensitivity C-reactive protein (hs-CRP), CVD events estimated by carotid intima-media thickness (cIMT), and hyperglycemia determined by glycated hemoglobin (HbA1c). Univariate analysis was performed to identify the characteristics of HbA1c-defined normoglycemia, prediabetes, and diabetes, whereas multivariate linear regression analysis was conducted to identify independent factors that correlated with hs-CRP levels. Results: Compared with HbA1c-defined normoglycemia, individuals with prediabetes and diabetes had significantly higher risks of cIMT thickening [risk ratio (RR) was 2.21 and 2.40, respectively], carotid atherosclerosis (RR was 2.29 and 3.04, respectively), and carotid plaque (RR was 2.15 and 2.63, respectively). Diabetes had higher risks of carotid atherosclerosis (RR was 1.33) and carotid plaque (RR was 1.22) than prediabetes. Increasing prevalence of cIMT thickening, atherosclerosis, and plaque was correlated with hs-CRP levels rising. There was a notable linear relationship between HbA1c and hs-CRP levels (R2 = 0.8685). In addition, both men and women showed an independent correlation of hs-CRP levels with HbA1c and low-density lipoprotein cholesterol, whereas men also had thyroid-stimulating hormone and women had age as an independent factor. Conclusions: Chronic inflammation links hyperglycemia to CVD events, and the relevant risk factors would be potential targets for alleviating inflammation and delaying the progression of the atherogenic process.

Is maternal serum endocan level a novel marker in gestational diabetes mellitus?

AIM

To determine whether there was a significant difference between serum endocan levels of pregnant women with and without gestational diabetes mellitus (GDM).

METHODS

A total of 90 pregnant women, 45 with gestational diabetes and 45 healthy pregnant women, between 24 and 28 gestational weeks, were included in this prospective case-control study. The pregnant women were screened for gestational diabetes using a two-step protocol. Serum endocan levels were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. A p-value of <0.05 was considered statistically significant.

RESULTS

Serum endocan level was significantly higher in the GDM group than in healthy controls (168.46 ± 160.6 vs. 105.66 ± 26.52 pg/mL, respectively; p < 0.001). Serum endocan concentrations were positively correlated with the results of 50 g oral glucose challenge test (GCT) (p < 0.001). Receiver operating characteristic curve analysis showed that endocan with a cut-off point of 133.9 ng/dL indicated women with GDM with a sensitivity of 55.6% and specificity of 88.9% (area under the curve [AUC]: 0.737, 95% CI: 0.634-0.824). The overall differential performance of endocan according to the GDM groups was determined as 73.7% (p < 0.001). Maternal serum endocan level was positively correlated with fasting glucose, postprandial glucose, and glycated hemoglobin (HbA1c) (p < 0.001).

CONCLUSIONS

Elevated endocan levels in gestational diabetes were correlated with fasting glucose, postprandial glucose, HbA1c, and oral glucose tolerance test (OGTT) results. Despite the low sensitivity of 55.6% and the high specificity of 88.9%, we found a high differential performance rate indicating that serum endocan levels were important for the pathophysiology of GDM and should be investigated for the possibility of being a novel marker in larger populations.

Impact of early postoperative blood glucose variability on serum endocan level in cardiac surgery patients: a sub study of the ENDOLUNG observational study

BACKGROUND

Early postoperative glycemic variability is associated with worse outcome after cardiac surgery, but the underlying mechanisms remain unknown. This study aimed to describe the relationship between postoperative glycemic variability and endothelial function, as assessed by serum endocan level in cardiac surgery patients.

METHODS

We performed a post hoc analysis of patients included in the single-center observational ENDOLUNG study. Adult patients who underwent planned isolated coronary artery bypass graft surgery were eligible. Postoperative glycemic variability was assessed by calculating the coefficient of variability (CV) of blood glucose measured within 24 (CV24) and 48 (CV48) hours after surgery. Serum endocan level was measured at 24 (Endocan24) and 48 (Endocan48) hours after surgery. Pearson's correlation coefficient with 95% confidence interval (95% CI) was calculated between CV24 and Endocan24, and between CV48 and Endocan48.

RESULTS

Data from 177 patients were analyzed. Median CV24 and CV48 were 18% (range 7 to 39%) and 20% (range 7 to 35%) respectively. Neither CV48 nor CV24 were significantly correlated to Endocan48 and Endocan24 respectively (r (95% CI) = 0.150 (0.001 to 0.290; and r (95% CI) = 0.080 (-0.070 to 0.220), respectively).

CONCLUSIONS

Early postoperative glycemic variability within 48 h after planned cardiac surgery does not appear to be correlated with postoperative serum endocan level.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02542423.

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.

Endocan in prediabetes, diabetes, and diabetes-related complications: a systematic review and meta-analysis

BACKGROUND

Diabetes is one of the chronic conditions with a high burden all around the world. Macrovascular and microvascular involvement are among the common mechanisms by which diabetes can impact patients' lives. Endocan as an inflammatory endothelial biomarker has been shown to increase in several communicable and non-communicable diseases. Herein, we aim to investigate the role of endocan as a biomarker in diabetes as a systematic review and meta-analysis.

