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Spyksma EE, Alexandridou A, Mai K, Volmer DA, Stokes CS. An Overview of Different Vitamin D Compounds in the Setting of Adiposity. Nutrients 2024; 16:231. [PMID: 38257127 PMCID: PMC10820956 DOI: 10.3390/nu16020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
A large body of research shows an association between higher body weight and low vitamin D status, as assessed using serum 25-hydroxyvitamin D concentrations. Vitamin D can be metabolised in adipose tissue and has been reported to influence gene expression and modulate inflammation and adipose tissue metabolism in vitro. However, the exact metabolism of vitamin D in adipose tissue is currently unknown. White adipose tissue expresses the vitamin D receptor and hydroxylase enzymes, substantially involved in vitamin D metabolism and efficacy. The distribution and concentrations of the generated vitamin D compounds in adipose tissue, however, are largely unknown. Closing this knowledge gap could help to understand whether the different vitamin D compounds have specific health effects in the setting of adiposity. This review summarises the current evidence for a role of vitamin D in adipose tissue and discusses options to accurately measure vitamin D compounds in adipose tissue using liquid chromatography tandem mass spectrometry (LC/MS-MS).
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Affiliation(s)
- Eva E. Spyksma
- Food and Health Research Group, Faculty of Life Sciences, Humboldt University Berlin, 14195 Berlin, Germany;
- Bioanalytical Chemistry, Department of Chemistry, Humboldt University Berlin, 12489 Berlin, Germany; (A.A.); (D.A.V.)
| | - Anastasia Alexandridou
- Bioanalytical Chemistry, Department of Chemistry, Humboldt University Berlin, 12489 Berlin, Germany; (A.A.); (D.A.V.)
| | - Knut Mai
- Department of Endocrinology & Metabolism, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany;
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- German Center for Diabetes Research, 90451 Nuremberg, Germany
- Department of Human Nutrition, German Institute of Human Nutrition, 14558 Nuthetal, Germany
| | - Dietrich A. Volmer
- Bioanalytical Chemistry, Department of Chemistry, Humboldt University Berlin, 12489 Berlin, Germany; (A.A.); (D.A.V.)
| | - Caroline S. Stokes
- Food and Health Research Group, Faculty of Life Sciences, Humboldt University Berlin, 14195 Berlin, Germany;
- Department of Molecular Toxicology, German Institute of Human Nutrition, 14558 Nuthetal, Germany
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Schorr P, Stokes CS, Volmer DA. Improved quantitative LC-MS/MS analysis of vitamin D metabolites in serum after one-pot double derivatization. J Pharm Biomed Anal 2023; 234:115522. [PMID: 37329649 DOI: 10.1016/j.jpba.2023.115522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
In this study, we report a one-pot double derivatization scheme, which used acetylation after a Diels-Alder reaction using 4-phenyl-1,2,4-triazoline-3,5-dione (PTAD) to improve separation efficiency and provide baseline separations of the five vitamin D metabolites 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), 24,25-dihydroxyvitamin D3 (24,25(OH)2D3), 3β-25-hydroxyvitamin D3 (3β-25(OH)D3), 3α-25-hydroxyvitamin D3 (3α-25(OH)D3) and vitamin D3 on a C-18 stationary phase. Vitamin D metabolites are often very challenging to measure quantitatively using mass spectrometry, due to their low serum concentration levels and low ionization efficiencies. Moreover, some of these species are isomers with virtually identical mass spectral dissociation behavior. To overcome the low ionization efficiency and unspecific fragmentation behavior, derivatization using Diels-Alder reactions with Cookson-type reagents such as PTAD are common. These derivatization reactions generally result in more complicated liquid chromatography separations, because both 6R- and 6S-isomers are formed during Diels-Alder reactions. It has been shown that separations have been particularly challenging for the 3α-25(OH)D3 and 3β-25(OH)D3 epimers. Here, we optimized the PTAD derivatization and the esterification using acetic anhydride. By utilizing the esterification catalyst 4-dimethylaminopyridine, we avoided quenching and evaporation between the two derivatization steps, but were also able to perform the esterification at room temperature without heating. The optimized one-pot double derivatization LC-MS/MS assay was validated with respect to inter/intra-day precision, accuracy, recovery and linear dynamic range and applied to metabolic fingerprinting of vitamin D3 metabolites in serum samples. The metabolites 3α-25(OH)D3, 3β-25(OH)D3 and 24,25(OH)2D3, were readily quantified in all investigated samples. The method was, in principle, also fit for purpose for quantification of the native vitamin D3 species; the relatively high blank concentration of the commercial vitamin D-depleted serum used for calibration, however, limited the limits of quantification for this metabolite. The method provided insufficient limits of quantification for serum levels of 1,25(OH)2D3.
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Affiliation(s)
- Pascal Schorr
- Department of Chemistry, Humboldt Universität zu Berlin, Brook-Taylor Str. 2, Berlin 12489, Germany
| | - Caroline S Stokes
- Thaer Institute, Humboldt Universität zu Berlin, Lentzeallee 75, Berlin 14195, Germany
| | - Dietrich A Volmer
- Department of Chemistry, Humboldt Universität zu Berlin, Brook-Taylor Str. 2, Berlin 12489, Germany.
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Smyk W, Papapostoli I, Żorniak M, Sklavounos P, Blukacz Ł, Madej P, Koutsou A, Weber SN, Friesenhahn-Ochs B, Cebula M, Bosowska J, Solomayer EF, Hartleb M, Milkiewicz P, Lammert F, Stokes CS, Krawczyk M. Liver phenotypes in PCOS: Analysis of exogenous and inherited risk factors for liver injury in two European cohorts. Liver Int 2023; 43:1080-1088. [PMID: 36683562 DOI: 10.1111/liv.15527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND & AIMS Fatty liver disease (FLD) is common in women with polycystic ovary syndrome (PCOS). Here, we use non-invasive tests to quantify liver injury in women with PCOS and analyse whether FLD-associated genetic variants contribute to liver phenotypes in PCOS. METHODS Prospectively, we recruited women with PCOS and controls at two university centres in Germany and Poland. Alcohol abuse was regarded as an exclusion criterion. Genotyping of variants associated with FLD was performed using TaqMan assays. Liver stiffness measurements (LSM), controlled attenuation parameters (CAP) and non-invasive HSI, FLI, FIB-4 scores were determined to assess hepatic steatosis and fibrosis. RESULTS A total of 42 German (age range 18-53 years) and 143 Polish (age range 18-40 years) women with PCOS, as well as 245 German and 289 Polish controls were recruited. In contrast to Polish patients, Germans were older, presented with more severe metabolic profiles and had significantly higher LSM (median 5.9 kPa vs. 3.8 kPa). In the German cohort, carriers of the PNPLA3 p.I148M risk variant had an increased LSM (p = .01). In the Polish cohort, the minor MTARC1 allele was linked with significantly lower serum aminotransferases activities, whereas the HSD17B13 polymorphism was associated with lower concentrations of 17-OH progesterone, total testosterone, and androstenedione (all p < .05). CONCLUSIONS FLD is common in women with PCOS. Its extent is modulated by both genetic and metabolic risk factors. Genotyping of variants associated with FLD might help to stratify the risk of liver disease progression in women suffering from PCOS.
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Affiliation(s)
- Wiktor Smyk
- Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland
| | - Ifigeneia Papapostoli
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Michał Żorniak
- Department of Gastroenterology, Hepatology and Oncology, Center for Postgraduate Medical Education, Warsaw, Poland.,Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Panagiotis Sklavounos
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Łukasz Blukacz
- Department of Gynecological Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Paweł Madej
- Department of Gynecological Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Andreani Koutsou
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Susanne N Weber
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Bettina Friesenhahn-Ochs
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Maciej Cebula
- Department of Radiology and Nuclear Medicine, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Joanna Bosowska
- Department of Radiology and Nuclear Medicine, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Erich-Franz Solomayer
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Marek Hartleb
- Department of Gastroenterology, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland.,Translational Medicine Group, Pomeranian Medical University, Szczecin, Poland
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Hannover Medical School, Hannover, Germany
| | - Caroline S Stokes
- Food and Health Research Group, Faculty of Life Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Molecular Toxicology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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Alexandridou A, Schorr P, Stokes CS, Volmer DA. Analysis of vitamin D metabolic markers by mass spectrometry: Recent progress regarding the "gold standard" method and integration into clinical practice. Mass Spectrom Rev 2021. [PMID: 34967037 DOI: 10.1002/mas.21768] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/03/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
Liquid chromatography/tandem mass spectrometry is firmly established today as the gold standard technique for analysis of vitamin D, both for vitamin D status assessments as well as for measuring complex and intricate vitamin D metabolic fingerprints. While the actual mass spectrometry technology has seen only incremental performance increases in recent years, there have been major, very impactful changes in the front- and back-end of MS-based vitamin D assays; for example, the extension to new types of biological sample matrices analyzed for an increasing number of different vitamin D metabolites, novel sample preparation techniques, new powerful chemical derivatization reagents, as well the continued integration of high resolution mass spectrometers into clinical laboratories, replacing established triple-quadrupole instruments. At the same time, the sustainability of mass spectrometry operation in the vitamin D field is now firmly established through proven analytical harmonization and standardization programs. The present review summarizes the most important of these recent developments.
