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Fu ZH, Zhao ZY, Liang YB, Cheng DY, Luo JM, Jiang HX, Qin SY. Impact of metabolic syndrome components on clinical outcomes in hypertriglyceridemia-induced acute pancreatitis. World J Gastroenterol 2024; 30:3996-4010. [PMID: 39351060 PMCID: PMC11438666 DOI: 10.3748/wjg.v30.i35.3996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/17/2024] [Accepted: 08/30/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND The incidence of hypertriglyceridemia (HTG)-induced acute pancreatitis (AP) is steadily increasing in China, becoming the second leading cause of AP. Clinical complications and outcomes associated with HTG-AP are generally more severe than those seen in AP caused by other etiologies. HTG-AP is closely linked to metabolic dysfunction and frequently coexists with metabolic syndrome or its components. However, the impact of metabolic syndrome components on HTG-AP clinical outcomes remains unclear. AIM To investigate the impact of metabolic syndrome component burden on clinical outcomes in HTG-AP. METHODS In this retrospective study of 255 patients diagnosed with HTG-AP at the First Affiliated Hospital of Guangxi Medical University, we collected data on patient demographics, clinical scores, complications, and clinical outcomes. Subsequently, we analyzed the influence of the presence and number of individual metabolic syndrome components, including obesity, hyperglycemia, hypertension, and low high-density lipoprotein cholesterol (HDL-C), on the aforementioned parameters in HTG-AP patients. RESULTS This study found that metabolic syndrome components were associated with an increased risk of various complications in HTG-AP, with low HDL-C being the most significant risk factor for clinical outcomes. The risk of complications increased with the number of metabolic syndrome components. Adjusted for age and sex, patients with high-component metabolic syndrome had significantly higher risks of renal failure [odds ratio (OR) = 3.02, 95%CI: 1.12-8.11)], SAP (OR = 5.05, 95%CI: 2.04-12.49), and intensive care unit admission (OR = 6.41, 95%CI: 2.42-16.97) compared to those without metabolic syndrome. CONCLUSION The coexistence of multiple metabolic syndrome components can synergistically worsen the clinical course of HTG-AP, making it crucial to monitor these components for effective disease management.
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Affiliation(s)
- Zhen-Hua Fu
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zi-Yue Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yao-Bing Liang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Dong-Yu Cheng
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jian-Ming Luo
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hai-Xing Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shan-Yu Qin
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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He L, Luo H, Li Y, Zhang Y, Peng L, Xu Y, Lu J, Li J, Liu H. The causal relationship between the gut microbiota and acute pancreatitis: A 2-sample Mendelian randomization study. Medicine (Baltimore) 2024; 103:e38331. [PMID: 39259083 PMCID: PMC11142829 DOI: 10.1097/md.0000000000038331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/05/2024] [Accepted: 05/02/2024] [Indexed: 09/12/2024] Open
Abstract
Several observational studies have reported a correlation between the gut microbiota (GM) and the risk of acute pancreatitis (AP). However, the causal relationship between them remains uncertain. We conducted a 2-sample Mendelian randomization (MR) study using pooled data from genome-wide association studies of 211 taxa (131 genera, 35 families, 20 orders, 16 classes, and 9 phyla) and AP patients. We evaluated the causal relationship between the GM and AP using methods such as inverse-variance weighting, MR-Egger, weighted medians, simple mode, and weighted mode. Cochran Q test, MR-Egger regression intercept analysis, and MR-PRESSO were used to examine the heterogeneity, multipotency, and outlier values of the variables, respectively. The reverse causal relationship between AP and the GM was assessed with reverse MR. In total, 5 gut microbial taxa were significantly associated with AP. The inverse-variance weighting results indicated that Acidaminococcaceae (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.66-1.00, P = .045) and Ruminococcaceae UCG004 (OR: 0.85, 95% CI: 0.72-0.99, P = .040) were protective factors against the occurrence of AP. Coprococcus 3 (OR: 1.32, 95% CI: 1.03-1.70, P = .030), Eisenbergiella (OR: 1.13, 95% CI: 1.00-1.28, P = .043), and the Eubacterium fissicatena group (OR: 1.18, 95% CI: 1.05-1.33, P = .006) were risk factors for the development of AP. A comprehensive sensitivity analysis proved our results to be reliable. Reverse MR analysis did not indicate any causal relationship between AP and the GM. This study revealed a complex causal relationship between 5 GM taxa and AP, providing new insights into the diagnostic and therapeutic potential of the GM in AP patients.
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Affiliation(s)
- Lin He
- Department of Pancreatitis Treatment Center, People’s Hospital of Deyang City, Deyang, China
| | - Haojun Luo
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Li
- Department of Pancreatitis Treatment Center, People’s Hospital of Deyang City, Deyang, China
| | - Yan Zhang
- Department of Pancreatitis Treatment Center, People’s Hospital of Deyang City, Deyang, China
| | - Li Peng
- Department of Pancreatitis Treatment Center, People’s Hospital of Deyang City, Deyang, China
| | - Yan Xu
- Department of Pancreatitis Treatment Center, People’s Hospital of Deyang City, Deyang, China
| | - Jing Lu
- Department of Pancreatitis Treatment Center, People’s Hospital of Deyang City, Deyang, China
| | - Jinzhi Li
- Department of Pancreatitis Treatment Center, People’s Hospital of Deyang City, Deyang, China
| | - Hang Liu
- Department of Pancreatitis Treatment Center, People’s Hospital of Deyang City, Deyang, China
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Zafrir B, Khoury R, Saliba W. Remnant cholesterol and risk of myocardial infarction in patients with coronary artery disease undergoing revascularization. J Clin Lipidol 2023; 17:332-341. [PMID: 37005155 DOI: 10.1016/j.jacl.2023.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Despite substantial reduction in low-density lipoprotein cholesterol (LDL-C), patients develop recurrent cardiovascular events. Remnant cholesterol (RC), the cholesterol content of triglyceride-rich lipoproteins, is a potential contributor to this residual risk. OBJECTIVES To investigate the association between RC and risk for myocardial infarction (MI) in patients with coronary artery disease, and examine whether the predictive value of RC is retained beyond non-high-density lipoprotein cholesterol (non-HDL-C). METHODS Data on 9451 patients undergoing coronary revascularization in a single center. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus LDL-C (estimated using Martin-Hopkins equation). Cox-regression models were used to estimate the association between RC and risk for MI. Discordance analyses were performed to examine the correlation between RC and non-HDL-C (or LDL-C) in relation to MI risk. RESULTS Mean age was 65±11 years; 67% presented with acute coronary syndrome. During median follow-up of 9.6 years, 1690 patients developed MI. After multivariable adjustment including lipid-lowering therapies and non-HDL-C, RC was associated with higher MI risk: hazard ratio (95% confidence interval): 1.36 (1.20-1.56) and 1.58 (1.35-1.85) in those with RC levels ≥75th (32.6 mg/dL) and ≥90th (41.8 mg/dL) percentile, compared to RC <50th percentile (25.5 mg/dL). When RC and non-HDL-C (or LDL-C) levels were discordant, the level of RC better reflected the risk for MI. CONCLUSIONS Elevated RC is a risk factor for MI independent of lipid-lowering therapies and non-HDL-C, providing further support that RC may serve as a residual cardiovascular risk marker and potential treatment target in patients with coronary artery disease.