METHODS

International databases, including PubMed, Web of Science, Scopus, and Embase were searched for relevant studies assessing blood endocan in diabetic patients. Estimation of the standardized mean difference (SMD) and 95% confidence interval (CI) for comparison of circulating endocan levels between diabetic patients and non-diabetic controls were conducted through random-effect meta-analysis.

RESULTS

Totally, 24 studies were included, assessing 3354 cases with a mean age of 57.4 ± 8.4 years. Meta-analysis indicated that serum endocan levels were significantly higher in diabetic patients in comparison with healthy controls (SMD 1.00, 95% CI 0.81 to 1.19, p-value < 0.01). Moreover, in the analysis of studies with only type-2 diabetes, the same result showing higher endocan was obtained (SMD 1.01, 95% CI 0.78 to 1.24, p-value < 0.01). Higher endocan levels were also reported in chronic diabetes complications such as diabetic retinopathy, diabetic kidney disease, and peripheral neuropathy.

CONCLUSION

Based on our study's findings, endocan levels are increased in diabetes, however, further studies are needed for assessing this association. In addition, higher endocan levels were detected in chronic complications of diabetes. This can help researchers and clinicians in recognizing disease endothelial dysfunction and potential complications.

The Role of Endocan in Cardiometabolic Disorders

Discovered two decades ago, endocan still represents an intriguing biomarker related to inflammation. Endocan is a soluble dermatan sulphate proteoglycan secreted by endothelial cells. Its expression is observed in tissues related to the enhanced proliferation, especially hepatocytes, lungs, kidneys, etc. Endocan has been investigated in many cardiometabolic disorders that are tightly connected with inflammation, such as type 2 diabetes mellitus, hypertension, atherosclerotic cardiovascular disease, kidney disease, obesity, polycystic ovary syndrome, metabolic syndrome, non-alcoholic fatty liver disease, etc. In this narrative, comprehensive review of the currently available literature, special attention will be paid to the role of endocan in the broad spectrum of cardiometabolic disorders. Since endocan has emerged as a novel endothelial dysfunction marker, the discovery of potential therapeutic strategies for patients with certain cardiometabolic risk factors would be of great importance to delay or even prevent the onset and progression of related complications, mainly cardiovascular.

Endothelial cell autophagy in the context of disease development

Endothelial cells (EC) are the anatomical boundaries between the intravascular and extravascular space. Damage to ECs is catastrophic and induces endothelial cell dysfunction. The pathogenesis is multifactorial and involves dysregulation in the signaling pathways, membrane lipids ratio disturbance, cell-cell adhesion disturbance, unfolded protein response, lysosomal and mitochondrial stress, autophagy dysregulation, and oxidative stress. Autophagy is a lysosomal-dependent turnover of intracellular components. Autophagy was recognized early in the pathogenesis of endothelial dysfunction. Autophagy is a remarkable patho (physiological) process in the cell homeostasis regulation including EC. Regulation of autophagy rate is disease-dependent and impaired with aging. Up-regulation of autophagy induces endothelial cell regeneration/differentiation and improves the function of impaired ones. The paper scrutinizes the molecular mechanisms and triggers of EC dysregulation and current perspectives for future therapeutic strategies by autophagy targeting.

Advances in the Role of Endothelial Cells in Cerebral Small Vessel Disease

Cerebral small vessel disease (CSVD) poses a serious socio-economic burden due to its high prevalence and severe impact on the quality of life of elderly patients. Pathological changes in CSVD mainly influence small cerebral arteries, microarteries, capillaries, and small veins, which are usually caused by multiple vascular risk factors. CSVD is often identified on brain magnetic resonance imaging (MRI) by recent small subcortical infarcts, white matter hyperintensities, lacune, cerebral microbleeds (CMBs), enlarged perivascular spaces (ePVSs), and brain atrophy. Endothelial cell (EC) dysfunction is earlier than clinical symptoms. Immune activation, inflammation, and oxidative stress may be potential mechanisms of EC injury. ECs of the blood–brain–barrier (BBB) are the most important part of the neurovascular unit (NVU) that ensures constant blood flow to the brain. Impaired cerebral vascular autoregulation and disrupted BBB cause cumulative brain damage. This review will focus on the role of EC injury in CSVD. Furthermore, several specific biomarkers will be discussed, which may be useful for us to assess the endothelial dysfunction and explore new therapeutic directions.

