Adipose tissue at the crossroads in the development of the metabolic syndrome, inflammation and atherosclerosis

Analysis of volume and topography of adipose tissue in the trunk: Results of MRI of 11,141 participants in the German National Cohort

This research addresses the assessment of adipose tissue (AT) and spatial distribution of visceral (VAT) and subcutaneous fat (SAT) in the trunk from standardized magnetic resonance imaging at 3 T, thereby demonstrating the feasibility of deep learning (DL)-based image segmentation in a large population-based cohort in Germany (five sites). Volume and distribution of AT play an essential role in the pathogenesis of insulin resistance, a risk factor of developing metabolic/cardiovascular diseases. Cross-validated training of the DL-segmentation model led to a mean Dice similarity coefficient of >0.94, corresponding to a mean absolute volume deviation of about 22 ml. SAT is significantly increased in women compared to men, whereas VAT is increased in males. Spatial distribution shows age- and body mass index-related displacements. DL-based image segmentation provides robust and fast quantification of AT (≈15 s per dataset versus 3 to 4 hours for manual processing) and assessment of its spatial distribution from magnetic resonance images in large cohort studies.

Factors Associated with Colorectal Cancer Prevalence Among Long-Haul Truck Drivers in the United States

PURPOSE

To determine the age-adjusted association between colorectal cancer (CRC) risk factors and CRC prevalence among long-haul truck drivers (aged 21-85), after adjustment for age.

DESIGN

Pooled cross-sectional analysis using Commercial Driver Medical Exam (CDME) data. Setting. National survey data from January 1, 2005, to October 31, 2012.

PARTICIPANTS

47,786 commercial motor vehicle drivers in 48 states.

MEASURES

CRC prevalence was the primary outcome; independent variables included demographics, body mass index (BMI), and concomitant medical conditions.

ANALYSIS

Kruskal-Wallis tests to analyze continuous variables; Fischer's exact tests to analyze categorical variables; univariate and multivariable logistic regression for rare events (Firth method) to quantify the association between the independent variables of interest and CRC prevalence. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, gender, years with current employer, year of exam, and BMI in a multivariate logistic regression.

RESULTS

Many factors were statistically significant. Obesity (OR = 3.14; 95% CI = 1.03-9.61) and increasing age (OR = 1.10 per year; 95% CI = 1.07-1.13) were significantly associated with CRC prevalence. Truckers with 4 or more concomitant medical conditions were significantly more likely to have CRC (OR = 7.03; 95% CI = 1.83-27.03).

CONCLUSIONS

Our findings highlight mutable risk factors and represent an opportunity for intervention that may decrease CRC morbidity and mortality among truck drivers, a unique population in the United States estimated to live up to 16 years less than the general population.

Role of nonsurgical periodontal therapy on leptin levels and total antioxidant capacity in chronic generalised periodontitis patients - A clinical trial

Introduction

Periodontitis causes oxidative stress and reduce total antioxidant levels. The aim of this study was to determine the effect of non-surgical periodontal treatment on leptin levels and total antioxidant capacity in chronic periodontitis.

Materials and methods

A total of 35 chronic periodontitis (ChP) patients and 35 systemically and periodontal healthy subjects were enrolled in this study. Further, the ChP group received nonsurgical periodontal therapy (NSPT). Leptin and total antioxidant capacity (TAOC) was measured in serum and saliva samples at baseline, 3 months and 6 months after non-surgical periodontal therapy. Clinical parameters measured were measured at baseline, 1, 3 and 6 months interval.

Results

The mean serum leptin and TAOC levels in control group were significantly higher compared to chronic periodontitis group (p < 0.05). The control group had lower mean salivary leptin levels and higher mean salivary TAOC levels as compared to periodontitis group(p < 0.05). Clinical parameters were improved in ChP group post therapy (p < 0.05). However, the periodontal treatment showed insignificant changes in serum and salivary leptin and TAOC levels.

Conclusion

Chronic periodontitis is significantly associated with serum and salivary TAOC and leptin levels. Non surgical periodontal therapy didn't alter the local and systemic TAOC and leptin levels.

The association between dietary diversity score and general and abdominal obesity in Iranian children and adolescents

BACKGROUND

To evaluate the association between diet and disease, the consideration of a whole diet has appeared to be more effective than the examination of single-nutrient intake. This study aimed to examine the relationship between dietary diversity score (DDS) and obesity in Iranian children.

METHODS

A cross-sectional study was conducted on 456 children aged 11-18 years, who were selected by random cluster sampling. The usual food intake for each participant assessed using a validated Food frequency questionnaire (FFQ). To calculate the dietary diversity score, food items were categorized into 5 broad groups and 23 subgroups based on the US Department of Agriculture Food Guide Pyramid. Participants were categorized based on the DDS tertile cut-off points. Anthropometric measurements were conducted based on standard protocols. Overweight and obesity were defined as 85th ≤ BMI < 95th, and ≥ 95th percentiles of BMI, respectively. Additionally, abdominal obesity was considered as WC ≥ 85th percentile.

RESULTS

Mean and standard deviation (SD) of subjects' Body Mass Index (BMI) and waist circumference were 20.88 (SD 4.22) kg/m² and 74.27 (SD 10.31) cm, respectively. The probability of overweight and obesity was increased as tertiles of DDS increased (OR among tertiles: 1.00, 1.82 and 2.13 for overweight and 1.00, 2.60 and 3.45 for obesity; this was the same for abdominal obesity: 1.00, 2.22 and 3.45, P <  0.001 for all). However, no statistically significant results were found after adjustment for energy intake.

CONCLUSION

Dietary diversity positively affected obesity through higher energy intake. Despite the wide recommendation of having high dietary diversity, public health programs should emphasize to improve dietary diversity only in selective food items.