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Affiliation(s)
- Barak Zafrir
- Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa, Israel; Faculty of Medicine, Technion, Israel Institute of Medicine, Israel.
| | - Razi Khoury
- Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa, Israel
| | - Walid Saliba
- Faculty of Medicine, Technion, Israel Institute of Medicine, Israel; Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
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Zaidi SMH, Iskander PA, Ahmed K, Jaber F, Paz M, Khan A, Malik F, Aloysius MM. A Rare Case of Paxlovid-Induced Pancreatitis. Cureus 2023; 15:e36528. [PMID: 37090326 PMCID: PMC10120881 DOI: 10.7759/cureus.36528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Acute pancreatitis can result secondary to an inflammatory cascade due to an insult to the pancreatic parenchyma, whether it be from infections, medications, etc. We present a case of a 37-year-old male with acute pancreatitis after being started on Paxlovid, a combination drug containing Nirmatrelvir and Ritonavir, for COVID-19 treatment. Multiple reports in the literature have documented such an association between acute pancreatitis and the protease inhibitor Ritonavir. We suspect that similar results may have taken place that link the initiation of this medication with pancreatic inflammation.
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Affiliation(s)
| | - Peter A Iskander
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Khalid Ahmed
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Fouad Jaber
- Internal Medicine, University of Missouri Kansas City, Kansas City, USA
| | - Merlin Paz
- Internal Medicine, Geisinger Hospitals, Scranton, USA
| | - Ali Khan
- Internal Medicine, United Health Services, Binghamton, USA
| | - Fahad Malik
- Internal Medicine, United Health Services, Binghamton, USA
| | - Mark M Aloysius
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
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Corli G, Tirri M, Arfè R, Marchetti B, Bernardi T, Borsari M, Odoardi S, Mestria S, Strano-Rossi S, Neri M, Gaudio RM, Bilel S, Marti M. Pharmaco-Toxicological Effects of Atypical Synthetic Cathinone Mephtetramine (MTTA) in Mice: Possible Reasons for Its Brief Appearance over NPSs Scene. Brain Sci 2023; 13:brainsci13020161. [PMID: 36831704 PMCID: PMC9954072 DOI: 10.3390/brainsci13020161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Over the last year, NPSs have been steadily on the rise in the illicit drug market. Among these, synthetic cathinones seem to become increasingly popular among young adults, mainly because of their ability to replicate the effects of traditional psychostimulant drugs, such as cocaine, MDMA and amphetamines. However, scarce data are available about the in vivo pharmaco-toxicology of these new substances. To this end, this study focused on evaluation of effects induced by repeated administration of mephtetramine (MTTA 0.1-30 mg/kg i.p.) in mice. This atypical cathinone highlighted a sensorial (inhibition of visual and acoustic reflexes) and transient physiological parameter (decrease in breath rate and temperature) change in mice. Regarding motor activity, both a dose-dependent increase (accelerod test) and biphasic effect (drag and mobility time test) have been shown. In addition, blood and urine samples have been analysed to enrich the experimental featuring of the present study with reference to evaluation of potential toxicity related to consumption of MTTA. The latter analysis has particularly revealed important changes in blood cells count and blood and urine physicochemical profile after repeated treatment with this atypical cathinone. Moreover, MTTA induced histological changes in heart, kidney and liver samples, emphasizing its potential toxicity.