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Affiliation(s)
| | - Pascal Schorr
- Department of Bioanalytical Chemistry, Humboldt University Berlin, Berlin, Germany
| | - Caroline S Stokes
- Food and Health Research Group, Faculty of Life Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Molecular Toxicology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Dietrich A Volmer
- Department of Bioanalytical Chemistry, Humboldt University Berlin, Berlin, Germany
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Mittag‐Roussou V, Wagenpfeil S, Lammert F, Stokes CS. Noninvasive monitoring of liver fat during treatment with GLP-1 analogues and SGLT-2 inhibitors in a real-world setting. Endocrinol Diabetes Metab 2020; 3:e00131. [PMID: 32704556 PMCID: PMC7375113 DOI: 10.1002/edm2.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Patients with NAFLD have a two-fold increased risk of diabetes, and conversely, NAFLD affects up to 80% of patients with type 2 diabetes. Due to the co-occurrence of both diseases and the lack of approved pharmacotherapy for NAFLD, the anti-steatogenic potential of diabetes-related drugs is being explored. In this study, we aim to monitor liver fat noninvasively during treatment with SGLT-2 inhibitors or GLP-1 analogues in a real-world setting. METHODS Overall, 39 patients (49% women, age 57.7 ± 10.9 years) with type 2 diabetes and hepatic steatosis (defined by controlled attenuation parameter [CAP] values ≥ 215 dB/m) were observed for 6 months and routinely monitored with respect to hepatic fat contents and liver stiffness (VCTE); body composition (BIA); and blood biochemistry, including liver function tests (LFTs), serum lipids and glucose metabolism markers. RESULTS Median liver fat contents were significantly (P = .026) reduced by 9% in patients taking either SGLT-2 (n = 22) or GLP-1 (n = 17) for 6 months (absolute median CAP decrease: -32 dB/m [-58 to 32 dB/m]). In parallel, serum ALT and γ-GT activities decreased significantly (P = .002 and P = .049, respectively). These improvements were accompanied by significant (P < .0001) changes to body weight and BMI (-2.5 ± 3.3 kg and -0.9 ± 1.2 kg/m2, respectively) and glucose homeostasis, with significant reductions in HbA1c and fasting plasma glucose (FDG) (both P < .0001). Of note, significant reductions of intrahepatic lipid contents occured in patients receiving SGLT-2 inhibitors only. CONCLUSIONS In this real-world observational evaluation of fatty liver monitored noninvasively in patients with type 2 diabetes treated with either SGLT2 or GLP-1, improvements in measures of hepatic steatosis, glucose and weight parameters were observed after 6 months, with significant reductions of intrahepatic lipid contents seen specifically in the SGLT2 subgroup.
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Affiliation(s)
- Vasiliki Mittag‐Roussou
- Department of Medicine II (Gastroenterology and Endocrinology)Saarland University Medical CenterSaarland UniversityHomburgGermany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical InformaticsSaarland UniversityHomburgGermany
| | - Frank Lammert
- Department of Medicine II (Gastroenterology and Endocrinology)Saarland University Medical CenterSaarland UniversityHomburgGermany
| | - Caroline S. Stokes
- Department of Medicine II (Gastroenterology and Endocrinology)Saarland University Medical CenterSaarland UniversityHomburgGermany
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Karatayli E, Stokes CS, Lammert F. Vitamin D in Preclinical Models of Fatty Liver Disease. Anticancer Res 2020; 40:527-534. [PMID: 31892608 DOI: 10.21873/anticanres.13981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022]
Abstract
Simple steatosis in non-alcoholic fatty liver disease (NAFLD) progresses to non-alcoholic steatohepatitis (NASH) when excessive fat accumulation is accompanied by ballooning, inflammation, and progressive hepatocellular injury. Due to the increasing global incidence of NAFLD/NASH and the lack of effective drugs, current treatment options are currently dominated by lifestyle interventions, including dietary and physical activity modifications. In this regard, vitamin D has received widespread attention in recent years. In line with its pleiotropic physiological effects, preclinical animal models and patient cohorts have demonstrated anti-inflammatory, anti-fibrotic and anti-proliferative effects of vitamin D on NAFLD and NASH. Several animal models have confirmed the association of vitamin D deficiency and NALFD/NASH severity in humans and revealed potential benefits of dietary vitamin D supplementation. These preclinical models also provide critical guidance to define the roles and therapeutic potential of vitamin D as well as its downstream functional mechanisms in the pathogenesis of fatty liver disease. This review summarizes vitamin D research in currently available animal models of fatty liver disease.
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Affiliation(s)
- Ersin Karatayli
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
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Stokes CS, Lammert F, Krawczyk M. Short-term Dietary Interventions for the Management of Nonalcoholic Fatty Liver. Curr Med Chem 2019; 26:3483-3496. [PMID: 28482789 DOI: 10.2174/0929867324666170508144409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 04/16/2017] [Accepted: 04/20/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) affects millions of individuals on a global scale and currently no gold standard treatment exists. The risk of developing NAFLD is considerably higher with increasing body mass index. Consequently, weight loss should be recommended to all overweight patients with fatty liver. However, lifestyle interventions, irrespective of weight status, may also influence the condition. The aim herein is to present examples of short-term interventions which assess direct effects of dietary-related components on hepatic steatosis. METHODS This review includes studies with short-term dietary-related interventions of up to 16 weeks that evaluate their efficacy in reducing intrahepatic lipid contents (hepatic steatosis). This review primarily focuses on the three main macronutrients: dietary carbohydrates, fats and proteins. RESULTS High saturated fat intake and high consumption of carbohydrates, particularly from simple sugars such as fructose are reported as risk factors for hepatic steatosis. Overall, shortterm hypocaloric diets have shown beneficial effects in reducing intrahepatic lipid contents. Macronutrient manipulations such as carbohydrate restriction as well as the consumption of unsaturated fatty acids are also reported to have efficacious effects. CONCLUSION This review highlights the different dietary interventions that can influence hepatic steatosis in the short term, illustrating both pro and anti-steatotic effects.
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Center for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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Koutsou‐Tassopoulou A, Papapostoli‐Sklavounou I, Krawczyk M, Friesenhahn‐Ochs B, Weber SN, Lammert F, Stokes CS. Hepatic steatosis in patients with acromegaly. Endocrinol Diabetes Metab 2019; 2:e00090. [PMID: 31592448 PMCID: PMC6775446 DOI: 10.1002/edm2.90] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/02/2019] [Accepted: 08/04/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Comorbid NAFLD is increasingly being diagnosed in patients with diabetes and nondiabetic endocrinopathies. The aim of this study was to assess hepatic steatosis noninvasively by transient elastography in patients with acromegaly. DESIGN A cross-sectional study including 22 patients with acromegaly. METHODS Hepatic steatosis was quantified using controlled attenuation parameter (CAP) during elastography. Anthropometric measurements were obtained, serum liver function tests and lipid and hormone profiles were measured, and prosteatogenic gene variants were genotyped using standard assays. RESULTS In total, 41% of patients were women (mean age 60 ± 14.7 years, mean BMI 31.2 ± 4.6 kg/m2). Hepatic steatosis, as defined by CAP > 248 dB/m, was present in 66% of patients. Five (45%) of the patients with hepatic steatosis also had fibrosis, and one presented with cirrhosis. Nine patients were carriers of the PNPLA3 p.I148M prosteatogenic [M] risk allele, eight of whom were heterozygotes. CAP values were significantly (P = .045) higher in these patients and corresponded to advanced steatosis, as compared to patients with the wild-type genotype, who demonstrated CAP values consistent with mild steatosis (311 ± 33 dB/m. vs 254 ± 62 dB/m). CAP values did not differ significantly in carriers of distinct TM6SF2 and MBOAT7 genotypes; however, carriers of the risk alleles displayed higher CAP as compared to wild-type patients. CONCLUSIONS This study shows that in patients with acromegaly, carriers of the PNPLA3 susceptibility allele are at risk of developing hepatic steatosis, as assessed by CAP. Comorbid NAFLD might compound prognosis in such patients; thus, further research into the pathomechanisms and treatment of NAFLD in acromegaly is warranted.
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Affiliation(s)
| | | | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical CenterSaarland UniversityHomburgGermany
- Laboratory of Metabolic Liver Diseases, Department of General, Transplantation and Liver SurgeryMedical University of WarsawWarsawPoland
| | | | - Susanne N. Weber
- Department of Medicine II, Saarland University Medical CenterSaarland UniversityHomburgGermany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical CenterSaarland UniversityHomburgGermany
| | - Caroline S. Stokes
- Department of Medicine II, Saarland University Medical CenterSaarland UniversityHomburgGermany
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Portincasa P, De Angelis M, Lammert F, Stokes CS. Medicinal Diets: From Molecules to Nutrients to Foods: Basic and Clinical Implications. Curr Med Chem 2019; 26:3372-3375. [PMID: 31564245 DOI: 10.2174/092986732619190821150547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Piero Portincasa
- Professor of Medicine Clinica Medica "A. Murri" Department of Biomedical Sciences and Human Oncology University of Bari Medical School Policlinico Hospital Piazza Giulio Cesare 11 - 70124 Bari, Italy
| | - Maria De Angelis
- Associate Professor of Microbiology Department of Soil, Plant and Food Science University of Bari Aldo Moro 70124 Bari, Italy
| | - Frank Lammert
- Professor of Gastroenterology Department of Medicine II Saarland University Medical Center Saarland University Kirrberger Str. 100 66424 Homburg, Germany
| | - Caroline S. Stokes
- Senior Nutrition Scientist Department of Medicine II Saarland University Medical Center Saarland University Kirrberger Str. 100 - 66424 Homburg, Germany
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Kuttner CS, Mancina R, Wagenpfeil G, Lammert F, Stokes CS. Four-Week Omega-3 Supplementation in Carriers of the Prosteatotic PNPLA3 p.I148M Genetic Variant: An Open-Label Study. Lifestyle Genom 2019; 12:10-17. [PMID: 31454802 DOI: 10.1159/000502008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS The PNPLA3 loss-of-function variant p.I148M is a strong genetic determinant of nonalcoholic fatty liver disease. The PNPLA3 protein functions as an intracellular lipase in the liver, with a greater activity on unsaturated fatty acids. This study aimed to determine whether short-term supplementation with omega-3 fatty acids impacts hepatic steatosis differently in PNPLA3 p.148I wild-type individuals as compared to homozygous carriers of the PNPLA3 p.148M variant. METHODS Twenty subjects with hepatic steatosis (50% women, age 18-77 years) were included. Ten subjects homozygous for the PNPLA3 148M variant were matched to 10 wild-type individuals. The subjects received 4 g omega-3 fatty acids (1,840 mg eicosapentaenoic acid and 1,520 mg docosahexaenoic acid) a day for 4 weeks. Transient elastography with a controlled attenuation parameter (CAP) was used to quantify liver fat before and after the intervention. Body composition, fibrosis, liver function tests, serum free fatty acids (FFA) and glucose markers were compared. RESULTS Patients homozygous for the PNPLA3 p.148M variant (risk group) demonstrated no significant changes in CAP compared to baseline (284 ± 55 vs. 287 ± 65 dB/m) as did the control group (256 ± 56 vs. 262 ± 55 dB/m). While serum liver enzyme activities remained unchanged in both groups, the risk group displayed significantly (p = 0.02) lower baseline FFA concentrations (334.5 [range 281.0-431.0] vs. 564.5 [range 509.0-682.0] μmol/L), which markedly increased by 9.1% after the intervention. In contrast, FFA concentrations decreased significantly (p = 0.01) by 28.3% in the wild-type group. CONCLUSIONS Short-term omega-3 fatty acid supplementation did not significantly alter hepatic steatosis. The nutrigenomic and metabolic effects of omega-3 fatty acids should be investigated further in carriers of the PNPLA3 148M risk variant.
