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Huang SS, Ding Y, Yi XN, Mao HY, Xie ZY, Shen XK, Lu Y, Yan J, Wang YW, Yang ZX. Exploring the inverse relationship between serum total bilirubin and systemic immune-inflammation index: insights from NHANES data (2009-2018). Eur J Med Res 2024; 29:362. [PMID: 38997774 PMCID: PMC11241915 DOI: 10.1186/s40001-024-01963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Bilirubin is known for its multifaceted attributes, including antioxidant, anti-inflammatory, immunomodulatory, and antiapoptotic properties. The systemic immune-inflammation index (SII) is a recent marker that reflects the balance between inflammation and immune response. Despite the wealth of information available on bilirubin's diverse functionalities, the potential correlation between the total bilirubin (TB) levels and SII has not been investigated so far. METHODS Leveraging data from the National Health and Nutrition Examination Survey spanning 2009-2018, the TB levels were categorized using tertiles. Employing the chi-squared test with Rao and Scott's second-order correction and Spearman's rank correlation analysis, the association between TB and SII was examined. The potential nonlinearities between TB and SII were evaluated using restricted cubic spline (RCS) analysis. Weighted linear regression, adjusted for covariates, was used to explore the correlation between TB and SII, with further subgroup analyses. RESULTS A total of 16,858 participants were included, and the findings revealed significant SII variations across TB tertiles (p < 0.001). The third tertile (Q3) exhibited the lowest SII level at 495.73 (295.00) 1000 cells/µL. Spearman rank correlation disclosed the negative association between TB and SII. RCS analysis exposed the lack of statistically significant variations in the nonlinear relationship (p > 0.05), thereby providing support for a linear relationship. Weighted linear regression analysis underscored the negative correlation between TB and SII (β 95% CI - 3.9 [- 5.0 to - 2.9], p < 0.001). The increase in the TB levels is associated with a significant linear trend toward decreasing SII. After controlling for relative covariates, this negative correlation increased (p < 0.001). Subgroup analysis confirmed the significant negative TB-SII association. CONCLUSION A notable negative correlation between TB and SII implies the potential protective effects of bilirubin in inflammation-related diseases.
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Affiliation(s)
- Shan-Shan Huang
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315100, China
| | - Yi Ding
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315100, China
| | - Xiao-Na Yi
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315100, China
| | - Hai-Yan Mao
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315100, China
| | - Zhen-Ye Xie
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315100, China
| | - Xing-Kai Shen
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315100, China
| | - Yan Lu
- Zhejiang Key Laboratory of Geriatrics and Geriatrics Institute of Zhejiang Province, Zhejiang Hospital, Hangzhou, 310030, China
| | - Jing Yan
- Zhejiang Key Laboratory of Geriatrics and Geriatrics Institute of Zhejiang Province, Zhejiang Hospital, Hangzhou, 310030, China.
| | - You-Wei Wang
- Institute of Medical Engineering & Translational Medicine, Tianjin University, Tianjin, 300072, China.
| | - Zhou-Xin Yang
- Zhejiang Key Laboratory of Geriatrics and Geriatrics Institute of Zhejiang Province, Zhejiang Hospital, Hangzhou, 310030, China.
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Di Gioia G, Crispino SP, Monosilio S, Maestrini V, Nenna A, Segreti A, Squeo MR, Lemme E, Ussia GP, Grigioni F, Pelliccia A. Cardiovascular and metabolic effects of hyperbilirubinemia in a cohort of Italian Olympic athletes. Scand J Med Sci Sports 2023; 33:2534-2547. [PMID: 37650311 DOI: 10.1111/sms.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Bilirubin was supposed to have cardio-metabolic protective role by signaling functions. Indeed, mild hyperbilirubinemia has immunosuppressive and endocrine activities and may offer protection against oxidative stress-mediated diseases. Gilbert syndrome (GS) has been hypothesized to provide cardio-metabolic benefits. OBJECTIVE To investigate the prevalence of hyperbilirubinemia and its cardio-metabolic effects in a cohort of elite Italian athletes engaged in different sports disciplines. METHODS We enrolled 1492 elite athletes (age 25.8 ± 5.1) practising different disciplines (power, skills, endurance, and mixed) underwent blood, echocardiographic, and exercise tests. GS was diagnosed per exclusionem in athletes with isolated asymptomatic unconjugated hyperbilirubinemia. RESULTS GS was highlighted in 91 athletes (6%; globally 9% male and 2.4% female); 82% were males (p < 0.0001) showing higher indirect bilirubin (0.53 ± 0.4 vs. 0.36 ± 0.24 mg/dL in females, p < 0.0001). GS athletes had fewer platelets (201 ± 35 vs. 214 ± 41, p = 0.01), higher iron (male: 124 ± 44 vs. 100.9 ± 34 mcg/dL, p < 0.0001; female: 143.3 ± 35 vs. 99.9 ± 42 mcg/dL, p < 0.0001), and lower erythrocyte sedimentation rate, (1.93 ± 0.9 vs. 2.80 ± 2.7 mm/H, p = 0.03). At multivariate analysis, male (OR 3.89, p = 0.001) and iron (OR 3.47, p = 0.001) were independently associated with GS. No significant differences were found in cardiac remodeling, heart rate, blood pressure, arrhythmias, or power capacity at stress test. Endurance athletes (313) presented higher total (p = 0.003) and indirect bilirubin (p = 0.001). CONCLUSION Bilirubin has several metabolic effects (including immunosuppressive and endocrine) and plays a role in regulating antioxidant pathways exercise-related with hematological consequences but seems not to affect significantly cardiovascular remodeling. Endurance athletes present higher bilirubin concentrations, likely as an adaptive mechanism to counteract increased oxidative stress.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Simone Pasquale Crispino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sara Monosilio
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Viviana Maestrini
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Nenna
- Department of Heart Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Segreti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Erika Lemme
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Antonio Pelliccia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
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Jia Y, Ye X, Song G, Li X, Ye J, Yang Y, Lu K, Huang S, Zhu S. Direct bilirubin: A predictor of hematoma expansion after intracerebral hemorrhage. Am J Emerg Med 2023; 71:150-156. [PMID: 37393774 DOI: 10.1016/j.ajem.2023.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Previous evidence demonstrated that several biomarkers involved in the pathological process of coagulation/hemostasis dysfunction, impairment of brain vascular integrity and inflammation are associated with hematoma expansion (HE) after intracerebral hemorrhage (ICH). We aimed to explore whether there were unreported laboratory biomarkers associated with HE that were readily and commonly available in clinical practice. METHODS We retrospectively analyzed consecutive acute ICH patients from 2012 to 2020 with admission laboratory tests and baseline and follow-up computed tomography (CT) scans. Univariate and multivariate regression analyses were used to evaluate associations between conventional laboratory indicators and HE. The results were verified in a prospective validation cohort. The relationship of candidate biomarker and 3-month outcomes was also investigated and mediation analysis was undertaken to determine causal associations among candidate biomarker, HE and outcome. RESULTS Of 734 ICH patients, 163 (22.2%) presented HE. Among the included laboratory indicators, higher direct bilirubin (DBil) was associated with HE (adjusted odds ratio [OR] of per 1.0 μmol/L change 1.082; 95% confidence interval [CI] 1.011-1.158). DBil >5.65 μmol/L was a predictor of HE in validation cohort. Higher DBil was also associated with poor 3-month outcomes. The mediation analysis indicated that the association of higher DBil and poor outcomes was partially mediated by HE. CONCLUSIONS DBil is a predictor of HE and poor 3-month outcomes after ICH. DBil's metabolic process and involvement in the pathological mechanism of HE are likely to contribute to the association between DBil and HE. Interventions targeting DBil to improve post-ICH prognosis may be meaningful and worthy of further exploration.
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Affiliation(s)
- Yuchao Jia
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xiaodong Ye
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Guini Song
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xianxian Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jiahe Ye
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yuyan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Kai Lu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
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Sun L, Zhao L, Yang K, Li Z, Wang Y, Wang T, Wang M, Zeng Y, Zhou X, Yang W. Serum total bilirubin and one-year prognosis of patients with coronary artery disease and psoriasis. iScience 2023; 26:107106. [PMID: 37416466 PMCID: PMC10320203 DOI: 10.1016/j.isci.2023.107106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
To evaluate the potential predictive value of total bilirubin (TBIL) for one-year prognosis in patients with coronary artery disease (CAD) and psoriasis. 278 psoriasis patients who underwent coronary angiography and were diagnosed as CAD were recruited. Baseline TBIL was measured at admission. Patients were divided into three groups according to the third tertiles of TBIL. The coronary angiography showed that lower TBIL was associated with the severity of lesion calcification. After a mean follow-up of 315 days, major adverse cardiac and cerebrovascular events (MACCEs) were reported in 61 patients. Compared with patients with higher TBIL tertiles, the incidence of MACCEs increased significantly in patients with middle and lower TBIL tertiles. The incidence of MACCEs in one-year follow-up was significantly different between higher and lower tertiles. The findings indicate that decreased TBIL is a potential predictor of poor prognosis in patients with psoriasis and CAD.
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Affiliation(s)
- Lin Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kunqi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zuozhi Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianjie Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Man Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zeng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Peng YF, Deng JH, Huang XY, Zhang QS. Serum Bilirubin Levels and Disease Severity in Patients with Pneumoconiosis. Can Respir J 2023; 2023:5642040. [PMID: 36960314 PMCID: PMC10030211 DOI: 10.1155/2023/5642040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/19/2023] [Accepted: 02/16/2023] [Indexed: 03/17/2023] Open
Abstract
Aim To investigate the association between serum bilirubin and disease severity in patients with pneumoconiosis. Methods The study comprised 45 patients with pneumoconiosis retrospectively; all pneumoconiosis patients were classified into I, II, and III stage according to the radiological severity. Results Serum direct bilirubin levels were significantly lower in III stage pneumoconiosis patients than those in I/II stage (p = 0.012) but not serum indirect bilirubin. Serum direct bilirubin was negatively correlated with radiological severity in patients with pneumoconiosis (r = -0.320; p = 0.032); by multiple linear-regression analysis, we observed that serum direct bilirubin levels had independent association with radiological severity in patients with pneumoconiosis (beta = -0.459; p = 0.005). Conclusions Serum direct bilirubin levels are negatively associated with disease severity in patients with pneumoconiosis.