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Affiliation(s)
- Giorgia Corli
- Department of Translational Medicine, Section of Legal Medicine, LTTA Center and University Center of Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Micaela Tirri
- Department of Translational Medicine, Section of Legal Medicine, LTTA Center and University Center of Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Raffaella Arfè
- Department of Translational Medicine, Section of Legal Medicine, LTTA Center and University Center of Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Beatrice Marchetti
- Department of Translational Medicine, Section of Legal Medicine, LTTA Center and University Center of Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Tatiana Bernardi
- Department of Environmental Sciences and Prevention, University of Ferrara, 44121 Ferrara, Italy
| | - Martina Borsari
- Department of Translational Medicine, Section of Legal Medicine, LTTA Center and University Center of Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Sara Odoardi
- Forensic Toxicology Laboratory, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, 00169 Rome, Italy
| | - Serena Mestria
- Forensic Toxicology Laboratory, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, 00169 Rome, Italy
| | - Sabina Strano-Rossi
- Forensic Toxicology Laboratory, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, 00169 Rome, Italy
| | - Margherita Neri
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Rosa Maria Gaudio
- Department of Translational Medicine, Section of Legal Medicine, LTTA Center and University Center of Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Sabrine Bilel
- Department of Translational Medicine, Section of Legal Medicine, LTTA Center and University Center of Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Matteo Marti
- Department of Translational Medicine, Section of Legal Medicine, LTTA Center and University Center of Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
- Collaborative Center for the Italian National Early Warning System, Department of Anti-Drug Policies, Presidency of the Council of Ministers, 00186 Rome, Italy
- Correspondence:
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Von Ruden S, Slusarenko N, Webster D. A Case Report of Hypertriglyceridemia-Associated Acute Pancreatitis Following Use of Brazil Nut Weight-Loss Supplement. J Pharm Pract 2022; 35:1049-1053. [DOI: 10.1177/08971900211015040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose: Brazil nuts ( Bertholletia excelsa) are consumed world-wide and have become a new trend in weight loss supplementation. We present a unique case of severe hypertriglyceridemia-associated acute pancreatitis following daily usage of a Brazil nut supplement product. Summary: A Hispanic female presented with severe hypertriglyceridemia and acute pancreatitis several months after starting a Brazil nut weight loss supplement in the setting of poorly controlled Type 2 Diabetes Mellitus. Her initial triglyceride level was undetectably high >10,000 mg/dL but improved rapidly following euglycemic insulin infusion and supplement cessation. The patient was managed with supportive care, started on oral fibrate therapy after abdominal symptoms improved, and was discharged to home in stable condition. Conclusion: It is essential for pharmacists to maintain a high index of suspicion for patients taking complementary and alternative medications and supplements who present with acutely altered laboratory parameters or onset of acute disease. In this instance, a patient was found to have profound hypertriglyceridemia with onset of acute pancreatitis following usage of a Brazil nut weight loss supplement.
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Oral EA, Garg A, Tami J, Huang EA, O'Dea LSL, Schmidt H, Tiulpakov A, Mertens A, Alexander VJ, Watts L, Hurh E, Witztum JL, Geary RS, Tsimikas S. Assessment of efficacy and safety of volanesorsen for treatment of metabolic complications in patients with familial partial lipodystrophy: Results of the BROADEN study: Volanesorsen in FPLD; The BROADEN Study. J Clin Lipidol 2022; 16:833-849. [PMID: 36402670 DOI: 10.1016/j.jacl.2022.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Volanesorsen, an antisense oligonucleotide, is designed to inhibit hepatic apolipoprotein C-III synthesis and reduce plasma apolipoprotein C-III and triglyceride concentrations. OBJECTIVE The present study assessed efficacy and safety of volanesorsen in patients with familial partial lipodystrophy (FPLD) and concomitant hypertriglyceridemia and diabetes. METHODS BROADEN was a randomized, placebo-controlled, phase 2/3, 52-week study with open-label extension and post-treatment follow-up periods. Patients received weekly subcutaneous volanesorsen 300 mg or placebo. The primary endpoint was percent change from baseline in fasting triglycerides at 3 months. Secondary endpoints included relative percent change in hepatic fat fraction (HFF), visceral adiposity, and glycated hemoglobin levels. RESULTS Forty patients (11 men, 29 women) were enrolled, majority of whom were aged <65 years (mean, 47 years) and White. Least squares mean (LSM) percent change in triglycerides from baseline to 3 months was -88% (95% CI, -134 to -43) in the volanesorsen group versus -22% (95% CI, -61 to 18) in the placebo group, with a difference in LSM of -67% (95% CI, -104 to -30; P=0.0009). Volanesorsen induced a significant LSM relative reduction in HFF of 53% at month 12 versus placebo (observed mean [SD]: 9.7 [7.65] vs. 18.0 [8.89]; P=0.0039). No statistically significant changes were noted in body volume measurements (fat, liver, spleen, visceral/subcutaneous adipose tissue) or glycated hemoglobin. Serious adverse events in patients assigned to volanesorsen included 1 case each of sarcoidosis, anaphylactic reaction, and systemic inflammatory response syndrome. CONCLUSION In BROADEN, volanesorsen significantly reduced serum triglyceride levels and hepatic steatosis in patients with FPLD.
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Affiliation(s)
- Elif A Oral
- Metabolism, Endocrinology and Diabetes Division and Brehm Center for Diabetes, University of Michigan, Ann Arbor, MI, USA (Dr Oral).
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX, USA (Dr Garg)
| | - Joseph Tami
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas)
| | - Eric A Huang
- Akcea Therapeutics, Inc., Boston, MA, USA (Drs Huang, O'Dea, and Hurh)
| | - Louis St L O'Dea
- Akcea Therapeutics, Inc., Boston, MA, USA (Drs Huang, O'Dea, and Hurh)
| | - Hartmut Schmidt
- University Hospital Muenster, Muenster, Germany (Dr Schmidt)
| | - Anatoly Tiulpakov
- Endocrinology Research Centre, Moscow, Russian Federation (Dr Tiulpakov)
| | - Ann Mertens
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism, and Ageing, KU Leuven, Leuven, Belgium (Dr Mertens)
| | - Veronica J Alexander
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas)
| | - Lynnetta Watts
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas)
| | - Eunju Hurh
- Akcea Therapeutics, Inc., Boston, MA, USA (Drs Huang, O'Dea, and Hurh)
| | - Joseph L Witztum
- School of Medicine, University of California San Diego, San Diego, CA, USA (Drs Witztum and Tsimikas)
| | - Richard S Geary
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas)
| | - Sotirios Tsimikas
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas); School of Medicine, University of California San Diego, San Diego, CA, USA (Drs Witztum and Tsimikas)
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Comparative efficacy of omega-3 polyunsaturated fatty acids on major cardiovascular events: A network meta-analysis of randomized controlled trials. Prog Lipid Res 2022; 88:101196. [PMID: 36341839 DOI: 10.1016/j.plipres.2022.101196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
The role of omega-3 polyunsaturated fatty acids (PUFAs) in primary and secondary prevention on major cardiovascular events (MCE) is inconclusive due to the potential heterogeneity in study designs of formulas, dosages, and ratios of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from the findings of previous randomized controlled trials (RCTs). Here we conducted a comprehensive narrative review of pre-clinical studies and updated a network meta-analysis (NMA) to determine the comparative efficacy against MCE with different EPA/DHA dosages and formulas. We found that pure EPA was ranked the best option in the secondary prevention (hazard ratio: 0.72, 95% confidence interval: 0.65 to 0.81) from the NMA of 39 RCTs with 88,359 participants. There was no evidence of omega-3 PUFAs' efficacy in primary prevention. The mechanisms of omega-3 PUFAs' cardiovascular protection might link to the effects of anti-inflammation and stabilization of endothelial function from PUFA's derivatives including eicosanoids and the special pre-resolving mediators (SPMs).