Dysregulation of insulin levels in Chagas heart disease is associated with altered adipocytokine levels

Metabolic, inflammatory, and autonomic nervous system (ANS) dysfunction are present in patients with heart failure. However, whether these changes are due to left ventricular dysfunction or heart failure etiology is unknown. We evaluated metabolism and inflammatory activity in patients with idiopathic dilated cardiomyopathy (IDC) and Chagas cardiomyopathy (CHG) and their correlation with the ANS. Forty-six patients were divided into 3 groups: IDC, CHG, and control. We evaluated adiponectin, leptin, insulin, interleukin-6, and tumor necrosis factor-alpha. ANS were analyzed by heart rate variability in time and frequency domains on a 24-hour Holter monitor. Levels of glucose, cholesterol, leptin, and adiponectin did not show differences between groups. Insulin levels were lower in CHG group (5.4 ± 3.3 μU/mL) when compared with control (8.0 ± 4.9 μU/mL) and IDC (9.9 ± 5.0 μU/mL) groups (p = 0.007). Insulin was positively associated with LFr/HFr ratio (r = 0.562; p = 0.029) and with the LFr component (r = 0.562; p = 0.029) and negatively associated with adiponectin (r = -0.603; p = 0.017) in CHG group. The addition of an adiponectin unit reduced average insulin by 0.332 μg/mL. Insulin levels were decreased in the CHG group when compared with the IDC group and were associated with ANS indexes and adiponectin levels.

Characterization of free fatty acid receptors expression in an obesity rat model with high sucrose diet

INTRODUCTION/AIMS

In recent years, it has been shown that free fatty acids receptors (FFAR) of whose function in the cell surface plays a significant role in the regulation of cell function and nutrition as well are activated by various endogenous ligands, but mainly by fatty acids. Within FFAR of our interest are GPR 41, 43 and 120. The functions of these receptors are varied and dependent on the tissue where they are. The activation and signaling of these receptors, FFAR, are involved in many physiological processes, and currently the target of many drugs in metabolic disorders like obesity, diabetes and atherosclerosis.

MATERIAL AND METHODS

Obesity was induced with hypercaloric diet (HD) in male Wistar rats for 20 weeks (n = 10). At the end, adipose tissue (abdominal and subcutaneous) was taken to perform assays for relative quantification mRNA expression by end-point RT-PCR and protein level expression by Western blot.

RESULTS

These present data have shown for the first time that total mRNA isolation and protein expression from both adipose tissues (abdominal and subcutaneous) of rat in obesity condition yield significative statistical difference among the control versus obese groups, showing that the diet high in carbohydrates modifies the total presence of mRNA and protein level expression of the receptors GPR41, 43 and 120.

CONCLUSIONS

Further comparative methods are in process to clarify whether or not the obesity changes the functional receptors in these two tissues for new pharmacological approaches.

Polycystic ovarian syndrome-associated cardiovascular complications: An overview of the association between the biochemical markers and potential strategies for their prevention and elimination

Polycystic ovarian syndrome (PCOS) is associated with multiple cardiovascular risk factors (CVRF) including endothelial dysfunction (ED) and presence of metabolic syndrome (MS). The probable reason suggested for elevated CVRF in PCOS is oxidative stress (OS), which is an integral factor in cardiometabolic complications (CMC) seen in PCOS women. The interrelated mechanisms by which CVRF instigate clinical manifestation plays a crucial role in identification of a strategy to treat different comorbidities in PCOS. The existing treatment for PCOS mostly focuses on management of individual disorders, however, therapeutic strategies or novel targets to address cardiovascular complications in PCOS deserve extensive analysis.

Clustered Cardiovascular Risk Factors Are Associated with Inflammatory Markers in Adolescents

BACKGROUND

Clusters of cardiovascular risk (CVR) factors are associated with an increased risk of developing cardiovascular diseases (CVDs). This cross-sectional study assessed the associations between classic CVR factor clusters and inflammatory markers in Brazilian adolescents.

METHODS

Measurements included anthropometric, clinical and biochemical parameters and selected inflammatory markers in 487 adolescents (236 boys/251 girls; 12.06 ± 1.41 years).

RESULTS

After stratifying the population by gender and adjusting for potential confounding variables, principal component analysis was performed and it produced 5 independent components in both genders: adiposity, glucose metabolism, blood pressure, high-density lipoprotein (HDL)/triacylglycerols (TG), and cholesterol/low-density lipoprotein. Glucose metabolism was inversely associated with interleukin-1β (IL-1β) in both genders (r = -0.026; r = -0.021); blood pressure was inversely associated with tumor necrosis factor alpha (TNF-α) in girls (r = -0.046); HDL/TG was positively associated with interleukin-6 in girls (r = 0.012), with IL-1β (r = 0.010) TNF-α (r = 0.045) in boys, and inversely associated with adiponectin in both genders (r = -0.015; r = -0.013).

CONCLUSION

The results suggest that lipid metabolism alterations, as potential early events in the development of CVDs, have a strong link to the inflammatory process, in contrast to other clusters of risk factors.

The Effects of the Combination of a Refined Carbohydrate Diet and Exposure to Hyperoxia in Mice

Obesity is a multifactorial disease with genetic, social, and environmental influences. This study aims at analyzing the effects of the combination of a refined carbohydrate diet and exposure to hyperoxia on the pulmonary oxidative and inflammatory response in mice. Twenty-four mice were divided into four groups: control group (CG), hyperoxia group (HG), refined carbohydrate diet group (RCDG), and refined carbohydrate diet + hyperoxia group (RCDHG). The experimental diet was composed of 10% sugar, 45% standard diet, and 45% sweet condensed milk. For 24 hours, the HG and RCDHG were exposed to hyperoxia and the CG and RCDG to ambient air. After the exposures were completed, the animals were euthanized, and blood, bronchoalveolar lavage fluid, and lungs were collected for analyses. The HG showed higher levels of interferon-γ in adipose tissue as compared to other groups and higher levels of interleukin-10 and tumor necrosis factor-α compared to the CG and RCDHG. SOD and CAT activities in the pulmonary parenchyma decreased in the RCDHG as compared to the CG. There was an increase of lipid peroxidation in the HG, RCDG, and RCDHG as compared to the CG. A refined carbohydrate diet combined with hyperoxia promoted inflammation and redox imbalance in adult mice.