Endocan: A Key Player of Cardiovascular Disease

Endothelial dysfunction is considered to be an early change in atherosclerosis. Endocan, also known as endothelial cell specific molecule-1, is a soluble proteoglycan mainly secreted by endothelial cells. Inflammatory factors such as IL-1β and TNF-α can up regulate the expression of endocan and then affect the expression of cell adhesion molecules, such as ICAM-1 and VCAM-1, which play an important role in promoting leukocyte migration and inflammatory response. Elevated plasma levels of endocan may reflect endothelial activation and dysfunction, and is considered to be a potential immuno-inflammatory marker that may be related to cardiovascular disease. In the case of hypertension, diabetes, angina pectoris and acute myocardial infarction, the increase or decrease of serum endocan levels is of great significance. Here, we reviewed the current research on endocan, and emphasis its possible clinical value as a prognostic marker of cardiovascular disease. Endocan may be a useful biomarker for the prognosis of cardiovascular disease, but more research is needed on its mechanism of action.

Endothelial Dysfunction and Endocan Levels in Patients with Gilbert Syndrome and Moderate Hyperbilirubinemia

In this study, we aim to evaluate the presence of endothelial dysfunction in Gilbert syndrome patients with left ventricular mass index (LVMI) and endocan levels. The study included 60 patients who diagnosed with Gilbert syndrome and 60 healthy controls who did not have any known diseases. Human endocan levels were measured using a sandwich ELISA method. The endocan and LVMI levels were lower in the Gilbert syndrome group than in the healthy controls. In the Gilbert syndrome group, total bilirubin level was negatively correlated with LVMI (r = -0246; P = .007) and endocan levels (r = -.270; P = .046). In the Gilbert syndrome group, increasing age (β ± SE = 20.78 ± 7.47; P = .006), was a positive independent predictor of LVMI, and increasing high-density lipoprotein cholesterol (HDL-C) (β ± SE = -.27 ± .09; P = .007), and total bilirubin levels (β ± SE = -6.09 ± 3.02; P = .046) were found to be a negative independent predictor. These results support that endothelial dysfunction is decreased in Gilbert Syndrome patients with mild hyperbilirubinemia compared with the healthy control group.

The relationship between carotid intima-media thickness and microvascular changes in retinal zones and optic disc in patients with type 1 diabetes mellitus

PURPOSE

The aim of this study was to detect early retinal vascular changes with optical coherence tomography angiography (OCTA) in type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy and to evaluate the correlation of the results with carotid intima-media thickness (IMT).

DESIGN

This is a case-control and cross-sectional study.

METHODS

This study included 38 adult patients with T1DM, and 38 age and gender-matched healthy controls. Retinal and optic disc (OD) measurements were taken using OCTA. The carotid artery IMT of each patient was measured using Doppler ultrasonography. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density, foveal avascular zone (FAZ), non-flow area (NFA) and foveal density (FD) were analysed in the fovea centred 6 × 6 mm macular area. The superficial capillary plexus and DCP were also scanned centred on the peripapillary region. The correlations between OCTA measurements and carotid IMT, duration of DM and haemoglobin A1c levels in patients with T1DM were evaluated.

RESULTS

The mean values for carotid IMT were significantly higher in diabetic patients than in controls (p < 0.001). The mean values for vessel density SCP, DCP and OD were significantly lower in the diabetic group (p < 0.05). There were correlations between the carotid IMT and duration of T1DM and the evaluated parameters of OCTA.

CONCLUSION

Microvascular changes in the SCP and DCP in patients with T1DM without DR offer important data. OCTA can be used to detect early microvascular changes in patients with T1DM without DR. In addition, a relationship was found between SCP vascular dropout and carotid IMT.

Novel Biomarkers of Endothelial Dysfunction in Cardiovascular Diseases

The review analyzes the role of assessing the state of the endothelium in the onset and progression of cardiovascular diseases, stratification of their risks, since endothelial dysfunction (ED) is a crucial predictor of this pathologies. In this regard, this paper presents the modern understanding of the methods for assessing ED, presents the advantages and disadvantages of various techniques. Despite the fact that flow-mediated dilation is widely used as a classical method for studying endothelial function, this technique depends on the physiological state of sensory nerves and calcium-activated potassium channels, cardiac output. This review focuses on new biomarkers for ED such as endothelial microparticles, endoglin and endocan, and discusses the relevance of the criteria for their use in clinical practice. Based on current scientific advances, the authors concluded that among these three newest biomarkers, today, endocan can be considered a more informative and reliable cellular marker of ED. Moreover, the authors have shown that when measured separately, many of the studied classical circulating biomarkers do not provide reliable information about the state of the endothelium, since the endothelial function has a complex physiological nature which therefore raises the question of the advisability of considering a combination of classical and new biomarkers for improving the assessment of the endothelial state.

Serum Inflammatory and Prooxidant Marker Levels in Different Periodontal Disease Stages

BACKGROUND

Periodontitis has been associated to systemic diseases and this association could be due to an increase in circulating inflammatory and oxidative stress biomarkers in the periodontal disease. This study aimed to evaluate the relationship between inflammatory and pro-oxidant markers according to different stages of periodontitis.