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Yotsapon T, Surat K, Veekij V, Kewalin W, Soontaree N, Sirinate K, Thep H. Recurrent Hypertriglyceridemia-Induced Pancreatitis due to Multifactorial Chylomicronemia Syndrome in a Patient With Ketosis-Prone Diabetes Mellitus. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221119445. [PMID: 36046370 PMCID: PMC9421055 DOI: 10.1177/11795476221119445] [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: 05/20/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
The triad of diabetic ketoacidosis (DKA), severe hypertriglyceridemia, and acute pancreatitis have been occasionally described in severely obese patients with type 2 diabetes mellitus (T2DM). Herein, we present a long-term clinical course of a Thai man with ketosis-prone diabetes mellitus (KPDM) complicated with recurrent pancreatitis due to multifactorial chylomicronemia syndrome. Genetic testing showed no mutation in lipoprotein lipase (LPL) and its co-factors. The patient was referred to multidisciplinary team for lifelong weight loss consultation, limiting intake of fat and simple carbohydrates, and adherence to lipid-lowering medications. Subsequent follow-up 1 year later showed no recurrent pancreatitis. In patients with multifactorial chylomicronemia syndrome, long-term management with dietary modifications together with pharmacotherapy remains the cornerstone of successful treatment.
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Affiliation(s)
| | - Komindr Surat
- Division of Clinical Nutrition, Theptarin Hospital, Bangkok, Thailand
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10
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Feng L, Sun Y, Liu F, Wang C, Zhang C, Liu J, Jiang L. Clinical features and functions of a novel Lpl mutation C.986A>C (p.Y329S) in patient with hypertriglyceridemia. Curr Res Transl Med 2022; 70:103337. [PMID: 35679768 DOI: 10.1016/j.retram.2022.103337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 12/11/2021] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate and assess the clinical features and functions of a new lipoprotein lipase (Lpl) gene mutation c.986A>C (p.Y329S) found in hypertriglyceridemia(HTG) patients from a Chinese family. METHODS Five members of a family with the proband were diagnosed with HTG were investigated, and fasting peripheral blood was collected . The plasma was then used to measure triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein cholesterol (HDL-C), free fatty acids (FFA), and glucose tolerance. Following that, genomic deoxyribonucleic acid (DNA) was extracted from whole-blood samples using the QIAamp whole-blood DNA kit, and the coding exon regions and flanking regions of 95 dyslipidemia-related genes were captured using GenCap liquid-phase target gene capture technology. The activity of LPL and its mutation were then determined using cell assays, and the newly discovered LPL mutant was functionally analyzed. The binding site of fenofibrate and LPL, as well as the mutation, were subjected to predictive analysis. RESULTS The LPL gene's c.986A>C (p.Y329S) heterozygous mutation was discovered, and patients with the mutation had the typical phenotype of LPL deficiency and weakened LPL activity. Furthermore, this mutant has been treated with fenofibrate, and its triglyceride level is perfectly controlled and stable. The prediction analysis of the fenofibrate and LPL binding sites reveals that the wild-type system, Phe378 contributes most to the binding energy of fenofibrate. In the mutant system, Tyr394, which contributes the most to the binding energy of fenofibrate, the contribution of S329 is greater than that of Y329 (0.9∼0.7 kal/mol) . After Y329 is mutated, the hydrogen bond data of fenofibrate and LPL will also increase to quote H-bond diagrams. CONCLUSIONS A heterozygous mutation c.986A>C (p.Y329S) in exon 6 of Lpl gene occurs in the proband with familial HTG. Lpl c.986A>C (p.Y329S) mutation weakens the activity of the LPL, which may be the pathogenic mutation of HTG. In addition, The proband has been treated with fenofibrate and the triglyceride level is ideally controlled and stable. The prediction analysis of the fenofibrate and LPL binding site shows that the wild-type system, Phe378 contributes most to the binding energy of fenofibrate. In the mutant system, Tyr394, which contributes the most to the binding energy of fenofibrate, the contribution of S329 is greater than that of Y329 (0.9∼0.7 kal/mol). After Y329 is mutated, the hydrogen bond data of fenofibrate and LPL will also increase, which may be one of the reasons why the mutation has no effect on the therapeutic effect of fenofibrate.
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Affiliation(s)
- Lingling Feng
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Department of Endocrinology, Laoling People's Hospital, Laoling 253600, Shandong Province, China
| | - Yujing Sun
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China
| | - Fuqiang Liu
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China
| | - Chuan Wang
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China
| | - Chao Zhang
- Department of Biochemistry and Molecular Biology, Shandong University School of Medicine, Jinan, Shandong, 250012, China
| | - Jidong Liu
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China
| | - Ling Jiang
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China.
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Comorbid overweight/obesity and chronic pancreatitis exacerbate the dyslipidemia progression in type 2 diabetic patients. Endocr Regul 2022; 56:168-177. [DOI: 10.2478/enr-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective. The aim of present study was to analyze the serum lipid profile parameters in patients with type 2 diabetes mellitus (T2DM) and comorbidities [overweight/obesity and/or chronic pancreatitis (CP)] to determine the contribution of these pathologic factors to lipid metabolism disorders in T2DM.
Methods. The study involved 579 type 2 diabetic (T2D) patients with comorbid overweight/ obesity and/or CP. The serum lipid panel parameters [total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C)] were determined by commercially available kits on a Cobas 6000 analyzer (Roche Hitachi, Germany). Low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and remnant cholesterol (RC) levels were calculated using formulas. The data were statistically analyzed using STATISTICA 7.0.