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Affiliation(s)
- You-Fan Peng
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Jun-Hua Deng
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Xiao-Ying Huang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Qing-Song Zhang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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Serum Bilirubin and Markers of Oxidative Stress and Inflammation in a Healthy Population and in Patients with Various Forms of Atherosclerosis. Antioxidants (Basel) 2022; 11:antiox11112118. [PMID: 36358491 PMCID: PMC9686784 DOI: 10.3390/antiox11112118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 01/08/2023] Open
Abstract
Oxidative stress and inflammation contribute significantly to atherogenesis. We and others have demonstrated that mildly elevated serum bilirubin levels protect against coronary and peripheral atherosclerosis, most likely due to the antioxidant and anti-inflammatory activities of bilirubin. The aim of the present study was to assess serum bilirubin and the markers of oxidative stress and inflammation in both healthy subjects and patients with various forms of atherosclerosis. The study was performed in patients with premature myocardial infarction (n = 129), chronic ischemic heart disease (n = 43), peripheral artery disease (PAD, n = 69), and healthy subjects (n = 225). In all subjects, standard serum biochemistry, UGT1A1 genotypes, total antioxidant status (TAS), and concentrations of various pro- and anti-inflammatory chemokines were determined. Compared to controls, all atherosclerotic groups had significantly lower serum bilirubin and TAS, while having much higher serum high-sensitivity C-reactive protein (hsCRP) and most of the analyzed proinflammatory cytokines (p < 0.05 for all comparisons). Surprisingly, the highest inflammation, and the lowest antioxidant status, together with the lowest serum bilirubin, was observed in PAD patients, and not in premature atherosclerosis. In conclusion, elevated serum bilirubin is positively correlated with TAS, and negatively related to inflammatory markers. Compared to healthy subjects, patients with atherosclerosis have a much higher degree of oxidative stress and inflammation.
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Ahmad A, Ansari MM, AlAsmari AF, Ali N, Maqbool MT, Raza SS, Khan R. Dose dependent safety implications and acute intravenous toxicity of aminocellulose-grafted-polycaprolactone coated gelatin nanoparticles in mice. Int J Biol Macromol 2021; 192:1150-1159. [PMID: 34653441 DOI: 10.1016/j.ijbiomac.2021.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
Polymeric nanoparticles (NPs) are the most widely researched nanoformulations and gained broad acceptance in nanotherapeutics for targeted drug delivery and theranostics. However, lack of regulations, guidelines, harmonized standards, and limitations with their employability in clinical circumstances necessitates an in-depth understanding of their toxicology. Here, we examined the in-vivo toxicity of core-shell polymeric NPs made up of gelatin core coated with an outer layer of aminocellulose-grafted polycaprolactone (PCL-AC) synthesized for drug delivery purposes in inflammatory disorders. Nanoparticles were administered intravenously in Swiss albino mice, in multiple dosing (10, 25, and 50 mg/kg body weight) and outcomes of serum biochemistry analysis and histopathology evaluation exhibited that the highest 50 mg/kg administration of NPs altered biochemistry and histopathology aspects of vital organs, while doses of 10 and 25 mg/kg were safe and biocompatible. Further, mast cell (toluidine blue) staining confirmed that administration of the highest dose enhanced mast cell infiltration in tissues of vital organs, while lower doses did not exhibit any of these alterations. Therefore, the results of the present study establish that the NPs disposal in-vivo culminates into alterations in organ structure and function consequences such that lower doses are quite biocompatible and do not demonstrate any structural or functional toxicity while some toxicological effects start appearing at the highest dose.
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Affiliation(s)
- Anas Ahmad
- Chemical Biology Unit, Institute of Nano Science and Technology (INST), Sector-81, Knowledge City, Sahibzada Ajit Singh Nagar, Punjab Pin 140306, India
| | - Md Meraj Ansari
- Chemical Biology Unit, Institute of Nano Science and Technology (INST), Sector-81, Knowledge City, Sahibzada Ajit Singh Nagar, Punjab Pin 140306, India
| | - Abdullah F AlAsmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P. O. Box 55760, Riyadh 11451, Saudi Arabia
| | - Nemat Ali
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P. O. Box 55760, Riyadh 11451, Saudi Arabia
| | - Mir Tahir Maqbool
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, MS 38677, USA
| | - Syed Shadab Raza
- Laboratory for Stem Cell & Restorative Neurology, Department of Biotechnology, Era's Lucknow Medical College and Hospital, Sarfarazganj, Lucknow 226003, Uttar Pradesh, India
| | - Rehan Khan
- Chemical Biology Unit, Institute of Nano Science and Technology (INST), Sector-81, Knowledge City, Sahibzada Ajit Singh Nagar, Punjab Pin 140306, India.
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Hyperbilirubinemia Maintained by Chronic Supplementation of Unconjugated Bilirubin Improves the Clinical Course of Experimental Autoimmune Arthritis. Int J Mol Sci 2021; 22:ijms22168662. [PMID: 34445367 PMCID: PMC8395408 DOI: 10.3390/ijms22168662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic multisystem disease, therapy of which remains a challenge for basic research. The present work examined the effect of unconjugated bilirubin (UCB) administration in adjuvant-induced arthritis (AIA)—an experimental model, in which oxidative stress (OS), inflammation and inadequate immune response are often similar to RA. Male Lewis rats were randomized into groups: CO—control, AIA—untreated adjuvant-induced arthritis, AIA-BIL—adjuvant-induced arthritis administrated UCB, CO-BIL—control with administrated UCB. UCB was administered intraperitoneally 200 mg/kg of body weight daily from 14th day of the experiment, when clinical signs of the disease are fully manifested, to 28th day, the end of the experiment. AIA was induced by a single intradermal immunization at the base of the tail with suspension of Mycobacterium butyricum in incomplete Freund’s adjuvant. Clinical, hematologic, biochemical and histologic examinations were performed. UCB administration to animals with AIA lead to a significant decrease in hind paws volume, plasma levels of C-reactive protein (CRP) and ceruloplasmin, drop of leukocytes, lymphocytes, erythrocytes, hemoglobin and an increase in platelet count. UCB administration caused significantly lowered oxidative damage to DNA in arthritic animals, whereas in healthy controls it induced considerable oxidative damage to DNA. UCB administration also induced atrophy of the spleen and thymus in AIA and CO animals comparing to untreated animals. Histological signs of joint damage assessed by neutrophils infiltration and deposition of fibrin were significantly reduced by UCB administration. The effects of exogenously administered UCB to the animals with adjuvant-induced arthritis might be identified as therapeutic, in contrast to the effects of UCB administration in healthy animals rather classified as toxic.
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Bellarosa C, Bedogni G, Bianco A, Cicolini S, Caroli D, Tiribelli C, Sartorio A. Association of Serum Bilirubin Level with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study of 1672 Obese Children. J Clin Med 2021; 10:jcm10132812. [PMID: 34202304 PMCID: PMC8268762 DOI: 10.3390/jcm10132812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Abstract
As in adults, obesity also plays a central role in the development of metabolic syndrome (MS) in children. Non-alcoholic fatty liver disease (NAFLD) is considered a manifestation of MS. Not only MS but also NAFLD seem to be inversely associated with serum bilirubin concentrations, an important endogenous tissue protector when only mild elevated. The aim of the study was to evaluate the association between serum bilirubin levels and the prevalence of MS and NAFLD in Italian obese children and adolescents. A retrospective cross-sectional study was performed in 1672 patients aged from 5 to 18 years. Clinical and laboratory parameters were assessed. NAFLD was measured by liver ultrasonography. The study was approved by the Ethical Committee of the Istituto Auxologico Italiano (research project code 1C021_2020, acronym BILOB). MS was present in 24% and fatty liver (FL) in 38% of this population. Bilirubin was not associated with FL and MS as a whole, but it was inversely associated only with selected components of MS, i.e., large WC, high blood pressure and high triglycerides. Our data suggest that bilirubin is not protective against MS and NAFLD in the presence of severe obesity.
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Affiliation(s)
- Cristina Bellarosa
- Italian Liver Foundation, 34149 Trieste, Italy; (G.B.); (A.B.); (C.T.)
- Correspondence:
| | - Giorgio Bedogni
- Italian Liver Foundation, 34149 Trieste, Italy; (G.B.); (A.B.); (C.T.)
| | - Annalisa Bianco
- Italian Liver Foundation, 34149 Trieste, Italy; (G.B.); (A.B.); (C.T.)
- Life Science Department, University of Trieste, 34127 Trieste, Italy
| | - Sabrina Cicolini
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.C.); (D.C.); (A.S.)
| | - Diana Caroli
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.C.); (D.C.); (A.S.)
| | - Claudio Tiribelli
- Italian Liver Foundation, 34149 Trieste, Italy; (G.B.); (A.B.); (C.T.)
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.C.); (D.C.); (A.S.)
- Istituto Auxologico Italiano, IRCCS, Division of Auxology and Metabolic Diseases, 28824 Verbania, Italy
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Wang H, Jia Q, Shi J, Hu Y. Prognostic value of serum bilirubin in patients with heart failure: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26180. [PMID: 34087882 PMCID: PMC8183714 DOI: 10.1097/md.0000000000026180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Heart failure (HF) is one of the common and critical disease, and often accompanied by increased level of serum bilirubin, but the role of an indicator of bilirubin to monitor the prognosis of patients with heart failure is still unclear, so we implemented the study to systematically evaluate the predictive value of bilirubin in HF. METHODS A comprehensive search and systematic review will be conducted on electronic databases such as Medline, Cochrane Library, Embase, Web of Science, Cochrane Clinical Trials Database of study on the relationship between bilirubin and prognosis of HF patients. Review Manager software (version 5.3.5) and STATA 14 software (version 14.0) will be used for data analysis and synthesis. RESULTS The results will systematically and comprehensively reveal the evidence on the predictive value of bilirubin in HF. CONCLUSION The study will display the effect of bilirubin level on the prognosis of patients with heart failure, and help clinicians to pay more attention to the level of bilirubin in patients with HF, and can take certain treatment measures as earlier as possible. INPLASY REGISTRATION NUMBER INPLASY202140116.
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Affiliation(s)
- Huan Wang
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Qiulei Jia
- Graduate School, Beijing University of Chinese Medicine
| | - Jingjing Shi
- Graduate School, Beijing University of Chinese Medicine
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
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Park HM, Kim H, Lee HS, Lee YJ. Inverse association between serum bilirubin level and testosterone deficiency in middle-aged and older men. Sci Rep 2021; 11:8026. [PMID: 33850200 PMCID: PMC8044079 DOI: 10.1038/s41598-021-87220-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/08/2021] [Indexed: 11/28/2022] Open
Abstract
Low serum bilirubin levels have been associated with increased risk of cardiovascular disease (CVD) and metabolic syndrome. Testosterone deficiency could also contribute to increased risk of CVD and metabolic syndrome. Therefore, this study aimed to examine the relationship between serum bilirubin level and testosterone deficiency in 1284 Korean men aged 45 to 70 years. Serum bilirubin level was categorized into quartiles: Q1 ≤ 0.7, Q2 0.8-0.9, Q3 1.0-1.1, and Q4 ≥ 1.2 mg/dL. Testosterone deficiency was defined as level less than 8.0 nmol/L, as suggested by the position statement of International Society of Andrology. The overall prevalence of testosterone deficiency was 5.8% and significantly decreased with the quartiles from Q1 to Q4. Compared with the referent fourth quartile (serum bilirubin ≥ 1.2 mg/dL), the ORs (95% CIs) for testosterone deficiency was 2.29 (1.04-4.94) for the first quartile after adjusting for age, fasting glucose, triglyceride, HDL-cholesterol, leukocyte count, hemoglobin, smoking status, and alcohol intake. We found inversely graded associations of serum bilirubin level with testosterone deficiency. These findings suggest that low bilirubin level may be interpreted as a state of testosterone deficiency in middle-aged and older men.
