Multiple fractures in infants who have Ehlers-Danlos/hypermobility syndrome and or vitamin D deficiency: A case series of 72 infants whose parents were accused of child abuse and neglect

Objective: To increase the level of awareness that Ehlers-Danlos/hypermobility syndrome (EDS) and vitamin D deficiency are associated with infantile fragility fractures and radiologic features that may be mistakenly reported to be caused by non-accidental trauma due to Child Abuse and Neglect (CAN).

Patients and Methods: We constructed a case series, the largest to date, of infants with EDS who were vitamin D sufficient, insufficient and deficient and infants without EDS but with documented vitamin D deficiency and radiologic evidence of rickets who presented with multiple fractures originally diagnosed as being non-accidental and caused by child abuse. These infants were referred to the outpatient Bone Health Care Clinic at Boston University Medical Campus over a 6-year (2010–2015) period. We also present 6 index cases in which the court concluded that there was no convincing evidence of child abuse and the infants were returned to their parents. Institutional Review Board (IRB) approval was obtained.

Results: We present 72 cases of infants with multiple fractures diagnosed to be caused by non-accidental trauma. All infants were younger than one year of age. Among them, 93%(67) had clinical evidence of EDS and/or a family history with a confirmed clinical diagnosis of at least one parent having EDS and the other 7%(5) without evidence of EDS had vitamin D deficiency/infantile rickets. Three of the EDS infants were diagnosed as osteogenesis imperfecta (OI)/EDS overlap syndrome. The most common fractures noted at diagnosis were ribs and extremity fractures (including classic metaphyseal lesions). Serum levels of 25-hydroxyvitamin D [25(OH)D] were reported in 48 infants (18.0 ± 8.5 ng/ml) and in 30 mothers (21.3 ± 11.7 ng/ml). Sixty-three percent (27) of the EDS infants who had their serum 25(OH)D measured were vitamin D deficient 25(OH)D<20 ng/ml and 5 were vitamin D sufficient 25(OH)D>30 ng/ml. The mean serum level for infants with vitamin D deficiency/rickets was (10.2 ± 3.0 ng/ml)

Conclusion: EDS, OI/EDS and vitamin D deficiency/infantile rickets are associated with fragility fractures in infants that can be misinterpreted as caused by non-accidental trauma due to child abuse.

The relationship between obesity and bone mineral density: evidence for a role of peroxisome proliferator-activated receptor gamma

AIM

Peroxisome proliferator-activated receptor γ (PPAR γ) is a critical factor for some pathways that involve in adipogenesis and osteogenesis. The aim of study was to compare PPARγ gene expression, different cytokines' levels and bone markers in osteopenic and non-osteopenic obese subjects.

METHODS

A total of 265 obese participants recruited in the current case-control cross sectional study. BMD at region of lumbar spine and hip were measured in all participants. We categorized all participants into two osteopenic and non-osteopenic groups.

RESULTS

Of the 265 obese participants, 77 (29.05 %) were osteopenic and 188 (70.95%) were non-osteopenic. We found significantly higher concentration of crosslaps and IL6 and lower free fat mass in osteopenic group. The relative gene expression of PPAR γ in osteopenic group was significantly higher than non-osteopenic group. Based on relative gene expression tertiles participants were rearranged all participants into two new groups; low expressed PPAR γ with low PPAR γ gene expression≤75% and high expressed PPAR γ with PPAR γ gene expression>75%. The levels of fat percents, triglyceride, LDL, HDL and total cholesterol in high expressed PPAR γ group were significantly higher than low expressed PPAR γ group. Also, significantly higher concentration of IL10, IL6 and TNFα and lower concentration of hs-CRP were detected in high expressed group compare to low expressed PPAR γ group. The BMD, T-score and Z-score in high expressed PPAR γ group were lower than low expressed PPAR γ group.

CONCLUSION

Our findings suggest that the over expression of PPARγ in obese individual's PBMCs may have a critical role in relationship between obesity and bone loss. Further studies recommended clarifying the mechanism of PPARγ in bone turnover in obese subjects.

Association between alterations in global DNA methylation and predisposing factors in diabetes: a high pressure liquid chromatography based study

AIM

The aim of this study was to investigate the relationship between inter-individual global DNA methylation and diabetes predisposing factors.

METHODS

The 5-methyl cytosine content was assessed by reverse phase high pressure liquid chromatography (RP-HPLC) of peripheral blood leukocytes obtained from 178 type 2 diabetes patients to determine individual global DNA methylation status.