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Affiliation(s)
- Clara-Sophie Kuttner
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Rosellina Mancina
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany,
| | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
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Ecker J, Lammert F, Gluud LL, Stokes CS. Bile acid derivatives for people with primary sclerosing cholangitis. Hippokratia 2019. [DOI: 10.1002/14651858.cd012061.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Johannes Ecker
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
| | - Frank Lammert
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
| | - Lise Lotte Gluud
- Copenhagen University Hospital Hvidovre; Gastrounit, Medical Division; Kettegaards Alle 30 Hvidovre Denmark 2650
| | - Caroline S Stokes
- Saarland University Medical Centre; Department of Medicine II; Kirrberger Str. 100 Homburg/Saar Germany 66421
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Ecker J, Lammert F, Gluud LL, Stokes CS. Bile acid derivatives for people with primary biliary cholangitis. Hippokratia 2019. [DOI: 10.1002/14651858.cd012062.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Johannes Ecker
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
| | - Frank Lammert
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
| | - Lise Lotte Gluud
- Copenhagen University Hospital Hvidovre; Gastrounit, Medical Division; Kettegaards Alle 30 Hvidovre Denmark 2650
| | - Caroline S Stokes
- Saarland University Medical Centre; Department of Medicine II; Kirrberger Str. 100 Homburg/Saar Germany 66421
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Völker D, Grünhage F, Wagenpfeil S, Lammert F, Stokes CS. Serum 25-hydroxyvitamin D levels and mortality risk in patients with liver cirrhosis: a protocol for a systematic review and meta-analysis of observational studies. Syst Rev 2019; 8:73. [PMID: 30904016 PMCID: PMC6431049 DOI: 10.1186/s13643-019-0988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Liver cirrhosis represents a substantial global burden in terms of morbidity and mortality. Observational studies have reported an increased risk of death with low circulating 25-hydroxyvitamin D concentrations in such patients. Because the occurrence of inadequate vitamin D status is very common in patients with liver cirrhosis, the aim of this study is to conduct a meta-analysis of observational studies in such patients to assess whether vitamin D deficiency increases their risk of mortality. METHODS We will search electronic databases (MEDLINE, Embase, Web of Science, CENTRAL and Google Scholar from time of inception until now), conference proceedings and conduct manual searches to identify studies eligible for inclusion. There will be no restrictions based on publication status or language, and the meta-analysis will be reported in accordance with the MOOSE guidelines. We will employ random-effects meta-analysis to assess the relationship between vitamin D deficiency and risk of mortality. Quality of studies will be judged using the Newcastle-Ottawa scale, and between-trial heterogeneity will be evaluated by means of subgroup and sensitivity analyses. DISCUSSION The study will assess the effects of serum 25-hydroxyvitamin D concentrations on mortality in patients with liver cirrhosis. The results will be published in a high-quality peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42016052007 .
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Affiliation(s)
- Désirée Völker
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Frank Grünhage
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66421 Homburg, Germany
- Department of Internal Medicine, Grevenbroich St. Elisabeth Hospital, Grevenbroich, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Caroline S. Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66421 Homburg, Germany
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Hahn D, Stokes CS, Kaiser R, Meyer MR, Lammert F, Gruenhage F. Antidepressant effects of direct-acting antivirals against hepatitis C virus-Results from a pilot study. Eur J Clin Invest 2018; 48:e13024. [PMID: 30175442 DOI: 10.1111/eci.13024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/30/2018] [Accepted: 08/29/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The new direct-acting antiviral agents (DAA) have revolutionized the treatment of patients with chronic hepatitis C virus (HCV) infection. This study investigates to which extent DAA affect fatigue and mood and, if so, whether this results from changes to tryptophan (TRP) metabolism, as reflected by two critical biosynthetic pathways, serotonin (SRT) generation from TRP and TRP degradation through kynurenines (KYN) via indoleamine 2,3-dioxygenase (IDO). METHODS This study assessed 24 patients with chronic HCV infection, before (T1), during (T2: at 4 weeks) and 12 weeks post-treatment with DAA (T3) with respect to viral load, fatigue and depressive symptoms (BDI-II questionnaire), physical activity (actigraph) and plasma serotonin-tryptophan metabolites (LC/MS). The KYN:TRP ratio reflected IDO activity. RESULTS All participants achieved sustained virological response (SVR12) with DAA treatment (79% sofosbuvir-based). Fatigue (scores at T1:0.83 ± 0.70, T2:0.48 ± 0.70, T3:0.30 ± 0.50; P = 0.023) and depressive symptoms (scores at T1:9.8 ± 10.2, T2:6.0 ± 7.3, T3:5.0 ± 7.6; P = 0.005) improved significantly on therapy, whereas no changes were noted in five untreated controls. TRP plasma concentrations markedly decreased (T1:306 ± 179 mg/L, T2:283 ± 84 mg/L), whereas 5-HTP levels increased (T1:0.08 ± 0.01 mg/L, T2:0.10 ± 0.06 mg/L). KYN concentrations (T1:2.4 ± 2.0 mg/L, T2:3.7 ± 1.4 mg/L, P = 0.003) increased significantly during treatment, as did IDO activity (T1:0.008 ± 0.006 mg/L, T2:0.014 ± 0.004 mg/L; P < 0.001). CONCLUSIONS In this study, DAA exert positive and persistent effects on both fatigue and mood in patients with chronic HCV infection. These extrahepatic benefits are, at least in part, related to the modulation of TRP metabolism. The robust elevation of KYN concentrations challenges the current paradigm of low KYN levels as prerequisite for mental health.
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Affiliation(s)
- Daphne Hahn
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Ralf Kaiser
- Department of Medicine V, Saarland University Medical Center, Saarland University Homburg, Homburg, Germany
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Frank Gruenhage
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Department of Internal Medicine, RKN-Clinics, St. Elisabeth Hospital, Grevenbroich, Germany
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Jamka M, Arslanow A, Bohner A, Krawczyk M, Weber SN, Grünhage F, Lammert F, Stokes CS. Effects of Gene Variants Controlling Vitamin D Metabolism and Serum Levels on Hepatic Steatosis. Digestion 2018. [PMID: 29514138 DOI: 10.1159/000485180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Common genetic variations in vitamin D metabolism are associated with liver stiffness. Whether these genes are implicated in hepatic steatosis remains unclear. Here we aimed to analyse the association of common vitamin D pathway gene variants with liver steatosis. METHODS Liver steatosis was assessed non-invasively in 241 patients with chronic liver conditions by controlled attenuation parameter (CAP). The following polymorphisms were genotyped using TaqMan assays: group-specific component (GC) rs7041, 7-dehydrocholesterol reductase (DHCR7) rs12785878, cytochrome P450 2R1 (CYP2R1) rs10741657, -vitamin D receptor (VDR) rs7974353. Chemiluminescence immunoassay determined serum 25-hydroxyvitamin D (25(OH) D) concentrations. RESULTS Vitamin D deficiency (defined by 25(OH)D concentrations <20 ng/mL) occurred in 66% of patients. Median CAP was 296 (100-400) dB/m. Patients with advanced steatosis (CAP ≥280 dB/m) had significantly (p = 0.033) lower 25(OH)D levels as compared to patients with CAP <280 dB/m. Moreover, the rare allele [T] in GC rs7041 was significantly (p = 0.018) associated with higher 25(OH)D levels in patients with CAP <280 dB/m. However, GC, DHCR7, CYP2R1, and VDR polymorphisms were not related to liver steatosis and obesity traits. CONCLUSIONS Higher CAP values are associated with low serum 25(OH)D concentrations but not with common vitamin D pathway gene variants.
