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Birukov A, Polemiti E, Jäger S, Stefan N, Schulze MB. Fetuin-A and risk of diabetes-related vascular complications: a prospective study. Cardiovasc Diabetol 2022; 21:6. [PMID: 34998417 PMCID: PMC8742328 DOI: 10.1186/s12933-021-01439-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Fetuin-A is a hepatokine which has the capacity to prevent vascular calcification. Moreover, it is linked to the induction of metabolic dysfunction, insulin resistance and associated with increased risk of diabetes. It has not been clarified whether fetuin-A associates with risk of vascular, specifically microvascular, complications in patients with diabetes. We aimed to investigate whether pre-diagnostic plasma fetuin-A is associated with risk of complications once diabetes develops. METHODS Participants with incident type 2 diabetes and free of micro- and macrovascular disease from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort (n = 587) were followed for microvascular and macrovascular complications (n = 203 and n = 60, respectively, median follow-up: 13 years). Plasma fetuin-A was measured approximately 4 years prior to diabetes diagnosis. Prospective associations between baseline fetuin-A and risk of complications were assessed with Cox regression. RESULTS In multivariable models, fetuin-A was linearly inversely associated with incident total and microvascular complications, hazard ratio (HR, 95% CI) per standard deviation (SD) increase: 0.86 (0.74; 0.99) for total, 0.84 (0.71; 0.98) for microvascular and 0.92 (0.68; 1.24) for macrovascular complications. After additional adjustment for cardiometabolic plasma biomarkers, including triglycerides and high-density lipoprotein, the associations were slightly attenuated: 0.88 (0.75; 1.02) for total, 0.85 (0.72; 1.01) for microvascular and 0.95 (0.67; 1.34) for macrovascular complications. No interaction by sex could be observed (p > 0.10 for all endpoints). CONCLUSIONS Our data show that lower plasma fetuin-A levels measured prior to the diagnosis of diabetes may be etiologically implicated in the development of diabetes-associated microvascular disease.
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Affiliation(s)
- Anna Birukov
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Elli Polemiti
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Susanne Jäger
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Norbert Stefan
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, Tübingen, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
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Herrmann M, Babler A, Moshkova I, Gremse F, Kiessling F, Kusebauch U, Nelea V, Kramann R, Moritz RL, McKee MD, Jahnen-Dechent W. Lumenal calcification and microvasculopathy in fetuin-A-deficient mice lead to multiple organ morbidity. PLoS One 2020; 15:e0228503. [PMID: 32074120 PMCID: PMC7029858 DOI: 10.1371/journal.pone.0228503] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/16/2020] [Indexed: 12/22/2022] Open
Abstract
The plasma protein fetuin-A mediates the formation of protein-mineral colloids known as calciprotein particles (CPP)-rapid clearance of these CPP by the reticuloendothelial system prevents errant mineral precipitation and therefore pathological mineralization (calcification). The mutant mouse strain D2,Ahsg-/- combines fetuin-A deficiency with the calcification-prone DBA/2 genetic background, having a particularly severe compound phenotype of microvascular and soft tissue calcification. Here we studied mechanisms leading to soft tissue calcification, organ damage and death in these mice. We analyzed mice longitudinally by echocardiography, X-ray-computed tomography, analytical electron microscopy, histology, mass spectrometry proteomics, and genome-wide microarray-based expression analyses of D2 wildtype and Ahsg-/- mice. Fetuin-A-deficient mice had calcified lesions in myocardium, lung, brown adipose tissue, reproductive organs, spleen, pancreas, kidney and the skin, associated with reduced growth, cardiac output and premature death. Importantly, early-stage calcified lesions presented in the lumen of the microvasculature suggesting precipitation of mineral containing complexes from the fluid phase of blood. Genome-wide expression analysis of calcified lesions and surrounding (not calcified) tissue, together with morphological observations, indicated that the calcification was not associated with osteochondrogenic cell differentiation, but rather with thrombosis and fibrosis. Collectively, these results demonstrate that soft tissue calcification can start by intravascular mineral deposition causing microvasculopathy, which impacts on growth, organ function and survival. Our study underscores the importance of fetuin-A and related systemic regulators of calcified matrix metabolism to prevent cardiovascular disease, especially in dysregulated mineral homeostasis.
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Affiliation(s)
- Marietta Herrmann
- Helmholtz Institute for Biomedical Engineering, Biointerface Lab, RWTH Aachen University Hospital, Aachen, Germany
| | - Anne Babler
- Helmholtz Institute for Biomedical Engineering, Biointerface Lab, RWTH Aachen University Hospital, Aachen, Germany
| | - Irina Moshkova
- Helmholtz Institute for Biomedical Engineering, Biointerface Lab, RWTH Aachen University Hospital, Aachen, Germany
| | - Felix Gremse
- Helmholtz Institute for Biomedical Engineering, Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany
| | - Fabian Kiessling
- Helmholtz Institute for Biomedical Engineering, Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany
| | - Ulrike Kusebauch
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Valentin Nelea
- Faculty of Dentistry, Faculty of Medicine (Dept. of Anatomy and Cell Biology), McGill University, Montreal, Quebec, Canada
| | - Rafael Kramann
- Division of Nephrology, RWTH Aachen University Hospital, Aachen, Germany
| | - Robert L. Moritz
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Marc D. McKee
- Faculty of Dentistry, Faculty of Medicine (Dept. of Anatomy and Cell Biology), McGill University, Montreal, Quebec, Canada
| | - Willi Jahnen-Dechent
- Helmholtz Institute for Biomedical Engineering, Biointerface Lab, RWTH Aachen University Hospital, Aachen, Germany
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Kılavuz A, Göker B, Savaş S, Biray Avcı Ç, Saraç F, Gündüz C. Mikroalbüminürisi olan ve olmayan tip 2 diyabetik hastalarda serum asimetrik dimetil arjinin, fetuin-a ve ankle-brakial indeks değerlerinin değerlendirilmesi. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.623697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gourgas O, Cole GB, Muiznieks LD, Sharpe S, Cerruti M. Effect of the Ionic Concentration of Simulated Body Fluid on the Minerals Formed on Cross-Linked Elastin-Like Polypeptide Membranes. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2019; 35:15364-15375. [PMID: 31729882 DOI: 10.1021/acs.langmuir.9b02542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Deposition of calcium phosphate minerals on the elastin-rich medial layers of arteries can cause severe cardiovascular complications. There are no available treatments for medial calcification, and the mechanism of mineral formation on elastin layers is still unknown. We recently developed an in vitro model of medial calcification using cross-linked elastin-like polypeptide (ELP) membranes immersed in simulated body fluid (SBF). While mineral phase evolution matched that observed in a mouse model of medial calcification, the long incubation required was a practical limitation of this model. Using higher SBF ion concentrations could be a solution to speed up mineral deposition, but its effect on the mineralization process is still not well understood. Here we analyze mineral formation and phase transformation on ELP membranes immersed in high concentration SBF. We show that while mineral deposition is significantly accelerated in these conditions, the chemistry and morphology of the minerals deposited on the ELP membranes and the overall mineralization process are strongly affected. Overall, this work suggests that while the use of low concentration SBF in this in vitro model is more appropriate to study medial calcification associated with the loss of calcification inhibitors, higher SBF ion concentration may be more relevant to study medial calcification in patients with life-threatening diseases such as chronic kidney disease.
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Affiliation(s)
- Ophélie Gourgas
- Department of Mining and Materials Engineering , McGill University , Montreal , Quebec H3A 0C5 , Canada
| | - Gregory B Cole
- Molecular Medicine , Hospital for Sick Children , Toronto , Ontario M5G 0A4 , Canada
- Department of Biochemistry , University of Toronto , Toronto , Ontario M5S 1A8 , Canada
| | - Lisa D Muiznieks
- Molecular Medicine , Hospital for Sick Children , Toronto , Ontario M5G 0A4 , Canada
| | - Simon Sharpe
- Molecular Medicine , Hospital for Sick Children , Toronto , Ontario M5G 0A4 , Canada
- Department of Biochemistry , University of Toronto , Toronto , Ontario M5S 1A8 , Canada
| | - Marta Cerruti
- Department of Mining and Materials Engineering , McGill University , Montreal , Quebec H3A 0C5 , Canada
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Jirak P, Stechemesser L, Moré E, Franzen M, Topf A, Mirna M, Paar V, Pistulli R, Kretzschmar D, Wernly B, Hoppe UC, Lichtenauer M, Salmhofer H. Clinical implications of fetuin-A. Adv Clin Chem 2019; 89:79-130. [PMID: 30797472 DOI: 10.1016/bs.acc.2018.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fetuin-A, also termed alpha2-Heremans-Schmid glycoprotein, is a 46kDa hepatocyte derived protein (hepatokine) and serves multifaceted functions.