Results. It was shown that dyslipidemia in T2D patients is characterized by unidirectional changes regardless the presence/absence of comorbid overweight/obesity or CP. At the same time, the most severe dyslipidemia was detected in T2D patients with a combination of comorbid over-weight/obesity and CP. Both the elevated body mass index (BMI) and CP can aggravate lipid metabolism disorders in T2DM. In our study, however, the BMI increase positively correlated with the number of dyslipidemia patients characterized by exceeding all target lipid levels for diabetic patients. This is in contrast to T2D patients with normal body weight and comorbid CP, in whom only LDL-C and TG exceeded the target lipid levels.
Conclusions. A combination of comorbidities, such as obesity and CP in T2D patients, produced a mutually aggravating course defined particularly by common pathogenic links, insulin resistance, chronic generalized low-intensity inflammation, endothelial dysfunction, and dyslipidemia caused primarily by triglyceridemia.
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Abachi S, Pilon G, Marette A, Bazinet L, Beaulieu L. Beneficial effects of fish and fish peptides on main metabolic syndrome associated risk factors: Diabetes, obesity and lipemia. Crit Rev Food Sci Nutr 2022; 63:7896-7944. [PMID: 35297701 DOI: 10.1080/10408398.2022.2052261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The definition of metabolic syndrome (MetS) fairly varies from one to another guideline and health organization. Per description of world health organization, occurrence of hyperinsulinemia or hyperglycemia in addition to two or more factors of dyslipidemia, hypoalphalipoproteinemia, hypertension and or large waist circumference factors would be defined as MetS. Conventional therapies and drugs, commonly with adverse effects, are used to treat these conditions and diseases. Nonetheless, in the recent decades scientific community has focused on the discovery of natural compounds to diminish the side effects of these medications. Among many available bioactives, biologically active peptides have notable beneficial effects on the management of diabetes, obesity, hypercholesterolemia, and hypertension. Marine inclusive of fish peptides have exerted significant bioactivities in different experimental in-vitro, in-vivo and clinical settings. This review exclusively focuses on studies from the recent decade investigating hypoglycemic, hypolipidemic, hypercholesterolemic and anti-obesogenic fish and fish peptides. Related extraction, isolation, and purification methodologies of anti-MetS fish biopeptides are reviewed herein for comparison purposes only. Moreover, performance of biopeptides in simulated gastrointestinal environment and structure-activity relationship along with absorption, distribution, metabolism, and excretion properties of selected oligopeptides have been discussed, in brief, to broaden the knowledge of readers on the design and discovery trends of anti-MetS compounds.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2052261 .
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Affiliation(s)
- Soheila Abachi
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, Quebec, Canada
- Department of Food Science, Faculty of Agricultural and Food Sciences, Université Laval, Quebec, Quebec, Canada
| | - Geneviève Pilon
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Cardiology Axis of the Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - André Marette
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Cardiology Axis of the Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Laurent Bazinet
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, Quebec, Canada
- Department of Food Science, Faculty of Agricultural and Food Sciences, Université Laval, Quebec, Quebec, Canada
- Laboratory of Food Processing and ElectroMembrane Processes (LTAPEM), Université Laval, Quebec, Quebec, Canada
| | - Lucie Beaulieu
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, Quebec, Canada
- Department of Food Science, Faculty of Agricultural and Food Sciences, Université Laval, Quebec, Quebec, Canada
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13
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Frent I, Bucsa C, Leucuta D, Farcas A, Mogosan C. An investigation on the association between sodium glucose co-transporter 2 inhibitors use and acute pancreatitis: A VigiBase study. Pharmacoepidemiol Drug Saf 2021; 30:1428-1440. [PMID: 34156119 DOI: 10.1002/pds.5313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To characterize acute pancreatitis (AP) related to sodium glucose co-transporter 2 inhibitors and to investigate this relationship through disproportionality analysis in an international pharmacovigilance database. METHODS We analyzed all AP reports for canagliflozin, dapagliflozin and/or empagliflozin from the WHOs Global adverse drug reactions database VigiBase® up to July 2019. We characterized the patients, reporters, and reactions, and we present the proportional reporting ratio (PRR) and information component (IC) for each of the gliflozins. AP cases were reports containing at least one of 11 previously selected preferred terms. Gliflozin exposure was considered for all reports with at least one gliflozin as suspected/ interacting drug. RESULTS Of the 19 834 180 individual case safety reports in VigiBase, in 600 reports containing 618 AP group reactions, gliflozins were suspected/ interacting drugs. Men were affected in 52.3% of the cases and 59.6% of the patients were in the 45-64 years age group. The reporters were in 417 cases healthcare professionals. Most of the reactions were reported for canagliflozin (59.7%), followed by empagliflozin (21%) and dapagliflozin (19.2%) and were serious (98.6%). Most of the reactions' outcomes (84% of the patients) were favorable. Ketoacidosis was frequently associated with the AP (21.3%). Significant PRR and IC were found for pancreatitis and pancreatitis acute for all three gliflozins, pancreatitis necrotizing for canagliflozin and empagliflozin and pancreatitis relapsing for empagliflozin. CONCLUSIONS Most of the AP cases were serious and with favorable outcome. We identified possible alternative causes for AP, like concomitant medication, hypertriglyceridemia, and cholelithiasis and a frequent association with ketoacidosis. We found a significant association between AP and the use of canagliflozin, dapagliflozin, and empagliflozin that would need further investigation.