Blueberry, blackberry, and blackcurrant differentially affect plasma lipids and pro-inflammatory markers in diet-induced obesity mice

BACKGROUND/OBJECTIVES

Evidence indicates that berry anthocyanins are anti-atherogenic, antioxidant, and anti-inflammatory. However, berries differ vastly in their anthocyanin composition and thus potentially in their biological and metabolic effects. The present study compared hypolipidemic, antioxidant, and anti-inflammatory properties of blueberry (BB), blackberry (BK), and blackcurrant (BC) in a diet-induced obesity (DIO) mouse model.

MATERIALS/METHODS

Male C57BL/6J mice were fed a high fat (HF; 35% fat, w/w) control diet or a HF diet supplemented with freeze-dried 5% BB, 6.3% BK or 5.7% BC for 12 weeks (10 mice/group) to achieve the same total anthocyanin content in each diet. Plasma lipids, antioxidant status and pro-inflammatory cytokines were measured. The expression of genes involved in antioxidant defense, inflammation, and lipid metabolism was determined in the liver, epididymal adipose tissue, proximal intestine, and skeletal muscle. Histological analysis was performed to identify crown-like structure (CLS) in epididymal fat pads to determine macrophage infiltration.

RESULTS

No differences were noted between the control and any berry-fed groups in plasma levels of liver enzymes, insulin, glucose, ferric reducing antioxidant power, superoxide dismutase, and tumor necrosis factor α. However, BK significantly lowered plasma triglyceride compared with the HF control and other berries, whereas BC significantly reduced F4/80 mRNA and the number of CLS in the epididymal fat pad, indicative of less macrophage infiltration.

CONCLUSIONS

The present study provides evidence that BB, BK and BC with varying anthocyanin composition differentially affect plasma lipids and adipose macrophage infiltration in DIO mice, but with no differences in their antioxidant capacity and anti-inflammatory potential.

Leukocytes as risk markers for cardiovascular disease in adolescents: association with birth characteristics, nutritional status and biochemical tests

Objective:

To evaluate the correlation between the number of leukocytes and cardiovascular risks associated with birth characteristics, nutritional status and biochemical tests.

Methods:

Cross-sectional study developed with 475 adolescents, born between 1992 and 2001, in the municipality of Viçosa (MG). Maternal medical records were analyzed in the hospital units, and the following was recorded: birth weight and length, head circumference, chest circumference, Apgar score, gestational age. In adolescents, body mass index, skinfold thickness, body composition, blood count, biochemical tests and clinical variables were also assessed. The statistical analyses was carried out using Statistical Package for Social Sciences (SPSS) version 20.0 and Data Analysis and Statistical Software (STATA) with Kruskal–Wallis, Mann–Whitney, chi-square or Fisher's exact tests and Linear Regression. Significance level was set at α<0.05. The study was approved by the Research Ethics Committee of UFV for studies with human subjects.

Results:

Weight and birth length, head and chest circumference were higher among boys. In adolescents, the number of leukocytes was higher in individuals with excess weight and body fat and high adiposity index, waist-to-height ratio and waist circumference. Only altered triglycerides showed differences between leukocyte medians. Regardless of the anthropometric variable of the final regression model, the stage of adolescence, number of platelets, eosinophils, monocytes and lymphocytes were associated with the increase in leukocytes.

Conclusions:

The birth variables were not associated with changes in leukocyte numbers, whereas the anthropometric variables were good indicators for a higher leukocyte count, regardless of the stage of adolescence and gender.

Study on inflammation-related genes and microRNAs, with special emphasis on the vascular repair factor HGF and miR-574-3p, in monocytes and serum of patients with T2D

BACKGROUND

Recently, we reported signs of inflammation (raised IL-8, reduced miR-146a) and signs of vascular repair (raised HGF) in the serum of Ecuadorian patients with type 2 diabetes (T2D). In contrast, we found that the circulating monocytes lacked up-regulation of classical inflammatory genes (IL-1B, IL-6, and TNF) and there was even significant down-regulation of PTGS2. Notably, genes and a microRNA involved in adhesion, cell differentiation and morphology (CD9, DHRS3, PTPN7 and miR-34c-5p) were up-regulated in the T2D monocytes, suggesting a role of the anti-inflammatory cells in adhesion, vascular repair and invasion.

AIM

To determine the gene expression of the vascular repair factor HGF in the circulating monocytes of patients with T2D and to investigate the relationship between HGF and the expression of the other previously tested monocyte genes and the contribution to the raised serum level of HGF. In addition, we tested the level of 6 microRNAs, which were previously found abnormal in the circulating monocytes, in the serum of the patients.

METHODS

A gene and microRNA expression study in monocytes and serum of 64 Ecuadorian patients with T2D (37-85 years) and 44 non-diabetic controls (32-87 years).

RESULTS

The gene expression of HGF was significantly raised in the monocytes of the patients with T2D and associated with the expression of genes involved in adhesion, cell differentiation and morphology. HGF gene expression did not correlate with the serum level of HGF. The monocyte expression of pro-inflammatory cytokine genes was also not associated with the serum levels of these cytokines. The level of miR-574-3p was significantly decreased in the serum of the patients with T2D, and correlated in expression with the decreased well-established inflammation-regulating miR-146a. The level of the microRNAs in serum did not correlate with their expression level in monocytes.

CONCLUSION

In circulating monocytes of Ecuadorian T2D patients, the microRNA and gene expression of important inflammatory/chemotactic/motility/vascular repair factors differs from the expression in serum. While monocytes show a gene expression profile compatible with an anti-inflammatory state, serum shows a molecular profile compatible with an inflammatory state. Both compartments show molecular signs of vascular repair support, i.e. up-regulated HGF levels.

[Leukocytes as risk markers for cardiovascular disease in adolescents: association with birth characteristics, nutritional status and biochemical tests]

OBJECTIVE

To evaluate the correlation between the number of leukocytes and cardiovascular risks associated with birth characteristics, nutritional status and biochemical tests.