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Affiliation(s)
- Peter Jirak
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Lars Stechemesser
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Elena Moré
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Michael Franzen
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria.
| | - Hermann Salmhofer
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
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Khadir A, Kavalakatt S, Madhu D, Hammad M, Devarajan S, Tuomilehto J, Tiss A. Fetuin-A levels are increased in the adipose tissue of diabetic obese humans but not in circulation. Lipids Health Dis 2018; 17:291. [PMID: 30579336 PMCID: PMC6303986 DOI: 10.1186/s12944-018-0919-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background The hepatokine fetuin-A is linked to obesity and type 2 diabetes, but its presence and expression in adipose tissue remain unclear. In this study, we aimed to assess the circulating levels of fetuin-A and its expression in subcutaneous adipose tissue (SAT) from diabetic and non-diabetic obese subjects and their modulation by exercise. Methods SAT and blood were obtained from adults obese (diabetic, n=118 and non-diabetic, n=166) before and after a 3-month exercise program (diabetic, n=40 and non-diabetic, n=36, respectively). Plasma fetuin-A was assayed using ELISA. The presence and expression of fetuin-A in SAT, peripheral blood mononuclear cells (PBMCs) and cell lines (3T3-L1, THP-1, HepG2, RAW 264.7) were analysed using confocal microscopy, immunoblotting and qRT-PCR. Results Plasma fetuin-A level did not significantly differ between diabetic and non-diabetic obese subjects. However, when the non-diabetic group was divided into metabolically healthy and unhealthy phenotypes, significantly higher fetuin-A level was observed in the unhealthy sub-group. Circulating fetuin-A was mainly associated with glycaemic markers. In SAT, fetuin-A protein level was significantly higher in the diabetic obese subjects but its mRNA was not detected. Similarly, fetuin-A protein was detected in PBMCs, but its mRNA was not. In line with this, the use of various cell lines and culture media indicated that the presence of fetuin-A in SAT and PBMCs was due to its uptake from circulation rather than its endogenous expression. Finally, physical exercise decreased fetuin-A levels in both plasma and SAT in both groups. Conclusions Fetuin-A levels increased in association with diabetes in SAT but not in circulation in the obese subjects. Moreover, physical exercise decreased fetuin-A level. Fetuin-A potentially acts as a hepatokine taken up by other tissues, such as adipose tissue. Electronic supplementary material The online version of this article (10.1186/s12944-018-0919-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sina Kavalakatt
- Research Division, Dasman Diabetes Institute, Al Kuwayt, Kuwait
| | - Dhanya Madhu
- Research Division, Dasman Diabetes Institute, Al Kuwayt, Kuwait
| | - Maha Hammad
- Research Division, Dasman Diabetes Institute, Al Kuwayt, Kuwait
| | | | | | - Ali Tiss
- Research Division, Dasman Diabetes Institute, Al Kuwayt, Kuwait. .,Functional Proteomics & Metabolomics Unit, Dasman Diabetes Institute, P.O. Box 1180, 15462, Dasman, Kuwait.
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Al-Said NH, Taha FM, Abdel-Aziz GM, Abdel-Tawab MS. Fetuin-A level in type 2 diabetic patients: relation to microvascular complications. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2018. [DOI: 10.4103/ejim.ejim_24_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Roshanzamir F, Miraghajani M, Rouhani MH, Mansourian M, Ghiasvand R, Safavi SM. The association between circulating fetuin-A levels and type 2 diabetes mellitus risk: systematic review and meta-analysis of observational studies. J Endocrinol Invest 2018. [PMID: 28643299 DOI: 10.1007/s40618-017-0697-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Fetuin-A is a liver-derived circulating protein that is associated with insulin resistance and diabetes. The objective of this systematic review and meta-analysis of published observational studies was to investigate mean levels of fetuin-A in T2D patients and the relationship between blood fetuin-A levels and T2D risk. MATERIALS AND METHODS PubMed, Embase, Google Scholar, Web of Science, and The Cochrane Library were systematically searched for potential relevant studies up to 1 December 2016. Natural logarithm-transformed estimate risks, standard mean differences on the basis of Hedges's adjusted g, and 95% confidence intervals (CIs) were calculated for all eligible studies and were combined to measure the pooled data using random-effects model. RESULTS A total of 32 studies including 27 case-control and 5 cohort studies were included in the current study. Fetuin-A levels in T2D patients were significantly higher than control groups [Hedges' g = 1.73, 95% CI (1.25-2.22), P < 0.001], with significant heterogeneity across studies (P < 0.001, I 2 = 98.46%). Findings from meta-analyses of cohort studies showed a statistically significant association between fetuin-A levels and T2D risk [rate ratio = 1.62, 95% CI (1.26-2.08), P < 0.001], with no significant heterogeneity (P = 0.10, I 2 = 46.06%). CONCLUSION We found a significant relationship between the fetuin-A levels with T2D risk. Although fetuin-A may be as a potential screening and prediction biomarker or a therapeutic target in T2D patients, further studies are required in this regard.
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Affiliation(s)
- F Roshanzamir
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Miraghajani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M H Rouhani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Mansourian
- Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - R Ghiasvand
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - S M Safavi
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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Eleftheriadou I, Grigoropoulou P, Kokkinos A, Mourouzis I, Perrea D, Katsilambros N, Sfikakis PP, Tentolouris N. Association of plasma fetuin-a levels with peripheral arterial disease and lower extremity arterial calcification in subjects with type 2 diabetes mellitus. J Diabetes Complications 2017; 31:599-604. [PMID: 27899247 DOI: 10.1016/j.jdiacomp.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/29/2016] [Accepted: 11/07/2016] [Indexed: 01/05/2023]
Abstract
AIMS Fetuin-A is a hepatic glycoprotein that is involved in insulin resistance and atherosclerosis. Herein we examined the association of plasma fetuin-A levels with peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS A total of 71 patients with T2DM and 57 non-diabetic individuals were recruited. Diagnosis of PAD was based on the absence of triphasic waveform at pedal arteries, while ankle-brachial index (ABI) was calculated. Radiographs of both feet and ankles were taken for the assessment of lower extremity arterial calcification (LEAC). Plasma fetuin-A levels were measured using ELISA. RESULTS Patients with T2DM had higher fetuin-A levels than non-diabetic participants. Participants with diabetes and PAD had lower fetuin-A levels than non-PAD diabetic patients. In subjects with T2DM fetuin-A levels were associated with ABI. Multivariate analysis demonstrated that in patients with T2DM the odds of PAD increased with long diabetes duration, smoking, presence of arterial hypertension and dyslipidemia, as well as with lower fetuin-A levels. A trend towards higher fetuin-A levels in subjects with less severe LEAC was found. CONCLUSION Plasma fetuin-A levels are lower in patients with T2DM and PAD and are associated with PAD, irrespective of traditional cardiovascular risk factors. Moreover, fetuin-A may be involved in arterial calcification.
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Affiliation(s)
- Ioanna Eleftheriadou
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Pinelopi Grigoropoulou
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Iordanis Mourouzis
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Perrea
- Laboratory for Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicholas Katsilambros
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Sindhu S, Akhter N, Shenouda S, Wilson A, Ahmad R. Plasma fetuin-A/α2-HS-glycoprotein correlates negatively with inflammatory cytokines, chemokines and activation biomarkers in individuals with type-2 diabetes. BMC Immunol 2016; 17:33. [PMID: 27671862 PMCID: PMC5037637 DOI: 10.1186/s12865-016-0171-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/19/2016] [Indexed: 01/15/2023] Open
Abstract
Background Fetuin-A/AHSH is a novel hepatokine that acts as a vascular calcification inhibitor and as an endogenous TLR-4 ligand. Fetuin-A may act as a positive or negative acute phase protein (APP) in disease conditions. The relationship between circulatory fetuin-A and inflammatory biomarkers in type-2 diabetes (T2D) remains controversial. Therefore, the purpose of this study was to determine the plasma fetuin-A levels in 53 T2D (BMI = 29.7 ± 4.5 kg/m2) and 72 non-diabetic individuals (BMI = 28.2 ± 5.8 kg/m2) using premixed 38-plex MAP human cytokine/chemokine magnetic bead immunoassays and the data (mean ± SEM) were statistically analyzed to determine Pearson’s correlation (r) between fetuin-A and detected analytes; P-values ≤0.05 were considered significant. Results The data show that plasma fetuin-A levels were comparable in both groups (P = 0.27) and in T2D individuals, fetuin-A associated negatively (P ≤ 0.05) with a large number of proinflammatory cytokines/chemokines and activation biomarkers including TNF-α, IFN-α2, IFN-γ, IL-1α, IL-1β, IL-1RA, IL-3, IL-4, IL-7, IL-9, IL-12p40/p70, IL-15, CCL-2, CCL-4, CCL-11, CCL-22, CXCL-8, CX3CL-1, EFF-2, EGF, G-CSF, GM-CSF, GRO, sCD40L, and VEGF. In non-diabetics, fetuin-A also correlated positively with certain TH2 cytokines (IL-5, IL-13) and chemokines (CCL-3, CCL-5, CCL-7). Notably, in vitro fetuin-A production was significantly suppressed in HepG2 cells treated with TNF-α, IL-1β, and IFN-γ which supported the clinical findings of a negative association between fetuin A and inflammatory mediators. Conclusions The negative association between circulatory fetuin-A and systemic inflammatory mediators in T2D patients suggests that plasma fetuin-A may have predictive significance as a negative APP in metabolic disease. Electronic supplementary material The online version of this article (doi:10.1186/s12865-016-0171-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sardar Sindhu
- Immunology & Innovative Cell Therapy Unit, Dasman Diabetes Institute (DDI), P.O. Box 1180, Dasman, 15462, Kuwait.
| | - Nadeem Akhter
- Immunology & Innovative Cell Therapy Unit, Dasman Diabetes Institute (DDI), P.O. Box 1180, Dasman, 15462, Kuwait
| | - Steve Shenouda
- Immunology & Innovative Cell Therapy Unit, Dasman Diabetes Institute (DDI), P.O. Box 1180, Dasman, 15462, Kuwait
| | - Ajit Wilson
- Immunology & Innovative Cell Therapy Unit, Dasman Diabetes Institute (DDI), P.O. Box 1180, Dasman, 15462, Kuwait
| | - Rasheed Ahmad
- Immunology & Innovative Cell Therapy Unit, Dasman Diabetes Institute (DDI), P.O. Box 1180, Dasman, 15462, Kuwait.