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Affiliation(s)
- Hye-Min Park
- Department of Family Medicine, Chaum Medical Checkup Center Samseongdong Branch, Cha University, Seoul, Republic of Korea
- Department of Medicine, Graduate School of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Haeyoung Kim
- Department of Integrative Medicine, Major in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Lee
- Department of Family medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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12
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Ahmad A, Ansari MM, Kumar A, Vyawahare A, Mishra RK, Jayamurugan G, Raza SS, Khan R. Comparative acute intravenous toxicity study of triple polymer-layered magnetic nanoparticles with bare magnetic nanoparticles in Swiss albino mice. Nanotoxicology 2020; 14:1362-1380. [DOI: 10.1080/17435390.2020.1829144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Anas Ahmad
- Institute of Nano Science and Technology, Habitat Centre, Mohali, India
| | - Md. Meraj Ansari
- Institute of Nano Science and Technology, Habitat Centre, Mohali, India
| | - Ajay Kumar
- Institute of Nano Science and Technology, Habitat Centre, Mohali, India
| | - Akshay Vyawahare
- Institute of Nano Science and Technology, Habitat Centre, Mohali, India
| | | | | | - Syed Shadab Raza
- Laboratory for Stem Cell and Restorative Neurology, Department of Biotechnology, Era’s Lucknow Medical College Hospital, Lucknow, India
- Department of Stem Cell Biology and Regenerative Medicine, Era University, Lucknow, India
| | - Rehan Khan
- Institute of Nano Science and Technology, Habitat Centre, Mohali, India
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13
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YILMAZ N, ÖZ C, EREN E, TEKELİ SÖ. Bilirubin metabolism and its role in atherosclerosis. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2020. [DOI: 10.25000/acem.699424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Hansen TWR, Wong RJ, Stevenson DK. Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn. Physiol Rev 2020; 100:1291-1346. [PMID: 32401177 DOI: 10.1152/physrev.00004.2019] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Bilirubin is the end product of heme catabolism formed during a process that involves oxidation-reduction reactions and conserves iron body stores. Unconjugated hyperbilirubinemia is common in newborn infants, but rare later in life. The basic physiology of bilirubin metabolism, such as production, transport, and excretion, has been well described. However, in the neonate, numerous variables related to nutrition, ethnicity, and genetic variants at several metabolic steps may be superimposed on the normal physiological hyperbilirubinemia that occurs in the first week of life and results in bilirubin levels that may be toxic to the brain. Bilirubin exists in several isomeric forms that differ in their polarities and is considered a physiologically important antioxidant. Here we review the chemistry of the bilirubin molecule and its metabolism in the body with a particular focus on the processes that impact the newborn infant, and how differences relative to older children and adults contribute to the risk of developing both acute and long-term neurological sequelae in the newborn infant. The final section deals with the interplay between the brain and bilirubin and its entry, clearance, and accumulation. We conclude with a discussion of the current state of knowledge regarding the mechanism(s) of bilirubin neurotoxicity.
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Affiliation(s)
- Thor W R Hansen
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ronald J Wong
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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15
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Ataseven A, Durmaz K, Temiz SA, Dursun R. Clinical and laboratory assessment for the inflammation role in chronic spontaneous urticaria: A clinical study. Dermatol Ther 2020; 33:e14125. [PMID: 32761761 DOI: 10.1111/dth.14125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
Chronic spontaneous urticaria (CSU) is triggered by unknown causes. We would like to explore the possible effect of hemogram parameters and several biochemical markers on CSU presence and also the severity of the disease. We also aimed to discuss the relationship between CSU and inflammation associated with these values. The study was planned prospectively. We selected patients already diagnosed with CSU who applied to the dermatology outpatient clinic and healthy controls. The patients and the healthy controls were tested for complete blood count, neutrophil/lymphocytes ratio and platelets/lymphocytes ratio, erythrocyte sedimentation rate, C-reactive protein, serum albumin and total bilirubin and indirect bilirubin levels. Urticaria activity score over 7 days (UAS-7) was calculated for the CSU patients. Forty patients with CSU and 55 healthy subjects were included in the study. Mean white blood cell (WBC) count is 8.37 ± 2.14 in the patients' group and 7.41 ± 2.01 in the healthy subjects group. Mean neutrophil (NEU) count is 4.88 ± 1.65 in the patients' group and 4.19 ± 1.39 in the healthy subjects group. Mean platelets (PLT) count is 308.48 ± 88.32 in the patients' group and 268.65 ± 64.80 in the healthy subjects group. We also detected positive correlations between UAS-7 score-WBC counts and UAS-7 score-NEU counts. Future studies are needed to investigate this possible relationship and confirm these results.
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Affiliation(s)
- Arzu Ataseven
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Koray Durmaz
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Selami Aykut Temiz
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Recep Dursun
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
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16
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Novák P, Jackson AO, Zhao GJ, Yin K. Bilirubin in metabolic syndrome and associated inflammatory diseases: New perspectives. Life Sci 2020; 257:118032. [PMID: 32621920 DOI: 10.1016/j.lfs.2020.118032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes mellitus is one of the major global health issues, which is closely related to metabolic dysfunction and the chronic inflammatory diseases. Multiple studies have demonstrated that serum bilirubin is negatively correlated with metabolic syndrome and associated inflammatory diseases, including atherosclerosis, hypertension, etc. However, the roles of bilirubin in metabolic syndrome and associated inflammatory diseases still remain unclear. Here, we explain the role of bilirubin in metabolic syndrome and chronic inflammatory diseases and its therapeutic potential. Understanding the role of bilirubin activities in diabetes may serve as a therapeutic target for the treatment of chronic inflammatory diseases in diabetic patients.
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Affiliation(s)
- Petr Novák
- Guangxi Key Laboratory of Diabetic Systems Medicine, Guilin Medical University, Guilin 541000, Guangxi, China
| | - Ampadu O Jackson
- International College, University of South China, Hengyang, Hunan Province 421001, China
| | - Guo-Jun Zhao
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan City People's Hospital, Qingyuan, Guangdong 511518, China.
| | - Kai Yin
- Guangxi Key Laboratory of Diabetic Systems Medicine, Guilin Medical University, Guilin 541000, Guangxi, China; The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541100, China.
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17
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Prognostic Value of Serum Total Bilirubin after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5243589. [PMID: 31275974 PMCID: PMC6558622 DOI: 10.1155/2019/5243589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/19/2019] [Indexed: 01/06/2023]
Abstract
Backgrounds Previous studies have reported a relationship between serum total bilirubin (STB) and coronary artery disease (CAD). However, the relationship between STB and prognosis of patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) remains inconclusive. The present study aimed to evaluate the relationship between STB level and prognosis of PCI in patients with ACS. Methods In total, 2850 ACS patients who underwent PCI at the Affiliated Zhongda Hospital of Southeast University from June 2009 to Jan 2017 were included in the study. Twenty-four-hour STB, 30-day, and 1-year postoperative major adverse cardiovascular events (MACE) were recorded. Subjects were assigned to one of three groups based on STB: Group A (STB ≤ 9.6 μmol/L), Group B (9.7 μmol/L < STB ≤ 15.4 μmol/L), and Group C (STB ≥ 15.5 μmol/L). COX survival analysis was subsequently used to investigate the relationship between the incidence of MACE and STB in the three groups. Results A total of 2770 subjects were successfully followed up; within 1 year after PCI, 115 (4.15%) subjects died and 191 (6.90%) subjects experienced MACE. One-year follow-up results showed that the incidence of MACE decreased significantly as STB increased; the risk of Group A was 2.002 times that of Group C (95% CI: 1.342-2.986). Cardiac mortality also decreased with increasing STB; the risk of Group A was 3.403 times that of Group C (95% CI: 1.319-8.785). Conclusion Lower mortality and MACE incidence rates were found in patients with higher STB within 1 year. Therefore, STB is highly recommended as an independent long-term prognosis predictor of PCI in patients with ACS.
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18
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Low serum bilirubin levels contribute to the presence and progression of distal symmetrical polyneuropathy in Chinese patients with type 2 diabetes. DIABETES & METABOLISM 2019; 45:47-52. [DOI: 10.1016/j.diabet.2018.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/10/2018] [Accepted: 02/18/2018] [Indexed: 11/22/2022]
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19
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Influence of radioactive iodine therapy on liver function in patients with differentiated thyroid cancer. Nucl Med Commun 2018; 39:1113-1120. [DOI: 10.1097/mnm.0000000000000919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Li M, Li X, Liu Y, Liu X, Song Y, Zhao J, Mohan C, Wu T, Peng A, Qin L. Relationship between serum bilirubin levels s and the progression of renal function in patients with chronic kidney disease and hyperuricemia. Clin Chim Acta 2018; 486:156-161. [PMID: 30076802 DOI: 10.1016/j.cca.2018.07.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/12/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022]
Abstract
It is known that inflammation and oxidative stress have strong influences on chronic kidney disease (CKD). As an antioxidant, bilirubin is currently under extensive scrutiny. However, there are disagreements with regard to the oxidative and antioxidative roles of serum uric acid (SUA). This study aimed to investigate the relationship between serum bilirubin and the progression of renal function in CKD patients with hyperuricemia (HUA). This retrospective longitudinal study included 427 CKD patients. The endpoint was renal replacement therapy or death. Patients were divided into the following two groups according to the SUA level: HUA group (SUA ≥ 420 μmol/L for men; SUA ≥ 360 μmol/L for women) and normal uric acid level (NUA) group. A Cox proportional hazards model was used to evaluate the risk factors for renal outcomes in the two patient groups. The median follow-up time was 36 months. In the Cox regression analysis, the risk of renal outcomes in patients with serum indirect bilirubin (IBIL) levels >4.55 μmol/L was 0.15 times the risk in patients with serum IBIL levels ≤4.55 μmol/L (hazard ratio = 0.15, p = .013). Our findings suggest that a high serum IBIL level might be a protective factor for the progression of renal function in CKD patients with HUA.
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Affiliation(s)
- Mengyuan Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Xinhua Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Yan Liu
- Department of Nephrology, Heze Municipal Hospital, 2888, West Caozhou Road, Shandong 274031, China
| | - Xinying Liu
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Yaxiang Song
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Jian Zhao
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Chandra Mohan
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204-5060, USA
| | - Tianfu Wu
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204-5060, USA
| | - Ai Peng
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Ling Qin
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China.
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21
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Zhang D, Zhang W, Jin S, Wang W, Guo D, Wang L. Elevated Serum Total Bilirubin Concentrations Are Negatively Associated with Diabetic Retinopathy among the Chinese Northeastern Population. Int J Endocrinol 2018; 2018:6539385. [PMID: 29780419 PMCID: PMC5892253 DOI: 10.1155/2018/6539385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the association between serum total bilirubin concentration (STBC) and diabetic retinopathy (DR) among the Chinese northeastern population. METHODS A cross-sectional study was conducted in Liaoning between January 2015 and May 2017. RESULTS A total of 742 subjects (419 men and 323 women) with type 2 diabetes mellitus (DM) who visited an ophthalmic clinic were included in this study. The mean age of the subjects was 59.55 ± 10.63 years, and 43.5% of the subjects were women. The mean of DM duration was 11.01 ± 7.35 years. STBC were negatively correlated with DM duration, urea nitrogen, serum creatinine, uric acid, and urine microalbumin. After adjusting for confounding factors, as a continuous variable, STBC was inversely associated with the risk of DR in total subjects (OR: 0.95, 95% CI: 0.93-0.99). When STBC was used as a tertiary variable, compared with the first tertile, the OR in the third tertile was 0.37 (95% CI: 0.22-0.64) in total subjects. CONCLUSION Our results demonstrate that a significant negative association was found between STBC and DR. STBC might be an early clinical marker for predicting the occurrence of DR.