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Affiliation(s)
- Małgorzata Jamka
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Department of Paediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Anita Arslanow
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Annika Bohner
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Susanne N Weber
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Frank Grünhage
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Department of Internal Medicine, Grevenbroich St. Elisabeth Hospital, Grevenbroich, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
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Gutt C, Jenssen C, Barreiros AP, Götze TO, Stokes CS, Jansen PL, Neubrand M, Lammert F. [Updated S3-Guideline for Prophylaxis, Diagnosis and Treatment of Gallstones. German Society for Digestive and Metabolic Diseases (DGVS) and German Society for Surgery of the Alimentary Tract (DGAV) - AWMF Registry 021/008]. Z Gastroenterol 2018; 56:912-966. [PMID: 30103228 DOI: 10.1055/a-0644-2972] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This guideline provides evidence-based key recommendations for the prevention, diagnosis and therapy of gallstones and upgrades the 2007 version. The guideline was developed by an interdisciplinary team of gastroenterologists and surgeons, and patient support groups under the auspice of the German Society for Gastroenterology and Metabolic Diseases and the German Society for General Surgery and Surgery of the Alimentary Tract. The guideline used structural S3 consensus-based methodology and includes statements on clinical practice, medical education, prevention, quality assurance, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone diseases.
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Affiliation(s)
- Carsten Gutt
- Klinik f. Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Klinikum Memmingen, Deutschland
| | - Christian Jenssen
- Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Wriezen, Deutschland
| | | | - Thorsten O Götze
- Institut für Klinisch-Onkologische Forschung, Krankenhaus Nordwest, Frankfurt, Deutschland
| | - Caroline S Stokes
- Klinik für Innere Medizin II - Gastroenterologie und Endokrinologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen, Berlin, Deutschland
| | - Michael Neubrand
- Abteilung Innere Medizin, Krankenhaus Maria Stern, Remagen, Deutschland
| | - Frank Lammert
- Klinik für Innere Medizin II - Gastroenterologie und Endokrinologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland.,Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen, Berlin, Deutschland
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Affiliation(s)
- Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen, Berlin, Deutschland
| | - Carsten Gutt
- Klinik f. Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Klinikum Memmingen, Deutschland
| | - Christian Jenssen
- Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Wriezen, Deutschland
| | | | - Caroline S Stokes
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Homburg, Deutschland
| | - Michael Neubrand
- Abteilung Innere Medizin, Krankenhaus Maria Stern, Remagen, Deutschland
| | - Frank Lammert
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen, Berlin, Deutschland
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Homburg, Deutschland
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Qi Y, Müller M, Stokes CS, Volmer DA. Rapid Quantification of 25-Hydroxyvitamin D 3 in Human Serum by Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry. J Am Soc Mass Spectrom 2018; 29:1456-1462. [PMID: 29633224 DOI: 10.1007/s13361-018-1956-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
LC-MS/MS is widely utilized today for quantification of vitamin D in biological fluids. Mass spectrometric assays for vitamin D require very careful method optimization for precise and interference-free, accurate analyses however. Here, we explore chemical derivatization and matrix-assisted laser desorption/ionization (MALDI) as a rapid alternative for quantitative measurement of 25-hydroxyvitamin D3 in human serum, and compare it to results from LC-MS/MS. The method implemented an automated imaging step of each MALDI spot, to locate areas of high intensity, avoid sweet spot phenomena, and thus improve precision. There was no statistically significant difference in vitamin D quantification between the MALDI-MS/MS and LC-MS/MS: mean ± standard deviation for MALDI-MS-29.4 ± 10.3 ng/mL-versus LC-MS/MS-30.3 ± 11.2 ng/mL (P = 0.128)-for the sum of the 25-hydroxyvitamin D epimers. The MALDI-based assay avoided time-consuming chromatographic separation steps and was thus much faster than the LC-MS/MS assay. It also consumed less sample, required no organic solvents, and was readily automated. In this proof-of-concept study, MALDI-MS readily demonstrated its potential for mass spectrometric quantification of vitamin D compounds in biological fluids. Graphical Abstract ᅟ.
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Affiliation(s)
- Yulin Qi
- Department of Chemistry, Humboldt University of Berlin, Berlin, Germany
| | | | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Dietrich A Volmer
- Department of Chemistry, Humboldt University of Berlin, Berlin, Germany.
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Goh ET, Stokes CS, Sidhu SS, Vilstrup H, Gluud LL, Morgan MY. L-ornithine L-aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database Syst Rev 2018; 5:CD012410. [PMID: 29762873 PMCID: PMC6494563 DOI: 10.1002/14651858.cd012410.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hepatic encephalopathy is a common complication of cirrhosis and has high associated morbidity and mortality. The condition is classified as overt if it is clinically apparent or minimal if only evident though psychometric testing. The exact pathogenesis of this syndrome is unknown although ammonia is thought to play a key role. L-ornithine L-aspartate has ammonia-lowering properties and may, therefore, benefit people with cirrhosis and hepatic encephalopathy. OBJECTIVES To evaluate the beneficial and harmful effects of L-ornithine L-aspartate versus placebo, no intervention, or other active interventions in people with cirrhosis and hepatic encephalopathy. SEARCH METHODS We undertook electronic searches of The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, LILACS and Science Citation Index Expanded to December 2017 and manual searches of meetings and conference proceedings; checks of bibliographies; and corresponded with investigators and pharmaceutical companies. SELECTION CRITERIA We included randomised clinical trials, irrespective of publication status, language, or blinding. We included participants with cirrhosis who had minimal or overt hepatic encephalopathy or who were at risk for developing hepatic encephalopathy. We compared: L-ornithine L-aspartate versus placebo or no intervention; and L-ornithine L-aspartate versus other active agents such as non-absorbable disaccharides, antibiotics, probiotics, or branched-chain amino acids. DATA COLLECTION AND ANALYSIS Two review authors, working independently, retrieved data from published reports and correspondence with investigators and pharmaceutical companies. The primary outcomes were mortality, hepatic encephalopathy, and serious adverse events. We undertook meta-analyses and presented the results as risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). We assessed bias control using the Cochrane Hepato-Biliary Group domains; we evaluated the risk of publication bias and other small trial effects in regression analyses; conducted subgroup and sensitivity analyses; and performed Trial Sequential Analyses. We determined the quality of the evidence using GRADE. MAIN RESULTS We identified 36 randomised clinical trials, involving at least 2377 registered participants, which fulfilled our inclusion criteria including 10 unpublished randomised clinical trials. However, we were only able to access outcome data from 29 trials involving 1891 participants. Five of the included trials assessed prevention, while 31 trials assessed treatment. Five trials were at low risk of bias in the overall assessment of mortality; one trial was at low risk of bias in the assessment of the remaining outcomes.L-ornithine L-aspartate had a beneficial effect on mortality compared with placebo or no intervention when including all trials (RR 0.42, 95% CI 0.24 to 0.72; I2 = 0%; 19 trials; 1489 participants; very low quality evidence), but not when the analysis was restricted to the trials at low risk of bias (RR 0.47, 95% CI 0.06 to 3.58; 4 trials; 244 participants). It had a beneficial effect on hepatic encephalopathy compared with placebo or no intervention when including all trials (RR 0.70, 95% CI 0.59 to 0.83; 22 trials; 1375 participants; I2 = 62%; very low quality evidence), but not in the one trial at low risk of bias (RR 0.96, 95% CI 0.85 to 1.07; 63 participants). The analysis of serious adverse events showed a potential benefit of L-ornithine L-aspartate when including all randomised clinical trials (RR 0.63, 95% CI 0.45 to 0.90; 1 trial; 1489 participants; I2 = 0%; very low quality evidence), but not in the one trial at low risk of bias for this outcome (RR 0.83, 95% CI 0.15 to 4.65; 63 participants). The Trial Sequential Analyses of mortality, hepatic encephalopathy, and serious adverse events found insufficient evidence to support or refute beneficial effects. Subgroup analyses showed no difference in outcomes in the trials evaluating evaluating the prevention or treatment of either overt or minimal hepatic encephalopathy or trials evaluating oral versus intravenous administration We were unable to undertake a meta-analysis of the three trials involving 288 participants evaluating health-related quality of life. Overall, we found no difference between L-ornithine L-aspartate and placebo or no intervention in non-serious adverse events (RR 1.15, 95% CI 0.75 to 1.77; 14 trials; 1076 participants; I2 = 40%). In comparison with lactulose, L-ornithine L-aspartate had no effect on mortality (RR 0.68, 95% CI 0.11 to 4.17; 4 trials; 175 participants; I2 = 0%); hepatic encephalopathy (RR 1.13, 95% CI 0.81 to 1.57); serious adverse events (RR 0.69, 95% CI 0.22 to 2.11); or non-serious adverse events (RR 0.05, 95% CI 0.01 to 0.18). In comparison with probiotics, L-ornithine L-aspartate had no effect on mortality (RR 1.01, 95% CI 0.11 to 9.51); serious adverse events (RR 1.07, 95% CI 0.23 to 4.88); or changes in blood ammonia concentrations from baseline (RR -2.30 95% CI -6.08 to 1.48), but it had a possible beneficial effect on hepatic encephalopathy (RR 0.71, 95% CI 0.56 to 0.90). Finally, in comparison with rifaximin, L-ornithine L-aspartate had no effect on mortality (RR 0.33, 95% CI 0.04 to 3.03; 2 trials; 105 participants); hepatic encephalopathy (RR 1.06, 95% CI 0.57 to 1.96); serious adverse events (RR 0.32, 95% CI 0.01 to 7.42), or non-serious adverse events (RR 0.32, 95% CI 0.01 to 7.42). AUTHORS' CONCLUSIONS The results of this review suggest a possible beneficial effect of L-ornithine L-aspartate on mortality, hepatic encephalopathy, and serious adverse events in comparisons with placebo or no-intervention, but, because the quality of the evidence is very low, we are very uncertain about these findings. There was very low quality evidence of a possible beneficial effect of L-ornithine L-aspartate on hepatic encephalopathy, when compared with probiotics, but no other benefits were demonstrated in comparison with other active agents. Additional access to data from completed, but unpublished trials, and new randomised placebo-controlled, double-blind clinical trials are needed.