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Abd Alamir M, Radulescu V, Goyfman M, Mohler ER, Gao YL, Budoff MJ. Prevalence and correlates of mitral annular calcification in adults with chronic kidney disease: Results from CRIC study. Atherosclerosis 2015; 242:117-22. [PMID: 26188533 PMCID: PMC4546905 DOI: 10.1016/j.atherosclerosis.2015.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Risk factors for mitral annular calcification (MAC) and cardiovascular disease (CVD) demonstrate significant overlap in the general population. The aim of this paper is to determine whether there are independent relationships between MAC and demographics, traditional and novel CVD risk factors using cardiac CT in the Chronic Renal Insufficiency Cohort (CRIC) in a cross-sectional study. METHODS A sample of 2070 subjects underwent coronary calcium scanning during the CRIC study. Data were obtained for each participant at time of scan. SUBJECTS were dichotomized into the presence and absence of MAC. Differences in baseline demographic and transitional risk factor data were evaluated across groups. Covariates used in multivariable adjustment were age, gender, BMI, HDL, LDL, lipid lowering medications, smoking status, family history of heart attack, hypertension, diabetes mellitus, phosphate, PTH, albuminuria, and calcium. RESULTS Our study consisted of 2070 subjects, of which 331 had MAC (prevalence of 16.0%). The mean MAC score was 511.98 (SD 1368.76). Age and white race remained independently associated with presence of MAC. Decreased GFR was also a risk factor. African American and Hispanic race, as well as former smoking status were protective against MAC. In multivariable adjusted analyses, the remaining covariates were not significantly associated with MAC. Among renal covariates, elevated phosphate was significant. CONCLUSION In the CRIC population, presence of MAC was independently associated with age, Caucasian race, decreased GFR, and elevated phosphate. These results are suggested by mechanisms of dysregulation of inflammation, hormones, and electrolytes in subjects with renal disease.
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Affiliation(s)
- Moshrik Abd Alamir
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Vlad Radulescu
- Stony Brook University Medical Center, Stony Brook, NY, USA
| | | | - Emile R Mohler
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yan Lin Gao
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
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Churchill TW, Rasania SP, Rafeek H, Mulvey CK, Terembula K, Ferrari V, Jha S, Lilly SM, Eraso LH, Reilly MP, Qasim AN. Ascending and descending thoracic aorta calcification in type 2 diabetes mellitus. J Cardiovasc Comput Tomogr 2015; 9:373-81. [PMID: 26119363 DOI: 10.1016/j.jcct.2015.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/24/2015] [Accepted: 04/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Calcification of the thoracic aorta is a risk factor for cardiovascular disease and peripheral arterial disease but has not been well studied in diabetics. In addition, many studies consider aortic calcium as a single anatomic entity, whereas calcification of the ascending and descending portions of the thoracic aorta may represent separate phenotypes. We sought to characterize the prevalence of ascending and descending aortic calcium among diabetics and to assess their associations with cardiovascular risk factors, coronary artery calcium, and peripheral arterial disease. METHODS Within the Penn Diabetes Heart Study, a cross-sectional study of subjects with type 2 diabetes mellitus but without coronary or renal disease, we quantified Agatston scores of the ascending and descending thoracic aorta in 1739 subjects (63% male, 61% Caucasian). Multivariate logistic and Tobit regressions were used to assess associations with cardiovascular risk factors, coronary calcium, and peripheral arterial disease. RESULTS Of all subjects, 54% had thoracic aortic calcium; of these, 37% had calcium solely in the ascending thoracic aorta and 20% solely in the descending thoracic aorta. In multivariate regression, age, Caucasian race, systolic blood pressure, low-density lipoprotein cholesterol, smoking, and diabetes duration were independently associated with calcium of both the ascending and descending thoracic aorta (P < .001 for all). Ascending and descending aortic calcium were each independently associated with coronary calcium in multivariate regression, but only calcification of the descending thoracic aortic was associated with low ankle-brachial index. CONCLUSION Ascending and descending thoracic aortic calcium have similar associations with traditional cardiovascular risk factors in diabetics and are independently associated with coronary artery calcium. Only calcium in the descending aorta is associated with peripheral arterial disease. Delineation of both phenotypes may provide information about the individualized vascular disease and risk profile of patients with type 2 diabetes mellitus.
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Affiliation(s)
| | - Suraj P Rasania
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Hashmi Rafeek
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Claire K Mulvey
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Karen Terembula
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Victor Ferrari
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Saurabh Jha
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott M Lilly
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Luis H Eraso
- Jefferson Vascular Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Muredach P Reilly
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Atif N Qasim
- Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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13
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Zhao C, Hou J, Wang S, Jiang R. Relation of Serum and Vitreous Concentrations of Fetuin-A with Diabetic Retinopathy. Med Sci Monit 2015; 21:1839-42. [PMID: 26110737 PMCID: PMC4492483 DOI: 10.12659/msm.893403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Fetuin-A, a liver-derived glycoprotein, is correlated with diabetes. The aim of the present investigation was to evaluate serum and vitreous concentrations of fetuin-A in patients with diabetic retinopathy (DR). Material/Methods We randomly selected 224 diabetic patients and 68 control subjects for this study. Results There were markedly higher serum and vitreous fetuin-A concentrations in proliferative diabetic retinopathy (PDR) patients than in the other three groups. NPDR patients exhibited elevated vitreous fetuin-A concentrations compared with patients without DR. However, no significant differences in serum fetuin-A concentrations were observed between NPDR patients and patients without DR. In addition, there were significantly lower concentrations of serum and vitreous fetuin-A in control subjects compared with the other three groups. Conclusions The occurrence and severity of DR is correlated with serum and vitreous fetuin-A concentrations.
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Affiliation(s)
- Chunming Zhao
- Department of Ophthalmology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Jiangping Hou
- Department of Ophthalmology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Shengxi Wang
- Department of Oncology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Rui Jiang
- Department of Oncology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
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14
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Akin F, Celik O, Altun I, Ayca B, Diker VO, Satılmıs S, Sahin C. Relationship of fibroblast growth factor 23 and fetuin--A to coronary atherosclerosis. J Diabetes Complications 2015; 29:550-5. [PMID: 25772252 DOI: 10.1016/j.jdiacomp.2015.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/15/2015] [Accepted: 02/26/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality due to cardiovascular disease. The objective of the present study is to evaluate the relationship between coronary artery disease (CAD) and serum concentrations of FGF-23 and fetuin-A. METHODS A total of 383 subjects who underwent coronary computed tomography angiography (CCTA) were included in the study. CCTA detected CAD in 208 patients; the rest of the patients had no detectable CAD. RESULTS Serum FGF-23 and fetuin-A levels were significantly increased in CAD patients compared to non-CAD patients (26.6±21.1pg/mL vs. 17.9±16.1pg/mL, p=0.001 and 826±350mg/L vs. 595±300mg/L, p<0.001, respectively). Serum FGF-23, fetuin-A, low-density lipoprotein (LDL)-cholesterol, and uric acid values were elevated in non-diabetic patients with CAD when compared to those without CAD. FGF-23, and fetuin-A were not significantly different in diabetic patients with CAD when compared to those without CAD. Using multivariate logistic regression analysis, we found that age, hypertension, LDL-Cholesterol, high-density lipoprotein (HDL)-Cholesterol, hs-CRP, uric acid, FGF-23 and fetuin-A levels were independently associated with the presence of CAD. CONCLUSION FGF-23 and fetuin-A were positively correlated with coronary atherosclerosis Similar trends were seen among diabetic patients, but this did not reach statistical significance. FGF-23 and fetuin-A could be used as novel risk markers of cardiovascular disease.