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Affiliation(s)
- Dan Zhang
- Department of Endocrinology, Fourth Hospital of China Medical University, Shenyang 110032, China
| | - Wei Zhang
- Department of Endocrinology, Fourth Hospital of China Medical University, Shenyang 110032, China
| | - Shi Jin
- Department of Endocrinology, Fourth Hospital of China Medical University, Shenyang 110032, China
| | - Wei Wang
- Department of Endocrinology, Fourth Hospital of China Medical University, Shenyang 110032, China
| | - Dan Guo
- Department of Endocrinology, Fourth Hospital of China Medical University, Shenyang 110032, China
| | - Lu Wang
- Department of Endocrinology, Fourth Hospital of China Medical University, Shenyang 110032, China
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22
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Abstract
Bilirubin is the final product of heme catabolism in the systemic circulation. For decades, increased serum/plasma bilirubin levels were considered an ominous sign of an underlying liver disease. However, data from recent years convincingly suggest that mildly elevated bilirubin concentrations are associated with protection against various oxidative stress-mediated diseases, atherosclerotic conditions being the most clinically relevant. Although scarce data on beneficial effects of bilirubin had been published also in the past, it took until 1994 when the first clinical study demonstrated an increased risk of coronary heart disease in subjects with low serum bilirubin levels, and bilirubin was found to be a risk factor for atherosclerotic diseases independent of standard risk factors. Consistent with these results, we proved in our own studies, that subjects with mild elevation of serum levels of unconjugated bilirubin (benign hyperbilirubinemia, Gilbert syndrome) have much lower prevalence/incidence of coronary heart as well as peripheral vascular disease. We have also demonstrated that this association is even more general, with serum bilirubin being a biomarker of numerous other diseases, often associated with increased risk of atherosclerosis. In addition, very recent data have demonstrated biological pathways modulated by bilirubin, which are responsible for observed strong clinical associations.
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Affiliation(s)
- L Vítek
- Fourth Department of Internal Medicine and Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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23
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Barber TJ, Moyle G, Hill A, Jagjit Singh G, Scourfield A, Yapa HM, Waters L, Asboe D, Boffito M, Nelson M. A cross-sectional study to evaluate the association of hyperbilirubinaemia on markers of cardiovascular disease, neurocognitive function, bone mineral density and renal markers in HIV-1 infected subjects on protease inhibitors. HIV CLINICAL TRIALS 2017; 17:123-30. [PMID: 27125367 DOI: 10.1080/15284336.2016.1176305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ongoing inflammation in controlled HIV infection contributes to non-AIDS comorbidities. High bilirubin appears to exhibit an anti-inflammatory effect in vivo. We therefore examined whether increased bilirubin in persons with HIV was associated with differences in markers of inflammation and cardiovascular, bone, renal disease, and neurocognitive (NC) impairment. METHODS This cross-sectional study examined inflammatory markers in individuals with stable HIV infection treated with two nucleoside reverse transcriptase inhibitors and a boosted protease inhibitor. Individuals recruited were those with a normal bilirubin (NBR; 0-17 μmol/L) or high bilirubin (>2.5 × upper limit of normal). Demographic and anthropological data were recorded. Blood and urine samples were taken for analyses. Pulse wave velocity (PWV) measurement, carotid intimal thickness (CIT), and calcaneal stiffness (CSI) were measured. Males were asked to answer a questionnaire about sexual function; NC testing was performed using CogState. RESULTS 101 patients were screened, 78 enrolled (43 NBR and 35 HBR). Atazanavir use was significantly higher in HBR. Whilst a trend for lower CIT was seen in those with HBR, no significant differences were seen in PWV, bone markers, calculated cardiovascular risk (Framingham), or erectile dysfunction score. VCAM-1 levels were significantly lower in the HBR group. HBR was associated with lower LDL and triglyceride levels. NBR was associated with a calculated FRAX significantly lower than HBR although no associations were found after adjusting for tenofovir use. No difference in renal markers was observed. Component tests of NC testing revealed differences favouring HBR but overall composite scores were similar. DISCUSSION High bilirubin in the context of boosted PI therapy was found not to be associated with differences in with the markers examined in this study. Some trends were noted and, on the basis of these, a larger, clinical end point study is warranted.
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Affiliation(s)
- T J Barber
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - G Moyle
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - A Hill
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - G Jagjit Singh
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - A Scourfield
- b University College London Hospitals NHS Foundation Trust , London , UK
| | - H M Yapa
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - L Waters
- c Mortimer Market Centre , Central and North West London NHS Foundation Trust, London , UK
| | - D Asboe
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - M Boffito
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK.,d Imperial College School of Medicine , London , UK
| | - M Nelson
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK.,d Imperial College School of Medicine , London , UK
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24
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Peng YF, Deng YB. Serum Bilirubin Concentrations in Patients With Takayasu Arteritis. Arch Pathol Lab Med 2017; 141:846-850. [DOI: 10.5858/arpa.2016-0362-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Bilirubin has strong anti-inflammatory and antioxidative stress action. Progression of inflammation involving arteries is a crucial activator in pathogenesis of Takayasu arteritis (TA).
Objective.—
To investigate the relationship between serum bilirubin and TA.
Design.—
Our study involved 115 consecutive TA patients. Patients with active-phase disease were followed and received prednisone therapy.
Results.—
Lower concentrations of serum bilirubin were detected in TA patients compared with healthy subjects (0.6 ± 0.31 versus 0.7 ± 0.22 mg/dL, P = .02). Serum bilirubin concentrations in active TA patients were lower than those in inactive patients (0.5 ± 0.20 versus 0.8 ± 0.32 mg/dL, P < .001). In all patients with TA, serum bilirubin correlated positively with total protein (r = 0.193, P = .04) and negatively with C-reactive protein and erythrocyte sedimentation rate (r = −0.213, P = .03, and r = −0.532, P < .001, respectively). Multiple logistic regression analysis showed that each decrease of 1 mg/dL in serum bilirubin was associated with a 1.10 times increase in the odds for TA compared with the controls (odds ratio = 0.913, 95% CI, 0.856–0.974; P = .006). Serum bilirubin was correlated with erythrocyte sedimentation rate (β = −0.170, P < .001) in multiple linear regression analysis. The area under the curve for serum bilirubin in predicting active TA patients was 0.802. Serum bilirubin levels were found to be significantly increased after prednisone treatment (0.5 ± 0.20 versus 0.7 ± 0.15 mg/dL, P = .002).
Conclusions.—
Lower serum bilirubin levels are associated with TA, and serum bilirubin may be influenced by prednisone therapy in active TA patients. Serum bilirubin levels in TA patients correlate negatively with erythrocyte sedimentation rate.
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Affiliation(s)
| | - Yi-Bin Deng
- From the Department of Laboratory Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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25
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Wang S, Zhang J, Zhu L, Song L, Meng Z, Jia Q, Li X, Liu N, Hu T, Zhou P, Zhang Q, Liu L, Song K, Jia Q. Association between liver function and metabolic syndrome in Chinese men and women. Sci Rep 2017; 7:44844. [PMID: 28317840 PMCID: PMC5357848 DOI: 10.1038/srep44844] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/14/2017] [Indexed: 02/07/2023] Open
Abstract
Metabolic syndrome (MS) could be associated with liver function. Our study aimed to investigate the association between liver function and MS in a large cohort of Chinese men and women. We enrolled 32,768 ostensibly healthy participants. The associations between liver function and MS of both genders were analyzed separately after dividing total bilirubin (TBIL), gamma glutamyltransferase (GGT), alanine aminotransferase (ALT) into quartiles. Young males had significantly higher MS prevalence than females, yet after menopause, females had higher MS prevalence. We used TBIL, GGT and ALT quartiles as categorical variables in binary logistic regression models. Significantly decreased MS risks were demonstrated in TBIL quartiles 2 to 4 for males, and quartiles 3 to 4 for females. As to GGT and ALT, significantly increased MS risks were shown in high quartiles for both genders. Aging also resulted in significantly higher MS risks in both genders except for young females. This study displayed close associations between liver function and MS, which were influenced by gender and age. A high TBIL level had protective effect against MS, while high GGT and ALT levels were risk factors for MS. It is meaningful that liver function is used as clinical risk predictors for MS.
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Affiliation(s)
- Sen Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Jie Zhang
- Section of Ultrasound and Interventional Therapy in Department of Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Li Zhu
- Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Linlin Song
- Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Xue Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Na Liu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Tianpeng Hu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Pingping Zhou
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Qing Zhang
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Li Liu
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Kun Song
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Qiyu Jia
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R. China
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Kundur AR, Santhakumar AB, Bulmer AC, Singh I. Mildly elevated unconjugated bilirubin is associated with reduced platelet activation-related thrombogenesis and inflammation in Gilbert’s syndrome. Platelets 2017; 28:779-785. [DOI: 10.1080/09537104.2017.1280146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Avinash R. Kundur
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Abishek B. Santhakumar
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Andrew C. Bulmer
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Indu Singh
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Zhu B, Wu X, Bi Y, Yang Y. Effect of bilirubin concentration on the risk of diabetic complications: A meta-analysis of epidemiologic studies. Sci Rep 2017; 7:41681. [PMID: 28134328 PMCID: PMC5278382 DOI: 10.1038/srep41681] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/28/2016] [Indexed: 12/25/2022] Open
Abstract
Diabetes can affect many parts of the body and is associated with serious complications. Oxidative stress is a major contributor in the pathogenesis of diabetic complications and bilirubin has been shown to have antioxidant effects. The number of studies on the effect of bilirubin on the risk of diabetic complications has increased, but the results are inconsistent. Thus, we performed a meta-analysis to determine the relationship between bilirubin concentration and the risk of diabetic complications, and to investigate if there was a dose-response relationship. We carried out an extensive search in multiple databases. A fixed or random-effects model was used to calculate the pooled estimates. We conducted a dose-response meta-analysis to analyze the association between these estimates. A total of 132,240 subjects from 27 included studies were analyzed in our meta-analysis. A negative nonlinear association between bilirubin concentration and the risk of diabetic complications was identified (OR: 0.77, 95% CI: 0.73-0.81), with a nonlinear association. We also found that there was a negative association between bilirubin concentration and the risk of diabetic nephropathy, diabetic retinopathy and diabetic neuropathy. The results of our meta-analysis indicate that bilirubin may play a protective role in the occurrence of diabetic complications.
