Effect of the Renin-Angiotensin System Inhibitors on Inflammatory Markers: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To synthesize more conclusive evidence on the anti-inflammatory effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).

METHODS

PubMed, Scopus, and Embase were searched from inception until March 1, 2021. We included randomized controlled trials (RCTs) that assessed the effect of ACEIs or ARBs, compared with placebo, on any of the following markers: C-reactive protein (CRP), interleukin 6 (IL-6), or tumor necrosis factor α (TNF-α). Mean changes in the levels of these markers were pooled as a weighted mean difference (WMD) with a 95% CI.

RESULTS

Thirty-two RCTs (n=3489 patients) were included in the final analysis. Overall pooled analysis suggested that ACEIs significantly reduced plasma levels of CRP (WMD, -0.54 [95% CI, -0.88 to -0.21]; P=.002; I²=96%), IL-6 (WMD, -0.84 [95% CI, -1.03 to -0.64]; P<.001; I²=0%), and TNF-α (WMD, -12.75 [95% CI, -17.20 to -8.29]; P<.001; I²=99%). Moreover, ARBs showed a significant reduction only in IL-6 (WMD, -1.34 [95% CI, -2.65 to -0.04]; P=.04; I²=85%) and did not significantly affect CRP (P=.15) or TNF-α (P=.97) levels. The lowering effect of ACEIs on CRP levels remained significant with enalapril (P=.006) and perindopril (P=.01) as well as with a treatment duration of less than 24 weeks (WMD, -0.67 [95% CI, -1.07 to -0.27]; P=.001; I²=94%) and in patients with coronary artery disease (WMD, -0.75 [95% CI, -1.17 to -0.33]; P<.001; I²=96%).

CONCLUSION

Based on this meta-analysis, ACEIs showed a beneficial lowering effect on CRP, IL-6, and TNF-α, whereas ARBs were effective as a class in reduction of IL-6 only.

Effect of the renin angiotensin system inhibitors on inflammatory markers: a systematic review and meta-analysis of 32 randomized controlled trials

Background

Inflammation plays a critical role in the etiology of cardiovascular disease (CVD). The renin-angiotensin system inhibitors including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to be effective in reducing elevated blood pressure. However, the information on their potential effect on inflammatory markers including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) is still lacking.

Purpose

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to synthesize evidence about effect of ACEIs and ARBs on selected inflammatory markers.

Methods

PubMed, Scopus, and Embase were searched from inception until February 15, 2021. We included RCTs that assessed the effect of ACEIs or ARBs, compared with placebo, on any of the following markers: CRP, IL-6, or TNF-α. Mean changes in the relevant markers levels were pooled as a standardized mean difference (SMD) with a 95% confidence interval (CI) under the random-effects model. Heterogeneity was assessed using I2 and χ2 tests.

Results

Thirty-two RCTs (n=3,403 patients) were included in the analysis. Overall pooled analysis suggested that ACEIs significantly reduced plasma levels of CRP (SMD: −1.08 [95% CI: −1.57 to −0.59]; I2: 95%), IL-6 (SMD: −0.75 [95% CI: −1.41 to −0.09]; I2: 81%), and TNF-α (SMD: −1.77 [95% CI: −2.82 to −0.73]; I2: 95%). This lowering effect remained statistically significant by perindopril in terms of all relevant markers, by quinapril and ramipril in terms of IL-6 and by enalapril in terms of TNF-α. As for the ARBs as a class, they showed a statistically significant reduction only in terms of CRP (SMD: −0.14 [95% CI: −0.28 to −0.01]; I2: 0%) and did not significantly affect any of the other markers. Moreover, the ARBs individual drugs did not show any significant effect on any of the relevant markers except for valsartan that significantly reduced plasma levels of IL-6 (SMD: −0.42 [95% CI: −0.80 to −0.04]; I2: 0%).

Conclusions

Based on the results of this meta-analysis, ACEIs showed a beneficial lowering effect on CRP, IL-6, and TNF-α, while ARBs were effective as a class only in terms of CRP reduction. Further larger RCTs are warranted to confirm these results particularly in case of individual drugs and to assess the significance of these reductions in terms of CVD prevention.

Funding Acknowledgement

Type of funding sources: None.

Association of statin use in older people primary prevention group with risk of cardiovascular events and mortality: a systematic review and meta-analysis of observational studies

Background

Current evidence from randomized controlled trials on statins for primary prevention of cardiovascular disease (CVD) in older people, especially those aged &gt;75 years, is still lacking.

Purpose

We conducted a systematic review and meta-analysis of observational studies to extend the current evidence about association of statin use in older people primary prevention group with risk of CVD and mortality.