RESULTS

There was a positive significant correlation between diabetes duration and DNA methylation levels (P=0.002) with increasing levels of DNA methylation associated with age (P=0.047). There was no significant correlation between DNA methylation levels and HbA1c (P=0.15). No significant differences were observed between patients with and without diabetes predisposing factors including: hypertension (P=0.772), dyslipidemia (P=0.617), insulin resistance (homeostatic model assessment index) (P=0.156) and obesity (P=0.609). As such, the duration of diabetes (>10 years) was the most important predictor of global DNA methylation levels in diabetic patients after adjusting for age and sex (P=0.023).

CONCLUSION

Our findings indicate that chronic hyperglycemic exposure plays an independent role in global DNA methylation levels in type 2 diabetes patients.

Insulin resistance via modification of PGC1α function identifying a possible preventive role of vitamin D analogues in chronic inflammatory state of obesity. A double blind clinical trial study

AIM

Obesity-induced chronic inflammation is a key component of the pathogenesis of insulin resistance. Mounting evidence has demonstrated anti-inflammatory characteristics for vitamin D. Although analogues of vitamin D3 have extensively been used in the treatment of various chronic inflammatory diseases, to our knowledge, no such research is conducted in regards with obesity. The aim of this double blind clinical trial study is to investigate whether alphacalcidol treatment in obese subjects can affect the cytokine profile and insulin resistance. Moreover, we evaluated the pathways of vitamin D receptor (VDR), PPARγ and PGC1α gene expressions which may lead to insulin resistance following treatment with either alphacalcidol or placebo.

METHODS

A total of 94 obese participants (BMI≥30) were recruited for the current double blind clinical trial study. Patients were divided into two intervention (N.=40) and control groups (N.=54) based on the stratified randomized method. One-Alpha® Capsules 1 microgram: alfacalcidol (1-α hydroxyvitamin D3) and placebo were given to subjects once a day for 8 weeks. Analysis of body composition was performed with use of Body Composition Analyzer. The circulating levels of TNF-α, IL-1β, IL-4, IL-6, IL-10, IL-13, IL-17, PTH, and 25-Hydroxy Vi-tamin D were measured with the use of EIA method. The PBMCs were separated from whole blood by Ficoll-hypaque technique. Total cellular RNA was extracted and the cDNA was synthesized. The real-time PCR using specific primer pairs for VDR, PGC1α, PPARγ, and β-actin was performed.

RESULTS

The FPG, fat percent and PTH levels were decreased and the levels of HDL-cholesterol and 25-hydroxy vitamin D were significantly increased after treatment with Alfacalcidol. Regarding to cytokines levels, the levels of IL6 were significantly decreased and IL10 were significantly increased in Alfacalcidol group in comparison with the control group. The relative expressions of VDR, PGC1α, and PPARγ genes significantly increased in Alfacalcidol group. We found also significant positive correlation between circulating 25-OH vitamin D and relative PGC1α gene expression in participants with insulin resistance.

CONCLUSION

It seems that Alfacalcidol treatment may be effective in amelioration of the inflammatory state in obesity. This supplement might also improve resistance to insulin through enhancement of relative VDR and its downstream genes expression, which are demonstrated to be involved in glucose homeostasis pathways.

A polymorphism in the resistin gene promoter and the risk of multiple sclerosis

AIM

Multiple sclerosis (MS) is an inflammatory neurodegenerative disorder that inflammatory cytokines have been implicated in its immunopathogenesis. Resistin, a member of cysteine-rich secretory proteins family, identified with inflammatory properties in humans. To elucidate whether different genotypes of resistin are involved in MS pathogenesis, we compared serum levels of TNF-α, IL-1β, hs-CRP, and resistin levels in different genotypes of MS patients with relapsing remitting type and healthy subjects.

METHODS

IN a case-control study, 86 MS patients and 86 age- and sex-matched healthy subjects were enrolled. The age, gender distribution, and BMI of MS patientsand control group were similar. The serum levels of TNF-α, IL-1β, and Resistin were measured by ELISA. hs-CRP was measured by imunoturbidimetric method. After DNA extraction, the analysis of -420C/G SNP (rs1862513) was performed via PCR-RFLP method.

RESULTS

The resistin, TNF-α, IL1β, and hs-CRP levels were significantly higher in MS patients compared with control group. The distribution of "rs1862513" genotypes were not significant between MS and control groups. Although resistin and TNFα levels were higher in GG genotype carriers of both groups, but the difference was significant only in MS patient.

CONCLUSION

Resistin gene polymorphisms may modify the being susceptible to MS disease, which may cause through various levels of cytokines between genotypes.