METHODS

Cross-sectional study developed with 475 adolescents, born between 1992 and 2001, in the municipality of Viçosa (MG). Maternal medical records were analyzed in the hospital units, and the following was recorded: birth weight and length, head circumference, chest circumference, Apgar score, gestational age. In adolescents, body mass index, skinfold thickness, body composition, blood count, biochemical tests and clinical variables were also assessed. The statistical analyses was carried out using Statistical Package for Social Sciences (SPSS) version 20.0 and Data Analysis and Statistical Software (STATA) with Kruskal-Wallis, Mann-Whitney, chi-square or Fisher's exact tests and Linear Regression. Significance level was set at α<0.05. The study was approved by the Research Ethics Committee of UFV for studies with human subjects.

RESULTS

Weight and birth length, head and chest circumference were higher among boys. In adolescents, the number of leukocytes was higher in individuals with excess weight and body fat and high adiposity index, waist-to-height ratio and waist circumference. Only altered triglycerides showed differences between leukocyte medians. Regardless of the anthropometric variable of the final regression model, the stage of adolescence, number of platelets, eosinophils, monocytes and lymphocytes were associated with the increase in leukocytes.

CONCLUSIONS

The birth variables were not associated with changes in leukocyte numbers, whereas the anthropometric variables were good indicators for a higher leukocyte count, regardless of the stage of adolescence and gender.

Magnesium Status and Its Relationship with C-Reactive Protein in Obese Women

This study assessed the relationship between magnesium status and C-reactive protein concentration in obese and nonobese women. This cross-sectional study included 131 women, aged between 20 and 50 years, who were divided into two groups: obese (n=65) and control (n=66) groups. Magnesium intake was monitored using 3-day food records and NutWin software version 1.5. The plasma, erythrocyte, and urinary magnesium concentrations were determined by flame atomic absorption spectrophotometry. C-reactive protein concentration in serum was measured by immunoturbidimetric assay. The mean values of the magnesium content in the diet were lower than those recommended, though there was no significant difference between groups (p>0.05). The mean concentrations of plasma and erythrocyte magnesium were within the normal range, with no significant difference between groups (p>0.05). Urinary excretion of this mineral was less than the reference values in both groups, with no significant difference (p>0.05). The mean concentration of serum C-reactive protein was within the normal range in both groups, with no significant difference (p>0.05). There was a positive correlation between urinary magnesium and serum C-reactive protein (p=0.015). Obese patients ingest low dietary magnesium content, which seems to induce hypomagnesuria as a compensatory mechanism to keep plasma concentrations of the mineral at adequate levels. The study shows a positive correlation between urinary magnesium concentrations and serum C-reactive protein, suggesting the influence of hypomagnesuria on this inflammatory protein in obese women.

Dysregulation of Autonomic Nervous System in Chagas' Heart Disease Is Associated with Altered Adipocytokines Levels

BACKGROUND

Chagas disease (CD) induces autonomic dysfunction and inflammatory activity, which may promote metabolic abnormalities. We studied metabolism and his correlation with Autonomic Nervous System (ANS) and inflammation in CD.

METHODS AND RESULTS

Sixty subjects were divided into 4 groups: control group (CG), IF (indeterminate form) group; ECG group (ECG abnormalities and normal left ventricular systolic function), and LVD group (left ventricular sistolic dysfunction). Levels of adiponectin, leptin, insulin, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) were assayed in serum samples by ELISA. ANS was assessed by heart rate variability in frequency domain in 24-hour Holter and postural tilt test (rest and orthostatic position). High frequency (HFr) component values were used to estimate parasympathetic activity and low frequency (LFr) component, sympathetic activity. Analyzes were made of the correlations of each of the metabolic parameters (leptin and adiponectin) with the inflammatory cytokines (interleukin-6 and TNF- alpha) and with the ANS assessment measurements. No significant differences were observed in leptin and insulin levels. Adiponectin was higher in ECG and LVD groups: [CG = 4766.5 (5529.5), IF = 4003.5 (2482.5), ECG = 8376.5 (8388.5), LVD = 8798 (4188.0) ng/mL, p<0.001)]. IL-6 and TNF-alpha were higher in LVD group: [IL-6: CG = 1.85 (6.41); IF = 1.58 (1.91); ECG = 1.0 (1.57); LVD= 31.44 (72.19) pg/ml; p = 0.001. TNF-alpha: CG = 22.57 (88.2); IF = 19.31 (33.16); ECG = 12.45 (3.07); LVD = 75.15 (278.57) pg/ml; p = 0.04]. Adiponectin levels had a positive association with the HFr component (r = 0.539; p = 0.038) and an inverse association with the LFr component (r = - 0.539; p = 0.038) in ECG group. Leptin levels had a negative association with the HFr component (r= - 0.632; p = 0.011) and a positive association with the LFr component (r = 0.632; p = 0.011) in LVD group.

CONCLUSIONS

We found increased adiponectin levels in Chagas' heart disease with systolic dysfunction and in patients with ECG abnormalities and normal systolic function at rest. Adipocytokines levels (adiponectin and leptin) were associated with ANS parameters in Chagas' heart disease.

Type 2 Diabetes Monocyte MicroRNA and mRNA Expression: Dyslipidemia Associates with Increased Differentiation-Related Genes but Not Inflammatory Activation

OBJECTIVE

To study the expression pattern of microRNAs and mRNAs related to inflammation in T2D monocytes.

DESIGN

A microRNA finding study on monocytes of T2D patients and controls using array profiling was followed by a quantitative Real Time PCR (qPCR) study on monocytes of an Ecuadorian validation cohort testing the top over/under-expressed microRNAs. In addition, monocytes of the validation cohort were tested for 24 inflammation-related mRNAs and 2 microRNAs previously found deregulated in (auto)-inflammatory monocytes.

