The relation between osteoprotegerin, inflammatory processes, and atherosclerosis in patients with metabolic syndrome

OBJECTIVE

To evaluate osteoprotegerin serum concentration (and compare with healthy controls), to estimate the relationship between serum osteoprotegerin and lipid parameters, insulin resistance, and selected inflammatory factors, and to assess the relationship between osteoprotegerin and intima media thickness in patients with metabolic syndrome.

PATIENTS AND METHODS

A total of 70 individuals aged 18-65 years with metabolic syndrome were enrolled. Anthropometric parameters, including body weight, body mass index, waist circumference, and waist-hip ratio, were assessed. The relative and absolute fat tissue contents were evaluated. Serum glucose, insulin, osteoprotegerin, C-reactive protein, and lipid profile were determined. Insulin resistance was calculated using Homeostasis Model Assessment. Intima media complex thickness was evaluated in each participant.

RESULTS

No significant differences were observed between patients and the controls with respect to lipid and carbohydrate profiles. Osteoprotegerin was significantly elevated in metabolic syndrome patients compared to the controls. Both C-reactive protein serum concentration and insulin resistance increased in the metabolic syndrome patients. Significant positive correlations between osteoprotegerin serum concentration and body mass index, waist-hip ratio, C-reactive protein serum concentration, and insulin resistance, were documented in patients with metabolic syndrome.

CONCLUSIONS

Patients with metabolic syndrome have increased osteoprotegerin serum levels than healthy individuals. Osteoprotegerin plays an important role in the development of arteriosclerosis, and the effect of osteoprotegerin on intima media thickness strongly depends on the extent of the arteriosclerotic changes that occur in metabolic syndrome.

[The etiology of Graves' disease--current state of knowledge]

Graves' disease (GD) is an autoimmune thyroid disease of unknown etiology. Recently, it is assumed that the occurrence of GD co-existence with endogenous factors (genetic and interthyroid) and exogenous (environmental). Autoantibodies against the TSHR are a key element leading to the occurrence of autoimmune thyroid disease. TSHR stimulating antibodies dominate and lead to the development of hyperthyroidism. Among the environmental factors which directly affecting the defect-suppressor T cells can be calculated: infections, smoking, stress, excessive iodine intake, certain medications, therapy with radioiodine. Scientific reports in recent years allow more and better understand the mechanisms leading to the development CD at the molecular level. Linked to this is the hope of creating new treatments and prevention strategies.

[Effect of amiodarone on the thyroid function and safety of the therapy--what's new]

This paper presents the current state of knowledge on the effects of amiodarone (AM) on the thyroid gland function, including the question of epidemiology, pathogenesis and prognostic factors. Of all the antiarrhythmic drugs hitherto used, AM has the most adverse effects on the thyroid gland. In patients receiving AM, it may lead to a development of a full- symptomatic hyperthyroidism (AIT-Amiodarone-induced thyrotoxicosis) and hypothyroidism (AIH - Amiodarone-induced hypothyroidism). The time from the start of the treatment of AM to the onset of symptoms of thyrotoxicosis is varied and amounts approximately to 3 years. The AIT may develop up to 2 years after the cessation of the AM treatment because of the accumulation of the drug and its metabolites in the body. The AIT treatment is complicated and often requires multiple treatment methods, such as: antithyroid drugs, glucocorticoids, iopanic acid, plasmapheresis, thyroidectomy and radioiodine. AIH is associated with the Wolff-Chaikoffa phenomenon. Thyroid hormone synthesis is impaired by blocking iodine organification. Hypothyroidism can also arise and be exacerbated by the output of thyroid disease - autoimmune diseases. The paper also devotes much attention to the relationship between smoking and the toxicity of AM. The components of tobacco smoke increase the activity of enzymes involved in the metabolism of AM. Increased concentrations of desetyloamiodarone in lung tissue may be responsible for the increased toxicity in the lungs in smokers. In addition, the paper presents a new antiarrhythmic drug - dronedarone (DN), an attractive alternative, but, because of the high risk of heart failure, stroke and death from cardiovascular disease, with a limited potential.