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Affiliation(s)
- Bo Zhu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute Shenyang, People’s Republic of China
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Evidence Medicine, The First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Yifei Bi
- Leiden University Center for Linguistics and Leiden Institute for Brain and Congnition, leiden, zuid-holland, Netherlands
| | - Yang Yang
- Department of mathematics, School of Fundamental Sciences, China Medical University, Shenyang, People’s Republic of China
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28
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Total bilirubin in athletes, determination of reference range. Biol Sport 2016; 34:45-48. [PMID: 28416897 PMCID: PMC5377560 DOI: 10.5114/biolsport.2017.63732] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/25/2016] [Accepted: 03/07/2016] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study was to determine a typical reference range for the population of athletes. Results of blood tests of 339 athletes (82 women and 257 men, aged 18-37 years) were retrospectively analysed. The subjects were representatives of different sports disciplines. The measurements of total bilirubin (BIT), iron (Fe), alkaline phosphatase (ALP), alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) were made using a Pentra 400 biochemical analyser (Horiba, France). Red blood cell count (RBC), reticulocyte count and haemoglobin concentration measurements were made using an Advia 120 haematology analyser (Siemens, Germany). In groups of women and men the percentage of elevated results were similar at 18%. Most results of total bilirubin in both sexes were in the range 7-14 μmol·L-1 (49% of women and 42% of men). The highest results of elevated levels of BIT were in the range 21-28 μmol·L-1 (12% of women and 11% of men). There was a significant correlation between serum iron and BIT concentration in female and male athletes whose serum total bilirubin concentration does not exceed the upper limit of the reference range. Elevated concentrations of total bilirubin appear to be due to changes caused by regular exercise. The obtained upper limit of the reference range for total bilirubin concentration in the group of athletes is 29.0 μmol·L-1. It seems reasonable to use dedicated reference values for total bilirubin concentration in relation to the group of athletes.
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Hamur H, Duman H, Demirtas L, Bakirci EM, Durakoglugil ME, Degirmenci H, Kalkan K, Yildirim E, Vuruskan E. Total Bilirubin Levels Predict Subclinical Atherosclerosis in Patients With Prediabetes. Angiology 2016; 67:909-915. [PMID: 26921264 DOI: 10.1177/0003319716632394] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bilirubin may have important antiatherosclerotic effects. Prediabetes (PD), the intermediate stage before diabetes mellitus, is associated with increased cardiovascular morbidity and mortality. We evaluated the relationship between serum bilirubin levels and carotid intima-media thickness (cIMT), as a surrogate marker of subclinical atherosclerosis, in patients with PD. We enrolled 170 consecutive patients with PD. The patients underwent ultrasonography to evaluate cIMT. The patients were divided into groups according to cIMT values (<0.9 vs ≥0.9 mm). The patients with cIMT ≥ 0.9 mm had significantly higher diastolic blood pressure, neutrophil-lymphocyte ratio (NLR), and glycated hemoglobin values compared with patients having cIMT < 0.9 mm, whereas total and direct bilirubin values were significantly lower in this group. Multivariate regression analyses revealed NLR and total bilirubin as the independent predictors of subclinical atherosclerosis. The present study demonstrated that NLR and lower total bilirubin levels were independent predictors of subclinical atherosclerosis in patients with PD. Simple measures such as NRL and total bilirubin may provide predictive information regarding the risk of cardiovascular disease in patients with PD.
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Affiliation(s)
- Hikmet Hamur
- 1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Hakan Duman
- 2 Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Levent Demirtas
- 3 Department of Internal Medicine, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Eftal Murat Bakirci
- 1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | | | - Husnu Degirmenci
- 1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Kamuran Kalkan
- 4 Department of Cardiology, Training and Research Hospital, Erzurum, Turkey
| | - Erkan Yildirim
- 4 Department of Cardiology, Training and Research Hospital, Erzurum, Turkey
| | - Ertan Vuruskan
- 5 Department of Cardiology, Dr. Ersin Arslan State Hospital, Gaziantep, Turkey
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30
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Werumeus Buning J, Kootstra-Ros JE, Brummelman P, van den Berg G, van der Klauw M, Wolffenbuttel BHR, van Beek AP, Dullaart RPF. Higher hydrocortisone dose increases bilirubin in hypopituitary patients- results from an RCT. Eur J Clin Invest 2016; 46:475-80. [PMID: 26999644 PMCID: PMC5111743 DOI: 10.1111/eci.12624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/16/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bilirubin has anti-oxidative and anti-inflammatory properties, which may explain its proposed protective effects on the development of cardiometabolic disorders. Glucocorticoids affect heme oxygenase regulation in vitro, which plays a key role in bilirubin production. Effects of variations in glucocorticoid exposure on circulating bilirubin levels in humans are unknown. Here we tested whether a higher hydrocortisone replacement dose affects circulating bilirubin in hypopituitary patients. MATERIALS AND METHODS A randomized double-blind cross-over study (ClinicalTrials.gov, number NCT01546992) was performed in 47 patients with secondary adrenal failure [10-week exposure to a higher hydrocortisone dose (0·4-0·6 mg/kg body weight) vs. 10 weeks of a lower hydrocortisone dose (0·2-0·3 mg/kg body weight)]. RESULTS Plasma total bilirubin was increased by 10% from 7 to 8 μM in response to the higher hydrocortisone dose (P = 0·033). This effect was inversely related to age (P = 0·042), but was unaffected by sex, obesity and (replacement for) other hormonal insufficiencies. The higher hydrocortisone dose also resulted in lower alkaline phosphatase (P = 0·006) and aspartate aminotransferase activities (P = 0·001). CONCLUSION Bilirubin is modestly increased in response to higher glucocorticoid exposure in humans, in conjunction with lower alkaline phosphatase and aspartate aminotransferase activities, which are supposed to represent biomarkers of a pro-inflammatory state and enhanced liver fat accumulation.
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Affiliation(s)
- Jorien Werumeus Buning
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenny E Kootstra-Ros
- Laboratory Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pauline Brummelman
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerrit van den Berg
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melanie van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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31
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Cho HS, Lee SW, Kim ES, Shin J, Moon SD, Han JH, Cha BY. Serum bilirubin levels are inversely associated with PAI-1 and fibrinogen in Korean subjects. Atherosclerosis 2015; 244:204-10. [PMID: 26684255 DOI: 10.1016/j.atherosclerosis.2015.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/22/2015] [Accepted: 11/06/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Oxidative stress may contribute to atherosclerosis and increased activation of the coagulation pathway. Bilirubin may reduce activation of the hemostatic system to inhibit oxidative stress, which would explain its cardioprotective properties shown in many epidemiological studies. This study investigated the association of serum bilirubin with fibrinogen and plasminogen activator inhibitor-1 (PAI-1), respectively. METHODS A cross-sectional analysis was performed on 968 subjects (mean age, 56.0 ± 11.2 years; 61.1% men) undergoing a general health checkup. Serum biochemistry was analyzed including bilirubin subtypes, insulin resistance (using homeostasis model of assessment [HOMA]), C-reactive protein (CRP), fibrinogen, and PAI-1. RESULTS Compared with subjects with a total bilirubin (TB) concentration of <10.0 μmol/L, those with a TB concentration of >17.1 μmol/L had a smaller waist circumference, a lower triglyceride level, a lower prevalence of metabolic syndrome, and decreased HOMA-IR and CRP levels. Correlation analysis revealed linear relationships of fibrinogen with TB and direct bilirubin (DB), whereas PAI-1 was correlated with DB. After adjustment for confounding factors, bilirubin levels were inversely associated with fibrinogen and PAI-1 levels, respectively. Multivariate regression models showed a negative linear relationship between all types of bilirubin and fibrinogen, whereas there was a significant linear relationship between PAI-1 and DB. CONCLUSIONS High bilirubin concentrations were independently associated with low levels of fibrinogen and PAI-1, respectively. The association between TB and PAI-1 was confined to the highest TB concentration category whereas DB showed a linear association with PAI-1. Bilirubin may protect against the development of atherothrombosis by reducing the hemostatic response.
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Affiliation(s)
- Hyun Sun Cho
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Health Promotion Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Sook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Juyoung Shin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Health Promotion Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Dae Moon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Je Ho Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Bong Yun Cha
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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32
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Kim ES, Lee SW, Mo EY, Moon SD, Han JH. Inverse association between serum total bilirubin levels and diabetic peripheral neuropathy in patients with type 2 diabetes. Endocrine 2015; 50:405-12. [PMID: 25846483 DOI: 10.1007/s12020-015-0583-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/17/2015] [Indexed: 12/18/2022]
Abstract
Several studies have suggested that bilirubin, a potent innate antioxidant, plays a protective role against cardiovascular and microvascular disease. This study investigated the association between serum concentrations of total bilirubin (TB) and the presence of diabetic peripheral neuropathy (DPN) in Korean diabetic patients. This cross-sectional study involved 1207 patients aged more than 30 years with type 2 diabetes. DPN was assessed according to clinical symptoms and physical examinations using Michigan Neuropathy Screening Instrument examination score, 10-g monofilament sensation, and current perception threshold. The subjects were stratified into gender-specific tertiles based on TB values, and the relationship between the TB values and DPN was analyzed. Compared with patients within the lowest TB tertile, those with higher TB levels consisted of patients with shorter duration of diabetes, lower HbA1c, better renal function, and less autonomic neuropathy, retinopathy, and albuminuria. Serum TB levels were inversely associated with DPN. In multivariate analysis for the development of DPN after adjusting for potential confounding factors including retinopathy, albuminuria, and autonomic neuropathy, the TB levels were inversely associated with the presence of DPN, both as a continuous variable [odds ratio (OR) per log standard deviation (SD) 0.79; 95% confidence interval (CI) 0.65-0.97; P = 0.022] and when categorized in tertiles (the highest vs. the lowest tertile; OR 0.63; 95% CI 0.40-0.99; P = 0.046). Low serum bilirubin levels are significantly associated with DPN, independently of classic risk factors and other microvascular complications. Further investigation is necessary to determine whether serum bilirubin has a prognostic significance on DPN.
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Affiliation(s)
- Eun Sook Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea
| | - Sung Won Lee
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea
| | - Eun Young Mo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea
| | - Sung Dae Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea.
| | - Je Ho Han
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea.
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33
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Huang SS, Chan WL, Leu HB, Huang PH, Lin SJ, Chen JW. Serum bilirubin levels predict future development of metabolic syndrome in healthy middle-aged nonsmoking men. Am J Med 2015; 128:1138.e35-41. [PMID: 25912203 DOI: 10.1016/j.amjmed.2015.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 04/05/2015] [Accepted: 04/11/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite epidemiologic research demonstrating an inverse relationship between serum bilirubin levels and the prevalence of metabolic syndrome, prospective data on serum bilirubin as a predictor of incident metabolic syndrome are limited. METHODS Serum bilirubin was examined as a risk marker for incident metabolic syndrome in a prospective study of 468 Taiwanese middle-aged men who were free of metabolic syndrome and other systemic diseases at baseline. These subjects were followed up in annual health examinations between 2001 and 2009 for the development of metabolic syndrome, which was defined according to unified criteria set by several major organizations. RESULTS Among the study subjects, 377 were nonsmokers and 91 were current smokers. All individuals were then stratified into 3 groups according to their baseline serum bilirubin levels (low, normal, and high). During a mean follow-up period of 7.58 years, 66 subjects developed metabolic syndrome. The incidence of metabolic syndrome was significantly reduced in the high-bilirubin group compared with the low-bilirubin group (6.4% vs 22.4%, P < .001). Multivariate Cox regression analysis revealed that the hazard ratio for incident metabolic syndrome between the highest and lowest tertiles of serum bilirubin levels was 0.246 (95% confidence interval 0.120-0.503). However, although it remained clearly evident in nonsmokers, the inverse correlation was attenuated in current smokers. CONCLUSIONS Increased serum bilirubin was associated with a reduced future risk of metabolic syndrome in apparently healthy middle-aged, nonsmoking men. Our findings support the predictive role of serum total bilirubin for future development of metabolic syndrome.