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Affiliation(s)
- Ioana Frent
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Camelia Bucsa
- Drug Information Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Leucuta
- Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Farcas
- Drug Information Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Mogosan
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Drug Information Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Pan J, Yang X, Zhu W. Domino effect of pituitary growth hormone tumor complicated by diabetic ketoacidosis and pituitary apoplexy: a case report. BMC Endocr Disord 2021; 21:109. [PMID: 34039339 PMCID: PMC8157700 DOI: 10.1186/s12902-021-00768-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/16/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients with growth hormone (GH)-secreting adenoma usually develop glucose intolerance. GH increases metabolic rate and, when secreted aberrantly, may result in metabolic syndrome. Herein, we examine the associations of pituitary tumor-induced secretion of hormone with insulin resistance and metabolic syndrome, and determine the relation of pituitary tumor apoplexy-induced diabetic ketoacidosis (DKA) and acute pancreatitis. CASE PRESENTATION A 44-year-old male with a history of hypertension presented to the emergency department of our hospital on February 14, 2019 with symptoms of headache, dizziness, and vomiting. Computed tomography of the head revealed pituitary tumor with bleeding. An ultrasound scan of the abdomen revealed fatty liver and acute pancreatitis. Further examination revealed the presence of DKA, hypertriglyceridemia, cortical hypofunction crisis and acute kidney injury. Surgical endoscopic resection of the pituitary tumor resection via the transsphenoidal approach was performed. The patient's postoperative recovery was remarkable. CONCLUSIONS Long-term growth hormone abnormality may trigger insulin resistance, leading to metabolic syndrome and impaired glucose and lipid metabolism. The pituitary adenoma apoplexy may also directly induce DKA, creating a domino effect, which further deteriorate the aberrant metabolism of glucose and lipids.
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Affiliation(s)
- JinYu Pan
- Graduate Department, BengBu Medical College, 233030, Bengbu, Anhui, China
| | - XiangHong Yang
- Department of Intensive Care Uint, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), 310014, Hangzhou, Zhejiang, China
| | - Wei Zhu
- Department of Emergency Medicine, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), 158 Shangtang Road, 310014, Hangzhou, Zhejiang, People's Republic of China.
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15
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Veltri NL, Chan M, Awad S. Undetectable measured serum bicarbonate associated with hypertriglyceridemia-induced pancreatitis. CMAJ 2021; 192:E1206-E1209. [PMID: 33051315 DOI: 10.1503/cmaj.200237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nicole L Veltri
- Division of General Internal Medicine (Veltri), Department of Medicine, and Departments of Pathology and Molecular Medicine (Chan), and Division of Endocrinology and Metabolism (Awad), Department of Medicine, Queen's University, Kingston, Ont.
| | - Michael Chan
- Division of General Internal Medicine (Veltri), Department of Medicine, and Departments of Pathology and Molecular Medicine (Chan), and Division of Endocrinology and Metabolism (Awad), Department of Medicine, Queen's University, Kingston, Ont
| | - Sara Awad
- Division of General Internal Medicine (Veltri), Department of Medicine, and Departments of Pathology and Molecular Medicine (Chan), and Division of Endocrinology and Metabolism (Awad), Department of Medicine, Queen's University, Kingston, Ont
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Akoumianakis I, Zvintzou E, Kypreos K, Filippatos TD. ANGPTL3 and Apolipoprotein C-III as Novel Lipid-Lowering Targets. Curr Atheroscler Rep 2021; 23:20. [PMID: 33694000 DOI: 10.1007/s11883-021-00914-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Despite significant progress in plasma lipid lowering strategies, recent clinical trials highlight the existence of residual cardiovascular risk. Angiopoietin-like protein 3 (ANGPTL3) and apolipoprotein C-III (Apo C-III) have been identified as novel lipid-lowering targets. RECENT FINDINGS Apo C-III and ANGPTL3 have emerged as novel regulators of triglyceride (TG) and low-density lipoprotein-cholesterol (LDL-C) levels. ANGPTL3 is an inhibitor of lipoprotein lipase (LPL), reducing lipolysis of Apo B-containing lipoproteins. Loss-of-function ANGPLT3 mutations are associated with reduced plasma cholesterol and TG, while novel ANGPLT3 inhibition strategies, including monoclonal antibodies (evinacumab), ANGPLT3 antisense oligonucleotides (IONIS-ANGPTL3-LRx), and small interfering RNA (siRNA) silencing techniques (ARO-ANG3), result in increased lipolysis and significant reductions of LDL-C and TG levels in phase I and II clinical trials. Similarly, Apo C-III inhibits LPL while promoting the hepatic secretion of TG-rich lipoproteins and preventing their clearance. Loss-of-function APOC3 mutations have been associated with reduced TG levels. Targeting of Apo C-III with volanesorsen, an APOC3 siRNA, results in significant reduction in plasma TG levels but possibly also increased risk for thrombocytopenia, as recently demonstrated in phase I, II, and III clinical trials. ARO-APOC3 is a novel siRNA-based agent targeting Apo C-III which is currently under investigation with regard to its lipid-lowering efficiency. ANGPTL3 and Apo C-III targeting agents have demonstrated striking lipid-lowering effects in recent clinical trials; however, more thorough safety and efficacy data are required. Here, we evaluate the role of ANGPLT3 and Apo C-III in lipid metabolism, present the latest clinical advances targeting those molecules, and outline the remaining scientific challenges on residual lipid-associated cardiovascular risk.
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Affiliation(s)
- Ioannis Akoumianakis
- Department of Internal Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Evangelia Zvintzou
- Department of Medicine, Pharmacology Laboratory, School of Health Sciences, University of Patras, Achaias, Rio, Greece
| | - Kyriakos Kypreos
- Department of Medicine, Pharmacology Laboratory, School of Health Sciences, University of Patras, Achaias, Rio, Greece.,Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Theodosios D Filippatos
- Department of Internal Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece. .,Metabolic Diseases Research Unit, Internal Medicine Laboratory, School of Sciences, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete, Greece.
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Berber E, Sumbria D, Rouse BT. Could targeting immunometabolism be a way to control the burden of COVID-19 infection? Microbes Infect 2021; 23:104780. [PMID: 33482357 PMCID: PMC7816601 DOI: 10.1016/j.micinf.2021.104780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
This review portrays the metabolic consequences of Covid-19 infection at different stages of the clinical syndrome. It also describes how events can change when patients with metabolic problems are infected and the effects that diet and nutrition might play to influence the outcome of infection. We also discuss the types of maneuvers that could be used to reshape metabolic events and question if this approach could be a practical therapy used alone or in combination with other approaches to reduce the burden of Covid-19 infection.