RESULTS

In the finding study, 142 significantly differentially expressed microRNAs were identified, 15 having the strongest power to discriminate T2D patients from controls (sensitivity 66%, specificity 90%). However, differences in expression of these microRNAs between patients and controls were small. On the basis of >1.4 or <0.6-fold change expression 5 microRNAs were selected for further validation. One microRNA (miR-34c-5p) was validated as significantly over-expressed in T2D monocytes. In addition, we found over expression of 3 mRNAs (CD9, DHRS3 and PTPN7) in the validation cohort. These mRNAs are important for cell morphology, adhesion, shape change, and cell differentiation. Classical inflammatory genes (e.g. TNFAIP3) were only over-expressed in monocytes of patients with normal serum lipids. Remarkably, in dyslipidemia, there was a reduction in the expression of inflammatory genes (e.g. ATF3, DUSP2 and PTGS2).

CONCLUSIONS

The expression profile of microRNAs/mRNAs in monocytes of T2D patients indicates an altered adhesion, differentiation, and shape change potential. Monocyte inflammatory activation was only found in patients with normal serum lipids. Abnormal lipid values coincided with a reduced monocyte inflammatory state.

The effects of periodontal therapy on serum and salivary leptin levels in chronic periodontitis patients with normal body mass index

SUMMARY

Leptin concentrations are altered in favour of pro health after periodontal therapy.

BACKGROUND

Leptin, a non-glycosylated peptide hormone, not only maintains fat stores, but is also an integral part of host defense repertoire. Leptin levels have been found to be altered in an array of inflammatory diseases including chronic periodontitis (CP), but the role of non-surgical periodontal therapy (NSPT) in altering the leptin concentrations in saliva and serum of CP patients is yet to be ascertained. The aim of the present study is to quantify leptin levels in CP patients having normal body mass index (BMI) pre-therapy as compared to periodontally healthy controls and to address whether successful NSPT alters leptin concentration in serum and saliva.

MATERIALS AND METHODS

Twenty-two saliva (modified draining method) and serum samples (by venipuncture) were collected from CP patients with normal BMI (n = 22), before and at 4 and 12 weeks after completion of NSPT, and periodontally healthy, age- and gender-matched controls (n = 22). Leptin levels were estimated using enzyme linked immunosorbent assay kits.

RESULTS

At baseline, CP patients had significantly different periodontal clinical parameters and the leptin concentrations in saliva of CP patients were found to be significantly lower than periodontally healthy volunteers (4710.10 ± 1133.21 vs 8721.10 ± 1019.58 pg/ml) (p < 0.05), whereas in serum the leptin concentrations were significantly higher than healthy controls (10749 ± 2062.24 vs 8085.00 ± 2859.68 pg/ml). Significant improvement in periodontal parameters, serum and salivary leptin levels were observed in CP patients at 4 and 12 weeks post-therapy (p < 0.01).

CONCLUSION

Altered concentrations of leptin in serum and saliva are observed in CP patients which can be restored in favor of health after periodontal therapy.

Prevalence of Metabolic Syndrome and its components in a Brazilian sample of pemphigus patients

BACKGROUND

Pemphigus foliaceus and pemphigus vulgaris are endemic in the northeastern region of São Paulo State, Brazil. They are treated mainly with systemic corticosteroids, which may provoke osteoporosis; atherosclerosis, higher blood pressure, insulin resistance, glucose intolerance, hyperlipidemia and abdominal obesity. These side effects of corticoids also constitute criteria for the diagnosis of metabolic syndrome.

OBJECTIVE

The prevalence of metabolic syndrome and each component of metabolic syndrome in Pemphigus foliaceus and pemphigus vulgaris groups was compared with Brazilian casuistic samples.

METHODS

Data of 147 patients (pemphigus foliaceus 48.9% and pemphigus vulgaris 51.1%) were compiled from medical records regarding metabolic syndrome and its components, and included in the analysis.

RESULTS

There was no significant difference regarding the prevalence of metabolic syndrome in pemphigus groups compared with the Brazilian casuistic samples. The analysis of each component of metabolic syndrome showed a higher prevalence of: higher blood pressure in male subjects with pemphigus vulgaris, and in pemphigus foliaceus in both genders; diabetes mellitus in both genders for pemphigus vulgaris and pemphigus foliaceus; obesity in females for pemphigus vulgaris and pemphigus foliaceus, and hypertriglyceridemia in both genders for pemphigus vulgaris and pemphigus foliaceus groups that were statistically significant compared to the Brazilian reports. Furthermore, the study noted a higher incidence of cardiovascular events in both genders in pemphigus foliaceus and pemphigus vulgaris groups than in Brazilian casuistic samples.

CONCLUSION

The components of metabolic syndrome are more numerous in pemphigus when compared with Brazilian casuistic samples. Future studies are necessary to assure that metabolic syndrome may be associated with pemphigus per se, including a greater casuistic sample of patients who have not taken corticoids.

Salivary and serum leptin concentrations in patients with chronic periodontitis

BACKGROUND

The discovery of leptin has led to the elucidation of a robust physiologic system that not only maintains fat stores but is also an integral part of the host defense mechanism. However, leptin concentrations in the saliva of patients with chronic periodontitis (CP) has not been explored despite the potential role of salivary biomarkers in determining the presence, risk, and progression of periodontal disease.

METHODS

Eighty-four participants (44 with generalized severe CP and 40 without periodontitis) were enrolled. For each patient, the values of periodontal parameters were recorded, such as plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL), and percentage of sites with bleeding on probing (BOP) and clinical AL ≥5 mm. Saliva and serum samples were collected to estimate the leptin concentrations using enzyme-linked immunosorbent assay kits. Statistical analysis was performed using software.

RESULTS

Participants with CP demonstrated significantly higher BOP, PI, GI, and percentage of sites with clinical AL >5 mm (P <0.05). Leptin was detectable in all the clinical samples. Salivary leptin concentrations in patients with CP were significantly lower than in healthy volunteers (6,200.61 ± 2,322.11 versus 8,799.60 ± 901.70 pg/mL), whereas serum leptin concentrations were significantly higher in patients with CP than in healthy volunteers (11,600.00 ± 1,705.01 versus 7,616.62 ± 1,169.83 pg/mL). In addition, the results reflected a significant negative correlation of salivary leptin and a positive correlation of serum leptin with PD (P <0.05).