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Affiliation(s)
- Shao-Sung Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wan-Leong Chan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Bang Leu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Hsun Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jaw-Wen Chen
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
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34
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Looking to the horizon: the role of bilirubin in the development and prevention of age-related chronic diseases. Clin Sci (Lond) 2015; 129:1-25. [DOI: 10.1042/cs20140566] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Bilirubin, the principal tetrapyrrole, bile pigment and catabolite of haem, is an emerging biomarker of disease resistance, which may be related to several recently documented biological functions. Initially believed to be toxic in infants, the perception of bilirubin has undergone a transformation: it is now considered to be a molecule that may promote health in adults. Data from the last decade demonstrate that mildly elevated serum bilirubin levels are strongly associated with reduced prevalence of chronic diseases, particularly cardiovascular diseases (CVDs), as well as CVD-related mortality and risk factors. Recent data also link bilirubin to other chronic diseases, including cancer and Type 2 diabetes mellitus, and to all-cause mortality. Therefore, there is evidence to suggest that bilirubin is a biomarker for reduced chronic disease prevalence and a predictor of all-cause mortality, which is of important clinical significance. In the present review, detailed information on the association between bilirubin and all-cause mortality, as well as the pathological conditions of CVD, cancer, diabetes and neurodegenerative diseases, is provided. The mechanistic background concerning how bilirubin and its metabolism may influence disease prevention and its clinical relevance is also discussed. Given that the search for novel biomarkers of these diseases, as well as for novel therapeutic modalities, is a key research objective for the near future, bilirubin represents a promising candidate, meeting the criteria of a biomarker, and should be considered more carefully in clinical practice as a molecule that might provide insights into disease resistance. Clearly, however, greater molecular insight is warranted to support and strengthen the conclusion that bilirubin can prevent disease, with future research directions also proposed.
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van Tienhoven-Wind LJN, Dullaart RPF. Low-normal thyroid function and novel cardiometabolic biomarkers. Nutrients 2015; 7:1352-77. [PMID: 25690422 PMCID: PMC4344592 DOI: 10.3390/nu7021352] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/16/2015] [Accepted: 02/04/2015] [Indexed: 12/14/2022] Open
Abstract
The concept is emerging that low-normal thyroid function, i.e., either higher thyroid-stimulating hormone or lower free thyroxine levels within the euthyroid reference range, could contribute to the development of atherosclerotic cardiovascular disease. It is possible that adverse effects of low-normal thyroid function on cardiovascular outcome may be particularly relevant for specific populations, such as younger people and subjects with high cardiovascular risk. Low-normal thyroid function probably relates to modest increases in plasma total cholesterol, low density lipoprotein cholesterol, triglycerides and insulin resistance, but effects on high density lipoprotein (HDL) cholesterol and non-alcoholic fatty liver disease are inconsistent. Low-normal thyroid function may enhance plasma cholesteryl ester transfer, and contribute to an impaired ability of HDL to inhibit oxidative modification of LDL, reflecting pro-atherogenic alterations in lipoprotein metabolism and HDL function, respectively. Low-normal thyroid function also confers lower levels of bilirubin, a strong natural anti-oxidant. Remarkably, all these effects of low-normal thyroid functional status appear to be more outspoken in the context of chronic hyperglycemia and/or insulin resistance. Collectively, these data support the concept that low-normal thyroid function may adversely affect several processes which conceivably contribute to the pathogenesis of atherosclerotic cardiovascular disease, beyond effects on conventional lipoprotein measures.
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Affiliation(s)
- Lynnda J N van Tienhoven-Wind
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, AV Groningen 19713, The Netherlands.
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, AV Groningen 19713, The Netherlands.
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36
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Bilirubin, platelet activation and heart disease: a missing link to cardiovascular protection in Gilbert's syndrome? Atherosclerosis 2014; 239:73-84. [PMID: 25576848 DOI: 10.1016/j.atherosclerosis.2014.12.042] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 02/07/2023]
Abstract
Gilbert's syndrome (GS) is a relatively common condition, inducing a benign, non-hemolytic, unconjugated hyperbilirubinemia. Gilbert's Syndrome is associated with mutation in the Uridine Glucuronosyl Transferase 1A1 (UGT1A1) gene promoter, reducing UGT1A1 activity, which normally conjugates bilirubin allowing its elimination from the blood. Individuals with GS demonstrate mildly elevated plasma antioxidant capacity caused by elevated levels of unconjugated bilirubin (UCB), reduced thiols and glutathione. Interestingly, the development of, and risk of mortality from, cardiovascular disease is remarkably reduced in GS individuals. An explanation for this protection may be explained by bilirubin's ability to inhibit multiple processes that induce platelet hyper-reactivity and thrombosis, thus far under-appreciated in the literature. Reactive oxygen species are produced continuously via metabolic processes and have the potential to oxidatively modify proteins and lipids within cell membranes, which may encourage the development of thrombosis and CVDs. Oxidative stress induced platelet hyper-reactivity significantly increases the risk of thrombosis, which can potentially lead to tissue infarction. Here, we discuss the possible mechanisms by which increased antioxidant status might influence platelet function and link this to cardiovascular protection in GS. In summary, this is the first article to discuss the possible role of bilirubin as an anti-thrombotic agent, which inhibits platelet activation and potentially, organ infarction, which could contribute to the reduced mortality rate in mildly hyperbilirbinemic individuals.
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Song YS, Koo BK, Cho NH, Moon MK. Effect of low serum total bilirubin levels (≤0.32 mg/dl) on risk of coronary artery disease in patients with metabolic syndrome. Am J Cardiol 2014; 114:1695-700. [PMID: 25288499 DOI: 10.1016/j.amjcard.2014.08.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 02/07/2023]
Abstract
The objective of this study was to investigate the effects of low serum bilirubin levels on the risk for future coronary artery disease (CAD) in a prospective cohort. CAD events were examined according to baseline serum bilirubin levels in a prospective large-scale, community-based Korean cohort in 2 subsequent prospective biennial surveys. A total of 8,593 subjects were included, 0.9% of whom reported newly developed CAD events during the 4 years of follow-up. Cox regression analyses showed that the lowest serum total bilirubin level category (bilirubin ≤0.32 mg/dl) was an independent risk factor for future CAD events (adjusted hazard ratio [HR] 1.890, 95% confidence interval [CI] 1.088 to 3.284; p = 0.024). Subjects with metabolic syndrome had a higher risk for future CAD events than those without metabolic syndrome (HR 3.366, 95% CI 2.079 to 5.448, p <0.001). Low bilirubin levels increased the CAD risk in subjects with metabolic syndrome further (HR 2.016, 95% CI 1.069 to 3.800; p = 0.030), with these subjects showing a >6 times higher risk for CAD than subjects with bilirubin levels >0.32 mg/dl and no metabolic syndrome (HR 6.228, 95% CI 3.118 to 12.437; p <0.001). In conclusion, the addition of low serum bilirubin levels to the traditional risk factors for CAD, such as metabolic syndrome, may yield an improvement of risk prediction.
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Affiliation(s)
- Young Shin Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University, Suwon, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
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Kim ES, Mo EY, Moon SD, Han JH. Inverse association between serum bilirubin levels and arterial stiffness in Korean women with type 2 diabetes. PLoS One 2014; 9:e109251. [PMID: 25299316 PMCID: PMC4192318 DOI: 10.1371/journal.pone.0109251] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 08/30/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Considerable evidence suggests that bilirubin is a potent physiologic antioxidant that may provide important protection against cardiovascular disease (CVD) and inflammation. We investigated the relationship between serum total bilirubin (TB) levels and arterial stiffness, measured by the brachial-ankle pulse wave velocity (baPWV), in patients with type 2 diabetes. METHODS We conducted a cross-sectional analysis of 1,711 subjects with type 2 diabetes (807 men and 904 women; mean age, 57.1 years). The subjects were stratified based on gender-specific tertiles of TB values, and a high baPWV was defined as greater than 1,745 cm/s ( >75th percentile). RESULTS The serum TB concentration was negatively correlated with the duration of diabetes, HbA1c, the 10-year Framingham risk score, and baPWV and was positively correlated with high-density lipoprotein cholesterol and the eGFR in both genders. Inverse association between TB categories and unadjusted prevalence of high PWV was only observed in women. After adjusting for confounding factors, the TB levels were inversely associated with a greater risk of a high baPWV, both as a continuous variable [a 1-SD difference; odds ratio (OR), 0.70; 95% confidence interval (CI), 0.54-0.90; P = 0.005] and when categorized in tertiles (the highest vs. the lowest tertile; OR, 0.49; 95% CI, 0.28-0.85; P = 0.011) in women but not in men. The relationship remained significant even after adjusting for retinopathy and nephropathy. CONCLUSIONS Low TB levels were significantly associated with arterial stiffness in Korean women with type 2 diabetes. Our data suggested that bilirubin may protect against macrovascular disease in diabetic women.
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Affiliation(s)
- Eun Sook Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea; The Catholic University of Korea Incheon St. Mary's hospital, Incheon, Korea
| | - Eun Young Mo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea; The Catholic University of Korea Incheon St. Mary's hospital, Incheon, Korea
| | - Sung Dae Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea; The Catholic University of Korea Incheon St. Mary's hospital, Incheon, Korea
| | - Je Ho Han
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea; The Catholic University of Korea Incheon St. Mary's hospital, Incheon, Korea
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Potential cardiovascular risk protection of bilirubin in end-stage renal disease patients under hemodialysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:175286. [PMID: 25276769 PMCID: PMC4174976 DOI: 10.1155/2014/175286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/19/2014] [Indexed: 12/18/2022]
Abstract
We evaluated the potential cardiovascular risk protection of bilirubin in hemodialysis (HD) patients. An enlarged set of studies were evaluated in 191 HD patients, including hematological study, lipid profile, iron metabolism, nutritional, inflammatory markers, and dialysis adequacy. The TA duplication screening in the UDP-glucuronosyltransferase 1 A1 (UGT1A1) promoter region was also performed. The UGT1A1 genotype frequencies in HD patients were 49.2%, 42.4%, and 8.4% for 6/6, 6/7, and 7/7 genotypes, respectively. Although no difference was found in UGT1A1 genotype distribution between the three tertiles of bilirubin, significant differences were found with increasing bilirubin levels, namely, a decrease in platelet, leukocyte, and lymphocyte counts, transferrin, oxidized low-density lipoprotein (ox-LDL), ox-LDL/low-density lipoprotein cholesterol ratio, apolipoprotein (Apo) A, Apo B, and interleukin-6 serum levels and a significant increased concentration of hemoglobin, hematocrit, erythrocyte count, iron, transferrin saturation, Apo A/Apo B ratio, adiponectin, and paraoxonase 1 serum levels. After adjustment for age these results remained significant. Our data suggest that higher bilirubin levels are associated with beneficial effects in HD patients, by improving lipid profile and reducing the inflammatory grade, which might contribute to increase in iron availability. These results suggest a potential cardiovascular risk protection of bilirubin in HD patients.