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Affiliation(s)
- Engin Berber
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA; Department of Virology, Faculty of Veterinary Medicine, Erciyes University, Kayseri, TR, Turkey
| | - Deepak Sumbria
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Barry T Rouse
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA.
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18
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Huang Z, Xu Z, Xu R, Huang L, Xu X, Lai X. Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis. J Diabetes 2021; 13:200-210. [PMID: 32734598 DOI: 10.1111/1753-0407.13100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/05/2020] [Accepted: 07/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This study aimed to analyze the genetics and treatments of the patients with the triad of diabetic ketoacidosis (DKA), hypertriglyceridemia, and acute pancreatitis (AP). METHODS We conducted a retrospective study of six patients with the triad of AP, hypertriglyceridemia, and DKA at our hospital. All patients underwent plasmapheresis as part of their treatment. The clinical characteristics of the patients were obtained from the hospital information system and analyzed. Whole exome sequencing was performed using samples of one patient (case 6) and his family members. RESULTS The average triglyceride level before plasmapheresis was 3282.17 ± 2975.43 mg/dL (range: 1646-9332 mg/dL). The triglyceride levels dropped by approximately 80% after plasmapheresis. None of the patients developed complications related from plasmapheresis. During follow-up, patients 5 and 6 developed recurrent pancreatitis for several times and showed the formation of pancreatic pseudocysts. We identified three novel heterozygous missense mutations in the family of patient 6, including c.12614C > T (p.Pro4205Leu) in APOB, c.160G > C (p.Glu54Gln) in CILP2, and c.1199C > A (p.Ala400Glu) in PEPD. CONCLUSIONS Three novel heterozygous missense mutations, including c.12614C > T (p.Pro4205Leu) in APOB, c.160G > C (p.Glu54Gln) in CILP2, and c.1199C > A (p.Ala400Glu) in PEPD were first identified in a patient with the triad of DKA, hypertriglyceridemia, and AP. The combination of plasmapheresis, hydration, and insulin therapy may have the greatest clinical benefits for these patients.
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Affiliation(s)
- Zixi Huang
- Department of General Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhenyan Xu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ruoqing Xu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Xu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoyang Lai
- Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Fu X, Jia Y, Liu J, Lei Q, Li L, Li N, Hu Y, Wang S, Liu H, Yan S. The Predictive Effect of Health Examination in the Incidence of Diabetes Mellitus in Chinese Adults: A Population-Based Cohort Study. J Diabetes Res 2021; 2021:3552080. [PMID: 34423045 PMCID: PMC8377476 DOI: 10.1155/2021/3552080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/25/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The incidence of diabetes mellitus (DM) was increasing in recent years, and it is important to screen those nondiabetic populations through health examination to detect the potential risk factors for DM. We aimed to find the predictive effect of health examination on DM. METHODS We used the public database from Rich Healthcare Group of China to evaluate the potential predictive effect of health examination in the onset of DM. The colinear regression was used for estimating the relationship between the dynamics of the health examination index and the incident year of DM. The time-dependent ROC was used to calculate the best cutoff in predicting DM in the follow-up year. The Kaplan-Meier method and Cox regression were used to evaluate the HR of related health examination. RESULTS A total of 211,833 participant medical records were included in our study, with 4,172 participants diagnosing as DM in the following years (among 2-7 years). All the initial health examination was significantly different in participants' final diagnosing as DM to those without DM. We found a negative correlation between the incidence of years of DM and the average initial FPG (r = -0.1862, P < 0.001). Moreover, the initial FPG had a strong predictive effect in predicting the future incidence of DM (AUC = 0.961), and the cutoff was 5.21 mmol/L. Participants with a higher initial FPG (>5.21 mmol/L) had a 2.73-fold chance to develop as DM in follow-up (95%CI = 2.65-2.81, P < 0.001). CONCLUSION Initial FPG had a good predictive effect for detecting DM. The FPG should be controlled less than 5.21 mmol/L.
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Affiliation(s)
- Xiaomin Fu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yingmin Jia
- Department of Nephrology, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, No. 5 Zhanqian East Street, Shunyi District, Beijing 101300, China
| | - Jing Liu
- Clinics of Cadre, Department of Outpatient, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Qinghua Lei
- Physical Examination Center, Central Hospital of Handan City, No. 59 Congtai North Road, Congtai District, Handan, Hebei Province 056008, China
| | - Lele Li
- Department of Endocrinology, Genetics, Metabolism and Adolescent Medicine, Beijing Children's Hospital, The Capital Medical University, National Center for Children's Health, No. 56 Nan Li Shi Road, West District, Beijing 100045, China
| | - Nan Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yanyan Hu
- Physical Examination Center, Central Hospital of Handan City, No. 59 Congtai North Road, Congtai District, Handan, Hebei Province 056008, China
| | - Shanshan Wang
- Physical Examination Center, Central Hospital of Handan City, No. 59 Congtai North Road, Congtai District, Handan, Hebei Province 056008, China
| | - Hongzhou Liu
- Department of Endocrinology, First Hospital of Handan City, No. 25 Congtai Road, Congtai District, Handan, Hebei Province 056002, China
| | - Shuangtong Yan
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
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Omega-3 polyunsaturated fatty acids: anti-inflammatory and anti-hypertriglyceridemia mechanisms in cardiovascular disease. Mol Cell Biochem 2020; 476:993-1003. [PMID: 33179122 DOI: 10.1007/s11010-020-03965-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease (CVD) is the world's most recognized and notorious cause of death. It is known that increased triglyceride-rich lipoproteins (TRLs) and remnants of triglyceride-rich lipoproteins (RLP) are the major risk factor for CVD. Furthermore, hypertriglyceridemia commonly leads to a reduction in HDL and an increase in atherogenic small dense low-density lipoprotein (sdLDL or LDL-III) levels. Thus, the evidence shows that Ω-3 fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have a beneficial effect on CVD through reprogramming of TRL metabolism, reducing inflammatory mediators (cytokines and leukotrienes), and modulation of cell adhesion molecules. Therefore, the purpose of this review is to provide the molecular mechanism related to the beneficial effect of Ω-3 PUFA on the lowering of plasma TAG levels and other atherogenic lipoproteins. Taking this into account, this study also provides the TRL lowering and anti-inflammatory mechanism of Ω-3 PUFA metabolites such as RvE1 and RvD2 as a cardioprotective function.