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Affiliation(s)
- Fatih Akin
- Department of Cardiology, Muğla Sıtkı Kocman University School of Medicine, Muğla, Turkey.
| | - Omer Celik
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Altun
- Department of Cardiology, Muğla Sıtkı Kocman University School of Medicine, Muğla, Turkey
| | - Burak Ayca
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Vesile Ornek Diker
- Department of Biochemistry, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Seckin Satılmıs
- Department of Cardiology, Acıbadem University, Istanbul, Turkey
| | - Cem Sahin
- Department of Internal Medicine, Muğla Sıtkı Kocman University School of Medicine, Muğla, Turkey
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15
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Dabrowska AM, Tarach JS, Wojtysiak-Duma B, Duma D. Fetuin-A (AHSG) and its usefulness in clinical practice. Review of the literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:352-9. [PMID: 25916279 DOI: 10.5507/bp.2015.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/10/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Fetuin-A, also called Alpha 2-Heremans Schmid Glycoprotein, is a multifunctional plasma agent what has been proven in animal and human studies. It plays a role as a physiological inhibitor of insulin receptor tyrosine kinase associated with insulin resistance and a negative acute phase reactant. It also regulates bone remodeling and calcium metabolism being an important inhibitor of calcium salt precipitation and vascular calcifications. METHODS PubMed database was searched for articles from 2002 up to December 2014 to identify the role of fetuin-A in the pathogenesis of selected internal diseases. RESULTS Due to secretion of fetuin-A mainly by the liver, it may be a marker of liver function and predictor of mortality in patients with cirrhosis and hepatocellular cancer. The associations between high fetuin-A and metabolic syndrome as well as its hepatic manifestation- nonalcoholic fatty liver disease and atherogenic lipid profile have been well proven. However, fetuin-A relation with BMI is not so clear. Contrary to few reports, many authors suggest that fetuin-A may be an independent risk factor for type 2 diabetes and marker of diabetic complications. Close associations of high and low fetuin-A concentrations with cardiovascular diseases and mortality risk have been reported which is explained by differences in analyzed populations, stages of atherosclerosis and calcifications, coexistence of type 2 diabetes or kidney dysfunction and different main pathways of fetuin-A actions in various diseases. CONCLUSIONS Fetuin-A has a diagnostic potential as a biomarker for liver dysfunction, cardiovascular diseases and disorders associated with metabolic syndrome.
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Affiliation(s)
| | | | | | - Dariusz Duma
- Department of Laboratory Diagnostics, Medical University of Lublin, Poland
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16
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Yin L, Cai WJ, Zhu LY, Li J, Su XH, Wang XL, Chang XY, Sun K. Association of plasma Fetuin-A and clinical characteristics in patients with new-onset type 2 diabetes mellitus. Int J Clin Exp Med 2015; 8:991-999. [PMID: 25785085 PMCID: PMC4358540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
CONTEXT Fetuin-A is an abundant plasma protein known to inhibit insulin signaling and pathologic calcification, has emerged as a promising candidate biomarker for diabetes risk. OBJECTIVE The objective of this study was to investigate the relationships between plasma Fetuin-A level with clinical characteristics in patients with new-onset type 2 diabetes mellitus (nT2DM). SUBJECTS AND METHODS Plasma Fetuin-A levels, and clinical characteristics were assessed in 100 patients with nT2DM and 100 normal glucose tolerance (NGT). RESULTS nT2DM subjects had significantly higher Fetuin-A levels than NGT subjects (368.5 ± 15.6 vs 152.7 ± 7.1 mg/ml, P < 0.01). In the Pearson's correlation coefficients, Fetuin-A levels and clinical parameters. Fetuin-A was positively correlated with HOMA-insulin resistance index (HOMA-IR), carotid intima media thickness(CIMT), HbA1c, triglyceride (TG), Low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FBG) and 2 h post-glucose load blood glucose (2 h OGTT) (P < 0.05 and P < 0.01), but negatively with fasting plasma insulin (FINS), 2 h plasma insulin after glucose overload (PINS), High-density lipoprotein cholesterol (HDL-C) and HOMA-beta-cell insulin secretion index (HOMA-IS) (P < 0.05 and P < 0.01). However, no significant relationships were observed between plasma Fetuin-A levels and estimated glomerular filtration rate (eGFR), age and gender in nT2DM subjects. In a multiple linear regression analysis, Fetuin-A levels were independently associated with FBG, 2 h OGTT, HOMA-IS, TG, and CIMT (R(2) = 0.6760). CIMT were negatively associated with FINS and HDL-C (r = -0.33, P = 0.008; r = -0.31, P = 0.01, respectively) in the Pearson's analyses. Moreover, they were positively associated with HOMA-IR (r = 0.28, P = 0.03). It showed significant correlations of plasma CIMT with FINS, PINS and HOMA-IR (R(2) = 0.6760). CONCLUSIONS Our study suggests that the plasma Fetuin-A levels may be associated with macroangiopathies in nT2DM patients. Therefore, detecting early plasma Fetuin-A levels nT2DM provides an opportunity to intervene of carotid artery disease in diabetic patients and giving timely treatment for the prevention of diabetic vascular complications.
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Affiliation(s)
- Liang Yin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of MedicineShihezi 832002, Xinjiang, P.R. China
| | - Wei-Juan Cai
- Department of Clinical Laboratory, The First Affiliated Hospital, Shihezi University School of MedicineShihezi 832002, Xinjiang, P.R. China
| | - Ling-Yun Zhu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of MedicineShihezi 832002, Xinjiang, P.R. China
| | - Jun Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of MedicineShihezi 832002, Xinjiang, P.R. China
| | - Xiang-Hui Su
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of MedicineShihezi 832002, Xinjiang, P.R. China
| | - Xiao-Li Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of MedicineShihezi 832002, Xinjiang, P.R. China
| | - Xiang-Yun Chang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of MedicineShihezi 832002, Xinjiang, P.R. China
| | - Kan Sun
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of MedicineShihezi 832002, Xinjiang, P.R. China
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17
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Trepanowski JF, Mey J, Varady KA. Fetuin-A: a novel link between obesity and related complications. Int J Obes (Lond) 2014; 39:734-41. [PMID: 25468829 DOI: 10.1038/ijo.2014.203] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/04/2014] [Accepted: 11/02/2014] [Indexed: 12/13/2022]
Abstract
Fetuin-A (FetA) is a 64-kDa glycoprotein that is secreted from both the liver and adipose tissue. Circulating FetA is elevated in obesity and related disorders including type 2 diabetes mellitus, nonalcoholic fatty liver disease and the metabolic syndrome; and a FetA-related parameter, caliciprotein particle, is highly relevant to vascular calcification in overweight/obese patients with chronic kidney disease. FetA level is also associated with impaired insulin sensitivity and glucose tolerance. Accumulating evidence suggests that elevated FetA level causes impaired glycemic control, as FetA has been implicated in impairment of insulin receptor signaling, toll-like receptor 4 activation, macrophage migration and polarization, adipocyte dysfunction, hepatocyte triacylglycerol accumulation and liver inflammation and fibrosis. Weight loss, aerobic exercise, metformin and pioglitazone have each been shown to be effective for reducing FetA level.
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Affiliation(s)
- J F Trepanowski
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - J Mey
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - K A Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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18
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Yin L, Cai WJ, Chang XY, Li J, Su XH, Zhu LY, Wang XL, Sun K. Association between fetuin-A levels with insulin resistance and carotid intima-media thickness in patients with new-onset type 2 diabetes mellitus. Biomed Rep 2014; 2:839-842. [PMID: 25279156 DOI: 10.3892/br.2014.356] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 07/24/2014] [Indexed: 12/29/2022] Open
Abstract
Fetuin-A, which is known to inhibit insulin signaling and pathological calcification, has emerged as a diabetes risk biomarker. In the present study, the association between the fetuin-A levels with insulin resistance (IR) and carotid intima-media thickness (CIMT) was investigated in patients with new-onset type 2 diabetes mellitus (nT2DM). A total of 100 patients with nT2DM (nT2DM group) and 100 normal glucose tolerance (NGT group) controls were evaluated. The serum fetuin-A level was measured by a commercial solid-phase ELISA kit. The estimate of IR was calculated by homeostasis model assessment (HOMA-IR). CIMT was measured by B-mode ultrasound. The association between the serum fetuin-A levels and the metabolic parameters was also analyzed. The serum fetuin-A levels were increased significantly in the nT2DM group compared to the NGT group (368.5±15.6 mg/ml vs. 152.7±7.1 mg/ml, P<0.01). Fetuin-A was positively correlated with HOMA-IR, CIMT, glycated hemoglobin, triglyceride, low-density lipoprotein cholesterol, body mass index, systolic blood pressure, fasting blood glucose and 2 h post-glucose load blood glucose (P<0.05 and P<0.01), but negatively correlated with fasting plasma insulin, 2 h plasma insulin after glucose overload, high-density lipoprotein cholesterol and HOMA-β-cell insulin secretion index (P<0.05 and P<0.01). To the best of our knowledge, the study demonstrated for the first time that there is a significant association between the serum fetuin-A levels with IR and CIMT in nT2DM. These results indicate that serum fetuin-A levels can be used as independent markers in the diagnosis of macroangiopathies in nT2DM.
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Affiliation(s)
- Liang Yin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Wei-Juan Cai
- Department of Clinical Laboratory, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Xiang-Yun Chang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Jun Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Xiang-Hui Su
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Ling-Yun Zhu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Xiao-Li Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Kan Sun
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
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Lanzer P, Boehm M, Sorribas V, Thiriet M, Janzen J, Zeller T, St Hilaire C, Shanahan C. Medial vascular calcification revisited: review and perspectives. Eur Heart J 2014; 35:1515-25. [PMID: 24740885 PMCID: PMC4072893 DOI: 10.1093/eurheartj/ehu163] [Citation(s) in RCA: 512] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 03/06/2014] [Accepted: 03/21/2014] [Indexed: 12/17/2022] Open
Abstract
Vascular calcifications (VCs) are actively regulated biological processes associated with crystallization of hydroxyapatite in the extracellular matrix and in cells of the media (VCm) or intima (VCi) of the arterial wall. Both patterns of VC often coincide and occur in patients with type II diabetes, chronic kidney disease, and other less frequent disorders; VCs are also typical in senile degeneration. In this article, we review the current state of knowledge about the pathology, molecular biology, and nosology of VCm, expand on potential mechanisms responsible for poor prognosis, and expose some of the directions for future research in this area.