Methods

PubMed, Scopus, and Embase were searched from inception until March 18, 2021. We included observational studies (cohort or nested case-control) that compared statin use vs non-use for primary prevention of CVD in older people aged ≥65 years; provided that each of them reported the risk estimate on at least one of the following primary outcomes: all cause-mortality, CVD death, myocardial infarction (MI), and stroke. Risk estimates of each relevant outcome were pooled as a hazard ratio (HR) with a 95% confidence interval (CI) using the random-effects meta-analysis model.

Results

Ten observational studies (9 cohort and one case-control study; n=872,845) fulfilled our criteria. The overall combined estimate suggested that statin therapy was associated with a significantly lower risk of all-cause mortality (HR: 0.86 [95% CI: 0.79 to 0.93]), CVD death (HR: 0.80 [95% CI: 0.78 to 0.81]), and stroke (HR: 0.85 [95% CI: 0.76 to 0.94]) and a non-significant association with risk of MI (HR: 0.74 [95% CI: 0.53 to 1.02]). The beneficial association of statins with the risk of all-cause mortality remained significant even at higher ages (&gt;75 years old; HR: 0.88 [95% CI: 0.81 to 0.96]) and in both men (HR: 0.75 [95% CI: 0.74 to 0.76]) and women (HR: 0.85 [95% CI: 0.72 to 0.99]). However, this association with the risk of all-cause mortality remained significant only in those with DM (HR: 0.82 [95% CI: 0.68 to 0.98]) but not in those without DM.

Conclusions

Statin therapy in older people (aged ≥65 years) without CVD was associated with a 14%, 20% and 15% lower risk of all-cause mortality, CVD death and stroke, respectively. The beneficial association with the risk of all-cause mortality remained significant even at higher ages (&gt;75 years old), in both men and women, and in individuals with DM, but not in those without DM. These observational findings support the need for trials to test benefits of statins in those above 75 years of age.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Results of the meta-analysis

Association between sarcoidosis and diabetes mellitus: a systematic review and meta-analysis

Background: Sarcoidosis is multisystem inflammatory granulomatosis that can potentially affect any organ of the human body. We aimed to estimate the prevalence of diabetes mellitus (DM) in sarcoidosis patients and determine the association between sarcoidosis and DM.Method: All relevant articles reporting the prevalence of DM in sarcoidosis published until September 19^th, 2020, were retrieved from ten electronic databases. We used the random effect model to perform the meta-analysis.Results: After screening 2,122 records, we included 19 studies (n = 18,686,162). The prevalence of DM in sarcoidosis patients was 12.7% (95% CI 10-16.1). The prevalence was highest in North America with 21.3% (13.5-31.8), followed by Europe 10.4 (7.9-13.7) and Asia 10% (1.8-39.7). Sarcoidosis patients had higher rates of DM compared to controls (OR 1.75; 95% CI 1.49-2.05). Sensitivity analysis, after removing the largest weighted study, did not reveal any effect on the significance of the results (OR 1.73; 95% CI 1.33-2.25).Conclusion: The prevalence of DM in sarcoidosis is considerably high, with increased odds of DM in sarcoidosis compared to healthy controls. Further research with a wide range of confounders is required to confirm the association of sarcoidosis with DM.

Field assessment of the mid winter mass kills of trophic fishes at Mariotteya stream, Egypt: chemical and biological pollution synergistic model

Pathogenic Candida albicans was isolated from water and fish samples collected during an emergent event of mass mortalities among the juvenile Nile tilapia (Oreochromis niloticus), Sharp toothed catfish (Clarias gariepinus) along the stream of Mariotteya drainage. Investigations indicated that fish mortalities were confined to the area of Shubramant and Aboul Noumros (North to Sakara 7 drainage). C. albicans was isolated from the lesions associated with multiple skin ulcers in both Nile tilapia juveniles and Sharp toothed catfish. Assessment of the field and laboratory data has indicated that Mariotteya environmental disaster was a multifactorial problem. The fish mass kills were initially flared up through the dumping of the improperly treated nasty organic and inorganic chemicals from Elhawamdia sugar factory and municipal sewage. The physical stagnation of the stream, high levels of ammonia, phenol and polycyclic aromatic hydrocarbons (PAHs) and low levels of dissolved oxygen (DO) were all incriminated as the initial stimulus behind biological invasion of pathogenic bacteria (Pseudomonas fluorescence) and yeast (C. albicans). Pathologically, fishes were dying from both respiratory and osmoregulatory failure induced by the severe damage of both gills and skin. It has been implied that such environmental pollutants have direct damaging effects on gills, skin and fins with consequent suppression of the skin's natural innate components. The adversely confronted immunological barriers were further exacerbated by the possible synergistic interactions of P. fluorescence dermotropic toxins followed by the secondary invasion of the pathogenic C. albicans.