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Affiliation(s)
- Ee Teng Goh
- Division of Medicine, Royal Free Campus, University College LondonUCL Institute for Liver & Digestive HealthRowland Hill StreetHampsteadLondonUKNW3 2PF
| | - Caroline S Stokes
- Saarland University Medical CentreDepartment of Medicine IIKirrberger Str. 100Homburg/SaarGermany66421
| | - Sandeep S Sidhu
- Dayanand Medical College & HospitalDepartment of GastroenterologyTagore Nagar, Civil LinesLudhianaPunjabIndia141001
| | - Hendrik Vilstrup
- Aarhus University HospitalDepartment of Hepatology and GastroenterologyNørrebrogade 44Aarhus8200 NDenmark
| | - Lise Lotte Gluud
- Copenhagen University Hospital HvidovreGastrounit, Medical DivisionKettegaards Alle 30HvidovreDenmark2650
| | - Marsha Y Morgan
- Division of Medicine, Royal Free Campus, University College LondonUCL Institute for Liver & Digestive HealthRowland Hill StreetHampsteadLondonUKNW3 2PF
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Schäfer SK, Weidner KJ, Hoppner J, Becker N, Friedrich D, Stokes CS, Lammert F, Köllner V. Design and validation of a German version of the GSRS-IBS - an analysis of its psychometric quality and factorial structure. BMC Gastroenterol 2017; 17:139. [PMID: 29202711 PMCID: PMC5715554 DOI: 10.1186/s12876-017-0684-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/17/2017] [Indexed: 12/15/2022] Open
Abstract
Background Currently, a suitable questionnaire in German language is not available to monitor the progression and evaluate the severity of irritable bowel syndrome (IBS). Therefore, this study aimed to translate the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS) into German and to evaluate its psychometric qualities and factorial structure. Methods This study is based on a total sample of 372 participants [62.6% female, mean age = 41 years (SD = 17 years)]. 17.5% of the participants had a diagnosis of IBS, 19.9% were receiving treatment for chronic inflammatory bowel disease, 12.1% of the participants were recruited from a psychosomatic clinic, and 50.5% belonged to a control group. All participants completed the German version of GSRS-IBS (called Reizdarm-Fragebogen, RDF), as well as the Gießen Subjective Complaints List (GBB-24) and the Hospital Anxiety and Depression Scale - German version (HADS-D). Results The internal consistency of the RDF total scale was at least satisfactory in all subsamples (Cronbach’s Alpha between .77 and .92), and for all subscales (Cronbach’s Alpha between .79 and .91). The item difficulties (between .25 and .73) and the item-total correlations (between .48 and .83) were equally satisfactory. Principal axis analysis revealed a four-factorial structure of the RDF items, which mainly resembled the structure of the English original. Convergent validity was established based on substantial and significant correlations with the stomach-complaint scale of the GBB-24 (r = .71; p < .01) and the anxiety (r = .42; p < .01) and depression scales (r = .43; p < .01) of the HADS-D. Conclusion The German version of the GSRS-IBS RDF proves to be an effective, reliable, and valid questionnaire for the assessment of symptom severity in IBS, which can be used in clinical practice as well as in clinical studies. Electronic supplementary material The online version of this article (10.1186/s12876-017-0684-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah K Schäfer
- Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Kathrin Julia Weidner
- University Mannheim, I. Medical Clinic-Cardiology, Pneumology and Angiology Mannheim, Mannheim, Germany
| | - Jorge Hoppner
- University Heidelberg, Clinic for Diagnostic and Interventional Radiology Heidelberg, Heidelberg, Germany
| | - Nicolas Becker
- Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Dana Friedrich
- Saarland University, Department of Medicine II - Gastroenterology und Endocrinology, Homburg, Germany
| | - Caroline S Stokes
- Saarland University, Department of Medicine II - Gastroenterology und Endocrinology, Homburg, Germany
| | - Frank Lammert
- Saarland University, Department of Medicine II - Gastroenterology und Endocrinology, Homburg, Germany
| | - Volker Köllner
- Department of Psychosomatic Medicine, Rehabilitation Clinic Seehof, Lichterfelder Allee 55, 14513, Teltow, Germany. .,Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Papapostoli I, Lammert F, Stokes CS. Effect of Short-Term Vitamin D Correction on Hepatic Steatosis as Quantified by Controlled Attenuation Parameter (CAP). J Gastrointestin Liver Dis 2017; 25:175-81. [PMID: 27308648 DOI: 10.15403/jgld.2014.1121.252.cap] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. A meta-analysis has confirmed decreased serum 25-hydroxyvitamin D levels in NAFLD patients. This intervention study investigates whether vitamin D correction ameliorates hepatic steatosis. METHODS We prospectively recruited 40 patients from an outpatient liver clinic with vitamin D deficiency (serum 25-hydroxyvitamin D < 20 ng/ml). Controlled attenuation parameter (CAP) during transient elastography quantified hepatic steatosis. Patients with significant liver fat accumulation were included, which was defined by a CAP value >/= 280 dB/m. Patients received 20,000 IU vitamin D/week for six months, while vitamin D status, liver function tests (LFTs), CAP and body composition were monitored. RESULTS The cohort comprised 47.5% women (age 54.9 +/- 12.1 years; BMI 29.5 +/- 3.0 kg/m2). Mean serum vitamin D level was 11.8 +/- 4.8 ng/ml. CAP decreased significantly from baseline (330 +/- 32 vs. 307 +/- 41 dB/m) during supplementation (P = 0.007). A mean CAP reduction relative to baseline was demonstrated at four weeks and three and six months: -5.3 +/- 13.8%; -6.0 +/- 14.6% and -6.4 +/- 13.0%, respectively. During these time points, restoration of serum vitamin D levels was observed (34.6 +/- 12.9, 36.3 +/- 10.2, 34.8 +/- 9.8 ng/ml; P < 0.0001). Liver function tests and body composition remained unchanged. CONCLUSIONS Hepatic steatosis, as assessed by CAP, significantly improves after only 4 weeks of vitamin D correction. Hepatic steatosis is a dynamic process, that can be monitored in the short-term using such non-invasive methods.
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Affiliation(s)
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Volmer DA, Stokes CS. How to prepare a manuscript fit-for-purpose for submission and avoid getting a 'desk-reject'. Rapid Commun Mass Spectrom 2016; 30:2573-2576. [PMID: 27673749 DOI: 10.1002/rcm.7746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
First impressions are very important and, when these are negative, they can adversely affect a manuscript's journey through the scientific publication system. This short guide highlights some crucial factors to take into consideration before submitting a manuscript for review in a scientific journal. The aim is to advise authors on the best way to present their research, to comply with formal requirements of a journal and to optimize the first impression made. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Dietrich A Volmer
- Editor, Rapid Communications in Mass Spectrometry, Institute of Bioanalytical Chemistry, Saarland University, Saarbrücken, Germany
| | - Caroline S Stokes
- Department of Internal Medicine, Saarland University Medical Center, Homburg, Germany
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Stokes CS, Volmer DA. Assessment of 3-epi-25-hydroxyvitamin D levels during cholecalciferol supplementation in adults with chronic liver diseases. Appl Physiol Nutr Metab 2016; 41:1311-1317. [DOI: 10.1139/apnm-2016-0196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, hepatic immaturity was cited as a possible reason for high levels of the C-3 epimer of 25-hydroxyvitamin (25(OH)D) in premature infants: however what role, if any, the liver plays in controlling epimer concentrations is unknown. This study assesses 3-epi-25-hydroxyvitamin D (3-epi-25(OH)D) levels during the course of cholecalciferol supplementation in adults with chronic liver diseases (CLD). Vitamin D metabolites were analyzed in 65 CLD patients with 25(OH)D <30 ng/mL who received 20 000 IU cholecalciferol/week for 6 months. The primary outcome assessed serum 25(OH)D and 3-epi-25(OH)D in response to supplementation. Corresponding values from 16 CLD patients with sufficient vitamin D levels receiving no supplementation were compared. The epimer was detected in all samples and at lower relative concentrations with lower vitamin D baseline status, i.e., severe vitamin D deficiency (<10 ng/mL) as compared with deficient (10–19.9 ng/mL), insufficient (20–29.9 ng/mL), or sufficient (≥30 ng/mL) vitamin D levels (2.4% vs. 4.8%, 5.2%, 5.8%, respectively; P < 0.001). Similar relative concentrations for 3-epi-25(OH)D, ranging from 4.3%–7.1% (absolute concentrations: 1.1–4.0 ng/mL; all P < 0.001), were obtained in response to cholecalciferol in all supplemented patients, regardless of inadequacy threshold. Epimer levels significantly decreased (P = 0.007) in unsupplemented patients, coinciding with decreasing serum 25(OH)D concentrations over time. No epimer differences between patients with (n = 17) or without (n = 48) cirrhosis were demonstrated. The 3-epi-25(OH)D was present in serum of all patients at comparable levels to those reported by others. Epimer levels increased linearly with increasing 25(OH)D levels after supplementation. However, no effect of cirrhosis on epimer concentrations was observed.
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Affiliation(s)
- Caroline S. Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Dietrich A. Volmer
- Institute of Bioanalytical Chemistry, Saarland University, Saarbrücken, Germany
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Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of L‐ornithine L‐aspartate versus placebo, no intervention, or other active interventions for people with cirrhosis and hepatic encephalopathy.