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Affiliation(s)
- Peter Lanzer
- Division of Cardiovascular Disease, Department of Internal Medicine, Health Care Center Bitterfeld, Bitterfeld-Wolfen gGmbH, Friedrich-Ludwig-Jahn-Straße 2, D-06749 Bitterfeld-Wolfen, Germany
| | - Manfred Boehm
- Center for Molecular Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Victor Sorribas
- Laboratory of Molecular Toxicology, University of Zaragoza, Zaragoza, Spain
| | - Marc Thiriet
- National Institute for Research in Computer Science and Control, Paris, France
| | | | - Thomas Zeller
- University Heart Center Freiburg, Bad Krozingen, Germany
| | - Cynthia St Hilaire
- Center for Molecular Medicine, National Institutes of Health, Bethesda, MD, USA
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20
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Abstract
Fetuin-A (also known as α2-Heremans-Schmid glycoprotein) is a multifunctional molecule secreted by the liver. It is a negative acute phase reactant with a debated role in subclinical inflammation. Fetuin-A is an inhibitor of the insulin receptor and its serum level correlates with insulin resistance. The protein has been implicated in adipocyte dysfunction and it is associated with obesity and non-alcoholic fatty liver disease. Although all these properties seem to promote atherosclerosis, the role of fetuin-A in cardiovascular diseases is more complex. As a natural inhibitor of tissue and vascular calcification, fetuin-A also acts as a protective factor in atherosclerosis. The potential role and prognostic value of fetuin-A in arterial calcification and cardiovascular diseases is discussed in this review, along with explanations for seemingly contradicting results in the literature and possible directions for future research.
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Affiliation(s)
- Krisztián Vörös
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - Károly Cseh
- Semmelweis Egyetem, Általános Orvostudományi Kar Népegészségtani Intézet Budapest
| | - László Kalabay
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
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Pandey B, Bhattarai JK, Pornsuriyasak P, Fujikawa K, Catania R, Demchenko AV, Stine KJ. Square-wave voltammetry assays for glycoproteins on nanoporous gold. J Electroanal Chem (Lausanne) 2014; 717-718:47-60. [PMID: 24611035 PMCID: PMC3941082 DOI: 10.1016/j.jelechem.2014.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Electrochemical enzyme-linked lectinsorbent assays (ELLA) were developed using nanoporous gold (NPG) as a solid support for protein immobilization and as an electrode for the electrochemical determination of the product of the reaction between alkaline phosphatase (ALP) and p-aminophenyl phosphate (p-APP), which is p-aminophenol (p-AP). Glycoproteins or concanavalin A (Con A) and ALP conjugates were covalently immobilized onto lipoic acid self-assembled monolayers on NPG. The binding of Con A - ALP (or soybean agglutinin - ALP) conjugate to glycoproteins covalently immobilized on NPG and subsequent incubation with p-APP substrate was found to result in square-wave voltammograms whose peak difference current varied with the identity of the glycoprotein. NPG presenting covalently bound glycoproteins was used as the basis for a competitive electrochemical assay for glycoproteins in solution (transferrin and IgG). A kinetic ELLA based on steric hindrance of the enzyme-substrate reaction and hence reduced enzymatic reaction rate after glycoprotein binding is demonstrated using immobilized Con A-ALP conjugates. Using the immobilized Con A-ALP conjugate, the binding affinity of immunoglobulin G (IgG) was found to be 105 nM, and that for transferrin was found to be 650 nM. Minimal interference was observed in the presence of 5 mg mL-1 BSA as a model serum protein in both the kinetic and competitive ELLA. Inhibition studies were performed with methyl D-mannoside for the binding of TSF and IgG to Con A-ALP; IC50 values were found to be 90 μM and 286 μM, respectively. Surface coverages of proteins were estimated using solution depletion and the BCA protein concentration assay.
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Affiliation(s)
- Binod Pandey
- Department of Chemistry and Biochemistry University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
- Center for Nanoscience University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
| | - Jay K. Bhattarai
- Department of Chemistry and Biochemistry University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
- Center for Nanoscience University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
| | - Papapida Pornsuriyasak
- Department of Chemistry and Biochemistry University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
| | - Kohki Fujikawa
- Department of Chemistry and Biochemistry University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
| | - Rosa Catania
- Department of Chemistry and Biochemistry University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
| | - Alexei V. Demchenko
- Department of Chemistry and Biochemistry University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
| | - Keith J. Stine
- Department of Chemistry and Biochemistry University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
- Center for Nanoscience University of Missouri-St. Louis One University Boulevard Saint Louis, MO 63121
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22
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Bakiner O, Bozkirli E, Ertugrul D, Sezgin N, Ertorer E. Plasma fetuin-A levels are reduced in patients with hypothyroidism. Eur J Endocrinol 2014; 170:411-8. [PMID: 24366942 DOI: 10.1530/eje-13-0831] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine plasma fetuin-A levels in hypothyroid patients before and after treatment with l-thyroxine (T4) and to determine the relation between plasma fetuin-A levels with cardiovascular risk factors. DESIGN A prospective, controlled, single-blind study. METHODS Forty-four treatment-naive female patients diagnosed with hypothyroidism and 39 age- and sex-matched control subjects were enrolled. Anthropometric measurements, blood pressure, plasma TSH, fetuin-A, free T4, LDL-cholesterol, triglyceride, C-reactive protein, fibrinogen levels, and brachial artery flow-mediated dilatation were measured. All measurements were repeated after 3 months in the control group and 3 months after the attainment of euthyroidism with l-T4 replacement in the hypothyroid group. Baseline data were compared between the two groups. Posttreatment plasma fetuin-A levels of hypothyroid patients were compared with baseline levels of both groups. The relationship between plasma fetuin-A, TSH levels, and other cardiovascular risk factors was evaluated. RESULTS Plasma fetuin-A levels were ∼20% lower in hypothyroid female patients compared with the controls (P=0.0001). Fetuin-A levels increased by ∼20% in hypothyroid patients after achievement of euthyroidism (P=0.0001) and were no longer different compared with controls (P=0.38). There was a negative correlation between plasma TSH and fetuin-A levels (r=-0.79; P=0.001). There was no significant correlation between plasma fetuin-A levels and cardiovascular risk factors within or between groups. The fetuin-A levels were normalized with thyroid hormone treatment. CONCLUSION Plasma fetuin-A levels are reduced in female patients with hypothyroidism, which are restored to normal during restoration of euthyroidism. There was no relation with cardiovascular risk factors.
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Affiliation(s)
- Okan Bakiner
- Department of Endocrinology and Metabolism Diseases, Faculty of Medicine, Baskent University, Dadaloglu Mah. Serinevler 2591 Sk., No:4/A 01250 Yuregir/ADANA, Adana, Turkey
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Jiménez MC, Sun Q, Schürks M, Hu FB, Manson JE, Rexrode KM. Circulating fetuin-A and risk of ischemic stroke in women. Clin Chem 2013; 60:165-73. [PMID: 24170613 DOI: 10.1373/clinchem.2013.212597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fetuin-A, a protein secreted primarily by the liver, has been associated with nonalcoholic fatty liver disease and insulin resistance. In a recent study, higher circulating fetuin-A was associated with cardiovascular events, particularly ischemic stroke. However, these data have not been replicated. METHODS A nested case control design was used to examine the relationship between fetuin-A and ischemic stroke among female participants of the Nurses' Health Study. Fetuin-A was measured in blood samples collected and stored between 1989 and 1990. A total of 459 incident cases of ischemic stroke were identified and confirmed by medical records according to the National Survey of Stroke criteria between 1990 and 2006 and matched to 459 controls by age, race/ethnicity, date of sample collection, menopausal status, postmenopausal hormone use, and smoking status. The association between fetuin-A and ischemic stroke was modeled using conditional logistic regression. RESULTS Circulating fetuin-A was higher in women (P < 0.01) who reported increased body mass index (BMI) of ≥25 kg/m(2), total cholesterol ≥200 mg/dL, high-sensitivity C-reactive protein ≥3 mg/L, and current hormone use at baseline. Significant partial Spearman correlations (P < 0.001), adjusted for matching factors, were found between measured concentrations of fetuin-A and triglycerides (r = 0.20), C-reactive protein (r = 0.14), and BMI (r = 0.15). Fetuin-A quartiles were not significantly associated with increased risk of incident ischemic stroke when adjusted for matching factors (relative risk, 1.03; 95% CI, 0.69-1.54, extreme quartiles); additional adjustment for lifestyle factors or cardiovascular disease risk factors and biomarkers did not alter results. CONCLUSIONS In this sample of women, fetuin-A was not significantly associated with risk of ischemic stroke. Further research is needed to explore this association.