Resistance to low-dose aspirin therapy among patients with acute coronary syndrome in relation to associated risk factors

BACKGROUND

A substantial proportion of patients have recurrence of vascular events despite daily intake of low-dose aspirin therapy. Therefore, different patients may require different aspirin dosages to achieve complete inhibition of platelet function.

OBJECTIVE

The aim of this work was to measure the response to low-dose aspirin therapy (150 mg/day) among patients with unstable angina or non-ST-segment elevation myocardial infarction and to find out whether titrating aspirin dosage to 300 mg/day, would provide a better therapeutic response in the resistant cases. Moreover, we also aimed to study any association between aspirin non-responsiveness and atherothrombotic risk factors.

METHODS

The antiplatelet effect of 150 mg/day aspirin was studied prospectively in 50 consecutive patients with unstable angina or non-ST-segment elevation myocardial infarction. Platelet aggregation was measured using optical platelet aggregometry and serum thromboxane B(2) level. Aspirin resistance was defined as collagen (1 μg/mL) and adenosine diphosphate (ADP) (5 μmol/L)-induced platelet aggregation of ≥ 40% when compared with control values. Twenty healthy age- and sex-matched individuals were taken as a control group. All patients were subjected to complete medical history (risk factors, medications), thorough clinical examination, ECG, coronary angiography and laboratory investigations including: complete haemogram, coagulation, kidney, liver and lipid profiles, fasting blood glucose and glycated haemoglobin (HbA(1C) ).

RESULTS

Eleven of 50 patients (22%) were found to be aspirin resistant. A highly significant difference was found between the mean values of ADP, collagen-induced platelet aggregation percentage and thromboxane B(2) level after aspirin 150 mg/day when compared with the corresponding mean values after aspirin 300 mg/day among the resistant patients (66 ± 7.01%, 62 ± 4.34% and 620 ± 64.58 pg/mL, respectively, vs. 26.87 ± 2.85%, 16.5 ± 3.8% and 77 ± 11.3 pg/mL) indicating enhanced response to aspirin after escalating the dose. The presence of atherothrombotic risk factors (hypertension, smoking, family history of ischaemic heart disease and previous MI) were not statistically different between aspirin-resistant and aspirin-sensitive patients. However, there was a highly significant difference between the aspirin sensitive and the resistant patients regarding the other risk factors (diabetes mellitus and dyslipidaemia) (P < 0.01).

CONCLUSION

There is inter-individual variability in response to the antiplatelet effect of standard doses of aspirin (150, 300 mg/day). The response to aspirin 300 mg/day is enhanced in resistant patients when compared to 150 mg/day. There was a significant association between aspirin resistance and atherothrombotic risk factors (diabetes, hyperlipidaemia and obesity).

Safety of Mycoplasma gallisepticum Vaccine Strain 6/85 After Backpassage in Turkeys

The objective of this research was to evaluate the safety of the 6/85 strain vaccine strain of Mycoplasma gallisepticum in turkeys by backpassing the vaccine strain up to 10 times by contact infection in turkeys and challenging turkeys with the resulting backpassaged strain. The vaccine strain, however, did not spread to in-contact turkeys, and it was necessary to reisolate the organism before challenging turkeys for the next passage. The challenge strain, therefore, was one that had been backpassaged four times in turkeys, with a total in vivo time in turkeys of 66 days. The backpassaged 6/85 vaccine strain was no different in pathogenicity than the original vaccine strain, except that at 10 days postchallenge, it was isolated in higher numbers from air sacs. Both the original 6/85 vaccine strain and the backpassaged strain were apathogenic in turkeys, except for a slightly increased diameter of the tracheal mucosa at 10 days postchallenge; at 20 days postchallenge the tracheal mucosal thickness was no different from that of controls.

Contraception in diabetic women: comparative metabolic study of Norplant, depot medroxyprogesterone acetate, low dose oral contraceptive pill and CuT380A

OBJECTIVE

To evaluate the long-term intake of Norplant, depot medroxyprogesterone acetate (DMPA) and low dose oral contraceptive pill (OCs) on glycemic control, lipoprotein metabolism and coagulation profile in diabetic women.

METHODS

Prospective comparative study including 80 uncomplicated controlled diabetic women. Twenty women allocated to each group. Clinical, metabolic and coagulation status were followed up at 3, 6 and 9 months' visits.

RESULTS

Fasting blood sugar increased in OCs and DMPA users. Total cholesterol (TC) and LDL-cholesterol (LDL-C) decreased in all groups except DMPA where it increased. Triglyceride (TG) only increased in OCs group. HDL-cholesterol (HDL-C) increased with OCs and decreased with Norplant and DMPA. Compared to IUD users, significantly higher percentage TG and HDL-C and lower LDL-C were observed in OCs users, while DMPA users had significantly higher TC and LDL-C and lower HDL-C. Partial thromboplastin time was prolonged in Norplant users.