Evidences of dual role of vitamin D through cellular energy homeostasis and inflammation pathway in risk of cancer in obese subjects

AIM

The underlying molecular mechanisms of the role obesity plays in increasing the risk of cancer are not well illuminated. Several mechanisms are proposed for vitamin D as an anti-cancer agent in various malignancies which may be attributed to both its both its anti-inflammatory characteristics as well as its mediatory role in cellular energy homeostasis. This study evaluates the expression of PBMCs' genes which are involved in cellular energy homeostasis such as VDR, PPARγ, PGC1a and UCP2. Moreover, considering the possible role of vitamin D in the inflammation mechanisms, we also aimed at measurement of some inflammatory mediators such as TNF-α, IL-1β, IL4, IL-6, IL10, IL13 and IL17 in inflammatory state in samples obtained from obese persons with and without positive family history of cancer. Moreover, to expand the study to a clinical context, we assessed the correlation of the resting metabolic rate with the evaluated gene.

METHODS

A total of 274 obese women were included in the current cross-sectional study. All of participants were class I obese. By constructing a pedigree that includes 3 generations, twenty-one subjects were at increased risk because of a positive family history of colorectal cancer. Accordingly, current study's analysis was based on positive and negative family history of colorectal cancer.

RESULTS

The concentration of Insulin and PTH were significantly high in group with positive history of cancer. 25 (OH) vitamin D, REE/kg and REE/FFM statuses in two groups; the level of mentioned terms were lower in group with positive history of cancer compared to group with negative history of cancer. We found significantly lower REE/kg in deficiency of vitamin D and higher REE/kg in sufficiency status. Our results demonstrated significant higher concentrations of IL1β, IL17, TNFα and IL6 in group with positive history of cancer compared to group with negative history of cancer. The concentrations of IL13, IL10 and IL4 were significantly lower in group with positive history of cancer compared to group with negative history of cancer. The relative expression of VDR, PGC1αand PPARγ gene was significantly lower in group with positive history of cancer. The relative expression of UCP2 was almost significantly lesser in group with positive history of cancer also.

CONCLUSION

The observed mutual alteration in the levels of inflammatory markers and relative expression of important gene in energy homeostasis may be caused by vitamin D deficiency among the obese subjects with positive history of colorectal cancer.

Resting energy expenditure may predict the relationship between obesity and susceptibility to depression disorders

AIM

The aim of the current research was to investigate the association between depressed mood and resting energy expenditure (REE) in a representative sample of obese women.

METHODS

Fasting blood sample was collected from 254 obese women to determine biochemical indicators. Body composition was measured using body composition analyzer. REE was measured by means of indirect calorimetry.

RESULTS

Comparison between depressed group and healthy obese women demonstrated that the mean of body mass index, fat percent, fat mass, visceral fat and triglyceride were higher in women with depressed mood.

CONCLUSION

The level of REE/kg was significantly low in depressed obese women compared to healthy subjects.

Vitamin D receptor FokI genotype may modify the susceptibility to schizophrenia and bipolar mood disorder by regulation of dopamine D1 receptor gene expression

AIM

This study is designed to test association of FOKI polymorphism in Vitamin D receptor (VDR) gene and its potential effect on expression of dopamine D1 receptor in schizophrenia and bipolar mood disorder as well as in healthy individuals.

METHODS

In this case-control study 196 patient with schizophrenia, 119 patients with bipolar mood disorder and 192 healthy individuals as the control group were recruited. All psychiatric disorders were diagnosed according to DSM IV criteria. Healthy control group denied any family history of such disorders. FOKI was genotyped by means of PCR-RFLP method. The mRNA was extracted from the peripheral blood mononuclear cells (PBMC) and the cDNA was synthesized.

RESULTS

Frequency of ff genotype was more common in patients with bipolar disorders compared to the healthy control group (Odds ratio=1.84, 95% CI; 0.81 to 4.17) with increased relative risk (Relative risk=1.31, CI 95%; 0.86 to 1.99). There were significant differences between relative expressions of dopamine D1 receptor gene in various genotypes. Our results indicated that the ff genotype was associated with lower expression of dopamine D1 receptor gene.

CONCLUSION

VDR as a nuclear receptor may contribute to bipolar disorders via modification of the expression of the neurotransmitters receptor such as dopamine.

Obesity, inflammation and resting energy expenditure: possible mechanism of progranulin in this pathway

AIM

The aim of the study was to measure circulating PGRN levels and to investigate its potential correlation with resting metabolic rate and obesity related complications. Moreover, to investigate on the PGRN and some important gene expressions in energy expenditure in vitro in samples of PBMCs derived from all participants of our study in a cellular model.