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Belo L, Nascimento H, Kohlova M, Bronze-da-Rocha E, Fernandes J, Costa E, Catarino C, Aires L, Mansilha HF, Rocha-Pereira P, Quintanilha A, Rêgo C, Santos-Silva A. Body fat percentage is a major determinant of total bilirubin independently of UGT1A1*28 polymorphism in young obese. PLoS One 2014; 9:e98467. [PMID: 24901842 PMCID: PMC4046990 DOI: 10.1371/journal.pone.0098467] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 05/04/2014] [Indexed: 12/05/2022] Open
Abstract
Objectives Bilirubin has potential antioxidant and anti-inflammatory properties. The UGT1A1*28 polymorphism (TA repeats in the promoter region) is a major determinant of bilirubin levels and recent evidence suggests that raised adiposity may also be a contributing factor. We aimed to study the interaction between UGT1A1 polymorphism, hematological and anthropometric variables with total bilirubin levels in young individuals. Methods 350 obese (mean age of 11.6 years; 52% females) and 79 controls (mean age of 10.5 years; 59% females) were included. Total bilirubin and C-reactive protein (CRP) plasma levels, hemogram, anthropometric data and UGT1A1 polymorphism were determined. In a subgroup of 74 obese and 40 controls body composition was analyzed by dual-energy X-ray absorptiometry. Results The UGT1A1 genotype frequencies were 49.9%, 42.7% and 7.5% for 6/6, 6/7 and 7/7 genotypes, respectively. Patients with 7/7 genotype presented the highest total bilirubin levels, followed by 6/7 and 6/6 genotypes. Compared to controls, obese patients presented higher erythrocyte count, hematocrit, hemoglobin and CRP levels, but no differences in bilirubin or in UGT1A1 genotype distribution. Body fat percentage was inversely correlated with bilirubin in obese patients but not in controls. This inverse association was observed either in 6/7 or 6/6 genotype obese patients. UGT1A1 polymorphism and body fat percentage were the main factors affecting bilirubin levels within obese patients (linear regression analysis). Conclusion In obese children and adolescents, body fat composition and UGT1A1 polymorphism are independent determinants of total bilirubin levels. Obese individuals with 6/6 UGT1A1 genotype and higher body fat mass may benefit from a closer clinical follow-up.
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Affiliation(s)
- Luís Belo
- Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
- * E-mail:
| | - Henrique Nascimento
- Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
| | - Michaela Kohlova
- Institute for Biomedical Imaging and Life Science (IBILI), Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Elsa Bronze-da-Rocha
- Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
| | - João Fernandes
- Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
- Institute for Biomedical Imaging and Life Science (IBILI), Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Elísio Costa
- Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
| | - Cristina Catarino
- Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
| | - Luísa Aires
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- Instituto Universitário da Maia (ISMAI), Maia, Portugal
| | - Helena Ferreira Mansilha
- Departamento da Infância e Adolescência/Serviço de Pediatria do Centro Hospitalar do Porto, Porto, Portugal
| | - Petronila Rocha-Pereira
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Alexandre Quintanilha
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Carla Rêgo
- Centro da Criança e do Adolescente. Hospital CUF Porto, Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Alice Santos-Silva
- Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
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Abstract
This review highlights the protective roles of bilirubin against the atherosclerotic process. Bilirubin belongs to the superfamily of tetrapyrrolic compounds formed during heme catabolism. Although for decades bilirubin was considered to be a harmful waste product, recent epidemiologic studies have shown that serum bilirubin levels have consistently been inversely associated with cardiovascular disease (CVD), as well as cardiovascular risk factors such as metabolic syndrome and diabetes. These clinical studies are supported by in vitro and in vivo experimental data and have demonstrated that bilirubin not only has an ability to scavenge overproduced reactive oxygen species and inhibit vascular smooth muscle cell proliferation but, additionally, has anti-inflammatory effects. In this review, we will discuss the inverse association of serum bilirubin and CVD and cardiovascular risk factors established in various clinical studies. We also review detailed experimental studies about the effect of bilirubin on atherosclerotic processes. In vitro, animal and human studies have proved that bilirubin inhibits oxidation of cholesterol which is an important step of atherosclerosis. Bilirubin attenuates chemotactic activity of monocytes and strongly inhibits adhesion of leukocytes to venule and production of pro-inflammatory cytokines. Bilirubin has inhibited serum-driven smooth muscle cell cycle progression at the G1 phase. Lastly, we will discuss briefly the influence of bilirubin on lipoprotein composition and endothelial dysfunction.
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Affiliation(s)
- Seung Joo Kang
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University, Hospital Healthcare System Gangnam Center , Seoul , Korea
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Wegiel B, Nemeth Z, Correa-Costa M, Bulmer AC, Otterbein LE. Heme oxygenase-1: a metabolic nike. Antioxid Redox Signal 2014; 20:1709-22. [PMID: 24180257 PMCID: PMC3961788 DOI: 10.1089/ars.2013.5667] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 11/01/2013] [Indexed: 10/26/2022]
Abstract
SIGNIFICANCE Heme degradation, which was described more than 30 years ago, is still very actively explored with many novel discoveries on its role in various disease models every year. RECENT ADVANCES The heme oxygenases (HO) are metabolic enzymes that utilize NADPH and oxygen to break apart the heme moiety liberating biliverdin (BV), carbon monoxide (CO), and iron. Heme that is derived from hemoproteins can be toxic to the cells and if not removed immediately, it causes cell apoptosis and local inflammation. Elimination of heme from the milieu enables generation of three products that influences numerous metabolic changes in the cell. CRITICAL ISSUES CO has profound effects on mitochondria and cellular respiration and other hemoproteins to which it can bind and affect their function, while BV and bilirubin (BR), the substrate and product of BV, reductase, respectively, are potent antioxidants. Sequestration of iron into ferritin and its recycling in the tissues is a part of the homeodynamic processes that control oxidation-reduction in cellular metabolism. Further, heme is an important component of a number of metabolic enzymes, and, therefore, HO-1 plays an important role in the modulation of cellular bioenergetics. FUTURE DIRECTIONS In this review, we describe the cross-talk between heme oxygenase-1 (HO-1) and its products with other metabolic pathways. HO-1, which we have labeled Nike, the goddess who personified victory, dictates triumph over pathophysiologic conditions, including diabetes, ischemia, and cancer.
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Affiliation(s)
- Barbara Wegiel
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Zsuzsanna Nemeth
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Matheus Correa-Costa
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew C. Bulmer
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Queensland, Australia
| | - Leo E. Otterbein
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Jung CH, Lee MJ, Kang YM, Hwang JY, Jang JE, Leem J, Park JY, Kim HK, Lee WJ. Higher serum bilirubin level as a protective factor for the development of diabetes in healthy Korean men: a 4 year retrospective longitudinal study. Metabolism 2014; 63:87-93. [PMID: 24140099 DOI: 10.1016/j.metabol.2013.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/23/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Bilirubin, a natural product of heme catabolism by heme oxygenase, one of key antioxidant enzymes, has been recognized as a substance with potent antioxidant and cytoprotective properties. Several studies have shown a significant negative relationship between serum bilirubin levels and the risk of metabolic disorders, including type 2 diabetes. However, longitudinal studies investigating the association of elevated serum bilirubin levels and type 2 diabetes are lacking. In the present study, we aimed to investigate the longitudinal effects of baseline serum bilirubin concentrations on the development of type 2 diabetes in healthy Korean men. MATERIALS AND METHODS This 4 year retrospective longitudinal observational study was conducted at the Asan Medical Center, Seoul, Republic of Korea. The study population consisted of 5960 men without type 2 diabetes who underwent routine health examinations in 2007 (baseline) and 2011 (follow-up). Baseline serum bilirubin concentrations were determined by the vanadate oxidation method. RESULTS During a 4 year period, 409 incident cases of diabetes (6.9 %) were identified. Incident type 2 diabetes decreased across the baseline bilirubin quartile categories (P for trend <0.001). In multivariable-adjusted model, the relative risk (RR) for the development of type 2 diabetes was significantly lower in the highest (i.e., 1.30-2.00 mg/dl) than in the lowest bilirubin quartile category (i.e., ≤ 0.90 mg/dl), even after adjustment for confounding variables (RR=0.69, 95% confidence interval 0.48-0.99, P for trend = 0.041). CONCLUSIONS The results indicate that serum total bilirubin level may provide additional information for predicting future development of type 2 diabetes in healthy subjects.
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Affiliation(s)
- Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Deetman PE, Bakker SJL, Dullaart RPF. High sensitive C-reactive protein and serum amyloid A are inversely related to serum bilirubin: effect-modification by metabolic syndrome. Cardiovasc Diabetol 2013; 12:166. [PMID: 24209691 PMCID: PMC4176750 DOI: 10.1186/1475-2840-12-166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/28/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Bilirubin has been implicated in cardiovascular protection by virtue of its anti-inflammatory and anti-oxidative properties. The metabolic syndrome is featured by enhanced low-grade systemic inflammation and oxidative stress. Serum amyloid A (SAA) impairs anti-oxidative properties of high-density lipoprotein (HDL). We determined relationships of high sensitive C-reactive protein (hs-CRP) and SAA with bilirubin in subjects with and without metabolic syndrome (MetS). METHODS Serum total bilirubin, hs-CRP, SAA and homeostasis model assessment- insulin resistance (HOMA-IR) were documented in 94 subjects with and in 73 subjects without MetS (26 and 54 subjects with type 2 diabetes mellitus (T2DM), respectively). RESULTS Bilirubin was lower in MetS (P = 0.013), coinciding with higher hs-CRP (P < 0.001) and SAA levels (P = 0.002). In all subjects combined, hs-CRP was inversely related to bilirubin (r = -0.203, P = 0.008), irrespective of the presence of MetS or T2DM (interaction terms: P ≥ 0.75). The inverse relationship of bilirubin with SAA was confined to subjects without MetS (r = -0.267, P = 0.009). Furthermore, the presence of either MetS or T2DM modified the relationship of bilirubin with SAA (interaction terms: β = 0.366, P = 0.003 and β = 0.289, P = 0.025, respectively) in age- and sex-adjusted analyses. Effect modification was also found for HOMA-IR (β = 0.790, P = 0.020). Of the individual MetS components, the strongest interaction of bilirubin on SAA was observed with low HDL cholesterol (β = 0.435, P < 0.001). CONCLUSIONS hs-CRP is inversely related to bilirubin, suggesting that low bilirubin is implicated in enhanced low-grade systemic inflammation. The inverse relationship of SAA with bilirubin was found to be absent in MetS, which could be attributable to MetS-associated abnormalities in HDL characteristics.
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Affiliation(s)
| | | | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, P,O, Box 30,001, Groningen 9700 RB, The Netherlands.