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Affiliation(s)
- Monik C Jiménez
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA
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Urinary fetuin-A is a novel marker for diabetic nephropathy in type 2 diabetes identified by lectin microarray. PLoS One 2013; 8:e77118. [PMID: 24143207 PMCID: PMC3797112 DOI: 10.1371/journal.pone.0077118] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/30/2013] [Indexed: 12/30/2022] Open
Abstract
We analyzed the urine samples of patients with type 2 diabetes at various stages of diabetic nephropathy by lectin microarray to identify a biomarker to predict the progression of diabetic nephropathy. Japanese patients with type 2 diabetes at various stages of nephropathy were enrolled and we performed lectin microarray analyses (n = 17) and measured urinary excretion of fetuin-A (n = 85). The increased signals of urine samples were observed in Siaα2-6Gal/GalNAc-binding lectins (SNA, SSA, TJA-I) during the progression of diabetic nephropathy. We next isolated sialylated glycoproteins by using SSA-lectin affinity chromatography and identified fetuin-A by liquid chromatography–tandem mass spectrometer. Urinary excretion of fetuin-A significantly increased during the progression of albuminuria (A1, 0.40±0.43; A2, 0.60±0.53; A3 1.57±1.13 ng/gCr; p = 7.29×10−8) and of GFR stages (G1, 0.39±0.39; G2, 0.49±0.45; G3, 1.25±1.18; G4, 1.34±0.80 ng/gCr; p = 3.89×10−4). Multivariate logistic regression analysis was employed to assess fetuin-A as a risk for diabetic nephropathy with microalbuminuria or GFR<60 mL/min. Fetuin-A is demonstrated as a risk factor for both microalbuminuria and reduction of GFR in diabetic nephropathy with the odds ratio of 4.721 (1.881–11.844) and 3.739 (1.785–7.841), respectively. Collectively, the glycan profiling analysis is useful method to identify the urine biomarkers and fetuin-A is a candidate to predict the progression of diabetic nephropathy.
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Jung CH, Kim BY, Kim CH, Kang SK, Jung SH, Mok JO. Associations of serum fetuin-A levels with insulin resistance and vascular complications in patients with type 2 diabetes. Diab Vasc Dis Res 2013; 10:459-67. [PMID: 23811603 DOI: 10.1177/1479164113490766] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We examined the relationship between serum fetuin-A, insulin resistance (IR), metabolic syndrome (MS) and vascular complications including cardiac autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 172 T2DM patients were recruited and evaluated for diabetic microangiopathies (nephropathy, retinopathy and peripheral neuropathy) including CAN. Serum fetuin-A levels were measured by enzyme-linked immunosorbent assay (ELISA), and the IR was assessed by the index of homeostasis model [homeostasis model assessment-insulin resistance (HOMA-IR)]. Atherosclerotic burden was assessed by ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV). RESULTS Serum fetuin-A levels showed significant positive correlations with HOMA-IR (r = 0.196, p = 0.022), and the mean levels of HOMA-IR were significantly increased progressively across fetuin-A tertiles (p for trend = 0.044). Serum fetuin-A showed significant positive correlations with baPWV, systolic blood pressure (BP), total cholesterol, triglycerides, serum fasting c-peptide and negative correlations with ABI. Serum fetuin-A levels were also negatively correlated with serum adiponectin and positively correlated with serum tumour necrosis factor-α (TNF-α). The mean levels of serum fetuin-A were not significantly different according to the presence of each microangiopathies including CAN. Also, the mean levels of serum fetuin-A were not different between patients with MS and without MS. CONCLUSIONS This present study showed that levels of serum fetuin-A are significantly associated with IR and arterial stiffness assessed by baPWV, while there are no associations with each microangiopathies in patients with T2DM.
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Affiliation(s)
- Chan-Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Republic of Korea
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Herrmann M, Kinkeldey A, Jahnen-Dechent W. Fetuin-A Function in Systemic Mineral Metabolism. Trends Cardiovasc Med 2012; 22:197-201. [DOI: 10.1016/j.tcm.2012.07.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Eraso LH, Fukaya E, Mohler ER, Xie D, Sha D, Berger JS. Peripheral arterial disease, prevalence and cumulative risk factor profile analysis. Eur J Prev Cardiol 2012; 21:704-11. [PMID: 22739687 DOI: 10.1177/2047487312452968] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The primary aim of the present study was to determine the cumulative effect of a set of peripheral artery disease (PAD) risk factors among age, gender and race/ethnicity groups in the United States. METHODS We examined data from a nationally representative sample of the US population (National Health and Nutrition Examination Survey [NHANES], 1999-2004). A total of 7058 subjects 40 years or older that completed the interview, medical examination and had ankle-brachial index (ABI) measurements were included in this study. RESULTS The age- and sex-standardized prevalence of PAD was 4.6 % (standard error [SE] 0.3%).The highest prevalence of PAD was observed among elderly, non-Hispanic Blacks and women. In a multivariable age-, gender- and race/ethnicity-adjusted model hypertension, diabetes, chronic kidney disease, and smoking were retained as PAD risk factors (p ≤ 0.05 for each). The odds of PAD increased with each additional risk factor present from a non-significant 1.5-fold increase (O.R 1.5, 95% confidence interval [CI] 0.9-2.6) in the presence of one risk factor, to more than ten-fold (OR 10.2, 95% CI 6.4-16.3) in the presence of three or more risk factors. In stratified analysis, non-Hispanic Blacks (OR 14.7, 95% CI 2.1-104.1) and women (OR 18.6, 95% CI 7.1-48.7) were particularly sensitive to this cumulative effect. CONCLUSION In a large nationally representative sample, an aggregate set of risk factors that included diabetes mellitus, chronic kidney disease, hypertension and smoking significantly increase the likelihood of prevalent PAD. A cumulative risk factor analysis highlights important susceptibility differences among different population groups and provides additional evidence to redefine screening strategies in PAD.
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Affiliation(s)
- Luis H Eraso
- Jefferson Vascular Center, Departments of Medicine and Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eri Fukaya
- Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Emile R Mohler
- Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Dawei Xie
- Departments of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Daohang Sha
- Departments of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jeffrey S Berger
- Cardiology, Hematology and Vascular Surgery, New York University School of Medicine, New York, NY, USA
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Ix JH, Biggs ML, Mukamal KJ, Kizer JR, Zieman SJ, Siscovick DS, Mozzaffarian D, Jensen MK, Nelson L, Ruderman N, Djousse L. Association of fetuin-a with incident diabetes mellitus in community-living older adults: the cardiovascular health study. Circulation 2012; 125:2316-22. [PMID: 22511752 DOI: 10.1161/circulationaha.111.072751] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The liver-secreted protein fetuin-A induces peripheral insulin resistance in vitro. In a pilot study, we observed that higher fetuin-A levels were associated with diabetes mellitus in older persons. However, this finding has not been confirmed in large cohorts. We sought to confirm the association of fetuin-A with incident diabetes mellitus in older persons and to determine whether the association differs by age, sex, and race and among persons with cardiovascular disease (CVD). METHODS AND RESULTS Among 3710 community-living individuals ≥ 65 years of age without diabetes mellitus at baseline, fetuin-A was measured in serum collected in 1992 to 1993. Participants were followed up for 10.6 years (median) for incident diabetes mellitus. Cox regression models evaluated the association of fetuin-A with incident diabetes mellitus. Interaction terms evaluated heterogeneity by age, sex, race, and CVD. Mean age was 75 years; 60 were female; 15 were black; and 16 had CVD. Mean fetuin-A concentrations were 0.47 ± 0.10 g/L. During follow-up, 305 incident diabetes cases occurred. Each 0.10-g/L (SD)-greater fetuin-A was associated with 19 higher risk of diabetes mellitus (hazard ratio, 1.19; 95 confidence interval, 1.06-1.33) after adjustment for demographics, lifestyle factors, albumin, kidney function, and CVD. Further adjustment for potential mediators (body mass index, waist circumference, hypertension, lipids, and C-reactive protein) moderately attenuated the association (hazard ratio, 1.13; 95 confidence interval, 1.00-1.28). Results were similar by sex, race, and CVD status but were stronger in persons <75 years old (P for interaction=0.01). CONCLUSIONS Higher fetuin-A is associated with incident diabetes mellitus in older persons regardless of sex, race, or prevalent CVD status. The association may be attenuated in those ≥ 75 years of age.
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Affiliation(s)
- Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego VA Healthcare System, San Diego, CA 92161, USA.
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Ix JH, Katz R, de Boer IH, Kestenbaum BR, Peralta CA, Jenny NS, Budoff M, Allison MA, Criqui MH, Siscovick D, Shlipak MG. Fetuin-A is inversely associated with coronary artery calcification in community-living persons: the Multi-Ethnic Study of Atherosclerosis. Clin Chem 2012; 58:887-95. [PMID: 22377528 DOI: 10.1373/clinchem.2011.177725] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Fetuin-A is a hepatic secretory protein that inhibits arterial calcification in vitro. The association of fetuin-A with coronary arterial calcification (CAC) in the general population is uncertain. METHODS Among 2457 community-living individuals without cardiovascular disease (CVD), we measured serum fetuin-A concentrations by ELISA and evaluated the cross-sectional association of fetuin-A with CAC prevalence (any vs none) and severity; on follow-up 3.2 years (median) later, we evaluated the association of fetuin-A with CAC incidence and progression. RESULTS The mean age was 62 (SD 10) years, and the mean fetuin-A concentration was 0.48 (0.10) g/L. At baseline, 1200 individuals (49%) had CAC, and 272 individuals developed CAC during follow-up. At baseline, there was a threshold effect at the lowest fetuin-A quartile with CAC prevalence. In models adjusted for demographics, traditional cardiovascular disease (CVD) risk factors and kidney function, the lowest fetuin-A quartile had 7% (95% CI 1%-13%; P = 0.04) greater CAC prevalence compared with quartiles 2-4. Similar associations were observed with CAC severity at baseline, but the association was more linear. Each SD (0.10 g/L) lower fetuin-A was associated with a 12% (95% CI 3%-21%; P = 0.01) greater CAC severity in adjusted models. There was no significant association of fetuin-A with CAC incidence or progression. CONCLUSIONS Fetuin-A is inversely associated with CAC severity among community-living individuals without CVD. Whether fetuin-A concentrations are associated with incident CVD event in the general population requires future study.