METHODS

Of the 163 participants who were recruited for the current cross-sectional study, 37 (22.69%) were normal weight (18.5≤BMI<25), 53 (32.51%) were overweight (25≤BMI<30), 48 (29.44%) were categorized as class I obese (BMI 30 -34.9) and 25 (15.33%) were classified as class II and III obese (BMI≥35). All participants were assessed for the measurement of RMR by means of indirect calorimetry following an overnight fasting. Body composition was analyzed with the Bioelectrical Impedance technique by the BODY COMPOSITION ANALYZER BC-418M -Tanita. The PBMCs were separated from whole blood by Ficoll-hypaque technique. Total cellular RNA was extracted and the cDNA was synthesized. This process was followed by real-time PCR using specific primer pairs for PGRN, AKT, MAPK and mRNA, and beta actin mRNA was used as the internal control. Circulating PGRN was measured with the use of ELISA method.

RESULTS

The circulating levels and gene expressions of PGRN rose in parallel with the increase of body weight. However, there was significant difference in the strength of association between circulating PGRN as well as PGRN gene expression and obesity-related variables. Moreover, PGRN gene expression had significant correlation with BMI, visceral fat, MAPK and AKT gene expression. The increased mass of visceral fat in correlation with the increased PGRN levels was more pronounced in high or normal resting metabolic rate group compared with the group with low resting metabolic rate. After adjusting for BMI and gender, we found that circulating PGRN can predict the RMR/kg independent of other variables such as TG, HDL, and hs-CRP (P=0.03).

CONCLUSION

PGRN associated with obesity and glucose homeostasis and may predict the resting metabolic rate levels independent of confounder factors. Experimental study may clarify the PGRN role in obesity etiology through metabolism regulation.

Potential role of OPG/RANKL system and FokI genotypes in pathogenesis and clinical manifestations in multiple sclerosis

AIM

The OPG/RANKL has identified role in immune system via T-cell-activating cytokines. Considering that immune mechanisms play a key role in the pathogenesis of MS, OPG/RANKL might be importance in the underlying mechanism of the disease. The aim of this study is to measure plasma levels of OPG and RANKL as well as to analyze VDR FokI polymorphism (rs2228570) in MS patients and healthy individuals to detect any potential correlation.

METHODS

We included a total of 397 participants, 105 of them suffering from two different types of MS, namely relapsing and remitting and secondary progressive multiple sclerosis. VDR genotyping was performed using PCR-RFLP method.

RESULTS

The results showed differences in the plasma levels of OPG and RANKL between patients and the healthy control group that were statistically significant. We found higher plasma levels of OPG and lower RANKL concentrations in RRMS patients in comparison with SPMS types of the disease. We detected higher plasma levels of OPG and lower levels of RANKL in subjects with F allele compared to those with f allele in healthy subjects. However, contradicting results were observed when patients with MS were analyzed. We detected lower plasma levels of OPG and higher RANKL concentrations in patients with F allele in comparison with those with f allele.

CONCLUSION

This might define a role for FokI polymorphism and OPG/RANKL system in the pathogenesis and progression of multiple sclerosis with further practical applications.

Mutual role of PGRN/TNF-α on osteopenia developing in obesity's inflammation state

AIM

The aim of the study was to investigate the concentration of PGRN and other inflammatory cytokines TNF-α, IL-1β, IL-4, IL-6, IL-10, IL-13 and IL-17 in osteopenic and non-osteopenic obese subjects. Bone mineral density in subjects with different PGRN levels were compared to the appraisal of our hypothesis.

METHODS

A total of 171 obese participants (BMI ≥30) were included in the study. Analysis of body composition was performed with use of Body Composition Analyzer. All blood samples were collected between 8:00 and 10:00 a.m. following an overnight fasting. The circulating levels of TNF-α, PGRN, IL-1β, IL-4, IL-6, IL-10, IL-13, IL-17, PTH, 25-Hydroxy Vitamin D and crosslaps were measured with the EIA method. BMD was measured by use of dual energy X-ray absorptiometery (DXA) at lumbar spine (vertebrae L2-L4) and hip level. Participants were categorized into osteopenic and healthy group according to the World Health Organization (WHO) criteria. Of 171 participants, 51 (29.82 %) were osteopenic and 120 (70.17%) were healthy.

RESULTS

We found significantly higher concentrations of crosslaps, IL-17, IL-6, TNFα and IL-4 and lower concentrations of IL-13, IL-10, PGRN and free fat mass in osteopenic group. With raising the PGRN level, the concentrations of IL-13, IL-10 and 25-(OH) vitamin D were increased and the concentration of TNFα and IL-17 were decreased. Our results demonstrated that the density of bone at both sites of lumbar spine (L2-L4) and hip region was highest in 4th quartile and lowest in first quartile of categorized PGRN concentration. The bone status was gradually improved with raising the PGRN level in parallel at lumbar spine (L2-L4) and hip regions.