CONCLUSION

The results suggest that leptin concentrations in saliva and serum are significantly altered in CP and relate closely to current disease activity; however, further studies are needed to confirm the findings.

Adipocyte exosomes induce transforming growth factor beta pathway dysregulation in hepatocytes: a novel paradigm for obesity-related liver disease

BACKGROUND

The pathogenesis of nonalcoholic fatty liver disease (NAFLD) has been attributed to increased systemic inflammation and insulin resistance mediated by visceral adipose tissue (VAT), although the exact mechanisms are undefined. Exosomes are membrane-derived vesicles containing messenger RNA, microRNA, and proteins, which have been implicated in cancer, neurodegenerative, and autoimmune diseases, which we postulated may be involved in obesity-related diseases. We isolated exosomes from VAT, characterized their content, and identified their potential targets. Targets included the transforming growth factor beta (TGF-β) pathway, which has been linked to NAFLD. We hypothesized that adipocyte exosomes would integrate into HepG2 and hepatic stellate cell lines and cause dysregulation of the TGF-β pathway.

METHODS

Exosomes from VAT from obese and lean patients were isolated and fluorescently labeled, then applied to cultured hepatic cell lines. After incubation, culture slides were imaged to detect exosome uptake. In separate experiments, exosomes were applied to cultured cells and incubated 48-h. Gene expression of TGF-β pathway mediators was analyzed by polymerase chain reaction, and compared with cells, which were not exposed to exosomes.

RESULTS

Fluorescent-labeled exosomes integrated into both cell types and deposited in a perinuclear distribution. Exosome exposure caused increased tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and integrin ανβ-5 expression and decreased matrix metalloproteinase-7 and plasminogen activator inhibitor-1 expression in to HepG2 cells and increased expression of TIMP-1, TIMP-4, Smad-3, integrins ανβ-5 and ανβ-8, and matrix metalloproteinase-9 in hepatic stellate cells.

CONCLUSIONS

Exosomes from VAT integrate into liver cells and induce dysregulation of TGF-β pathway members in vitro and offers an intriguing possibility for the pathogenesis of NAFLD.

MyD88-dependent interplay between myeloid and endothelial cells in the initiation and progression of obesity-associated inflammatory diseases

MyD88-dependent GM-CSF production by endothelial cells plays a role in the initiation of obesity-associated inflammation by promoting adipose macrophage recruitment and M1-like polarization.

Low-grade systemic inflammation is often associated with metabolic syndrome, which plays a critical role in the development of the obesity-associated inflammatory diseases, including insulin resistance and atherosclerosis. Here, we investigate how Toll-like receptor–MyD88 signaling in myeloid and endothelial cells coordinately participates in the initiation and progression of high fat diet–induced systemic inflammation and metabolic inflammatory diseases. MyD88 deficiency in myeloid cells inhibits macrophage recruitment to adipose tissue and their switch to an M1-like phenotype. This is accompanied by substantially reduced diet-induced systemic inflammation, insulin resistance, and atherosclerosis. MyD88 deficiency in endothelial cells results in a moderate reduction in diet-induced adipose macrophage infiltration and M1 polarization, selective insulin sensitivity in adipose tissue, and amelioration of spontaneous atherosclerosis. Both in vivo and ex vivo studies suggest that MyD88-dependent GM-CSF production from the endothelial cells might play a critical role in the initiation of obesity-associated inflammation and development of atherosclerosis by priming the monocytes in the adipose and arterial tissues to differentiate into M1-like inflammatory macrophages. Collectively, these results implicate a critical MyD88-dependent interplay between myeloid and endothelial cells in the initiation and progression of obesity-associated inflammatory diseases.

Gastric bypass and sleeve gastrectomy: the same impact on IL-6 and TNF-α. Prospective clinical trial

BACKGROUND

Due to the association between the quantity of adipose tissue and concentrations of interleukin-6 (IL-6) and tumor necrosis factor (TNF-α), this work aimed to assess the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures on serum IL-6 and TNF-α concentrations.

METHODS

This study evaluated serum IL-6 and TNF-α levels, as well as routine anthropometric and biochemical values, before and 1 year post-bariatric surgery. Fifty percent of patients (n = 24) underwent RYGB, and 50 % (n = 24) underwent SG. Prior to bariatric surgery, IL-6 and TNF-α mRNA expression levels in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were investigated in obese women.

RESULTS

There was a significant reduction (p < 0.05) in all anthropometric and routine biochemical measurements in patients in the RYGB and SG groups 1 year post-surgery. The serum concentrations of IL-6 and TNF-α were reduced following surgery in both groups (p < 0.05). No differences in the relative expression levels of IL-6 and TNF-α were found between SAT and VAT prior to bariatric surgery.

CONCLUSIONS

RYGB and SG procedures demonstrated a similar impact on adipokine levels in women 1 year post-surgery. Both techniques may improve the course of chronic diseases and the state of inflammation associated with obesity.

Cortisol: the villain in Metabolic Syndrome?

Objective This article reviews the state of the art regarding the association between glucocorticoid actions and both obesity and insulin resistance, two main features of the metabolic syndrome. Methods A methodological assessment of the literature on PubMed and SciELO databases was conducted by using the following terms: stress, metabolic syndrome, glucocorticoids, obesity, insulin resistance, hypothalamic-pituitary-adrenal-axis and 11β-hydroxysteroid dehydrogenase. Results Chronic stress, mainly through hypothalamic-pituitary-adrenal axis dysregulation, promotes the accumulation of visceral fat. Reciprocally, obesity promotes a systemic low-grade inflammation state, mediated by increased adipokine secretion, which can chronically stimulate and disturb stress system. This vicious cycle, probably initiated by visceral adipose tissue dysfunction, might be the trigger for the development of metabolic syndrome. Conclusion Given the strong evidences linking glucocorticoid release, obesity and type 2 diabetes, better understanding of the mechanisms underlying this connection might be useful for prevention and treatment of the metabolic syndrome.