METHODS

This cross-sectional study included 70 subjects who were divided into three groups according to periodontitis stage: stage II (n = 22), stage III (n = 30), and stage IV (n = 18). We evaluated periodontal parameters and levels of high-sensitivity C-reactive protein (hsCRP), fibrinogen, and malondialdehyde (MDA) in serum, and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine.

RESULTS

Serum hsCRP and fibrinogen levels were associated with periodontitis severity, which were higher in stage IV than in stages III and II of periodontitis (p = 0.003 and p = 0.025, respectively). We observed a slight yet insignificant increase in MDA levels related to periodontitis severity. Probing depth and clinical attachment loss were associated with serum fibrinogen and hsCRP levels. However, there were no significant associations between periodontal variables and MDA and 8-OHdG levels.

CONCLUSION

Our data support an association between periodontitis and systemic inflammation, which increases with periodontal disease severity. This indicates the importance of the early diagnosis and treatment of periodontal disease to avoid the development or worsening of systemic inflammatory diseases.

Evaluation of salusin-α and salusin-β levels in patients with type 2 diabetes mellitus and determination of the impact of severity of hyperglycemia on salusin levels

AIMS

To investigate the usefulness of salusin-α and salusin-β as biomarkers in patients with type 2 diabetes mellitus (T2DM) and to determine whether diabetes severity and obesity have an effect on the salusin levels in diabetic patients.

METHODS

The study included a total of 90 patients, comprising 55 diagnosed with T2DM and 35 healthy volunteers with similar demographic characteristics. Salusins were assayed by a commercially available ELISA kit.

RESULTS

The salusin-β levels were found to be significantly higher in T2DM group compared to control group, while the salusin-α levels were lower (p < 0.05, for both). Furthermore, in patient group, Spearman analysis showed a statistically significant negative correlation between salusin-α and fasting glucose and glycated hemoglobin (HbA1c), whereas salusin-β had a statistically significant positive correlation with fasting glucose and HbA1c (p < 0.05, for both). When analyzed according to the HbA1c groups, the patients with HbA1c > 9% had significantly lower salusin-α and higher salusin-β levels levels compared to those with HbA1c < 9% (p < 0.05, for both). When examined according to body-mass-index groups, there was no significant difference in the salusin levels of the patient and control groups (p > 0.05).

CONCLUSION

We demonstrated that the serum salusin-α level was decreased whereas the salusin-β level was increased in patients with T2DM compared to healthy subjects, and this was more pronounced as T2DM-deteriorated. We also showed that obesity had no effect on salusin levels among diabetics. This study may provide a basis for the availability of salusin-targeted therapies, especially in uncontrolled T2DM.

Endocan: A Novel Predictor of Endothelial Dysfunction in Silent Brain Infarction

Silent brain infarction (SBI) has been considered as a subclinical risk factor for symptomatic possible future stroke. We investigated the association between serum inflammatory markers and SBI. Patients (n = 54) diagnosed with SBI as the study group and 52 individuals as the control group were included in this study. Silent brain infarction is defined as a hyperintense lesion that was ≥3 mm in 1 dimension on fluid-attenuated inversion recovery T2-weighted magnetic resonance image, if the patient had normal neurological examination or had an abnormality that was not consistent with the brain lesion locations, after being evaluated by a neurologist. Serum endocan levels (P = .036) and high-sensitivity C-reactive protein (hsCRP; P = .022) were significantly higher in patients with SBI than the controls. Pentraxin 3, erythrocyte sedimentation rate, white blood count, lymphocyte, monocyte, neutrophil, low-density lipoprotein, and triglyceride levels were not significantly different when comparing the groups with and without SBI. There was a significant correlation (r = -0.196; P = .16) between hsCRP and endocan levels in the SBI group. Endocan, a novel biomarker of endothelial pathology, was significantly increased in patients with SBI and may be useful to predict the future risk of stroke.

The relationship of the serum endocan level with the CHA2DS2-VASc score in patients with paroxysmal atrial fibrillation

Background

In this study considering the relationship between serum endocan and CHA₂DS₂-VASc score, we assumed that endocan level could be a new biomarker for stroke risk in patients with paroxysmal atrial fibrillation (PAF). It was examined that endocan could be an alternative to determine the risk of stroke and anticoagulation strategy in patients with PAF. The CHA₂DS₂-VASc scores were calculated for 192 patients with PAF, and their serum endocan levels were measured. The patients were divided into two groups as those with low to moderate (0-1) and those with high (≥ 2) CHA₂DS₂-VASc scores, and the endocan levels were compared between these two groups.

Results

The serum endocan level was significantly higher in the high CHA₂DS₂-VASc score group (p < 0.001). In the multivariate logistic regression analysis, endocan, C-reactive protein, and low-density lipoprotein were found to be independent determinants of the CHA₂DS₂-VASc score. The predictive value of endocan was analyzed using the ROC curve analysis, which revealed that endocan predicted a high stroke risk (CHA₂DS₂-VASc ≥ 2) at 82.5% sensitivity and 71.2% specificity at the cutoff value of 1.342.