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Wallner M, Bulmer AC, Mölzer C, Müllner E, Marculescu R, Doberer D, Wolzt M, Wagner OF, Wagner KH. Haem catabolism: a novel modulator of inflammation in Gilbert's syndrome. Eur J Clin Invest 2013; 43:912-9. [PMID: 23865893 DOI: 10.1111/eci.12120] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 05/23/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Moderately elevated unconjugated bilirubin concentrations protect against inflammatory diseases and are present in individuals with Gilbert's syndrome. This study examined the relationship between circulating haem oxygenase catabolites, unconjugated bilirubin, carboxy haemoglobin, iron and inflammatory parameters. MATERIALS AND METHODS Seventy-six matched individuals were allocated to Gilbert's syndrome (GS) or control group (unconjugated bilirubin ≥ or < 17.1 μM). Iron, carboxy haemoglobin and high-sensitivity C-reactive protein were analysed using routine diagnostic tests. Unconjugated bilirubin and haem were analysed using high-performance liquid chromatography. The cytokines IL-1β, TNF-α and IL-6 were assessed using high-sensitivity enzyme-linked immunosorbent assays. RESULTS Gilbert's syndrome subjects had significantly greater levels of unconjugated bilirubin (P < 0.05), carboxy haemoglobin (P < 0.05), iron (P < 0.05), IL-1β (P < 0.05), a significantly lower body mass index (P < 0.05) and IL-6 concentrations (P < 0.05) vs. controls. Regression analysis revealed that unconjugated bilirubin mainly explained IL-1β results (16%), and body mass index+IL-6 predicted 26% of the variance in C-reactive protein concentrations. CONCLUSIONS A positive relationship between unconjugated bilirubin and free plasma haem, iron and carboxy haemoglobin indicated a positive feedback loop of haem oxygenase induction possibly mediated by unconjugated bilirubin. Furthermore, reduced body mass index in Gilbert's syndrome individuals was linked to reduced inflammation status, which could be influenced by circulating haem oxygenase catabolites and contribute to reduced risk of noncommunicable diseases in this population.
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Affiliation(s)
- Marlies Wallner
- Department of Nutritional Sciences, Emerging Field Oxidative Stress and DNA Stability, University of Vienna, Austria
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Protection from age-related increase in lipid biomarkers and inflammation contributes to cardiovascular protection in Gilbert's syndrome. Clin Sci (Lond) 2013; 125:257-64. [PMID: 23566065 DOI: 10.1042/cs20120661] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent epidemiological and clinical data show protection from CVD (cardiovascular disease), all-cause mortality and cancer in subjects with GS (Gilbert's syndrome), which is characterized by a mildly elevated blood bilirubin concentration. The established antioxidant effect of bilirubin, however, contributes only in part to this protection. Therefore we investigated whether mildly elevated circulating UCB (unconjugated bilirubin) is associated with altered lipid metabolism. The study was performed on GS and age- and gender-matched healthy subjects (n=59 per group). Full lipoprotein profile, TAG (triacylglycerols), Apo (apolipoprotein)-A1, Apo-B, lipoprotein(a), the subfractions of LDL (low-density lipoprotein) and selected pro-inflammatory mediators were analysed. A hyperbilirubinaemic rodent model (Gunn rats, n=40) was investigated to further support the presented human data. GS subjects had significantly (P<0.05) improved lipid profile with reduced total cholesterol, LDL-C (LDL-cholesterol), TAG, low- and pro-atherogenic LDL subfractions (LDL-1+LDL-2), Apo-B, Apo-B/Apo-A1 ratio and lower IL-6 (interleukin 6) and SAA (serum amyloid A) concentrations (P=0.094). When the control and GS groups were subdivided into younger and older cohorts, older GS subjects demonstrated reduced lipid variables (total cholesterol and LDL-C, TAG and LDL-C subfractions, Apo-B/Apo-A1 ratio; P<0.05; Apo-B: P<0.1) compared with controls. These data were supported by lipid analyses in the rodent model showing that Gunn rat serum had lower total cholesterol (2.29±0.38 compared with 1.27±0.72 mM; P<0.001) and TAG (1.66±0.67 compared with 0.99±0.52 mM; P<0.001) concentrations compared with controls. These findings indicate that the altered lipid profile and the reduced pro-inflammatory status in hyperbilirubinaemic subjects, particularly in the older individuals, probably contribute additionally to the commonly accepted beneficial antioxidant effects of bilirubin in humans.
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Jenko-Pražnikar Z, Petelin A, Jurdana M, Žiberna L. Serum bilirubin levels are lower in overweight asymptomatic middle-aged adults: an early indicator of metabolic syndrome? Metabolism 2013; 62:976-85. [PMID: 23414908 DOI: 10.1016/j.metabol.2013.01.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Low levels of bilirubin have recently been associated with obesity, diabetes mellitus, and metabolic syndrome. Here, we hypothesized that serum bilirubin levels might be already altered in overweight asymptomatic middle-aged individuals before full development of the metabolic syndrome. METHODS Healthy nonsmoking adults aged 25-49 (64 women and 32 men) participated in this cross-sectional study. All participants who reported stable weight within the last three months underwent standard anthropomorphological measurements of body composition, blood pressure measurements, aerobic and anaerobic capabilities assessment, dietary intake evaluation, and fasting serological measurements of total and direct bilirubin, glucose, insulin, triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and C-reactive protein. Participants were divided into normal-weight and overweight groups. Linear correlation and multiple regression analyses were used to examine the association of serum bilirubin levels with all metabolic syndrome risk factor changes. RESULTS Serum bilirubin levels were lower in overweight healthy individuals of both sexes, and were negatively associated with abdominal obesity, insulin resistance, fasting glucose, fasting insulin, fasting triglycerides, total cholesterol, low-density lipoprotein cholesterol, and C-reactive protein levels but positively associated with aerobic body capabilities. CONCLUSION Our findings suggest that serum bilirubin levels have the potential to be employed as an early biomarker for indicating asymptomatic individuals at increased risk of developing metabolic syndrome.
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Affiliation(s)
- Zala Jenko-Pražnikar
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia
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Ong KL, Allison MA, Cheung BMY, Wu BJ, Barter PJ, Rye KA. Trends in C-reactive protein levels in US adults from 1999 to 2010. Am J Epidemiol 2013; 177:1430-42. [PMID: 23669654 DOI: 10.1093/aje/kws443] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
C-reactive protein (CRP) is a well-known biomarker of systemic inflammation and cardiovascular disease. We investigated the trends in prevalence of elevated CRP levels (>3.0 mg/L) in a general population of US adults. Data from 27,214 subjects aged ≥20 years in the 1999-2010 National Health and Nutrition Examination Survey were analyzed. After adjustment for age, sex, race/ethnicity, body mass index (weight (kg)/height (m)(2)), and medications for lowering blood pressure, glucose, and lipids, the prevalence of elevated CRP decreased significantly from 36.7% in 1999-2002 to 32.0% in 2007-2010, corresponding to a decrease in mean CRP level from 1.92 to 1.66 mg/L (both P < 0.001). The trend remained significant after additional adjustment for several traditional cardiovascular risk factors and use of different medications, including statins. However, the decreasing trends were attenuated after additional adjustment for total bilirubin (P = 0.08 and 0.02), which increased from 0.62 to 0.73 mg/dL over 12 years (P < 0.001). The decreasing trend of CRP levels is encouraging and may be related to the increase in total bilirubin levels. Such trends may be explained in part by the increasing use of medications such as statins, which can increase bilirubin levels and decrease CRP levels.
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Affiliation(s)
- Kwok Leung Ong
- Lipid Research Group, Heart Research Institute, Sydney, New South Wales, Australia.
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Demirkol S, Balta S, Celik T, Unlu M, Arslan Z, Cakar M, Kucuk U, Iyisoy A, Barcin C, Demirbas S, Kocak N, Cayci T. Carotid Intima Media Thickness and Its Association With Total Bilirubin Levels in Patients With Coronary Artery Ectasia. Angiology 2013; 71:425-430. [DOI: 10.1177/0003319712473796] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Atherosclerosis plays an important role in the etiopathogenesis of coronary artery ectasia (CAE). The relationship between total bilirubin (TBil) and carotid intima media thickness (cIMT) in patients with CAE has not been fully investigated. Hence, we evaluated the relationship between TBil levels and cIMT in 142 consecutive eligible patients with CAE, newly diagnosed coronary artery disease (CAD), and normal coronary arteries. There were no significant differences in TBil ( P = .772) and cIMT ( P = .791) between the CAE and CAD groups. Bilirubin levels were significantly lower in both CAE and CAD groups compared to the controls ( P < .01). The cIMT was significantly higher in both CAE and CAD groups compared to control participants ( P < .01). A negative correlation between cIMT and TBil was found in all the groups ( P < .01, r = .354). We show for the first time that patients with CAE and CAD have lower TBil and greater cIMT compared to controls with normal coronary angiograms.
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Affiliation(s)
- Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Sevket Balta
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Turgay Celik
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Murat Unlu
- Department of Cardiology, Beytepe Hospital, Ankara, Turkey
| | - Zekeriya Arslan
- Department of Cardiology, Gelibolu Hospital, Canakkale, Turkey
| | - Mustafa Cakar
- Department of Internal Medicine, Gulhane Medical Academy, Ankara, Turkey
| | - Ugur Kucuk
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Atila Iyisoy
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Cem Barcin
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Seref Demirbas
- Department of Internal Medicine, Gulhane Medical Academy, Ankara, Turkey
| | - Necmettin Kocak
- Department of Public Health, Gulhane Medical Academy, Ankara, Turkey
| | - Tuncer Cayci
- Department of Clinical Chemistry, Gulhane Medical Academy, Ankara, Turkey
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Bulmer AC, Verkade HJ, Wagner KH. Bilirubin and beyond: a review of lipid status in Gilbert's syndrome and its relevance to cardiovascular disease protection. Prog Lipid Res 2012. [PMID: 23201182 DOI: 10.1016/j.plipres.2012.11.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gilbert's syndrome (GS) is characterized by a benign, mildly elevated bilirubin concentration in the blood. Recent reports show clear protection from cardiovascular disease in this population. Protection of lipids, proteins and other macromolecules from oxidation by bilirubin represents the most commonly accepted mechanism contributing to protection in this group. However, a recent meta-analysis estimated that bilirubin only accounts for ~34% of the cardioprotective effects within analysed studies. To reveal the additional contributing variables we have explored circulating cholesterol and triacylglycerol concentrations, which appear to be decreased in hyperbilirubinemic individuals/animals, and are accompanied by lower body mass index in highly powered studies. These results suggest that bilirubin could be responsible for the development of a lean and hypolipidemic state in GS. Here we also discuss the possible contributing mechanisms that might reduce circulating cholesterol and triacylglycerol concentrations in individuals with syndromes affecting bilirubin metabolism/excretion, which we hope will stimulate future research in the area. In summary, this article is the first review of lipid status in animal and human studies of hyperbilirubinemia and explores possible mechanisms that could contribute to lowering circulating lipid parameters and further explain cardiovascular protection in Gilbert's syndrome.
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Affiliation(s)
- A C Bulmer
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Australia
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