[Osteoprotegerin--a new atherosclerosis marker]

Studies on bones metabolism regulation mechanisms leaded to discovery of RANKL/OPG/RANK signal system (receptor activator of nuclear factor kappaB ligand/osteoprotegerin/receptor activator of nuclear factor kappaB). It was found that beyond bone metabolism regulation Osteoprotegerin (OPG) is involved in some other processes: apoptosis, regulation of immunological system. Data from numerous studies performed in the last years indicate potential association between OPG and cardiovascular pathology. OPG was identified as atherosclerosis marker. Molecular mechanism by which OPG exerts its atherogenic effect is not fully elucidated.

[Obesity--a challenge for modern ortopedy]

In 1997 World Health Organization regarded obesity as an illness caused by modern civilization. Elevated values of BMI index over 30 kg/m2 increase the risk of movement organ diseases. Growing ailment pains in lumbar part of vertebral column and disfunction of its joints leads to severe disability. Many studies revealed, that BMI > 30 kg/m2 increased the risk of joints injuries up to 4-5 times. Most common cause of back pain and knee pains, amount obese patients, seems to be a degenerative disease. Finn studies prove correlation between visceral obesity index (waist/hip ratio) and intensification of pain in lower part of vertebral column. Women were suffering more often than men, 39.5% vs 31.2%. Amount causes of individual degeneration changes the most common is "overloaded mechanism". Nowadays, scientists claim, that subclinical inflammatory process might be connected with obesity. Fat tissue is a source of many adipocytokines. Such adipocytokines as leptin, resistin, adiponectin and proinflammatory cytokines such as IL-6, IL-1, IL-8, TNF-alpha, IL-18 and hsCRP modulate inflammatory process and lead to damage of joint cartilage. Other cytokine, like osteoprotegrin, exerts osteo-protection impact. The reduction of body mass index seems to be necessary as far as patients with joints and vertebrae bone illnesses are concerned. That aim might be achieved by excessive physical activity and proper diet. Physical training should be fitted individually to every patient. Static and endurance training are not recommended. Proper weight loss should be more less 1 kg per week, and general physical ability improves. Cooperation between obesitologists and orthopedists seems to be necessary.

[Influence of regular physical activity on oxidative stress in women with simple obesity]

Obesity epidemics is a growing medical problem all over the world. Obesity is an independent atherosclerosis risk factor. Commonly known risk factors don't fully explains increased coronary artery disease risk in this group of patients. One of the potential mechanisms responsible for the direct influence of obesity on atherosclerosis progression is impaired oxidation-antioxidation balance estimated by TAS (Total Antioxidant Status). The aim of study was to evaluate the regular physical activity influence on oxidative stress activity in women with simple obesity.

MATERIAL AND METHODS

20 women with simple obesity, aged 23-65 years, were studied. All of them underwent a 6-month physical activity programme under the observation of a physiotherapist. Before and after the programme TAS, lipid profile and C-reactive protein concentration were assessed.

RESULTS

After 6 months of the physical therapy programme a significant increase of TAS was found. Favorable changes in biochemical parameters were accompanied by decrease of waist circumference. Positive correlation between change in waist circumference and change in TAS was observed.

CONCLUSIONS

Obesity in women increases inflammatory process activity. Regular physical activity favorably influence lipids parameters and blood pressure. Regular physical activity in obese women increases total antioxidant capacity, mainly related to waist circumference reduction.

[Successful treatment of severe hypertriglyceridemia with plasmapheresis--case report]

Presented case report shows hypertriglycerydemia treatment problem in 26-year-old woman with 2 episodes of acute pancreatitis history. Very high serum triglycerides concentration and clinical symptoms suggested chylomicronemia syndrome with urgent need for treatment. After a course of several subsequent therapeutic plasmapheresis triglycerides significantly decreased. Safety and effectiveness of this method was confirmed.