Conclusion

This study indicates that endocan is significantly associated with CHA₂DS₂-VASc score. We demonstrated that endocan could be a new biomarker for the prediction of a high stroke risk among patients diagnosed with PAF.

Endocan and Lumican in Relation to Cardiometabolic Risk in a Pediatric Overweight and Obese Cohort: A Cross-Sectional Study

The aim of the study was to evaluate serum Endocan and Lumican levels as biomarkers for pediatric Nonalcoholic Fatty Liver Disease (NAFLD) and to explore their associations with pediatric cardiometabolic risk factors. We conducted a cross-sectional study on 68 pediatric obese and overweight (O&O) patients. Ten healthy controls were recruited. Serum Lumican and Endocan levels were analyzed using ELISA kits. O&O patients had lower levels of Endocan compared to healthy controls (p < 0.001). There were no differences between serum Endocan levels in O&O patients with NAFLD and those without (p = 0.53). Patients considered having Nonalcoholic Steatohepatitis (NASH) had lower Endocan levels compared to O&O patients without NASH (p = 0.026). Patients with metabolic syndrome had lower levels of Endocan (p = 0.003). There were no significant differences between serum Lumican levels in O&O children compared to healthy controls. Lumican levels were higher in patients with hypertension (p = 0.04). In O&O patients, Lumican levels were negatively correlated with Endocan levels (r = −0.37, p = 0.002). Endocan seems a promising biomarker for the evaluation of pediatric NASH. Lumican was not confirmed as a biomarker for NAFLD in our cohort but was associated with higher arterial pressure. Low Endocan levels are accompanied by high serum Lumican levels, and this could be an early signature of cardiometabolic risk.

The relation of serum endocan and soluble endoglin levels with metabolic control in children and adolescents with type 1 diabetes mellitus

Objectives Endothelial dysfunction is an early marker of vascular disease in Type 1 diabetes mellitus (T1DM). In the present study, we aimed to investigate serum endocan and soluble endoglin (S-endoglin) levels, and their relation with metabolic control in children with T1DM, which was not previously assessed. Methods A total of 64 T1DM subjects and 64 healthy subjects were included in this study. Their anthropometric features, arterial blood pressures, pubertal status, insulin doses were recorded. Glycated hemoglobin, serum endocan and S-endoglin levels were measured and compared to each other. Results Serum endocan and S-endoglin levels were higher in children with T1DM than those of healthy group (p<0.01). Significant positive correlation was detected between both endocan and S-endoglin (r=0.579, p<0.001); and HbA1c and endocan (r=0.296, p=0.01). Compared to patients with good metabolic control, those with poorer metabolic control (HbA1c > 8%) had an older age, longer duration of diabetes, higher number of pubertal children. Also, patients with poorer metabolic control had higher endocan and S-endoglin levels than those of healthy group, but this finding did not reach statistical significance. There was no correlation between the endocan/S-endoglin levels and age, duration of diabetes and insulin dose. Conclusion Serum levels of endocan and S-endoglin which are novel biomarkers of endothelial dysfunction are high in children with T1DM. Elevated serum endocan and endoglin levels in children with T1DM without microvascular complications indicates endothelial damage in very early stages of the disease.

Children with type 1 diabetes have elevated high-sensitivity C-reactive protein compared with a control group

INTRODUCTION

Our objective was to compare high-sensitivity C-reactive protein (hsCRP) levels in children with type 1 diabetes, healthy controls, and children with obesity. Additionally, we aimed to analyze the association between hsCRP levels and glycemic control measured by glycohemoglobin A (HbA1c) and anthropometric and biochemical variables.

RESEARCH DESIGN AND METHODS

We conducted a non-randomized descriptive study of children with type 1 diabetes matched for sex and age with a control group and group with obesity. We recorded anthropometric parameters and studied variables related to diabetes, blood pressure, lipid profile, and HbA1c. hsCRP was measured by ELISA.

RESULTS

We included 49 children with type 1 diabetes, 46 controls, and 40 children with obesity. hsCRP levels were significantly higher in the group with type 1 diabetes compared with controls and nearly significantly lower than in the group comprising children with obesity. We found no correlation between hsCRP and HbA1c and characteristics of type 1 diabetes with the exception of albumin to creatinine ratio. Statistically significant association was found between hsCRP and body mass index (BMI) and waist circumference Z-score.

CONCLUSIONS

The higher hsCRP levels observed in children with type 1 diabetes compared with a control group with a similar BMI suggest a basal inflammatory state that could increase cardiovascular risk. The main factors related to hsCRP are BMI and waist circumference, so obesity prevention should be a priority when performing follow-up in children with type 1 diabetes.