Leptin: molecular mechanisms, systemic pro-inflammatory effects, and clinical implications

Leptin, the adipokine produced mainly by the white adipose tissue, plays important roles not only in the regulation of food intake, but also in controlling immunity and inflammation. It has been widely demonstrated that the absence of leptin leads to immune defects in animal and human models, ultimately increasing mortality. Leptin also regulates inflammation by means of actions on its receptor, that is widely spread across different immune cell populations. The molecular mechanisms by which leptin determines its biological actions have also been recently elucidated, and three intracellular pathways have been implicated in leptin actions: JAK-STAT, PI3K, and ERK 1/2. These pathways are closely regulated by intracellular proteins that decrease leptin biological activity. In this review, we discuss the molecular mechanisms by which leptin regulates immunity and inflammation, and associate those mechanisms with chronic inflammatory disorders.

Insulin resistance: an adaptive mechanism becomes maladaptive in the current environment - an evolutionary perspective

Human survival has relied upon the ability to withstand starvation through energy storage, the capacity to fight off infection by a proinflammatory immune response, and the ability to cope with physical stressors by an adaptive stress response. Energy storage, mainly as glycogen in liver and triglycerides in adipose tissue, is regulated by the anabolic actions of insulin. On the other hand, mobilization of stored energy during infection, trauma or stress is served by the temporary inhibition of insulin action (insulin resistance) in target tissues by proinflammatory cytokines and stress hormones. In the current environment, high energy intake, low physical activity, and chronic stress favor the storage of surplus fat in adipose tissue depots that far exceeds their storage capacity and liporegulation. Lipid overload in central fat depots initiates an inflammatory response and adipocyte dysfunction with resultant low-grade systemic inflammation and lipid overflow to peripheral tissues. In turn, proinflammatory cytokines and non-oxidized lipid metabolites, accumulated in liver and muscle cells, activate the mechanism of insulin resistance as would occur in the case of infection or stress. The same factors together with the ensuing insulin resistance further contribute to pancreatic β-cell dysfunction and ultimately to type 2 diabetes and cardiovascular disease. The present review supports the hypothesis that insulin resistance evolved as a physiological adaptive mechanism in human survival and that the same mechanism is inappropriately activated on a chronic basis in the current environment, leading to the manifestations of the metabolic syndrome.

Leptin in heart failure

INTRODUCTION

In the study of heart failure (HF), biomarkers have served as an important tool for diagnostic, therapeutic and prognostic assessment. Their main categories in the area of HF are markers of ventricular dysfunction, inflammation, metabolism, neurohormones, oxidative stress, myocardial injury and extracellular matrix remodeling.

AREAS COVERED

Leptin contributes to the modulation of metabolism, respiratory control and inflammation, which are factors associated with cardiovascular disease. Serum levels of leptin in patients with HF have shown conflicting results in previous studies. Most studies have suggested that serum leptin levels may be increased in patients without cachexia. On the other hand, leptin levels are decreased in patients with advanced HF and cardiac cachexia or specific HF etiologies such as Chagas' disease. Other studies have showed that leptin levels were related to exercise intolerance. The only exception of the direct correlation of serum leptin levels with severity of CHF is present in CHF with cardiac cachexia, because patients with cardiac cachexia have plasma leptin concentrations lower than those without cardiac cachexia.

EXPERT OPINION

These findings can make leptin an important diagnostic and prognostic marker for HF and be included in routine investigation of patients with HF.

Associations among organochlorine pesticides, Methanobacteriales, and obesity in Korean women

BACKGROUND

Although Methanobacteriales in the gut has recently been linked to obesity, no study has examined the hypothesis that waist circumference, a marker of visceral obesity, are positively associated with Methanobacteriales in the general population. Since Methanobacteriales increase in a petroleum-contaminated environment to biodegrade petroleum as one way of autopurification, we also hypothesized that high body burden of highly lipophilic petroleum-based chemicals like organochlorine pesticides (OCPs) is associated with higher levels of Methanobacteriales in the gut.

METHODOLOGY/PRINCIPAL FINDINGS

Among 83 Korean women who visited a community health service center for a routine health checkup, quantitative real-time PCR (qPCR) based on 16S rDNA was used to quantify Methanobacteriales in feces. Nine OCPs were measured in both serum and feces of 16 subjects. Methanobacteriales were detected in 32.5% (27/83 women). Both BMI and waist circumference among women with Methanobacteriales were significantly higher than in women without Methanobacteriales (P = 0.04 and P = 0.01, respectively). Also, Methanobacteriales levels in feces were positively associated with BMI and waist circumference (r = +0.23 and P = 0.03 for both). Furthermore, there were significant correlations between feces Methanobacteriales levels and serum concentrations of most OCPs, including with cis-nonachlor (r = +0.53, P<0.05), oxychlordane (r = +0.46, P<0.1), and trans-nonachlor (r = +0.43, P<0.1). Despite high correlations of serum and feces concentrations of most OCPs, feces OCP concentrations were not clearly associated with feces Methanobacteriales levels.

CONCLUSION/SIGNIFICANCE

In this cross-sectional study, the levels of Methanobacteriales in the human gut were associated with higher body weight and waist circumference. In addition, serum OCP concentrations were positively correlated with levels of Methanobacteriales. There may be a meaningful link among body burden of OCP, Methanobacteriales in the gut, and obesity in the general population.