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21
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Jin JL, Zhang HW, Cao YX, Liu HH, Hua Q, Li YF, Zhang Y, Guo YL, Wu NQ, Zhu CG, Xu RX, Gao Y, Li XL, Cui CJ, Liu G, Sun J, Dong Q, Santos R, Li JJ. Long-term prognostic utility of low-density lipoprotein (LDL) triglyceride in real-world patients with coronary artery disease and diabetes or prediabetes. Cardiovasc Diabetol 2020; 19:152. [PMID: 32981521 PMCID: PMC7520976 DOI: 10.1186/s12933-020-01125-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Recent guidelines highlighted the association between atherosclerosis and triglyceride-enriched lipoproteins in patients with impaired glucose metabolism. However, evidence from prospective studies for long-term prognostic utility of low-density lipoprotein triglyceride (LDL-TG) in real-world patients with prediabetes (Pre-DM) or diabetes mellitus (DM) and coronary artery disease (CAD) is currently not available. The aim of the present study was to evaluate the impact of LDL-TG on major adverse cardiovascular events (MACEs) in patients with stable CAD under different glucose metabolism status. METHODS A total of 4381 patients with CAD were consecutively enrolled and plasma LDL-TG level was measured by an automated homogeneous assay. They were categorized according to both status of glucose metabolism [DM, Pre-DM, normal glycaemia regulation (NGR)] and tertiles of LDL-TG. All subjects were followed up for the occurrence of MACEs. RESULTS During a median of 5.1 (interquartile range 3.9 to 5.9) years' follow-up, 507 (11.6%) MACEs occurred. Cubic spline models showed a significant association between LDL-TG and MACEs in DM and Pre-DM but not in NGR. When the combined effect of elevated LDL-TG and glucose disorders was considered for risk stratification, the medium tertile of LDL-TG plus DM, and the highest tertile of LDL-TG plus Pre-DM or plus DM subgroups were associated with significantly higher risk of MACEs after adjustment of confounders including triglyceride [hazard ratios (95% confidence intervals): 1.843 (1.149-2.955), 1.828 (1.165-2.867), 2.212 (1.396-3.507), all p < 0.05]. Moreover, adding LDL-TG into the original model increased the C-statistic from 0.687 to 0.704 (∆C-statistic = 0.016, p = 0.028) and from 0.734 to 0.749 (∆C-statistic = 0.014, p = 0.002) in Pre-DM and DM, respectively. CONCLUSIONS In this longitudinal cohort study on real-world practice, higher LDL-TG was associated with worse outcomes among Pre-DM and DM patients with stable CAD.
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Affiliation(s)
- Jing-Lu Jin
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Hui-Wen Zhang
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Ye-Xuan Cao
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Hui-Hui Liu
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Qi Hua
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yan-Fang Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yan Zhang
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Yuan-Lin Guo
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Na-Qiong Wu
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Cheng-Gang Zhu
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Rui-Xia Xu
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Ying Gao
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Xiao-Lin Li
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Chuan-Jue Cui
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Geng Liu
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Jing Sun
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Qian Dong
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Raul Santos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
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Goldberg RB, Chait A. A Comprehensive Update on the Chylomicronemia Syndrome. Front Endocrinol (Lausanne) 2020; 11:593931. [PMID: 33193106 PMCID: PMC7644836 DOI: 10.3389/fendo.2020.593931] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022] Open
Abstract
The chylomicronemia syndrome is characterized by severe hypertriglyceridemia and fasting chylomicronemia and predisposes affected individuals to acute pancreatitis. When due to very rare monogenic mutations in the genes encoding the enzyme, lipoprotein lipase, or its regulators, APOC2, APOA5, GPIHBP1, and LMF1, it is referred to as the familial chylomicronemia syndrome. Much more frequently, the chylomicronemia syndrome results from a cluster of minor genetic variants causing polygenic hypertriglyceridemia, which is exacerbated by conditions or medications which increase triglyceride levels beyond the saturation point of triglyceride removal systems. This situation is termed the multifactorial chylomicronemia syndrome. These aggravating factors include common conditions such as uncontrolled diabetes, overweight and obesity, alcohol excess, chronic kidney disease and pregnancy and several medications, including diuretics, non-selective beta blockers, estrogenic compounds, corticosteroids, protease inhibitors, immunosuppressives, antipsychotics, antidepressants, retinoids, L-asparaginase, and propofol. A third uncommon cause of the chylomicronemia syndrome is familial forms of partial lipodystrophy. Development of pancreatitis is the most feared complication of the chylomicronemia syndrome, but the risk of cardiovascular disease as well as non-alcoholic steatohepatitis is also increased. Treatment consists of dietary fat restriction and weight reduction combined with the use of triglyceride lowering medications such as fibrates, omega 3 fatty acids and niacin. Effective management of aggravating factors such as improving diabetes control, discontinuing alcohol and replacing or reducing the dose of medications that raise triglyceride levels is essential. Importantly, many if not most cases of the chylomicronemia syndrome can be prevented by effective identification of polygenic hypertriglyceridemia in people with conditions that increase its likelihood or before starting medications that may increase triglyceride levels. Several new pharmacotherapeutic agents are being tested that are likely to considerably improve treatment of hypertriglyceridemia in people at risk.
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Affiliation(s)
- Ronald B. Goldberg
- Departments of Medicine, Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Ronald B. Goldberg,
| | - Alan Chait
- Department of Medicine, University of Washington, Seattle, WA, United States
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