CONCLUSION

Based on the pathway of effect of TNFα on bone metabolism, it appears that PGRN acts on the bone with mechanisms involving TNFR signaling, disturbance and TNFα performance, similar to the results that have been found in animal model study.

Cytokine profile, Foxp3 and nuclear factor-kB ligand levels in multiple sclerosis subtypes

AIM

Patients with multiple sclerosis (MS) present with heterogeneous clinical courses. To elucidate whether different immunopathological mechanisms are involved in MS subgroups, we compared serum levels of TNF-α, IL-1β, hs-CRP, receptor activator of nuclear factor kappa-B ligand (RANKL) and peripheral blood foxp3 expression in clinical subtypes of MS (relapsing remitting: RR-MS; secondary progressive: SP-MS; primary progressive: PP-MS) and healthy subjects.

METHODS

In a case-control study, 72 healthy individuals and 72 age- and sex-matched multiple sclerotic patients (57% RR-MS, 18% SP- MS and 25% PP-MS) were evaluated. The age, gender distribution, and BMI of MS patients in these three sup-types were similar. The serum levels of TNF-α, IL-1β, and RANKL were measured by ELISA. hs-CRP was measured by imunoturbidimetric method. Peripheral blood mononuclear cells expression of Foxp3 was measured by real time PCR.

RESULTS

A significant elevation of TNF-α, hs-CRP, IL-1β and RANKL and diminution of Foxp3 expression in MS patients compared to control was found (P<0.001). PP-MS had highest levels of TNF-α, IL-1β, CRP and RANKL, and lowest levels of foxp3, with difference in TNF-α reached significant level (P<0.01). RANKL and TNF-α showed a reverse (P<0.01) significant correlation with Foxp3 relative expression levels. Patients with early age onset (onset before 30 years) had significantly higher levels of hs-CRP compared to late age onset patients.

CONCLUSION

These data demonstrate the presence of immunopathogenesis differences between relapsing and non-relapsing form and is also the first to stress a role for cytokine RANKL in MS patients.

MIF Expression in Induced Peripheral Blood Mononuclear Cells by Vitamin D3 and its Potential Correlation with Resting Metabolic Rate in Obesity

Macrophage migration inhibitory factor (MIF) plays a pivotal role in systemic and local inflammatory and immune responses. The aim of this study is to assess MIF gene expression in PBMCs harvested from obese individuals and to compare it with that of lean subjects to analyze any potential relationship between resting metabolic rate as well as several different parameters and MIF expression in PBMC. We also aim to assess anti-inflammatory characteristics of vitamin D3 on MIF expression in vitro. Participants were 30 obese and 18 non-obese subjects who were assessed following an overnight fasting for RMR by means of indirect calorimetry. Body composition was measured using a Bodystat device. The PBMCs were separated from whole blood by the Ficoll-hypaque technique. The mRNA was extracted and the cDNA was synthesized. This process was followed by real-time PCR using primer pairs specific for MIF mRNA and beta actin as internal control. Our findings clearly demonstrate that there were significant differences in terms of BMI, BMR predict, fat proportion, fat mass, free fat mass, TBW, visceral fat, fasting serum glucose, TG, HDL, Hs-CRP and RMR between the two groups. Moreover, the level of MIF expression in the obese group was approximately 2.5 times higher compared to the lean group. An increased level of MIF expression in the obese group and a decreased expression of that non-obese was observed after inducing PBMCs with vitamin D3. One of the intriguing results of this study was the observed reverse correlation between MIF expression and fat mass as well as fat proportion after PBMCs were cultured in the presence of vitamin D3. Therefore, it could be concluded that MIF expression, which is in turn influenced by vitamin D3, has a role in the hyperactive immune profile and the pro-inflammatory state observed in obese individuals which is suggested to have a causal relationship with obesity.

Tandem Repeats of the Catt Element of Macrophage Migration Inhibitory Factor Gene May Predict Gestational Diabetes Mellitus Severity

Previous investigations have demonstrated the association of the CATT repeated allele in the Macrophage migration inhibitory factor (MIF) with obesity and diabetes. Since there are common risk factors and molecular pathways in Type 2 Diabetes and Gestational Diabetes Mellitus (GDM), we focused on the associations of MIF variation with GDM. In a case-control study we enrolled 157 GDM and 217 healthy pregnant women, referred to the outpatient clinic of Shariati Hospital. The different repeats of CATT in MIF promoter were determined. MIF relative gene expression was evaluated in Peripheral blood mononuclear cells of all the participants. The GDM group had higher mean age and pre-gravid BMI. Also fasting serum glucose, insulin and MIF gene expression were significantly higher in the GDM patients. The statistically significant difference was observed between GDM and a healthy group in carrying 7-CATT allele and MIF gene expression. Regarding GDM risk factors, MIF 7-CATT allele showed significant relation with pre-pregnancy obesity, as well as the need for insulin therapy. Our results indicate that an association between MIF genotypes and its expression with GDM, obesity and the need of insulin for management of GDM patients exists.