CONCLUSION

In diabetics, Norplant results in minimal metabolic alterations followed by OCs while DMPA has unfavorable outcome.

The isolation of pathogenic fungi and actinomycetes from soil in Egypt

140 soil samples from the Assiut governorate were examined for pathogenic fungi and actinomycetes. The paraffin-bait technique and a modified sodium citrate-utilizing procedure were used for recovery of Nocardia strains. Five isolations of N. brasiliensis were made by the sodium citrate method while 3 isolates were obtained by the other method. N. gypsoides was isolated for the first time, only the the modified method. It appears that the latter method suppresses to a great extent the growth of saprophytic fungi, hence increasing the possibility of the isolation of Nocardia spp. The effect of keratin enrichment on the isolation of dermatophytes from soil by the hair-bait technique was also investigated. Pretreatment of samples with dog hair or feathers increased the yield of isolates of Microsporum gypseum, Trichophyton terrestre and to a lesser extent, T. mentagrophytes, M. canis was recovered from soil only after its enrichment with dog hair. It is suggested that enrichment with other forms of keratinous material, either separately or in combination, might increase the recovery of keratinophilic fungi from soil.

The effect of the herbicide atrazine on rhizosphere microflora of broad bean plants, infested with Fusarium oxysporum f. fabae and Rhizoctonia solani

The effect of the herbicide atrazine on Fusarium oxysporum f. fabae and Rhizoctonia solani, the causative agents of wilt and rot, respectively, as well as rhizosphere microflora of broad bean plants was studied. The herbicide was applied at intervals of 30, 20, 10, and 0 days before sowing. Atrazine application reduced both densities and per cent of infection of these two pathogenic fungi, R. solani, however, was sensitive to atrazine itself, while F. oxysporum was affected by atrazine by-products. Rhizosphere flora, i.e., total microbial flora, actinomycetes, phosphate-dissolving bacteria, and fungal flora, were not affected by atrazine, but were deleteriously reduced by its by-products at early stages of plant growth. However, rhizosphere flora attained the normal levels after atrazine by-products had completely disappeared from soil (1 month after application), except for actinomycetes. Therefore, it is recommended to apply atrazine within 20 days before sowing for weed control as well as for controlling wilt and root rot infestations.

Changes in metabolic activities of Fusarium oxysporum f. fabae and Rhizoctonia solani in response to Dithan A-40 fungicide

The effect of different concentrations of Dithan A-40 fungicide on the metabolic activities of the wilt fungus Fusarium oxysporum f. fabae and the root rot agent Rhizoctonia solani was studied. All toxicant concentrations reduced energy generation, total phosphorus and nitrogen content of both fungi. In addition, the toxicant caused a shift in free amino acids pool. As a result of these changes, the mycelium dry weight of both fungi was greatly reduced. R. solani was more sensitive to the toxic effect of Dithan A-40 than F. oxysporum.

Factors affecting the microbial and chemical composition of silage. IV. Effect of wilting on maize silage

The effect of wilting on the microbial and chemical composition of ensiled maize plants was studied. Wilting stimulated high densities of lactic acid bacteria, with the decrease in counts of undesirable flora, i.e., yeasts, moulds, proteolytic and saccharolytic anaerobes, causing spoilage of silage. Moreover, wilting decreased the losses of dry matter, total acidity, and butyric acid content of silage. Accordingly, wilting proved to be a favourable treatment for the production of good quality silage from maize plants.

Factors affecting the microbial and chemical composition of silage. III. Effect of urea additions on maize silage

The effect of urea additions on the microbiological and chemical properties of silage, produced from young maize plants (Darawa stage), was studied. Urea treatments, i.e., 0.25%, 0.50%, 0.75%, and 1.00%, stimulated higher densities of the desired microorganisms than the control, while undesired organisms showed lower counts (proteolytic and saccharolytic anaerobes). Addition of 0.25 to 0.50% or urea resulted in the production of high quality silage with pleasant small and high nutritive value, as confirmed by the various microbiological and chemical analyses conducted. Higher levels (0.75 and 1.00%) of urea decreased the quality of the product.

Relation between the toxogenicity and pyogenicity of Corynebacterium ovis in experimentally infected mice

Suspensions of Corynebacterium ovis subjected to physical and chemical treatment failed to kill inoculated mice but were able to produce sterile pyogenic lesions. It appears that the exotoxin is different from the pyogenic factor and that the latter is attached to a heat-stable substance in the bacterial cell. Mice immunised with antitoxin showed local non-spreading lesions when subsequenly inoculated with washed C ovis cells while unprotected control mice showed a spreading type of infection when similarly injected. Antitoxin did not prevent the formation of pus but hindered the spread of infection from the site of inoculation to the internal organs.