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Affiliation(s)
- Caroline S Stokes
- Saarland University Medical CentreDepartment of Medicine IIKirrberger Str. 100Homburg/SaarGermany66421
| | - Ee Teng Goh
- Division of Medicine, Royal Free Campus, University College LondonUCL Institute for Liver & Digestive HealthRowland Hill StreetHampsteadLondonUKNW3 2PF
| | - Hendrik Vilstrup
- Aarhus KommunehospitalDepartment of Hepatology and GastroenterologyNørrebrogade 44Aarhus CDenmarkDK‐8000
| | - Marsha Y Morgan
- Division of Medicine, Royal Free Campus, University College LondonUCL Institute for Liver & Digestive HealthRowland Hill StreetHampsteadLondonUKNW3 2PF
| | - Lise Lotte Gluud
- Copenhagen University Hospital HvidovreGastrounit, Medical DivisionKettegaards AlleHvidovreDenmark2650
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Abstract
Vitamin D is a secosteroid hormone with multiple functions that extend beyond the regulation of intestinal calcium absorption. In recent years, the publication of research articles investigating associations between vitamin D status and health has reached an all-time high, and an increase in supplementation studies has followed. Given the pleiotropic effects of vitamin D, the scientific focus has gone beyond its known classic benefits on skeletal health to include diabetes and cardiovascular, neurological, respiratory, renal, and liver diseases, yet numerous conflicting findings continue to emerge. This review presents some examples of recent work within the context of controversies surrounding vitamin D and highlights key factors that should be considered when designing vitamin D supplementation regimens.
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
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Geib T, Sleno L, Hall RA, Stokes CS, Volmer DA. Triple Quadrupole Versus High Resolution Quadrupole-Time-of-Flight Mass Spectrometry for Quantitative LC-MS/MS Analysis of 25-Hydroxyvitamin D in Human Serum. J Am Soc Mass Spectrom 2016; 27:1404-1410. [PMID: 27154021 DOI: 10.1007/s13361-016-1412-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 06/05/2023]
Abstract
We describe a systematic comparison of high and low resolution LC-MS/MS assays for quantification of 25-hydroxyvitamin D3 in human serum. Identical sample preparation, chromatography separations, electrospray ionization sources, precursor ion selection, and ion activation were used; the two assays differed only in the implemented final mass analyzer stage; viz. high resolution quadrupole-quadrupole-time-of-flight (QqTOF) versus low resolution triple quadrupole instruments. The results were assessed against measured concentration levels from a routine clinical chemiluminescence immunoassay. Isobaric interferences prevented the simple use of TOF-MS spectra for extraction of accurate masses and necessitated the application of collision-induced dissociation on the QqTOF platform. The two mass spectrometry assays provided very similar analytical figures of merit, reflecting the lack of relevant isobaric interferences in the MS/MS domain, and were successfully applied to determine the levels of 25-hydroxyvitamin D for patients with chronic liver disease. Graphical Abstract ᅟ.
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Affiliation(s)
- Timon Geib
- Institute of Bioanalytical Chemistry, Saarland University, Saarbrücken, Germany
| | - Lekha Sleno
- Department of Chemistry, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Rabea A Hall
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Dietrich A Volmer
- Institute of Bioanalytical Chemistry, Saarland University, Saarbrücken, Germany.
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Arslanow A, Teutsch M, Walle H, Grünhage F, Lammert F, Stokes CS. Short-Term Hypocaloric High-Fiber and High-Protein Diet Improves Hepatic Steatosis Assessed by Controlled Attenuation Parameter. Clin Transl Gastroenterol 2016; 7:e176. [PMID: 27311064 PMCID: PMC4931593 DOI: 10.1038/ctg.2016.28] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/23/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Non-alcoholic fatty liver disease is one of the most prevalent liver diseases and increases the risk of fibrosis and cirrhosis. Current standard treatment focuses on lifestyle interventions. The primary aim of this study was to assess the effects of a short-term low-calorie diet on hepatic steatosis, using the controlled attenuation parameter (CAP) as quantitative tool. METHODS In this prospective observational study, 60 patients with hepatic steatosis were monitored during a hypocaloric high-fiber, high-protein diet containing 1,000 kcal/day. At baseline and after 14 days, we measured hepatic fat contents using CAP during transient elastography, body composition with bioelectrical impedance analysis, and serum liver function tests and lipid profiles using standard clinical-chemical assays. RESULTS The median age was 56 years (25-78 years); 51.7% were women and median body mass index was 31.9 kg/m(2) (22.4-44.8 kg/m(2)). After 14 days, a significant CAP reduction (14.0%; P<0.001) was observed from 295 dB/m (216-400 dB/m) to 266 dB/m (100-353 dB/m). In parallel, body weight decreased by 4.6% (P<0.001), of which 61.9% was body fat. In addition, liver stiffness (P=0.002), γ-GT activities, and serum lipid concentrations decreased (all P<0.001). CONCLUSIONS This study shows for the first time that non-invasive elastography can be used to monitor rapid effects of dietary treatment for hepatic steatosis. CAP improvements occur after only 14 days on short-term low-calorie diet, together with reductions of body composition parameters, serum lipids, and liver enzymes, pointing to the dynamics of hepatic lipid turnover.
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Affiliation(s)
- Anita Arslanow
- Department of Medicine II, Saarland University and Saarland University Medical Center, Homburg, Germany
| | | | | | - Frank Grünhage
- Department of Medicine II, Saarland University and Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University and Saarland University Medical Center, Homburg, Germany
| | - Caroline S Stokes
- Department of Medicine II, Saarland University and Saarland University Medical Center, Homburg, Germany
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Arslanow A, Stokes CS, Weber SN, Grünhage F, Lammert F, Krawczyk M. The common PNPLA3 variant p.I148M is associated with liver fat contents as quantified by controlled attenuation parameter (CAP). Liver Int 2016; 36:418-26. [PMID: 26264356 DOI: 10.1111/liv.12937] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/07/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is becoming the most prevalent liver disorder. The PNPLA3 (adiponutrin) variant p.I148M has been identified as common genetic modifier of NAFLD. Our aim was to assess the relationships between genetic risk and non-invasively measured liver fat content. METHODS Hepatic steatosis was quantified by transient elastography, using the controlled attenuation parameter (CAP) in 174 patients with chronic liver diseases (50% women, age 18-77 years). In addition, a cohort of 174 gender-matched healthy controls (50% women, age 32-77 years) was recruited. The PNPLA3 mutation as well as the novel NAFLD-predisposing genetic variant (TM6SF2 p.E167K) were genotyped with allele-specific probes. RESULTS The PNPLA3 genotype correlated significantly (P = 0.001) with hepatic CAP measurements. The p.148M risk allele increased the odds of developing liver steatosis (OR = 2.39, P = 0.023). In multivariate models, BMI and PNPLA3 mutation were both independently associated with CAP values (P < 0.001 and P = 0.007, respectively). Carriers of the TM6SF2 risk allele presented with increased aminotransferase activities (ALT: P = 0.007, AST: P = 0.004), but the presence of this variant did not affect CAP values. CONCLUSIONS The PNPLA3 p.I148M variant represents the most important prosteatotic genetic risk factor. NAFLD carriers of this variant should be followed up carefully, with elastography and CAP being ideally suited for this purpose.
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Affiliation(s)
- Anita Arslanow
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Susanne N Weber
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Frank Grünhage
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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Ecker J, Lammert F, Gluud LL, Stokes CS. Bile acid derivatives for people with primary sclerosing cholangitis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Johannes Ecker
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
| | - Frank Lammert
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
| | - Lise Lotte Gluud
- Copenhagen University Hospital Hvidovre; Gastrounit, Medical Division; Kettegaards Alle Hvidovre Denmark 2650
| | - Caroline S Stokes
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
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Ecker J, Lammert F, Gluud LL, Stokes CS. Bile acid derivatives for people with primary biliary cholangitis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Johannes Ecker
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
| | - Frank Lammert
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
| | - Lise Lotte Gluud
- Copenhagen University Hospital Hvidovre; Gastrounit, Medical Division; Kettegaards Alle Hvidovre Denmark 2650
| | - Caroline S Stokes
- Saarland University Medical Center; Department of Medicine II; Homburg/Saar Germany 66421
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Mayer LB, Krawczyk M, Grünhage F, Lammert F, Stokes CS. A genetic variant in the promoter of phosphate-activated glutaminase is associated with hepatic encephalopathy. J Intern Med 2015; 278:313-22. [PMID: 25880019 DOI: 10.1111/joim.12374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatic encephalopathy (HE) is a serious complication of liver cirrhosis. Recently, a microsatellite in the promoter region of the phosphate-activated glutaminase (GLS ) gene was associated with the risk of HE. The aim of the present study was to investigate, using the critical flicker frequency (CFF) test, whether the described GLS variant increases the risk of developing HE in patients with cirrhosis. METHODS We recruited 158 patients (66% men; mean age 59 years, range 23-86) with liver cirrhosis. Mean model for end-stage liver disease score was 13.8 (range 5-35); 48% of patients presented with Child-Pugh score B or C. The presence and severity of HE were determined by the CFF test, with frequencies ≤39 Hz denoting cases. GLS variants were genotyped by sequencing the microsatellite in the promoter region and were classified as short, long or short-long forms (depending on the length of the macrosatellite alleles). RESULTS In total, 53% of patients had abnormal CFF results (i.e. ≤39 Hz; range for entire cohort 26-57). The GLS microsatellite distribution amongst patients was short form (20%), long form (32%) and short-long form (48%) and was consistent with Hardy-Weinberg equilibrium. CFF values differed significantly between groups (P = 0.043). Carriers of the GLS long microsatellite had a significantly higher risk of HE according to multivariate analyses (odds ratio 3.23, 95% confidence interval 1.46-7.13, P = 0.004). CONCLUSION CFF results were significantly lower amongst carriers of the GLS long microsatellite. Our findings support the role of the GLS long microsatellite in the development of HE; this could be important for identifying susceptible patients and for the prevention of this condition.