Evidence of a role of ANGPTL6 in resting metabolic rate and its potential application in treatment of obesity

AIM

ANGPTL6 (Angiopoietin-related growth factor 6) is a circulating protein which is suggested to antagonize obesity. The purpose of this study was to evaluate a potential relationship between fasting serum ANGPTL6 and resting metabolic rate (RMR) as well as the body composition in obese and subjects with normal weight.

METHODS

Participants were 62 obese and 41 non-obese subjects who were assessed following an overnight fasting for RMR by means of indirect calorimetry. Body composition was measured using Bodystat devise. Serum ANGPTL6 levels were quantified by ELISA method.

RESULTS

Based on ROC analysis best RMR/kg cut-off value for predicting the risk of obesity was 20 kcal/24h /kg. The participants with RMR/kg≥20 kcal/24h/kg were considered as and subjects with RMR/kg<20 kcal/24h/kg were categorized as. In group I, 72.3% of subjects were obese, whereas, 47.4% subjects in group II were suffering from the disease. Participants in group II who showed significantly lower HDL and ANGPTL6 levels. Moreover, we found significantly higher triglyceride and hs-CRP levels in this group. There was significant difference in weight, body mass index, fat mass, visceral fat, RMR/kg, fasting serum glucose, insulin and hs-CRP among those with different levels of the serum ANGPTL6 concentration. We found higher values of RMR/kg in subjects with higher circulating ANGPTL6 concentration.

CONCLUSION

ANGPTL6 affects RMR and significantly improves lipid profile and slightly does so regarding insulin concentrations and sensitivity to it. Further study is warranted as it seems that the results of this study might potentially lead to advent of a pharmacological treatment for obesity.

The Role of Osteoprotegrin/Nuclear Factor kB Ligand in Coronary Collateral Development

Osteoprotegrin (OPG), as a member of the TNF family is demonstrated to be a potential regulator of the endothelial function and angiogenesis by neutralization of nuclear factor kB ligand (RANKL). We investigated the OPG and RANKL gene expressions in circulating peripheral blood mononuclear cells (PBMCs) of Coronary artery disease (CAD) patients with different extents of coronary collateral development. In a cross-sectional study, 206 individuals with angiographically documented CAD were recruited. Severity of CAD was defined by the number of involved coronary vessels. The Rentrop scoring system was used to grade the extent of collateral development. Grade 0 or 1 collateralization was considered poor collateralization. RNA extraction and cDNA synthesis were performed. OPG and RANKL gene expressions were evaluated using quantitative real-time PCR. Among patients with CAD, 48.5% (100), 16.5%(34) and 35%(72) were considered to have one to three degrees of coronary artery involvement, respectively. The OPG and the ratio of OPG to RANKL expression were significantly elevated in patients with well-developed collateralization. In a logistic regression, severity of CAD was associated with a better collateral development, and OPG gene over expression was correlated with a better collateralization, independently of other variables. In conclusion, it seems that OPG might have an important role in prognosis of CAD; its up-regulation is parallel with CAD severity while it can enhance collateral development.

Visfatin/NAMPT/PBCEF and Cytokine Concentration in Multiple Sclerosis Patients Compared to Healthy Subjects

