Receptor for Advanced Glycation End Product, Organ Crosstalk, and Pathomechanism Targets for Comprehensive Molecular Therapeutics in Diabetic Ischemic Stroke

Diabetes mellitus, a well-established risk factor for stroke, is related to higher mortality and poorer outcomes following the stroke event. Advanced glycation end products(AGEs), their receptors RAGEs, other ligands, and several other processes contribute to the cerebrovascular pathomechanism interaction in the diabetes-ischemic stroke combination. Critical reappraisal of molecular targets and therapeutic agents to mitigate them is required to identify key elements for therapeutic interventions that may improve patient outcomes. This scoping review maps evidence on the key roles of AGEs, RAGEs, other ligands such as Leukotriene B4 (LTB4), High-mobility group box 1 (HMGB1) nuclear protein, brain-kidney-muscle crosstalk, alternate pathomechanisms in neurodegeneration, and cognitive decline related to diabetic ischemic stroke. RAGE, HMGB1, nitric oxide, and polyamine mechanisms are important therapeutic targets, inflicting common consequences of neuroinflammation and oxidative stress. Experimental findings on a number of existing-emerging therapeutic agents and natural compounds against key targets are promising. The lack of large clinical trials with adequate follow-up periods is a gap that requires addressing to validate the emerging therapeutic agents. Five therapeutic components, which include agents to mitigate the AGE-RAGE axis, improved biomarkers for risk stratification, better renal dysfunction management, adjunctive anti-inflammatory-antioxidant therapies, and innovative neuromuscular stimulation for rehabilitation, are identified. A comprehensive therapeutic strategy that features all the identified components is needed for outcome improvement in diabetic stroke patients.

Correlation of serum fluorescence of advanced glycation end products with diabetes duration and glycemic control in type 2 diabetic patients

Introduction: Advanced glycation end products (AGEs) and diabetes duration have roles in the development of the vascular complications associated with morbidity and mortality in diabetic patients. The present study was conducted to estimate and find the association between serum fluorescence levels of advanced glycation products with diabetes duration and glycemic control in type 2 diabetic patients. Methods: 46 patients who had diabetic duration of less than ten years and 49 patients with duration more than ten years were included in the study. Serum fluorescence of AGEs was measured using a simple spectrofluorometric method. Correlations of AGEs with diabetes duration, fasting glucose, and glycated hemoglobin levels were analyzed. The incidence of microvascular complications in patients of both groups was examined. Results: Significantly higher serum fluorescent AGE levels (p < 0.001) and higher incidence of microvascular complications (p = 0.000) were found in diabetic patients who had diabetes duration of more than ten years, poorer glycemic control and higher age. Serum levels of fluorescent AGEs showed significant positive correlations with duration of diabetes mellitus, glycated haemoglobin and fasting glucose levels. Conclusion: Screening patients for AGEs, intensive glycemic control, and therapeutic strategies that target molecular mechanisms involving advanced glycation end products are warranted in older patients with longer diabetes duration to minimize their risk of developing complications.

Serum Fluorescence of Advanced Glycation End Products: A Potential Screening Tool to Distinguish Between Diabetic Patients with and without Microvascular Complications

Introduction: Enhanced formation and accumulation of Fluorescent Advanced Glycation End products (F-AGEs) in diabetes mellitus have been linked to increased risk of developing the associated vascular complications. Aim: To evaluate the potential of serum fluorescence levels of F-AGEs as screening tools to distinguish between type 2 diabetic patients with and without microvascular complications such as retinopathy, neuropathy. Materials and Methods: This cross-sectional study was conducted between June 2016 and June 2017, included 95 type 2 diabetic patients with more than 1 year of diabetes duration. Fasting blood glucose, glycated haemoglobin and total protein levels were estimated by automated methods. Serum F-AGEs were estimated by using a simple spectrofluorometric method. Microvascular complications due to diabetes mellitus were studied in each patient from medical records data on fundus examination for retinopathy and touch, vibration sensation detection for neuropathy. Diabetic patients were categorised into two groups as those without microvascular complications and those with microvascular complications-retinopathy and neuropathy. Statistical tests used for comparisons between groups were chi-square test for gender distribution, independent t-test for other parameters and Pearson’s correlations. The p-value <0.05 indicated significant difference between variables. Results: Mean age of the population was 55.1±5.3 years. Diabetic patients with microvascular complications (n=26) in the form of retinopathy, neuropathy had significantly higher levels of serum F-AGEs with mean 7.4±1.8 AU/g protein compared with diabetic patients without complications with mean value 1.5±0.7 AU/g protein (p<0.01). Conclusion: Two categories of serum fluorescent AGE values, without overlap, could be distinguished between diabetic patients with and without complications. Measurement of serum F-AGEs products has the potential to emerge as a simple, valuable screening tool to distinguish between diabetic patients with and without microvascular complications.

Salivary C-Reactive Protein in Hashimoto's Thyroiditis and Subacute Thyroiditis

C-reactive protein (CRP), an acute-phase reactant, has been identified as a saliva-based biomarker of inflammation. The objective of the study was to estimate and compare salivary CRP levels in Hashimoto's thyroiditis (HT) and Subacute thyroiditis (SAT). The study included 30 HT patients who presented with clinical features of hypothyroidism, 15 SAT patients who presented with clinical features of hyperthyroidism, and 20 healthy age- and sex-matched euthyroid controls. CRP levels in saliva were estimated using an Enzyme-Linked Immunosorbent Assay method with enhanced sensitivity. In HT, the mean salivary CRP levels did not differ significantly from controls. SAT patients had significantly elevated salivary CRP levels compared to HT patients and controls. The rise in salivary CRP levels in SAT patients conceivably reflects the presence of an inflammatory process. Saliva CRP levels appear to serve as inflammatory markers in SAT patients and may aid their clinical evaluation.