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Affiliation(s)
- Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
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Ix JH, Barrett-Connor E, Wassel CL, Cummins K, Bergstrom J, Daniels LB, Laughlin GA. The associations of fetuin-A with subclinical cardiovascular disease in community-dwelling persons: the Rancho Bernardo Study. J Am Coll Cardiol 2012; 58:2372-9. [PMID: 22115642 DOI: 10.1016/j.jacc.2011.08.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 08/09/2011] [Accepted: 08/18/2011] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine the association of fetuin-A with subclinical cardiovascular disease (CVD) in community-living individuals. BACKGROUND Fetuin-A is a hepatic secretory protein that inhibits arterial calcium deposition in vitro. Lower fetuin-A levels are associated with arterial calcification and death in end-stage renal disease populations. The association of fetuin-A with subclinical CVD in the general population is unknown. METHODS Among 1,375 community-living individuals without prevalent clinical CVD, we measured plasma fetuin-A concentrations. Peripheral arterial disease (PAD) was defined by ankle brachial index <0.90, coronary artery calcification (CAC) was measured by computed tomography, and common and internal intima-media thickness (cIMT) were measured by carotid ultrasound. PAD was measured concurrent with fetuin-A, and CAC and cIMT were measured 4.6 years (mean) later. RESULTS Mean age was 70 ± 11 years, and 64% were women. Fetuin-A levels were inversely associated with CAC severity. When evaluated as CAC categories (0, 1 to 100, 101 to 300, >300) with ordinal logistic regression, each SD higher fetuin-A was associated with 31% lower odds of CAC severity (proportional odds ratio: 0.69; 95% confidence interval: 0.46 to 0.92; p = 0.008) in models adjusted for demographic data, lifestyle factors, traditional CVD risk factors, and kidney function. In contrast, no association of fetuin-A was observed with PAD or high common or internal cIMT in adjusted models. CONCLUSIONS Lower fetuin-A levels are independently associated with greater CAC severity but not PAD or cIMT. If confirmed, fetuin-A might mark calcium deposition within the vasculature but not atherosclerosis per se.
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Affiliation(s)
- Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California 92161, USA.
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Abstract
Fetuin was first isolated from bovine serum in 1944. It is now most commonly known as either fetuin-A or alpha-2-HS-glycoprotein (AHSG), the protein product of Ahsg gene. A prominent feature of this protein is the functional diversity exerted in human physiology and pathophysiology. Fetuin-A plays a role in bone metabolism, metabolic disorders such as insulin resistance and diabetes mellitus (DM), and central nervous system (CNS) disorders such as ischemic stroke (IS) and neurodegenerative diseases. In addition, emerging evidence suggests involvement of fetuin-A in the cardiovascular system. However, there are many discordant findings on the associations between fetuin-A and vascular diseases. In other words, it is unknown whether fetuin-A is an exacerbating or a protective factor in the cardiovascular system. One reason for the seemingly inconsistent behavior is the dual functionality of fetuin-A in vascular diseases where it can act as an atherogenic factor or as a vascular calcification inhibitor. In addition, the existence of confounding factors such as DM and renal dysfunction can veil the primary association between fetuin-A and clinical parameters. Considering these issues, we discuss the role of fetuin-A for atherosclerosis and vascular calcification in this review.
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Affiliation(s)
- Katsuhito Mori
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
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Yang SJ, Hong HC, Choi HY, Yoo HJ, Cho GJ, Hwang TG, Baik SH, Choi DS, Kim SM, Choi KM. Effects of a three-month combined exercise programme on fibroblast growth factor 21 and fetuin-A levels and arterial stiffness in obese women. Clin Endocrinol (Oxf) 2011; 75:464-9. [PMID: 21521346 DOI: 10.1111/j.1365-2265.2011.04078.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We examined the relationship between brachial-ankle pulse wave velocity (baPWV) reflecting arterial stiffness and the levels of novel hepatokines fibroblast growth factor 21 (FGF21) and fetuin-A. In addition, we evaluated the effect of a 3-month combined aerobic and resistance exercise programme on FGF21 and fetuin-A levels as well as arterial stiffness in obese women. METHODS Forty nondiabetic, obese women (body mass index = 27·6 ± 2·4 kg/m(2) ) were included in the study and were compared before and after a 3-month exercise programme, which was composed of 45 min of aerobic exercise at an intensity of 60-75% of the age-predicted maximum heart rate (300 kcal/session) and 20 min of resistance training (100 kcal/session) five times a week. All exercise sessions were supervised by a professional exercise physiologist. RESULTS At baseline, baPWV levels were correlated with age, body mass index (BMI), systolic blood pressure (SBP), high density lipoprotein cholesterol, fasting glucose and serum FGF21 levels. In a multiple stepwise regression analysis using baPWV as a dependent variable, baPWV levels were associated with age, BMI, SBP, FGF21 and fetuin-A levels (R(2) = 0·744). After the exercise programme, BMI, waist circumference, SBP, diastolic blood pressure and triglyceride levels were significantly decreased. Moreover, baPWV values were significantly improved (P < 0·001) along with modest decrease in FGF21 levels (P = 0·043). However, fetuin-A levels were not changed significantly (P = 0·202). CONCLUSIONS A 3-month combined exercise programme decreases the FGF21 levels as well as arterial stiffness in obese Korean women.
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Affiliation(s)
- Sae Jeong Yang
- Division of Endocrinology and Metabolism, Korea University College of Medicine, Seoul, Korea
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Vörös K, Gráf L, Prohászka Z, Gráf L, Szenthe P, Kaszás E, Böröcz Z, Cseh K, Kalabay L. Serum fetuin-A in metabolic and inflammatory pathways in patients with myocardial infarction. Eur J Clin Invest 2011; 41:703-9. [PMID: 21226708 DOI: 10.1111/j.1365-2362.2010.02456.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although multifunctional glycoprotein α2HS-glycoprotein/human fetuin-A (AHSG) is involved in atherosclerosis, it is not clear whether high or low concentrations are more important. We studied the correlation of serum AHSG with adiponectin, leptin, resistin, C-reactive protein (CRP) and tumour necrosis factor-α (TNF-α) to see whether its metabolic effects or its involvement in subclinical inflammation are dominant in patients with established coronary disease. MATERIALS AND METHODS In this cross-sectional study, AHSG concentration was determined in sera of 171 patients (age: 62 ± 6 years, mean ± SD) with previous myocardial STEMI infarction and normal renal function and 81 age-matched healthy controls by radial immunodiffusion. Results Patients had increased AHSG levels (673 ± 103 vs. 619 ± 96 mg L(-1), P < 0·001) compared to controls. Obese and diabetic patients had higher AHSG concentration than those with normal BMI or without diabetes but even the latter group had elevated AHSG levels (667 ± 101 mg L(-1), n = 88) compared to controls (P = 0·002). Serum AHSG correlated negatively with adiponectin (r = -0·236, P = 0·006) even after adjusting for BMI (r = -0·177, P = 0·043). AHSG determined adiponectin levels independently from BMI, age and other adipocytokines (P = 0·014). The correlation between leptin and AHSG (r = 0·321, P = 0·021) weakened following adjustment for BMI (r = 0·209, P = 0·072). Serum AHSG did not correlate significantly with CRP, resistin and TNF-α concentrations. BMI and resistin but not AHSG determined TNF-α levels independently. CONCLUSIONS AHSG is elevated in sera of patients with previous myocardial infarction. Association with adipokines favours the concept that AHSG is involved in atherosclerosis more likely through metabolic pathways (insulin resistance, obesity and adipocyte dysfunction) than by inflammation in patients with post-myocardial infarction.
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Affiliation(s)
- Krisztián Vörös
- Department of Family Medicine, Semmelweis University, Budapest, Hungary.