Metformin Had Potential to Increase Endocan Levels in STZ-Induced Diabetic Mice

Background: Type 2 diabetes mellitus is a chronic metabolic disorder with prominent vascular injuries. In this condition, the levels of multiple pro- and anti-angiogenic factors have been shown to change. This study aimed to investigate the possible effect of metformin on pro-angiogenic factor, endocan levels, via the modulation of p-AMPK/AMPK axis in diabetic mice. Methods: Mice were randomly assigned to one of 4 groups (n=6): Control (normal saline) and the diabetic group was injected streptozotocin and two groups were given 50 and 100 mg/kg metformin orally, once daily for two weeks after diabetes induction. Endocan protein levels were detected in the liver and kidneys by ELISA and immunofluorescence analysis. Phosphorylation of AMPK was assessed using western blotting. Histological examination was performed to follow the metformin effect on Von Willebrand factor expression and diabetes-related pathologies. Results: ELISA assay showed an elevated levels of endocan in the renal and hepatic tissues of diabetic mice following treatment with metformin (p<0.05). Immunofluorescence and immunohistochemistry examination of kidneys showed that the increase of endocan protein coincided with the promotion of vWF factors in mice treated with metformin (p<0.05). We did not find endocan factor in hepatic tissue of diabetic mice pre- and post-treatment with metformin. Western blotting confirmed the phosphorylation of AMPK by metformin in kidneys (p<0.05), but these changes did not reach statistically significant levels in hepatic tissues (p>0.05). Conclusion: Metformin could change the endocan levels during diabetic condition possibly by the modulation of p-AMPK/AMPK axis.

Proteoglycans in Obesity-Associated Metabolic Dysfunction and Meta-Inflammation

Proteoglycans are a specific subset of glycoproteins found at the cell surface and in the extracellular matrix, where they interact with a plethora of proteins involved in metabolic homeostasis and meta-inflammation. Over the last decade, new insights have emerged on the mechanism and biological significance of these interactions in the context of diet-induced disorders such as obesity and type-2 diabetes. Complications of energy metabolism drive most diet-induced metabolic disorders, which results in low-grade chronic inflammation, thereby affecting proper function of many vital organs involved in energy homeostasis, such as the brain, liver, kidney, heart and adipose tissue. Here, we discuss how heparan, chondroitin and keratan sulfate proteoglycans modulate obesity-induced metabolic dysfunction and low-grade inflammation that impact the initiation and progression of obesity-associated morbidities.

Relationship between elevated bilirubin level and subclinical atherosclerosis as well as oxidative stress in Gilbert syndrome

Aim:

This study aimed to determine oxidant status and left ventricular mass index (LVMI) and their relationship with mild hyperbilirubinemia in patients with Gilbert syndrome (GS).

Background:

Gilbert syndrome (GS) presents with mild indirect hyperbilirubinemia, normal liver function tests, and normal hepatic histology.

Methods:

A total of 84 patients, including 41 (48.8%) patients with GS and 43 (51.2%) patients without GS, were included in the study. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were examined for oxidant status.

Results:

TAS was found to be higher in the GS patients compared to the non-GS patients (1.7±0.1 vs. 1.5±0.2; p=0.002); there was no significant difference between the groups in terms of mean TOS and mean OSI (p>0.05). No significant difference was observed either between the GS and non-GS patients in terms of mean left ventricular volume and mean LVMI (p>0.05). However, subgroup analysis based on sex revealed that GS patients had a lower LVMI for both sexes. In GS patients, TAS level had a positive correlation with albumin (r=0.319; p=0.042), triglyceride (r=0.392; p=0.011), total bilirubin (r=0.420; p=0.006), direct bilirubin (r=0.361; p=0.020), and indirect bilirubin (r=0.338; p=0.0311) levels; no correlation was found between TAS level and other laboratory findings (p>0.05). The regression model indicated that risk factors of direct bilirubin (β±SE=0.13±0.03; p<0.001), uric acid (β±SE=0.04±0.01; p=0.001), and albumin (β±SE=0.17±0.04; p<0.001) were independent predictors of TAS level.

Conclusion:

This study revealed a relationship between mild hyperbilirubinemia and antioxidant balance in GS. Although statistical significance was not reached, LVMI was found to be lower in the GS group compared to the non-GS group for both sexes.

Biomarkers of vascular disease in diabetes: the adipose-immune system cross talk

Experimental and clinical studies aimed at investigating the mechanism(s) underlying vascular complications of diabetes indicate that a great number of molecules are involved in the pathogenesis of these complications. Most of these molecules are inflammatory mediators or markers generated by immune or adipose tissue. Some of them, i.e. resistin and sortilin, have been shown to be involved in the cross talk between adipocytes and inflammatory cells. This interaction is an attractive area of research, particularly in type 2 diabetes and obesity. Other proteins, such as adiponectin and visfatin, appear to be more promising as possible vascular markers. In addition, some molecules involved in calcium/phosphorus metabolism, such as klotho and FGF23, have an involvement in the pathogenesis of diabetic vasculopathy, which appears to be dependent on the degree of vascular impairment. Inflammatory markers are a promising tool for treatment decisions while measuring plasma levels of adipokines, sortilin, Klotho and FGF23 in adequately sized longitudinal studies is expected to allow a more precise characterization of diabetic vascular disease and the optimal use of personalized treatment strategies.