The aim of the study is to measure IL-1 β, TNF-α, hs-CRP levels and Nampt/visfatin/PBCEF concentrations in patients with multiple sclerosis and to compare them with those of healthy control subjects. In a case-control study a total number of 192 people were recruited. Ninety-six of them were suffering from multiple sclerosis, age 34.80±8.75 years (mean±SD), who were referred form the Iranian Multiple Sclerosis Society. They included relapsing remitting (82 subjects) and both primary and secondary progressive (14 subjects) types of MS. The diagnosis was made according to the diagnostic criteria by a neurology consultant. Ninety-six healthy individuals were recruited from the Iranian Multicenter Osteoporosis Study (IMOS) as the control group. Following an overnight fasting, peripheral blood was taken from all subjects and centrifuged in order to separate serum for measurement of serum visfatin, Interleukin-1beta (IL-1β), TNF-α, and hs-CRP concentrations. Fat tissue mass was measured using DXA. Levels of visfatin, TNF-α and hs-CRP were significantly higher in MS patients. Besides, significant correlation was found between visfatin levels and those of TNF-α, IL-1β, hs-CRP in MS patients. Regarding the control group, significant correlation was found between visfatin levels and levels of TNF-α. However, we did not find any significant correlation between fat tissue mass and visfatin, TNF-α, IL-1β or hs-CRP levels in the MS group. However, there was a significant correlation between fat tissue mass and TNF-α level in the study population. Our findings demonstrated that proinflammatory factor levels were, although not significantly, higher in RRMS patients compared to PPMS and SPMS patients. The results suggest that levels of visfatin and pro-inflammatory cytokines are higher in MS patients compared to healthy subjects. Their higher levels may be, in part, attributable to the MS phenotypes independent of fat mass in patients. We believe that these results may shed some light on a potentially novel source of visfatin as well as explaining its regulating role in the inflammation process.

Variation in the Cox-2 Gene May Modify the Effect of Alendronate on Vertebral Fracture Prevention

Bisphosphonates such as alendronate, which are potent specific inhibitors of osteoclast-mediated bone resorption, are widely used for treatment of postmenopausal osteoporosis as well as other diseases related to bone remodeling. We evaluated whether the reportedly functional PTGS2 (prostaglandin-endoperoxide synthase 2/cyclooxygenase [COX] 2) genotypes influence the efficacy of alendronate on vertebral fracture prevention. Sixty postmenopausal osteoporotic women participated in this interventional study. The extent of vertebral fracture was evaluated in all participants before and after intervention using X-ray imaging. Alendronate (10mg/day), calcium (1gr/day) and vitamin D (400mg/day) were given to participants for 2 years. Laboratory measurements included circulating crosslaps, osteocalcin, PTH, osteoporotegrin, RANKL, vitamin D, TNF-α, IL-6, IL-1 levels. Hip and spine BMD (bone mass density) were measured using DEXA. Genotyping for cox-2 gene SNP (−765G/C) was performed using PCR- RFLP method. Genotype frequency of homozygous major allele (GG), heterozygous (GC) and homozygous minor allele (CC) were 61.7%, 33.3% and 5% respectively. Evaluation of vertebral fracture before alendronate therapy in participants demonstrated no significant difference between carriers of G and C alleles, although the difference appeared near to significant after alendronate therapy at the end of 2 years. Serum PTH level and L2-L4 BMD were significantly different between subjects with different alleles. Moreover, IL-1 had prominently higher concentration in C allele carries. Furthermore, there was a significant difference in terms of the extent of vertebral fracture between two allelic groups after two years of treatment. Since bone remodeling process has been proved to be affected by inflammatory factors; it appears that variation in COX-2 genotypes may influence alendronate efficacy in fracture prevention among postmenopausal osteoporotic women.

Comparison of the Bone Turn-over Markers in Patients with Multiple Sclerosis and Healthy Control Subjects

One of the major concerns for patients with multiple sclerosis (MS) is developing osteoporosis, especially when corticosteroid treatment is used. The aim of the present study is to compare the bone turnover markers in patients with multiple sclerosis and healthy control subjects. A total of 176 subjects were enrolled in this case-control. Ninety-one MS patients with mean age of 35.26 ± 8.76 yrs were randomly selected from the Committee on Multiple Sclerosis Registry. The control group was composed of 85 healthy subjects who were recruited from the Iranian Multicenter Osteoporosis Study (IMOS). Fasting serum levels of parathyroid hormone (PTH), 25 (OH) D3, osteocalcin and cross laps were measured in two groups. Hip and spine BMD were measured using DXA. Our findings showed significant differences in hip BMD and its T-score and Z-score values between MS patients and the control group. Osteoporosis prevalence at hip area of the MS patients was almost 5 times higher than the control group [OR=4.66, (95% CI 0.97 to 22.27), RR=4.29, (95% CI 0.95 to l9.32), p value=0.03]. No significant difference was found in BMD L2-L4, BMD T-score and BMD Z-score of lumbar area between two groups. The PTH and cross laps serum concentrations in MS patients were significantly higher than the control group. We did not find significant difference in serum osteocalcin level between the two groups. We concluded that in our study the serum levels of bone resorbtion markers in MS patients were significantly higher than the healthy control group. This may explain, at least in part, the elevated susceptibility of MS patients for developing osteoporosis.

Visfatin genotype may modify the insulin resistance and lipid profile in type 2 diabetes patients

AIM

We investigated the role of the -4689G/T promoter variant of the visfatin gene on serum visfatin concentration and biochemical markers in T2DM patient.