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Affiliation(s)
- L B Mayer
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - M Krawczyk
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - F Grünhage
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - F Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - C S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
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Stokes CS, Grünhage F, Baus C, Volmer DA, Wagenpfeil S, Riemenschneider M, Lammert F. Vitamin D supplementation reduces depressive symptoms in patients with chronic liver disease. Clin Nutr 2015. [PMID: 26212170 DOI: 10.1016/j.clnu.2015.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Vitamin D deficiency and depression frequently occur in patients with chronic liver diseases (CLD). Depression has recently been inversely associated with vitamin D in a meta-analysis, and vitamin D receptor is expressed in brain. This pilot study investigates whether vitamin D replacement ameliorates depressive symptoms in CLD patients and consists of a cross-sectional and an interventional analysis. METHODS Overall, 111 patients with CLD were included in the cross-sectional analysis. The Beck Depression Inventory II (BDI-II) was used to assess depression. Chemiluminescence immunoassay and LC-MS/MS quantified serum 25-hydroxyvitamin D levels. For the interventional analysis, 77 patients with inadequate vitamin D concentrations received 20,000 IU vitamin D per week for six months. The final follow-up was carried out six months post supplementation. RESULTS In the cross-sectional analysis, 81% of patients (median age 55 years, 47% women) had inadequate baseline vitamin D levels (<30 ng/ml), and 31% presented with depressive symptoms (BDI-II score ≥14). Depression severity correlated inversely with vitamin D level in depressed patients (β = -0.483, P = 0.004). Depression scores improved significantly from baseline in depressed patients after three and six months (P = 0.003 and P = 0.004, respectively) of supplementation, with vitamin D levels increasing to normal (P < 0.0001). Subgroup analyses revealed this anti-depressant effect of vitamin D to occur predominantly in women. The final follow-up showed increases in median BDI-II scores in the setting of decreased vitamin D levels. CONCLUSIONS Vitamin D levels correlated with BDI-II scores, and vitamin D replacement significantly improved depressive symptoms in women with CLD. Adjuvant vitamin D may be considered in these patients. REGISTRATION NO DRKS00007782 German Clinical Trials Registry (DRKS).
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
| | - Frank Grünhage
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Crystal Baus
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Dietrich A Volmer
- Institute of Bioanalytical Chemistry, Saarland University, Saarbrücken, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Germany
| | - Matthias Riemenschneider
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
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Arslanow A, Teutsch M, Walle H, Lammert F, Stokes CS. Two week protein-enriched low-calorie diet (HEPAFAST) shows rapid improvement of fatty liver as assessed by controlled attenuation parameter. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Krawczyk M, Stokes CS, Romeo S, Lammert F. HCC and liver disease risks in homozygous PNPLA3 p.I148M carriers approach monogenic inheritance. J Hepatol 2015; 62:980-1. [PMID: 25559327 DOI: 10.1016/j.jhep.2014.10.048] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
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Geib T, Meier F, Schorr P, Lammert F, Stokes CS, Volmer DA. A simple micro-extraction plate assay for automated LC-MS/MS analysis of human serum 25-hydroxyvitamin D levels. J Mass Spectrom 2015; 50:275-279. [PMID: 25601703 DOI: 10.1002/jms.3522] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 09/19/2014] [Accepted: 10/06/2014] [Indexed: 06/04/2023]
Abstract
This short application note describes a simple and automated assay for determination of 25-hydroxyvitamin D (25(OH)D) levels in very small volumes of human serum. It utilizes commercial 96-well micro-extraction plates with commercial 25(OH)D isotope calibration and quality control kits. Separation was achieved using a pentafluorophenyl liquid chromatography column followed by multiple reaction monitoring-based quantification on an electrospray triple quadrupole mass spectrometer. Emphasis was placed on providing a simple assay that can be rapidly established in non-specialized laboratories within days, without the need for laborious and time consuming sample preparation steps, advanced calibration or data acquisition routines. The analytical figures of merit obtained from this assay compared well to established assays. To demonstrate the applicability, the assay was applied to analysis of serum samples from patients with chronic liver diseases and compared to results from a routine clinical immunoassay.
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Affiliation(s)
- Timon Geib
- Institute of Bioanalytical Chemistry, Department of Chemistry, Saarland University, Saarbrücken, Germany
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Volmer DA, Mendes LRBC, Stokes CS. Analysis of vitamin D metabolic markers by mass spectrometry: current techniques, limitations of the "gold standard" method, and anticipated future directions. Mass Spectrom Rev 2015; 34:2-23. [PMID: 24318020 DOI: 10.1002/mas.21408] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 05/10/2023]
Abstract
Vitamin D compounds belong to a group of secosteroids, which occur naturally as vitamin D3 in mammals and D2 in plants. Vitamin D is vital for bone health but recent studies have shown a much wider role in the pathologies of diseases such as diabetes, cancer, autoimmune, neurodegenerative, mental and cardiovascular diseases. Photosynthesis of vitamin D in the human skin and subsequent hepatic and renal metabolism generate a wide range of transformation products occurring over a large dynamic range spanning from picomolar to nanomolar levels. This necessitates selective and sensitive analytical methods to quantitatively capture these low concentration levels in relevant tissues such as blood. Ideally, vitamin D assessment would be performed using a universal and standardized analytical method available to clinical laboratories that provides reliable and accurate quantitative results for all relevant vitamin D metabolites with sufficiently high throughput. At present, LC-MS/MS assays are the most promising techniques for vitamin D analysis. The present review focuses on developments in mass spectrometry methodologies of the past 12 years. It will highlight detrimental influences of the biological matrix, epimer contributions, pitfalls of specific mass spectrometry data acquisition routines (in particular multiple reaction monitoring, MRM), influence of ionization source, derivatization reactions, inter-laboratory comparisons on precision, accuracy, and application range of vitamin D metabolites.
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Affiliation(s)
- Dietrich A Volmer
- Institute of Bioanalytical Chemistry, Saarland University, Saarbrücken, Germany
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Stokes CS, Gluud LL, Casper M, Lammert F. Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol 2014; 12:1090-1100.e2; quiz e61. [PMID: 24321208 DOI: 10.1016/j.cgh.2013.11.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/04/2013] [Accepted: 11/21/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The prevalence of gallstones is increasing in association with the obesity epidemic, but rapid weight loss also increases the risk of stone formation. We conducted a systematic review of the efficacy of strategies to prevent gallbladder stones in adults as they lose weight. METHODS Randomized controlled trials of nonsurgical strategies to prevent gallstones were identified by electronic and manual searches. Our final analysis included 13 trials, comprising 1836 participants undergoing weight loss through dieting (8 trials) or bariatric surgery (5 trials). The trials compared ursodeoxycholic acid (UDCA) or high-fat weight loss diets with control interventions. We performed random-effects meta-analyses and evaluated heterogeneity and bias with subgroup, sensitivity, regression, and sequential analysis. RESULTS UDCA reduced the risk of ultrasound-verified gallstones compared with control interventions (risk ratio, 0.33; 95% confidence interval [CI], 0.18-0.60; number needed to treat, 9). This effect was significantly larger in trials of diets alone (risk ratio, 0.17; 95% CI, 0.11-0.25) than in trials of patients who underwent bariatric surgery (risk ratio, 0.42; 95% CI, 0.21-0.83) (test for subgroup differences, P =.03). UDCA reduced the risk of cholecystectomy for symptomatic stones (risk ratio, 0.20; 95% CI, 0.07-0.53). Diets high in fat content also reduced gallstones, compared with those with low fat content (risk ratio, 0.09; 95% CI, 0.01-0.61). The meta-analyses were confirmed in trials with a low risk of bias but not in sequential analysis. No additional beneficial or harmful outcomes were identified. CONCLUSIONS On the basis of a meta-analysis of randomized controlled trials, during weight loss, UDCA and/or higher dietary fat content appear to prevent formation of gallstones.