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Szeberin Z, Fehérvári M, Krepuska M, Apor A, Rimely E, Sarkadi H, Bíró G, Sótonyi P, Széplaki G, Szabolcs Z, Prohászka Z, Kalabay L, Acsády G. Fetuin-A serum levels in patients with aortic aneurysms of Marfan syndrome and atherosclerosis. Eur J Clin Invest 2011; 41:176-82. [PMID: 21039445 DOI: 10.1111/j.1365-2362.2010.02393.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fetuin-A is a glycoprotein that inhibits extraosseous and vascular calcification. Its serum level is lower in patients with atherosclerosis compared with healthy controls, but its role is unknown in aneurysmal diseases. The aim of our study was to investigate the association of serum fetuin-A levels with aortic aneurysms of different aetiology: Marfan syndrome and atherosclerosis. MATERIAL AND METHODS In a single centre cross-sectional observational study, 105 patients (30 with atherosclerotic aortic aneurysm, 15 with Marfan syndrome, 30 with peripheral arterial disease and 30 healthy controls) were examined; sera were analysed for fetuin-A, standard markers of possible inflammation, lipid profile, kidney and hepatic disease and diabetes. Systemic atherosclerosis was assessed by carotid intima-media thickness (IMT) measurement and arterial calcification score of cardiac valves, carotids, aorta and femoral arteries determined by ultrasound. RESULTS Serum fetuin-A levels (median and IQR) were significantly lower in the atherosclerotic aneurysm cohort than in patients with Marfan syndrome: 708 μg mL⁻¹ (612-780) and 756 μg mL⁻¹ (708-816), respectively, (P = 0·0428). Fetuin-A levels were 754 μg mL⁻¹ (713-777) in the control group and 654 μg mL⁻¹ (600-756) in patients with peripheral arterial disease. Mean and maximum IMT, ACS values and homocysteine levels were significantly higher in patients with atherosclerosis: P < 0·0001, P < 0·0001, P < 0·0001 and P = 0·0034, respectively. There was no significant difference between aneurysm groups analysing the results of lipid profile and acute-phase markers. CONCLUSIONS The significantly lower serum level of fetuin-A in the atherosclerotic aneurysm group supports the protective role of fetuin-A in the evolution of arterial calcification.
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Affiliation(s)
- Zoltán Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary.
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Xu Y, Xu M, Bi Y, Song A, Huang Y, Liu Y, Wu Y, Chen Y, Wang W, Li X, Ning G. Serum fetuin-A is correlated with metabolic syndrome in middle-aged and elderly Chinese. Atherosclerosis 2011; 216:180-6. [PMID: 21310413 DOI: 10.1016/j.atherosclerosis.2011.01.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 12/28/2010] [Accepted: 01/07/2011] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Fetuin-A is an important player in the enhancement of insulin resistance. We aimed to investigate the association of serum fetuin-A and metabolic syndrome (MetS) in a community based Chinese population. METHODS A total of 5469 subjects aged 40 years or above were recruited from two urban communities in Shanghai. Demographic, anthropometric and biochemical features were collected according to a standard protocol. Serum fetuin-A levels were measured using ELISA and the modified NCEP-ATP III criteria were adopted to diagnose MetS. RESULTS A higher level of serum fetuin-A was well associated with a variety of metabolic disorders and an increased prevalence of MetS. The relative risks for MetS were markedly elevated in a dose-dependent manner both before and after extended adjustment in total participants (adjusted odds ratios were 1.00, 1.11, 1.20 and 1.40 for fetuin-A quartiles 1, 2, 3 and 4, respectively; P value for trend = 0.0002). MetS risks were also significantly associated with serum fetuin-A in various subgroups of sex, age, body mass index and glycaemic status. Moreover, an elevated serum fetuin-A was also independently associated with MetS components including central obesity, high blood pressure, high blood glucose and high triglycerides. Stepwise regression analyses revealed fetuin-A as an independent determinant of insulin resistance measured by the index of homeostasis model (HOMA-IR) (β = 0.064; P = 0.009). CONCLUSION Serum fetuin-A levels were strongly and independently associated with MetS and its components in community-dwelling Chinese adults.
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Affiliation(s)
- Yu Xu
- State Key Laboratory of Medical Genomics, E-Institute of Shanghai Universities, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200025, China
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Lorant DP, Grujicic M, Hoebaus C, Brix JM, Hoellerl F, Schernthaner G, Koppensteiner R, Schernthaner GH. Fetuin-A levels are increased in patients with type 2 diabetes and peripheral arterial disease. Diabetes Care 2011; 34:156-61. [PMID: 20929991 PMCID: PMC3005446 DOI: 10.2337/dc10-0788] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Low levels of fetuin-A, a systemic calcification inhibitor, are linked to mortality in patients on dialysis. In contrast, elevated fetuin-A is associated with cardiovascular events in non-renal patients. We investigated fetuin-A in patients with type 2 diabetes and peripheral arterial disease (PAD). RESEARCH DESIGN AND METHODS We studied fetuin-A in 76 patients with PAD and normal glucose metabolism (NGM-PAD) and in 129 patients with PAD and type 2 diabetes (type 2 diabetes-PAD). Additionally, 40 patients with diabetes without any complications (type 2 diabetes-non-PAD) were examined. RESULTS Type 2 diabetes-PAD subjects (399 ± 155 μg/ml) had significantly higher fetuin-A levels than type 2 diabetes-non-PAD subjects (247 ± 42; P < 0.001). In NGM-PAD subjects (376 ± 144), fetuin-A was significantly higher than in type 2 diabetes-non-PAD subjects (P < 0.001). Type 2 diabetes-PAD patients with mediasclerosis had lower fetuin-A than subjects without (P < 0.03). Regression analysis in type 2 diabetes-PAD subjects revealed that glycated A1C (P < 0.001) and mediasclerosis (P = 0.004) were the strongest predictors of fetuin-A. Multivariate regression revealed that a 1-SD increase in fetuin-A was associated with an odds ratio (OR) of 2.1 (95% CI 1.1-3.3; P < 0.001) for the prevalence of PAD and an OR of 1.4 (1.0-1.7, P = 0.039) for the prevalence of myocardial infarction. CONCLUSIONS In contrast to previous findings, fetuin-A was higher in type 2 diabetes-PAD patients than in type 2 diabetes-non-PAD patients. In NGM-PAD patients, fetuin-A was also higher than in type 2 diabetes-non-PAD patients. In type 2 diabetes-PAD patients, fetuin-A was inversely associated with mediasclerosis-the calcification process pathognomonic for diabetic PAD. This association persisted in multivariate regression, which is in line with the calcification inhibition in coronary heart or renal disease.
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Affiliation(s)
- David Peter Lorant
- Department of Medicine II, Medical University of Vienna, Vienna, Austria
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37
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Roos M, Oikonomou D, von Eynatten M, Luppa PB, Heemann U, Lutz J, Baumann M, Nawroth PP, Bierhaus A, Humpert PM. Associations of fetuin-A levels with vascular disease in type 2 diabetes patients with early diabetic nephropathy. Cardiovasc Diabetol 2010; 9:48. [PMID: 20822519 PMCID: PMC2949712 DOI: 10.1186/1475-2840-9-48] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 09/07/2010] [Indexed: 12/29/2022] Open
Abstract
Background Ambigous results exist on fetuin-A as marker for vascular disease in type 2 diabetes. This study aims to define the role of fetuin-A as marker for micro- and macrovascular disease in a high risk population of patients with type 2 diabetes mellitus and early diabetic nephropathy. Methods Fetuin-A serum levels were assessed by ELISA in a cross-sectional setting in 153 patients with type 2 diabetes. Associations of fetuin-A with metabolic, inflammatory and vascular markers were studied. Atherosclerotic burden was assessed by ankle-brachial-index (ABI) as well as detection of common carotid artery intima-media thickness (IMT). Results Levels of fetuin-A were lower in male than in female patients (0.49 ± 0.15 vs. 0.56 ± 0.20 g/L, p = 0.02). In addition, there was an inverse correlation with age (r = -0.20, P = 0.01). Bivariate correlations adjusted for age and gender revealed no significant correlations with metabolic parameters, except for a weak inverse correlation with serum adiponectin (r = -0.19, p = 0.02). Regarding parameters of micro- and macrovascular disease, fetuin-A was significantly associated with ABI (r = 0.18, p = 0.04), while there was no association with IMT (r = -0.07, p = n.s). Patients with an ABI < 0.9 had lower fetuin A levels than patients with an ABI 0.9-1.3 or > 1.3 (0.43 ± 0.10 vs. 0.52 ± 0.17 vs. 0.54 ± 0.18 g/L p = 0.05). Neither GFR nor albuminuria were associated with fetuin-A serum levels. Patients with prevalent neuropathy did not have altered fetuin-A levels compared to diabetic controls. In step-wise logistic regression analysis including age, gender, HbA1c, total cholesterol, glomerular filtration rate and fetuin-A, only total cholesterol (β = 0.01, p = 0.02) and fetuin-A (β = -5.99, p = 0.03) proved to be independent predictors of an ABI < 0.9. Conclusions The results of this cross-sectional study suggest that lower fetuin-A levels are associated with macrovascular late complications in high-risk type 2 diabetes patients while there are no associations of fetuin-A with metabolic status or microvascular complications.
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Affiliation(s)
- Marcel Roos
- Department of Nephrology, Klinikum rechts der Isar, Munich, Germany.
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Stefan N, Weikert C, Ix JH, Fritsche A, Häring HU. Association of lower plasma fetuin-a levels with peripheral arterial disease in type 2 diabetes: response to Eraso et al. Diabetes Care 2010; 33:e55; author reply e56. [PMID: 20351222 DOI: 10.2337/dc10-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Norbert Stefan
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Cornelia Weikert
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany
| | - Joachim H. Ix
- Department of Medicine, Division of Nephrology, and Division of Preventive Medicine, University of California San Diego, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Andreas Fritsche
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University of Tübingen, Tübingen, Germany
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