METHODS

In a cross-sectional study we recruited 93 patients with type 2 diabetes. Laboratory and anthropometric measurements were included FBG, OGTT, HbA1C, lipid Profile, fasting serum visfatin, fasting serum insulin, weight, height, Body Mass Index (BMI) and waist hip ratio (WHR). Genotyping for visfatin gene was performed by using the PCR-RFLP method.

RESULTS

Our findings showed significant differences in levels of low density lipoprotein (LDL) cholesterol, total cholesterol, high density lipoprotein (HDL) cholesterol and fasting serum insulin among various types of visfatin genotype (TT, GG, and GT). This study showed a significant correlation between circulating levels of visfatin and weight, BMI, hs-CRP and fasting insulin in TT genotype. But regarding GG genotype only fasting insulin had a significant correlation with circulating visfatin.

CONCLUSIONS

Visfatin genotypes may account for insulin resistance and levels of lipid profile that may cause by different visfatin expression between genotypes.

A novel tissue engineering-based assay for immunological infertility

Antisperm antibodies (ASA) are present in 9-36% of infertile couples, a condition called immunological infertility. The variability of ASA in terms of antigenic specificity and biological effects has made it difficult to design a test able to distinguish reliably between ASA that contribute to infertility and those that do not. To develop a reliable and reproducible method able to detect sperm antibodies, we took advantage of recent progress made in tissue engineering techniques. We used collagen gel as a bio-scaffold for the production of engineered sperm analogues. The advantages of using collagen gels include biocompatibility, ease of fabrication and low cost. We found that this tissue engineering-based assay is more specific and more sensitive than a conventional test routinely used for ASA detection. In addition, it exhibited low intra- and inter-variations. We envision the use of this novel approach for the detection of a variety of autoantibodies in autoimmune diseases. In addition to diagnostic purposes, tissue-engineering based tests could be useful in monitoring treatments with bio-drugs.

Relationship between leptin concentration and insulin resistance

Available evidences suggest that leptin has inhibitory role on insulin secretion. The aim of the work was to examine the association between plasma leptin concentrations and insulin resistance in patients with gestational diabetes mellitus. As a cross-sectional study we recruited 741 pregnant women. The universal screening was performed with an oral glucose challenge test-50 g. The recruits with plasma glucose levels of > or = 7.2 mmol/l were diagnosed as having gestational diabetes mellitus if they had an impaired oral glucose tolerance test-100 g based on Carpenter and Coustan criteria. In all pregnancies plasma insulin and leptin concentrations were measured. Gestational diabetes mellitus developed in 7% (52) of pregnancies. Elevated leptin concentrations were positively associated with insulin levels, BMI, and HOMA index while it was negatively associated with Quicky index. After adjusting for age and BMI before pregnancy, gestational diabetes mellitus had independent direct correlation with leptin concentration. Indeed, leptin level equal to or more than 20 ng/ml could help to predict the developing gestational diabetes mellitus. Measurement of leptin together with the assessment of other risk factors could help identifying women at risk of developing GDM.

Epidemiologic analysis of the Tehran Cancer Institute Data System Registry (TCIDSR)

OBJECTIVE

To review epidemiological data on thyroid cancer in Iran.

METHODS

The Tehran Cancer Institute Data System Registry (TCIDSR) was used to identify patients with different histological types of thyroid cancer (TC) in Iran. Data were analysed from 438 thyroid cancer cases identified by the TCIDSR in 1998-99. Disease prevalence was calculated with reference to age, time and place.

RESULTS

The TCIDSR recorded 438 primary malignancies of the thyroid gland: papillary, follicular, medullary, and anaplastic carcinomas accounted for 67.1%, 10.7%, 5.3% and 4.3% of cases, respectively. The remaining 12.6% were classified as OD (other diagnoses). The prevalence of TC was highest in ethnic Farsis. The age range of patients was 8-85 years. Mean patient age was 44.52+17.03 years (mean + SD) overall, 47.74+18.10 years in female patients and 43.04+16.34 years in male patients. Anaplastic (6.5% vs. 3.3%) and medullary (10.0% vs. 3.0%) cancers were more common in men than women.

CONCLUSION

This study was undertaken to define the epidemiological aspects of thyroid carcinoma in Iran, an area of endemic iodine deficiency until fairly recently. Against expectation for an iodine-deficient area, the frequency distribution of tumours in our study was closer to that seen in iodine-rich areas. Additional research on the risk factors for thyroid cancer--genetic, ethnic, geographic and environmental--is needed to explain the high incidence of PTC overall, and among ethnic Farsis in particular, in Iran.