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Lise Lotte Gluud
- Diabetes Research Division, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Markus Casper
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Hochrath K, Stokes CS, Geisel J, Pollheimer MJ, Fickert P, Dooley S, Lammert F. Vitamin D modulates biliary fibrosis in ABCB4-deficient mice. Hepatol Int 2014; 8:443-52. [PMID: 25191532 PMCID: PMC4148166 DOI: 10.1007/s12072-014-9548-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/18/2014] [Indexed: 12/31/2022]
Abstract
Purpose Impaired vitamin D receptor signaling represents an aggravating factor during liver injury, and recent studies suggest that vitamin D might exert a protective role in chronic hepatobiliary diseases. We hypothesized that vitamin D supplementation would ameliorate liver fibrosis in ATP-binding cassette transporter B4 knockout (Abcb4−/−) mice as a preclinical model of sclerosing cholangitis. Methods Abcb4−/− and wild-type mice were fed a regular chow diet (600 IU vitamin D/kg food) or diets with lower (100 IU/kg) and higher (2,400 IU/kg) vitamin D concentrations for 12 weeks. Serum 25-hydroxyvitamin D concentrations were measured by chemiluminescence immunoassays. Liver injury and biliary fibrosis were assessed by liver enzyme activities, histopathology and hepatic collagen contents. Hepatic mRNA expression of markers for fibrosis, vitamin D and bile acid metabolism were analyzed by quantitative PCR. Results Different vitamin D concentrations were observed depending on genotype and diet group, with Abcb4−/− mice on the control diet showing lower vitamin D concentrations compared to wild-type mice. Abcb4−/− animals on the low vitamin D diet demonstrated the most advanced liver fibrosis and highest hepatic collagen contents. Feeding Abcb4−/− mice a high vitamin D diet enriched serum vitamin D levels, lowered liver enzyme activities, altered expression levels of profibrogenic genes and ameliorated, in part, liver injury. Conclusions This is the first report to demonstrate that fibrogenesis in the established Abcb4−/− model is influenced by vitamin D supplementation. Since vitamin D modulates sclerosing cholangitis in vivo, we speculate that sufficient vitamin D intake might improve liver damage and induce antifibrotic effects in chronic cholestasis in humans. Electronic supplementary material The online version of this article (doi:10.1007/s12072-014-9548-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katrin Hochrath
- Department of Medicine II, Saarland University Medical Center, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Caroline S. Stokes
- Department of Medicine II, Saarland University Medical Center, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Jürgen Geisel
- Institute of Clinical Chemistry and Laboratory Medicine, Saarland University Medical Center, Homburg, Germany
| | | | - Peter Fickert
- Insititute of Pathology, Medical University Graz, Graz, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Steven Dooley
- Division of Molecular Hepatology-Alcohol Associated Diseases, Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Kirrberger Str. 100, 66421 Homburg, Germany
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Stokes CS, Gluud LL, Casper M, Lammert F. Pharmacological interventions for the primary prevention of gallbladder stones in adults. Hippokratia 2014. [DOI: 10.1002/14651858.cd011037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Caroline S. Stokes
- Saarland University Hospital; Department of Medicine II; Kirrberger Str. 1 Homburg/Saar Germany 66421
| | - Lise Lotte Gluud
- Copenhagen University Hospital Hvidovre; Gastro Unit, Medical Division; Kettegaards Alle Hvidovre Denmark 2650
| | - Markus Casper
- Saarland University Hospital; Department of Medicine II; Kirrberger Str. 1 Homburg/Saar Germany 66421
| | - Frank Lammert
- Saarland University Hospital; Department of Medicine II; Kirrberger Str. 1 Homburg/Saar Germany 66421
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Stokes CS, Krawczyk M, Reichel C, Lammert F, Grünhage F. Vitamin D deficiency is associated with mortality in patients with advanced liver cirrhosis. Eur J Clin Invest 2014; 44:176-83. [PMID: 24236541 DOI: 10.1111/eci.12205] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 11/10/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic liver disease is the fifth most common cause of mortality in Europe. Recently, vitamin D deficiency has been associated with an increased risk of mortality in the general population. As patients with advanced liver disease frequently exhibit vitamin D deficiency, we assessed for a possible association of vitamin D deficiency with survival in a cohort of patients with advanced liver disease. METHODS Sixty-five patients with liver cirrhosis (median age, 58 years; range, 19-76 years; 66% male; Child-Pugh stage C, 46%) were included in our prospective single-centre survival study. Serum 25-hydroxyvitamin D concentrations were measured by chemiluminescence immunoassay. The optimal cut-off was determined using receiver operating characteristic (ROC) and Kaplan-Meier analysis. Chi-square statistics and multivariate binary logistic regression analysis were also conducted. RESULTS Median serum vitamin D levels were 8·2 ng/mL (range <4·0-95·8 ng/mL). Overall, 48% of patients (31/65) died during a 24-month follow-up period. ROC analysis determined a vitamin D level of 6·0 ng/mL as optimal cut-off for discriminating survivors from nonsurvivors. Kaplan-Meier analysis of survival confirmed low vitamin D levels as significant predictor of death (P = 0·012). Finally, multivariate analysis identified low vitamin D levels (OR = 6·3; 95% CI, 1·2-31·2; P = 0·012) and MELD scores (OR = 1·4; 95% CI, 1·2-1·7; P < 0·001) as independent predictors of survival. CONCLUSION Low vitamin D levels are associated with increased mortality in patients with advanced liver disease. Thus, serum levels of vitamin D might represent a critical marker of survival in advanced liver cirrhosis.
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
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Krawczyk M, Miquel JF, Stokes CS, Zuniga S, Hampe J, Mittal B, Lammert F. Genetics of biliary lithiasis from an ethnic perspective. Clin Res Hepatol Gastroenterol 2013; 37:119-25. [PMID: 23340007 DOI: 10.1016/j.clinre.2012.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 09/25/2012] [Indexed: 02/04/2023]
Abstract
Gallstone disease represents one of the most common gastroenterological disorders worldwide. Gallstones affect over 15% of adults in Europe and 25-30% of Hispanic populations in Central and South America. The heritability of gallstones varies considerably according to ethnicity, with Native Americans and Hispanics with Amerindian admixture being the most susceptible populations. Genetic factors have been shown to account for 25-30% of total gallstone risk in Europe, however, in Hispanic populations, this risk percentage may increase to 45-65%. Recent genome-wide association and candidate gene studies have identified common polymorphisms in enterohepatic transporters (ABCG5/8, SLC10A2) and the Gilbert syndrome UGT1A1 variant as genetic determinants of gallstone formation. Together, these polymorphisms cover a significant proportion of the previously predicted genetic background of gallstones in European populations. New lithogenic genes need to be discovered in future studies in high-risk populations. In this review, we address the latest developments in the genetic analysis of gallstones and discuss the ethnic background of this condition in European, Central and South American and Asian populations.
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Affiliation(s)
- Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66421 Homburg, Germany
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Abstract
UNLABELLED Chronic liver disease (CLD) and several related extrahepatic manifestations such as hepatic osteodystrophy are associated with deficiency of vitamin D, which has therefore been suggested as therapeutic target. Vitamin D undergoes hepatic 25-hydroxylation, rendering the liver critical to the metabolic activation of this vitamin. Vitamin D deficiency is highly prevalent in CLD patients, and vitamin D levels are inversely related to the severity of CLD. Declining levels of carrier proteins such as albumin and vitamin D-binding protein might also be critical in CLD. Intervention studies report improvements of CLD following supplementation, and benefits to health outcomes in particular with respect to hepatitis C virus infection have recently been documented. CONTENT We discuss vitamin D sources, functions and metabolism with a focus on the inherent complications of analytical measurements, such as the interference of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D C-3 epimers. Global discrepancies in the definition of optimal serum 25-hydroxyvitamin D levels are covered, and the prevalence of vitamin D deficiency in CLD is reviewed. We also address the functional mechanisms underlying this deficiency, and refer to associations between genetic variation in vitamin D metabolism and CLD. Lastly, we consider the health implications of a vitamin D deficiency in CLD and consider therapeutic options. SUMMARY Herein, we focus on the epidemiological and functional relationships between vitamin D deficiency and CLD, followed by a discussion of the potential implications for therapeutic interventions.
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Abstract
Abstract
Gallstones are a common and costly disease with a projected increase in prevalence due to the increasing ageing population. Numerous endogenous and environmental factors are aetiologically related to this multifactorial disease, and genetic studies continue to unravel the pathobiological mechanisms related to gallstone formation. In particular, variants of genes encoding hepatobiliary transporters have been implicated in gallstone disease and, given their ability to influence biliary lipid composition, have undergone considerable investigation. Here we summarize the role of enterohepatic transporters in cholelithogenesis with a particular focus on pertinent ATP-binding cassette transporters (ABCB4, ABCB11, ABCC7, and ABCG5/G8).
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Abstract
Gallstone disease represents one of the most common and costly gastroenterological disorders. In Germany, 0.25% of the population undergo cholecystectomy per year, and cholelithiasis incurs annual medical expenses of more than USD 6.5 billion in the United States. The paradigm of environmental risk factors for gallstones has lately been challenged by genetic studies in experimental models and humans. The analysis of more than 40,000 Swedish twin pairs with gallstones demonstrated that genetic factors account for 25% of the phenotypic variance. Since then, studies employing genome-wide association analysis, case-control cohorts and analysis of sib-pairs in families with gallstones have expanded our knowledge of 'gallstone genes'. Indeed, gallstone disease phenotypes are likely to result from the complex interaction of genetic factors, chronic overnutrition with carbohydrates, depletion of dietary fibre and other not fully defined environmental factors including physical inactivity and infections. This hypothesis is supported by the profound increases of cholesterol gallstone prevalence rates in Native Americans, post-war European countries and current urban centres in East Asia, all of which were associated with 'westernized' nutrition. Herein, we summarise the spectrum of environmental and genetic risk factors which should pave the way to 'personalised' strategies for the prevention and therapy of gallstones.
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Hospital, Homburg, Germany
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Stokes CS. Nutrition and Health: Current Topics 6–7. NUTR BULL 2008. [DOI: 10.1111/j.1467-3010.2008.00684.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
An important area of concern among rural health researchers and policy analysts is the social and ecological correlates of mortality levels. This research is concerned with the empirical relationship between the prevalence of poverty and the mortality experience of different age groups within the population. Poverty is viewed as a characteristic of the social organization of local areas and operationalized by employing several indicators, including a measure of rurality. The empirical results indicate that the magnitude of the association between the prevalence of poverty and mortality varies among different age groups. The impact of rurality, while being consistently positive, is shown to be statistically nonsignificant. The research also shows that the availability of primary care is associated with lower mortality.
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Affiliation(s)
- F L Farmer
- University of Arkansas, Fayetteville 72701
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Rhea AH, Howell D, Stokes CS. Gunshot wounds to the head in Florence County. J S C Med Assoc 1997; 93:107-11. [PMID: 9077055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A H Rhea
- McLeod Regional Medical Center, Florence, SC, USA
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Abstract
SummaryThe influence of household type on reproductive behaviour is examined for a national probability sample of Taiwanese women. In spite of remarkable social and economic development over the past three decades, extended families are still widely found in Taiwan. Women in extended households have only slightly higher fertility preferences and current fertility than women in nuclear families once marital duration is controlled. Although women in extended households marry earlier and receive more family help with child care than women in nuclear households, such factors are no longer sufficient to produce major differentials in reproductive behaviour. The findings suggest that preferences for smaller families and low fertility need not await a transformation to a nuclear family structure.
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Miller MK, Stokes CS, Clifford WB. A comparison of the rural-urban mortality differential for deaths from all causes, cardiovascular disease and cancer. J Rural Health 1987; 3:23-34. [PMID: 10284088 DOI: 10.1111/j.1748-0361.1987.tb00165.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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