Endocan: A Biomarker for Hepatosteatosis in Patients with Metabolic Syndrome

Background

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, which has recently been mentioned as an independent cardiovascular risk factor.

Objectives

Endocan is a novel molecule of endothelial dysfunction. We aimed to evaluate the associations of serum endocan levels with the hepatic steatosis index (HSI), fatty liver index (FLI), and degrees of hepatosteatosis in patients with metabolic syndrome with NAFLD. Design and Setting. This cross-sectional prospective study was performed in the outpatient clinic of an internal medicine department.

Methods

The study included 40 patients with metabolic syndrome with NAFLD as noted using hepatic ultrasound and 20 healthy controls. Secondary causes of fatty liver were excluded. FLI and HSI calculations were recorded. Serum endocan level values were obtained after overnight fasting.

Results

Higher values of HSI and FLI were found in the NAFLD groups than in the control groups (p < 0.001). Five (12.5%) of 20 patients with liver steatosis had grade 1 liver steatosis, 15 (37.5%) patients had grade 2 liver steatosis, and 20 (50%) patients had grade 3 liver steatosis. Serum endocan levels were lower in patients with NAFLD compared with the healthy controls (146.56 ± 133.29 pg/mL vs. 433.71 ± 298.01 pg/mL, p < 0.001). ROC curve analysis suggested that the optimum endocan value cutoff point for NAFLD was 122.583 pg/mL (sensitivity: 71.79%, specificity: 90%, PPV: 93.3%, and NPV: 62.1%).

Conclusion

Serum endocan concentrations are low in patients with NAFLD, and the optimum cutoff point is 122.583 pg/mL. HSI and FLI were higher in patients with NAFLD; however, there was no correlation with serum endocan.

Novel Biomarkers for Evaluation of Endothelial Dysfunction

Endothelial dysfunction is one of the earliest indicators of cardiovascular (CV) dysfunction, and its evaluation would be of considerable importance to stratify CV risk of many diseases and to assess the efficacy of atheroprotective treatments. Flow-mediated dilation is the most widely used method to study endothelial function. However, it is operator-dependent and can be influenced by physiological variations. Circulating biomarkers are a promising alternative. Due to the complexity of endothelial function, many of the biomarkers studied do not provide consistent information about the endothelium when measured alone. New circulating markers are being explored and some of them are thought to be suitable for the clinical setting. In this review, we focus on novel biomarkers of endothelial dysfunction, particularly endothelial microparticles, endocan, and endoglin, and discuss whether they fulfill the criteria to be applied in clinical practice.

Relationship between Plasma Endocan Level and Clinical Outcome of Chinese Peritoneal Dialysis Patients

BACKGROUND

Endocan is associated with endothelial dysfunction. In peritoneal dialysis (PD) patients, cardiovascular disease is a common cause of mortality. We examined the relationship between serum endocan level and clinical outcome of PD patients.

METHODS

We recruited 193 new PD patients (118 males, mean age 58.8 ± 11.6 years). Serum endocan levels were determined and stratified into tertile 1 (lowest) to 3 (highest). Nutritional status, arterial pulse wave velocity (PWV) and serum C-reactive protein (CRP) levels were measured. The patients were followed for at least 4 years for clinical outcomes.

RESULTS

For the whole cohort, patients with higher serum endocan levels had lower serum albumin and subjective global assessment score, higher carotid-femoral PWV, and higher serum CRP. For patients with suboptimal blood pressure (BP) control, cardiovascular event-free survival was 95.0, 95.5, and 78.5% for tertiles 1, 2, and 3 at 60 months respectively (p = 0.019). Multivariate Cox regression analysis showed that serum endocan level was an independent predictor of cardiovascular event-free survival. No association with cardiovascular event-free survival was found for patients with adequate BP control (95.0, 92.3, and 100% for tertile 1, 2, and 3 at 60 months, respectively, p = 0.6).

CONCLUSIONS

Higher serum endocan level is associated with unfavourable nutritional, arterial and inflammatory conditions in PD patients. In patients with suboptimal BP control, higher serum endocan is also associated with worse cardiovascular outcome.

Endocan and a novel score for dyslipidemia, oxidative stress and inflammation (DOI score) are independently correlated with glycated hemoglobin (HbA1c) in patients with prediabetes and type 2 diabetes

INTRODUCTION

We aimed to examine serum endocan level and the summary involvement of dyslipidemia, oxidative stress (OS) and inflammation by calculation of its comprehensive score (i.e. Dyslipidemia-Oxy-Inflammation (DOI) score) in relation to glucoregulation in subjects with prediabetes and overt type 2 diabetes (T2D).