The interleukin-6 gene promoter polymorphism -174 and atherosclerotic events in overweight transplanted patients

Chronic inflammation plays a pivotal role in atherosclerosis. We hypothesized that combining overweight and a greater genetic capacity to produce IL-6 predicted by IL-6 gene promoter polymorphism at position -174 (G→C) may allow to identify individuals exhibiting higher IL-6 and C-reactive protein (CRP) concentrations with a higher risk of atherosclerotic events (AE). The occurrence of AE was analyzed with respect to body mass index, IL-6 gene promoter polymorphism at position -174 (G→C), and other relevant risk factors, retrospectively, in 217 renal transplant recipients and, prospectively, in 132. Circulating IL-6 concentrations were closely related to BMI (r = 0.55, P = .0005). In overweight patients, serum IL-6 concentration was found to be significantly lower in C carriers than in GG patients (4.2 [1.0–5.1] versus 7.3 pg/mL [4.4–100]; P = .025). The incidence of AE was higher in overweight GG patients (29.5% versus 10.1%; P = .0003). In multivariate analysis, overweight-GG had an increased risk to develop AE (HR 2.96 [95% CI 1.09–8.04], P = .034 in the retrospective cohort, and HR 2.99 [95% CI 0.92–9.33], P = .069 in the prospective cohort). All these data are consistent with a role for both genetic and environmental determinants of inflammation (white adipose tissue mass) in the development of AE in renal transplanted patients.

Single-cell analysis of insulin-regulated fatty acid uptake in adipocytes

Increased body fat correlates with the enlargement of average fat cell size and reduced adipose tissue insulin sensitivity. It is currently unclear whether adipocytes, as they accumulate more triglycerides and grow in size, gradually become less insulin sensitive or whether obesity-related factors independently cause both the enlargement of adipocyte size and reduced adipose tissue insulin sensitivity. In the first instance, large and small adipocytes in the same tissue would exhibit differences in insulin sensitivity, whereas, in the second instance, adipocyte size per se would not necessarily correlate with insulin response. To analyze the effect of adipocyte size on insulin sensitivity, we employed a new single-cell imaging assay that resolves fatty acid uptake and insulin response in single adipocytes in subcutaneous adipose tissue explants. Here, we report that subcutaneous adipocytes are heterogeneous in size and intrinsic insulin sensitivity. Whereas smaller adipocytes respond to insulin by increasing lipid uptake, adipocytes with cell diameters larger than 80-100 microm are insulin resistant. We propose that, when cell size approaches a critical boundary, adipocytes lose insulin-dependent fatty acid transport. This negative feedback mechanism may protect adipocytes from lipid overload and restrict further expansion of adipose tissue, which leads to obesity and metabolic complications.

Frequency and risk factors associated with non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

OBJECTIVE

To evaluate the frequency of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (DM2) and to describe its risk factors.

SUBJECTS AND METHODS

Blood samples of 78 patients were collected for assessment of glycemic and lipid profile, liver enzymes, TNF-alpha and HOMA-IR. The diagnosis of NAFLD was established by ultrasound.

RESULTS

NAFLD was observed in 42% of patients who had greater BMI (p < 0.001), and frequency of hypertension (p < 0.001). Metabolic syndrome was more frequent in those with NAFLD (p = 0.019). The levels of aspartate, alanine aminotransferase, gamma-glutamyl transpeptidase, uric acid, TNF-alpha, insulin and HOMA-IR were significantly higher in patients with NAFLD than those without NAFLD.

CONCLUSION

Almost half of patients with DM2 were found to have NAFLD, and they have more elevated BMI, as well as higher levels of aminotransferases, gamma-GT, uric acid, TNF-alpha, insulin and HOMA-IR than subjects without NAFLD.

Contaminantes ambientais e os interferentes endócrinos

A toxicidade de diversos poluentes ambientais em seres humanos e demais espécies tem sido habitualmente investigada quanto aos seus efeitos teratogênicos e cancerígenos. Nas últimas décadas, muitos contaminantes têm demonstrado efeitos adversos sobre o sistema endócrino. Atualmente, cerca de onze milhões de substâncias químicas são conhecidas em todo mundo, sendo três mil delas produzidas em larga escala. Numerosos compostos químicos de uso doméstico, industrial e agrícola possuem comprovada atividade hormonal. Entre os produtos químicos com atividade estrogênica, destacam-se hormônios presentes em cosméticos, anabolizantes utilizados em rações animais, fitoestrógenos e poluentes orgânicos persistentes (POPs). Esses agentes que estão presentes nos efluentes industriais, residenciais e das estações de tratamento de água e esgoto representam uma importante fonte de contaminação ambiental. O Programa Internacional de Segurança Química (International Programme on Chemical Safety - IPCS) define como interferente endócrino substâncias ou misturas presentes no ambiente capazes de interferir nas funções do sistema endócrino, causando efeitos adversos em um organismo intacto ou na sua prole. No presente artigo, os autores apresentam uma revisão da literatura atual sobre o papel desses elementos nas doenças endócrinas e metabólicas, os prováveis mecanismos de ação envolvidos, discutindo-se perspectivas futuras em termos de investigação e estratégias para prevenção e redução dos seus possíveis danos.

Transcriptional regulation of cytokines and oxidative stress by gallic acid in human THP-1 monocytes

Increased inflammation/prooxidation has been linked not only to Type 2 diabetes but also in prediabetes state. In this study we investigated hyperglycemia-mediated proinflammatory/prooxidant effects in THP-1 monocytes and tested whether gallic acid could attenuate changes in gene expression induced by high-glucose. Cells were treated either with 5.5mM glucose or 25mM glucose in the absence and presence of gallic acid. While oxidative DNA damage was assessed by COMET assay, GSH and GSSG levels were estimated fluorimetrically. Gene expression patterns were determined by RT-PCR. Cells treated with high-glucose showed increased DNA damage and glutathione depletion and this was attenuated in the presence of gallic acid. High-glucose treated cells exhibited increased mRNA expression of TNF-alpha, IL-6, NADPH oxidase and TXNIP and gallic acid attenuated these proinflammatory and prooxidant effects. Cells treated with high-glucose revealed a deficiency in mounting SOCS-3 expression and gallic acid upregulates this feedback regulatory signal. Gallic acid attenuates DNA damage, maintains glutathione turnover, and suppresses hyperglycemia-induced activation of proinflammatory and prooxidant gene expression. Gallic acid beneficially modulate transcription of functionally diverse groups of genes and its regulation of SOCS-3 and TXNIP signals is a newly identified mechanism that has therapeutic implications.