MATERIAL AND METHODS

A total of 59 patients with prediabetes and 102 patients with T2D were compared with 117 diabetes-free controls. Glycated hemoglobin (HbA1c), inflammation, OS and lipid parameters were measured. Associations of clinical data with HbA1c level were tested with univariate and multivariate logistic ordinal regression analysis. HbA1c as a dependent variable is given at the ordinal level (i.e. < 5.7%; 5.7-6.4%, > 6.4%, respectively).

RESULTS

Endocan was significantly higher in the T2D group than in the controls. As endocan concentration rose by 1 unit, the probability for higher HbA1c concentration increased by more than 3 times (OR = 3.69, 95% CI: 1.84-7.01, p < 0.001). Also, a rise in the dyslipidemia score, oxy score, inflammation score and DOI score by 1 unit increased the probability of higher HbA1c concentration by 19%, 13%, 51% and 11%, respectively. In the models, after adjustment for confounding variables, endocan and DOI score remained independent predictors of HbA1c level.

CONCLUSIONS

Endocan and DOI score are independently correlated with HbA1c in patients with prediabetes and overt T2D.

Endocan as a marker of microvascular inflammation in kidney transplant recipients

Endocan is a water-soluble proteoglycan exclusively secreted by vascular endothelium. Endocan levels may be elevated in kidney transplant recipients experiencing antibody-mediated rejection (ABMR), which is characterized by vascular inflammation in transplanted kidney. We evaluated the clinical relevance of endocan as markers of microvascular inflammation in patients who underwent kidney transplantation. Plasma and urinary endocan levels were measured in 203 kidney transplant recipients and were compared across different etiologies of allograft dysfunction and various pathologic scores. Both plasma and urinary endocan levels were significantly higher in patients with acute ABMR than those in patients with normal pathology, acute tubular necrosis (ATN), acute pyelonephritis, BK virus associated nephropathy (BKVN), and T-cell mediated rejection (TCMR). Patients with chronic active ABMR also exhibited significantly higher plasma and urinary endocan levels than patients with long-term graft survival. Scores of glomerulitis and peritubular capillaritis, which are typical features of microvascular inflammation, were significantly elevated in patients with higher plasma and/or urinary endocan levels. Furthermore, plasma and urinary endocan levels could effectively discriminate ABMR from ATN, BKVN, and TCMR. Finally, patients exhibiting high urinary and plasma endocan levels in acute ABMR group showed significantly worse renal survival. Altogether, plasma and urinary endocan levels may serve as potential markers of microvascular inflammation in kidney transplant recipients.

Predictive Value of Endocan Based on TIMI Risk Score on Major Adverse Cardiovascular Events After Acute Coronary Syndrome

We assessed the prognostic value of serum levels of endocan in patients with the acute coronary syndrome (ACS) through its correlation with the Thrombolysis in Myocardial Infarction (TIMI) risk score and compared the possible association with clinical outcomes. In this prospective cross-sectional study, we enrolled 320 patients with documented ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), or unstable angina (UA) who underwent diagnostic coronary angiography. Endocan was measured soon after admission in the emergency department. In-hospital death, heart failure, and recurrent infarction were considered major adverse cardiac events (MACEs). There was a significant positive correlation between endocan level and TIMI risk score and MACE. The optimal cutoff values of endocan to predict clinical end points were 3.45 ng/mL in patients with STEMI and 2.85 ng/mL in patients with UA/NSTEMI. Multivariate logistic regression analysis indicated that endocan independently correlated with MACE. Moreover, cardiac troponin I, creatine kinase-MB, and circulating endocan were found to be independently associated with MACE in patients with ACS. In conclusion, a high endocan level on hospital admission is an independent predictor of worse cardiovascular outcomes and higher TIMI risk score in patients with ACS.

Enhanced Function of Induced Pluripotent Stem Cell-Derived Endothelial Cells Through ESM1 Signaling

The mortality rate for (cardio)‐vascular disease is one of the highest in the world, so a healthy functional endothelium is of outmost importance against vascular disease. In this study, human induced pluripotent stem (iPS) cells were reprogrammed from 1 ml blood of healthy donors and subsequently differentiated into endothelial cells (iPS‐ECs) with typical EC characteristics. This research combined iPS cell technologies and next‐generation sequencing to acquire an insight into the transcriptional regulation of iPS‐ECs. We identified endothelial cell‐specific molecule 1 (ESM1) as one of the highest expressed genes during EC differentiation, playing a key role in EC enrichment and function by regulating connexin 40 (CX40) and eNOS. Importantly, ESM1 enhanced the iPS‐ECs potential to improve angiogenesis and neovascularisation in in vivo models of angiogenesis and hind limb ischemia. These findings demonstrated for the first time that enriched functional ECs are derived through cell reprogramming and ESM1 signaling, opening the horizon for drug screening and cell‐based therapies for vascular diseases. Therefore, this study showcases a new approach for enriching and enhancing the function of induced pluripotent stem (iPS) cell‐derived ECs from a very small amount of blood through ESM1 signaling, which greatly enhances their functionality and increases their therapeutic potential. Stem Cells2019;37:226–239